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Zhan X, Liu Y, Cecchi NJ, Gevaert O, Zeineh MM, Grant GA, Camarillo DB. Brain Deformation Estimation With Transfer Learning for Head Impact Datasets Across Impact Types. IEEE Trans Biomed Eng 2024; 71:1853-1863. [PMID: 38224520 DOI: 10.1109/tbme.2024.3354192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVE The machine-learning head model (MLHM) to accelerate the calculation of brain strain and strain rate, which are the predictors for traumatic brain injury (TBI), but the model accuracy was found to decrease sharply when the training/test datasets were from different head impacts types (i.e., car crash, college football), which limits the applicability of MLHMs to different types of head impacts and sports. Particularly, small sizes of target dataset for specific impact types with tens of impacts may not be enough to train an accurate impact-type-specific MLHM. METHODS To overcome this, we propose data fusion and transfer learning to develop a series of MLHMs to predict the maximum principal strain (MPS) and maximum principal strain rate (MPSR). RESULTS The strategies were tested on American football (338), mixed martial arts (457), reconstructed car crash (48) and reconstructed American football (36) and we found that the MLHMs developed with transfer learning are significantly more accurate in estimating MPS and MPSR than other models, with a mean absolute error (MAE) smaller than 0.03 in predicting MPS and smaller than [Formula: see text] in predicting MPSR on all target impact datasets. High performance in concussion detection was observed based on the MPS and MPSR estimated by the transfer-learning-based models. CONCLUSION The MLHMs can be applied to various head impact types for rapidly and accurately calculating brain strain and strain rate. SIGNIFICANCE This study enables developing MLHMs for the head impact type with limited availability of data, and will accelerate the applications of MLHMs.
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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Field B, Waddington G, McKune A, Goecke R, Gardner AJ. Validation of an instrumented mouthguard in rugby union-a pilot study comparing impact sensor technology to video analysis. Front Sports Act Living 2023; 5:1230202. [PMID: 38053522 PMCID: PMC10694248 DOI: 10.3389/fspor.2023.1230202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background To better understand the biomechanical profile of direct head impacts and the game scenarios in which they occur in Rugby Union, there is a need for an on-field validation of a new instrumented mouthguard (IMG) against the reference standard. This study considers the potential of a combined biomechanical (IMG) and video analysis approach to direct head impact recognition, both of which in isolation have limitations. The aim of this study is to assess the relationship between an instrumented mouthguard and video analysis in detection of direct head impacts in rugby union. Design Pilot Study - Observational Cohort design. Methods The instrumented mouthguard was worn by ten (3 backs, 7 forwards) professional Rugby Union players during the 2020-21 Gallagher Premiership (UK) season. Game-day video was synchronized with timestamped head acceleration events captured from the instrumented mouthguard. Direct Head Impacts were recorded in a 2 × 2 contingency table to determine sensitivity. Impact characteristics were also collected for all verified head impacts to further the understanding of head biomechanics during the game. Results There were 2018 contact events that were reviewed using video analysis. Of those 655 were categorized as direct head impacts which also correlated with a head acceleration event captured by the IMG. Sensitivity analysis showed an overall sensitivity of 93.6% and a positive predictive value (PPV of 92.4%). When false positives were excluded due to ball out of play, mouthguard removal or handling after a scoring situation or stoppage, PPV was improved (98.3%). Most verified head impacts occurred in and around the ruck contest (31.2%) followed by impacts to the primary tackler (28.4%). Conclusion This pilot validation study demonstrates that this IMG provides a highly accurate measurement device that could be used to complement video verification in the recognition of on-field direct head impacts. The frequency and magnitude of direct head impacts derived from specific game scenarios has been described and allows for greater recognition of high-risk situations. Further studies with larger sample sizes and in different populations of Rugby Union players are required to develop our understanding of head impact and enable strategies for injury mitigation.
