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Hamel R, Waltzing BM, Massey T, Blenkinsop J, McConnell L, Osborne K, Sesay K, Stoneman F, Carter A, Maaroufi H, Jenkinson N. Sub-concussive head impacts from heading footballs do not acutely alter brain excitability as compared to a control group. PLoS One 2024; 19:e0306560. [PMID: 39088385 PMCID: PMC11293750 DOI: 10.1371/journal.pone.0306560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 06/18/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Repeated sub-concussive head impacts are a growing brain health concern, but their possible biomarkers remain elusive. One impediment is the lack of a randomised controlled human experimental model to study their effects on the human brain. OBJECTIVES This work had two objectives. The first one was to provide a randomised controlled human experimental model to study the acute effects of head impacts on brain functions. To achieve this, this work's second objective was to investigate if head impacts from heading footballs acutely alter brain excitability by increasing corticospinal inhibition as compared to a control group. METHODS In practised and unpractised young healthy adults, transcranial magnetic stimulation was used to assess corticospinal silent period (CSP) duration and corticospinal excitability (CSE) before and immediately after performing headings by returning 20 hand-thrown balls directed to the head (Headings; n = 30) or the dominant foot (Control; n = 30). Moreover, the Rivermead Post-Concussion Questionnaire (RPQ) was used to assess the symptoms of head impacts. Head acceleration was also assessed in subgroups of participants. RESULTS The intervention lengthened CSP duration in both the Headings (6.4 ± 7.5%) and Control groups (4.6 ± 2.6%), with no difference in lengthening between the two groups. Moreover, CSE was not altered by the intervention and did not differ between groups. However, performing headings increased headaches and dizziness symptoms and resulted in greater head acceleration upon each football throw (12.5 ± 1.9g) as compared to the control intervention (5.5 ± 1.3g). CONCLUSIONS The results suggest that head impacts from football headings do not acutely alter brain excitability as compared to a control intervention. However, the results also suggest that the present protocol can be used as an experimental model to investigate the acute effects of head impacts on the human brain.
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Affiliation(s)
- Raphael Hamel
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Tom Massey
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - James Blenkinsop
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Leah McConnell
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kieran Osborne
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Karamo Sesay
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Finn Stoneman
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adam Carter
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hajar Maaroufi
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ned Jenkinson
- School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Peek K, Franchi M, Lemmink K, Balsom P, Meyer T. Quality Criteria for Studies Assessing the Acute Effects of Heading: Results from a UEFA Expert Panel. Sports Med 2024; 54:1089-1095. [PMID: 38150166 PMCID: PMC11127840 DOI: 10.1007/s40279-023-01977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
There is increasing concern regarding the effects of heading in football on brain health including cognitive, behavioural and neuromotor function, with research suggesting an association between repeated ball-head impacts and neurodegenerative disease. While longitudinal studies to determine the long-term consequences of heading are challenging, there have been short-term 'acute' studies conducted, with some studies lacking appropriate methodology to ensure valid results. The Union of European Football Associations (UEFA) established a panel of experts to determine methodological recommendations for the conduct of studies that explore the acute effects of heading (defined as a single session of heading conducted either in a laboratory setting or following match play or a training session). The aim of this panel was to create quality criteria for acute heading studies that will form part of the eligibility assessment when applying for UEFA research funding (although the criteria can be applied to the conduct of acute heading research more widely). This process was deemed necessary to counter studies with poor methodological quality that used heading trials that did not accurately represent player exposure to ball-head impacts through football practice and match play (such as small sample sizes, unrealistically high heading exposure, and a lack of consideration of confounding variables). The panel identified core design decisions that authors should consider when designing and conducting acute heading research, with key methodological requirements for each domain pertaining to participants, heading trials, confounding variables, statistics and dependent/target variables and their measurement. After two rounds of reviews, the final list of quality criteria was agreed by the panel and will be applied to the next round of UEFA grant applications.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Martino Franchi
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Koen Lemmink
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul Balsom
- Swedish Football Association, Solna, Stockholm, Sweden
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarland, Germany
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3
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Weber J, Reinsberger C, Krutsch V, Seiffert R, Huber L, Alt V, Krutsch W. Heading and risk of injury situations for the head in professional German football: a video analysis of over 150,000 headers in 110,000 match minutes. SCI MED FOOTBALL 2023; 7:307-314. [PMID: 35994618 DOI: 10.1080/24733938.2022.2114602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
