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Espahbodi S, Hogervorst E, Macnab TMP, Thanoon A, Fernandes GS, Millar B, Duncan A, Goodwin M, Batt M, Fuller CW, Fuller G, Ferguson E, Bast T, Doherty M, Zhang W. Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players. JAMA Netw Open 2023; 6:e2323822. [PMID: 37459095 PMCID: PMC10352859 DOI: 10.1001/jamanetworkopen.2023.23822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Although professional soccer players appear to be at higher risk of neurodegenerative disease, the reason remains unknown. Objective To examine whether heading frequency is associated with risk of cognitive impairment in retired professional soccer players. Design, Setting, and Participants A UK nationwide cross-sectional study was conducted between August 15, 2020, and December 31, 2021, in 459 retired male professional soccer players older than 45 years and registered with the Professional Footballers' Association or a League Club Players' Association. Exposure Data on heading frequency in 3 bands-0 to 5, 6 to 15, and more than 15 times per match or training session and other soccer-specific risk factors, such as player position and concussion-were collected through a self-reported questionnaire. Main Outcomes and Measures Cognitive impairment was defined using the Telephone Interview for Cognitive Status-modified as scores of less than or equal to 21. Hopkins Verbal Learning Test, verbal fluency, and independent activities of daily living were also assessed. Test Your Memory and physician-diagnosed dementia/Alzheimer disease were self-reported via the questionnaire. Adjusted odds ratios (AORs) with 95% CIs were calculated. Results Of 468 retired male professional soccer players who completed questionnaires (mean [SD] age, 63.68 [10.48]; body mass index, 27.22 [2.89]), 459 reported heading frequency: 114 headed 0 to 5 times, 185 headed 6 to 15 times, 160 headed more than 15 times per match, and 125 headed 0 to 5 times, 174 headed 6 to 15 times, and 160 headed more than 15 times per training session during their careers. The prevalence of cognitive impairment was 9.78% (0-5 times), 14.78% (6-15 times), and 15.20% (>15 times) per match (P = .51). Compared with players reporting 0 to 5 headers per match, the AORs were 2.71 (95% CI, 0.89-8.25) for players reporting 6 to 15 headers per match and 3.53 (95% CI, 1.13-11.04) for players reporting more than 15 headers per match (P = .03 for trend). Corresponding AORs for heading frequency per training session were 2.38 (95% CI, 0.82-6.95) for those reporting 6 to 15, and 3.40 (95% CI, 1.13-10.23) for those reporting more than 15 in comparison with those who reported 0 to 5 (P = .03 for trend). Concussion involving memory loss was also associated with a greater risk of cognitive impairment (AOR, 3.16; 95% CI, 1.08-9.22). Similar results were observed with other cognitive tests and self-reported physician-diagnosed dementia/Alzheimer disease. Conclusions and Relevance The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk.
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Affiliation(s)
- Shima Espahbodi
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Eef Hogervorst
- NCSEM, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tara-Mei Povall Macnab
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Ahmed Thanoon
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Gwen Sacha Fernandes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie Millar
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Ashley Duncan
- National Institute for Health Research ARC EM, University of Nottingham, Nottingham, UK
| | - Maria Goodwin
- NCSEM, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark Batt
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
| | | | - Gordon Fuller
- Centre for Urgent and Emergency Research, University of Sheffield, Sheffield, UK
| | - Eamonn Ferguson
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Tobias Bast
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- Neuroscience@Nottingham, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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2
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Henley S, Andrews K, Kabaliuk N, Draper N. Soft-shell headgear in rugby union: a systematic review of published studies. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
To review the rate of soft-shell headgear use in rugby union, consumer knowledge of the protection potential of soft-shell headgear, incidence of concussion reported in rugby headgear studies, and the capacity of soft-shell headgear to reduce acceleration impact forces.
Design
A systematic search was conducted in July and August 2021 using the databases SPORT Discus, PubMed, MEDLINE, CINAHL (EBSCO), Scopus, and Science Direct. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this systematic review was registered on PROSPERO (registration number: CRD42021239595).
Outcome measures
Rates of headgear use, reports of estimated protection of headgear against head injury, incidence of concussion and magnitude of impact collisions with vs. without headgear, impact attenuation of headgear in lab studies.
Results
Eighteen studies were identified as eligible: qualitative (N = 4), field (N = 7), and lab (N = 7). Qualitative studies showed low rates of headgear use and varying understanding of the protection afforded by headgear. Field studies showed negligible association of headgear use with reduced impact magnitude in headgear vs. non-headgear cohorts. Lab studies showed increased energy attenuation for thicker headgear material, poorer performance of headgear after repetitive impacts and increased drop heights, and promising recent results with headgear composed of viscoelastic polymers.
Conclusions
Rates of adoption of soft-shell headgear remain low in rugby and any association between its use and reduction in acceleration impact forces remains unclear. Lab results indicating improved impact attenuation need to be validated in the field. Further headgear-related research is needed with youth and female rugby players.
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3
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Krizman J, Bonacina S, Colegrove D, Otto-Meyer R, Nicol T, Kraus N. Athleticism and sex impact neural processing of sound. Sci Rep 2022; 12:15181. [PMID: 36071146 PMCID: PMC9452578 DOI: 10.1038/s41598-022-19216-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
Biology and experience both influence the auditory brain. Sex is one biological factor with pervasive effects on auditory processing. Females process sounds faster and more robustly than males. These differences are linked to hormone differences between the sexes. Athleticism is an experiential factor known to reduce ongoing neural noise, but whether it influences how sounds are processed by the brain is unknown. Furthermore, it is unknown whether sports participation influences auditory processing differently in males and females, given the well-documented sex differences in auditory processing seen in the general population. We hypothesized that athleticism enhances auditory processing and that these enhancements are greater in females. To test these hypotheses, we measured auditory processing in collegiate Division I male and female student-athletes and their non-athlete peers (total n = 1012) using the frequency-following response (FFR). The FFR is a neurophysiological response to sound that reflects the processing of discrete sound features. We measured across-trial consistency of the response in addition to fundamental frequency (F0) and harmonic encoding. We found that athletes had enhanced encoding of the harmonics, which was greatest in the female athletes, and that athletes had more consistent responses than non-athletes. In contrast, F0 encoding was reduced in athletes. The harmonic-encoding advantage in female athletes aligns with previous work linking harmonic encoding strength to female hormone levels and studies showing estrogen as mediating athlete sex differences in other sensory domains. Lastly, persistent deficits in auditory processing from previous concussive and repetitive subconcussive head trauma may underlie the reduced F0 encoding in athletes, as poor F0 encoding is a hallmark of concussion injury.
