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Abdolmohammadi B, Tuz-Zahra F, Uretsky M, Nicks R, Mosaheb S, Labonte J, Yhang E, Durape S, Martin B, Palmisano J, Nowinski C, Cherry JD, Alvarez VE, Huber BR, Dams-O’Connor K, Crary J, Dwyer B, Daneshvar DH, Goldstein LE, Au R, Katz DI, Kowall NW, Cantu RC, Stern RA, Alosco ML, Stein TD, Tripodis Y, McKee AC, Mez J. Duration of Ice Hockey Play and Chronic Traumatic Encephalopathy. JAMA Netw Open 2024; 7:e2449106. [PMID: 39630446 PMCID: PMC11618473 DOI: 10.1001/jamanetworkopen.2024.49106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 10/14/2024] [Indexed: 12/08/2024] Open
Abstract
Importance Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHIs). Prior research suggests a dose-response association between American football play duration and CTE risk and severity, but this association has not been studied for ice hockey. Objective To investigate associations of duration of ice hockey play with CTE diagnosis and severity, functional status, and dementia. Design, Setting, and Participants This cross-sectional study was conducted among male brain donors in the Understanding Neurological Injury and Traumatic Encephalopathy and Framingham Heart Study Brain Banks whose primary RHI exposure was from ice hockey. Donors died, brains were donated, and data were collected between July 1997 and January 2023. Data analysis was conducted from January 2023 to May 2024. Exposures Ice hockey years played as an RHI proxy. Main Outcomes and Measures CTE neuropathological diagnosis, cumulative phosphorylated tau (ptau) burden across 11 brain regions commonly affected in CTE, informant-reported Functional Activities Questionnaire (FAQ) score at death, and consensus dementia diagnosis were assessed. Results Among 77 male donors (median [IQR] age, 51 [33-73] years), 42 individuals (54.5%) had CTE, including 27 of 28 professional players (96.4%). CTE was found in 5 of 26 donors (19.2%) who played fewer than 13 years, 14 of 27 donors (51.9%) who played 13 to 23 years, and 23 of 24 donors (95.8%) who played more than 23 years of hockey. Increased years played was associated with increased odds for CTE (odds ratio [OR] per 1-year increase, 1.34; 95% CI, 1.15-1.55; P < .001) and with increased ptau burden (SD increase per 1-year increase = 0.037; 95% CI, 0.017-0.057; P < .001) after adjusting for age at death, other contact sports played, age of first hockey exposure, concussion count, and hockey position. Simulation demonstrated that years played remained associated with CTE when years played and CTE were both associated with brain bank selection across widely ranging scenarios (median [full range] OR across all simulations, 1.34 [1.29-1.40]). Increased ptau burden was associated with FAQ score (βstandardized = 0.045; 95% CI, 0.021-0.070; P < .001) and dementia (OR per SD increase, 1.12; 95% CI, 1.01-1.26; P = .04) after adjusting for age at death, other contact sports played, hockey years played, enforcer status, age of first hockey exposure, concussion count, and hockey position. Conclusions and Relevance In this study of male former ice hockey players, a dose-response association was observed between hockey years played and risk and severity of CTE. Simulation suggested that brain bank selection may not bias the magnitude of outcomes in the association.
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Affiliation(s)
- Bobak Abdolmohammadi
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Raymond Nicks
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Sydney Mosaheb
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jacob Labonte
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Eukyung Yhang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Shruti Durape
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Christopher Nowinski
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Jonathan D. Cherry
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Victor E. Alvarez
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Crary
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Daniel H. Daneshvar
- Department of Rehabilitation Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lee E. Goldstein
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Rhoda Au
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Neil W. Kowall
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
- Department of Neurosurgery, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Neurosurgery, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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2
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Gellner RA, Begonia MT, Wood M, Rockwell L, Geiman T, Jung C, Rowson S. Instrumented Mouthguard Decoupling Affects Measured Head Kinematic Accuracy. Ann Biomed Eng 2024; 52:2854-2871. [PMID: 38955890 PMCID: PMC11402849 DOI: 10.1007/s10439-024-03550-9] [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: 02/20/2024] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Abstract
Many recent studies have used boil-and-bite style instrumented mouthguards to measure head kinematics during impact in sports. Instrumented mouthguards promise greater accuracy than their predecessors because of their superior ability to couple directly to the skull. These mouthguards have been validated in the lab and on the field, but little is known about the effects of decoupling during impact. Decoupling can occur for various reasons, such as poor initial fit, wear-and-tear, or excessive impact forces. To understand how decoupling influences measured kinematic error, we fit a boil-and-bite instrumented mouthguard to a 3D-printed dentition mounted to a National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform. We also instrumented the headform with linear accelerometers and angular rate sensors at its center of gravity (CG). We performed a series of pendulum impact tests, varying impactor face and impact direction. We measured linear acceleration and angular velocity, and we calculated angular acceleration from the mouthguard and the headform CG. We created decoupling conditions by varying the gap between the lower jaw and the bottom face of the mouthguard. We tested three gap conditions: 0 mm (control), 1.6 mm, and 4.8 mm. Mouthguard measurements were transformed to the CG and compared to the reference measurements. We found that gap condition, impact duration, and impact direction significantly influenced mouthguard measurement error. Error was higher for larger gaps and in frontal (front and front boss) conditions. Higher errors were also found in padded conditions, but the mouthguards did not collect all rigid impacts due to inherent limitations. We present characteristic decoupling time history curves for each kinematic measurement. Exemplary frequency spectra indicating characteristic decoupling frequencies are also described. Researchers using boil-and-bite instrumented mouthguards should be aware of their limitations when interpreting results and should seek to address decoupling through advanced post-processing techniques when possible.
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Affiliation(s)
- Ryan A Gellner
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA.
| | - Mark T Begonia
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
| | - Matthew Wood
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
| | - Lewis Rockwell
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
| | - Taylor Geiman
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
| | - Caitlyn Jung
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
| | - Steve Rowson
- Virginia Tech (Biomedical Engineering and Mechanics), Blacksburg, VA, USA
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3
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Aguiar OMG, Chow TR, Chong H, Vakili O, Robinovitch SN. Associations between the circumstances and severity of head impacts in men's university ice hockey. Sci Rep 2023; 13:17402. [PMID: 37833303 PMCID: PMC10575878 DOI: 10.1038/s41598-023-43785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Improved evidence on the most common and severe types of head impacts in ice hockey can guide efforts to preserve brain health through improvements in protective gear, rink design, player training, and rules of play. In this observational cohort study of men's university hockey, we compared video evidence on the circumstances of 234 head impacts to measures of head impact severity (peak linear accelerations and rotational velocities) from helmet-mounted sensors (GForceTracker). Videos were analyzed with a validated questionnaire, and paired with helmet sensor data. Shoulder-to-head impacts were more common than hand- or elbow-, but there were no differences in head impact severity between upper limb contact sites (p ≥ 0.2). Head-to-glass impacts were nearly four times more common, and just as severe as head-to-board impacts (p ≥ 0.4). Head impacts resulting in major penalties (versus no penalty), or visible signs of concussion (versus no signs), involved greater head rotational velocities (p = 0.038 and 0.049, respectively). Head impacts occurred most often to the side of the head, along the boards to players in their offensive zone without puck possession. Head impact severity did not differ between cases where the head was (versus was not) the primary site of contact (p ≥ 0.6). Furthermore, penalties were called in only 4% of cases where the head was the initial point of contact. Accordingly, rules that focus on primary targeting of the head, while important and in need of improved enforcement, offer a limited solution.
