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Peek K, Ross A, Andersen TE, Meyer T, Dahlen S, Georgieva J, Williamson PR, Clarke M, Serner A. Heading in football: a systematic review of descriptors, definitions, and reporting methods used in heading incidence studies. SCI MED FOOTBALL 2024:1-18. [PMID: 38855969 DOI: 10.1080/24733938.2024.2362191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
The primary objective of this systematic review was to describe the number and type of heading descriptors used in all published studies which report on heading incidence in football. The secondary objective was to detail the data collection and reporting methods used in the included studies to present heading incidence data. Eligible studies were identified through searches of five electronic databases: Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science, using a combination of free-text keywords (inception to 12th September 2023). Manual searching of reference lists and retrieved systematic reviews was also performed. A descriptive overview and synthesis of the results is presented. From 1620 potentially eligible studies, 71 studies were included, with the following key findings: 1) only 61% of studies defined a header with even fewer (23%) providing an operational definition of a header within the methods; 2) important study and player demographic data including year and country were often not reported; 3) reported heading descriptors and their coding options varied greatly; 4) visual identification of headers was essential when inertial measurement units were used to collect heading incidence data; and 5) there was a lack of standardisation in the reporting methods used in heading incidence studies making comparison between studies challenging. To address these findings, the development of a standardised, internationally supported, operational definition of a header and related heading descriptors should be prioritised. Further recommendations include the development of minimum reporting criteria for heading incidence research.
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Affiliation(s)
- Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, College of Sport, Health and Engineering, Victoria University, Melbourne, Australia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian Football Association's Sports Medical Centre, Oslo, Norway
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Sara Dahlen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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Shibukawa K, Hoshikawa Y. Decrease in aerial challenges after revision of goal kick rules in Japan Professional Soccer League: explorative study of the possibility of a risk reduction for head injury, concussion, and brain damage by a rule revision. SCI MED FOOTBALL 2024; 8:15-20. [PMID: 36315233 DOI: 10.1080/24733938.2022.2142274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
In 2019, FIFA revised the goal kick (GLK) rule such that a GLK could be performed even if the kicker had teammates in the penalty area. This study aimed to examine whether the rule revision reduced the frequency of aerial challenge (AC) and long GLKs (LGLKs), which are risk factors for head injury and concussion in soccer. We analyzed all official league matches (306 matches/season) of the Japan Professional Soccer League 1st Division before (2018 season) and after the rule revision (2020 season). The analysis categorized GLKs into short GLKs (SGLKs) and LGLKs, depending on the GLK distance, and included the frequency and causes of AC, in each match following a GLK, which were compared between the 2018 and 2020 seasons. The average number of LGLKs per match in the 2020 season (8.85) decreased compared to that in the 2018 season (14.20). Additionally, for ACs following a GLK, the frequency of ACs decreased from 6.08 to 3.92 per match. Meanwhile, the frequency of LGLKs tended to increase toward the end of the first and second halves in matches. The results of this study revealed that the 2019 GLK rule revision reduced the number of LGLKs and ACs.
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Affiliation(s)
- Kenichi Shibukawa
- Sports & Health Sciences Lab, Faculty of Sciences, Toho University, Chiba, Japan
| | - Yoshihiro Hoshikawa
- Department of Sports Science, Japan Women's College of Physical Education, Tokyo, Japan
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Georgieva J, Arnold EJ, Peek K, Smith A, Lavender AP, Serner A, Fitzgerald M, Ma'ayah F, Campbell A. The incidence and characteristics of heading in the 2019 FIFA Women's World Cup™. SCI MED FOOTBALL 2024:1-8. [PMID: 38293754 DOI: 10.1080/24733938.2024.2305396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION To quantify the incidence and characteristics of purposeful heading and other head impacts in professional women's football at the 2019 FIFA Women's World Cup™. METHODS This cross-sectional cohort study analysed purposeful headers (uncontested and contested) and their characteristics (e.g. playing position, match situation, field location, and distance ball travelled), and other head impact events using video analysis. Total headers and head impact events, and incidence rate (IR) per 1000 match-hours were calculated for countries, positions, and other characteristics, such as location on the pitch. RESULTS Purposeful headers accounted for 76% of all coded events (uncontested: 71%; contested: 29%), followed by attempted headers (21%), unintentional ball-head impacts (2%), and other head impacts (1%). Headers ranged from 0 to 22 per player, per match with a mean of 4.8 [±1.2]. Of all field positions, centrebacks had the highest heading rates and wingers the lowest. Strikers performed significantly more contested headers than any other position, and significantly less uncontested headers. Most headers occurred in the middle third (48%), from free game play (72%) and from long balls (>20 m) (68%). CONCLUSION The findings of this study could assist the development of player heading risk profiles, sex-specific heading guidelines, and coaching practices.
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Affiliation(s)
- Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Eloise J Arnold
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Kerry Peek
- Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
| | - Andrew P Lavender
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Fadi Ma'ayah
- School of Education, Curtin University, Perth, WA, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
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Kenny R, Elez M, Clansey A, Virji-Babul N, Wu LC. Individualized monitoring of longitudinal heading exposure in soccer. Sci Rep 2024; 14:1796. [PMID: 38245604 PMCID: PMC10799858 DOI: 10.1038/s41598-024-52163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
There is growing concern that repetitive soccer headers may have negative long-term consequences on brain health. However, inconsistent and low-quality heading exposure measurements limit past investigations of this effect. Here we conducted a comprehensive heading exposure analysis across all players on a university women's soccer team for over two calendar years (36 unique athletes), quantifying both game and practice exposure during all in-season and off-season periods, with over ten thousand video-confirmed headers. Despite an average of approximately 2 headers per day, players' daily exposures ranged from 0 to 45 headers, accumulating to highly variable total exposure of 2-223 headers over each in-season/off-season period. Overall, practices and off-season periods accounted for 70% and 45% of headers, respectively. Impact sensor data showed that heading kinematics fell within a tight distribution, but sensors could not capture full heading exposure due to factors such as compliance. With first-of-its-kind complete heading exposure data, we recommend exposure assessments be made on an individual level and include practice/off-season collection in addition to games and competitive seasons. Commonly used group statistics do not capture highly variable exposures, and individualized complete heading exposure tracking needs to be incorporated in future study designs for confirming the potential brain injury risk associated with soccer heading.
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Affiliation(s)
- Rebecca Kenny
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada
| | - Marko Elez
- Department of Integrated Sciences, University of British Columbia, 6356 Agricultural Rd Room 464, Vancouver, BC, V6T 1Z2, Canada
| | - Adam Clansey
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada
| | - Naznin Virji-Babul
- Department of Physical Therapy, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lyndia C Wu
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada.
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Wahlquist VE, Glutting JJ, Kaminski TW. Examining the influence of the Get aHEAD Safely in Soccer™ program on head impact kinematics and neck strength in female youth soccer players. Res Sports Med 2024; 32:17-27. [PMID: 35611394 DOI: 10.1080/15438627.2022.2079982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
The objective was to examine the efficacy of the Get aHEAD Safely in Soccer™ intervention on head impact kinematics and neck strength in female youth soccer players. The control group (CG) consisted of 13 players (age: 11.0 ± 0.4 yrs), while the experimental group (EG) consisted of 14 players (age: 10.6 ± 0.5 yrs). Head impact kinematics included peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV). Pre- and post-season measures included strength measures of neck/torso flexion (NF/TF) and extension (NE/TE). Data were analysed using a multilevel linear model and ANOVA techniques. No differences in PLA, PRA, or PRV were observed between groups. The EG showed significant improvement in NF strength while the CG showed significant improvement in NE strength. Both groups significantly improved in TF pre- to post-season. The foundational strength components of the Get aHEAD Safely in Soccer program appear to show a benefit in youth soccer players beginning to learn the skill of purposeful heading.
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Affiliation(s)
| | | | - Thomas W Kaminski
- Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
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Ferdousi J, Post A, Karton C, Doelle K, Gilchrist MD, Hoshizaki TB. Head trauma analysis of laboratory reconstructed headers using 1966 Slazenger Challenge and 2018 Telstar 18 soccer balls. Sci Rep 2023; 13:18575. [PMID: 37903796 PMCID: PMC10616227 DOI: 10.1038/s41598-023-45489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Retired soccer players are presenting with early onset neurodegenerative diseases, potentially from heading the ball. It has been proposed that the older composition of soccer balls places higher strains on brain tissues. The purpose of this research was to compare the dynamic head response and brain tissue strain of laboratory reconstructed headers using replicas of the 1966 Slazenger Challenge and 2018 Telstar 18 World Cup soccer balls. Head-to-ball impacts were physically conducted in the laboratory by impacting a Hybrid III head form at three locations and four velocities using dry and wet soccer ball conditions, and computational simulation was used to measure the resulting brain tissue strain. This research showed that few significant differences were found in head dynamic response and maximum principal strain between the dry 1966 and 2018 balls during reconstructed soccer headers. Headers using the wet 1966 soccer ball resulted in higher head form responses at low-velocity headers and lower head responses as velocities increased. This study demonstrates that under dry conditions, soccer ball construction does not have a significant effect on head and brain response during headers reconstructed in the laboratory. Although ball construction didn't show a notable effect, this study revealed that heading the ball, comparable to goalkeeper kicks and punts at 22 m/s, led to maximum principal strains exceeding the 50% likelihood of injury risk threshold. This has implications for the potential risks associated with repetitive heading in soccer for current athletes.