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Affiliation(s)
- Jennifer Krizman
- Auditory Neuroscience Laboratory
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, 60208, USA
| | - Silvia Bonacina
- Auditory Neuroscience Laboratory
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, 60208, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern Medicine, Chicago, IL, 60611, USA
| | - Rembrandt Otto-Meyer
- Auditory Neuroscience Laboratory
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, 60208, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, 60208, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory, .
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, 60208, USA.
- Department of Neurobiology, Northwestern University, Evanston, IL, 60208, USA.
- Department of Otolaryngology, Northwestern University, Chicago, IL, 60611, USA.
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4
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Jansen AE, McGrath M, Samorezov S, Johnston J, Bartsch A, Alberts J. Characterizing Head Impact Exposure in Men and Women During Boxing and Mixed Martial Arts. Orthop J Sports Med 2021; 9:23259671211059815. [PMID: 34901294 PMCID: PMC8664317 DOI: 10.1177/23259671211059815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The accumulation of subconcussive impacts has been implicated in permanent neurological impairment. A gap in understanding the relationship between head impacts and neurological function is the lack of precise characterization and quantification of forces that individuals experience during sports training and competition. Purpose: To characterize impact exposure during training and competition among male and female athletes participating in boxing and mixed martial arts (MMA) via an instrumented custom-fit Impact Monitoring Mouthguard (IMM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-three athletes (n = 4 women) were provided a custom-fit IMM. The IMM monitored impacts during sparring and competition. All training and competition sessions were videotaped. Video and IMM data were synchronized for post hoc data verification of true positives and substantiation of impact location. IMM data were collected from boxing and MMA athletes at a collaborating site. For each true-positive impact, peak linear acceleration and peak angular acceleration were calculated. Wilcoxon rank sum tests were used to evaluate potential differences in sport, activity type, and sex with respect to each outcome. Differences in impact location were assessed via Kruskal-Wallis tests. Results: IMM data were collected from 53 amateur training sessions and 6 competitions (session range, 5-20 minutes). A total of 896 head impacts (men, n = 786; women, n = 110) were identified using IMM data and video verification: 827 in practice and 69 during competition. MMA and boxers experienced a comparable number of impacts per practice session or competition. In general, MMA impacts produced significantly higher peak angular acceleration than did boxing impacts (P < .001) and were more varied in impact location on the head during competitions. In terms of sex, men experienced a greater number of impacts than women per practice session. However, there was no significant difference between men and women in terms of impact magnitude. Conclusion: Characteristic profiles of head impact exposure differed between boxing and MMA athletes; however, the impact magnitudes were not significantly different for male and female athletes.
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Affiliation(s)
- A Elizabeth Jansen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan McGrath
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sergey Samorezov
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Johnston
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jay Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA.,Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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5
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McCunn R, Beaudouin F, Stewart K, Meyer T, MacLean J. Heading in Football: Incidence, Biomechanical Characteristics and the Association with Acute Cognitive Function-A Three-Part Systematic Review. Sports Med 2021; 51:2147-2163. [PMID: 34129222 DOI: 10.1007/s40279-021-01492-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is growing concern surrounding the role of repetitive sub-concussive head impacts, such as football heading, on brain health. OBJECTIVES Three questions were addressed while only considering studies that observed heading exposure directly: (1) how frequently does heading occur within football training and matches, (2) what are the biomechanical characteristics of heading, and (3) is cognitive function affected by heading? METHODS This review followed the steps described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including MEDLINE and SPORTDiscus were searched from the earliest entry to July 2020. Studies that reported independently quantified heading exposure, biomechanical characteristics of heading or the relationship between heading and cognitive function were included. Data were extracted and used to populate summary tables with reference to each research question. RESULTS Heading incidence ranged between one to nine headers per player per match. The number of headers observed in small-sided games during training varied depending on the exact format used but generally speaking ranged between zero to one per player per game. The three most commonly reported biomechanical variables were head acceleration, head rotational velocity and overall movement kinematics during the heading action. Average head acceleration ranged from approximately four to 50 g. Nine out of 12 included studies did not observe a negative impact on cognitive test performance following exposure to heading and while three did, these negative effects were limited to specific outcome measures: reaction time and memory function. CONCLUSION The current weight of evidence summarised herein does not support the notion that heading is deleterious to cognitive performance in the short term; however, this conclusion is tentative due to methodological shortcomings in the existing evidence base.
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Affiliation(s)
- Robert McCunn
- Heart of Midlothian Football Club, Tynecastle Park , Edinburgh, EH11 2NL, UK.