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Affiliation(s)
- Byron Field
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Andrew McKune
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Discipline of Biokinetics, Exercise, and Leisure Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Roland Goecke
- Research Institute for Sport and Exercise, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Croteau F, Leclerc S, Moroz M. Incidence of Concussions in Elite Female Water Polo: A Retrospective Analysis. Clin J Sport Med 2023; 33:e181-e185. [PMID: 37796221 DOI: 10.1097/jsm.0000000000001194] [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: 09/22/2022] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Current evidence for concussions is mixed in water polo players. Surveys suggest rates as high as 36%, whereas surveillance studies at international competitions often fail to report them at all. The goal of this study was to examine the incidence of concussions in elite female water polo players from surveillance tools implemented longitudinally. DESIGN Retrospective chart analysis of 10 years spanning between 2012 and 2022. SETTING National teams or professional sports. PARTICIPANTS Female players from the Canadian senior national water polo teams that participated in international competitions and trained more than 10 hours per week in a competitive environment. ASSESSMENT OF RISK FACTORS Included player position, recurrence, and time loss before full return to play. MAIN OUTCOME MEASURES Prevalence of concussion diagnosis. RESULTS Forty-three concussions were identified over the 10 years observed at a median count of 3 concussions per year. Cumulative days lost spanned between 25 and 348 days per team*year. Altogether, this produced a median rate of 14.3 injuries per 100 player*years. Goalkeepers in the sample suffered the highest rates of concussion (25.8%), compared with players in other positions (22.8% of centers and 16.7% of drivers). CONCLUSIONS This study found evidence for prevalence of concussions in elite female water polo players. Improved guidelines preceded a significant reduction in time loss after the year 2017. This adds to a body of knowledge suggesting that improved surveillance methods are needed to detect and care for concussions in this population.
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Affiliation(s)
- Félix Croteau
- Sports Medicine, Institut National du Sport du Québec, Montréal, Canada
- Faculty of Medicine, McGill University, Montréal, Canada
- Water Polo Canada, Montréal, Canada; and
| | - Suzanne Leclerc
- Sports Medicine, Institut National du Sport du Québec, Montréal, Canada
- Water Polo Canada, Montréal, Canada; and
- Faculté de médecine, Université de Montréal, Montréal, Canada
| | - Mickey Moroz
- Sports Medicine, Institut National du Sport du Québec, Montréal, Canada
- Faculty of Medicine, McGill University, Montréal, Canada
- Water Polo Canada, Montréal, Canada; and
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Le RK, Lempke LB, Anderson MN, Johnson RS, Schmidt JD, Lynall RC. Quantifying head impact biomechanical differences between commonly employed cleaning levels: a critical research interpretation consideration. Brain Inj 2023; 37:1173-1178. [PMID: 37166252 DOI: 10.1080/02699052.2023.2211351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes. OBJECTIVE Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impacts recorded within start and end times, Level-2: impacts during pauses/breaks removed, Level-3: video verified) for male youth tackle football. METHODS Participants (n = 23, age = 10.9 ± 0.3 yrs, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax SIM-G sensors throughout Fall 2019. Impact rates, ratios (IRRs), and 95% confidence intervals (95%CI) were used to compare levels. Random-effects general linear models were used to compare peak linear acceleration (PLA;g) and angular velocity (PAV;rads/s). RESULTS Level-1 resulted in higher impact rates (4.57; 95%CI = 4.14-5.05) compared to Level-2 (3.09; 95%CI = 2.80-3.42; IRR = 1.48; 95%CI = 1.34-1.63) and Level-3 datasets (2.56; 95%CI = 2.30-2.85; IRR = 1.78; 95%CI = 1.60-1.98). Level-2 had higher impact rates compared to Level-3 (1.21; 95%CI = 1.08-1.35). Level-1 resulted in higher PAV than Level-2 and Level-3 (p < 0.001) datasets. PLA did not differ across datasets (p = 0.296). CONCLUSIONS Head impact data should be filtered of pauses/breaks, and does not substantially differ outcome estimates compared to time-intensive video verification.
