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McAlister KL, Mack WJ, Bir C, Baron DA, Som C, Li K, Chavarria-Garcia A, Sawardekar S, Baron D, Toth Z, Allem C, Beatty N, Nakayama J, Kelln R, Zaslow T, Bansal R, Peterson BS. Longitudinal, prospective study of head impacts in male high school football players. PLoS One 2023; 18:e0291374. [PMID: 37682984 PMCID: PMC10490840 DOI: 10.1371/journal.pone.0291374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Repetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players. METHODS In this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration. RESULTS 4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g's higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g's higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g's higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g's higher (0.8), p<0.001]. CONCLUSION Including screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.
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Affiliation(s)
- Kelsey L. McAlister
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Cynthia Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States of America
| | - David A. Baron
- Western University, Pomona, CA, United States of America
| | - Christine Som
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Karen Li
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Anthony Chavarria-Garcia
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Siddhant Sawardekar
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - David Baron
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Zachary Toth
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Courtney Allem
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Nicholas Beatty
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Junko Nakayama
- Crescenta Valley High School, La Crescenta, CA, United States of America
| | - Ryan Kelln
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Tracy Zaslow
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Ravi Bansal
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Bradley S. Peterson
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Sundaram V, Sundar V, Pearce AJ. Biomechanical characteristics of concussive and sub-concussive impacts in youth sports athletes: A systematic review and meta-analysis. J Sports Sci 2023:1-15. [PMID: 37393593 DOI: 10.1080/02640414.2023.2231317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
This study aimed to quantitatively investigate and report the biomechanical characteristics of concussive and sub-concussive impacts in youth sports. A systematic search was conducted in September 2022 to identify biomechanical impact studies in athletes ≤18 years of age. Twenty-six studies met the inclusion criteria for quantitative synthesis and analysis. DerSimonian Laird random effects model was used to pool data across the included studies. The pooled estimate of mean peak linear and rotational acceleration of concussive impacts in male youth athletes was 85.56 g (95% CI 69.34-101.79) and 4505.58 rad/s2 (95% CI 2870.28-6140.98), respectively. The pooled estimate of mean peak linear and rotational acceleration of sub-concussive impacts in youth athletes was 22.89 g (95% CI 20.69-25.08) and 1290.13 rad/s2 (95% CI 1050.71-1529.55), respectively. A male vs female analysis in sub-concussive impacts revealed higher linear and rotational acceleration in males and females, respectively. This is the first study to report on impact data in both sexes of youth athletes. Disparity in kinematic impact values suggests future research should aim for standardised measures to reduce heterogeneity in data. Despite this, the data reveals notable impact data that youth athletes are exposed to, suggesting modifications may be required to reduce long-term neurological risks.
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Affiliation(s)
- Vasanth Sundaram
- Department of Sports Biomechanics and Kinesiology, Tamil Nadu Physical Education and Sports University, Chennai, India
| | - Viswanath Sundar
- Physical Education and Sports Science, Visva-Bharati University, West Bengal, India
| | - Alan J Pearce
- College of Science, Health, and Engineering, La Trobe University, Bundoora, Melbourne, Australia
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3
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Daneshvar DH, Nair ES, Baucom ZH, Rasch A, Abdolmohammadi B, Uretsky M, Saltiel N, Shah A, Jarnagin J, Baugh CM, Martin BM, Palmisano JN, Cherry JD, Alvarez VE, Huber BR, Weuve J, Nowinski CJ, Cantu RC, Zafonte RD, Dwyer B, Crary JF, Goldstein LE, Kowall NW, Katz DI, Stern RA, Tripodis Y, Stein TD, McClean MD, Alosco ML, McKee AC, Mez J. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat Commun 2023; 14:3470. [PMID: 37340004 PMCID: PMC10281995 DOI: 10.1038/s41467-023-39183-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI), but the components of RHI exposure underlying this relationship are unclear. We create a position exposure matrix (PEM), composed of American football helmet sensor data, summarized from literature review by player position and level of play. Using this PEM, we estimate measures of lifetime RHI exposure for a separate cohort of 631 football playing brain donors. Separate models examine the relationship between CTE pathology and players' concussion count, athletic positions, years of football, and PEM-derived measures, including estimated cumulative head impacts, linear accelerations, and rotational accelerations. Only duration of play and PEM-derived measures are significantly associated with CTE pathology. Models incorporating cumulative linear or rotational acceleration have better model fit and are better predictors of CTE pathology than duration of play or cumulative head impacts alone. These findings implicate cumulative head impact intensity in CTE pathogenesis.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA.
| | - Evan S Nair
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Zachary H Baucom
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Abigail Rasch
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nicole Saltiel
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arsal Shah
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Johnny Jarnagin
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brett M Martin
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - John F Crary
- Neuropathology Brain Bank & Research Core, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael D McClean
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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4
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Head Impact Exposure in Youth and Collegiate American Football. Ann Biomed Eng 2022; 50:1488-1497. [PMID: 35507229 PMCID: PMC10081156 DOI: 10.1007/s10439-022-02974-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/25/2022] [Indexed: 11/01/2022]
Abstract
The relationship between head impact and subsequent brain injury for American football players is not well-defined, especially for youth. The objective of this study is to quantify and assess Head Impact Exposure (HIE) metrics among youth and collegiate football players. This multi-season study enrolled 639 unique athletes (354 collegiate; 285 youth, ages 9-14), recording 476,209 head impacts (367,337 collegiate; 108,872 youth) over 971 sessions (480 collegiate; 491 youth). Youth players experienced 43 and 65% fewer impacts per competition and practice, respectively, and lower impact magnitudes compared to collegiate players (95th percentile peak linear acceleration (PLA, g) competition: 45.6 vs 61.9; 95th percentile PLA practice: 42.6 vs 58.8; 95th percentile peak rotational acceleration (PRA, rad·s-2) competition: 2262 vs 4422; 95th percentile PRA practice: 2081 vs 4052; 95th percentile HITsp competition: 25.4 vs 32.8; 95th percentile HITsp practice: 23.9 vs 30.2). Impacts during competition were more frequent and of greater magnitude than during practice at both levels. Quantified comparisons of head impact frequency and magnitude between youth and collegiate athletes reveal HIE differences as a function of age, and expanded insight better informs the development of age-appropriate guidelines for helmet design, prevention measures, standardized testing, brain injury diagnosis, and recovery management.
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5
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Head Impact Kinematics and Brain Deformation in Paired Opposing Youth Football Players. J Appl Biomech 2022; 38:136-147. [PMID: 35483702 DOI: 10.1123/jab.2021-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
Head impact exposure is often quantified using peak resultant kinematics. While kinematics describes the inertial response of the brain to impact, they do not fully capture the dynamic brain response. Strain, a measure of the tissue-level response of the brain, may be a better predictor of injury. In this study, kinematic and strain metrics were compared to contact characteristics in youth football. Players on 2 opposing teams were instrumented with head impact sensors to record impact kinematics. Video was collected to identify contact scenarios involving opposing instrumented players (ie, paired contact scenarios) and code contact characteristics (eg, player role, impact location). A previously validated, high-resolution brain finite element model, the atlas-based brain model, was used to simulate head impacts and calculate strain metrics. Fifty-two paired contact scenarios (n = 105 impacts) were evaluated. Lighter players tended to have greater biomechanical metrics compared to heavier players. Impacts to the top of the helmet were associated with lower strain metrics. Overall, strain was better correlated with rotational kinematics, suggesting these metrics may be better predictors of the tissue-level brain response than linear kinematics. Understanding the effect of contact characteristics on brain strain will inform future efforts to improve sport safety.
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6
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Swartz EE, Register-Mihalik JK, Broglio SP, Mihalik JP, Myers JL, Guskiewicz KM, Bailes J, Hoge M. National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players. J Athl Train 2022; 57:113-124. [PMID: 35201304 PMCID: PMC8876879 DOI: 10.4085/1062-6050-0062.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. BACKGROUND In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. CONCLUSIONS The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.
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Affiliation(s)
- Erik E. Swartz
- Department of Physical Therapy and Kinesiology, University of Massachusetts, Lowell
| | - Johna K. Register-Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | | | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Jay L Myers
- Department of Physical Therapy and Kinesiology, University of Massachusetts, Lowell
| | - Kevin M. Guskiewicz
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
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7
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Fickling SD, Poel DN, Dorman JC, D’Arcy RCN, Munce TA. Subconcussive changes in youth football players: objective evidence using brain vital signs and instrumented accelerometers. Brain Commun 2021; 4:fcab286. [PMID: 35291689 PMCID: PMC8914875 DOI: 10.1093/braincomms/fcab286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Brain vital signs, measured by EEG, were used for portable, objective,
neurophysiological evaluation of cognitive function in youth tackle football
players. Specifically, we investigated whether previously reported pre- and
post-season subconcussive changes detected in youth ice hockey players were
comparably detected in football. The two objectives were to: (i) replicate
previously published results showing subconcussive cognitive deficits; and (ii)
the relationship between brain vital sign changes and head-impact exposure.
