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Averell N, Goodwin B, Zia H. The consideration of post-exercise impact on SCAT3 scores in athletes immediately following a head injury: considerations for future studies. Brain Inj 2024; 38:1-2. [PMID: 38225736 DOI: 10.1080/02699052.2024.2304862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Nicholas Averell
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
- Future Forward Research Institute, Toms River, New Jersey, USA
| | - Brandon Goodwin
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
- Future Forward Research Institute, Toms River, New Jersey, USA
| | - Hasan Zia
- Future Forward Research Institute, Toms River, New Jersey, USA
- Lumina Institute, Cream Ridge, New Jersey, USA
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Garrett JM, Mastrorocco M, Peek K, van den Hoek DJ, McGuckian TB. The Relationship Between Neck Strength and Sports-Related Concussion in Team Sports: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2023; 53:585–593. [PMID: 37428807 DOI: 10.2519/jospt.2023.11727] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE: We aimed to quantify the relationship between neck strength and sports-related concussion (SRC) for athletes participating in team sports. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: PubMed, PsycINFO, MEDLINE, CINAHL, CENTRAL, and Scopus were searched on March 17, 2022, and updated on April 18, 2023. STUDY SELECTION CRITERIA: Team sports where an opponent invades the player's territory (eg, football, rugby, basketball) that reported at least 1 measure of neck strength, and 1 measure of SRC incidence, using cohort, case-control, or cross-sectional study designs. The Newcastle-Ottawa scale was used to assess risk of bias; certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Studies were summarized qualitatively and quantitatively. To understand the relationship between neck strength and future SRC incidence, random-effects meta-analysis was conducted on prospective longitudinal studies. RESULTS: From a total of 1445 search results, eight studies including 7625 participants met the inclusion criteria. Five studies reported a relationship between greater neck strength or motor control and reduced concussion incidence. Pooled results from 4 studies indicated small (r = 0.08-0.14) nonsignificant effects with substantial heterogeneity (I2>90%). The considerable heterogeneity is likely a result of synthesized studies with vastly different sample characteristics, including participant age, playing level, and sports. CONCLUSIONS: There was very low-certainty evidence suggesting a small, nonsignificant relationship between greater neck strength and a lower risk of sustaining a SRC. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11727.
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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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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Cecchi NJ, Callan AA, Watson LP, Liu Y, Zhan X, Vegesna RV, Pang C, Le Flao E, Grant GA, Zeineh MM, Camarillo DB. Padded Helmet Shell Covers in American Football: A Comprehensive Laboratory Evaluation with Preliminary On-Field Findings. Ann Biomed Eng 2023:10.1007/s10439-023-03169-2. [PMID: 36917295 PMCID: PMC10013271 DOI: 10.1007/s10439-023-03169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
Abstract
Protective headgear effects measured in the laboratory may not always translate to the field. In this study, we evaluated the impact attenuation capabilities of a commercially available padded helmet shell cover in the laboratory and on the field. In the laboratory, we evaluated the padded helmet shell cover's efficacy in attenuating impact magnitude across six impact locations and three impact velocities when equipped to three different helmet models. In a preliminary on-field investigation, we used instrumented mouthguards to monitor head impact magnitude in collegiate linebackers during practice sessions while not wearing the padded helmet shell covers (i.e., bare helmets) for one season and whilst wearing the padded helmet shell covers for another season. The addition of the padded helmet shell cover was effective in attenuating the magnitude of angular head accelerations and two brain injury risk metrics (DAMAGE, HARM) across most laboratory impact conditions, but did not significantly attenuate linear head accelerations for all helmets. Overall, HARM values were reduced in laboratory impact tests by an average of 25% at 3.5 m/s (range: 9.7 to 39.6%), 18% at 5.5 m/s (range: - 5.5 to 40.5%), and 10% at 7.4 m/s (range: - 6.0 to 31.0%). However, on the field, no significant differences in any measure of head impact magnitude were observed between the bare helmet impacts and padded helmet impacts. Further laboratory tests were conducted to evaluate the ability of the padded helmet shell cover to maintain its performance after exposure to repeated, successive impacts and across a range of temperatures. This research provides a detailed assessment of padded helmet shell covers and supports the continuation of in vivo helmet research to validate laboratory testing results.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Ashlyn A Callan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Landon P Watson
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Xianghao Zhan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Ramanand V Vegesna
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Collin Pang
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Enora Le Flao
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
- Department of Neurology, Stanford University, Stanford, CA, 94305, USA
- Department of Neurosurgery, Duke University, Durham, NC, 27710, USA
| | - Michael M Zeineh
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - David B Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA.