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Affiliation(s)
| | - Andrew Post
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Clara Karton
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada.
| | - Klara Doelle
- Health Sciences, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
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Le RK, Lempke LB, Anderson MN, Johnson RS, Schmidt JD, Lynall RC. Quantifying head impact biomechanical differences between commonly employed cleaning levels: a critical research interpretation consideration. Brain Inj 2023; 37:1173-1178. [PMID: 37166252 DOI: 10.1080/02699052.2023.2211351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes. OBJECTIVE Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impacts recorded within start and end times, Level-2: impacts during pauses/breaks removed, Level-3: video verified) for male youth tackle football. METHODS Participants (n = 23, age = 10.9 ± 0.3 yrs, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax SIM-G sensors throughout Fall 2019. Impact rates, ratios (IRRs), and 95% confidence intervals (95%CI) were used to compare levels. Random-effects general linear models were used to compare peak linear acceleration (PLA;g) and angular velocity (PAV;rads/s). RESULTS Level-1 resulted in higher impact rates (4.57; 95%CI = 4.14-5.05) compared to Level-2 (3.09; 95%CI = 2.80-3.42; IRR = 1.48; 95%CI = 1.34-1.63) and Level-3 datasets (2.56; 95%CI = 2.30-2.85; IRR = 1.78; 95%CI = 1.60-1.98). Level-2 had higher impact rates compared to Level-3 (1.21; 95%CI = 1.08-1.35). Level-1 resulted in higher PAV than Level-2 and Level-3 (p < 0.001) datasets. PLA did not differ across datasets (p = 0.296). CONCLUSIONS Head impact data should be filtered of pauses/breaks, and does not substantially differ outcome estimates compared to time-intensive video verification.
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Affiliation(s)
- Rachel K Le
- Department of Exercise Science, Mercer University, Macon, Georgia, USA
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
| | - Landon B Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa N Anderson
- Department of Kinesiology & Applied Physiology, Concussion Research Laboratory, University of Delaware, Newark, Delaware, USA
| | - Rachel S Johnson
- Department of Kinesiology, Center for Orthopaedic & Biomechanics Research, Boise State University, Boise, Idaho, USA
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
| | - Julianne D Schmidt
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
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Peek K, Duffield R, Cairns R, Jones M, Meyer T, McCall A, Oxenham V. Where are We Headed? Evidence to Inform Future Football Heading Guidelines. Sports Med 2023; 53:1335-1358. [PMID: 37285067 PMCID: PMC10289964 DOI: 10.1007/s40279-023-01852-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
Given the scientific and public concern regarding the short-, medium- and long-term consequences of heading on brain health, being proactive about developing and implementing guidelines that help reduce the burden (volume, impact magnitude and injury risk) of heading in young and beginner players appears justified. This narrative review explores the evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football. A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion were: (1) original data, (2) study population included football players, (3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head/brain injury incidence, and (4) published in English or English translation available. In total, 58 papers were included that outlined strategies based on (1) game or team development, (2) player skill development and (3) equipment. In particular, greater emphasis existed for small-sided games (particularly in young players) where fewer headers are observed when compared with the conventional 11 versus 11 game, as well as reducing headers from goal kicks and corners. Evidence also existed for developing a heading coaching framework that focusses on technical proficiency as well as neuromuscular neck exercises integrated into general injury reduction exercise programs, enforcement of rules related to deliberate head contact and using lower-pressure match and training balls. To mitigate potential risks of heading on brain health, a number of pragmatic strategies have been examined in scientific studies and may be considered as part of future heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Rob Duffield
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Ross Cairns
- Newcastle Sports Medicine, Warners Bay, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Mark Jones
- Football Australia, Sydney, NSW Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Alan McCall
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Vincent Oxenham
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW Australia
- Department of Neuropsychology, Royal North Shore Hospital, Sydney, NSW Australia
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Schmidt JD, Johnson RS, Lempke LB, Anderson M, Le RK, Lynall RC. Youth Tackle Football Head-Impact Estimation by Players and Parents: Is the Perception the Reality? J Athl Train 2023; 58:285-292. [PMID: 35475900 PMCID: PMC11215644 DOI: 10.4085/1062-6050-0560.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate. OBJECTIVE To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location. DESIGN Prospective cohort study. SETTING Football field. PATIENTS OR OTHER PARTICIPANTS We administered a 10-question head-impact estimation tool to parents (n = 23; mean age = 36.5 years [95% CI = 31.7, 37.3 years]) and players (n = 16 boys; mean age = 11.1 years [95% CI = 10.3, 11.8 years]). MAIN OUTCOME MEASURE(S) Player on-field head-impact exposure was captured using the Triax SIM-G system. We determined the accuracy between player and parent estimates relative to on-field head-impact exposures using κ and weighted κ values. RESULTS Youth tackle football players and parents did not accurately estimate on-field head-impact frequency (κ range = -0.09 to 0.40), severity (κ range = -0.05 to 0.34), or location (κ range = -0.30 to 0.13). Players and parents overestimated head-impact frequency in practices but underestimated the frequency in games. Both groups overestimated head-impact severity, particularly in games. Most players and parents underestimated the number of head impacts to the top of the head, particularly during practices. CONCLUSIONS Underestimations of head-impact frequency in games and to the top of the head suggest that informed consent processes aimed at educating players and parents should be improved. Overestimations of head-impact frequency in practices and severity may explain declining rates of youth tackle football participation.
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Affiliation(s)
- Julianne D. Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Rachel S. Johnson
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Landon B. Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Melissa Anderson
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Rachel Khinh Le
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Robert C. Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
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Caccese JB, Bryk KN, Porfido T, Bretzin AC, Peek K, Kaminski TW, Kontos AP, Chrisman SPD, Putukian M, Buckley TA, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Esopenko C. Cognitive and Behavioral Outcomes in Male and Female NCAA Soccer Athletes across Multiple Years: A CARE Consortium Study. Med Sci Sports Exerc 2023; 55:409-417. [PMID: 36288576 DOI: 10.1249/mss.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared with a control group of noncontact athletes. METHODS Generalized estimating equations were used to compare changes in annual, preseason baseline measures of neurocognitive function, neurobehavioral and psychological symptoms, and postural stability between collegiate soccer players ( n = 75; 51 [68%] female soccer players) and noncontact athletes ( n = 210; 133 [63%] female noncontact athletes) across three consecutive years. RESULTS Among all participants, the group-time interaction was not significant for any outcome measures. Overall, soccer players reported lower (better) Brief Symptom Inventory 18 Depression ( P = 0.004, Exp(B) = 0.36, 95% confidence interval [CI] = 0.18-0.73), Global Severity Index ( P = 0.006, Exp(B) = 0.53, 95% CI = 0.33-0.84), and Post-Concussion Symptom Scale Symptom Severity ( P < 0.001, Exp(B) = 0.45, 95% CI = 0.22-0.95) scores than noncontact athletes. No other outcome measures were different between soccer players and noncontact athletes. CONCLUSIONS Among collegiate athletes, soccer players report similar or better psychosocial functioning and symptom scores than noncontact athletes. Importantly, neurocognitive functioning, neurobehavioral and psychological symptoms, and postural stability do not worsen over time in collegiate soccer players relative to their noncontact counterparts. Our findings suggest that despite possible exposure to repetitive head impacts, collegiate soccer players do not exhibit changes in observable function and symptoms across multiple seasons.
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Affiliation(s)
| | - Kelsey N Bryk
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Tara Porfido
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, AUSTRALIA
| | - Thomas W Kaminski
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA
| | - Margot Putukian
- Major League Soccer, New York, NY (previously Princeton University, Princeton, NJ)
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul F Pasquina
- Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Kuo C, Patton D, Rooks T, Tierney G, McIntosh A, Lynall R, Esquivel A, Daniel R, Kaminski T, Mihalik J, Dau N, Urban J. On-Field Deployment and Validation for Wearable Devices. Ann Biomed Eng 2022; 50:1372-1388. [PMID: 35960418 DOI: 10.1007/s10439-022-03001-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 11/01/2022]
Abstract
Wearable sensors are an important tool in the study of head acceleration events and head impact injuries in sporting and military activities. Recent advances in sensor technology have improved our understanding of head kinematics during on-field activities; however, proper utilization and interpretation of data from wearable devices requires careful implementation of best practices. The objective of this paper is to summarize minimum requirements and best practices for on-field deployment of wearable devices for the measurement of head acceleration events in vivo to ensure data evaluated are representative of real events and limitations are accurately defined. Best practices covered in this document include the definition of a verified head acceleration event, data windowing, video verification, advanced post-processing techniques, and on-field logistics, as determined through review of the literature and expert opinion. Careful use of best practices, with accurate acknowledgement of limitations, will allow research teams to ensure data evaluated is representative of real events, will improve the robustness of head acceleration event exposure studies, and generally improve the quality and validity of research into head impact injuries.