To provide detailed epidemiological data on situations with a propensity of head injuries due to heading in professional football. In a prospective cohort study including the four highest professional football leagues in Germany, headers carried out in 1244 official matches and critical situations (CI) with a potential risk for injuries over one season were assessed by video analysis and a standardised video protocol. Results: 154,766 headers in 111,960 match minutes were recorded (1.4 headings/min). Video analysis showed a mean of 6.2 headers per field player and match (SD: 2,9; min: 0; max: 19) in the entire study population with a peak in the third league (7.1 per player and match). Headers were predominantly carried out with the forehead (78.5%), and nearly two-thirds occurred during defence (64.3%). 49.9% of all headers occurred during tackling, of which 78.3% involved body contact with an opponent. Video analysis yielded 848 CI. 74.5% of all critical incidents occurred during heading duels as a part of tackling (odds ratio: 3.6, 95%-CI: 2.4-5.2), and 99.4% involved body contact (odds ratio: 5.9, 95%-CI: 2,8-12,7). This study is the first to provide detailed epidemiological data on heading and critical incidences with high risk for head injuries in professional football. Heading duels bear a high risk of head injury and thus represent a key target for prevention strategies. The impacts of headers should be critically investigated regarding neurological consequences in further studies, by including the mean heading rate per mal field player and match.
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Affiliation(s)
- Johannes Weber
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Volker Krutsch
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Robin Seiffert
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Lorenz Huber
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
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Huber CM, Patton DA, Rownd KR, Patterson Gentile C, Master CL, Arbogast KB. Neurophysiological Effects of Repeated Soccer Heading in Youth. J Biomech Eng 2023; 145:091005. [PMID: 37216312 PMCID: PMC10259471 DOI: 10.1115/1.4062423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Repeated head loading in sports is associated with negative long-term brain health, and there is growing evidence of short-term neurophysiological changes after repeated soccer heading. The objective of this study was to quantify the head kinematics and effects of repetitive soccer headers in adolescents using an instrumented mouthguard. Adolescent soccer players aged 13-18 years were randomly assigned to a kicking control, frontal heading, or oblique heading group. Participants completed neurophysiological assessments at three-time points: immediately prior to, immediately after, and approximately 24 h after completing 10 headers or kicks. The suite of assessments included the Post-Concussion Symptom Inventory, visio-vestibular exam, King-Devick test, modified Clinical Test of Sensory Interaction and Balance with force plate sway measurement, pupillary light reflex, and visual evoked potential. Data were collected for 19 participants (17 male). Frontal headers resulted in significantly higher peak resultant linear acceleration (17.4 ± 0.5 g) compared to oblique headers (12.1 ± 0.4 g, p < 0.001), and oblique headers resulted in significantly higher peak resultant angular acceleration (frontal: 1147 ± 45 rad/s2, oblique: 1410 ± 65 rad/s2, p < 0.001). There were no neurophysiological deficits for either heading group or significant differences from controls at either post-heading timepoint, and therefore, a bout of repeated headers did not result in changes in the neurophysiological measures evaluated in this study. The current study provided data regarding the direction of headers with the goal to reduce the risk of repetitive head loading for adolescent athletes.
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Affiliation(s)
- Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Declan A. Patton
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Kathryn R. Rownd
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Carlyn Patterson Gentile
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Jain D, Huber CM, Patton DA, McDonald CC, Wang L, Ayaz H, Master CL, Arbogast KB. Use of functional near-infrared spectroscopy to quantify neurophysiological deficits after repetitive head impacts in adolescent athletes. Sports Biomech 2023:1-15. [PMID: 37430440 PMCID: PMC10776807 DOI: 10.1080/14763141.2023.2229790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
There is concern that repetitive head impact exposure (RHIE) may lead to neurophysiological deficits in adolescents. Twelve high school varsity soccer players (5 female) completed the King-Devick (K-D) and complex tandem gait (CTG) assessments pre- and post-season while wearing a functional near-infrared spectroscopy (fNIRS) sensor. The average head impact load (AHIL) for each athlete-season was determined via a standardised protocol of video-verification of headband-based head impact sensor data. Linear mixed effect models were used to determine the effects of AHIL and task condition (3 K-D cards or 4 CTG conditions) on the change in mean prefrontal cortical activation measured by fNIRS, and performance on K-D and CTG, from pre- to post-season. Although there was no difference in the pre- to post-season change in K-D or CTG performance, greater AHIL was associated with greater cortical activation at post-season in comparison to pre-season during the most challenging conditions of K-D (p = 0.003) and CTG (p = 0.02), suggesting that greater RHIE necessitates increased cortical activation to complete the more challenging aspects of these assessments at the same level of performance. These results describe the effect of RHIE on neurofunction and suggest the need for further study of the time course of these effects.