Using a longitudinal design, 15 male football players (age
12.89 ± 0.35 years) were tested pre- and
post-season, with none having a concussion diagnosis during the season. Peak
latencies and amplitudes were quantified for Auditory sensation (N100), Basic
attention (P300) and Cognitive processing (N400). Regression analyses tested the
relationships between these brain vital signs and exposure to head impacts
through both number of impacts sustained, and total sessions (practices and
games) participated. The results demonstrated significant pre/post differences
in N400 latencies, with ∼70 ms delay
(P < 0.01), replicating prior findings.
Regression analysis also showed significant linear relationships between brain
vital signs changes and head impact exposure based on accelerometer data and
games/practices played (highest
R = 0.863, P
< 0.001 for overall sessions). Number of head impacts in youth
football (age 12–14 years) findings corresponded most closely
with prior Junior-A ice hockey (age 16–21 years) findings,
suggesting comparable contact levels at younger ages in football. The predictive
relationship of brain vital signs provided a notable complement to instrumented
accelerometers, with a direct physiological measure of potential individual
exposure to subconcussive impacts.
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Affiliation(s)
- Shaun D Fickling
- Faculty of Sciences and Applied Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- BrainNET, Health and Technology District, Surrey, BC V3V 0C6, Canada
- Center for Neurology Studies, HealthTech Connex, Surrey, BC V3V 0C6, Canada
| | - Daniel N Poel
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Jason C Dorman
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Ryan C N D’Arcy
- Faculty of Sciences and Applied Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- BrainNET, Health and Technology District, Surrey, BC V3V 0C6, Canada
- Center for Neurology Studies, HealthTech Connex, Surrey, BC V3V 0C6, Canada
| | - Thayne A Munce
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
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8
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Rose SC, Yeates KO, Nguyen JT, Pizzimenti NM, Ercole PM, McCarthy MT. Exposure to Head Impacts and Cognitive and Behavioral Outcomes in Youth Tackle Football Players Across 4 Seasons. JAMA Netw Open 2021; 4:e2140359. [PMID: 34967882 PMCID: PMC8719231 DOI: 10.1001/jamanetworkopen.2021.40359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Repetitive head impacts have been posited to contribute to neurocognitive and behavioral difficulties in contact sport athletes. OBJECTIVE To identify associations between cognitive and behavioral outcomes and head impacts measured in youth tackle football players over 4 seasons of play. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from July 2016 through January 2020, spanning 4 football seasons. The setting was a youth tackle football program and outpatient medical clinic. Players were recruited from 4 football teams composed of fifth and sixth graders, and all interested players who volunteered to participate were enrolled. Data analysis was performed from March 2020 to June 2021. EXPOSURES Impacts were measured using helmet-based sensors during practices and games throughout 4 consecutive seasons of play. Impacts were summed to yield cumulative head impact gravitational force equivalents per season. MAIN OUTCOMES AND MEASURES Ten cognitive and behavioral measures were completed before and after each football season. RESULTS There were 70 male participants aged 9 to 12 years (mean [SD] age, 10.6 [0.64] years), with 18 completing all 4 years of the study. At the post-season 1 time point, higher cumulative impacts were associated with lower self-reported symptom burden (β = -0.6; 95% CI, -1.0 to -0.2; P = .004). After correcting for multiple comparisons, no other associations were found between impacts and outcome measures. At multiple times throughout the study, premorbid attention-deficit/hyperactivity disorder, anxiety, and depression were associated with worse cognitive or behavioral scores, whereas a premorbid headache disorder or history of concussion was less often associated with outcomes. CONCLUSIONS AND RELEVANCE In this cohort of youth tackle football players, premorbid conditions, including attention-deficit/hyperactivity disorder, anxiety, and depression, were associated with cognitive and behavioral outcomes more often than cumulative impact.
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Affiliation(s)
- Sean C. Rose
- Child Neurology, Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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9
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Vale A, Post A, Cournoyer J, Hoshizaki TB, Gilchrist MD. Influence of play type on the magnitude and number of head impacts sustained in youth American football. Comput Methods Biomech Biomed Engin 2021; 25:1195-1210. [PMID: 34788175 DOI: 10.1080/10255842.2021.2003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The magnitude and number of head impacts experienced by young American football players are associated with negative brain health outcomes and may be affected by play-type strategies. The purpose of this research was to examine how play type affects the magnitude and number of head impacts in youth American tackle football. Head impacts were recorded for 30 games in the 5-9 age category and 30 games in the 9-14 age category. Impacts using physical and finite element models were conducted to determine the brain strain. Run plays had a higher head impact frequency in both age groups (p < 0.05). This increase in head impacts was consistent for all positions (p < 0.05), except wide receiver, and offensive line and defensive back in the 9-14 age group (p > 0.05). Both age groups experienced significantly different magnitude proportions with higher numbers of very low and low strain magnitude impacts during run plays (p < 0.05), and a higher proportion of moderate magnitude impacts in the 5-9 age category (p < 0.05). This data can be used to inform and educate teams and coaches and influence decisions around the use of runs and passing plays that may lead to a decrease in head impacts.
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Affiliation(s)
- Adam Vale
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Janie Cournoyer
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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10
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Narad ME, Epstein J, Peugh J, Barber Foss KD, Diekfuss JA, Bonnette S, Orban S, Yuan W, Dudley J, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer J, Avedesian JM, Slutsky-Ganesh AB, Lloyd RS, Howell D, Myer GD. The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial. J Neurotrauma 2021; 39:49-57. [PMID: 34779241 DOI: 10.1089/neu.2021.0078] [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: 11/12/2022] Open
Abstract
This prospective longitudinal trial aimed to 1) determine the role of head impact exposure on behavioral/cognitive outcomes, and 2) assess the protective effect(s) of a jugular vein compression (JVC) collar on behavioral/cognitive outcomes following one season of high-school football. Participants included 284 male high-school football players aged 13-18 years enrolled from seven midwestern high-schools. Schools were allocated to the JVC collar intervention(four teams, 140 players) or non-collar/no intervention control (three teams, 144 players) condition. Head impact exposure was measured throughout the season using CSx accelerometers. Outcome measures included post season parent and adolescent report on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN) and Post-Concussion Symptom Inventory (PCSI), as well as adolescent performance on Attention Network Task (ANT), digital Trail Making Task (dTMT), and Cued Switching task. No significant effect of head impact exposure or JVC collar use on post-season SWAN or PCSI scores or performance on dTMT and Cued Switching task were noted. There was no effect of head impact exposure on ANT performance; however, the JVC collar group had greater post-season Alerting network scores than the non-collar group (p=.026, d=.22). Findings provide preliminary evidence that the JVC collar may provide some protection to the alerting attention system. These findings should be interpreted cautiously as a greater understanding of the long-term sequalae of head impact exposure and the role of cumulative head impact exposure behavioral/cognitive outcomes is required.
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Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, 3333 Burnet Ave, mlc 10006, Cincinnati, Ohio, United States, 45229;
| | - Jeffery Epstein
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, United States;
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, 2518, Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, United States;
| | - Kim D Barber Foss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Jed A Diekfuss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Scott Bonnette
- Cincinnati Children's Hospital Medical Center, 2518, The SPORT Center, Division of Sports Medicine, Cincinnati, Ohio, United States;
| | - Sarah Orban
- University of Tampa, Department of psychology, Tampa, FL, United States;
| | - Weihong Yuan
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnew Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Jonathan Dudley
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnet Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Christopher A DiCesare
- University of Michigan, 1259, Department of Mechanical engineering, Ann Arbor, Michigan, United States;
| | - Danielle L Reddington
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | - Wen Zhong
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Jessica Shafer
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Alexis B Slutsky-Ganesh
- The University of North Carolina at Greensboro, Department of Kinesiology, Greensboro, North Carolina, United States;
| | - Rhodri S Lloyd
- Cardiff Metropolitan University, 11352, Cardiff, Cardiff, United Kingdom of Great Britain and Northern Ireland.,AUT University, Auckland, New Zealand.,Waikato Institute of Technology, 3715, Hamilton, New Zealand;
| | - David Howell
- University of Colorado Denver School of Medicine, 12225, Department of Orthopedics , Aurora, Colorado, United States;
| | - Greg D Myer
- Emory University School of Medicine, 12239, Atlanta, Georgia, United States.,the Micheli Center for Sports Injury Prevention, Waltham, Ma, United States;
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11
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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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12
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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13
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Rose SC, Yeates KO, Nguyen JT, Ercole PM, Pizzimenti NM, McCarthy MT. Subconcussive Head Impacts and Neurocognitive Function Over 3 Seasons of Youth Football. J Child Neurol 2021; 36:768-775. [PMID: 33834862 DOI: 10.1177/08830738211004490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the association between repetitive subconcussive head impacts and neurobehavioral outcomes in youth tackle football players. METHODS Using helmet-based sensors, we measured head impacts for 3 consecutive seasons of play in 29 male players age 9-11. Cumulative impact g's were calculated. Players completed a battery of outcome measures before and after each season, including neuropsychological testing, vestibular-ocular sensitivity, and self- and parent-reported measures of symptoms and attention-deficit hyperactivity disorder (ADHD). RESULTS Average cumulative impact over 3 seasons was 13 900g. High-intensity hits predicted worse change for self-reported social adjustment (P = .001). Cumulative impact did not predict change in any of the outcome measures. History of ADHD, anxiety, and depression predicted worse change for self-reported symptoms and social adjustment, independent of head impacts. When players were stratified into 3 groups based on cumulative impact across all 3 seasons, differences in outcome measures existed prior to the start of the first season. These differences did not further increase over the course of the 3 seasons. CONCLUSION Over 3 consecutive seasons of youth tackle football, we found no association between cumulative head impacts and neurobehavioral outcomes. Larger sample sizes and longer follow-up times would further assist in characterizing this relationship.