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Affiliation(s)
- Calvin Kuo
- The University of British Columbia, Vancouver, Canada
| | - Declan Patton
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Tyler Rooks
- United States Army Aeromedical Research Laboratory, Fort Rucker, USA
| | | | - Andrew McIntosh
- McIntosh Consultancy and Research, Sydney, Australia.,Monash University Accident Research Centre Monash University, Melbourne, Australia.,School of Engineering Edith Cowan University, Perth, Australia
| | | | | | - Ray Daniel
- United States Army Aeromedical Research Laboratory, Fort Rucker, USA
| | | | - Jason Mihalik
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nate Dau
- Biocore, LLC, Charlottesville, USA
| | - Jillian Urban
- Wake Forest University School of Medicine, 575 Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA.
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12
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Rezaei A, Wu LC. Automated soccer head impact exposure tracking using video and deep learning. Sci Rep 2022; 12:9282. [PMID: 35661123 PMCID: PMC9166706 DOI: 10.1038/s41598-022-13220-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
Head impacts are highly prevalent in sports and there is a pressing need to investigate the potential link between head impact exposure and brain injury risk. Wearable impact sensors and manual video analysis have been utilized to collect impact exposure data. However, wearable sensors suffer from high deployment cost and limited accuracy, while manual video analysis is a long and resource-intensive task. Here we develop and apply DeepImpact, a computer vision algorithm to automatically detect soccer headers using soccer game videos. Our data-driven pipeline uses two deep learning networks including an object detection algorithm and temporal shift module to extract visual and temporal features of video segments and classify the segments as header or nonheader events. The networks were trained and validated using a large-scale professional-level soccer video dataset, with labeled ground truth header events. The algorithm achieved 95.3% sensitivity and 96.0% precision in cross-validation, and 92.9% sensitivity and 21.1% precision in an independent test that included videos of five professional soccer games. Video segments identified as headers in the test data set correspond to 3.5 min of total film time, which can be reviewed through additional manual video verification to eliminate false positives. DeepImpact streamlines the process of manual video analysis and can help to collect large-scale soccer head impact exposure datasets for brain injury research. The fully video-based solution is a low-cost alternative for head impact exposure monitoring and may also be expanded to other sports in future work.
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Affiliation(s)
- Ahmad Rezaei
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Lyndia C Wu
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, Canada.
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13
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Basinas I, McElvenny DM, Pearce N, Gallo V, Cherrie JW. A Systematic Review of Head Impacts and Acceleration Associated with Soccer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095488. [PMID: 35564889 PMCID: PMC9100160 DOI: 10.3390/ijerph19095488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Epidemiological studies of the neurological health of former professional soccer players are being undertaken to identify whether heading the ball is a risk factor for disease or premature death. A quantitative estimate of exposure to repeated sub-concussive head impacts would provide an opportunity to investigate possible exposure-response relationships. However, it is unclear how to formulate an appropriate exposure metric within the context of epidemiological studies. We have carried out a systematic review of the scientific literature to identify the factors that determine the magnitude of head impact acceleration during experiments and from observations during playing or training for soccer, up to the end of November 2021. Data were extracted from 33 experimental and 27 observational studies from male and female amateur players including both adults and children. There was a high correlation between peak linear and angular accelerations in the observational studies (p < 0.001) although the correlation was lower for the experimental data. We chose to rely on an analysis of maximum or peak linear acceleration for this review. Differences in measurement methodology were identified as important determinants of measured acceleration, and we concluded that only data from accelerometers fixed to the head provided reliable information about the magnitude of head acceleration from soccer-related impacts. Exposures differed between men and women and between children and adults, with women on average experiencing higher acceleration but less frequent impacts. Playing position appears to have some influence on the number of heading impacts but less so on the magnitude of the head acceleration. Head-to-head collisions result in high levels of exposure and thus probably risk causing a concussion. We concluded, in the absence of evidence to the contrary, that estimates of the cumulative number of heading impacts over a playing career should be used as the main exposure metric in epidemiological studies of professional players.
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Affiliation(s)
- Ioannis Basinas
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Damien M. McElvenny
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Valentina Gallo
- Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands;
| | - John W. Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh EH14 4AS, UK
- Correspondence:
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14
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Porfido T, Caccese J, Gutt J, Wentworth C, Peek K, Bretzin AC, Esopenko C. A standardized method for quantifying and characterizing repetitive head impacts in soccer matches using video footage. SCI MED FOOTBALL 2022; 6:331-339. [DOI: 10.1080/24733938.2022.2056233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tara Porfido
- School of Graduate Studies, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107 USA
| | - Jaclyn Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, 43210 USA
| | - Jessica Gutt
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107 USA
| | - Conor Wentworth
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107 USA
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW 2006 Australia
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107 USA
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15
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Head Impact Exposure and Biomechanics in University Varsity Women's Soccer. Ann Biomed Eng 2022; 50:1461-1472. [PMID: 35041117 PMCID: PMC8765100 DOI: 10.1007/s10439-022-02914-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/01/2022] [Indexed: 11/17/2022]
Abstract
Soccer is a unique sport where players purposefully and voluntarily use their unprotected heads to manipulate the direction of the ball. There are limited soccer head impact exposure data to further study brain injury risks. The objective of the current study was to combine validated mouthpiece sensors with comprehensive video analysis methods to characterize head impact exposure and biomechanics in university varsity women’s soccer. Thirteen female soccer athletes were instrumented with mouthpiece sensors to record on-field head impacts during practices, scrimmages, and games. Multi-angle video was obtained and reviewed for all on-field activity to verify mouthpiece impacts and identify contact scenarios. We recorded 1307 video-identified intentional heading impacts and 1011 video-verified sensor impacts. On average, athletes experienced 1.83 impacts per athlete-exposure, with higher exposure in practices than games/scrimmages. Median and 95th percentile peak linear and peak angular accelerations were 10.0, 22.2 g, and 765, 2296 rad/s2, respectively. Long kicks, top of the head impacts and jumping headers resulted in the highest impact kinematics. Our results demonstrate the importance of investigating and monitoring head impact exposure during soccer practices, as well as the opportunity to limit high-kinematics impact exposure through heading technique training and reducing certain contact scenarios.
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16
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Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure. Sports Med 2021; 52:481-504. [PMID: 34677820 DOI: 10.1007/s40279-021-01574-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number and magnitude of head impacts have been assessed in-vivo using inertial sensors to characterise the exposure in various sports and to help understand their potential relationship to concussion. OBJECTIVES We aimed to provide a comprehensive review of the field of in-vivo sensor acceleration event research in sports via the summary of data collection and processing methods, population demographics and factors contributing to an athlete's exposure to sensor acceleration events. METHODS The systematic search resulted in 185 cohort or cross-sectional studies that recorded sensor acceleration events in-vivo during sport participation. RESULTS Approximately 5800 participants were studied in 20 sports using 18 devices that included instrumented helmets, headbands, skin patches, mouthguards and earplugs. Female and youth participants were under-represented and ambiguous results were reported for these populations. The number and magnitude of sensor acceleration events were affected by a variety of contributing factors, suggesting sport-specific analyses are needed. For collision sports, being male, being older, and playing in a game (as opposed to a practice), all contributed to being exposed to more sensor acceleration events. DISCUSSION Several issues were identified across the various sensor technologies, and efforts should focus on harmonising research methods and improving the accuracy of kinematic measurements and impact classification. While the research is more mature for high-school and collegiate male American football players, it is still in its early stages in many other sports and for female and youth populations. The information reported in the summarised work has improved our understanding of the exposure to sport-related head impacts and has enabled the development of prevention strategies, such as rule changes. CONCLUSIONS Head impact research can help improve our understanding of the acute and chronic effects of head impacts on neurological impairments and brain injury. The field is still growing in many sports, but technological improvements and standardisation of processes are needed.
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Liu Y, Domel AG, Cecchi NJ, Rice E, Callan AA, Raymond SJ, Zhou Z, Zhan X, Li Y, Zeineh MM, Grant GA, Camarillo DB. Time Window of Head Impact Kinematics Measurement for Calculation of Brain Strain and Strain Rate in American Football. Ann Biomed Eng 2021; 49:2791-2804. [PMID: 34231091 DOI: 10.1007/s10439-021-02821-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023]
Abstract
Wearable devices have been shown to effectively measure the head's movement during impacts in sports like American football. When a head impact occurs, the device is triggered to collect and save the kinematic measurements during a predefined time window. Then, based on the collected kinematics, finite element (FE) head models can calculate brain strain and strain rate, which are used to evaluate the risk of mild traumatic brain injury. To find a time window that can provide a sufficient duration of kinematics for FE analysis, we investigated 118 on-field video-confirmed football head impacts collected by the Stanford Instrumented Mouthguard. The simulation results based on the kinematics truncated to a shorter time window were compared with the original to determine the minimum time window needed for football. Because the individual differences in brain geometry influence these calculations, we included six representative brain geometries and found that larger brains need a longer time window of kinematics for accurate calculation. Among the different sizes of brains, a pre-trigger time of 40 ms and a post-trigger time of 70 ms were found to yield calculations of brain strain and strain rate that were not significantly different from calculations using the original 200 ms time window recorded by the mouthguard. Therefore, approximately 110 ms is recommended for complete modeling of impacts for football.