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Affiliation(s)
- Divya Jain
- Department of Bioengineering, University of Pennsylvania, PA, USA
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, PA, USA
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lei Wang
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
- Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hasan Ayaz
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Department of Psychology, College of Arts and Sciences, Drexel University, Philadelphia, PA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Drexel Solutions Institute, Drexel University, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Shamloo F, Kon M, Ritter E, Sereno AB. Quantifying the Magnitude and Longevity of the Effect of Repetitive Head Impacts in Adolescent Soccer Players: Deleterious Effect of Long Headers Extend Beyond a Month. Neurotrauma Rep 2023; 4:267-275. [PMID: 37095854 PMCID: PMC10122256 DOI: 10.1089/neur.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
There is growing interest in the effects of sports-related repetitive head impacts (RHIs) on athletes' cognitive capabilities. This study examines the effect of RHIs in data collected from adolescent athletes to estimate the magnitude and longevity of RHIs on sensorimotor and cognitive performance. A non-linear regression model estimated the longevity of RHI effects by adding a half-life parameter embedded in an exponential decay function. A model estimate of this parameter allows the possibility of RHI effects to attenuate over time and introduces a mechanism to study the cumulative effect of RHIs. The posterior distribution of the half-life parameter associated with short-distance headers (<30 m) is centered around 6 days, whereas the posterior distribution of the half-life parameter associated with long-distance headers extends beyond a month. Additionally, the magnitude of the effect of each short header is around 3 times smaller than that of a long header. The results indicate that, on both tasks, response time (RT) changes after long headers are bigger in magnitude and last longer compared to the effects of short headers. Most important, we demonstrate that deleterious effects of long headers extend beyond 1 month. Although estimates are based on data from a relatively short-duration study with a relatively small sample size, the proposed model provides a mechanism to estimate long-term behavioral slowing from RHIs, which may be helpful to reduce the risk of additional injury. Finally, differences in the longevity of the effects of short and long RHIs may help to explain the large variance found between biomechanical input and clinical outcome in studies of concussion tolerance.
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Affiliation(s)
- Farzin Shamloo
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Maria Kon
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
- Navy Center for Applied Research in Artificial Intelligence, Naval Research Laboratory, Washington, DC, USA
- Address correspondence to: Maria Kon, PhD, Department of Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN 47907, USA.
| | - Elizabeth Ritter
- University of North Carolina Health, Chapel Hill, North Carolina, USA
| | - Anne B. Sereno
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
- Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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7
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Weber J, Ernstberger A, Reinsberger C, Popp D, Nerlich M, Alt V, Krutsch W. Video analysis of 100 matches in male semi-professional football reveals a heading rate of 5.7 headings per field player and match. BMC Sports Sci Med Rehabil 2022; 14:132. [PMID: 35842676 PMCID: PMC9288693 DOI: 10.1186/s13102-022-00521-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Heading is an integral part of football and frequent media reports and previous studies about potential danger of heading and head trauma in football fuelled discussions. Epidemiological data and video analyses regarding headings situation and associated head injuries are still missing in male adult professional football. METHODS In a prospective cohort study in the male fourth German football league, 100 official matches of the 2015-2016 season were assessed by video analysis and a standardized protocol. Heading situations and concomitant circumstances as well as incidents with a propensity of injury (critical incidents) were analyzed. Critical incidents (CI) and seasonal reported head injuries were cross-referenced. RESULTS Overall, 11,514 headings were analysed in detail. Video analysis yielded a mean of 5.7 headings per player and match (SD: 1.2; range 0-15). Heading was predominantly performed with the frontal part of the head (76.8%), and nearly two thirds of all headings occurred during defending (65.8%). 71.0% of all headings occured during tacklings, of which 71.9% involved body contact with the opponent player. Video analysis yielded 31 CI on the head due to heading (incidence: 1.02 per 1000 h match exposure and player). 29 CI occurred during heading duels (odds ratio: 5.91), 30 CI with body contact (odds ratio: 28.8) and 6 CI with elbow contact (odds ratio: 6.13). CONCLUSION Heading frequency in male semi-professional football could be determined with a rate of 5.7 headings per match and field player. Cross referencing CI and seasonal reported head injuries revealed a very low number of reported head injuries.