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Affiliation(s)
- Olivia M G Aguiar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Tim R Chow
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Omid Vakili
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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4
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Wahlquist VE, Buckley TA, Caccese JB, Glutting JJ, Royer TD, Kaminski TW. Quantitative Analysis of Ball-Head Impact Exposure in Youth Soccer Players. J Sports Sci Med 2023; 22:591-596. [PMID: 37711709 PMCID: PMC10499164 DOI: 10.52082/jssm.2023.591] [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: 06/27/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
Since the implementation of the US Soccer heading guidelines released in 2015, little to no research on ball-head impact exposure in the United States youth soccer population has been conducted. The purpose was to compare ball-head impact exposure across sex and age in youth soccer players over a weekend tournament. Ten male and female games for each age group (Under-12 [U12], U13, and U14) were video recorded at a weekend tournament for a total of 60 games. Ball-head impact exposure for each game was then coded following a review of each recording. Male players were 2.8 times more likely to have ball-head impacts than female players, (p < 0.001) particularly in the U14 age group when compared to the U12 age group (p = 0.012). Overall 92.4% of players experienced 0-1 ball-head impacts per game with the remaining players experiencing 2+ ball-head impacts per game. Ball-head impact exposure levels are low in the youth players. Most youth soccer players do not head the soccer ball during match play and those that did, only headed the ball on average once per game. Overall, the difference in ball-head impact exposure per player was less than 1 between all the groups, which may have no clinical meaning.
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Affiliation(s)
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, USA
| | | | - Todd D Royer
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
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5
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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: 1] [Impact Index Per Article: 0.5] [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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6
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Butterfield J, Post A, Karton C, Robidoux MA, Gilchrist M, Hoshizaki TB. A video analysis examination of the frequency and type of head impacts for player positions in youth ice hockey and FE estimation of their impact severity. Sports Biomech 2023:1-17. [PMID: 36911883 DOI: 10.1080/14763141.2023.2186941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This research employed head impact frequency and frequency of estimated strain to analyse the influence of player position on brain trauma in U15 and U18 youth ice hockey. The methods involved a video analysis of 30 U15 and 30 U18 games where frequency, type of head impact event, and player position during impact was recorded. These impacts were then simulated in the laboratory using physical reconstructions and finite element modelling to determine the brain strains for each impact category. U15 forwards experienced significantly higher head impact frequencies (139) when compared to defenceman (50), with goalies showing the lowest frequency (6) (p < 0.05). U18 forwards experienced significantly higher head impact frequencies (220) when compared to defenceman (92), with goalies having the least frequent head impacts (4) (p < 0.05). The U15 forwards had a significantly higher frequency of head impacts at the very low and med strains and the U18s had higher frequency of head impacts for the very low and low level strains (p < 0.05). Game rule changes and equipment innovation may be considered to mitigate the increased risk faced by forwards compared to other positions in U15 and U18 youth ice hockey.
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Affiliation(s)
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Clara Karton
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael Gilchrist
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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7
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Marks ME, Holcomb TD, Pritchard NS, Miller LE, Espeland MA, Miles CM, Moore JB, Foley KL, Stitzel JD, Urban JE. Characterizing Exposure to Head Acceleration Events in Youth Football Using an Instrumented Mouthpiece. Ann Biomed Eng 2022; 50:1620-1632. [PMID: 36274103 PMCID: PMC9815159 DOI: 10.1007/s10439-022-03097-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 01/11/2023]
Abstract
Understanding characteristics of head acceleration events (HAEs) in youth football is vital in developing strategies to improve athlete safety. This study aimed to characterize HAEs in youth football using an instrumented mouthpiece. Youth football athletes (ages 11-13) participating on two teams were enrolled in this study for one season. Each athlete was instrumented with a mouthpiece-based sensor throughout the season. HAEs were verified on film to ensure that mouthpiece-based sensors triggered during contact. The number of HAEs, peak resultant linear and rotational accelerations, and peak resultant rotational velocity were quantified. Mixed effects models were used to evaluate differences in mean kinematic metrics among all HAEs for session type, athlete position, and contact surface. A total of 5,292 HAEs were collected and evaluated from 30 athletes. The median (95th percentile) peak resultant linear acceleration, rotational acceleration, and rotational velocity was 9.5 g (27.0 g), 666.4 rad s-2 (1863.3 rad s-2), and 8.5 rad s-1 (17.4 rad s-1), respectively. Athletes experienced six (22) HAEs per athlete per session (i.e., practice, game). Competition had a significantly higher mean number of HAEs per athlete per session and mean peak rotational acceleration. Peak resultant rotational kinematics varied significantly among athlete positions. Direct head impacts had higher mean kinematics compared to indirect HAEs, from body collisions. The results of this study demonstrate that session type, athlete position, and contact surface (i.e., direct, indirect) may influence HAE exposure in youth football.
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Affiliation(s)
- Madison E Marks
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Ty D Holcomb
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christopher M Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Justin B Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA.
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA.
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8
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Arbogast KB, Caccese JB, Buckley TA, McIntosh AS, Henderson K, Stemper BD, Solomon G, Broglio SP, Funk JR, Crandall JR. Consensus Head Acceleration Measurement Practices (CHAMP): Origins, Methods, Transparency and Disclosure. Ann Biomed Eng 2022; 50:1317-1345. [PMID: 35920964 PMCID: PMC9652170 DOI: 10.1007/s10439-022-03025-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
The use of head kinematic measurement devices has recently proliferated owing to technology advances that make such measurement more feasible. In parallel, demand to understand the biomechanics of head impacts and injury in sports and the military has increased as the burden of such loading on the brain has received focused attention. As a result, the field has matured to the point of needing methodological guidelines to improve the rigor and consistency of research and reduce the risk of scientific bias. To this end, a diverse group of scientists undertook a comprehensive effort to define current best practices in head kinematic measurement, culminating in a series of manuscripts outlining consensus methodologies and companion summary statements. Summary statements were discussed, revised, and voted upon at the Consensus Head Acceleration Measurement Practices (CHAMP) Conference in March 2022. This manuscript summarizes the motivation and methods of the consensus process and introduces recommended reporting checklists to be used to increase transparency and rigor of future experimental design and publication of work in this field. The checklists provide an accessible means for researchers to apply the best practices summarized in the companion manuscripts when reporting studies utilizing head kinematic measurement in sport and military settings.
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Affiliation(s)
- Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, 2716 South St., PA, 19146, Philadelphia, USA. .,Department of Pediatrics, University of Pennsylvania, PA, Philadelphia, USA.
| | - Jaclyn B Caccese
- The Ohio State University Chronic Brain Injury Program, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Andrew S McIntosh
- McIntosh Consultancy and Research, Sydney, NSW, Australia.,Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia.,School of Engineering, Edith Cowan University, Perth, WA, Australia
| | | | - Brian D Stemper
- Joint Department of Biomedical Engineering, Medical College of Wisconsin & Marquette University, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research, Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Gary Solomon
- National Football League Player Health and Safety, New York, NY, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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9
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Head Kinematics in Youth Ice Hockey by Player Speed and Impact Direction. J Appl Biomech 2022; 38:201-209. [PMID: 35894976 DOI: 10.1123/jab.2021-0331] [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] [Received: 10/21/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
Hockey is a fast-paced sport known for body checking, or intentional collisions used to separate opponents from the puck. Exposure to these impacts is concerning, as evidence suggests head impact exposure (HIE), even if noninjurious, can cause long-term brain changes. Currently, there is limited understanding of the effect of impact direction and collision speed on HIE. Video analysis was used to determine speed and direction for 162 collisions from 13 youth athletes. These data were paired with head kinematic data collected with an instrumented mouthpiece. Relationships between peak resultant head kinematics and speeds were evaluated with linear regression. Mean athlete speeds and relative velocity between athletes ranged from 2.05 to 2.76 m/s. Mean peak resultant linear acceleration, rotational velocity, and rotational acceleration were 13.1 g, 10.5 rad/s, and 1112 rad/s2, respectively. Significant relationships between speeds and head kinematics emerged when stratified by contact characteristics. HIE also varied by direction of collision; most collisions occurred in the forward-oblique (ie, offset from center) direction; frontal collisions had the greatest magnitude peak kinematics. These findings indicate that HIE in youth hockey is influenced by speed and direction of impact. This study may inform future strategies to reduce the severity of HIE in hockey.
