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Iverson GL, Gaudet CE, Kissinger-Knox A, Gardner AJ. Examining Whether Loss of Consciousness Is Associated With Worse Performance on the SCAT5 and Slower Clinical Recovery After Concussion in Professional Athletes. J Neurotrauma 2023; 40:2330-2340. [PMID: 36541353 DOI: 10.1089/neu.2022.0043] [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: 12/24/2022] Open
Abstract
Video surveillance has almost universally been employed by professional sports to identify signs of concussion during competition. This study examined associations between video-identified possible loss of consciousness (LOC), acute concussion evaluation findings, and recovery time in concussed professional rugby league players. Medical personnel and sideline video operators identified head impact events sustained during three seasons of National Rugby League (NRL) matches to determine the need for further medical evaluation. If a concussion was suspected, players were removed from play and underwent a Head Injury Assessment, including the Sports Concussion Assessment Tool, Fifth Edition (SCAT5). Video footage was later examined to identify signs of possible LOC (i.e., observed LOC, no protective action in the fall, and unresponsiveness or lying motionless). Possible LOC was identified in 99 of the 1706 head impact events (5.8%). The median duration of apparent unresponsiveness was 4.2 sec (M = 7.4, standard deviation [SD] = 12.8, interquartile range [IQR] = 2.5-6.6). In the 661 athletes for whom SCAT5 data were available, those with possible LOC endorsed more SCAT5 symptoms and performed worse on Maddocks questions, Standardized Assessment of Concussion (SAC) total scores, orientation, immediate recall, concentration, and delayed recall. For the 255 players with medically diagnosed concussions, SCAT5 data were available for 245. Concussed players with possible LOC performed significantly worse on Maddocks questions. However, there were no group differences in SCAT5 symptom endorsement, SAC total scores, orientation, immediate recall, concentration, delayed recall, or the modified version of the Balance Error Scoring System (mBESS) total errors. Further, the presence or absence of possible LOC was not associated with number of games missed or time to medical clearance for match play. The duration of possible LOC was not associated with the number of games missed or time to medical clearance for match play. According to video review in NRL players, brief LOC might be more common than previously thought. The present study reveals possible LOC is not predictive of missed games or time to recover following concussion.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Charles E Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Aguiar OMG, Chow TR, Chong H, Vakili O, Robinovitch SN. Associations between the circumstances and severity of head impacts in men's university ice hockey. Sci Rep 2023; 13:17402. [PMID: 37833303 PMCID: PMC10575878 DOI: 10.1038/s41598-023-43785-5] [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: 04/20/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Improved evidence on the most common and severe types of head impacts in ice hockey can guide efforts to preserve brain health through improvements in protective gear, rink design, player training, and rules of play. In this observational cohort study of men's university hockey, we compared video evidence on the circumstances of 234 head impacts to measures of head impact severity (peak linear accelerations and rotational velocities) from helmet-mounted sensors (GForceTracker). Videos were analyzed with a validated questionnaire, and paired with helmet sensor data. Shoulder-to-head impacts were more common than hand- or elbow-, but there were no differences in head impact severity between upper limb contact sites (p ≥ 0.2). Head-to-glass impacts were nearly four times more common, and just as severe as head-to-board impacts (p ≥ 0.4). Head impacts resulting in major penalties (versus no penalty), or visible signs of concussion (versus no signs), involved greater head rotational velocities (p = 0.038 and 0.049, respectively). Head impacts occurred most often to the side of the head, along the boards to players in their offensive zone without puck possession. Head impact severity did not differ between cases where the head was (versus was not) the primary site of contact (p ≥ 0.6). Furthermore, penalties were called in only 4% of cases where the head was the initial point of contact. Accordingly, rules that focus on primary targeting of the head, while important and in need of improved enforcement, offer a limited solution.
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Affiliation(s)
- Olivia M G Aguiar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Tim R Chow
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Omid Vakili
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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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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Carey L, Terry DP, McIntosh AS, Stanwell P, Iverson GL, Gardner AJ. Video Analysis and Verification of Direct Head Impacts Recorded by Wearable Sensors in Junior Rugby League Players. SPORTS MEDICINE - OPEN 2021; 7:66. [PMID: 34529180 PMCID: PMC8446122 DOI: 10.1186/s40798-021-00353-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rugby league is a high-intensity collision sport that carries a risk of concussion. Youth athletes are considered to be more vulnerable and take longer to recover from concussion than adult athletes. PURPOSE To review head impact events in elite-level junior representative rugby league and to verify and describe characteristics of X-patchTM-recorded impacts via video analysis. STUDY DESIGN Observational case series. METHODS The X-patchTM was used on twenty-one adolescent players (thirteen forwards and eight backs) during a 2017 junior representative rugby league competition. Game-day footage, recorded by a trained videographer from a single camera, was synchronised with X-patchTM-recorded timestamped events. Impacts were double verified by video review. Impact rates, playing characteristics, and gameplay situations were described. RESULTS The X-patchTM-recorded 624 impacts ≥ 20g between game start and finish, of which 564 (90.4%) were verified on video. Upon video review, 413 (73.2%) of all verified impacts ≥ 20g where determined to be direct head impacts. Direct head impacts ≥ 20g occurred at a rate of 5.2 impacts per game hour; 7.6 for forwards and 3.0 for backs (range = 0-18.2). A defender's arm directly impacting the head of the ball carrier was the most common event, accounting for 21.3% (n = 120) of all impacts, and 46.7% of all "hit-up" impacts. There were no medically diagnosed concussions during the competition. CONCLUSION The majority (90.4%) of head impacts ≥ 20g recorded by the X-patchTM sensor were verified by video. Double verification of direct head impacts in addition to cross-verification of sensor-recorded impacts using a secondary source such as synchronised video review can be used to ensure accuracy and validation of data.