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Affiliation(s)
- Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Andreas Ernstberger
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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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: 20] [Impact Index Per Article: 6.7] [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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9
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Balagopal R, Won M, Patel SS, Chuang AZ, Sereno AB. Heading-Related Slowing by Twenty-Four Hours in Youth Athletes. J Neurotrauma 2020; 37:2664-2673. [PMID: 32799741 DOI: 10.1089/neu.2020.7085] [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: 10/23/2022] Open
Abstract
Research suggests cumulative effects of repetitive head impacts (RHIs) on brain structure, especially with younger age of first exposure. Further, recent evidence suggests no immediate cognitive changes with increased RHIs but impairments across a sports season. The aim was to examine more closely the short-term time course of behavioral effects of exposure to RHI. Across 2 years, 18 female adolescent soccer players were tested on ProPoint (sensorimotor) and AntiPoint (cognitive) tasks with reaction time (RT) being the main outcome measure. The athletes were tested before and after workout with ball heading (immediate effect), as well as 24 h after workout (24 h effect) throughout two consecutive seasons. The number of headers performed 24 h before workout, during workout, and season average per workout were recorded. The athletes showed a decrease in ProPoint and AntiPoint RTs immediately after a workout, with no change or decrease in RTs with increasing RHIs. However, increasing RHIs during workout increased RTs in both tasks when tested 24 h later. The athletes also showed an increase in AntiPoint RTs with increasing season average RHIs. Our findings show a complex time course of effects of RHIs on sensorimotor and cognitive performance in adolescent athletes, with exposure to RHIs associated with no change or immediate benefits and then deficits by 24 h. Pathophysiological changes associated with exercise and traumatic brain injury can account for the sensorimotor and cognitive performance changes occurring within 24 h after RHIs.
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Affiliation(s)
- Radhika Balagopal
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Biological Sciences, University of California, Santa Barbara, California, USA
| | - Michelle Won
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Neurobiology and Anatomy, Texas A&M College of Medicine, Bryan, Texas, USA
| | - Saumil S Patel
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Alice Z Chuang
- Department of Ophthalmology and Visual Science, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Anne B Sereno
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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10
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Snowden T, Reid H, Kennedy S, Kenny R, McQuarrie A, Stuart-Hill L, Garcia-Barrera MA, Gawryluk J, Christie BR. Heading in the Right Direction: A Critical Review of Studies Examining the Effects of Heading in Soccer Players. J Neurotrauma 2020; 38:169-188. [PMID: 32883162 DOI: 10.1089/neu.2020.7130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The practice of heading in soccer has become a public concern because of the potential for subconcussive impacts to cause cumulative concussive-like effects; however, experimental evidence for this hypothesis has been mixed. This systematic review used pre-defined search parameters to assess primary literature that examined changes in cognitive, behavioral, structural, and/or biological processes after acute heading exposure in youth and young adult soccer players. The findings were synthesized into a concise and comprehensive summary of the research following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format, and suggestions for standardization of acute heading protocols are described. A total of 1189 articles were considered for this review, with 19 articles meeting all of the inclusion criteria for full analysis. An attempt was made to identify methods with significant sensitivity and reliability by grouping studies based on their outcome measures. Because of lack of standardization across intervention types and data collection protocols, no sensitive and reliable methods could be identified conclusively to assess the effects of acute heading exposure in soccer players. Based on this review, there is not enough evidence to either support or refute the potential of effects of subconcussive events from acute soccer heading exposure. Recommendations for standardization of acute heading exposure studies based on the included literature are discussed. Standardization is required to better understand the impact of acute heading exposure in soccer players, while allowing for the development of guidelines that mitigate any potential risks and allowing athletes to remain active and develop their skills.