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Affiliation(s)
- Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
| | - August G Domel
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Nicholas J Cecchi
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Eli Rice
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, 94305, USA
| | - Ashlyn A Callan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Samuel J Raymond
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Zhou Zhou
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Xianghao Zhan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Yiheng Li
- Department of Biomedical Informatics, Stanford University, Stanford, CA, 94305, USA
| | - Michael M Zeineh
- Department of Radiology, 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
| | - 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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18
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Brooks JS, Allison W, Harriss A, Bian K, Mao H, Dickey JP. Purposeful Heading Performed by Female Youth Soccer Players Leads to Strain Development in Deep Brain Structures. Neurotrauma Rep 2021; 2:354-362. [PMID: 34901935 PMCID: PMC8655815 DOI: 10.1089/neur.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Head impacts in soccer have been associated with both short- and long-term neurological consequences. Youth players' brains are especially vulnerable given that their brains are still developing, and females are at an increased risk of traumatic brain injury (TBI) compared to males. Approximately 90% of head impacts in soccer occur from purposeful heading. Accordingly, this study assessed the relationship between kinematic variables and brain strain during purposeful headers in female youth soccer players. A convenience sample of 36 youth female soccer players (13.4 [0.9] years of age) from three elite youth soccer teams wore wireless sensors to quantify head impact magnitudes during games. Purposeful heading events were categorized by game scenario (e.g., throw-in, goal kick) for 60 regular season games (20 games per team). A total of 434 purposeful headers were identified. Finite element model simulations were performed to calculate average peak maximum principal strain (APMPS) in the corpus callosum, thalamus, and brainstem on a subset of 110 representative head impacts. Rotational velocity was strongly associated with APMPS in these three regions of the brain (r = 0.83-0.87). Linear acceleration was weakly associated with APMPS (r = 0.13-0.31). Game scenario did not predict APMPS during soccer games (p > 0.05). Results demonstrated considerable APMPS in the corpus callosum (mean = 0.102) and thalamus (mean = 0.083). In addition, the results support the notion that rotational velocity is a better predictor of brain strain than linear acceleration and may be a potential indicator of changes to the brain.
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Affiliation(s)
- Jeffrey S. Brooks
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Wayne Allison
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alexandra Harriss
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kewei Bian
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - James P. Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
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19
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Le RK, Anderson MN, Johnson RS, Lempke LB, Schmidt JD, Lynall RC. On-field Characteristics and Head Impact Magnitude in Youth Tackle Football. Pediatr Neurol 2021; 121:33-39. [PMID: 34146964 DOI: 10.1016/j.pediatrneurol.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study determined the effect of video-verified collision characteristics on head impact magnitudes in male youth tackle football. METHODS Participants (n = 23, age = 10.9 ± 0.3 years, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax Sim-G sensors throughout the fall 2019 season. Ten filmed games were used to identify nine different collision characteristics: mechanism, preparedness, head direction, struck versus striking activity, stance, play type, closing distance, penalty, and quarter. Random-effects general linear models and Cohen d effect sizes were used to examine differences in log-transformed peak linear (PLA; g) and rotational (PRA; rad/s2) accelerations across characteristics. The 10 games produced 533 total video-verified impacts and 23.2 ± 7.2 impacts per athlete. RESULTS PLA (P range: 0.107 to 0.923) and PRA (P range: 0.057 to 0.768) did not differ across characteristics. Struck players (3370 rads/s2, 95% confidence interval [CI] = 2986 to 3808) had a small effect for higher PRA compared with striking players (3037 rads/s2, 95% CI = 2713 to 3404, d = 0.251), but negligible effect for simultaneous struck-striking players (3340 rad/s2, 95% CI = 2945 to 3792, d = 0.018). Fourth quarter impacts (3490 rads/s2, 95% CI = 3083 to 3951) had a small effect for higher PRA compared with first (2945 rads/s2, 95% CI = 2596 to 3337, d = 0.404), second (3196 rads/s2, 95% CI = 2832 to 3604, d = 0.219), and third quarters (3241 rads/s2, 95% CI = 2841 to 3699, d = 0.144). CONCLUSION Youth tackle football characteristics did not significantly affect head impact magnitudes during games. More research is needed to explore additional factors that could be modified for sport safety rather than mitigating impact mechanism.
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Affiliation(s)
- Rachel K Le
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia.
| | - Melissa N Anderson
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Rachel S Johnson
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
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20
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Filben TM, Pritchard NS, Hanes-Romano KE, Miller LE, Miles CM, Urban JE, Stitzel JD. Comparison of women's collegiate soccer header kinematics by play state, intent, and outcome. J Biomech 2021; 126:110619. [PMID: 34325122 DOI: 10.1016/j.jbiomech.2021.110619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Although most head impacts in soccer are headers, limited knowledge exists about how header magnitude varies by on-field scenario. This study aimed to compare head kinematics during on-field headers by play state (i.e., corner kick, goal kick, free kick, throw-in, drill, or live ball), intent (i.e., pass, shot, or clearance), and outcome (i.e., successful or unsuccessful). Fifteen female collegiate soccer players were instrumented with mouthpiece-based head impact sensors during 72 practices and 24 games. A total of 336 headers were verified and contextualized via film review. Play state was associated with peak linear acceleration, rotational acceleration, and rotational velocity (all p < .001) while outcome was associated with peak linear acceleration (p < .010). Header intent was not significantly associated with any kinematic metric. Headers during corner kicks (22.9 g, 2189.3 rad/s2, 9.87 rad/s), goal kicks (24.3 g, 2658.9 rad/s2, 10.1 rad/s), free kicks (18.0 g, 1843.3 rad/s2, 8.43 rad/s), and live balls (18.8 g, 1769.7 rad/s2, 8.09 rad/s) each had significantly greater mean peak linear acceleration (all p < .050), rotational acceleration (all p < .001), and rotational velocity (all p < .001) than headers during drills (13.0 g, 982.4 rad/s2, 5.28 rad/s). Headers during goal kicks also had a significantly greater mean rotational acceleration compared to headers during live ball scenarios (p < .050). Successful headers (18.3 g) had a greater mean peak linear acceleration compared to unsuccessful headers (13.8 g; p < .010). Results may help inform efforts to reduce head impact exposure in soccer.
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Affiliation(s)
- Tanner M Filben
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA.
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | | | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Sports Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA; Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
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21
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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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22
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Abstract
Recent public concern over the short- and long-term effects of repetitive head impacts (RHI) associated with purposeful heading in soccer has led researchers to study a multitude of variables related to this important aspect of the game. Of particular interests are the effects of soccer heading in the youth population (≤ 13 years old) whose brains are undergoing rapid development. We conducted a review on youth soccer heading that includes purposeful heading frequency, head impact biomechanics, head injuries, clinical outcomes, and modifying factors. We have concluded that youth soccer players head the ball at a low frequency that typically increases with age and with a finding that boys head the ball more often than girls do. Interestingly, although girls head the ball less frequently than boys do, they tend to sustain higher head impact magnitudes. Head injuries are more likely to occur in girls versus boys and during games because of contact with another player. Clinical outcome measures of concussion are often utilized to study the effects of soccer heading, in both field and laboratory environments. Immediately following soccer heading, youth often report having a headache and demonstrate some deficits in balance measures. Modifying factors that may benefit soccer players participating in purposeful heading activities include stronger neck musculature, wearing headgear, and the use of mouthguards. Research involving youth soccer players needs to be expanded and funded appropriately to better understand the consequences of RHI in both the short and long term.