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10
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Swenson AG, Pritchard NS, Miller LE, Urban JE, Stitzel JD. Characterization of head impact exposure in boys' youth ice hockey. Res Sports Med 2021:1-11. [PMID: 34689676 DOI: 10.1080/15438627.2021.1989433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.
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Affiliation(s)
- Abigail G Swenson
- Department of Neuroscience, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - N Stewart Pritchard
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
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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: 12] [Impact Index Per Article: 3.0] [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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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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13
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Fitzpatrick D, Thompson P, Kipps C, Webborn N. Head impact forces in blind football are greater in competition than training and increased cervical strength may reduce impact magnitude. Int J Inj Contr Saf Promot 2021; 28:194-200. [PMID: 33781178 DOI: 10.1080/17457300.2021.1905667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Paralympic Blind Association Football has the highest rate of injury of any Paralympic sport and head injuries are common. This study aims to quantify head impact incidence and magnitude in Blind Football, and to examine contributing factors. This Observational study based on a Blind Football Team comprising seven male athletes 28.63 years (SD 9.74, range 16-46) over 6 months. Head mounted impact sensors were used to measure the frequency and location of impacts, as well as their linear acceleration and rotational velocity. Cervical isometric strength and proprioception was measured. There were 374 impacts recorded in 212.5 athlete hours. There was a higher rate of impacts in matches than training (Incidence Risk Ratio 2.58, 95% CI 2.01-3.30). Greater cervical strength was associated with reduced linear acceleration of impacts (R2 = 0.1912, p = .020). Blind Football players are exposed to a greater number of head impacts in matches than training. Neck muscle strength may influence magnitude of head impact forces in this sport but further study is required to further investigate.
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Affiliation(s)
- Daniel Fitzpatrick
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Brighton, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | | | - Courtney Kipps
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Brighton, UK
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14
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Caccese JB, Bodt BA, Iverson GL, Kaminski TW, Bryk K, Oldham J, Broglio SP, McCrea M, McAllister T, Buckley TA. Estimated Age of First Exposure to Contact Sports and Neurocognitive, Psychological, and Physical Outcomes in Healthy NCAA Collegiate Athletes: A Cohort Study. Sports Med 2021; 50:1377-1392. [PMID: 32002824 DOI: 10.1007/s40279-020-01261-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Collegiate football players who started playing tackle football before age 12 years did not show worse neuropsychological test performance than those who started playing tackle football after age 12 years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performance, greater psychological distress, or worse postural stability in collegiate student athletes. OBJECTIVE The purpose of this study was to examine the association between estimated age of first exposure (eAFE) to repetitive head impacts (RHI) and these outcome measures in collegiate student athletes. METHODS 1891 female and 4448 male collision/contact (i.e., football, ice hockey, lacrosse, wrestling, soccer) and non-contact (i.e., golf, rifle, rowing/crew, swimming, tennis) sport athletes completed baseline testing, including the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory 18 (BSI-18), and Balance Error Scoring System (BESS). RESULTS For women, the eAFE-by-sport interaction was associated with ImPACT Verbal Memory and Visual Memory, whereby earlier eAFE to contact sports was associated with higher composite scores (B = - 0.397, B = - 0.485, respectively). For men, the eAFE-by-sport interaction was associated with BSI-18 Depression and Global Severity Index and symptom severity scores, whereby earlier eAFE to football was associated with lower psychological distress and symptom severity [Depression, Exp(B) = 1.057; Global Severity Index, Exp(B) = 1.047; Symptom Severity, Exp(B) = 1.046]. Parameter estimates were small suggesting these results may have minimal practical relevance. CONCLUSION Findings suggest that RHI during early adolescence is unrelated to brain health as measured by these specific outcome measures in collegiate student athletes.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, 43210, USA
| | - Barry A Bodt
- College of Health Sciences, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA.,Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown, MA, 20129, USA
| | - Thomas W Kaminski
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 541 S. College Ave, Newark, DE, 19716, USA
| | - Kelsey Bryk
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Jessie Oldham
- The Micheli Center for Sports Injury Prevention, Boston Children's Hospital, 9 Hope Ave, Waltham, MA, 02453, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, 401 Washtenaw Ave, Ann Arbor, MI, 48104, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Thomas McAllister
- Indiana University School of Medicine, Goodman Hall, 355 W. 16th St., Suite 4800, Indianapolis, IN, 46202, USA
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 100 Discovery Blvd, Newark, DE, 19713, USA.
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15
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Eagle SR, Kontos AP, Collins MW, Connaboy C, Flanagan SD. Network Analysis of Sport-Related Concussion Research During the Past Decade (2010-2019). J Athl Train 2021; 56:454353. [PMID: 33543307 PMCID: PMC8063657 DOI: 10.4085/1062-6050-0280.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Research into sport-related concussion (SRC) has grown substantially over the past decade, yet no authors to date have synthesized developments over this critical time period. OBJECTIVE To apply a network-analysis approach in evaluating trends in the SRC literature using a comprehensive search of original, peer-reviewed research articles involving human participants published between January 1, 2010, and December 15, 2019. DESIGN Narrative review. MAIN OUTCOME MEASURE(S) Bibliometric maps were derived from a comprehensive search of all published, peer-reviewed SRC articles in the Web of Science database. A clustering algorithm was used to evaluate associations among journals, organizations or institutions, authors, and key words. The online search yielded 6130 articles, 528 journals, 7598 authors, 1966 organizations, and 3293 key words. RESULTS The analysis supported 5 thematic clusters of journals: (1) biomechanics/sports medicine (n = 15), (2) pediatrics/rehabilitation (n = 15), (3) neurotrauma/neurology/neurosurgery (n = 11), (4) general sports medicine (n = 11), and (5) neuropsychology (n = 7). The analysis identified 4 organizational clusters of hub institutions: (1) University of North Carolina (n = 19), (2) University of Toronto (n = 19), (3) University of Michigan (n = 11), and (4) University of Pittsburgh (n = 10). Network analysis revealed 8 clusters for SRC key words, each with a central topic area: (1) epidemiology (n = 14), (2) rehabilitation (n = 12), (3) biomechanics (n = 11), (4) imaging (n = 10), (5) assessment (n = 9), (6) mental health/chronic traumatic encephalopathy (n = 9), (7) neurocognition (n = 8), and (8) symptoms/impairments (n = 5). CONCLUSIONS The findings suggest that during the past decade SRC research has (1) been published primarily in sports medicine, pediatric, and neuro-focused journals, (2) involved a select group of researchers from several key institutions, and (3) concentrated on new topical areas, including treatment or rehabilitation and mental health.
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Affiliation(s)
- Shawn R. Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, PA
| | | | | | - Chris Connaboy
- Neuromuscular Research Laboratory, University of Pittsburgh, PA
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16
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Karton C, Post A, Laflamme Y, Kendall M, Cournoyer J, Robidoux MA, Gilchrist MD, Hoshizaki TB. Exposure to brain trauma in six age divisions of minor ice hockey. J Biomech 2020; 116:110203. [PMID: 33412437 DOI: 10.1016/j.jbiomech.2020.110203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 12/14/2022]
Abstract
Acute and chronic neurological risks associated with brain trauma sustained in professional ice hockey has generated concern for youth participants. Minor hockey is a different game when compared to elite players presenting distinctive risk factors for each age division. Objective measures of brain trauma exposure were documented for six divisions in minor ice hockey; U7, U9, U11, U13, U15, U18. Game video analysis, physical reconstruction and computational modelling was employed to capture the event conditions, frequency of impacts, frequency of high strain magnitude (>0.17) impacts, and cumulative trauma. The results showed proportional differences in the event conditions; event type, closing velocity, and head impact location, informing the improvement of age appropriate protection, testing protocols, and safety standards. Frequency of events were highest for U7 when players were learning to skate, and again in U18 as game physicality increases. No significant difference was observed in frequency of high magnitude impacts across age divisions. A peak in high magnitude impacts was empirically observed at both U7 and U15 where skill development in skating and body checking, respectively, were most prominent. Finally, a cumulative trauma metric incorporating frequency and magnitude of impacts provided a detailed analysis of trauma exposure provides for a targeted approach to managing injury risk specific to age division. Objective measures of brain trauma exposure identified in the current study are important to inform strategy, guide legislation and initiate policy for safe play in minor ice hockey.