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Affiliation(s)
- Sean C Rose
- Division of Child Neurology, 2647Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, 2129University of Calgary, Calgary, Alberta, Canada
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14
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Le RK, Anderson MN, Johnson RS, Lempke LB, Schmidt JD, Lynall RC. On-field Characteristics and Head Impact Magnitude in Youth Tackle Football. Pediatr Neurol 2021; 121:33-39. [PMID: 34146964 DOI: 10.1016/j.pediatrneurol.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study determined the effect of video-verified collision characteristics on head impact magnitudes in male youth tackle football. METHODS Participants (n = 23, age = 10.9 ± 0.3 years, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax Sim-G sensors throughout the fall 2019 season. Ten filmed games were used to identify nine different collision characteristics: mechanism, preparedness, head direction, struck versus striking activity, stance, play type, closing distance, penalty, and quarter. Random-effects general linear models and Cohen d effect sizes were used to examine differences in log-transformed peak linear (PLA; g) and rotational (PRA; rad/s2) accelerations across characteristics. The 10 games produced 533 total video-verified impacts and 23.2 ± 7.2 impacts per athlete. RESULTS PLA (P range: 0.107 to 0.923) and PRA (P range: 0.057 to 0.768) did not differ across characteristics. Struck players (3370 rads/s2, 95% confidence interval [CI] = 2986 to 3808) had a small effect for higher PRA compared with striking players (3037 rads/s2, 95% CI = 2713 to 3404, d = 0.251), but negligible effect for simultaneous struck-striking players (3340 rad/s2, 95% CI = 2945 to 3792, d = 0.018). Fourth quarter impacts (3490 rads/s2, 95% CI = 3083 to 3951) had a small effect for higher PRA compared with first (2945 rads/s2, 95% CI = 2596 to 3337, d = 0.404), second (3196 rads/s2, 95% CI = 2832 to 3604, d = 0.219), and third quarters (3241 rads/s2, 95% CI = 2841 to 3699, d = 0.144). CONCLUSION Youth tackle football characteristics did not significantly affect head impact magnitudes during games. More research is needed to explore additional factors that could be modified for sport safety rather than mitigating impact mechanism.
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Affiliation(s)
- Rachel K Le
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia.
| | - Melissa N Anderson
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Rachel S Johnson
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens, Georgia
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15
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Sarmiento K, Waltzman D, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies. Am J Sports Med 2021; 49:2218-2226. [PMID: 33999722 PMCID: PMC8335321 DOI: 10.1177/03635465211011754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. PURPOSE To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods. RESULTS For impacts ≥10g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games. CONCLUSION This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
- Address correspondence to Kelly Sarmiento, MPH, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Hwy, NE, MS S106-09, Atlanta, GA 30341, USA ()
| | - Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | - Xinjian Zhang
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | - Lara DePadilla
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, Atlanta, Georgia, USA
| | - Marcie-Jo Kresnow
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | | | - David Jones
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Ravi Goyal
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Matthew J. Breiding
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
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16
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Oldham JR, Master CL, Walker GA, Meehan WP, Howell DR. The Association between Baseline Eye Tracking Performance and Concussion Assessments in High School Football Players. Optom Vis Sci 2021; 98:826-832. [PMID: 34328459 PMCID: PMC9254265 DOI: 10.1097/opx.0000000000001737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Concussions are complex injuries that require a multifaceted testing battery. Vision impairments are common after concussion, but it is unknown exactly how eye tracking may be affected after injury and how it is associated with other clinical concussion assessments. PURPOSE This study aimed to (1) examine the relationship between eye tracking performance (BOX score) and other common concussion evaluations, (2) identify if eye tracking adds novel information that augments baseline concussion evaluations, and (3) examine the effect of age, concussion history, and attention-deficit/hyperactivity disorder on eye tracking and other ophthalmological measures. METHODS A total of 102 male high school football athletes (age, 16.0 years; 95% confidence interval, 15.8 to 16.2 years) completed a series of visual and neurocognitive tests during their pre-season baseline assessment. The main outcome measures were BOX score, near point of convergence (NPC) distance, binocular accommodative amplitude (BAA) distance, Standardized Assessment of Concussion score, and Immediate Post-Concussion Assessment and Cognitive Testing composite scores. RESULTS BOX score was not significantly associated with symptoms, Standardized Assessment of Concussion score, NPC distance, BAA distance, or any Immediate Post-Concussion Assessment and Cognitive Testing composite scores. Age, concussion history, attention-deficit/hyperactivity disorder, and number of prior years playing football were not significantly associated with BOX score or NPC distance, but there was a significant association between concussion history and greater BAA distance (β = 1.60; 95% confidence interval = 0.19 to 3.01; P < .03). The BOX score cutoff of 10 resulted in a 12% false-positive rate. CONCLUSIONS Eye tracking was not significantly associated with the commonly used clinical concussion assessments. These results suggest that an objective eye tracking variable may be a valuable addition to the current concussion battery.
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Affiliation(s)
- Jessie R. Oldham
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, Boston, MA, USA
| | - Christina L. Master
- Sports Medicine and Performance Center, Division of Orthopedics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gregory A. Walker
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - William P. Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics and Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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17
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Gyemi DL, Andrews DM, Jadischke R. Three-dimensional video analysis of helmet-to-ground impacts in North American youth football. J Biomech 2021; 125:110587. [PMID: 34274559 DOI: 10.1016/j.jbiomech.2021.110587] [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: 01/01/2021] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
This study presents a video analysis of helmet-to-ground impacts in youth football (≤14 years). A total of 21 non-injurious helmet-to-ground impact cases were assessed from game video of two age divisions (9-12 years: n = 9; 13-14 years: n = 12) using a novel multi-camera videogrammetry approach. Descriptive parameters related to the game situation and impact mechanisms were documented. Motion analysis software was used to manually track and compute three-dimensional helmet kinematics and uncertainty of the motion tracking analysis was assessed. Overall, the impact cases primarily followed a body-to-body, body-to-ground, helmet-to-ground contact progression. Impact locations on the helmet were mostly distributed across the rear and side helmet shell. The resultant pre-impact velocities for these cases averaged 4.04 ± 1.24 m/s at an angle of -49.6° to the ground. The average resultant impact-induced change in helmet velocity was 3.32 ± 1.14 m/s; the time interval associated with the duration of helmet-to-ground contact was approximately 0.06 s. The average maximum uncertainty (±) error of the position coordinates from the helmet tracking was 1.5 ± 0.3 cm. In summary, this video-based methodology can effectively be used to quantify helmet impact velocities and locations in youth football games. To date, the acquisition of such information has largely been limited to professional football game footage. Therefore, the data reported here may help inform the development of more representative assessment methods for youth-specific helmet test standards.
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18
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Smith AM, Alford PA, Aubry M, Benson B, Black A, Brooks A, Burke C, D'Arcy R, Dodick D, Eaves M, Eickhoff C, Erredge K, Farrell K, Finnoff J, Fraser DD, Giza C, Greenwald RM, Hoshizaki B, Huston J, Jorgensen J, Joyner M, Krause D, LaVoi N, Leaf M, Leddy J, Margarucci K, Margulies S, Mihalik J, Munce T, Oeur A, Prideaux C, Roberts WO, Shen F, Soma D, Tabrum M, Stuart MB, Wethe J, Whitehead J, Wiese-Bjornstal D, Stuart MJ. Proceedings From the Ice Hockey Summit III: Action on Concussion. Clin J Sport Med 2021; 31:e150-e160. [PMID: 31842055 DOI: 10.1097/jsm.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these 5 objectives: (1) describe sport related concussion (SRC) epidemiology; (2) classify prevention strategies; (3) define objective, diagnostic tests; (4) identify treatment; and (5) integrate science and clinical care into prioritized action plans and policy. METHODS Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. RESULTS To (1) establish a national and international hockey database for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care; and (6) mandate baseline testing to improve concussion diagnosis for all age groups. CONCLUSIONS Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.