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Affiliation(s)
- Rachel K Le
- Department of Exercise Science, Mercer University, Macon, Georgia, USA
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
| | - Landon B Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa N Anderson
- Department of Kinesiology & Applied Physiology, Concussion Research Laboratory, University of Delaware, Newark, Delaware, USA
| | - Rachel S Johnson
- Department of Kinesiology, Center for Orthopaedic & Biomechanics Research, Boise State University, Boise, Idaho, USA
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
| | - Julianne D Schmidt
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- Department of Kinesiology, Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
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Huibregtse ME, Sweeney SH, Stephens MR, Cheng H, Chen Z, Block HJ, Newman SD, Kawata K. Association Between Serum Neurofilament Light and Glial Fibrillary Acidic Protein Levels and Head Impact Burden in Women's Collegiate Water Polo. J Neurotrauma 2023; 40:1130-1143. [PMID: 36259456 PMCID: PMC10266555 DOI: 10.1089/neu.2022.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent investigations have identified water polo athletes as at risk for concussions and repetitive subconcussive head impacts. Head impact exposure in collegiate varsity women's water polo, however, has not yet been longitudinally quantified. We aimed to determine the relationship between cumulative and acute head impact exposure across pre-season training and changes in serum biomarkers of brain injury. Twenty-two Division I collegiate women's water polo players were included in this prospective observational study. They wore sensor-installed mouthguards during all practices and scrimmages during eight weeks of pre-season training. Serum samples were collected at six time points (at baseline, before and after scrimmages during weeks 4 and 7, and after the eight-week pre-season training period) and assayed for neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) using Simoa® Human Neurology 2-Plex B assay kits. Serum GFAP increased over time (e.g., an increase of 0.6559 pg/mL per week; p = 0.0087). Neither longitudinal nor acute pre-post scrimmage changes in GFAP, however, were associated with head impact exposure. Contrarily, an increase in serum NfL across the study period was associated with cumulative head impact magnitude (sum of peak linear acceleration: B = 0.015, SE = 0.006, p = 0.016; sum of peak rotational acceleration: B = 0.148, SE = 0.048, p = 0.006). Acute changes in serum NfL were not associated with head impacts recorded during the two selected scrimmages. Hormonal contraceptive use was associated with lower serum NfL and GFAP levels over time, and elevated salivary levels of progesterone were also associated with lower serum NfL levels. These results suggest that detecting increases in serum NfL may be a useful way to monitor cumulative head impact burden in women's contact sports and that female-specific factors, such as hormonal contraceptive use and circulating progesterone levels, may be neuroprotective, warranting further investigations.
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Affiliation(s)
- Megan E. Huibregtse
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Sage H. Sweeney
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Mikayla R. Stephens
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Hu Cheng
- Department of Department of Psychological and Brain Sciences and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Zhongxue Chen
- Department of Mathematics and Statistics, College of Arts, Sciences and Education, Florida International University, Miami, Florida, USA
- Department of Epidemiology and Biostatistics, School of Public Health, and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Hannah J. Block
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
- Department of Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Sharlene D. Newman
- Alabama Life Research Institute, College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
- Department of Electrical and Computer Engineering, College of Engineering, and College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Keisuke Kawata
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
- Department of Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
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Translational models of mild traumatic brain injury tissue biomechanics. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022. [DOI: 10.1016/j.cobme.2022.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhan X, Liu Y, Cecchi NJ, Gevaert O, Zeineh MM, Grant GA, Camarillo DB. Finding the Spatial Co-Variation of Brain Deformation With Principal Component Analysis. IEEE Trans Biomed Eng 2022; 69:3205-3215. [PMID: 35349430 PMCID: PMC9580615 DOI: 10.1109/tbme.2022.3163230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Strain and strain rate are effective traumatic brain injury metrics. In finite element (FE) head model, thousands of elements were used to represent the spatial distribution of these metrics. Owing that these metrics are resulted from brain inertia, their spatial distribution can be represented in more concise pattern. Since head kinematic features and brain deformation vary largely across head impact types (Zhan et al., 2021), we applied principal component analysis (PCA) to find the spatial co-variation of injury metrics (maximum principal strain (MPS), MPS rate (MPSR) and MPS × MPSR) in four impact types: simulation, football, mixed martial arts and car crashes, and used the PCA to find patterns in these metrics and improve the machine learning head model (MLHM). METHODS We applied PCA to decompose the injury metrics for all impacts in each impact type, and investigate the spatial co-variation using the first principal component (PC1). Furthermore, we developed a MLHM to predict PC1 and then inverse-transform to predict for all brain elements. The accuracy, the model complexity and the size of training dataset of PCA-MLHM are compared with previous MLHM (Zhan et al., 2021). RESULTS PC1 explained variance on the datasets. Based on PC1 coefficients, the corpus callosum and midbrain exhibit high variance on all datasets. Finally, the PCA-MLHM reduced model parameters by 74% with a similar MPS estimation accuracy. CONCLUSION The brain injury metric in a dataset can be decomposed into mean components and PC1 with high explained variance. SIGNIFICANCE The spatial co-variation analysis enables better interpretation of the patterns in brain injury metrics. It also improves the efficiency of MLHM.