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Affiliation(s)
- Clara Karton
- University of Ottawa, School of Human Kinetics, Ottawa, Canada.
| | - Andrew Post
- University of Ottawa, School of Human Kinetics, Ottawa, Canada
| | | | | | - Janie Cournoyer
- University of Ottawa, School of Human Kinetics, Ottawa, Canada
| | | | - Michael D Gilchrist
- University College Dublin, School of Mechanical and Materials Engineering, Dublin, Ireland
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17
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MIHALIK JASONP, AMALFE STEPHANIEA, ROBY PATRICIAR, FORD CASSIEB, LYNALL ROBERTC, RIEGLER KAITLINE, TEEL ELIZABETHF, WASSERMAN ERINB, PUTUKIAN MARGOT. Sex and Sport Differences in College Lacrosse and Soccer Head Impact Biomechanics. Med Sci Sports Exerc 2020; 52:2349-2356. [DOI: 10.1249/mss.0000000000002382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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18
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Comparison of head impact measurements via an instrumented mouthguard and an anthropometric testing device. SPORTS ENGINEERING 2020. [DOI: 10.1007/s12283-020-00324-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractThe purpose of this study was to determine and compare the efficacy of head impact measurements via an electronic sensor framework, embedded within a mouthguard, against an anthropometric testing device. Development of the former is in response to the growing issue of head impacts and concussion in rugby union. Testing was conducted in a vehicle safety laboratory using a standard impact protocol utilising the headforms of anthropometric testing devices. The headforms were subjected to controlled front and side impacts. For each impact, the linear acceleration and rotational velocity was measured over a 104-ms interval at a frequency of 1 kHz. The magnitude of peak linear acceleration and peak rotational velocity was determined from the measured time-series traces and statistically compared. The peak linear acceleration and rotational velocity had intraclass correlation coefficients of 0.95 and 0.99, respectively. The root-mean-square error between the measurement systems was 4.3 g with a standard deviation of 3.5 g for peak linear acceleration and 0.7 rad/s with a standard deviation of 0.4 rad/s for rotational velocity. Bland and Altman analysis indicated a systematic bias of 2.5 g and − 0.5 rad/s and limits of agreement (1.96 × standard deviation) of ± 13.1 g and ± 1.25 rad/s for the instrumented mouthguard. These results provide the basis on which the instrumented mouthguard can be further developed for deployment and application within professional rugby, with a view to accurately and reliably quantify head collision dynamics.
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19
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Caccese JB, Iverson GL, Cameron KL, Houston MN, McGinty GT, Jackson JC, O'Donnell P, Pasquina PF, Broglio SP, McCrea M, McAllister T, Buckley TA. Estimated Age of First Exposure to Contact Sports Is Not Associated with Greater Symptoms or Worse Cognitive Functioning in Male U.S. Service Academy Athletes. J Neurotrauma 2019; 37:334-339. [PMID: 31375052 DOI: 10.1089/neu.2019.6571] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study examined the association between estimated age of first exposure (eAFE) to contact sport participation and neurocognitive performance and symptom ratings in U.S. service academy National Collegiate Athletic Association (NCAA) athletes. Male cadets (N = 891), who participate in lacrosse (n = 211), wrestling (n = 170), ice hockey (n = 81), soccer (n = 119), rugby (n = 10), or non-contact sports (n = 298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each neurocognitive domain score and total symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact); eAFE (eAFE <12 years vs. eAFE ≥12 years); group-by-eAFE; and covariates for learning accommodation status, concussion history, and age. The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald χ2 = 0.073, p = 0.788; Visual Memory, Wald χ2 = 2.71, p = 0.100; Visual Motor Speed, Wald χ2 = 0.078, p = 0.780; Reaction Time, Wald χ2 = 0.003, p = 0.955; Symptom Severity, Wald χ2 = 2.87, p = 0.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (χ2 = 6.19, p = 0.013, B = -2.97). Older age was associated with faster reaction time (χ2 = 4.40, p = 0.036, B = -0.006) and lesser symptom severity (χ2 = 5.55, p = 0.019, B = -0.068). No other parameters were significant. We observed no association between eAFE, contact sport participation, neurocognitive functioning, or subjectively experienced symptoms in this cohort. Earlier eAFE to contact sport participation is not related to worse neurocognitive performance or greater subjectively experienced symptoms in male U.S. service academy NCAA athletes.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts; Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Gerald T McGinty
- United States Air Force Academy, U.S. Air Force Academy, Colorado
| | | | - Patrick O'Donnell
- United States Coast Guard Academy Regional Clinic, New London, Connecticut
| | - Paul F Pasquina
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences; Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan
| | - Michael McCrea
- Medical College of Wisconsin, Department of Neurosurgery, Milwaukee, Wisconsin
| | | | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware.,Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
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Head Impact Biomechanics Differ Between Girls and Boys Youth Ice Hockey Players. Ann Biomed Eng 2019; 48:104-111. [PMID: 31435751 DOI: 10.1007/s10439-019-02343-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
The influence of sex on head impact biomechanics is unknown for youth ice hockey. We sought to determine sex differences in head impact severity and frequency in youth ice hockey players. Male (n = 110) and female (n = 25) players (13-16 years old) were recruited from a local hockey organization. Players wore helmets instrumented with the Head Impact Telemetry System for all competitions and practices throughout the season. Seven team-seasons were captured. Random intercepts general mixed linear models determined whether linear acceleration and rotational acceleration differed by sex. Linear regression models evaluated the relationship between sex and impact frequency. All head impact biomechanics were natural log-transformed as their distributions were right-skewed. Females sustained fewer impacts per player than males (27 fewer impacts per player-season, p < 0.0001) even when analysis was limited to games only (21 fewer impacts per player-season, p < 0.0001). The linear acceleration was higher among females (1.07 g; 95% CI 1.00, 1.13; p = 0.04). There were no other meaningful sex differences in head impact severity. Female players are not permitted to body check, and this likely explains why they sustain fewer head impacts than males. However, as a result, females likely sustain a higher proportion of head impacts through illegal or unintentional head contact, and these impacts may result in more force being delivered to the head.
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Video corroboration of player incurred impacts using trunk worn sensors among national ice-hockey team members. PLoS One 2019; 14:e0218235. [PMID: 31233527 PMCID: PMC6590802 DOI: 10.1371/journal.pone.0218235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/30/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Video corroboration of player incurred impacts (PII) using trunk-worn wearable sensors (WS) among national ice-hockey team members. METHODS 23 members of the U.S. National (NTDP) U18 team consented to procedures approved by EMU Human Subjects Committee. Bioharness-3 (Zephyr, MD) WS recorded occurrences of PII during games and impacts were generated using Impact Processor (Zephyr, MD). Eight players with the top activity levels each game determined by WS, were observed using video and synchronized with game video collected by NTDP staff. Impacts identified by WS of 6-7.9 g (Z3), 8-9.9 g (Z4) and 10+ g (Z5) were used to corroborate PII. Magnitude and duration of each identified impact were compared by category using MANOVA with Tukey post hoc (α = 0.05; SPSS 22.0, IBM, NY). RESULTS Of 419 on-ice impacts, 358 were confirmed true PII (85.5%), 60 as other non-PII (14.3%) and 1 false positive (0.2%). For 358 PII, 17 (4.1%) were 1) Board contact/no check, 74 (17.7%), 2) Board contact/check, 202 (48.2%), 3) Open ice check, 65 (15.5%), 4) Player fall. Of 60 Non-PII, 19 (4.5%) as 5) other form of player to player event, 16 (3.8%) as 6) Hard Stop, 19 (4.5%) as 7) Slapshots and 6 (1.4%) as 8) other identifiable player events. 160 of the 200 Z3 events were PII (80%), 103 of 110 Z4 events (93.6%) and 95 of 109 Z5 events were PII (87.2%). The magnitude of impacts was not different by category, but the duration of category 6 (Hard stop; .058 s) was lower than categories 2, 4 and 7 (.112, .112, .133 s, respectively, p < .05). CONCLUSION These data show that using some limited criteria (e.g. impact magnitude and duration), PII can be identified with relatively high accuracy in ice hockey using trunk-worn wearable sensors.