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Affiliation(s)
| | - Patrick A Alford
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Mark Aubry
- Ottawa Sports Medicine Center, Ottawa, ON, Canada
| | - Brian Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Amanda Black
- Sport Injury Prevention Research Center, University of Calgary, Calgary, AB, Canada
| | - Alison Brooks
- Department of Orthopedic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Charles Burke
- Brook & Bradley Orthopedics, University of Pittsburgh at St. Margaret, Pittsburgh, Pennsylvania
| | - Ryan D'Arcy
- School of Engineering Science, Advances Neuroimaging, Siman Fraser University, Burnaby, BC, Canada
| | - David Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Michael Eaves
- Men's Ice Hockey, St. Olaf College, Northfield, Minnesota
| | - Chad Eickhoff
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jonathan Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Douglas D Fraser
- Department of Pediatrics, Physiology/Pharmacology/Clinical Neuroscience, University of Western Ontario, London, ON, Canada
| | - Christopher Giza
- Department of Neurosurgery, Brain Research Institute, University of California Los Angeles Health, Los Angeles, California
| | - Richard M Greenwald
- Department of Biomechanics, Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - David Krause
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Nicole LaVoi
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Leaf
- Officiating Program, USA Hockey, Colorado Springs, Colorado
| | - John Leddy
- Department of Orthopedics, University at Buffalo, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Susan Margulies
- Department of Biomedical Engineering, Georgia School of Technology, Atlanta, Georgia
| | - Jason Mihalik
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thayne Munce
- Sports Medicine Center, Sanford Medical Center, Sioux Falls, South Dakota
| | - Anna Oeur
- Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Cara Prideaux
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - William O Roberts
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, Minnesota
| | - Francis Shen
- University of Minnesota Law School, University of Minnesota, Minneapolis, Minnesota
| | - David Soma
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark Tabrum
- Coaching Education, USA Hockey, Colorado Springs, Colorado
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19
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Fickling SD, Smith AM, Stuart MJ, Dodick DW, Farrell K, Pender SC, D'Arcy RCN. Subconcussive brain vital signs changes predict head-impact exposure in ice hockey players. Brain Commun 2021; 3:fcab019. [PMID: 33855296 PMCID: PMC8023684 DOI: 10.1093/braincomms/fcab019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 01/09/2023] Open
Abstract
The brain vital signs framework is a portable, objective, neurophysiological evaluation of brain function at point-of-care. We investigated brain vital signs at pre- and post-season for age 14 or under (Bantam) and age 16-20 (Junior-A) male ice hockey players to (i) further investigate previously published brain vital sign results showing subconcussive cognitive deficits and (ii) validate these findings through comparison with head-impact data obtained from instrumented accelerometers. With a longitudinal study design, 23 male ice hockey players in Bantam (n = 13; age 13.63 ± 0.62) and Tier II Junior-A (n = 10; age 18.62 ± 0.86) divisions were assessed at pre- and post-season. None were diagnosed with a concussion during the season. Cognitive evoked potential measures of Auditory sensation (N100), Basic attention (P300) and Cognitive processing (N400) were analysed as changes in peak amplitudes and latencies (six standard scores total). A regression analysis examined the relationship between brain vital signs and the number of head impacts received during the study season. Significant pre/post differences in brain vital signs were detected for both groups. Bantam and Junior-A players also differed in number of head impacts (Bantam: 32.92 ± 17.68; Junior-A: 195.00 ± 61.08; P < 0.001). Importantly, the regression model demonstrated a significant linear relationship between changes in brain vital signs and total head impacts received (R = 0.799, P = 0.007), with clear differences between the Bantam and Junior-A groups. In the absence of a clinically diagnosed concussion, the brain vital sign changes appear to have demonstrated the compounding effects of repetitive subconcussive impacts. The findings underscored the importance of an objective physiological measure of brain function along the spectrum of concussive impacts.
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Affiliation(s)
- Shaun D Fickling
- Faculty of Science and Applied Sciences, Simon Fraser University, Metro Vancouver, BC V5A1S6, Canada.,Center for Neurology Studies, HealthTech Connex, Metro Vancouver, BC V3V0C6, Canada.,BrainNET, Health and Technology District, Surrey, BC V3V0C6, Canada
| | - Aynsley M Smith
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN 55905, USA.,Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN 55905, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ 85259, USA
| | - Kyle Farrell
- Creighton University School of Medicine, Omaha, Nebraska 68178, USA
| | - Sara C Pender
- School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland
| | - Ryan C N D'Arcy
- Faculty of Science and Applied Sciences, Simon Fraser University, Metro Vancouver, BC V5A1S6, Canada.,Center for Neurology Studies, HealthTech Connex, Metro Vancouver, BC V3V0C6, Canada.,BrainNET, Health and Technology District, Surrey, BC V3V0C6, Canada.,DM Centre for Brain Health, Radiology, University of British Columbia, Metro Vancouver, BC V6T1Z4, Canada
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20
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Waltzman D, Sarmiento K, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Head Impact Exposures Among Youth Tackle and Flag American Football Athletes. Sports Health 2021; 13:454-462. [PMID: 33618557 PMCID: PMC8404728 DOI: 10.1177/1941738121992324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis: Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. Study Design: Cohort study. Level of Evidence: Level 4. Methods: Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. Results: There were 186,239 head impacts recorded during the study. Tackle football athletes sustained 14.67 (95% CI 9.75-21.95) times more head impacts during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15g (17.95-18.34) and 52.55g (51.06-54.09) for a tackle football athlete and 16.84g (15.57-18.21) and 33.51g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40g) per athletic exposure compared with a flag football athlete. Conclusion: This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. Clinical Relevance: These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.
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Affiliation(s)
- Dana Waltzman
- Dana Waltzman, PhD, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341 ()
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21
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Abstract
OBJECTIVES Head impact exposure (HIE) in youth football is a public health concern. The objective of this study was to determine if one season of HIE in youth football was related to cognitive changes. METHOD Over 200 participants (ages 9-13) wore instrumented helmets for practices and games to measure the amount of HIE sustained over one season. Pre- and post-season neuropsychological tests were completed. Test score changes were calculated adjusting for practice effects and regression to the mean and used as the dependent variables. Regression models were calculated with HIE variables predicting neuropsychological test score changes. RESULTS For the full sample, a small effect was found with season average rotational values predicting changes in list-learning such that HIE was related to negative score change: standardized beta (β) = -.147, t(205) = -2.12, and p = .035. When analyzed by age clusters (9-10, 11-13) and adding participant weight to models, the R2 values increased. Splitting groups by weight (median split), found heavier members of the 9-10 cohort with significantly greater change than lighter members. Additionaly, significantly more participants had clinically meaningful negative changes: X2 = 10.343, p = .001. CONCLUSION These findings suggest that in the 9-10 age cluster, the average seasonal level of HIE had inverse, negative relationships with cognitive change over one season that was not found in the older group. The mediation effects of age and weight have not been explored previously and appear to contribute to the effects of HIE on cognition in youth football players.
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22
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Abstract
As awareness on the short-term and long-term consequences of sports-related concussions and repetitive head impacts continues to grow, so too does the necessity to establish biomechanical measures of risk that inform public policy and risk mitigation strategies. A more precise exposure metric is central to establishing relationships among the traumatic experience, risk, and ultimately clinical outcomes. Accurate exposure metrics provide a means to support evidence-informed decisions accelerating public policy mandating brain trauma management through sport modification and safer play.
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Affiliation(s)
- Clara Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, A106-200 Lees Avenue, Ottawa, ON K1N 6N5, Canada.
| | - Thomas Blaine Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, A106-200 Lees Avenue, Ottawa, ON K1N 6N5, Canada
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23
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Major BP, McDonald SJ, O'Brien WT, Symons GF, Clough M, Costello D, Sun M, Brady RD, Mccullough J, Aniceto R, Lin IH, Law M, Mychasiuk R, O'Brien TJ, Agoston DV, Shultz SR. Serum Protein Biomarker Findings Reflective of Oxidative Stress and Vascular Abnormalities in Male, but Not Female, Collision Sport Athletes. Front Neurol 2020; 11:549624. [PMID: 33117257 PMCID: PMC7561422 DOI: 10.3389/fneur.2020.549624] [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] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Studies have indicated that concussive and sub-concussive brain injuries that are frequent during collision sports may lead to long-term neurological abnormalities, however there is a knowledge gap on how biological sex modifies outcomes. Blood-based biomarkers can help to identify the molecular pathology induced by brain injuries and to better understand how biological sex affects the molecular changes. We therefore analyzed serum protein biomarkers in male (n = 50) and female (n = 33) amateur Australian rules footballers (i.e., Australia's most participated collision sport), both with a history of concussion (HoC) and without a history of concussion (NoHoC). These profiles were compared to those of age-matched control male (n = 24) and female (n = 20) athletes with no history of neurotrauma or participation in collision sports. Serum levels of protein markers indicative of neuronal, axonal and glial injury (UCH-L1, NfL, tau, p-tau, GFAP, BLBP, PEA15), metabolic (4-HNE) and vascular changes (VEGF-A, vWF, CLDN5), and inflammation (HMGB1) were assessed using reverse phase protein microarrays. Male, but not female, footballers had increased serum levels of VEGF-A compared to controls regardless of concussion history. In addition, only male footballers who had HoC had increased serum levels of 4-HNE. These findings being restricted to males may be related to shorter collision sport career lengths for females compared to males. In summary, these findings show that male Australian rules footballers have elevated levels of serum biomarkers indicative of vascular abnormalities (VEGF-A) and oxidative stress (4-HNE) in comparison to non-collision control athletes. While future studies are required to determine how these findings relate to neurological function, serum levels of VEGF-A and 4-HNE may be useful to monitor subclinical neurological injury in males participating in collision sports.