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - John MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
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6
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Draper N, Kabaliuk N, Stitt D, Alexander K. Potential of Soft-Shelled Rugby Headgear to Reduce Linear Impact Accelerations. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5567625. [PMID: 33981403 PMCID: PMC8088347 DOI: 10.1155/2021/5567625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine the potential of soft-shelled rugby headgear to reduce linear impact accelerations. A hybrid III head form instrumented with a 3-axis accelerometer was used to assess headgear performance on a drop test rig. Six headgear units were examined in this study: Canterbury Clothing Company (CCC) Ventilator, Kukri, 2nd Skull, N-Pro, and two Gamebreaker headgear units of different sizes (headgears 1-6, respectively). Drop heights were 238, 300, 610, and 912 mm with 5 orientations at each height (forehead, front boss, rear, rear boss, and side). Impact severity was quantified using peak linear acceleration (PLA) and head injury criterion (HIC). All headgear was tested in comparison to a no headgear condition (for all heights). Compared to the no headgear condition, all headgear significantly reduced PLA and HIC at 238 mm (16.2-45.3% PLA and 29.2-62.7% HIC reduction; P < 0.0005, η p 2 = 0.987-0.991). Headgear impact attenuation lowered significantly as the drop height increased (32.4-5.6% PLA and 50.9-11.7% HIC reduction at 912 mm). There were no significant differences in PLA or HIC reduction between headgear units 1-3. Post hoc testing indicated that headgear units 4-6 significantly outperformed headgear units 1-3 and additionally headgear units 5 and 6 significantly outperformed headgear 4 (P < 0.05). The lowest reduction PLA and HIC was for impacts rear orientation for headgear units 1-4 (3.3 ± 3.6%-11 ± 5.8%). In contrast, headgear units 5 and 6 significantly outperformed all other headgear in this orientation (P < 0.0005, η p 2 = 0.982-0.990). Side impacts showed the greatest reduction in PLA and HIC for all headgear. All headgear units tested demonstrated some degree of reduction in PLA and HIC from a linear impact; however, units 4-6 performed significantly better than headgear units 1-3.
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Affiliation(s)
- Nick Draper
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Danyon Stitt
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Keith Alexander
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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7
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Montanino A, Li X, Zhou Z, Zeineh M, Camarillo D, Kleiven S. Subject-specific multiscale analysis of concussion: from macroscopic loads to molecular-level damage. BRAIN MULTIPHYSICS 2021. [DOI: 10.1016/j.brain.2021.100027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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8
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Guell X, Arnold Anteraper S, Gardner AJ, Whitfield-Gabrieli S, Kay-Lambkin F, Iverson GL, Gabrieli J, Stanwell P. Functional Connectivity Changes in Retired Rugby League Players: A Data-Driven Functional Magnetic Resonance Imaging Study. J Neurotrauma 2020; 37:1788-1796. [PMID: 32183583 DOI: 10.1089/neu.2019.6782] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is considerable interest in the long-term brain health of retired contact and collision sport athletes; however, little is known about possible underlying changes in functional brain connectivity in this group. We evaluated whole-brain functional connectivity patterns using multi-voxel pattern analysis (MVPA) to determine whether alterations in functional connectivity distinguish retired professional athletes from a matched group of healthy community control subjects. Thirty-two retired athletes with a history of multiple self-reported sport-related concussions and 36 healthy community control subjects who were similar in age and education, completed functional magnetic resonance imaging. We identified brain regions with abnormal functional connectivity patterns using whole-brain MVPA as implemented in the Conn toolbox. First-level MVPA was performed using 64 principal component analysis (PCA) components. Second-level F test was performed using the first three MVPA components for retired athletes > controls group contrast. Post hoc seed-to-voxel analyses using the MVPA cluster results as seeds were performed to characterize functional connectivity abnormalities from brain regions identified by MVPA. MVPA revealed one cluster of abnormal functional connectivity located in cerebellar lobule V. This region of lobule V corresponded to the ventral attention network. Post hoc seed-to-voxel analysis using the cerebellar MVPA cluster as a seed revealed multiple areas of cerebral cortical hyper-connectivity and hypo-connectivity in retired athletes when compared with controls. This initial report suggests that cerebellar dysfunction might be present and clinically important in some retired athletes.
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Affiliation(s)
- Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Andrew J Gardner
- Hunter New England Local Health District Sport Concussion Program, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Peter Stanwell
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
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9
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Bartsch AJ, McCrea MM, Hedin DS, Gibson PL, Miele VJ, Benzel EC, Alberts JL, Samorezov S, Shah A, Stemper BS. Laboratory and On-field Data Collected by a Head Impact Monitoring Mouthguard. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2068-2072. [PMID: 31946308 DOI: 10.1109/embc.2019.8856907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although concussion continues to be a major source of acute and chronic injury in automotive, athletic and military arenas, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing and protective countermeasures. Recent research has provided evidence of the role of repetitive head impact exposure as a predisposing factor for the onset of concussion using developed instrumented helmets and mouthguards.To overcome this knowledge gap, we have developed, tested and deployed a head impact monitoring mouthguard (IMM) system. In this study, we deployed the IMM system to gather high quality estimates of athlete head impacts in situ. And with enough longer-term data collection, potential concussive events or mild traumatic brain injuries (mTBIs) will be gathered and ideally will provide actionable risk-based threshold.