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Potvin BM, Aguiar OM, Komisar V, Sidhu A, Elabd K, Robinovitch SN. A comparison of the magnitude and duration of linear and rotational head accelerations generated during hand-, elbow- and shoulder-to-head checks delivered by hockey players. J Biomech 2019; 91:43-50. [DOI: 10.1016/j.jbiomech.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
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Caswell SV, Kelshaw P, Lincoln AE, Hepburn L, Dunn R, Cortes N. Game-Related Impacts in High School Boys' Lacrosse. Orthop J Sports Med 2019; 7:2325967119835587. [PMID: 31058198 PMCID: PMC6452429 DOI: 10.1177/2325967119835587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The rate of concussions in boys' lacrosse is reported to be the third highest among high school sports in the United States, but no studies have described game-related impacts among boys' lacrosse players. Purpose To characterize verified game-related impacts, both overall and those directly to the head, in boys' varsity high school lacrosse. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 77 male participants (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.05 m; mean weight, 73.4 ± 12.2 kg) were instrumented with sensors and were videotaped during 39 games. All verified game-related impacts ≥20g were summarized in terms of frequency, peak linear acceleration (PLA), and peak rotational velocity (PRV). Descriptive statistics and impact rates per player-game (PG) with corresponding 95% CIs were calculated. Results Overall, 1100 verified game-related impacts were recorded (PLA: median, 33.5g [interquartile range (IQR), 25.7-51.2]; PRV: median, 1135.5 deg/s [IQR, 790.0-1613.8]) during 795 PGs. The rate for all verified game-related impacts was 1.38 impacts per PG (95% CI, 1.30-1.47). Of these, 680 (61.8%) impacts (PLA: median, 35.9g [IQR, 26.7-55.5]; PRV: 1170.5 deg/s [IQR, 803.2-1672.8]) were directly to the head (impact rate, 0.86 impacts/PG [95% CI, 0.79-0.92]). Overall, midfielders (n = 514; 46.7%) sustained the most impacts, followed by attackers (n = 332; 30.2%), defenders (n = 233; 21.2%), and goalies (n = 21; 1.9%). The most common mechanisms for overall impacts and direct head impacts were contact with player (overall: n = 706 [64.2%]; head: n = 397 [58.4%]) and stick (overall: n = 303 [27.5%]; head: n = 239 [35.1%]), followed by ground (overall: n = 73 [6.6%]; head: n = 26 [3.8%]) and ball (overall: n = 15 [1.4%]; head: n = 15 [2.2%]). Direct head impacts were associated with a helmet-to-helmet collision 31.2% of the time, and they were frequently (53.7%) sustained by the players delivering the impact. Nearly half (48.8%) of players delivering contact used their helmets to initiate contact that resulted in a helmet-to-helmet impact. Players receiving a head impact from player contact were most often unprepared (75.9%) for the collision. Conclusion The helmet is commonly used to initiate contact in boys' high school lacrosse, often targeting defenseless opponents. Interventions to reduce head impacts should address rules and coaching messages to discourage intentional use of the helmet and encourage protection of defenseless opponents.
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Affiliation(s)
- Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | - Patricia Kelshaw
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | - Andrew E Lincoln
- MedStar Sports Medicine, Baltimore, Maryland, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., USA
| | - Lisa Hepburn
- MedStar Sports Medicine, Baltimore, Maryland, USA
| | | | - Nelson Cortes
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
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Carey L, Stanwell P, Terry DP, McIntosh AS, Caswell SV, Iverson GL, Gardner AJ. Verifying Head Impacts Recorded by a Wearable Sensor using Video Footage in Rugby League: a Preliminary Study. SPORTS MEDICINE - OPEN 2019; 5:9. [PMID: 30874938 PMCID: PMC6419663 DOI: 10.1186/s40798-019-0182-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/27/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Rugby league is a full-contact collision sport with an inherent risk of concussion. Wearable instrumented technology was used to observe and characterize the level of exposure to head impacts during game play. PURPOSE To verify the impacts recorded by the x-patch™ with video analysis. STUDY DESIGN Observational case series. METHODS The x-patch™ was used on eight men's semi-professional rugby league players during the 2016 Newcastle Rugby League competition (five forwards and three backs). Game day footage was recorded by a trained videographer using a single camera located at the highest midfield location to verify the impact recorded by the x-patch™. Videographic and accelerometer data were time synchronized. RESULTS The x-patch™ sensors recorded a total of 779 impacts ≥ 20 g during the games, of which 732 (94.0%) were verified on video. In addition, 817 impacts were identified on video that did not record an impact on the sensors. The number of video-verified impacts ≥ 20 g, per playing hour, was 7.8 for forwards and 4.8 for backs (range = 3.9-19.0). Impacts resulting in a diagnosed concussion had much greater peak linear acceleration (M = 76.1 g, SD = 17.0) than impacts that did not result in a concussion (M = 34.2g, SD = 18.0; Cohen's d = 2.4). CONCLUSIONS The vast majority (94%) of impacts ≥ 20 g captured by the x-patch™ sensor were video verified in semi-professional rugby league games. The use of a secondary source of information to verify impact events recorded by wearable sensors is beneficial in clarifying game events and exposure levels.
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Affiliation(s)
- Lauchlan Carey
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales Australia
| | - Peter Stanwell
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales Australia
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA
- Spaulding Rehabilitation Hospital, Boston, MA USA
- MassGeneral Hospital for Children™ Sport Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA USA
| | - Andrew S. McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Perth, Western Australia Australia
- Monash University Accident Research Centre, Monash University, Clayton, Victoria Australia
| | - Shane V. Caswell
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA
- Spaulding Rehabilitation Hospital, Boston, MA USA
- MassGeneral Hospital for Children™ Sport Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA USA
| | - Andrew J. Gardner
- Hunter New England Local Health District Sports Concussion Program, New Lambton Heights, New South Wales Australia
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales Australia
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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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26
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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: 11] [Impact Index Per Article: 1.8] [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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Laboratory Evaluation of Low-Cost Wearable Sensors for Measuring Head Impacts in Sports. J Appl Biomech 2018; 34:320-326. [DOI: 10.1123/jab.2017-0256] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Advances in low-cost wearable head impact sensor technology provide potential benefits regarding sports safety for both consumers and researchers. However, previous laboratory evaluations are not directly comparable and do not incorporate test conditions representative of unhelmeted impacts. This study addresses those limitations. The xPatch by X2 Biosystems and the SIM-G by Triax Technologies were placed on a National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform with a Hybrid III neck which underwent impact tests using a pendulum. Impact conditions included helmeted, padded impactor to bare head, and rigid impactor to bare head to represent long- and short-duration impacts seen in helmeted and unhelmeted sports. The wearable sensors were evaluated on their kinematic accuracy by comparing results to reference sensors located at the headform center of gravity. Statistical tests for equivalence were performed on the slope of the linear regression between wearable sensors and reference. The xPatch gave equivalent measurements to the reference in select longer-duration impacts, whereas the SIM-G had large variance leading to no equivalence. For the short-duration impacts, both wearable sensors underpredicted the reference. This error can be improved with increases in sampling rate from 1 to 1.5 kHz. Follow-up evaluations should be performed on the field to identify error in vivo.