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Affiliation(s)
- Brendan P Major
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, VIC, Australia
| | - William T O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jesse Mccullough
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Roxanne Aniceto
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - I-Hsuan Lin
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Meng Law
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia.,Departments of Neurological Surgery and Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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24
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The effects of repetitive head impacts on postural control: A systematic review. J Sci Med Sport 2020; 24:247-257. [PMID: 32948449 DOI: 10.1016/j.jsams.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/24/2020] [Accepted: 09/01/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. DESIGN Systematic review. METHODS PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. RESULTS All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n=8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n=13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. CONCLUSIONS Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI.
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25
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Phelps A, Mez J, Stern RA, Alosco ML. Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework. Semin Neurol 2020; 40:439-449. [PMID: 32674182 DOI: 10.1055/s-0040-1713633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.
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Affiliation(s)
- Alyssa Phelps
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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26
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Is King-Devick Testing, Compared With Other Sideline Screening Tests, Superior for the Assessment of Sports-related Concussion? Neurologist 2020; 25:33-37. [DOI: 10.1097/nrl.0000000000000268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Jadischke R, Zendler J, Lovis E, Elliott A, Goulet GC. Quantitative and qualitative analysis of head and body impacts in American 7v7 non-tackle football. BMJ Open Sport Exerc Med 2020; 6:e000638. [PMID: 32095268 PMCID: PMC7011012 DOI: 10.1136/bmjsem-2019-000638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Non-tackle American football is growing in popularity, and it has been proposed as a safer alternative for young athletes interested in American football. Little is known about the nature of head contact in the sport, which is necessary to inform the extent to which protective headgear is warranted. The objective of this study was to identify the location, types and frequency of head and body contacts in competitive 7v7 non-tackle American football. Methods Video analysis was used to document the type, frequency and mechanism of contacts across a series of under 12, under 14 and high school non-tackle tournament games. A subset of impacts was quantitatively analysed via 3-D model-based image matching to calculate the preimpact and postimpact speed of players’ heads and the change in resultant translational and rotational velocities. Results The incidence rate of head contact was found to be low (3.5 contacts per 1000 athlete-plays). Seventy-five per cent of head contacts were caused by a head-to-ground impact. No head-to-head contacts were identified. Most contacts occurred to the rear upper (occiput) or side upper (temporal/parietal) regions. Head-to-ground impact was associated with a maximum preimpact velocity of 5.9±2.2 m/s and a change in velocity of 3.0±1.1 m/s. Conclusion Non-tackle football appears to represent a lower contact alternative to tackle football. The distribution of head impact locations, mechanisms and energies found in the present study is different than what has been previously reported for tackle football. The existing tackle football standards are not appropriate to be applied to the sport of non-tackle football, and sport-specific head protection and headgear certification standards must be determined.
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Affiliation(s)
| | - Jessica Zendler
- Xenith, Detroit, Michigan, USA.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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28
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White-Schwoch T, Krizman J, McCracken K, Burgess JK, Thompson EC, Nicol T, LaBella CR, Kraus N. Performance on auditory, vestibular, and visual tests is stable across two seasons of youth tackle football. Brain Inj 2019; 34:236-244. [DOI: 10.1080/02699052.2019.1683899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Travis White-Schwoch
- Auditory Neuroscience Laboratory (www.brainvolts.northwestern.edu) & Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory (www.brainvolts.northwestern.edu) & Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Kristi McCracken
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Jamie K. Burgess
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Elaine C. Thompson
- Auditory Neuroscience Laboratory (www.brainvolts.northwestern.edu) & Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory (www.brainvolts.northwestern.edu) & Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Cynthia R. LaBella
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory (www.brainvolts.northwestern.edu) & Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
- Departments of Neurobiology and Otolaryngology, Northwestern University, Evanston, Illinois, USA
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29
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Rose SC, Yeates KO, Nguyen JT, McCarthy MT, Ercole PM, Pizzimenti NM. Neurocognitive Function and Head Impact Burden over Two Seasons of Youth Tackle Football. J Neurotrauma 2019; 36:2803-2809. [DOI: 10.1089/neu.2019.6519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Sean C. Rose
- Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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30
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Alosco ML, Mez J, Tripodis Y, Kiernan PT, Abdolmohammadi B, Murphy L, Kowall NW, Stein TD, Huber BR, Goldstein LE, Cantu RC, Katz DI, Chaisson CE, Martin B, Solomon TM, McClean MD, Daneshvar DH, Nowinski CJ, Stern RA, McKee AC. Age of first exposure to tackle football and chronic traumatic encephalopathy. Ann Neurol 2019; 83:886-901. [PMID: 29710395 DOI: 10.1002/ana.25245] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effect of age of first exposure to tackle football on chronic traumatic encephalopathy (CTE) pathological severity and age of neurobehavioral symptom onset in tackle football players with neuropathologically confirmed CTE. METHODS The sample included 246 tackle football players who donated their brains for neuropathological examination. Two hundred eleven were diagnosed with CTE (126 of 211 were without comorbid neurodegenerative diseases), and 35 were without CTE. Informant interviews ascertained age of first exposure and age of cognitive and behavioral/mood symptom onset. RESULTS Analyses accounted for decade and duration of play. Age of exposure was not associated with CTE pathological severity, or Alzheimer's disease or Lewy body pathology. In the 211 participants with CTE, every 1 year younger participants began to play tackle football predicted earlier reported cognitive symptom onset by 2.44 years (p < 0.0001) and behavioral/mood symptoms by 2.50 years (p < 0.0001). Age of exposure before 12 predicted earlier cognitive (p < 0.0001) and behavioral/mood (p < 0.0001) symptom onset by 13.39 and 13.28 years, respectively. In participants with dementia, younger age of exposure corresponded to earlier functional impairment onset. Similar effects were observed in the 126 CTE-only participants. Effect sizes were comparable in participants without CTE. INTERPRETATION In this sample of deceased tackle football players, younger age of exposure to tackle football was not associated with CTE pathological severity, but predicted earlier neurobehavioral symptom onset. Youth exposure to tackle football may reduce resiliency to late-life neuropathology. These findings may not generalize to the broader tackle football population, and informant-report may have affected the accuracy of the estimated effects. Ann Neurol 2018;83:886-901.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Patrick T Kiernan
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Lauren Murphy
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,Departments of Psychiatry, Ophthalmology, Boston University School of Medicine, Boston, MA.,Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Department of Neurosurgery, Boston University School of Medicine, Boston, MA.,Concussion Legacy Foundation, Boston, MA.,Department of Neurosurgery, Emerson Hospital, Boston, MA
| | - Douglas I Katz
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Braintree Rehabilitation Hospital, Braintree, MA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Data Coordinating Center, Boston University School of Public Health, Boston, MA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Data Coordinating Center, Boston University School of Public Health, Boston, MA
| | - Todd M Solomon
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Department of Orthopaedics, Stanford University, Stanford, CA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Concussion Legacy Foundation, Boston, MA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Department of Neurosurgery, Boston University School of Medicine, Boston, MA.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA.,Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
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31
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Alosco ML, Stern RA. Youth Exposure to Repetitive Head Impacts From Tackle Football and Long-term Neurologic Outcomes: A Review of the Literature, Knowledge Gaps and Future Directions, and Societal and Clinical Implications. Semin Pediatr Neurol 2019; 30:107-116. [PMID: 31235012 DOI: 10.1016/j.spen.2019.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Youth participation in contact and collision sports, particularly tackle football, is associated with exposure to repetitive head impacts during a time period when tremendous brain maturation is occurring. Accumulating evidence suggests that exposure to repetitive head impacts from youth tackle football may increase vulnerability to long-term cognitive, neuropsychiatric, and neurologic disturbances. There are limitations to the current literature and conflicting findings exist. Nonetheless, participation in youth football has become a cause of concern to clinicians, scientists, politicians, coaches, parents, and children. The objective of this paper is to review the literature on the long-term cognitive, neuropsychiatric, and neurologic outcomes associated with participation in youth contact and collision sports, with a focus on tackle football. We provide an overview of the empirically derived framework that has served as the foundation for the investigation of youth tackle football and neurologic outcomes. The extant research studies on age of first exposure to tackle football and later-life cognitive and neuropsychiatric functioning, as well as structural brain changes are reviewed. We discuss the limitations of the current evidence, suggest future directions, and conclude with our opinions on societal and clinical implications.
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Affiliation(s)
- Michael L Alosco
- Boston University (BU), Alzheimer's Disease Center, BU CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Robert A Stern
- Boston University (BU), Alzheimer's Disease Center, BU CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA; Departments of Neurosurgery and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA.