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10
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Kinney AR, Anderson D, Stearns-Yoder KA, Brenner LA, Forster JE. Risk and recovery among high school athletes who sustained at least one sports-related concussion. Concussion 2020; 5:CNC72. [PMID: 32509324 PMCID: PMC7270836 DOI: 10.2217/cnc-2020-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Evidence of factors explaining sports-related concussion (SRC) risk and recovery among high school athletes remains inconclusive. Materials & methods: Prospective study of a real-world sample of high school athletes (n = 77) who sustained ≤1 SRC. Among those with multiple SRCs, recovery time between events was investigated. To investigate concussion risk, baseline characteristics of athletes with a single versus multiple SRC(s) were compared. Results: Recovery time did not differ across events. There were no differences between those with a single versus multiple SRCs. Conclusion: Recovery time between initial and subsequent concussive events did not differ, suggesting that prior concussion may not prolong recovery. Baseline characteristics did not explain heightened concussion risk. Investigation of these relationships using more representative samples is needed. Evidence that prior concussions and pre-injury symptoms explain sports-related concussion (SRC) risk and recovery among high school (HS) athletes remains inconclusive. This may be due to studies investigating HS athletes in medical settings. These athletes may experience more severe SRC, and therefore may not represent risk and recovery in real-world settings. We used a real-world sample of HS athletes to investigate whether prior concussion prolongs recovery for subsequent concussive events. To investigate heightened risk for concussion during the study period, we also examined differences between athletes who sustained a single versus multiple SRC during the study period. There were no differences between those with single versus multiple SRC(s). Based on our real-world sample of HS athletes, recovery time across concussive events during the study period did not differ, suggesting that a prior concussion may not prolong recovery.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dustin Anderson
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC, Department of Veterans Affairs, Aurora, Colorado; Departments of Physical Medicine & Rehabilitation, Psychiatry and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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11
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Kelman JC, Hodge C, Stanwell P, Mustafic N, Fraser CL. Retinal nerve fibre changes in sports-related repetitive traumatic brain injury. Clin Exp Ophthalmol 2020; 48:204-211. [PMID: 31691473 DOI: 10.1111/ceo.13673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is limited literature on the use of optical coherence tomography in the assessment of retinal nerve fibre layer (RNFL) thickness in sports-related repetitive mild traumatic brain injury. BACKGROUND To evaluate RNFL thickness in professional rugby league players. RNFL thinning may serve as a proxy for wider white matter degeneration. DESIGN Cross-sectional observational study. PARTICIPANTS Thirteen retired Australian professional rugby league players were recruited. METHODS Participants underwent binocular optical coherence tomography to measure RNFL thickness. Each participant underwent a complete ophthalmic assessment to exclude concurrent disease. MAIN OUTCOME MEASURES RNFL thickness of each eye were compared with a normative database. RESULTS Participants had played professional Rugby League for 18 years on average and reported sustaining 15 sports-related concussions throughout their career. The RNFL in participants was four micrometres thinner than that of matched normative data. Cohort average RNFL thickness was reduced in 12 out of 14 optical coherence testing parameters. These findings were statistically significant in the left inferonasal [P = .013] and left nasal [P = .006] sectors. There was no statistically significant relationship between RNFL thickness and other visual measures. CONCLUSIONS AND RELEVANCE This study is the first to demonstrate RNFL thinning in a cohort of retired Australian professional Rugby League players. RNFL changes have been shown to correlate with cerebral white matter loss and neurodegeneration. Optical coherence tomography may serve as a safe and economical means of screening for repetitive traumatic brain injury related neurodegeneration in contact sport athletes.
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Affiliation(s)
- Julian C Kelman
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Hodge
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter Stanwell
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nina Mustafic
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Cutting to the Pathophysiology Chase: Translating Cutting-Edge Neuroscience to Rehabilitation Practice in Sports-Related Concussion Management. J Orthop Sports Phys Ther 2019; 49:811-818. [PMID: 31154951 DOI: 10.2519/jospt.2019.8884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mild traumatic brain injury, or concussion, is a common sports injury. Concussion involves physical injury to brain tissue and vascular and axonal damage that manifests as transient and often nonspecific clinical symptoms. Concussion diagnosis is challenging, and the relationship between brain injury and clinical symptoms is unclear. The purpose of this commentary was to translate cutting-edge neuroscience to rehabilitation practice. We (1) highlight potential biomarkers that may improve our understanding of concussion and its recovery, (2) explain why researchers must address the paucity of concussion research in female athletes, and (3) present female-specific factors that should be accounted for in future studies. Integrating objective, quantitative measures of concussion pathophysiology with concussion history, genetics, and genomics will help caregivers identify concussed athletes, tailor recovery protocols, and protect athletes from potential long-term effects of cumulative head impact. J Orthop Sports Phys Ther 2019;49(11):811-818. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8884.
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13
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The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthop Sports Phys Ther 2019; 49:768-778. [PMID: 31672116 DOI: 10.2519/jospt.2019.9105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105.
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14
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Nevins D, Hildenbrand K, Vasavada A, Kensrud J, Smith L. In-Game Head Impact Exposure of Male and Female High School Soccer Players. ACTA ACUST UNITED AC 2019. [DOI: 10.3928/19425864-20180802-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Abstract
OBJECTIVE Evaluate postconcussive symptom reporting and recovery. SETTING Public high school. PARTICIPANTS Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). DESIGN Prospective longitudinal cohort study. OUTCOME MEASURE Immediate Postconcussion Assessment and Cognitive Testing. RESULTS At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). CONCLUSIONS Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.
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16
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Hurst HT, Atkins S, Dickinson BD. The magnitude of translational and rotational head accelerations experienced by riders during downhill mountain biking. J Sci Med Sport 2018; 21:1256-1261. [PMID: 29606559 DOI: 10.1016/j.jsams.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Howard T Hurst
- School of Sport and Wellbeing, University of Central Lancashire, UK.