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Affiliation(s)
- Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Hannah Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Samantha Kennedy
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Rebecca Kenny
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Amanda McQuarrie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Lynneth Stuart-Hill
- School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
| | | | - Jodie Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.,School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
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11
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Mooney J, Self M, ReFaey K, Elsayed G, Chagoya G, Bernstock JD, Johnston JM. Concussion in soccer: a comprehensive review of the literature. Concussion 2020; 5:CNC76. [PMID: 33005435 PMCID: PMC7506470 DOI: 10.2217/cnc-2020-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
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12
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Zuckerman SL, Brett BL, Jeckell A, Yengo-Kahn AM, Solomon GS. Chronic Traumatic Encephalopathy and Neurodegeneration in Contact Sports and American Football. J Alzheimers Dis 2019; 66:37-55. [PMID: 30223396 DOI: 10.3233/jad-180218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by the presence of abnormally phosphorylated tau protein in the depths of one or more cortical sulci. Controversy over the risk of CTE and neurologic disorders later in life among contact sport athletes has taken hold in the public spotlight, most notably in American football. Players, parents, coaches, and legislators have taken action based on the commonly held notion that contact sports invariably lead to neurodegenerative disorders. However, to fully understand the science behind this assumed association, a critical appraisal of the evidence is warranted. With regards to CTE in sports, the objectives of the current report are to: 1) describe the history of CTE, 2) review current CTE definitions, 3) critically evaluate the empiric data, divided into all contact sports and exclusively American football, and 4) summarize notable themes for future research.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Kaminski TW, Thompson A, Wahlquist VE, Glutting J. Self-reported head injury symptoms exacerbated in those with previous concussions following an acute bout of purposeful soccer heading. Res Sports Med 2019; 28:217-230. [PMID: 31257930 DOI: 10.1080/15438627.2019.1635130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rates of concussion in soccer are high, especially in female players. The primary aim of this study was to examine differences in self-reported concussion-related symptoms (CRS), balance (BESS), and neurocognitive performance (ImPACT) following an acute bout of soccer heading in a group of female collegiate players with and without a history of concussion. Eighty-seven players with 0 to 3+ previous concussions participated. The measurement variables were assessed before and after heading sessions; including one linear and one rotational bout. Players with concussion histories reported more CRS than their non-concussed teammates both before and after the heading sessions. Balance and neurocognitive scores were generally unaffected. This finding should heighten our awareness to carefully monitor soccer players who have experienced concussions and be aware that they may develop concussion-like symptoms, especially after acute bouts of heading either during practice or in matches. The long-term implications of this finding remain unknown.
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Affiliation(s)
- Thomas W Kaminski
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Adam Thompson
- Family Medicine, Crozer Chester Medical Center, Springfield, PA, USA
| | - Victoria E Wahlquist
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE, USA
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14
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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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15
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Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:1295-1302. [PMID: 28180920 DOI: 10.1007/s00167-017-4431-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury. METHODS In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population. RESULTS The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected. CONCLUSION In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms. LEVEL OF EVIDENCE Level III.
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16
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Abstract
My objectives are to review: 1) a brief history of sport-related concussion (SRC) and chronic traumatic encephalopathy (CTE), 2) the evolution of CTE in American professional football, 3) the data regarding SRC/CTE as they relate to depression and suicide, 4) the data on the neurocognitive effects of subconcussion/repetitive head trauma (with emphases on heading the ball in soccer and early exposure to football), 5) the evidence related to SRC and neurodegenerative diseases, 6) the published studies of CTE, 7) the NINDS neuropathological criteria for CTE, 8) public beliefs about SRC/CTE, and 9) the scientific questions regarding CTE.
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Affiliation(s)
- Gary Solomon
- a Department of Neurological Surgery, Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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17
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Affiliation(s)
- Alexander A. Tarnutzer
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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18
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Abstract
Soccer is the most popular sport in the world. Soccer players are at high risk for repetitive subconcussive head impact when heading the ball. Whether this leads to long-term alterations of the brain's structure associated with cognitive decline remains unknown. The aim of this study was to evaluate cortical thickness in former professional soccer players using high-resolution structural MR imaging. Fifteen former male professional soccer players (mean age 49.3 [SD 5.1] years) underwent high-resolution structural 3 T MR imaging, as well as cognitive testing. Fifteen male, age-matched former professional non-contact sport athletes (mean age 49.6 [SD 6.4] years) served as controls. Group analyses of cortical thickness were performed using voxel-based statistics. Soccer players demonstrated greater cortical thinning with increasing age compared to controls in the right inferolateral-parietal, temporal, and occipital cortex. Cortical thinning was associated with lower cognitive performance as well as with estimated exposure to repetitive subconcussive head impact. Neurocognitive evaluation revealed decreased memory performance in the soccer players compared to controls. The association of cortical thinning and decreased cognitive performance, as well as exposure to repetitive subconcussive head impact, further supports the hypothesis that repetitive subconcussive head impact may play a role in early cognitive decline in soccer players. Future studies are needed to elucidate the time course of changes in cortical thickness as well as their association with impaired cognitive function and possible underlying neurodegenerative process.