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Abstract
OBJECTIVE To determine whether players with heavier faceguards have increased odds of sustaining top of the head impacts and head impacts of higher severity. DESIGN Cohort study. SETTING On-field. PARTICIPANTS Thirty-five division I collegiate football players. INTERVENTIONS Faceguard mass was measured. Head impact location and severity (linear acceleration [gravity], rotational acceleration [radian per square second], and Head Impact Technology severity profile [unitless]) were captured for 19 379 total head impacts at practices using the Head Impact Telemetry System. MAIN OUTCOME MEASURES Players' faceguards were categorized as either heavier (>480 g) or lighter (≤480 g) using a median split. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for sustaining top of the head impacts between faceguard groups using a random intercepts generalized logit model. We compared head impact severity between groups using random intercepts general linear models (α = 0.05). Player position was included in all models. RESULTS Overall, the 4 head impact locations were equally distributed across faceguard groups (F(3,26) = 2.16, P = 0.117). Football players with heavier faceguards sustained a higher proportion impacts to the top of the head (24.7% vs 17.5%) and had slightly increased odds of sustaining top (OR, 1.72; 95% CI, 1.01-2.94) head impacts rather than front of the head impacts. CONCLUSIONS Football players wearing heavier faceguards might be slightly more prone to sustaining a higher proportion of top of the head impacts, suggesting that greater faceguard mass may make players more likely to lower their head before collision. Individuals involved with equipment selection should consider the potential influence of faceguard design on head impact biomechanics when recommending the use of a heavier faceguard.
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Caswell SV, Lincoln AE, Stone H, Kelshaw P, Putukian M, Hepburn L, Higgins M, Cortes N. Characterizing Verified Head Impacts in High School Girls' Lacrosse. Am J Sports Med 2017; 45:3374-3381. [PMID: 28918649 DOI: 10.1177/0363546517724754] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Girls' high school lacrosse players have higher rates of head and facial injuries than boys. Research indicates that these injuries are caused by stick, player, and ball contacts. Yet, no studies have characterized head impacts in girls' high school lacrosse. PURPOSE To characterize girls' high school lacrosse game-related impacts by frequency, magnitude, mechanism, player position, and game situation. STUDY DESIGN Descriptive epidemiology study. METHODS Thirty-five female participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered during 28 games in the 2014 and 2015 lacrosse seasons. Participants wore impact sensors affixed to the right mastoid process before each game. All game-related impacts recorded by the sensors were verified using game video. Data were summarized for all verified impacts in terms of frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Descriptive statistics and impact rates were calculated. RESULTS Fifty-eight verified game-related impacts ≥20 g were recorded (median PLA, 33.8 g; median PRA, 6151.1 rad/s2) during 467 player-games. The impact rate for all game-related verified impacts was 0.12 per athlete-exposure (AE) (95% CI, 0.09-0.16), equivalent to 2.1 impacts per team game, indicating that each athlete suffered fewer than 2 head impacts per season ≥20 g. Of these impacts, 28 (48.3%) were confirmed to directly strike the head, corresponding with an impact rate of 0.05 per AE (95% CI, 0.00-0.10). Overall, midfielders (n = 28, 48.3%) sustained the most impacts, followed by defenders (n = 12, 20.7%), attackers (n = 11, 19.0%), and goalies (n = 7, 12.1%). Goalies demonstrated the highest median PLA and PRA (38.8 g and 8535.0 rad/s2, respectively). The most common impact mechanisms were contact with a stick (n = 25, 43.1%) and a player (n = 17, 29.3%), followed by the ball (n = 7, 12.1%) and the ground (n = 7, 12.1%). One hundred percent of ball impacts occurred to goalies. Most impacts occurred to field players within the attack area of the field (n = 32, 55.2%) or the midfield (n = 18, 31.0%). Most (95%) impacts did not result in a penalty. CONCLUSION The incidence of verified head impacts in girls' high school lacrosse was quite low. Ball to head impacts were associated with the highest impact magnitudes. While stick and body contacts are illegal in girls' high school lacrosse, rarely did such impacts to the head result in a penalty. The verification of impact mechanisms using video review is critical to collect impact sensor data.
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Affiliation(s)
- Shane V Caswell
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | | | - Hannah Stone
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | - Patricia Kelshaw
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | | | - Lisa Hepburn
- MedStar Sports Medicine, Baltimore, Maryland, USA
| | | | - Nelson Cortes
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
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Schmitt KU, Muser MH, Thueler H, Bruegger O. Crash-test dummy and pendulum impact tests of ice hockey boards: greater displacement does not reduce impact. Br J Sports Med 2017; 52:41-46. [PMID: 29084724 PMCID: PMC5754856 DOI: 10.1136/bjsports-2017-097735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND One injury mechanism in ice hockey is impact with the boards. We investigated whether more flexible hockey boards would provide less biomechanical loading on impact than did existing (reference) boards. METHODS We conducted impact tests with a dynamic pendulum (mass 60 kg) and with crash test dummies (ES-2 dummy, 4.76 m/s impact speed). Outcomes were biomechanical loading experienced by a player in terms of head acceleration, impact force to the shoulder, spine, abdomen and pelvis as well as compression of the thorax. RESULTS The more flexible board designs featured substantial displacement at impact. Some so-called flexible boards were displaced four times more than the reference board. The new boards possessed less stiffness and up to 90 kg less effective mass, reducing the portion of the board mass a player experienced on impact, compared with boards with a conventional design. Flexible boards resulted in a similar or reduced loading for all body regions, apart from the shoulder. The displacement of a board system did not correlate directly with the biomechanical loading. CONCLUSIONS Flexible board systems can reduce the loading of a player on impact. However, we found no correlation between the displacement and the biomechanical loading; accordingly, displacement alone was insufficient to characterise the overall loading of a player and thus the risk of injury associated with board impact. Ideally, the performance of boards is assessed on the basis of parameters that show a good correlation to injury risk.
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Affiliation(s)
| | | | | | - Othmar Bruegger
- Bfu-Swiss Council for Accident Prevention, Berne, Switzerland
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Cortes N, Lincoln AE, Myer GD, Hepburn L, Higgins M, Putukian M, Caswell SV. Video Analysis Verification of Head Impact Events Measured by Wearable Sensors. Am J Sports Med 2017; 45:2379-2387. [PMID: 28541813 DOI: 10.1177/0363546517706703] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wearable sensors are increasingly used to quantify the frequency and magnitude of head impact events in multiple sports. There is a paucity of evidence that verifies head impact events recorded by wearable sensors. PURPOSE To utilize video analysis to verify head impact events recorded by wearable sensors and describe the respective frequency and magnitude. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Thirty male (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.06 m; mean weight, 73.4 ± 12.2 kg) and 35 female (mean age, 16.2 ± 1.3 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) players volunteered to participate in this study during the 2014 and 2015 lacrosse seasons. Participants were instrumented with GForceTracker (GFT; boys) and X-Patch sensors (girls). Simultaneous game video was recorded by a trained videographer using a single camera located at the highest midfield location. One-third of the field was framed and panned to follow the ball during games. Videographic and accelerometer data were time synchronized. Head impact counts were compared with video recordings and were deemed valid if (1) the linear acceleration was ≥20 g, (2) the player was identified on the field, (3) the player was in camera view, and (4) the head impact mechanism could be clearly identified. Descriptive statistics of peak linear acceleration (PLA) and peak rotational velocity (PRV) for all verified head impacts ≥20 g were calculated. RESULTS For the boys, a total recorded 1063 impacts (2014: n = 545; 2015: n = 518) were logged by the GFT between game start and end times (mean PLA, 46 ± 31 g; mean PRV, 1093 ± 661 deg/s) during 368 player-games. Of these impacts, 690 were verified via video analysis (65%; mean PLA, 48 ± 34 g; mean PRV, 1242 ± 617 deg/s). The X-Patch sensors, worn by the girls, recorded a total 180 impacts during the course of the games, and 58 (2014: n = 33; 2015: n = 25) were verified via video analysis (32%; mean PLA, 39 ± 21 g; mean PRV, 1664 ± 619 rad/s). CONCLUSION The current data indicate that existing wearable sensor technologies may substantially overestimate head impact events. Further, while the wearable sensors always estimated a head impact location, only 48% of the impacts were a result of direct contact to the head as characterized on video. Using wearable sensors and video to verify head impacts may decrease the inclusion of false-positive impacts during game activity in the analysis.