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Lynall RC, Lempke LB, Johnson RS, Anderson MN, Schmidt JD. A Comparison of Youth Flag and Tackle Football Head Impact Biomechanics. J Neurotrauma 2019; 36:1752-1757. [DOI: 10.1089/neu.2018.6236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert C. Lynall
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Landon B. Lempke
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Rachel S. Johnson
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Melissa N. Anderson
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Julianne D. Schmidt
- Department of Kinesiology, UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
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Head Impact Burden and Change in Neurocognitive Function During a Season of Youth Football. J Head Trauma Rehabil 2019; 34:87-95. [DOI: 10.1097/htr.0000000000000441] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith AM, Alford PA, Aubry M, Benson B, Black A, Brooks A, Burke C, D’Arcy R, Dodick D, Eaves M, Eickhoff C, Erredge K, Farrell K, Finnoff J, Fraser DD, Giza C, Greenwald RM, Hanzel M, Hoshizaki B, Huston J, Jorgenson J, Joyner M, Krause D, LaVoi N, Leaf M, Leddy J, Leopold J, Margarucci K, Margulies S, Mihalik J, Munce T, Oeur A, Podein S, Prideaux C, Roberts WO, Shen F, Soma D, Tabrum M, Stuart MB, Wethe J, Whitehead JR, Wiese-Bjornstal D, Stuart MJ. Proceedings from the Ice Hockey Summit III: Action on Concussion. EXERCISE MEDICINE 2019. [DOI: 10.26644/em.2019.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Smith AM, Farrell KJ, Roberts WO, Moris MR, Stuart MJ. Eliminating Fighting and Head Hits from Hockey: Opportunities and Barriers. Curr Sports Med Rep 2019; 18:35-40. [PMID: 30624333 DOI: 10.1249/jsr.0000000000000556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Removing fighting from ice hockey is an essential concussion prevention strategy that will improve the safety of the game at all levels.
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Affiliation(s)
- Aynsley M Smith
- Department of Orthopedic Surgery and Physical Medicine and Rehabilitation, Sports Medicine, Mayo Clinic, Rochester, MN
| | | | - William O Roberts
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, MN
| | | | - Michael J Stuart
- Department of Orthopedic Surgery, Sports Medicine, Mayo Clinic, Rochester, MN
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Smith AM, Alford PA, Aubry M, Benson B, Black A, Brooks A, Burke C, D'Arcy R, Dodick D, Eaves M, Eickhoff C, Erredge K, Farrell K, Finnoff J, Fraser DD, Giza C, Greenwald RM, Hoshizaki B, Huston J, Jorgensen J, Joyner M, Krause D, LaVoi N, Leaf M, Leddy J, Margarucci K, Margulies S, Mihalik J, Munce T, Oeur A, Prideaux C, Roberts WO, Shen F, Soma D, Tabrum M, Stuart MB, Wethe J, Whitehead JR, Wiese-Bjornstal D, Stuart MJ. Proceedings from the Ice Hockey Summit III: Action on Concussion. Curr Sports Med Rep 2019; 18:23-34. [PMID: 30624332 DOI: 10.1249/jsr.0000000000000557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: 1) describe sport-related concussion (SRC) epidemiology, 2) classify prevention strategies, 3) define objective, diagnostic tests, 4) identify treatment, and 5) integrate science and clinical care into prioritized action plans and policy. Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. 1) Establish a national and international hockey data base for SRC at all levels, 2) eliminate body checking in Bantam youth hockey games, 3) expand a behavior modification program (Fair Play) to all youth hockey levels, 4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues, 5) establish objective tests to diagnose concussion at point of care (POC), and 6) mandate baseline testing to improve concussion diagnosis for all age groups. Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.
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Affiliation(s)
- Aynsley M Smith
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Patrick A Alford
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Mark Aubry
- Sports Medicine, Ottawa Sports Medicine Center, Ottawa, ON, Canada
| | - Brian Benson
- Faculty of Kinesiology, Department of Clinical Neurosciences, Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Amanda Black
- Sport Injury Prevention Research Centre and the Integrated Concussion Research Program at the University of Calgary, Calgary, AB, Canada
| | - Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, Madison, WI
| | - Charles Burke
- Department of Orthopedics, Burke & Bradley Orthopedics, UPMC St. Margaret, Pittsburgh, PA
| | - Ryan D'Arcy
- School of Computing Science, School of Engineering Science, Simon Frasier University, Surrey, BC, Canada
| | - David Dodick
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Chad Eickhoff
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Kristen Erredge
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Kyle Farrell
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Jonathon Finnoff
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Douglas D Fraser
- Department of Pediatrics, Department of Physiology/Pharmacology and Clinical Neurosciences, University of Western Ontario, London, ON, Canada
| | - Christopher Giza
- Department of Pediatrics, University of California-Los Angeles, Los Angeles, CA
| | - Richard M Greenwald
- Simbex, Lebanon, NH.,Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Blaine Hoshizaki
- Neurotrauma Impact Science Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Janelle Jorgensen
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Michael Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - David Krause
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - Nicole LaVoi
- School of Kinesiology, University of Minnesota, Minneapolis, MN
| | | | - John Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Science, University of Buffalo, Buffalo, NY
| | | | - Susan Margulies
- Wallace Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA.,Georgia Institute of Technology, Atlanta, GA
| | - Jason Mihalik
- Department of Exercise and Sports Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thayne Munce
- Sanford Sports Science Institution, Sanford Medical South Dakota, Sioux Falls, SD
| | - Anna Oeur
- Wallace Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA
| | - Cara Prideaux
- Sports Medicine, Department of Physical Medicine Rehabilitation, Mayo Clinic, Rochester, MN
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Francis Shen
- University of Minnesota Law School, Minneapolis, MN
| | - David Soma
- Department of Pediatric and Adolescent Medicine, Sports Medicine, Mayo Clinic, Rochester, MN
| | | | - Michael B Stuart
- Department of Orthopedic Surgery, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Jennifer Wethe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | | | - Michael J Stuart
- Department of Orthopedic Surgery, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Kelley ME, Espeland MA, Flood WC, Powers AK, Whitlow CT, Maldjian JA, Stitzel JD, Urban JE. Comparison of head impact exposure in practice drills among multiple youth football teams. J Neurosurg Pediatr 2018; 23:381-389. [PMID: 30579266 PMCID: PMC11233417 DOI: 10.3171/2018.9.peds18314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
Objective Limiting contact in football practice can reduce the number of head impacts a player receives, but further research is needed to inform the modification of optimal drills that mitigate head impact exposure (HIE) while the player develops the skills needed to safely play the game. This study aimed to compare HIE in practice drills among 6 youth football teams and to evaluate the effect of a team on HIE. Methods On-field head impact data were collected from athletes (ages 10–13 years) playing on 6 local youth football teams (teams A–F) during all practices using the Head Impact Telemetry System. Video was recorded and analyzed to verify and assign impacts to a specific drill. Drills were identified as follows: dummy/sled tackling, half install, install, install walk through, multiplayer tackle, Oklahoma, one-on-one, open field tackling, other, passing, position skill work, scrimmage, special teams, tackling drill stations, and technique. HIE was quantified in terms of impacts per player per minute (ppm) and peak linear and rotational head acceleration. Generalized linear models were used to assess differences in head impact magnitude and frequency among drills as well as among teams within the most common drills. Results Among 67 athlete-seasons, a total of 14,718 impacts during contact practices were collected and evaluated in this study. Among all 6 teams, the mean linear (p < 0.0001) and rotational (p < 0.0001) acceleration varied significantly among all drills. Open field tackling had significantly (p < 0.001) higher mean linear acceleration than all other drills. Multiplayer tackle had the highest mean impact rate (0.35 ppm). Significant variations in linear acceleration and impact rate were observed among teams within specific drills. Team A had the highest mean linear acceleration in install, one-on-one, and open field tackling and the highest mean impact rate in Oklahoma and position skill work. Although team A spent the greatest proportion of their practice on minimal- or no-player versus player contact drills (27%) compared to other teams, they had the highest median (20.2g) and 95th percentile (56.4g) linear acceleration in practice. Conclusions Full-speed tackling and blocking drills resulted in the highest HIE. Reducing time spent on contact drills relative to minimal or no contact drills may not lower overall HIE. Instead, interventions such as reducing the speed of players engaged in contact, correcting tackling technique, and progressing to contact may reduce HIE more effectively.