| | | | - Ben D Dickinson
- School of Sport and Wellbeing, University of Central Lancashire, UK
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17
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Yuan W, Barber Foss KD, Thomas S, DiCesare CA, Dudley JA, Kitchen K, Gadd B, Leach JL, Smith D, Altaye M, Gubanich P, Galloway RT, McCrory P, Bailes JE, Mannix R, Meehan WP, Myer GD. White matter alterations over the course of two consecutive high-school football seasons and the effect of a jugular compression collar: A preliminary longitudinal diffusion tensor imaging study. Hum Brain Mapp 2017; 39:491-508. [PMID: 29080230 DOI: 10.1002/hbm.23859] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 12/23/2022] Open
Abstract
The cumulative effects of repetitive subclinical head impacts during sports may result in chronic white matter (WM) changes and possibly, neurodegenerative sequelae. In this pilot study, we investigated the longitudinal WM changes over the course of two consecutive high-school football seasons and explored the long-term effects of a jugular vein compression collar on these WM alterations. Diffusion tensor imaging data were prospectively collected both pre- and postseason in the two consecutive seasons. Participants were assigned into either collar or noncollar groups. Tract-based spatial statistics (TBSS) approach and region of interest-based approach were used to quantify changes in WM diffusion properties. Despite comparable exposure to repetitive head impacts, significant reductions in mean, axial, and/or radial diffusivity were identified in Season 1 in multiple WM regions in the noncollar group but not in the collar group. After an 8- to 9-month long off-season, these changes observed in the noncollar group partially and significantly reversed but also remained significantly different from the baseline. In Season 2, trend level WM alterations in the noncollar group were found but located in spatially different regions than Season 1. Last, the WM integrity in the collar group remained unchanged throughout the four time points. In conclusion, we quantitatively assessed the WM structural changes and partial reversal over the course of two consecutive high-school football seasons. In addition, the mitigated WM alterations in athletes in the collar group might indicate potential effect of the collar in ameliorating the changes against repetitive head impacts. Hum Brain Mapp 39:491-508, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Staci Thomas
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katie Kitchen
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brooke Gadd
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - David Smith
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul Gubanich
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ryan T Galloway
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois
| | - Rebekah Mannix
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio.,Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Werhane ML, Evangelista ND, Clark AL, Sorg SF, Bangen KJ, Tran M, Schiehser DM, Delano-Wood L. Pathological vascular and inflammatory biomarkers of acute- and chronic-phase traumatic brain injury. Concussion 2017; 2:CNC30. [PMID: 30202571 PMCID: PMC6094091 DOI: 10.2217/cnc-2016-0022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022] Open
Abstract
Given the demand for developing objective methods for characterizing traumatic brain injury (TBI), research dedicated to evaluating putative biomarkers has burgeoned over the past decade. Since it is critical to elucidate the underlying pathological processes that underlie the higher diverse outcomes that follow neurotrauma, considerable efforts have been aimed at identifying biomarkers of both the acute- and chronic-phase TBI. Such information is not only critical for helping to elucidate the pathological changes that lead to poor long-term outcomes following TBI but it may also assist in the identification of possible prevention and interventions for individuals who sustain head trauma. In the current review, we discuss the potential role of vascular dysfunction and chronic inflammation in both acute- and chronic-phase TBI, and we also highlight existing studies that have investigated inflammation biomarkers associated with poorer injury outcome.
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Affiliation(s)
- Madeleine L Werhane
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Alexandra L Clark
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Scott F Sorg
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - My Tran
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- San Diego State University (SDSU), San Diego, CA 92182, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
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19
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Hecimovich MD, King D. Prevalence of head injury and medically diagnosed concussion in junior-level community-based Australian Rules Football. J Paediatr Child Health 2017; 53:246-251. [PMID: 27862527 DOI: 10.1111/jpc.13405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/22/2016] [Accepted: 09/05/2016] [Indexed: 02/03/2023]
Abstract
AIM For junior-level Australian Rules Football there is a paucity of head injury and concussion surveillance data; thus, the primary aim was to document head injury and concussion incidence in participants aged 9-17 years with a secondary aim to identify the mechanism-of-injury. METHODS A prospective cohort study in which a designated representative for each of the 41 teams recorded on a weekly basis the number of head injuries suspected of being a concussion, diagnosed concussions and the mechanism-of-injury during competition games over the course of a 12-game season. For analysis three groups were formed - number of Player-Seasons, Athlete-Exposures, head injury and concussion incidence per 1000 Athlete-Exposures - and were calculated. Narrative data was categorised. RESULTS There was 13 reported head injuries resulting in seven concussions in the sample population (n = 976). The incidence rates for head injury and concussion were 1.1 (95% confidence interval: 0.5-1.7) and 0.59 (95% confidence interval: 0.2-1.0) per 1000 Athlete-Exposures. There were four head injuries resulting in two concussions in the 12-13-year-old group and nine head injuries and five concussions in the 14-17-year-old group. Two categories emerged for mechanism-of-injury: player-to-surface and player-to-player, with 9 of the 13 head injuries resulting from player-to-player contact. CONCLUSIONS The incidence rates were similar in the two older groups and lower in comparison with American football and rugby. The data collected have advanced our knowledge of head injury incidence and established baseline data which to compare in future years and may assist in development of preventative measures.
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Affiliation(s)
- Mark D Hecimovich
- Division of Athletic Training, University of Northern Iowa, Cedar Falls, Iowa, United States.,School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - Doug King
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.,Emergency Department, Hutt Valley District Health Board, Wellington, New Zealand
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21
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Stewart WF, Kim N, Ifrah CS, Lipton RB, Bachrach TA, Zimmerman ME, Kim M, Lipton ML. Symptoms from repeated intentional and unintentional head impact in soccer players. Neurology 2017; 88:901-908. [PMID: 28148633 DOI: 10.1212/wnl.0000000000003657] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the rate and differential contribution of heading vs unintentional head impacts (e.g., head to head, goal post) to CNS symptoms in adult amateur soccer players. METHODS Amateur soccer players completed baseline and serial on-line 2-week recall questionnaires (HeadCount) and reported (1) soccer practice and games, (2) heading and unintentional soccer head trauma, and (3) frequency and severity (mild to very severe) of CNS symptoms. For analysis, CNS symptoms were affirmed if one or more moderate, severe, or very severe episodes were reported in a 2-week period. Repeated measures logistic regression was used to assess if 2-week heading exposure (i.e., 4 quartiles) or unintentional head impacts (i.e., 0, 1, 2+) were associated with CNS symptoms. RESULTS A total of 222 soccer players (79% male) completed 470 HeadCount questionnaires. Mean (median) heading/2 weeks was 44 (18) for men and 27 (9.5) for women. One or more unintentional head impacts were reported by 37% of men and 43% of women. Heading-related symptoms were reported in 20% (93 out of 470) of the HeadCounts. Heading in the highest quartile was significantly associated with CNS symptoms (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.57-6.37) when controlling for unintentional exposure. Those with 2+ unintentional exposures were at increased risk for CNS symptoms (OR 6.09, 95% CI 3.33-11.17) as were those with a single exposure (OR 2.98, 95% CI 1.69-5.26) when controlling for heading. CONCLUSIONS Intentional (i.e., heading) and unintentional head impacts are each independently associated with moderate to very severe CNS symptoms.