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Affiliation(s)
- Lauchlan Carey
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew S McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Perth, Australia
| | - Peter Stanwell
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia.
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia.
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambtom Height, NSW, Australia.
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Guillaume S, Lincoln AE, Hepburn L, Caswell SV, Kerr ZY. Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse. J Athl Train 2021; 56:437-445. [PMID: 33878178 DOI: 10.4085/1062-6050-0489.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012-2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013-2014 academic year to minimize body checking. OBJECTIVE To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. DESIGN Descriptive epidemiology study. SETTING Web-based online surveillance system. PATIENTS OR OTHER PARTICIPANTS Boys' high school lacrosse players during the 2008-2009 to 2016-2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. INTERVENTION(S) Rule 5.4 in the 2012-2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013-2014 year eliminated body checking to a player in a defenseless position. MAIN OUTCOME MEASURE(S) Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. RESULTS A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. CONCLUSIONS When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.
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Affiliation(s)
- Stanley Guillaume
- Department of Physical Medicine & Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL
| | - Andrew E Lincoln
- Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD
| | - Lisa Hepburn
- Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD
| | - Shane V Caswell
- School of Recreation, Health and Tourism, George Mason University, Manassas, VA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
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Gardner AJ. Reliability of Using the Proposed International Consensus Video Signs of Potential Concussion for National Rugby League Head Impact Events. Neurosurgery 2021; 88:538-543. [PMID: 33027812 DOI: 10.1093/neuros/nyaa437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a "fair" ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.
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Affiliation(s)
- Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
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DiCesare CA, Green B, Yuan W, Diekfuss JA, Barber Foss KD, Dudley J, Qin Y, Wang P, Myer GD. Machine Learning Classification of Verified Head Impact Exposure Strengthens Associations with Brain Changes. Ann Biomed Eng 2020; 48:2772-2782. [PMID: 33111970 DOI: 10.1007/s10439-020-02662-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022]
Abstract
Cumulative exposure to head impacts during contact sports can elicit potentially deleterious brain white matter alterations in young athletes. Head impact exposure is commonly quantified using wearable sensors; however, these sensors tend to overestimate the number of true head impacts that occur and may obfuscate potential relationships with longitudinal brain changes. The purpose of this study was to examine whether data-driven filtering of head impact exposure using machine learning classification could produce more accurate quantification of exposure and whether this would reveal more pronounced relationships with longitudinal brain changes. Season-long head impact exposure was recorded for 22 female high school soccer athletes and filtered using three methods-threshold-based, heuristic filtering, and machine learning (ML) classification. The accuracy of each method was determined using simultaneous video recording of a subset of the sensor-recorded impacts, which was used to confirm which sensor-recorded impacts corresponded with true head impacts and the ability of each method to detect the true impacts. Each filtered dataset was then associated with the athletes' pre- and post-season MRI brain scans to reveal longitudinal white matter changes. The threshold-based, heuristic, and ML approaches achieved 22.0% accuracy, 44.6%, and 83.5% accuracy, respectively. ML classification also revealed significant longitudinal brain white matter changes, with negative relationships observed between head impact exposure and reductions in mean and axial diffusivity and a positive relationship observed between exposure and fractional anisotropy (all p < 0.05).
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Affiliation(s)
- Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA.