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Affiliation(s)
- Mireille E. Kelley
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William C. Flood
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexander K. Powers
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christopher T. Whitlow
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Radiology (Neuroradiology), Wake Forest School of Medicine, Winston-Salem, North Carolina
- Clinical and Translational Sciences Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A. Maldjian
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Joel D. Stitzel
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jillian E. Urban
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Hurst HT, Atkins S, Dickinson BD. The magnitude of translational and rotational head accelerations experienced by riders during downhill mountain biking. J Sci Med Sport 2018; 21:1256-1261. [PMID: 29606559 DOI: 10.1016/j.jsams.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Howard T Hurst
- School of Sport and Wellbeing, University of Central Lancashire, UK.
| | | | - Ben D Dickinson
- School of Sport and Wellbeing, University of Central Lancashire, UK
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39
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Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: A systematic review of the evidence. Int J Psychophysiol 2018; 132:39-54. [DOI: 10.1016/j.ijpsycho.2018.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
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40
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Bellamkonda S, Woodward SJ, Campolettano E, Gellner R, Kelley ME, Jones DA, Genemaras A, Beckwith JG, Greenwald RM, Maerlender AC, Rowson S, Duma SM, Urban JE, Stitzel JD, Crisco JJ. Head Impact Exposure in Practices Correlates With Exposure in Games for Youth Football Players. J Appl Biomech 2018; 34:354-360. [PMID: 29651910 PMCID: PMC6600826 DOI: 10.1123/jab.2017-0207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to compare head impact exposures between practices and games in football players ages 9 to 14 years, who account for approximately 70% of all football players in the United States. Over a period of 2 seasons, 136 players were enrolled from 3 youth programs, and 49,847 head impacts were recorded from 345 practices and 137 games. During the study, individual players sustained a median of 211 impacts per season, with a maximum of 1226 impacts. Players sustained 50th (95th) percentile peak linear acceleration of 18.3 (46.9) g, peak rotational acceleration of 1305.4 (3316.6) rad·s-2, and Head Impact Technology Severity Profile of 13.7 (24.3), respectively. Overall, players with a higher frequency of head impacts at practices recorded a higher frequency of head impacts at games (P < .001, r2 = .52), and players who sustained a greater average magnitude of head impacts during practice also recorded a greater average magnitude of head impacts during games (P < .001). The youth football head impact data quantified in this study provide valuable insight into the player exposure profile, which should serve as a key baseline in efforts to reduce injury.
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Affiliation(s)
- Srinidhi Bellamkonda
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Samantha J. Woodward
- 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
| | - Mireille E. Kelley
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Derek A. Jones
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | | | | | | | - Arthur C. Maerlender
- Center for Brain, Biology & Behavior at University of Nebraska, Lincoln, NE, 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
| | - Jillian E. Urban
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, 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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Brokaw EB, Fine MS, Kindschi KE, Santago Ii AC, Lum PS, Higgins M. Cross-sectional evaluation of visuomotor tracking performance following subconcussive head impacts. Technol Health Care 2018; 26:109-118. [PMID: 29125529 DOI: 10.3233/thc-171079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repeated mild traumatic brain injury (mTBI) has been associated with increased risk of degenerative neurological disorders. While the effects of mTBI and repeated injury are known, studies have only recently started examining repeated subconcussive impacts, impacts that do not result in a clinically diagnosed mTBI. In these studies, repeated subconcussive impacts have been connected to cognitive performance and brain imaging changes. OBJECTIVE Recent research suggests that performance on a visuomotor tracking (VMT) task may help improve the identification of mTBI. The goal of this study was to investigate if VMT performance is sensitive to the cumulative effect of repeated subconcussive head impacts in collegiate men's lacrosse players. METHODS A cross-sectional, prospective study was completed with eleven collegiate men's lacrosse players. Participants wore helmet-mounted sensors and completed VMT and reaction time assessments. The relationship between cumulative impact metrics and VMT metrics were investigated. RESULTS In this study, VMT performance correlated with repeated subconcussive head impacts; individuals approached clinically diagnosed mTBI-like performance as the cumulative rotational velocity they experienced increased. CONCLUSION This suggests that repeated subconcussive impacts can result in measurable impairments and indicates that visuomotor tracking performance may be a useful tool for monitoring the effects of repeated subconcussive impacts.
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Affiliation(s)
- E B Brokaw
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - M S Fine
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - K E Kindschi
- Department of Sports Medicine, The MedStar Health Union Memorial Hospital, Baltimore, MD, USA
| | - A C Santago Ii
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - P S Lum
- Center for Applied Biomechanics and Rehabilitation Research, The MedStar Health National Rehabilitation Hospital, Washington, DC, USA.,Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - M Higgins
- Kinesiology Department, Towson University, Towson, MD, USA
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Gong NJ, Kuzminski S, Clark M, Fraser M, Sundman M, Guskiewicz K, Petrella JR, Liu C. Microstructural alterations of cortical and deep gray matter over a season of high school football revealed by diffusion kurtosis imaging. Neurobiol Dis 2018; 119:79-87. [PMID: 30048802 DOI: 10.1016/j.nbd.2018.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/01/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To probe microstructural changes that are associated with subconcussive head impact exposure in deep and cortical gray matter of high school football players over a single season. METHODS Players underwent diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) scans. Head impact data was recorded. Association between parametric changes and frequency of frontal head impact was assessed. RESULTS In deep gray matter, significant decreases in mean kurtosis (MK) and increases in mean diffusivity (MD) over the season were observed in the thalamus and putamen. Correlations between changes in DKI metrics and frequency of frontal impacts were observed in the putamen and caudate. In cortical gray matter, decreases in MK were observed in regions including the pars triangularis and inferior parietal. In addition, increases in MD were observed in the rostral middle frontal cortices. Negative correlations between MK and frequency of frontal impacts were observed in the posterior part of the brain including the pericalcarine, lingual and middle temporal cortices. Magnetic susceptibility values exhibited no significant difference or correlation, suggesting these diffusion changes common within the group may not be associated with iron-related mechanisms. CONCLUSION Microstructural alterations over the season and correlations with head impacts were captured by DKI metrics, which suggested that DKI imaging of gray matter may yield valuable biomarkers for evaluating brain injuries associated with subconcussive head impact. Findings of associations between frontal impacts and changes in posterior cortical gray matter also indicated that contrecoup injury rather than coup injury might be the dominant mechanism underlying the observed microstructural alterations. ADVANCES IN KNOWLEDGE Significant microstructural changes, as reflected by DKI metrics, in cortical gray matter such as the rostral middle frontal cortices, and in deep gray matter such as the thalamus were observed in high school football players over the course of a single season without clinically diagnosed concussion. QSM showed no evidence of iron-related changes in the observed subconcussive brain injuries. The detected microstructural changes in cortical and deep gray matter correlated with frequency of subconcussive head impacts. IMPLICATIONS FOR PATIENT CARE DKI may yield valuable biomarkers for evaluating the severity of brain injuries associated with subconcussive head impacts in contact sport athletes.
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Affiliation(s)
- Nan-Jie Gong
- Electrical Engineering and Computer Sciences, University of California, Berkeley; Brain Imaging and Analysis Center, Duke University School of Medicine, United States.
| | | | - Michael Clark
- Human Movement Science, University of North Carolina at Chapel Hill School of Medicine, United States.
| | - Melissa Fraser
- Allied Health Sciences, University of North Carolina at Chapel Hill School of Medicine, United States.
| | - Mark Sundman
- Department of Psychology, University of Arizona, United States
| | - Kevin Guskiewicz
- Exercise Sports Sciences, University of North Carolina at Chapel Hill School of Medicine, United States.
| | | | - Chunlei Liu
- Electrical Engineering and Computer Sciences, University of California, Berkeley; Brain Imaging and Analysis Center, Duke University School of Medicine, United States; Radiology, Duke University School of Medicine, United States; Helen Wills Neuroscience Institute, University of California, Berkeley, CA, United States.
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Kelley ME, Kane JM, Espeland MA, Miller LE, Powers AK, Stitzel JD, Urban JE. Head impact exposure measured in a single youth football team during practice drills. J Neurosurg Pediatr 2017; 20:489-497. [PMID: 28937917 PMCID: PMC6258189 DOI: 10.3171/2017.5.peds16627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study evaluated the frequency, magnitude, and location of head impacts in practice drills within a youth football team to determine how head impact exposure varies among different types of drills. METHODS On-field head impact data were collected from athletes participating in a youth football team for a single season. Each athlete wore a helmet instrumented with a Head Impact Telemetry (HIT) System head acceleration measurement device during all preseason, regular season, and playoff practices. Video was recorded for all practices, and video analysis was performed to verify head impacts and assign each head impact to a specific drill. Eleven drills were identified: dummy/sled tackling, install, special teams, Oklahoma, one-on-one, open-field tackling, passing, position skill work, multiplayer tackle, scrimmage, and tackling drill stations. Generalized linear models were fitted to log-transformed data, and Wald tests were used to assess differences in head accelerations and impact rates. RESULTS A total of 2125 impacts were measured during 30 contact practices in 9 athletes (mean age 11.1 ± 0.6 years, mean mass 44.9 ± 4.1 kg). Open-field tackling had the highest median and 95th percentile linear accelerations (24.7 g and 97.8 g, respectively) and resulted in significantly higher mean head accelerations than several other drills. The multiplayer tackle drill resulted in the highest head impact frequency, with an average of 0.59 impacts per minute per athlete, but the lowest 95th percentile linear accelerations of all drills. The front of the head was the most common impact location for all drills except dummy/sled tackling. CONCLUSIONS Head impact exposure varies significantly in youth football practice drills, with several drills exposing athletes to high-magnitude and/or high-frequency head impacts. These data suggest that further study of practice drills is an important step in developing evidence-based recommendations for modifying or eliminating certain high-intensity drills to reduce head impact exposure and injury risk for all levels of play.