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Affiliation(s)
- Nelson Cortes
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
| | | | - Gregory D Myer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa Hepburn
- MedStar Health Research Institute, Baltimore, Maryland, USA
| | | | | | - Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia, USA
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Reed N, Taha T, Greenwald R, Keightley M. Player and Game Characteristics and Head Impacts in Female Youth Ice Hockey Players. J Athl Train 2017; 52:771-775. [PMID: 28715282 DOI: 10.4085/1062-6050-52.5.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Despite the growing popularity of ice hockey among female youth and interest in the biomechanics of head impacts in sport, the head impacts sustained by this population have yet to be characterized. OBJECTIVES To describe the number of, biomechanical characteristics of, and exposure to head impacts of female youth ice hockey players during competition and to investigate the influences of player and game characteristics on head impacts. DESIGN Cohort study. METHODS Twenty-seven female youth ice hockey players (mean age = 12.5 ± 0.52 years) wore instrumented ice hockey helmets during 66 ice hockey games over a 3-year period. Data specific to player, game, and biomechanical head impact characteristics were recorded. A multiple regression analysis identified factors most associated with head impacts of greater frequency and severity. RESULTS A total of 436 total head impacts were sustained during 6924 minutes of active ice hockey participation (0.9 ± 0.6 impacts per player per game; range, 0-2.1). A higher body mass index (BMI) significantly predicted a higher number of head impacts sustained per game (P = .008). Linear acceleration of head impacts was greater in older players and those who played the forward position, had a greater BMI, and spent more time on the ice (P = .008), whereas greater rotational acceleration was present in older players who had a greater BMI and played the forward position (P = .008). During tournament games, increased ice time predicted increased severity of head impacts (P = .03). CONCLUSIONS This study reveals for the first time that head impacts are occurring in female youth ice hockey players, albeit at a lower rate and severity than in male youth ice hockey players, despite the lack of intentional body checking.
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Affiliation(s)
- Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
| | - Tim Taha
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Richard Greenwald
- Simbex, Lebanon, NH.,Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Michelle Keightley
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
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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: 112] [Impact Index Per Article: 14.0] [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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VIRANI SHANE, RUSSELL COLINN, BRUSCHETTA MEGANL, HUA KEVINNGOC, POTVIN BRIGITTEM, COX DAVIDN, ROBINOVITCH STEPHENN. The Effect of Shoulder Pad Design on Head Impact Severity during Checking. Med Sci Sports Exerc 2017; 49:573-580. [DOI: 10.1249/mss.0000000000001136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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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: 55] [Impact Index Per Article: 6.1] [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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Sensor Fusion and Smart Sensor in Sports and Biomedical Applications. SENSORS 2016; 16:s16101569. [PMID: 27669260 PMCID: PMC5087358 DOI: 10.3390/s16101569] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
The following work presents an overview of smart sensors and sensor fusion targeted at biomedical applications and sports areas. In this work, the integration of these areas is demonstrated, promoting a reflection about techniques and applications to collect, quantify and qualify some physical variables associated with the human body. These techniques are presented in various biomedical and sports applications, which cover areas related to diagnostics, rehabilitation, physical monitoring, and the development of performance in athletes, among others. Although some applications are described in only one of two fields of study (biomedicine and sports), it is very likely that the same application fits in both, with small peculiarities or adaptations. To illustrate the contemporaneity of applications, an analysis of specialized papers published in the last six years has been made. In this context, the main characteristic of this review is to present the largest quantity of relevant examples of sensor fusion and smart sensors focusing on their utilization and proposals, without deeply addressing one specific system or technique, to the detriment of the others.
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Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA, Sproule DW, Tyson AM, Duma SM. Biomechanical Perspectives on Concussion in Sport. Sports Med Arthrosc Rev 2016; 24:100-7. [PMID: 27482775 PMCID: PMC4975525 DOI: 10.1097/jsa.0000000000000121] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussions can occur in any sport. Often, clinical and biomechanical research efforts are disconnected. This review paper analyzes current concussion issues in sports from a biomechanical perspective and is geared toward Sports Med professionals. Overarching themes of this review include the biomechanics of the brain during head impact, role of protective equipment, potential population-based differences in concussion tolerance, potential intervention strategies to reduce the incidence of injury, and common biomechanical misconceptions.
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Affiliation(s)
- Steven Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
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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: 4.7] [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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Accelerometers for the Assessment of Concussion in Male Athletes: A Systematic Review and Meta-Analysis. Sports Med 2016; 47:469-478. [DOI: 10.1007/s40279-016-0582-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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43
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Broglio SP, Williams RM, O'Connor KL, Goldstick J. Football Players' Head-Impact Exposure After Limiting of Full-Contact Practices. J Athl Train 2016; 51:511-8. [PMID: 27333460 DOI: 10.4085/1062-6050-51.7.04] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Sporting organizations limit full-contact football practices to reduce concussion risk and based on speculation that repeated head impacts may result in long-term neurodegeneration. OBJECTIVE To directly compare head-impact exposure in high school football players before and after a statewide restriction on full-contact practices. DESIGN Cross-sectional study. SETTING High school football field. PATIENTS OR OTHER PARTICIPANTS Participants were varsity football athletes from a single high school. Before the rule change, 26 athletes (age = 16.2 ± 0.8 years, height = 179.6 ± 6.4 cm, weight = 81.9 ± 13.1 kg) participated. After the rule change, 24 athletes (age = 15.9 ± 0.8 years, height = 178.3 ± 6.5 cm, weight = 76.2 ± 11.6 kg) participated. Nine athletes participated in both years of the investigation. MAIN OUTCOME MEASURE(S) Head-impact exposure was monitored using the Head Impact Telemetry System while the athletes participated in football games and practices in the seasons before and after the rule change. Head-impact frequency, location, and magnitude (ie, linear acceleration, rotational acceleration, and Head Impact Telemetry severity profile [HITsp], respectively) were measured. RESULTS A total of 15 398 impacts (592 impacts per player per season) were captured before the rule change and 8269 impacts (345 impacts per player per season) after the change. An average 42% decline in impact exposure occurred across all players, with practice-exposure declines occurring among linemen (46% decline); receivers, cornerbacks, and safeties (41% decline); and tight ends, running backs (including fullbacks), and linebackers (39% decline). Impact magnitudes remained largely unchanged between the years. CONCLUSIONS A rule change limiting full-contact high school football practices appears to have been effective in reducing head-impact exposure across all players, with the largest reduction occurring among linemen. This finding is likely associated with the rule modification, particularly because the coaching staff and offensive scheme remained consistent, yet how this reduction influences concussion risk and long-term cognitive health remains unknown.
