What do coaches want to know about sports-related concussion? A needs assessment study

Brain Deformation Estimation With Transfer Learning for Head Impact Datasets Across Impact Types

OBJECTIVE

The machine-learning head model (MLHM) to accelerate the calculation of brain strain and strain rate, which are the predictors for traumatic brain injury (TBI), but the model accuracy was found to decrease sharply when the training/test datasets were from different head impacts types (i.e., car crash, college football), which limits the applicability of MLHMs to different types of head impacts and sports. Particularly, small sizes of target dataset for specific impact types with tens of impacts may not be enough to train an accurate impact-type-specific MLHM.

METHODS

To overcome this, we propose data fusion and transfer learning to develop a series of MLHMs to predict the maximum principal strain (MPS) and maximum principal strain rate (MPSR).

RESULTS

The strategies were tested on American football (338), mixed martial arts (457), reconstructed car crash (48) and reconstructed American football (36) and we found that the MLHMs developed with transfer learning are significantly more accurate in estimating MPS and MPSR than other models, with a mean absolute error (MAE) smaller than 0.03 in predicting MPS and smaller than [Formula: see text] in predicting MPSR on all target impact datasets. High performance in concussion detection was observed based on the MPS and MPSR estimated by the transfer-learning-based models.

CONCLUSION

The MLHMs can be applied to various head impact types for rapidly and accurately calculating brain strain and strain rate.

SIGNIFICANCE

This study enables developing MLHMs for the head impact type with limited availability of data, and will accelerate the applications of MLHMs.

Machine-learning-based head impact subtyping based on the spectral densities of the measurable head kinematics

BACKGROUND

Traumatic brain injury can be caused by head impacts, but many brain injury risk estimation models are not equally accurate across the variety of impacts that patients may undergo, and the characteristics of different types of impacts are not well studied. We investigated the spectral characteristics of different head impact types with kinematics classification.

METHODS

Data were analyzed from 3262 head impacts from lab reconstruction, American football, mixed martial arts, and publicly available car crash data. A random forest classifier with spectral densities of linear acceleration and angular velocity was built to classify head impact types (e.g., football, car crash, mixed martial arts). To test the classifier robustness, another 271 lab-reconstructed impacts were obtained from 5 other instrumented mouthguards. Finally, with the classifier, type-specific, nearest-neighbor regression models were built for brain strain.

RESULTS

The classifier reached a median accuracy of 96% over 1000 random partitions of training and test sets. The most important features in the classification included both low- and high-frequency features, both linear acceleration features and angular velocity features. Different head impact types had different distributions of spectral densities in low- and high-frequency ranges (e.g., the spectral densities of mixed martial arts impacts were higher in the high-frequency range than in the low-frequency range). The type-specific regression showed a generally higher R2 value than baseline models without classification.

CONCLUSION

The machine-learning-based classifier enables a better understanding of the impact kinematics spectral density in different sports, and it can be applied to evaluate the quality of impact-simulation systems and on-field data augmentation.

Existence ≠ adherence. Exploring barriers to best practice in sports-related concussion return to play (SRC-RTP) in Irish amateur female sport

OBJECTIVES

Sports-Related Concussion (SRCs) are of relevant risk and burden for female athletes. The following study aimed to explore potential barriers to return to play (RTP) best practice in coaches of amateur female athletes, and medical professionals who may treat and manage SRCs in amateur female athletes.

DESIGN

Qualitative, semi-structured, virtual interviews following a critical analysis framework.

METHODS

Twenty-five coaches, allied healthcare professionals (AHPs), and general practitioners (GPs) were recruited and interviewed using a convenience snowball sample. Data were transcribed verbatim and thematically analysed.

RESULTS

Three themes were identified following reflexive thematic analysis; biopsychosocial norms, stakeholder inaction, and practitioner effectiveness. The findings identify numerous factors which limit the uptake of best practice guidelines as endorsed by Irish national governing bodies (NGBs). Education, training, and implementation of these guidelines are lacking, with sub-standard or non-existent medical support and poor general injury and/or SRC attitudes providing further resistance to these measures.

CONCLUSION

Existence of SRC-RTP protocols does not equal adherence to such. Greater efforts are required to translate knowledge provided by the 6th Concussion Consensus statement. NGBs, league and club administrators, and educators need to better support coaches, practitioners and athletes in the implementation of these protocols in amateur female sport.