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Zhan X, Li Y, Liu Y, Cecchi NJ, Gevaert O, Zeineh MM, Grant GA, Camarillo DB. Piecewise Multivariate Linearity Between Kinematic Features and Cumulative Strain Damage Measure (CSDM) Across Different Types of Head Impacts. Ann Biomed Eng 2022; 50:1596-1607. [PMID: 35922726 DOI: 10.1007/s10439-022-03020-0] [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: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
In a previous study, we found that the relationship between brain strain and kinematic features cannot be described by a generalized linear model across different types of head impacts. In this study, we investigate if such a linear relationship exists when partitioning head impacts using a data-driven approach. We applied the K-means clustering method to partition 3161 impacts from various sources including simulation, college football, mixed martial arts, and car crashes. We found piecewise multivariate linearity between the cumulative strain damage (CSDM; assessed at the threshold of 0.15) and head kinematic features. Compared with the linear regression models without partition and the partition according to the types of head impacts, K-means-based data-driven partition showed significantly higher CSDM regression accuracy, which suggested the presence of piecewise multivariate linearity across types of head impacts. Additionally, we compared the piecewise linearity with the partitions based on individual features used in clustering. We found that the partition with maximum angular acceleration magnitude at 4706 rad/s2 led to the highest piecewise linearity. This study may contribute to an improved method for the rapid prediction of CSDM in the future.
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Affiliation(s)
- Xianghao Zhan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Yiheng Li
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
| | - Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
| | - Nicholas J Cecchi
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA.,Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, 94305, USA
| | - Michael M Zeineh
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - David B Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
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Schroeder GG, McClintick DJ, Trikha R, Kremen TJ. Injuries Affecting Intercollegiate Water Polo Athletes: A Descriptive Epidemiologic Study. Orthop J Sports Med 2022; 10:23259671221110208. [PMID: 35898203 PMCID: PMC9310270 DOI: 10.1177/23259671221110208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are few data on injuries suffered by collegiate water polo athletes. Purpose To describe the epidemiology of injuries suffered by National College Athletic Association (NCAA) male and female water polo players by using injury surveillance data over a 5-year period. Study Design Descriptive epidemiology study. Methods Deidentified data on all water polo injuries and illnesses recorded in the Pac-12 Sports Injury Research Archive from July 2016 through June 2021 were obtained and analyzed. Three men's and 4 women's teams were observed for the entire 5-year period, and 1 men's and 1 women's team was observed from July 2018 through June 2021. Results During the observation period, 729 injuries were recorded in the database, with no differences in overall injury rates between male and female athletes (relative risk [RR] = 1.0; 95% CI, 0.9-1.2); 33.7% of injuries required a physician encounter, and 3.6% required surgery. The shoulder was the most injured body part, making up 20.6% of all injuries, followed by the head/face (18.8%) and hand/wrist/forearm (11.7%). Shoulder tendinopathy was the most common shoulder injury diagnosis (4.5% of all injuries). Concussion was the most common injury diagnosis overall, making up 11.4% of injuries, and 81.9% of concussions occurred outside of competition. Male athletes were significantly more likely than female athletes to have a concussion in an off-season practice (RR, 3.25; 95% CI, 1.2-8.8) and via contact with another player (RR, 2.9; 95% CI, 1.3-6.4). Half of the 26 surgical procedures occurring over the observation period were for chronic joint trauma of the groin/hip/pelvis/buttock, with 9 of those 13 being for femoroacetabular impingement specifically. Conclusion Among NCAA water polo athletes, the shoulder was the most injured body part; however, shoulder injuries rarely required missed time from sport or necessitated surgical intervention. Concussions were the most common injury diagnosis, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition. Femoroacetabular impingement was found to be the dominant diagnosis for which surgical intervention was required.