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Brittany Green
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Weihong Yuan
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
| | - Jon Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yichen Qin
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Peng Wang
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
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Gardner AJ. Commentary: Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League. Neurosurgery 2020; 87:E298-E300. [DOI: 10.1093/neuros/nyaa158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, New South Wales, Australia
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Alois J, Bellamkonda S, Campolettano E, Gellner R, Genemaras A, Beckwith JG, Greenwald RM, Smith E, Rowson S, Duma SM, Crisco JJ. Do American Youth Football Players Intentionally Use Their Heads for High-Magnitude Impacts? Am J Sports Med 2019; 47:3498-3504. [PMID: 31697564 PMCID: PMC7408298 DOI: 10.1177/0363546519882034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concern for head injuries is widespread and has been reported by the media to be the number one cause of decreased participation in football among the American youth population. Identifying player mechanisms associated with intentional, or purposeful, head impacts should provide critical data for rule modifications, educational programs, and equipment design. PURPOSE To investigate the frequency of intentional and unintentional head impacts and to examine the player mechanisms associated with intentional high-magnitude head impacts by comparing the impact mechanism distributions among session type, player position, and ball possession. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Head impact sensors and video footage of 68 players were used to analyze and classify 1319 high-magnitude impacts recorded over 1 season of youth football. RESULTS In total, 80% of the high-magnitude head impacts were classified as being caused by intentional use of the head. Head-to-head impact was the primary impact mechanism (n = 868; 82.7%) within the 1050 intentional high-magnitude impacts, with classifiable mechanisms, followed by head-to-body (n = 139; 13.2%), head-to-ground (n = 34; 3.2%), and head-to-equipment (n = 9; 0.9%). Head-to-head impacts also accounted for a greater proportion of impacts during practices (n = 625; 88.9%) than games, for linemen (n = 585; 90.3%) than perimeters and backs, and for ball carriers (n = 72; 79.1%) than tacklers. CONCLUSION Overall, the majority of high-magnitude head impacts were intentional and resulted from head-to-head contact. The proportion of head-to-head contact was significantly higher for practices than games, linemen than backs and perimeter players, and ball carriers than tacklers.
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Affiliation(s)
- Jaclyn Alois
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Srinidhi Bellamkonda
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Eamon Campolettano
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Ryan Gellner
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | | | | | | | - Eric Smith
- Department of Statistics at Virginia Tech, Blacksburg, VA, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Stefan M. Duma
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Joseph J. Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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Caswell SV, Kelshaw P, Lincoln AE, Hepburn L, Dunn R, Cortes N. Game-Related Impacts in High School Boys' Lacrosse. Orthop J Sports Med 2019; 7:2325967119835587. [PMID: 31058198 PMCID: PMC6452429 DOI: 10.1177/2325967119835587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The rate of concussions in boys' lacrosse is reported to be the third highest among high school sports in the United States, but no studies have described game-related impacts among boys' lacrosse players. Purpose To characterize verified game-related impacts, both overall and those directly to the head, in boys' varsity high school lacrosse. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 77 male participants (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.05 m; mean weight, 73.4 ± 12.2 kg) were instrumented with sensors and were videotaped during 39 games. All verified game-related impacts ≥20g were summarized in terms of frequency, peak linear acceleration (PLA), and peak rotational velocity (PRV). Descriptive statistics and impact rates per player-game (PG) with corresponding 95% CIs were calculated. Results Overall, 1100 verified game-related impacts were recorded (PLA: median, 33.5g [interquartile range (IQR), 25.7-51.2]; PRV: median, 1135.5 deg/s [IQR, 790.0-1613.8]) during 795 PGs. The rate for all verified game-related impacts was 1.38 impacts per PG (95% CI, 1.30-1.47). Of these, 680 (61.8%) impacts (PLA: median, 35.9g [IQR, 26.7-55.5]; PRV: 1170.5 deg/s [IQR, 803.2-1672.8]) were directly to the head (impact rate, 0.86 impacts/PG [95% CI, 0.79-0.92]). Overall, midfielders (n = 514; 46.7%) sustained the most impacts, followed by attackers (n = 332; 30.2%), defenders (n = 233; 21.2%), and goalies (n = 21; 1.9%). The most common mechanisms for overall impacts and direct head impacts were contact with player (overall: n = 706 [64.2%]; head: n = 397 [58.4%]) and stick (overall: n = 303 [27.5%]; head: n = 239 [35.1%]), followed by ground (overall: n = 73 [6.6%]; head: n = 26 [3.8%]) and ball (overall: n = 15 [1.4%]; head: n = 15 [2.2%]). Direct head impacts were associated with a helmet-to-helmet collision 31.2% of the time, and they were frequently (53.7%) sustained by the players delivering the impact. Nearly half (48.8%) of players delivering contact used their helmets to initiate contact that resulted in a helmet-to-helmet impact. Players receiving a head impact from player contact were most often unprepared (75.9%) for the collision. Conclusion The helmet is commonly used to initiate contact in boys' high school lacrosse, often targeting defenseless opponents. Interventions to reduce head impacts should address rules and coaching messages to discourage intentional use of the helmet and encourage protection of defenseless opponents.
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Affiliation(s)
- Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | - Patricia Kelshaw
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | - Andrew E Lincoln
- MedStar Sports Medicine, Baltimore, Maryland, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., USA
| | - Lisa Hepburn
- MedStar Sports Medicine, Baltimore, Maryland, USA
| | | | - Nelson Cortes
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
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