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Affiliation(s)
- Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor.,Injury Center, University of Michigan, Ann Arbor
| | | | | | - Jason Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor.,Injury Center, University of Michigan, Ann Arbor
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44
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Schmidt JD, Pierce AF, Guskiewicz KM, Register-Mihalik JK, Pamukoff DN, Mihalik JP. Safe-Play Knowledge, Aggression, and Head-Impact Biomechanics in Adolescent Ice Hockey Players. J Athl Train 2016; 51:366-72. [PMID: 27111585 DOI: 10.4085/1062-6050-51.5.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Addressing safe-play knowledge and player aggression could potentially improve ice hockey sport safety. OBJECTIVES To compare (1) safe-play knowledge and aggression between male and female adolescent ice hockey players and (2) head-impact frequency and severity between players with high and low levels of safe-play knowledge and aggression during practices and games. DESIGN Cohort study. SETTING On field. PATIENTS OR OTHER PARTICIPANTS Forty-one male (n = 29) and female (n = 12) adolescent ice hockey players. INTERVENTION(S) Players completed the Safe Play Questionnaire (0 = less knowledge, 7 = most knowledge) and Competitive Aggressiveness and Anger Scale (12 = less aggressive, 60 = most aggressive) at midseason. Aggressive penalty minutes were recorded throughout the season. The Head Impact Telemetry System was used to capture head-impact frequency and severity (linear acceleration [g], rotational acceleration [rad/s(2)], Head Impact Technology severity profile) at practices and games. MAIN OUTCOME MEASURE(S) One-way analyses of variance were used to compare safe play knowledge and aggression between sexes. Players were categorized as having high or low safe-play knowledge and aggression using a median split. A 2 × 2 mixed-model analysis of variance was used to compare head-impact frequency, and random-intercept general linear models were used to compare head-impact severity between groups (high, low) and event types (practice, game). RESULTS Boys (5.8 of 7 total; 95% confidence interval [CI] = 5.3, 6.3) had a trend toward better safe-play knowledge compared with girls (4.9 of 7 total; 95% CI = 3.9, 5.9; F1,36 = 3.40, P = .073). Less aggressive male players sustained significantly lower head rotational accelerations during practices (1512.8 rad/s (2) , 95% CI = 1397.3, 1637.6 rad/s(2)) versus games (1754.8 rad/s (2) , 95% CI = 1623.9, 1896.2 rad/s(2)) and versus high-aggression players during practices (1773.5 rad/s (2) , 95% CI = 1607.9, 1956.3 rad/s (2) ; F1,26 = 6.04, P = .021). CONCLUSIONS Coaches and sports medicine professionals should ensure that athletes of all levels, ages, and sexes have full knowledge of safe play and should consider aggression interventions for reducing head-impact severity among aggressive players during practice.
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Affiliation(s)
- Julianne D Schmidt
- Department of Kinesiology and Concussion Research Laboratory, University of Georgia, Athens
| | - Alice F Pierce
- Carolina Family Practice and Sports Medicine - A Duke Health Clinic, Cary, NC
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Derek N Pamukoff
- Department of Kinesiology, California State University at Fullerton
| | - Jason P Mihalik
- Department of Exercise and Sport Science, Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, and Injury Prevention Research Center, University of North Carolina at Chapel Hill
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Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015; 43:2429-43. [PMID: 25822907 PMCID: PMC4569651 DOI: 10.1007/s10439-015-1278-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
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46
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Campbell KR, Warnica MJ, Levine IC, Brooks JS, Laing AC, Burkhart TA, Dickey JP. Laboratory Evaluation of the gForce Tracker™, a Head Impact Kinematic Measuring Device for Use in Football Helmets. Ann Biomed Eng 2015. [DOI: 10.1007/s10439-015-1391-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Saigal R, Berger MS. The long-term effects of repetitive mild head injuries in sports. Neurosurgery 2015; 75 Suppl 4:S149-55. [PMID: 25232880 DOI: 10.1227/neu.0000000000000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
At least 300 000 sports-related concussions occur in the United States annually. With millions of American athletes, the long-term effects of repeated concussion or mild traumatic brain injury are an important topic. Unfortunately, there is a lack of strong data on the causality or prevalence of long-term effects among athletes. Chronic traumatic encephalopathy (CTE), a progressive neurodegenerative tauopathy, with associated clinical, behavioral, and neuropathological findings, is an important clinical entity in need of further study. Diffusion tensor imaging can elucidate trauma-induced white matter damage, but the diagnosis of CTE cannot be proven until postmortem neuropathology shows characteristic neurofibrillary and astrocytic tangles. Concern exists that athletes subject to repeated concussive and even subconcussive blows may be at risk of CTE, but no definitive data exist due to the difficulty in diagnosis. Animal models suggest that mild traumatic brain injuries lead to primarily a metabolic derangement with increased excitotoxic neurotransmitter release, extracellular potassium, and intracellular calcium. Further understanding of the underlying pathophysiology may eventually lead to better therapeutic and diagnostic options for the treating clinician.
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Affiliation(s)
- Rajiv Saigal
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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48
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Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015. [PMID: 25822907 DOI: 10.1007/s10439-015-1278-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
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49
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Grant JA, Bedi A, Kurz J, Bancroft R, Gagnier JJ, Miller BS. Ability of preseason body composition and physical fitness to predict the risk of injury in male collegiate hockey players. Sports Health 2015; 7:45-51. [PMID: 25553212 PMCID: PMC4272692 DOI: 10.1177/1941738114540445] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Injuries in collegiate ice hockey can result in significant time lost from play. The identification of modifiable risk factors relating to a player’s physical fitness allows the development of focused training and injury prevention programs targeted at reducing these risks. Purpose: To determine the ability of preseason fitness outcomes to predict in-season on-ice injury in male collegiate ice hockey players. Study Design: Prognostic cohort study. Level of Evidence: Level 3. Methods: Athlete demographics, percentage body fat, aerobic capacity (300-m shuttle run; 1-, 1.5-, 5-mile run), and strength assessment (sit-ups, push-ups, grip strength, bench press, Olympic cleans, squats) data were collected at the beginning of 8 successive seasons for 1 male collegiate ice hockey team. Hockey-related injury data and player-level practice/game athlete exposure (AE) data were also prospectively collected. Seventy-nine players participated (203 player-years). Injury was defined as any event that resulted in the athlete being unable to participate in 1 or more practices or games following the event. Multivariable logistic regression was performed to determine the ability of the independent variables to predict the occurrence of on-ice injury. Results: There were 132 injuries (mean, 16.5 per year) in 55 athletes. The overall injury rate was 4.4 injuries per 1000 AEs. Forwards suffered 68% of the injuries. Seventy percent of injuries occurred during games with equal distribution between the 3 periods. The mean number of days lost due to injury was 7.8 ± 13.8 (range, 1-127 days). The most common mechanism of injury was contact with another player (54%). The odds of injury in a forward was 1.9 times (95% CI, 1.1-3.4) that of a defenseman and 3 times (95% CI, 1.2-7.7) that of a goalie. The odds of injury if the player’s body mass index (BMI) was ≥25 kg/m2 was 2.1 times (95% CI, 1.1-3.8) that of a player with a BMI <25 kg/m2. The odds ratios for bench press, maximum sit-ups, and Olympic cleans were statistically significant but close to 1.0, and therefore the clinical relevance is unknown. Conclusion: Forwards have higher odds of injury relative to other player positions. BMI was predictive of on-ice injury. Aerobic fitness and maximum strength outcomes were not strongly predictive of on-ice injury.
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Affiliation(s)
- John A Grant
- Department of Surgery, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan ; Department of Athletics, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Kurz
- School of Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Richard Bancroft
- Department of Athletics, University of Michigan, Ann Arbor, Michigan
| | - Joel J Gagnier
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan ; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bruce S Miller
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan ; Department of Athletics, University of Michigan, Ann Arbor, Michigan
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Measurement of Hybrid III Head Impact Kinematics Using an Accelerometer and Gyroscope System in Ice Hockey Helmets. Ann Biomed Eng 2014; 43:1896-906. [DOI: 10.1007/s10439-014-1197-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
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