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Affiliation(s)
- Grant G Schroeder
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Rishi Trikha
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas J Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Salivary S100 calcium-binding protein beta (S100B) and neurofilament light (NfL) after acute exposure to repeated head impacts in collegiate water polo players. Sci Rep 2022; 12:3439. [PMID: 35236877 PMCID: PMC8891257 DOI: 10.1038/s41598-022-07241-0] [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: 09/03/2021] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
Blood-based biomarkers of brain injury may be useful for monitoring brain health in athletes at risk for concussions. Two putative biomarkers of sport-related concussion, neurofilament light (NfL), an axonal structural protein, and S100 calcium-binding protein beta (S100B), an astrocyte-derived protein, were measured in saliva, a biofluid which can be sampled in an athletic setting without the risks and burdens associated with blood sampled by venipuncture. Samples were collected from men’s and women’s collegiate water polo players (n = 65) before and after a competitive tournament. Head impacts were measured using sensors previously evaluated for use in water polo, and video recordings were independently reviewed for the purpose of validating impacts recorded by the sensors. Athletes sustained a total of 107 head impacts, all of which were asymptomatic (i.e., no athlete was diagnosed with a concussion or more serious). Post-tournament salivary NfL was directly associated with head impact frequency (RR = 1.151, p = 0.025) and cumulative head impact magnitude (RR = 1.008, p = 0.014), while controlling for baseline salivary NfL. Change in S100B was not associated with head impact exposure (RR < 1.001, p > 0.483). These patterns suggest that repeated head impacts may cause axonal injury, even in asymptomatic athletes.
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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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Wang J, Abdella Kemal M. Comparison of the Metabolites of Water Polo Players before and after Competition by the Metabolomic Approach. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7600835. [PMID: 34336166 PMCID: PMC8318763 DOI: 10.1155/2021/7600835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
Background The metabolic characteristics of body fluids of excellent water polo players before and after competition have not been reported. The purpose of the study was to compare the metabolites in the urine of water polo players before and after competition by 1H-NMR-based metabolomic approach. Methods Twenty-six young water polo players participated in the study voluntarily. The urine and blood samples of players were collected one week before competition (A), immediately after competition (B), and one week after competition (C). Metabolomic analysis was conducted on the urine samples. Urine routine items and biochemical indicators in blood samples were detected. Results Metabolomic results showed that the contents of eleven metabolites including lactic acid, acetoacetate, and succinic acid in the urine of the subjects increased and four metabolites such as dimethylamine, choline, and glucose decreased at stage B. Most metabolites at stage C had basically returned to the levels at stage A. Pyruvate metabolism, pantothenate and CoA biosynthesis, synthesis, and degradation of ketone bodies were mainly involved in the above process. Urine conventional analysis results showed that the urine pH decreased dramatically and the levels of PRO and URO significantly increased at stage B, and the three indicators had similar values between stages A and C. The other indicators did not have obvious difference among the three stages. Analysis of blood biochemical indicators showed that the levels of LDH, BUN, CK, and AST significantly increased at stage B and did not show an obvious difference between stages A and C. The results are helpful for coaches to arrange the athletes' diet reasonably and to conduct scientific training for athletes.
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Affiliation(s)
- Jingjing Wang
- School of Physical Education, Shanxi University, Taiyuan 030006, China
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14
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Croteau F, Brown H, Pearsall D, Robbins SM. Prevalence and mechanisms of injuries in water polo: a systematic review. BMJ Open Sport Exerc Med 2021; 7:e001081. [PMID: 34150321 PMCID: PMC8183217 DOI: 10.1136/bmjsem-2021-001081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To summarise the information available in the literature on the prevalence of injuries in water polo and injury risk factors. Methods Protocol was registered on Open Science Framework. MEDLINE, CINAHL, Embase and SPORTDiscus databases were searched for keywords relating to water polo and injuries on 3 February 2021. References were searched for additional studies. Only original research papers in English or French were included, and studies without an injured group were excluded. A data extraction file was made based on the Cochrane Collaboration recommendations. Study quality was evaluated with the Newcastle-Ottawa scales for cohorts and a modified version for cross-sectional studies. Results The initial search yielded 581 articles, with 5 more added from reference lists, but only 41 remained after removing duplicates and applying inclusion/exclusion criteria. Thirty-one articles identified the head, fingers and shoulders as the most common sites of injury. Ten articles on mechanism of injury focused mainly on the shoulder, with degenerative changes, posture, scapular alignment, strength, flexibility and overhead shooting kinematics as the main injury risk factors. Publication types included cohort studies, cross-sectional studies, and one case series. Conclusions Most traumatic injuries affect the hands and the head from unexpected contact with the ball or opponents. Conversely, training injuries seem to affect mainly the shoulder area. Low level evidence suggests a correlation between shoulder injuries and lack of strength or flexibility as well as large volumes of overhead throwing. Further prospective research is needed to investigate risk factors for other body areas.