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23
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Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Postural Control Deficits After Repetitive Soccer Heading. Clin J Sport Med 2021; 31:266-272. [PMID: 30550416 DOI: 10.1097/jsm.0000000000000709] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the acute effects of repetitive soccer heading on postural control. DESIGN Prospective study; participants were divided into 2 groups: a soccer heading group and a control group. SETTING Biomechanics laboratory. PARTICIPANTS One hundred sixty participants, including youth (age = 13.0 ± 0.8 years), high school (age = 17.2 ± 1.0 years), and collegiate (age = 20.2 ± 1.3 years) male and female soccer players, participated in this study. INTERVENTIONS Participants in the soccer heading group performed 12 soccer headers (initial velocity = 11.2 m/s). Postural control testing was performed both before (PRE) and immediately after (POST) the purposeful soccer headers. Control participants performed postural control testing PRE and POST a 15-minute wait period. During postural control testing, participants were asked to stand on the MobileMat (Tekscan Inc, Boston, Massachusetts) for two 2-minute intervals with their hands on their hips and their feet together with one eyes-open and one eyes-closed trial. MAIN OUTCOME MEASURES Using the center-of-pressure data, 95% area, sway velocity, and ApEn were calculated. Multilevel linear models were used to analyze the effects of age, sex, group, condition, and concussion history simultaneously. RESULTS Participants in the soccer heading group had significantly higher sway velocity POST than participants in the control group after controlling for age, sex, concussion history, condition, and PRE (t = -3.002; P = 0.003; 95% confidence interval, -0.482 to -0.100). There were no significant differences from PRE to POST for 95% area, M/L ApEn, and A/P ApEn. CONCLUSIONS Repetitive soccer heading does not affect most postural control measures, even among youth athletes. However, sway velocity increased after heading relative to control participants independent of age, sex, and concussion history.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware
| | - Ryan T Tierney
- Department of Kinesiology, Temple University, Philadelphia, Pennsylvania; and
| | - William C Rose
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware
| | | | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware
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Becker S, Berger J, Ludwig O, Günther D, Kelm J, Fröhlich M. Heading in Soccer: Does Kinematics of the Head-Neck-Torso Alignment Influence Head Acceleration? J Hum Kinet 2021; 77:71-80. [PMID: 34168693 PMCID: PMC8008297 DOI: 10.2478/hukin-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is little scientific evidence regarding the cumulative effect of purposeful heading. The head-neck-torso alignment is considered to be of great importance when it comes to minimizing potential risks when heading. Therefore, this study determined the relationship between head-neck-torso alignment (cervical spine, head, thoracic spine) and the acceleration of the head, the relationship between head acceleration and maximum ball speed after head impact and differences between head accelerations throughout different heading approaches (standing, jumping, running). A total of 60 male soccer players (18.9 ± 4.0 years, 177.6 ± 14.9 cm, 73.1 ± 8.6 kg) participated in the study. Head accelerations were measured by a telemetric Noraxon DTS 3D Sensor, whereas angles for the head-neck-torso alignment and ball speed were analyzed with a Qualisys Track Manager program. No relationship at all was found for the standing, jumping and running approaches. Concerning the relationship between head acceleration and maximum ball speed after head impact only for the standing header a significant result was calculated (p = 0.024, R2 = .085). A significant difference in head acceleration (p < .001) was identified between standing, jumping and running headers. To sum up, the relationship between head acceleration and head-neck-torso alignment is more complex than initially assumed and could not be proven in this study. Furthermore first data were generated to check whether the acceleration of the head is a predictor for the resulting maximum ball speed after head impact, but further investigations have to follow. Lastly, we confirmed the results that the head acceleration differs with the approach.
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Affiliation(s)
- Stephan Becker
- Department of Sport Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Joshua Berger
- Department of Sport Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Oliver Ludwig
- Department of Sport Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Daniel Günther
- Department of Sport Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Jens Kelm
- Chirurgisch-Orthopädisches Zentrum, Illingen, Germany
| | - Michael Fröhlich
- Department of Sport Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
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Sandmo SB, Gooijers J, Seer C, Kaufmann D, Bahr R, Pasternak O, Lipton ML, Tripodis Y, Koerte IK. Evaluating the validity of self-report as a method for quantifying heading exposure in male youth soccer. Res Sports Med 2020; 29:427-439. [PMID: 33283535 DOI: 10.1080/15438627.2020.1853541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Assessing heading exposure in football is important when exploring the association between heading and brain alterations. To this end, questionnaires have been developed for use in adult populations. However, the validity of self-report in adolescents remains to be elucidated. Male youth soccer players (n = 34) completed a questionnaire on heading exposure after a two-week period, which included matches and training sessions. Self-reported numbers were compared to observation (considered reference). In total, we observed 157 training sessions and 64 matches. Self-reported heading exposure correlated with observed heading exposure (Spearman's rho 0.68; p < 0.001). Players systematically overestimated their heading exposure by a factor of 3 with the random error of 46%. Area under the curve was 0.87 (95% CI 0.67-1) utilizing self-report for identifying players from high- and low-exposure groups. Thus, in this study, self-reported data could be used to group youth players into high and low heading exposure groups, but not to quantify individual heading exposure.
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Affiliation(s)
- Stian B Sandmo
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Biomedical Sciences, KU Leuven, Leuven, Belgium.,LBI - KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Biomedical Sciences, KU Leuven, Leuven, Belgium.,LBI - KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - David Kaufmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and the Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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26
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Rowson B, Duma SM. A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies. Ann Biomed Eng 2020; 48:2734-2750. [PMID: 33200263 DOI: 10.1007/s10439-020-02684-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
This review paper summarizes the scientific advancements in the field of concussion biomechanics in American football throughout the past five decades. The focus is on-field biomechanical data collection, and the translation of that data to injury metrics and helmet evaluation. On-field data has been collected with video analysis for laboratory reconstructions or wearable head impact sensors. Concussion biomechanics have been studied across all levels of play, from youth to professional, which has allowed for comparison of head impact exposure and injury tolerance between different age groups. In general, head impact exposure and injury tolerance increase with increasing age. Average values for concussive head impact kinematics are lower for youth players in both linear and rotational acceleration. Head impact data from concussive and non-concussive events have been used to develop injury metrics and risk functions for use in protective equipment evaluation. These risk functions have been used to evaluate helmet performance for each level of play, showing substantial differences in the ability of different helmet models to reduce concussion risk. New advances in head impact sensor technology allow for biomechanical measurements in helmeted and non-helmeted sports for a more complete understanding of concussion tolerance in different demographics. These sensors along with advances in finite element modeling will lead to a better understanding of the mechanisms of injury and human tolerance to head impact.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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27
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Cecchi NJ, Monroe DC, Moscoso WX, Hicks JW, Reinkensmeyer DJ. Effects of soccer ball inflation pressure and velocity on peak linear and rotational accelerations of ball-to-head impacts. SPORTS ENGINEERING 2020. [DOI: 10.1007/s12283-020-00331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Beaudouin F, Gioftsidou A, Larsen MN, Lemmink K, Drust B, Modena R, Espinola JR, Meiu M, Vouillamoz M, Meyer T. The UEFA Heading Study: Heading incidence in children's and youth' football (soccer) in eight European countries. Scand J Med Sci Sports 2020; 30:1506-1517. [PMID: 32335945 DOI: 10.1111/sms.13694] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
To assess the real-life magnitude of the heading incidence in children's and youth' football in eight European countries with different "football cultures," a cross-sectional observational design, in which one match per team in 480 different teams from eight European countries (2017/18-2018/19), was recorded by video. One training session was recorded in 312 teams. Clubs with Under-10, Under-12 (female/male/mixed), and Under-16 female and male teams were eligible to participate. Heading frequencies and types were analyzed. Results are presented as headers per match/training and per team. Incidence rates (IR) per 1000 match/training hours were calculated. Under-10 teams carried out the lowest average number of headers per match (8.8), followed by Under-16 female (17.7), Under-12 (18.4), and Under-16 male (35.5). Total number of headers per match and team varied between countries. 80% of the total number of headers were single intentional headers, 12% heading duels, 3% unintentional headers by getting hit, and 5% others (trends apparent in all age groups). Three head injuries occurred during match play corresponding to an IR of 0.70 (95% CI, 0.23-2.16). The lowest number of headers per training and team was found in Under-10 (21.3), followed by Under-16 females (34.1), Under-12 (35.8), and Under-16 males (45.0). In conclusion, this large-scale study presents novel data about the number and type of headers in youth' football throughout Europe. A more precise understanding of the heading incidence, specifically in young players, is mandatory for the debate of restrictions on heading in youth football.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Asimenia Gioftsidou
- Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Malte Nejst Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Koen Lemmink
- Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barry Drust
- Sport and Exercise Sciences, John Moores University, Liverpool, UK
| | - Roberto Modena
- CeRiSM Research Center Sport Mountain and Health, University of Verona, Verona, Italy
| | | | - Mihai Meiu
- Romanian Football Federation, Bucharest, Romania
| | - Marc Vouillamoz
- Union des Associations Européennes de Football (UEFA), Nyon, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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29