Randomized Evaluation of Centers for Disease Control and Prevention HEADS UP Concussion Education Materials for Youth Sport Coaches

The Centers for Disease Control and Prevention (CDC) HEADS UP youth sports coach materials are the most widely adopted form of concussion education for coaches across the United States-reaching millions of youth sports coaches over the last decade. These materials focus on concussion symptom identification, response, and management (e.g., return to school and sports), while also addressing the importance of communicating to athletes and their families about concussion safety. The purpose of this study was to assess the effectiveness of CDC HEADS UP materials on coach knowledge and communication with youth athletes about concussion safety. This is the first randomized control study of the CDC HEADS UP materials in real world youth sport conditions. Participants were 764 coaches at 15 YMCA associations. Cluster randomization was used to assign branches within associations to intervention (CDC HEADS UP) and control (treatment as usual) conditions. Coaches completed surveys prior to and at the end of the competitive season. Communication with athletes about concussion increased among coaches in the intervention group (adjusted risk ratio [aRR] = 1.24, 95% confidence interval [CI] = 1.14, 1.36) but not the control group (aRR = 1.09, 95% CI = 0.90, 1.31), in multi-variate analyses controlling for coach demographic characteristics and baseline communication practices. Concussion symptom knowledge and communication intentions also significantly increased in the intervention group but not in the control group. This study provides evidence that CDC HEADS UP materials increase the likelihood that youth sport coaches communicate with their athletes about concussion safety. As youth sports organizations increasingly mandate concussion education for coaches, CDC HEADS UP materials may be considered a leading resource for adoption and setting-relevant implementation.

Epidemiology of sport-related concussion rates in female contact/collision sport: a systematic review

Objectives

To determine sport-related concussion (SRC) incidence rates in female contact/collision sport.

Design

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Data sources

Four databases (PubMed, SportsDiscus, Web of Science, CINAHL) were searched for data from 2012 to 2021.

Eligibility criteria

Studies reporting SRC incidence rates or the number of concussions and athletic exposures (AEs) per 1000 participating events or hours in healthy female contact and collision sport athletes of any age were included.

Results

The search yielded 8438 non-duplicate articles. Following screening, 19 were included in the analysis (median quality score=70%), with 8 reporting match or training incidence rates. Studies were primarily from US high school and collegiate populations; data are reported for eight sports. Rugby union reported the highest match SRC rates (8.2-16.11 per 1000 AE hours), followed by Gaelic football (5.21 per 1000 AE hours) and soccer (2.08-4.04 per 1000 AE events). Where available, match SRC rates were substantially higher than training and overall SRC rates.

Conclusion

Female sports such as rugby union, Gaelic football and soccer present the highest risk for SRCs within the available data. Previous research indicates a potentially greater injury burden for female athletes experiencing SRCs than their male counterparts. Thus, future research should analyse concussion knowledge and return-to-play protocols in these sports. Future research should also prioritise exploration of the gap in SRC rates within amateur sports, and data should be presented specifically in the context of athletic exposures (match vs training).

Trial registration number

CRD42021281569.

Visible Signs of Concussion and Cognitive Screening in Community Sports

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, and recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% confidence interval [CI]: 84-100%) of CoSign+ players demonstrated clinically significant deficits on SCAT3 or Cogstate tasks, compared with 59% (95% CI: 46-71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically significant decline on the Standardized Assessment of Concussion (SAC). Detection of visible signs of concussion represents a rapid, real-time method for screening players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players be immediately removed from play for further concussion screening.

Male and female Gaelic games coaches' and referees' experiences, knowledge and views on sports-related concussion

OBJECTIVES

Concern regarding identification and management of sports-related concussion (SRC) in the community sports of Gaelic games exists. This study aimed to examine Gaelic games coaches' and referees' previous SRC experiences, knowledge of and attitudes on SRC and views on SRC education.

DESIGN

Cross-sectional study; SETTING: Online survey instrument.

PARTICIPANTS

Irish male and female Gaelic games coaches (n = 144) and referees (n = 110).

MAIN OUTCOME MEASURES

Demographics, SRC previous experience, SRC knowledge, attitudes towards SRC reporting and previous and future interest in SRC education.

RESULTS

Most coaches (70.1%) and referees (74.5%) previously dealt with a suspected SRC event. In the most recent SRC event, coaches predominantly removed the player from play (97.0%) and referees frequently informed medical staff (97.1%) or coaches present (96.3%). Coaches and referees were predominantly (>90%) able to identify common SRC signs and symptoms such as dizziness, nausea, confusion, poor balance and headache. Coaches and referees displayed positive attitudes towards removing players from play regardless of game importance.