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19
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Investigating Cognitive Performance Deficits in Male and Female Soccer Players after a 4-week Heading- Training Programme: A Controlled Study. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This experimental study with a controlled pre-test and post-test group design investigated the possible effects of four sessions of heading training on cognitive performance. A total of 118 participants (mean age of 22.25 years) were assigned to one of the three following groups: a heading-training group, a passing-training group and a waiting control group. The participants completed a cognitive test battery of attention (D2-test), working memory (Paced Auditory Serial Addition Task, PASAT-2) and visual spatial intelligence (Mental Rotation Test) tests before, immediately after the second training session and one week after the fourth training session. There were no between-group differences in cognitive performance after the second or the fourth heading training sessions. However, within the heading-training group, women complained more of headaches than men after the fourth training session. These results build on the results from the study of Rieder and Jansen (2011) that showed no neuropsychological consequences after one heading session, showing no cumulative effects of repeat heading.
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20
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Koerte IK, Nichols E, Tripodis Y, Schultz V, Lehner S, Igbinoba R, Chuang AZ, Mayinger M, Klier EM, Muehlmann M, Kaufmann D, Lepage C, Heinen F, Schulte-Körne G, Zafonte R, Shenton ME, Sereno AB. Impaired Cognitive Performance in Youth Athletes Exposed to Repetitive Head Impacts. J Neurotrauma 2017; 34:2389-2395. [PMID: 28381107 DOI: 10.1089/neu.2016.4960] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Worldwide, more than 22 million children and adolescents are exposed to repetitive head impacts (RHI) in soccer. Evidence indicates cumulative effects on brain structure, but it is not known whether exposure to RHI affects cognitive improvement in adolescents. The aim of the study was to determine whether exposure to RHI while heading the ball in soccer affects improvement in cognitive performance in adolescents over time. The study group consisted of a convenience sample of 16 male soccer players (mean age 15.7 ± 0.7 years). A comparison cohort of 14 male non-contact sports athletes (mean age 14.9 ± 1.1 years) was recruited from competitive athletic clubs and group-matched in age. Using the ProPoint and AntiPoint tasks, sensorimotor and cognitive functions were measured over both immediate (pre- vs. post-training) as well as across multiple time points within a play season. The number and type of head impacts that occurred during the training were counted. The main outcome measure was the change in response time (RT) in the ProPoint and AntiPoint tasks. The immediate (pre- vs. post-training) and longer-term (across a play season) change in RT was analyzed, and the effect of the number and type of head impacts was tested. Thirty athletes with and without exposure to RHI demonstrated a decrease in RT in both tasks immediately after training. Over the play season, both groups showed improvement in sensorimotor function. While the control group also improved in cognitive performance, the soccer players did not, however. Further, the more long headers performed, the slower the improvement in RT over the season. Youth athletes experience an immediate cognitive improvement after training most likely because of physical exercise. Results of this study also suggest an association between exposure to specific RHI (long headers) and lack of improvement in cognitive performance in youth athletes over time.