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Affiliation(s)
- Walter F Stewart
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Namhee Kim
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Chloe S Ifrah
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Richard B Lipton
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Tamar A Bachrach
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Molly E Zimmerman
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Mimi Kim
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Michael L Lipton
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY.
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22
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King D, Hume P, Gissane C, Brughelli M, Clark T. The Influence of Head Impact Threshold for Reporting Data in Contact and Collision Sports: Systematic Review and Original Data Analysis. Sports Med 2016; 46:151-69. [PMID: 26545363 DOI: 10.1007/s40279-015-0423-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies. OBJECTIVE The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported. METHODS A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated. RESULTS Of the 52 studies identified, 42% reported impacts using a >10-g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45% less) impacts of >15 g, and 4024 (81% less) impacts of >30 g. DISCUSSION Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10-g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport. CONCLUSION Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10-g impact threshold.
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Affiliation(s)
- D King
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand. .,Emergency Department, Hutt Valley District Health Board, Private Bag 31-907, Lower Hutt, New Zealand.
| | - P Hume
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - C Gissane
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, Middlesex, UK
| | - M Brughelli
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - T Clark
- Faculty of Human Performance, Australian College of Physical Education, Sydney Olympic Park, NSW, Australia
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23
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Tsushima WT, Siu AM, Yamashita N, Oshiro RS, Murata NM. Comparison of neuropsychological test scores of high school athletes in high and low contact sports: A replication study. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 7:14-20. [DOI: 10.1080/21622965.2016.1220860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- William T. Tsushima
- Psychiatry and Psychology Department, Straub Clinic and Hospital, Honolulu, Hawaii
| | - Andrea M. Siu
- Research Institute, Hawaii Pacific Health, Honolulu, Hawaii
| | | | - Ross S. Oshiro
- Queen’s Center for Sports Medicine, POB III, Honolulu, Hawaii
| | - Nathan M. Murata
- Department of Kinesiology and Rehabilitation Science, University of Hawaii at Manoa, Honolulu, Hawaii
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24
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King D, Hume P, Gissane C, Clark T. Use of the King-Devick test for sideline concussion screening in junior rugby league. J Neurol Sci 2015; 357:75-9. [PMID: 26152829 DOI: 10.1016/j.jns.2015.06.069] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/03/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022]
Abstract
AIM To determine whether the King-Devick (K-D) test used as a sideline test in junior rugby league players over 12 matches in a domestic competition season could identify witnessed and incidentally identified episodes of concussion. METHODS A prospective observational cohort study of a club level junior rugby league team (n=19) during the 2014 New Zealand competition season involved every player completing two pre-competition season baseline trials of the K-D test. Players removed from match participation, or who reported any signs or symptoms of concussion were assessed on the sideline with the K-D test and referred for further medical assessment. Players with a pre- to post-match K-D test difference >3s were referred for physician evaluation. RESULTS The baseline test-retest reliability of the K-D test was high (rs=0.86; p<0.0001). Seven concussions were medically identified in six players who recorded pre- to post-match K-D test times greater than 3s (mean change of 7.4s). Post-season testing of players demonstrated improvement of K-D time scores consistent with learning effects of using the K-D test (67.7s vs. 62.2s). DISCUSSION Although no witnessed concussions occurred during rugby play, six players recorded pre- to post-match changes with a mean delay of 4s resulting in seven concussions being subsequently confirmed post-match by health practitioners. All players were medically managed for a return to sports participation. CONCLUSION The K-D test was quickly and easily administered making it a practical sideline tool as part of the continuum of concussion assessment tools for junior rugby league players.
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Affiliation(s)
- D King
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand; Department of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
| | - P Hume
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - C Gissane
- School of Sport Health and Applied Science, St. Mary's University, Twickenham, Middlesex, United Kingdom
| | - T Clark
- Australian College of Physical Education, Faculty of Human Performance, Sydney Olympic Park, New South Wales, Australia
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Shetty T, Raince A, Manning E, Tsiouris AJ. Imaging in Chronic Traumatic Encephalopathy and Traumatic Brain Injury. Sports Health 2015; 8:26-36. [PMID: 26733590 PMCID: PMC4702153 DOI: 10.1177/1941738115588745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: The diagnosis of chronic traumatic encephalopathy (CTE) can only be made pathologically, and there is no concordance of defined clinical criteria for premorbid diagnosis. The absence of established criteria and the insufficient imaging findings to detect this disease in a living athlete are of growing concern. Evidence Acquisition: The article is a review of the current literature on CTE. Databases searched include Medline, PubMed, JAMA evidence, and evidence-based medicine guidelines Cochrane Library, Hospital for Special Surgery, and Cornell Library databases. Study Design: Clinical review. Level of Evidence: Level 4. Results: Chronic traumatic encephalopathy cannot be diagnosed on imaging. Examples of imaging findings in common types of head trauma are discussed. Conclusion: Further study is necessary to correlate the clinical and imaging findings of repetitive head injuries with the pathologic diagnosis of CTE.
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Affiliation(s)
- Teena Shetty
- Hospital for Special Surgery, New York, New York
| | | | - Erin Manning
- Hospital for Special Surgery, New York, New York
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26
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Tong DC, Winter TJ, Jin J, Bennett AC, Waddell JN. Quantification of subconcussive impact forces to the head using a forensic model. J Clin Neurosci 2015; 22:747-51. [PMID: 25744077 DOI: 10.1016/j.jocn.2014.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Abstract
Concussive and subconcussive head injury is a global phenomenon that affects millions of people each year. Concussive injury has been extensively studied in sport, which has led to a greater understanding of the biomechanical forces involved and guidelines aimed at preventing athletes from playing while concussed. Subconcussive forces by definition do not meet the threshold for concussion but nonetheless may have significant long term consequences due to the repetitive pattern of injury to the head. Quantifying these impact forces using a forensic head model provides the groundwork for future studies by establishing a range or threshold of subconcussive impact forces that could be correlated with clinical assessments. The use of a forensic head model has distinct advantages in terms of ethics and safety.