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
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Daly E, Blackett AD, Pearce AJ, Ryan L. Protect the Player, Protect the Game: Reflections from Ex-Professional Rugby Union Players on Law Changes, Protective Equipment, and Duty of Care in the Professional Game. J Funct Morphol Kinesiol 2022; 7:jfmk7040091. [PMID: 36278752 PMCID: PMC9624300 DOI: 10.3390/jfmk7040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
The emphasis of this study was to interview ex-professional male rugby union players (n = 23, mean age 35.5 ± 4.7 years) and discuss concussion management during their careers. In this study, two major themes were identified: (1) the duty of care to professional rugby union players by medical personnel, coaching staff, and owners of professional clubs and (2) the use of protective equipment and law changes to enhance player safety. In total, twenty-three ex-professional rugby union players were interviewed, and the majority (61%) had represented their countries at international test-level rugby. These interviews highlighted the belief that medical teams should be objective, independent entities within a professional rugby club. Furthermore, medical teams should not be in a position of being pressurised by head coaches, members of the coaching team, or club owners regarding return-to-play (RTP) protocols specific to concussion. The interviewees believed that they were pressured by coaches or members of the coaching team to play with concussion or concussive symptoms and other physical injuries. The results indicated that they had manipulated concussion testing themselves or with assistance to pass standard concussion testing protocols. The interviewees indicated that club owners have a duty of care to players even in retirement due to the high incidence of physical and mental injuries endured as a professional rugby player. Most participants indicated that a reduction in match playing time and reducing the amount of time engaged in contact training (workload volume) may assist in reducing concussion incidence. The participants suggested that changes to the current laws of the game or the use of protective equipment did not mitigate against concussion risk in the game of rugby union. The main limitation to the study is that participants had retired in the past ten years, and conditions for players may have changed. This study has highlighted that additional efforts are required by professional clubs to ensure the highest duty of care is delivered to current players and recently retired players.
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Affiliation(s)
- Ed Daly
- School of Science & Computing, Atlantic Technological University, H91 T8NW Galway, Ireland
| | - Alexander D. Blackett
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Alan J. Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia
| | - Lisa Ryan
- School of Science & Computing, Atlantic Technological University, H91 T8NW Galway, Ireland
- Correspondence:
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International perspectives on trends in paediatric sports-related concussion: knowledge, management, unanswered questions. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-01014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose
In the last 20 years, concussion has received increased attention in the media, with distinct recognition of sports-related concussion (SRC). Much of this attention has centred on the paediatric population, due to concerns over adolescent brain development and the high numbers of teenagers playing contact sport. This qualitative study explored (1) what experts in the field of concussion perceive regarding trends in paediatric concussion awareness and management, and (2) how responses to these questions differ by country (US vs. NZ) and by discipline (research vs. sports coaching vs. sports medicine).
Methods
After the development of a semi-structured interview template, questions were coded for interviews of six (N = 6) experts in academia, medicine, and coaching: three in the United States (N = 3) and three in New Zealand (N = 3). Interviews were then transcribed and qualitatively analysed using a thematic narrative analysis. Emergent themes included concussion knowledge, management, and unanswered questions.
Results
Findings showed general commonalities on the importance of concussion education, the improvement of concussion awareness, compliance to concussion protocols, and the need to research long-term outcomes. Fewer commonalities were found regarding the level of concussion reporting, the impact of multiple concussions, whether paediatric and adult concussion should be treated similarly, and the utility of concussion tests.
Conclusions
Concussion experts agree on many areas; however, divergent opinions were apparent. Further original research is required within the paediatric population to analyse the efficacy of current concussion guidelines.
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