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Affiliation(s)
- Felix Croteau
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Institut national du sport du Quebec, Montreal, Quebec, Canada
| | - Harry Brown
- Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - David Pearsall
- Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Lethbridge- Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada.,PERFORM Centre, Montreal, Quebec, Canada
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15
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Cecchi NJ, Monroe DC, Fote GM, Small SL, Hicks JW. Head impact exposure and concussion in women's collegiate club lacrosse. Res Sports Med 2021; 30:677-682. [PMID: 33998942 DOI: 10.1080/15438627.2021.1929226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study sought to describe head impact exposure in women's collegiate club lacrosse. Eleven women's collegiate club lacrosse players wore head impact sensors during eight intercollegiate competitions. Video recordings of competitions were used to verify impact data. Athletes completed questionnaires detailing their concussion history and perceived head impact exposure. During the monitored games, no diagnosed concussions were sustained. Three athletes reported sustaining head impacts (median = 0; range: 0-3 impacts per game). Six impacts registered by the sensors were verified on video across a total of 81 athlete-game exposures. Verified impacts had a median peak linear acceleration of 21.0 g (range: 18.3 g - 48.3 g) and peak rotational acceleration of 1.1 krad/s2 (range: 0.7 krad/s2 - 5.7 krad/s2). Women competing in collegiate club lacrosse are at a low risk of sustaining head impacts, comparable to previous reports of the high school and collegiate varsity levels of play.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, California, USA
| | - Derek C Monroe
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - Gianna M Fote
- Department of Biological Chemistry, University of California, Irvine, Irvine, California, USA
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, California, USA.,School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, California, USA
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16
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Melchiorri G, Viero V, Bianchi D, Tancredi V, Bonifazi M, Campagna A, Triossi T. New aspects for match analysis to improve understanding of game scenario and training organization in top-level male water polo players. J Sports Med Phys Fitness 2021; 62:485-491. [PMID: 33871237 DOI: 10.23736/s0022-4707.21.12189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We intended to verify through time-motion analysis the characteristics of the sequences of actions in terms of occurrence during water polo matches: number, duration, and possible relationships with technical-tactical aspects. METHODS Water polo matches played at the 18th FINA World Championships 2019 were chosen for examination, and the analysis involved both single actions and Trains of Actions (ToAs). A ToA is a sequence of actions that occurs during the match without actual game interruption. RESULTS A total of 1261 game actions were evaluated in the 17 matches analyzed. In 89% of cases the actions occurred in ToAs while in 11% of cases they took place as single actions. On average, each match included 74.4±5.3 actions; of these, only 7.9±3.4 (C.I. at 95%: lower bound 6.1 and upper bound 9.6) were single actions while 66.2±5.5 occurred in sequences (ToA2 = 29.6 ± 9.0%; ToA3 = 26.1 ± 9.7%; ToA4 = 16.5 ± 10.6%). The winning team performed on average more actions than the losing one (42.1±6.1 vs 32.0±6.4; effect size: 1.67; p value: 0.001). The ToAs had different compositions, from 2 to 18 actions, and then very different durations, from about 1 minute up to 8 minutes. 66% of goals were scored after ToAs and 34% after single actions. CONCLUSIONS The study of ToAs provides useful information on the physiological demand of the game, which may help to plan and organize physical training making it as specific as possible. The description of ToAs, can help coaches to better define the game scenario and understand which technical and tactical measures are needed to improve game organization.
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Affiliation(s)
- Giovanni Melchiorri
- Department of Systems Medicine, School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.,Italian Swimming Federation, Rome, Italy.,Don Gnocchi Foundation IRCS, Milan, Italy
| | - Valerio Viero
- Italian Swimming Federation, Rome, Italy - .,School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Bianchi
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Virginia Tancredi
- Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Bonifazi
- Italian Swimming Federation, Rome, Italy.,Department of Medical, Surgical and Neuroscience Sciences, University of Siena, Siena, Italy
| | | | - Tamara Triossi
- Italian Swimming Federation, Rome, Italy.,School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Monroe DC, Blumenfeld RS, Keator DB, Solodkin A, Small SL. One season of head-to-ball impact exposure alters functional connectivity in a central autonomic network. Neuroimage 2020; 223:117306. [PMID: 32861790 PMCID: PMC7822072 DOI: 10.1016/j.neuroimage.2020.117306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/26/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022] Open
Abstract
Repetitive head impacts represent a risk factor for neurological impairment in team-sport athletes. In the absence of symptoms, a physiological basis for acute injury has not been elucidated. A basic brain function that is disrupted after mild traumatic brain injury is the regulation of homeostasis, instantiated by activity across a specific set of brain regions that comprise a central autonomic network. We sought to relate head-to-ball impact exposure to changes in functional connectivity in a core set of central autonomic regions and then to determine the relation between changes in brain and changes in behavior, specifically cognitive control. Thirteen collegiate men's soccer players and eleven control athletes (golf, cross-country) underwent resting-state fMRI and behavioral testing before and after the season, and a core group of cortical, subcortical, and brainstem regions was selected to represent the central autonomic network. Head-to-ball impacts were recorded for each soccer player. Cognitive control was assessed using a Dot Probe Expectancy task. We observed that head-to-ball impact exposure was associated with diffuse increases in functional connectivity across a core CAN subnetwork. Increased functional connectivity between the left insula and left medial orbitofrontal cortex was associated with diminished proactive cognitive control after the season in those sustaining the greatest number of head-to-ball impacts. These findings encourage measures of autonomic physiology to monitor brain health in contact and collision sport athletes.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States.