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Affiliation(s)
- D C Tong
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand.
| | - T J Winter
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
| | - J Jin
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
| | - A C Bennett
- Division of International Affairs, Kansai University, Suita-shi, Osaka, Japan
| | - J N Waddell
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
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27
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Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci 2015; 66:75-80. [PMID: 25748121 DOI: 10.1016/j.mcn.2015.03.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022] Open
Abstract
Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion. More severe traumatic brain injury (TBI) is a well-established risk factor for a variety of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Recently, large epidemiological studies have additionally identified MTBI as a risk factor for dementia. The role of MTBI in risk of PD or ALS is less well established. Repetitive MTBI and repetitive sub-concussive head trauma have been linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE). CTE is a unique neurodegenerative tauopathy first described in boxers but more recently described in a variety of contact sport athletes, military veterans, and civilians exposed to repetitive MTBI. Studies of repetitive MTBI and CTE have been limited by referral bias, lack of consensus clinical criteria for CTE, challenges of quantifying MTBI exposure, and potential for confounding. The prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear. This review will summarize the current literature regarding the epidemiology of MTBI, post-TBI dementia and Parkinson's disease, and CTE while highlighting methodological challenges and critical future directions of research in this field. This article is part of a Special Issue entitled SI:Traumatic Brain Injury.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, University of California San Francisco, CA, United States.
| | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, CA, United States; Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, CA, United States
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28
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King D, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med 2015; 43:614-24. [PMID: 25535096 DOI: 10.1177/0363546514560876] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union. PURPOSE To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches. STUDY DESIGN Descriptive epidemiology study. METHODS Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches. RESULTS A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P < .001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s(2). CONCLUSION The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players.
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Affiliation(s)
- Doug King
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand Emergency Department, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Matt Brughelli
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Conor Gissane
- School of Sport Health and Applied Science, St Mary's University, Twickenham, Middlesex, UK
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29
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Baugh CM, Kiernan PT, Kroshus E, Daneshvar DH, Montenigro PH, McKee AC, Stern RA. Frequency of head-impact-related outcomes by position in NCAA division I collegiate football players. J Neurotrauma 2014; 32:314-26. [PMID: 25155288 DOI: 10.1089/neu.2014.3582] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Concussions and subconcussive impacts sustained in American football have been associated with short- and long-term neurological impairment, but differences in head impact outcomes across playing positions are not well understood. The American Medical Society for Sports Medicine has identified playing position as a key risk factor for concussion in football and one for which additional research is needed. This study examined variation in head impact outcomes across primary football playing positions in a group of 730 National Collegiate Athletic Association Division I Football Championship Series athletes, using a self-report questionnaire. Although there were no significant differences between position groups in the number of diagnosed concussions during the 2012 football season, there were significant differences between groups in undiagnosed concussions (p=0.008) and "dings" (p<0.001); offensive linemen reported significantly higher numbers than most other positions. Significant differences were found between position groups in the frequencies of several postimpact symptoms, including dizziness (p<0.001), headache (p<0.001), and seeing stars (p<0.001) during the 2012 football season, with offensive linemen reporting significantly more symptoms compared to most other groups. There were also positional differences in frequency of returning to play while symptomatic (p<0.001) and frequency of participating in full-contact practice (p<0.001). Offensive linemen reported having returned to play while experiencing symptoms more frequently and participating in more full-contact practices than other groups. These findings suggest that offensive linemen, a position group that experiences frequent, but low-magnitude, head impacts, develop more postimpact symptoms than other playing positions, but do not report these symptoms as a concussion.
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Affiliation(s)
- Christine M Baugh
- 1 Harvard Interfaculty Initiative in Health Policy, Harvard University , Cambridge, Massachusetts
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30
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Johnson B, Neuberger T, Gay M, Hallett M, Slobounov S. Effects of subconcussive head trauma on the default mode network of the brain. J Neurotrauma 2014; 31:1907-13. [PMID: 25010992 DOI: 10.1089/neu.2014.3415] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although they are less severe than a full blown concussive episodes, subconcussive impacts happen much more frequently and current research has suggested this form of head trauma may have an accumulative effect and lead to neurological impairment later in life. To investigate the acute effects that subconcussive head trauma may have on the default mode network of the brain resting-state, functional magnetic resonance was performed. Twenty-four current collegiate rugby players were recruited and all subjects underwent initial scanning 24 h prior to a scheduled full contact game to provide a baseline. Follow-up scanning of the rugby players occurred within 24 h following that game to assess acute effects from subconcussive head trauma. Differences between pre-game and post-game scans showed both increased connectivity from the left supramarginal gyrus to bilateral orbitofrontal cortex and decreased connectivity from the retrosplenial cortex and dorsal posterior cingulate cortex. To assess whether or not a history of previous concussion may lead to a differential response following subconcussive impacts, subjects were further divided into two subgroups based upon history of previous concussion. Individuals with a prior history of concussion exhibited only decreased functional connectivity following exposure to subconcussive head trauma, while those with no history showed increased connectivity. Even acute exposure to subconcussive head trauma demonstrates the ability to alter functional connectivity and there is possible evidence of a differential response in the brain for those with and without a history of concussion.