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Caccese JB, Santos FV, Yamaguchi F, Jeka JJ. Age of First Exposure to Soccer Heading and Sensory Reweighting for Upright Stance. Int J Sports Med 2020; 41:616-627. [PMID: 32365387 DOI: 10.1055/a-1141-3553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
US Soccer eliminated soccer heading for youth players ages 10 years and younger and limited soccer heading for children ages 11-13 years. Limited empirical evidence associates soccer heading during early adolescence with medium-to-long-term behavioral deficits. The purpose of this study was to compare sensory reweighting for upright stance between college-aged soccer players who began soccer heading ages 10 years and younger (AFE ≤ 10) and those who began soccer heading after age 10 (AFE > 10). Thirty soccer players self-reported age of first exposure (AFE) to soccer heading. Sensory reweighting was compared between AFE ≤ 10 and AFE > 10. To evaluate sensory reweighting, we simultaneously perturbed upright stance with visual, vestibular, and proprioceptive stimulation. The visual stimulus was presented at two different amplitudes to measure the change in gain to vision, an intra-modal effect; and change in gain to galvanic vestibular stimulus (GVS) and vibration, both inter-modal effects. There were no differences in gain to vision (p=0.857, η2=0.001), GVS (p=0.971, η2=0.000), or vibration (p=0.974, η2=0.000) between groups. There were no differences in sensory reweighting for upright stance between AFE ≤ 10 and AFE > 10, suggesting that soccer heading during early adolescence is not associated with balance deficits in college-aged soccer players, notwithstanding potential deficits in other markers of neurological function.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, United States
| | | | - Felipe Yamaguchi
- College of Health Sciences, Kinesiology and Applied Physiology, University of Delaware, Newark, United States
| | - John J Jeka
- College of Health Sciences, Kinesiology and Applied Physiology, University of Delaware, Newark, United States
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30
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Patton DA, Huber CM, McDonald CC, Margulies SS, Master CL, Arbogast KB. Video Confirmation of Head Impact Sensor Data From High School Soccer Players. Am J Sports Med 2020; 48:1246-1253. [PMID: 32130020 PMCID: PMC7405551 DOI: 10.1177/0363546520906406] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent advances in technology have enabled the development of head impact sensors, which provide a unique opportunity for sports medicine researchers to study head kinematics in contact sports. Studies have suggested that video or observer confirmation of head impact sensor data is required to remove false positives. In addition, manufacturer filtering algorithms may be ineffective in identifying true positives and removing true negatives. PURPOSE To (1) identify the percentage of video-confirmed events recorded by headband-mounted sensors in high school soccer through video analysis, overall and by sex; (2) compare video-confirmed events with the classification by the manufacturer filtering algorithms; and (3) quantify and compare the kinematics of true- and false-positive events. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Adolescent female and male soccer teams were instrumented with headband-mounted impact sensors (SIM-G; Triax Technologies) during games over 2 seasons of suburban high school competition. Sensor data were sequentially reduced to remove events recorded outside of game times, associated with players not on the pitch (ie, field) and players outside the field of view of the camera. With video analysis, the remaining sensor-recorded events were identified as an impact event, trivial event, or nonevent. The mechanisms of impact events were identified. The classifications of sensor-recorded events by the SIM-G algorithm were analyzed. RESULTS A total of 6796 sensor events were recorded during scheduled varsity game times, of which 1893 (20%) were sensor-recorded events associated with players on the pitch in the field of view of the camera during verified game times. Most video-confirmed events were impact events (n = 1316, 70%), followed by trivial events (n = 396, 21%) and nonevents (n = 181, 10%). Female athletes had a significantly higher percentage of trivial events and nonevents with a significantly lower percentage of impact events. Most impact events were head-to-ball impacts (n = 1032, 78%), followed by player contact (n = 144, 11%) and falls (n = 129, 10%) with no significant differences between male and female teams. The SIM-G algorithm correctly identified 70%, 52%, and 66% of video-confirmed impact events, trivial events, and nonevents, respectively. CONCLUSION Video confirmation is critical to the processing of head impact sensor data. Percentages of video-confirmed impact events, trivial events, and nonevents vary by sex in high school soccer. Current manufacturer filtering algorithms and magnitude thresholds are ineffective at correctly classifying sensor-recorded events and should be used with caution.
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Affiliation(s)
- Declan A. Patton
- Address correspondence to Declan A. Patton, PhD, Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, 734 Schuylkill Avenue, Philadelphia, PA 19104, USA ()
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31
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Caccese JB, DeWolf RM, Kaminski TW, Broglio SP, McAllister TW, McCrea M, Buckley TA. Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study. Sports Med 2020; 49:477-487. [PMID: 30747378 DOI: 10.1007/s40279-019-01069-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes. OBJECTIVE The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes. METHODS We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history. RESULTS Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction. CONCLUSION Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Ryan M DeWolf
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA.
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA.
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32
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Caccese JB, Best C, Lamond LC, Difabio M, Kaminski TW, Watson D, Getchell N, Buckley TA. Effects of Repetitive Head Impacts on a Concussion Assessment Battery. Med Sci Sports Exerc 2020; 51:1355-1361. [PMID: 30649104 DOI: 10.1249/mss.0000000000001905] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players. METHODS Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: preseason (PRE) and postseason (POST). The outcome measures consisted of tandem gait (TG), Standardized Assessment of Concussion, Balance Error Scoring System, King-Devick (KD), clinical reaction time, and Immediate Post-Concussion Assessment and Cognitive Testing. Repetitive head impact during the season was quantified using the Head Impact Telemetry System (Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, Norwalk, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts ≥98g. RESULTS Results from direct-entry multiple regression analyses suggest significant associations between RHI and both visual memory (R = 0.670, F = 6.487, P = 0.002) and TG (R = 0.636, F = 3.841, P = 0.029) for WSOC and between RHI and KD (R = 0.756, F = 5.579, P = 0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant. CONCLUSIONS These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and visual memory/TG among WSOC, RHI, and KD among FB.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | | | - Lindsey C Lamond
- Department of Family Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Melissa Difabio
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Dan Watson
- University of Delaware Athletics, Newark, DE
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
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An Evaluation of Heart Rate Variability in Female Youth Soccer Players Following Soccer Heading: A Pilot Study. Sports (Basel) 2019; 7:sports7110229. [PMID: 31689916 PMCID: PMC6915463 DOI: 10.3390/sports7110229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
Most head impacts in soccer occur from purposeful heading; however, the link between heading and neurological impairment is unknown. Previous work suggests concussion may result in an uncoupling between the autonomic nervous system and cardiovascular system. Accordingly, heart rate variability (HRV) may be a sensitive measure to provide meaningful information regarding repetitive heading in soccer. The purpose of this pilot study assesses the feasibility of measuring HRV to evaluate autonomic function following soccer heading. Sixteen youth female participants underwent heart rate monitoring during a heading and footing condition. Participants completed a five minute resting supine trial at the start and end of each testing session. Standard 450 g soccer balls were projected at 6 m/s towards participants. Participants performed five headers, for the header condition, and five footers for the footer condition. The HRV for resting supine trials, pre- and post-header and footer conditions were assessed for both time and frequency domains. HRV effect sizes were small when comparing conditions, except absolute low frequency (d = 0.61) and standard deviation of the normal-normal (NN) intervals (d = 0.63). Participant retention and adherence were high, without adverse events. Findings suggest HRV is a feasible measure for evaluating the effects of heading on autonomic function.
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34
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Caccese JB, Iverson GL, Cameron KL, Houston MN, McGinty GT, Jackson JC, O'Donnell P, Pasquina PF, Broglio SP, McCrea M, McAllister T, Buckley TA. Estimated Age of First Exposure to Contact Sports Is Not Associated with Greater Symptoms or Worse Cognitive Functioning in Male U.S. Service Academy Athletes. J Neurotrauma 2019; 37:334-339. [PMID: 31375052 DOI: 10.1089/neu.2019.6571] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study examined the association between estimated age of first exposure (eAFE) to contact sport participation and neurocognitive performance and symptom ratings in U.S. service academy National Collegiate Athletic Association (NCAA) athletes. Male cadets (N = 891), who participate in lacrosse (n = 211), wrestling (n = 170), ice hockey (n = 81), soccer (n = 119), rugby (n = 10), or non-contact sports (n = 298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each neurocognitive domain score and total symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact); eAFE (eAFE <12 years vs. eAFE ≥12 years); group-by-eAFE; and covariates for learning accommodation status, concussion history, and age. The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald χ2 = 0.073, p = 0.788; Visual Memory, Wald χ2 = 2.71, p = 0.100; Visual Motor Speed, Wald χ2 = 0.078, p = 0.780; Reaction Time, Wald χ2 = 0.003, p = 0.955; Symptom Severity, Wald χ2 = 2.87, p = 0.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (χ2 = 6.19, p = 0.013, B = -2.97). Older age was associated with faster reaction time (χ2 = 4.40, p = 0.036, B = -0.006) and lesser symptom severity (χ2 = 5.55, p = 0.019, B = -0.068). No other parameters were significant. We observed no association between eAFE, contact sport participation, neurocognitive functioning, or subjectively experienced symptoms in this cohort. Earlier eAFE to contact sport participation is not related to worse neurocognitive performance or greater subjectively experienced symptoms in male U.S. service academy NCAA athletes.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts; Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Gerald T McGinty
- United States Air Force Academy, U.S. Air Force Academy, Colorado
| | | | - Patrick O'Donnell
- United States Coast Guard Academy Regional Clinic, New London, Connecticut
| | - Paul F Pasquina
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences; Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan
| | - Michael McCrea
- Medical College of Wisconsin, Department of Neurosurgery, Milwaukee, Wisconsin
| | | | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware.,Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
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35
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Cecchi NJ, Oros TJ, Monroe DC, Fote GM, Moscoso WX, Hicks JW, Reinkensmeyer DJ. The Effectiveness of Protective Headgear in Attenuating Ball-to-Forehead Impacts in Water Polo. Front Sports Act Living 2019; 1:2. [PMID: 33344926 PMCID: PMC7739673 DOI: 10.3389/fspor.2019.00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Recent reports have demonstrated that there is a serious risk of head impact and injury in water polo. The use of protective headgear in contact sports is a commonly accepted strategy for reducing the risk of head injury, but there are few available protective headgears for use in water polo. Many of those that are available are banned by the sport's governing bodies due to a lack of published data supporting the effectiveness of those headgears in reducing head impact kinematics. To address this gap in knowledge, we launched a water polo ball at the forehead of an anthropomorphic testing device fitted with either a standard water polo headgear or one of two protective headgears. We selected a range of launch speeds representative of those observed across various athlete ages. Mixed-model ANOVAs revealed that, relative to standard headgear, protective headgears reduced peak linear acceleration (by 10.8-21.6%; p < 0.001), and peak rotational acceleration (by 24.5-48.5%; p < 0.001) induced by the simulated ball-to-forehead impacts. We discuss the possibility of using protective headgears in water polo to attenuate head impact kinematics.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States.,Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Theophil J Oros
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Gianna M Fote
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, United States
| | - Wyatt X Moscoso
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - David J Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
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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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37
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Lynall RC, Lempke LB, Johnson RS, Anderson MN, Schmidt JD. A Comparison of Youth Flag and Tackle Football Head Impact Biomechanics. J Neurotrauma 2019; 36:1752-1757. [DOI: 10.1089/neu.2018.6236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert C. Lynall
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Landon B. Lempke
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Rachel S. Johnson
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Melissa N. Anderson
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Julianne D. Schmidt
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
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Tiernan S, Byrne G, O’Sullivan DM. Evaluation of skin-mounted sensor for head impact measurement. Proc Inst Mech Eng H 2019; 233:735-744. [DOI: 10.1177/0954411919850961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Gary Byrne
- Technological University Dublin, Dublin, Ireland
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Harriss A, Johnson AM, Walton DM, Dickey JP. Head impact magnitudes that occur from purposeful soccer heading depend on the game scenario and head impact location. Musculoskelet Sci Pract 2019; 40:53-57. [PMID: 30708266 DOI: 10.1016/j.msksp.2019.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/07/2019] [Accepted: 01/21/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE This study quantified the linear and angular kinematics that result from purposeful heading during youth soccer games, and the influence of game scenario and head impact location on these magnitudes. METHOD This observational study recruited thirty-six female soccer players (13.4 ± 0.9 years old) from three elite youth soccer teams (U13, U14, U15) and followed for an entire soccer season. Players wore wireless sensors during each game to quantify head impact magnitudes. A total of 60 regular season games (20 games per team) were video recorded, and purposeful heading events were categorized by game scenario (e.g. throw in), and head impact location (e.g. front of head). RESULTS Game scenario had a statistically significant effect on the linear head acceleration, and rotational head velocity, that resulted from purposeful headers. Rotational velocity from purposeful headers varied significantly between head impact locations, with impacts to the top of the head (improper technique) resulting in larger peak rotational velocities than impacts to the front of the head (proper technique); this was also the case for the linear acceleration for punts. CONCLUSION Our findings suggest that the magnitude for both linear and angular head impact kinematics depend on the game scenario and head impact location. Headers performed with the top of the head (improper technique) result in larger rotational velocities compared to the front of the head (proper technique). Accordingly, youth players should be educated on how to execute proper heading technique to reduce head impact accelerations.
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Affiliation(s)
- Alexandra Harriss
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M Johnson
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada; School of Health Studies, The University of Western Ontario, London, Ontario, Canada
| | - David M Walton
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - James P Dickey
- School of Kinesiology, The University of Western Ontario, London, Ontario, Canada.
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40
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Miller LE, Pinkerton EK, Fabian KC, Wu LC, Espeland MA, Lamond LC, Miles CM, Camarillo DB, Stitzel JD, Urban JE. Characterizing head impact exposure in youth female soccer with a custom-instrumented mouthpiece. Res Sports Med 2019; 28:55-71. [DOI: 10.1080/15438627.2019.1590833] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Logan E. Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Elizabeth K. Pinkerton
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katie C. Fabian
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lyndia C. Wu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsey C. Lamond
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Christopher M. Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
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41
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Putukian M, Echemendia RJ, Chiampas G, Dvorak J, Mandelbaum B, Lemak LJ, Kirkendall D. Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York. Br J Sports Med 2019; 53:1332. [DOI: 10.1136/bjsports-2018-100232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.
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Harriss A, Johnson AM, Walton DM, Dickey JP. The number of purposeful headers female youth soccer players experience during games depends on player age but not player position. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1506591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Alexandra Harriss
- School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M. Johnson
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
| | - David M. Walton
- School of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - James P. Dickey
- School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
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43
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Hunter LE, Ifrah C, Zimmerman ME, Kim M, Lipton RB, Stewart WF, Lipton ML. Heading and unintentional head impacts have opposing associations with Patient Reported Outcomes in amateur soccer players. Res Sports Med 2018; 26:390-400. [PMID: 30003822 DOI: 10.1080/15438627.2018.1492396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The effects of soccer-related head impacts, beyond overt concussions, on Patient Reported Outcomes (PROs) have not been explored to date. Generalized estimating equations were employed to determine the association between soccer-related head impacts (headers in the prior 2 weeks, unintentional head impacts in the prior 2 weeks, headers in the prior 12 months and lifetime concussions) on PROs including depression, anxiety, sleep disturbance and sleep impairment. Compared to players with no unintentional head impacts in the prior 2 weeks, players with one unintentional exposure reported more symptoms of anxiety (p = 0.002) and players with 2+ exposures reported more symptoms of depression (p = 0.006) and anxiety (p < 0.001). In contrast, players in the 3rd Quartile of 12 mo. headers reported less anxiety (p = 0.001), sleep disturbance (p = 0.002) and sleep impairment (p < 0.001) compared to those in the 1st quartile. Unintentional head impacts are associated with worse PROs while more headers are paradoxically associated with better PROs.
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Affiliation(s)
- Liane E Hunter
- a The Gruss Magnetic Resonance Imaging Center , Bronx , Albert Einstein College of Medicine and Montefiore Medical Center , NY, USA
| | - Chloe Ifrah
- a The Gruss Magnetic Resonance Imaging Center , Bronx , Albert Einstein College of Medicine and Montefiore Medical Center , NY, USA
| | | | - Mimi Kim
- c Department of Epidemiology & Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Richard B Lipton
- c Department of Epidemiology & Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,d Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | | | - Michael L Lipton
- a The Gruss Magnetic Resonance Imaging Center , Bronx , Albert Einstein College of Medicine and Montefiore Medical Center , NY, USA.,f Departments of Radiology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,g The Dominick P. Purpura Department of Neuroscience , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,h Department of Psychiatry & Behavioral Sciences , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
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44
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Miller LE, Kuo C, Wu LC, Urban JE, Camarillo DB, Stitzel JD. Validation of a Custom Instrumented Retainer Form Factor for Measuring Linear and Angular Head Impact Kinematics. J Biomech Eng 2018; 140:2671738. [DOI: 10.1115/1.4039165] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 11/08/2022]
Abstract
Head impact exposure in popular contact sports is not well understood, especially in the youth population, despite recent advances in impact-sensing technology which has allowed widespread collection of real-time head impact data. Previous studies indicate that a custom-instrumented mouthpiece is a superior method for collecting accurate head acceleration data. The objective of this study was to evaluate the efficacy of mounting a sensor device inside an acrylic retainer form factor to measure six-degrees-of-freedom (6DOF) head kinematic response. This study compares 6DOF mouthpiece kinematics at the head center of gravity (CG) to kinematics measured by an anthropomorphic test device (ATD). This study found that when instrumentation is mounted in the rigid retainer form factor, there is good coupling with the upper dentition and highly accurate kinematic results compared to the ATD. Peak head kinematics were correlated with r2 > 0.98 for both rotational velocity and linear acceleration and r2 = 0.93 for rotational acceleration. These results indicate that a rigid retainer-based form factor is an accurate and promising method of collecting head impact data. This device can be used to study head impacts in helmeted contact sports such as football, hockey, and lacrosse as well as nonhelmeted sports such as soccer and basketball. Understanding the magnitude and frequency of impacts sustained in various sports using an accurate head impact sensor, such as the one presented in this study, will improve our understanding of head impact exposure and sports-related concussion.