| | - Robert S Blumenfeld
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; Department of Psychology, California State Polytechnic University, 3801 West Temple Avenue, Pomona, CA 91768, United States
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, 163 Irvine Hall, Irvine, CA 92697- 3960, United States
| | - Ana Solodkin
- Department of Anatomy and Neurobiology, University of California-Irvine, B240 Medical Science, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
| | - Steven L Small
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
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Monroe DC, Cecchi NJ, Gerges P, Phreaner J, Hicks JW, Small SL. A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players. Front Neurol 2020; 11:218. [PMID: 32300329 PMCID: PMC7145392 DOI: 10.3389/fneur.2020.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r(16) > 0.626, p < 0.03 corrected], global efficiency [r(16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r(16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r(16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F(4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Paul Gerges
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Jenna Phreaner
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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19
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Cecchi NJ, Monroe DC, Phreaner JJ, Small SL, Hicks JW. Patterns of head impact exposure in men's and women's collegiate club water polo. J Sci Med Sport 2020; 23:927-931. [PMID: 32303477 DOI: 10.1016/j.jsams.2020.03.008] [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: 12/23/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Recent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo. DESIGN Prospective cohort study. METHODS Head impact sensors (SIM-G, Triax Technologies) were worn by men's (n=16) and women's (n=15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts. RESULTS Men's players sustained 52 verified head impacts of magnitude 39.7±16.3g PLA and 5.2±3.2 krad/s2 PRA, and women's players sustained 43 verified head impacts of magnitude 33.7±12.6g PLA and 4.0±2.8krad/s2 PRA. Impacts sustained by men had greater PLA than those sustained by women (p=.045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent's torso or limb. CONCLUSIONS Our cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
| | - Derek C Monroe
- Department of Neurology, University of California-Irvine, United States.
| | - Jenna J Phreaner
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
| | - Steven L Small
- Department of Neurology, University of California-Irvine, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
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20
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Cecchi NJ, Oros TJ, Monroe DC, Fote GM, Moscoso WX, Hicks JW, Reinkensmeyer DJ. The Effectiveness of Protective Headgear in Attenuating Ball-to-Forehead Impacts in Water Polo. Front Sports Act Living 2019; 1:2. [PMID: 33344926 PMCID: PMC7739673 DOI: 10.3389/fspor.2019.00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Recent reports have demonstrated that there is a serious risk of head impact and injury in water polo. The use of protective headgear in contact sports is a commonly accepted strategy for reducing the risk of head injury, but there are few available protective headgears for use in water polo. Many of those that are available are banned by the sport's governing bodies due to a lack of published data supporting the effectiveness of those headgears in reducing head impact kinematics. To address this gap in knowledge, we launched a water polo ball at the forehead of an anthropomorphic testing device fitted with either a standard water polo headgear or one of two protective headgears. We selected a range of launch speeds representative of those observed across various athlete ages. Mixed-model ANOVAs revealed that, relative to standard headgear, protective headgears reduced peak linear acceleration (by 10.8-21.6%; p < 0.001), and peak rotational acceleration (by 24.5-48.5%; p < 0.001) induced by the simulated ball-to-forehead impacts. We discuss the possibility of using protective headgears in water polo to attenuate head impact kinematics.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States.,Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Theophil J Oros
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Gianna M Fote
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, United States
| | - Wyatt X Moscoso
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - David J Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
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