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Affiliation(s)
- Brian Johnson
- 1 Department of Kinesiology, The Pennsylvania State University , University Park, Pennsylvania
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31
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Assessment, Management and Knowledge of Sport-Related Concussion: Systematic Review. Sports Med 2014; 44:449-71. [DOI: 10.1007/s40279-013-0134-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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32
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Lipton ML, Kim N, Zimmerman ME, Kim M, Stewart WF, Branch CA, Lipton RB. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Radiology 2013; 268:850-7. [PMID: 23757503 DOI: 10.1148/radiol.13130545] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the association of soccer heading with subclinical evidence of traumatic brain injury. MATERIALS AND METHODS With institutional review board approval and compliance with HIPAA guidelines, 37 amateur soccer players (mean age, 30.9 years; 78% [29] men, 22% [eight] women) gave written informed consent and completed a questionnaire to quantify heading in the prior 12 months and lifetime concussions. Diffusion-tensor magnetic resonance (MR) imaging at 3.0 T was performed (32 directions; b value, 800 sec/mm(2); 2 × 2 × 2-mm voxels). Cognitive function was measured by using a computerized battery of tests. Voxelwise linear regression (heading vs fractional anisotropy [FA]) was applied to identify significant regional associations. FA at each location and cognition were tested for a nonlinear relationship to heading by using an inverse logit model that incorporated demographic covariates and history of concussion. RESULTS Participants had headed 32-5400 times (median, 432 times) over the previous year. Heading was associated with lower FA at three locations in temporo-occipital white matter with a threshold that varied according to location (885-1550 headings per year) (P < .00001). Lower levels of FA were also associated with poorer memory scores (P < .00001), with a threshold of 1800 headings per year. Lifetime concussion history and demographic features were not significantly associated with either FA or cognitive performance. CONCLUSION Heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance. This relationship is not explained by a history of concussion.
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Affiliation(s)
- Michael L Lipton
- Gruss Magnetic Resonance Research Center, Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY 10461, USA.
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33
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King D, Brughelli M, Hume P, Gissane C. Concussions in amateur rugby union identified with the use of a rapid visual screening tool. J Neurol Sci 2013; 326:59-63. [PMID: 23374885 DOI: 10.1016/j.jns.2013.01.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/07/2013] [Accepted: 01/09/2013] [Indexed: 12/20/2022]
Abstract
AIM To use the King-Devick (KD) test and Sports Concussion Assessment Tool 2 (SCAT2) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation. METHODS A prospective observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zealand. Every player completed a pre-competition questionnaire on concussion history, a baseline PCSS and two trials of the KD before they participated in any match activities. RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player. There were 22 concussive incidents recorded over the duration of the competition (46 per 1000 match hours). Five concussive incidents were witnessed (11 per 1000 match hours) and 17 unrecognised concussive incidents were identified with the KD (37 per 1000 match hours). Witnessed concussions recorded, on average, a longer KD on the day of injury (5.5±2.4s) than unrecognised concussions (4.4±0.9s) when compared with their baseline KD. DISCUSSION The KD was able to identify players that had not shown, or reported, any signs or symptoms of a concussion but who had meaningful head injury. The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates. This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union.
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Affiliation(s)
- Doug King
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand.
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34
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Baugh CM, Stamm JM, Riley DO, Gavett BE, Shenton ME, Lin A, Nowinski CJ, Cantu RC, McKee AC, Stern RA. Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav 2012; 6:244-54. [PMID: 22552850 DOI: 10.1007/s11682-012-9164-5] [Citation(s) in RCA: 314] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease thought to be caused, at least in part, by repetitive brain trauma, including concussive and subconcussive injuries. It is thought to result in executive dysfunction, memory impairment, depression and suicidality, apathy, poor impulse control, and eventually dementia. Beyond repetitive brain trauma, the risk factors for CTE remain unknown. CTE is neuropathologically characterized by aggregation and accumulation of hyperphosphorylated tau and TDP-43. Recent postmortem findings indicate that CTE may affect a broader population than was initially conceptualized, particularly contact sport athletes and those with a history of military combat. Given the large population that could potentially be affected, CTE may represent an important issue in public health. Although there has been greater public awareness brought to the condition in recent years, there are still many research questions that remain. Thus far, CTE can only be diagnosed post-mortem. Current research efforts are focused on the creation of clinical diagnostic criteria, finding objective biomarkers for CTE, and understanding the additional risk factors and underlying mechanism that causes the disease. This review examines research to date and suggests future directions worthy of exploration.
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Affiliation(s)
- Christine M Baugh
- Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, MA 02118, USA
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35
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Shultz SR, MacFabe DF, Foley KA, Taylor R, Cain DP. Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res 2011; 229:145-52. [PMID: 22245525 DOI: 10.1016/j.bbr.2011.12.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 12/05/2011] [Accepted: 12/11/2011] [Indexed: 11/16/2022]
Abstract
Sub-concussive brain injuries may result in neurophysiological changes, cumulative effects, and neurodegeneration. The current study investigated the effects of a mild lateral fluid percussion injury (0.50-0.99 atm) on rat behavior and neuropathology to address the need to better understand sub-concussive brain injury. Male Long-Evans rats received either a single mild lateral fluid percussion injury or a sham-injury, followed by either a short (24 h) or long (4 weeks) recovery period. After recovery, rats underwent extensive behavioral testing consisting of tasks for rodent cognition, anxiety- and depression-like behaviors, social behavior, and sensorimotor function. At the completion of behavioral testing rats were sacrificed and brains were examined immunohistochemically with markers for neuroinflammation and axonal injury. No significant group differences were found on behavioral and axonal injury measures. However, rats given one mild fluid percussion injury displayed an acute neuroinflammatory response, consisting of increased microglia/macrophages and reactive astrogliosis, at 4 days post-injury. Neuroinflammation is a mechanism with the potential to contribute to the cumulative and neurodegenerative effects of repeated sub-concussive injuries. The current findings are consistent with findings in humans experiencing a sub-concussive blow, and provide support for the use of mild lateral fluid percussion injury in the rat as a model of sub-concussive brain injury.
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Affiliation(s)
- Sandy R Shultz
- Graduate Program in Neuroscience, Department of Psychology, University of Western Ontario, London, Ontario, Canada.
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