CONCLUSIONS

Good knowledge of common SRC symptoms were displayed, however their ability to recognise false signs and symptoms was limited. Widespread promotion of Gaelic games SRC education across all stakeholders is warranted and should target the misconceptions highlighted in this study.

Is It Time to Give Athletes a Voice in the Dissemination Strategies of Concussion-Related Information? Exploratory Examination of 2444 Adolescent Athletes

OBJECTIVE

The objective of the research was to screen male and female adolescent athletes on their concussion educational histories and preferred future methods of education in terms of educational messenger, modality, and concussion-related areas of interest.

DESIGN

Cross-sectional survey.

SETTING

Examination setting within the classroom.

PARTICIPANTS

Adolescent male (n = 1854) and female (n = 590) athletes aged 12 to 18 years.

MAIN OUTCOME MEASURES

To explore the concussion educational histories and preferred future methods of education in Irish male and female adolescent athletes.

RESULTS

19.7% (n = 482) of the sample received education in the past 12 months. Male athletes had a significantly higher rate of previous education than female athletes (41% vs 17%). The methods used in previous educational interventions are failing to match the interests of the athletes. Sex played a significant role in the preferred educational methods, as male and female athletes had significant differences in their choice of educational messenger, modality, and concussion-related areas of interest.

CONCLUSIONS

The current disparity in previous concussion education rates between male and female adolescent athletes should be addressed. Forthcoming research should explore the efficacy of tailoring knowledge translation strategies to match the specific needs of the recipient.

Sports & exercise related traumatic brain injury in the Republic of Ireland - The neurosurgical perspective

BACKGROUND

While the concerns regarding the long-term cognitive effects of repeated sports related head injury have become a major source of debate, it is not uncommon for these patients to require neurosurgical interventions in the acute setting. The aim of this study was to provide a unique insight into the acute nature and neurosurgical management of sports and exercise related traumatic brain injury.

METHODS

We retrospectively analysed electronic records of all referrals made between July 2016 and December 2018 to the National Neurosurgical Centre at Beaumont Hospital to identify instances of sport and exercise related traumatic brain injuries (TBI). A sub-group analysis was carried out on patients transferred to the tertiary centre requiring neurosurgical/neuro-critical care.

RESULTS

Over the 30-month period, 194 patients (mean age: 36) were referred withsports and exercise related TBI, of which 56 were transferred to our unit (26 adults, 30 paediatrics). The most frequently encountered sporting activities were cycling, gaelic football, horse riding and rugby. Injuries included cerebral contusions, subdural haematomas, extradural haematomas and skull fractures. Neurosurgical intervention via intracranial pressure monitoring (ICP), decompressive craniectomy and elevation of depressed skull fracture was required in 28 out of 194 patients (14.4%). 85.7% (n = 48) of patients had a discharge Glasgow Coma Scale (GCS) of 15. 4 patients had a tracheostomy in place at discharge and there were 4 mortalities.

CONCLUSIONS

Sports and exercise activities, ranging from contact team sports to individual activities, are a common cause of traumatic brain injury and maybe associated with a significant morbidity and mortality.

Evaluation of a theory-based concussion education program for secondary school student-athletes in Ireland

Concussion education is an important aspect of concussion prevention. The purpose of this study was to investigate the effect of a novel, theory of planned behavior (TPB)-driven concussion education program on secondary school athletes' concussion-reporting relevant cognitions immediately post-intervention and at 3 months follow-up. Data were collected from 428 secondary school athletes during the 2016-2017 academic year: 229 were assigned to an intervention group of which 59 (25.76%) completed assessments at all timepoints; 199 were assigned to a control group of which 153 (76.88%) completed assessments at all timepoints. Using repeated measures ANOVAs, we examined differences in athletes' concussion-reporting cognitions, by group and gender. The program had a significant positive effect on athletes' knowledge (P < 0.01), perceived behavioral control over concussion recognition and reporting (P < 0.01), and reporting intention (P < 0.01). These results were maintained at 3 months follow-up, with the exception of perceived behavioral control. The program did not have a significant effect on athletes' attitudes toward concussion reporting and subjective reporting norms. Results suggest that the TPB may be a useful framework to inform the development of more effective educational programs. There is a need for multi-layered interventions that aim to create sporting environments that encourage positive concussion care seeking behaviors.