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Affiliation(s)
- Logan E. Miller
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106 e-mail:
| | - Calvin Kuo
- Department of Mechanical Engineering, Stanford University, 443 Via Ortega, Room 202, Stanford, CA 94305 e-mail:
| | - Lyndia C. Wu
- Department of Bioengineering, Stanford University, 443 Via Ortega, Room 202, Stanford, CA 94305 e-mail:
| | - Jillian E. Urban
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106; Clinical and Translational Science Institute, Wake Forest School of Medicine, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106 e-mail:
| | - David B. Camarillo
- Department of Bioengineering, Stanford University, 443 Via Ortega, Room 202, Stanford, CA 94305
- Clinical and Translational Science Institute, Wake Forest School of Medicine, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106 e-mail:
| | - Joel D. Stitzel
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Avenue, Suite 120, Winston-Salem, NC 27106 e-mail:
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45
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Lamond LC, Caccese JB, Buckley TA, Glutting J, Kaminski TW. Linear Acceleration in Direct Head Contact Across Impact Type, Player Position, and Playing Scenario in Collegiate Women's Soccer Players. J Athl Train 2018; 53:115-121. [PMID: 29373056 DOI: 10.4085/1062-6050-90-17] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Heading, an integral component of soccer, exposes athletes to a large number of head impacts over a career. The literature has begun to indicate that cumulative exposure may lead to long-term functional and psychological deficits. Quantifying an athlete's exposure over a season is a first step in understanding cumulative exposure. OBJECTIVE To measure the frequency and magnitude of direct head impacts in collegiate women's soccer players across impact type, player position, and game or practice scenario. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I institution. PATIENTS OR OTHER PARTICIPANTS Twenty-three collegiate women's soccer athletes. MAIN OUTCOME MEASURE(S) Athletes wore Smart Impact Monitor accelerometers during all games and practices. Impacts were classified during visual, on-field monitoring of athletic events. All direct head impacts that exceeded the 10 g threshold were included in the final data analysis. The dependent variable was linear acceleration, and the fixed effects were (1) type of impact: clear, pass, shot, unintentional deflection, or head-to-head contact; (2) field position: goalkeeper, defense, forward, or midfielder; (3) playing scenario: game or practice. RESULTS Shots (32.94 g ± 12.91 g, n = 38; P = .02) and clears (31.09 g ± 13.43 g, n = 101; P = .008) resulted in higher mean linear accelerations than passes (26.11 g ± 15.48 g, n = 451). Head-to-head impacts (51.26 g ± 36.61 g, n = 13; P < .001) and unintentional deflections (37.40 g ± 34.41 g, n = 24; P = .002) resulted in higher mean linear accelerations than purposeful headers (ie, shots, clears, and passes). No differences were seen in linear acceleration across player position or playing scenario. CONCLUSIONS Nonheader impacts, including head-to-head impacts and unintentional deflections, resulted in higher mean linear accelerations than purposeful headers, including shots, clears, and passes, but occurred infrequently on the field. Therefore, these unanticipated impacts may not add substantially to an athlete's cumulative exposure, which is a function of both frequency and magnitude of impact.
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Affiliation(s)
- Lindsey C Lamond
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | | | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
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46
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Rowson B, Tyson A, Rowson S, Duma S. Measuring head impacts: accelerometers and other sensors. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:235-243. [PMID: 30482351 DOI: 10.1016/b978-0-444-63954-7.00023-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Understanding the biomechanics of head injuries is essential for the development of preventive strategies and protective equipment design. However, there are many challenges associated with determining the forces that cause injury. Acceleration of the skull is often measured because it is relatively easy to quantify and relates to severity of impact, but it is difficult to relate those measurements to the type and extent of injury that occurs. Experimental work in the laboratory has used either human cadavers or volunteers. Cadavers can be instrumented with high-grade sensors that are tightly coupled to the skull for accurate measurements, but they cannot exhibit a functional response to determine a threshold for brain injury. Volunteers can also be instrumented with high-grade sensors in controlled laboratory experiments, but any head accelerations they experience must be well below an injurious level. Athletes participating in contact sports present a unique opportunity to collect biomechanical data from populations that have increased exposure to head impacts and a higher risk of head injury than the general population. Recent advances in sensor technology have allowed for more accurate measurements from instrumented athletes during play, but it is challenging to tightly couple the instrumentation to the skull to provide meaningful measurements. Because of the challenges associated with on-field measurements, it is important to consider the type of sensor used and its accuracy in the field when evaluating head impact data from athletes.
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Affiliation(s)
- Bethany Rowson
- Institute for Critical Technology and Applied Science, Virginia Tech, Blacksburg, VA, United States
| | - Abigail Tyson
- Institute for Critical Technology and Applied Science, Virginia Tech, Blacksburg, VA, United States
| | - Steven Rowson
- Institute for Critical Technology and Applied Science, Virginia Tech, Blacksburg, VA, United States
| | - Stefan Duma
- Institute for Critical Technology and Applied Science, Virginia Tech, Blacksburg, VA, United States.
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47
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Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Sex and age differences in head acceleration during purposeful soccer heading. Res Sports Med 2017; 26:64-74. [PMID: 29067816 DOI: 10.1080/15438627.2017.1393756] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Differences in head-neck segment mass, purposeful heading technique, and cervical strength and stiffness may contribute to differences in head accelerations across sex and age. The purpose of this study was to compare head acceleration across sex and age (youth [12-14 years old], high school and collegiate) during purposeful soccer heading. One-hundred soccer players (42 male, 58 female, 17.1 ± 3.5 years, 168.5 ± 20.3 cm, 61.5 ± 13.7 kg) completed 12 controlled soccer headers at an initial ball velocity of 11.2 m/s. Linear and rotational accelerations were measured using a triaxial accelerometer and gyroscope and were transformed to the head centre-of-mass. A MANOVA revealed a significant multivariate main effect for sex (Pillai's Trace = .165, F(2,91) = 11.868, p < .001), but not for age (Pillai's Trace = .033, F(4,182) = 0.646, p = .630). Peak linear and rotational accelerations were higher in females (40.9 ± 13.3 g; 3279 ± 1065 rad/s2) than males (27.6 ± 8.5 g, 2219 ± 823 rad/s2). These data suggest that under controlled soccer heading conditions, females may be exposed to higher head accelerations than males.
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Affiliation(s)
- Jaclyn B Caccese
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Thomas A Buckley
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Ryan T Tierney
- c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - William C Rose
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | | | - Thomas W Kaminski
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
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48
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Jones R, Greig M. In-vivo measurement of tri-axial loading at the head during the rugby tackle. Res Sports Med 2017; 25:437-450. [PMID: 28795591 DOI: 10.1080/15438627.2017.1365297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To investigate the anatomical distribution of linear and rotational forces during the tackle scenario, male rugby players performed a total of 48 trials, as ball carrier or tackler. Participants wore headgear accommodating three global positioning system units measuring uniaxial acceleration at the occipital region (OR), left tempero-parietal (LT-PR) and right tempero-parietal region (RT-PR). An additional unit was located at the cervico-thoracic spinal region in a custom vest. There was a significant main effect for tackle condition (P < 0.001), with the tackler exposed to significantly greater load than the ball carrier, supporting epidemiological observations. A repeated measure general linear model also revealed a significant (P < 0.001) main effect for unit location upon 3D load, with significantly higher load at the CSR (1.63 ± 0.54 a.u.) and OR (1.67 ± 0.94 a.u.) units when compared to the LT-PR (1.23 ± 0.39 a.u.) and RT-PR (1.21 ± 0.44 a.u.) units. The anatomical specificity in loading supports epidemiological observations and provides an insight into potential concussion aetiology.
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Affiliation(s)
- Ross Jones
- a Sports Injuries Research Group, Department of Sport & Physical Activity , Edge Hill University , Ormskirk , UK
| | - Matt Greig
- a Sports Injuries Research Group, Department of Sport & Physical Activity , Edge Hill University , Ormskirk , UK
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49
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Buckley TA, Baugh CM, Meehan WP, DiFabio MS. Concussion Management Plan Compliance: A Study of NCAA Power 5 Conference Schools. Orthop J Sports Med 2017; 5:2325967117702606. [PMID: 28473995 PMCID: PMC5407527 DOI: 10.1177/2325967117702606] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: In response to concerns over concussions and repeated head impacts that occur during sports, the National Collegiate Athletic Association (NCAA) mandated that all member institutions enact a concussion management plan (CMP). Although institutional and health care provider self-reports have been investigated, compliance with NCAA protocol recommendations has not been examined. Purpose: To examine the CMPs from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines. Study Design: Descriptive epidemiology study. Methods: Each institution’s publicly available CMP was obtained in 2015, reviewed, and coded for compliance with each of the required 47 components. Overall compliance rate, item-level, category-level, and institution-level compliance was assessed. Independent predictors of compliance, including each institution’s athletic training staff size, academic performance, and athletic performance, were examined with quasi-binomial regression. Results: CMPs varied substantially in length and level of detail. The overall compliance rate for all components across all institutions was 94.3% (2880/3055). Twelve components achieved 100% (65/65) compliance, and the lowest levels of compliance were clustered in “return to learn.” There were 22 institutions that achieved a 100% compliance rate; the lowest institutional compliance was 59.6%. There were no significant associations between the independent predictors and institutional compliance. Conclusion: Overall compliance with NCAA concussion management requirements was high, but there remains room for improvement. The lowest level of compliance was clustered in the return-to-learn section. There were limited details provided in the reducing head trauma component. Items with lower compliance (reducing head trauma, return to learn) tended to be outside the core competencies of the medical staff, indicating an area for improvement. Encouragingly, many institutions and specific components demonstrated full compliance.
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Affiliation(s)
- Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
- Thomas A. Buckley, EdD, Department of Kinesiology and Applied Physiology, University of Delaware, 541 South College Avenue, 150 Human Performance Lab, Newark, DE 19716, USA ()
| | - Christine M. Baugh
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA
- Micheli Center for Sport Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, Massachusetts, USA
| | - William P. Meehan
- Micheli Center for Sport Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, Massachusetts, USA
| | - Melissa S. DiFabio
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
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