Correlation of Head Impact Exposures With Vestibulo-Ocular Assessments

Musculoskeletal injury or Sports-Related Concussion (SRC) in a season of rugby union does not affect performance on concussion battery testing in university-aged student-athletes

BACKGROUND

Sub-concussive and concussive impacts sustained during contact sports such as rugby may affect neurocognitive performance, vestibular-ocular-motor function, symptom burden and academic ability.

METHOD

Student-athletes (n = 146) participating in rugby union British Universities or domestic competitions were assessed on the Immediate Post-Concussion and Cognitive Test, Post-Concussion Symptom Scale, vestibular-oculo-motor screening tool and revised perceived academic impact tool. Individual change from pre-season (July-September 2021) to 2-weeks following last exposure to contact (April-July 2022) was analysed.

RESULTS

Symptom burden significantly worsened (p=0.016) over the season. Significant improvements on verbal memory (p=0.016), visual memory (p=0.008) and motor processing speed (p=0.001) suggest a possible learning effect. Surprisingly, the number of days lost to concussion significantly and positively affected performance on verbal memory (p = 0.018) and reaction time (p = 0.027). Previous concussive events significantly predicted a worsening in symptom burden (p < 0.028), as did in-season concussive events, predicting improved verbal memory (p = 0.033) and symptom burden change (p = 0.047). Baseline performance significantly affected change on several neurocognitive tests, with low-scorers showing more improvement over the season.

CONCLUSION

Participation in rugby union was not associated with deleterious effects on brain function. Previous concussive events and in-season factors, possibly related to learning effects, may explain improvement in cognitive function across the season.

Pre- and post-season visio-vestibular function in healthy adolescent athletes

OBJECTIVE

To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes.

METHODS

This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season).

RESULTS

Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25).

CONCLUSIONS

Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.

Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure

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.

Quality of life of ice hockey players after retirement due to concussions

Background:

Sports-related concussion (SRC) is increasingly recognized as a potential health problem in ice hockey. Quality of life (QoL) in players retiring due to SRC has not been thoroughly addressed.

Materials & methods:

QoL using the Sports Concussion Assessment Tool 5th Edition, Impact of Event Scale-Revised and Short Form Health Survey was measured in Swedish ice hockey players who retired due to persistence of postconcussion symptoms or fear of attaining additional SRC.

Results:

A total of 76 players were assessed, on average of 5 years after their most recent SRC. Overall, retired players had a high burden of postconcussion symptoms and reduced QoL.

Conclusion:

Retired concussed ice hockey players have a reduced QoL, particularly those retiring due to postconcussion symptoms. Symptom burden should be continuously evaluated and guide the decision to retire.

Concussions sustained while playing ice hockey are increasingly recognized as a potential health problem. Long-term consequences for players retiring due to concussions have not been fully investigated. Therefore, we evaluated symptoms, quality of life and post-traumatic stress in former Swedish ice hockey players who retired due to postconcussion symptoms or to a fear of attaining additional concussions. We found that retired ice hockey players with a history of concussions had a low quality of life and high post-traumatic stress, particularly in players with a high symptom burden. We recommend that symptom burden should be continuously evaluated and guide the decision to retire.

Vestibular and Balance Dysfunction Following Sport-Related Concussion

Purpose

Sport-related concussion is a significant public health concern that requires a multidisciplinary team to appropriately manage. Athletes often report dizziness and imbalance following concussion, and these symptoms can predict increased time to recover. Vestibular diagnostic evaluations provide important information regarding the athlete's oculomotor, gaze stability, and balance function in order to identify deficits for rehabilitation. These measures also describe objective function helpful for determining when an athlete is ready to return to play. The purpose of this clinical focus article is to provide background on the current understanding of the effects of concussion on the peripheral and central vestibular system, as well as information on a protocol that can be used for acute concussion assessment. Case studies describing 3 common postconcussion presentations will highlight the usefulness of this protocol.

Conclusion

Sport-related concussion is a highly visible disorder with many symptoms that may be evaluated in the vestibular clinic. A thoughtful protocol evaluating the typical presentation of these patients may help guide the multidisciplinary team in determining appropriate management and clearance for return to sport.