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Affiliation(s)
- Mireille E. Kelley
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joeline M. Kane
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Logan E. Miller
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexander K. Powers
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joel D. Stitzel
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jillian E. Urban
- Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences; Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Kerr ZY, Yeargin SW, Djoko A, Dalton SL, Baker MM, Dompier TP. Examining Play Counts and Measurements of Injury Incidence in Youth Football. J Athl Train 2017; 52:955-965. [PMID: 28880572 DOI: 10.4085/1062-6050-52.7.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Whereas researchers have provided estimates for the number of head impacts sustained within a youth football season, less is known about the number of plays across which such impact exposure occurs. OBJECTIVE To estimate the number of plays in which youth football players participated during the 2013 season and to estimate injury incidence through play-based injury rates. DESIGN Descriptive epidemiology study. SETTING Youth football. PATIENTS OR OTHER PARTICIPANTS Youth football players (N = 2098; age range, 5-15 years) from 105 teams in 12 recreational leagues across 6 states. MAIN OUTCOME MEASURE(S) We calculated the average number of athlete-plays per season and per game using independent-samples t tests to compare age groups (5-10 years old versus 11-15 years old) and squad sizes (<20 versus ≥20 players); game injury rates per 1000 athlete-exposures (AEs) and per 10 000 athlete-plays; and injury rate ratios (IRRs) with 95% confidence intervals (CIs) to compare age groups. RESULTS On average, youth football players participated in 333.9 ± 178.5 plays per season and 43.9 ± 24.0 plays per game. Age groups (5- to 10-year-olds versus 11- to 15-year-olds) did not differ in the average number of plays per season (335.8 versus 332.3, respectively; t2086.4 = 0.45, P = .65) or per game (44.1 versus 43.7, respectively; t2092.3 = 0.38, P = .71). However, players from smaller teams participated in more plays per season (373.7 versus 308.0; t1611.4 = 8.15, P < .001) and per game (47.7 versus 41.4; t1523.5 = 5.67, P < .001). Older players had a greater game injury rate than younger players when injury rates were calculated per 1000 AEs (23.03 versus 17.86/1000 AEs; IRR = 1.29; 95% CI = 1.04, 1.60) or per 10 000 athlete-plays (5.30 versus 4.18/10 000 athlete-plays; IRR = 1.27; 95% CI = 1.02, 1.57). CONCLUSIONS A larger squad size was associated with a lower average number of plays per season and per game. Increasing youth football squad sizes may help reduce head-impact exposure for individual players. The AE-based injury rates yielded effect estimates similar to those of play-based injury rates.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Susan W Yeargin
- Athletic Training Education Program, University of South Carolina, Columbia
| | - Aristarque Djoko
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Sara L Dalton
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Melissa M Baker
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
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Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry 2017; 7:e1236. [PMID: 28926003 PMCID: PMC5639242 DOI: 10.1038/tp.2017.197] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/16/2017] [Accepted: 07/30/2017] [Indexed: 12/14/2022] Open
Abstract
Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.
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O'Connor KL, Rowson S, Duma SM, Broglio SP. Head-Impact-Measurement Devices: A Systematic Review. J Athl Train 2017; 52:206-227. [PMID: 28387553 DOI: 10.4085/1062-6050.52.2.05] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT With an estimated 3.8 million sport- and recreation-related concussions occurring annually, targeted prevention and diagnostic methods are needed. Biomechanical analysis of head impacts may provide quantitative information that can inform both prevention and diagnostic strategies. OBJECTIVE To assess available head-impact devices and their clinical utility. DATA SOURCES We performed a systematic search of the electronic database PubMed for peer-reviewed publications, using the following phrases: accelerometer and concussion, head impact telemetry, head impacts and concussion and sensor, head impacts and sensor, impact sensor and concussion, linear acceleration and concussion, rotational acceleration and concussion, and xpatch concussion. In addition to the literature review, a Google search for head impact monitor and concussion monitor yielded 15 more devices. STUDY SELECTION Included studies were performed in vivo, used commercially available devices, and focused on sport-related concussion. DATA EXTRACTION One author reviewed the title and abstract of each study for inclusion and exclusion criteria and then reviewed each full-text article to confirm inclusion criteria. Controversial articles were reviewed by all authors to reach consensus. DATA SYNTHESIS In total, 61 peer-reviewed articles involving 4 head-impact devices were included. Participants in boxing, football, ice hockey, soccer, or snow sports ranged in age from 6 to 24 years; 18% (n = 11) of the studies included female athletes. The Head Impact Telemetry System was the most widely used device (n = 53). Fourteen additional commercially available devices were presented. CONCLUSIONS Measurements collected by impact monitors provided real-time data to estimate player exposure but did not have the requisite sensitivity to concussion. Proper interpretation of previously reported head-impact kinematics across age, sport, and position may inform future research and enable staff clinicians working on the sidelines to monitor athletes. However, head-impact-monitoring systems have limited clinical utility due to error rates, designs, and low specificity in predicting concussive injury.
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Affiliation(s)
| | - Steven Rowson
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg
| | - Stefan M Duma
- School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor
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Abstract
Context: Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels. Evidence Acquisition: PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications. Study Design: Clinical review. Level of Evidence: Level 4. Results: Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility. Conclusion: Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.
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Affiliation(s)
- Richelle M Williams
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Margaret Dowling
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kathryn L O'Connor
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, Michigan
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Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of Head Impacts to Change in Balance Error Scoring System Scores in Division I Men's Lacrosse Players. Sports Health 2017; 9:318-323. [PMID: 28060567 PMCID: PMC5496699 DOI: 10.1177/1941738116685306] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Investigation into the effect of cumulative subconcussive head impacts has yielded various results in the literature, with many supporting a link to neurological deficits. Little research has been conducted on men's lacrosse and associated balance deficits from head impacts. HYPOTHESES (1) Athletes will commit more errors on the postseason Balance Error Scoring System (BESS) test. (2) There will be a positive correlation to change in BESS scores and head impact exposure data. STUDY DESIGN Prospective longitudinal study. LEVEL OF EVIDENCE Level 3. METHODS Thirty-four Division I men's lacrosse players (age, 19.59 ± 1.42 years) wore helmets instrumented with a sensor to collect head impact exposure data over the course of a competitive season. Players completed a BESS test at the start and end of the competitive season. RESULTS The number of errors from pre- to postseason increased during the double-leg stance on foam ( P < 0.001), tandem stance on foam ( P = 0.009), total number of errors on a firm surface ( P = 0.042), and total number of errors on a foam surface ( P = 0.007). There were significant correlations only between the total errors on a foam surface and linear acceleration ( P = 0.038, r = 0.36), head injury criteria ( P = 0.024, r = 0.39), and Gadd Severity Index scores ( P = 0.031, r = 0.37). CONCLUSION Changes in the total number of errors on a foam surface may be considered a sensitive measure to detect balance deficits associated with cumulative subconcussive head impacts sustained over the course of 1 lacrosse season, as measured by average linear acceleration, head injury criteria, and Gadd Severity Index scores. If there is microtrauma to the vestibular system due to repetitive subconcussive impacts, only an assessment that highly stresses the vestibular system may be able to detect these changes. CLINICAL RELEVANCE Cumulative subconcussive impacts may result in neurocognitive dysfunction, including balance deficits, which are associated with an increased risk for injury. The development of a strategy to reduce total number of head impacts may curb the associated sequelae. Incorporation of a modified BESS test, firm surface only, may not be recommended as it may not detect changes due to repetitive impacts over the course of a competitive season.
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King D, Hume P, Gissane C, Brughelli M, Clark T. The Influence of Head Impact Threshold for Reporting Data in Contact and Collision Sports: Systematic Review and Original Data Analysis. Sports Med 2016; 46:151-69. [PMID: 26545363 DOI: 10.1007/s40279-015-0423-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies. OBJECTIVE The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported. METHODS A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated. RESULTS Of the 52 studies identified, 42% reported impacts using a >10-g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45% less) impacts of >15 g, and 4024 (81% less) impacts of >30 g. DISCUSSION Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10-g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport. CONCLUSION Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10-g impact threshold.
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Affiliation(s)
- D King
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand. .,Emergency Department, Hutt Valley District Health Board, Private Bag 31-907, Lower Hutt, New Zealand.
| | - P Hume
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - C Gissane
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, Middlesex, UK
| | - M Brughelli
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - T Clark
- Faculty of Human Performance, Australian College of Physical Education, Sydney Olympic Park, NSW, Australia
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A Review of Instrumented Equipment to Investigate Head Impacts in Sport. Appl Bionics Biomech 2016; 2016:7049743. [PMID: 27594780 PMCID: PMC4993933 DOI: 10.1155/2016/7049743] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/23/2016] [Indexed: 11/18/2022] Open
Abstract
Contact, collision, and combat sports have more head impacts as compared to noncontact sports; therefore, such sports are uniquely suited to the investigation of head impact biomechanics. Recent advances in technology have enabled the development of instrumented equipment, which can estimate the head impact kinematics of human subjects in vivo. Literature pertaining to head impact measurement devices was reviewed and usage, in terms of validation and field studies, of such devices was discussed. Over the past decade, instrumented equipment has recorded millions of impacts in the laboratory, on the field, in the ring, and on the ice. Instrumented equipment is not without limitations; however, in vivo head impact data is crucial to investigate head injury mechanisms and further the understanding of concussion.
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