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Affiliation(s)
- Inga K Koerte
- 1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany .,2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Nichols
- 1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany
| | - Yorghos Tripodis
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Vivian Schultz
- 1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany .,2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Stefan Lehner
- 4 Department of Applied Sciences and Mechatronics, University of Applied Sciences , Munich, Germany
| | - Randy Igbinoba
- 5 Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | - Alice Z Chuang
- 6 Department of Ophthalmology and Visual Science, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | - Michael Mayinger
- 1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany .,2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Eliana M Klier
- 5 Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | - Marc Muehlmann
- 7 Institute for Clinical Radiology , Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Christian Lepage
- 2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Florian Heinen
- 9 Department of Pediatric Neurology, Dr. von Hauner Children's Hospital , Ludwig-Maximilians- Universität, Munich, Germany
| | - Gerd Schulte-Körne
- 1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany
| | - Ross Zafonte
- 10 Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital , Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Martha E Shenton
- 2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts.,11 VA Boston Healthcare System , Boston, Massachusetts
| | - Anne B Sereno
- 5 Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
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21
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Caccese JB, Lamond LC, Buckley TA, Kaminski TW. Reducing purposeful headers from goal kicks and punts may reduce cumulative exposure to head acceleration. Res Sports Med 2016; 24:407-415. [DOI: 10.1080/15438627.2016.1230549] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jaclyn B. Caccese
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Lindsey C. Lamond
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Thomas A. Buckley
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Thomas W. Kaminski
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
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22
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Chrisman SPD, Mac Donald CL, Friedman S, Andre J, Rowhani-Rahbar A, Drescher S, Stein E, Holm M, Evans N, Poliakov AV, Ching RP, Schwien CC, Vavilala MS, Rivara FP. Head Impact Exposure During a Weekend Youth Soccer Tournament. J Child Neurol 2016; 31:971-8. [PMID: 26951540 DOI: 10.1177/0883073816634857] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/18/2016] [Indexed: 12/26/2022]
Abstract
Concussion is a known risk in youth soccer, but little is known about subconcussive head impacts. The authors provided a prospective cohort study measuring frequency and magnitude of subconcussive head impacts using accelerometry in a middle school-age soccer tournament, and association between head impacts and changes in (1) symptoms, (2) cognitive testing, and (3) advanced neuroimaging. A total of 17 youth completed the study (41% female, mean 12.6 years). There were 73 head impacts >15g measured (45% headers) and only 2 had a maximum peak linear acceleration >50g No youth reported symptoms consistent with concussion. After correction for multiple comparisons and a sensitivity analysis excluding clear outliers, no significant associations were found between head impact exposure and neuropsychological testing or advanced neuroimaging. The authors conclude that head impacts were relatively uncommon and low in acceleration in youth playing a weekend soccer tournament. This study adds to the limited data regarding head impacts in youth soccer.
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Affiliation(s)
- Sara P D Chrisman
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Christine L Mac Donald
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Neurosurgery, University of Washington, Seattle, WA, USA
| | - Seth Friedman
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Radiology, Seattle Children's Hospital, Seattle, WA, USA Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jalal Andre
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Neuroradiology, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Epidemiology, University of Washington, Seattle, WA, USA
| | - Sara Drescher
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Elizabeth Stein
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Matthew Holm
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Nicole Evans
- Neurosurgery, University of Washington, Seattle, WA, USA
| | | | - Randal P Ching
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Applied Biomechanics Laboratory, University of Washington, Seattle, WA, USA
| | - Christina C Schwien
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
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24
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Ott S, Schatz P, Solomon G, Ryan JJ. Neurocognitive Performance and Symptom Profiles of Spanish-Speaking Hispanic Athletes on the ImPACT Test. Arch Clin Neuropsychol 2014; 29:152-63. [DOI: 10.1093/arclin/act091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Zhang MR, Red SD, Lin AH, Patel SS, Sereno AB. Evidence of cognitive dysfunction after soccer playing with ball heading using a novel tablet-based approach. PLoS One 2013; 8:e57364. [PMID: 23460843 PMCID: PMC3583826 DOI: 10.1371/journal.pone.0057364] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
Does frequent head-to-ball contact cause cognitive dysfunctions and brain injury to soccer players? An iPad-based experiment was designed to examine the impact of ball-heading among high school female soccer players. We examined both direct, stimulus-driven, or reflexive point responses (Pro-Point) as well as indirect, goal-driven, or voluntary point responses (Anti-Point), thought to require cognitive functions in the frontal lobe. The results show that soccer players were significantly slower than controls in the Anti-Point task but displayed no difference in Pro-Point latencies, indicating a disruption specific to voluntary responses. These findings suggest that even subconcussive blows in soccer can result in cognitive function changes that are consistent with mild traumatic brain injury of the frontal lobes. There is great clinical and practical potential of a tablet-based application for quick detection and monitoring of cognitive dysfunction.
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Affiliation(s)
- Marsha R. Zhang
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Stuart D. Red
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Angela H. Lin
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Saumil S. Patel
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Baylor College of Medicine, Houston, Texas, United States of America
| | - Anne B. Sereno
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail:
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26
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Possible lingering effects of multiple past concussions. Rehabil Res Pract 2012; 2012:316575. [PMID: 22550590 PMCID: PMC3328154 DOI: 10.1155/2012/316575] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/02/2012] [Accepted: 01/03/2012] [Indexed: 11/26/2022] Open
Abstract
Background. The literature on lingering or “cumulative” effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT) was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.
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