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Eliason PH, Galarneau JM, Babul S, Mrazik M, Bonfield S, Schneider KJ, Hagel BE, Emery CA. Safe2Play in youth ice hockey: injury profile and risk factors in a 5-year Canadian longitudinal cohort study. Ann Med 2024; 56:2385024. [PMID: 39189073 DOI: 10.1080/07853890.2024.2385024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/04/2023] [Accepted: 04/09/2024] [Indexed: 08/28/2024] Open
Abstract
INTRODUCTION Ice hockey is a popular global sport with growing participation for boys and girls yet remains a high-risk sport for injury. While the evidence for some risk factors, such as bodychecking policy is well established, other risk factors such as player sex have been understudied. The objectives of this study were to examine factors associated with rates of game-related injury, game-related injury resulting in >7 days of time-loss, and practice-related injury in youth ice hockey. MATERIALS AND METHODS Safe2Play was a five-year prospective cohort study (2013-2018). All injuries were identified using validated injury surveillance methodology. Multilevel Poisson regression (adjusting for cluster by team and including multiple imputation of missing covariates) was used to estimate incidence rate ratios (IRRs) for player sex, age group, bodychecking policy, year of play, level of play, weight, previous injury within last 12 months, previous lifetime concussion history, and position. RESULTS A total of 4418 male and female ice hockey players (representing 6584 player-seasons) participating in under-13 (ages 11-12), under-15 (ages 13-14) and under-18 (ages 15-17) age groups were recruited. There were 1184 game-related and 182 practice-related injuries. Factors associated with game-related injury included female sex (IRR = 1.57; 95% CI: 1.18-2.08), previous injury (IRR = 1.46; 95% CI: 1.26-1.70) and lifetime concussion history (IRR = 1.41; 95% CI: 1.23-1.62). Goaltenders had a lower rate of injury (IRR = 0.54; 95% CI: 0.40-0.72) relative to forwards, as did players exposed to policy disallowing bodychecking in games (IRR = 0.44; 95% CI: 0.35-0.55). Female sex (IRR = 1.90; 95% CI: 1.10-3.28) and lifetime concussion history were also significantly associated with practice-related injury (IRR = 1.53; 95% CI: 1.08-2.18). CONCLUSIONS Based on data from a large 5-year Canadian youth ice hockey longitudinal cohort, several factors associated with injury were identified. Future injury prevention strategies should consider age, sex, previous concussion and injury history, and body checking leagues. Future research in female youth ice hockey including female-only leagues should be a priority to inform prevention strategies in this understudied population.
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Affiliation(s)
- Paul H Eliason
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Jean-Michel Galarneau
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
| | - Shelina Babul
- Faculty of Medicine, British Columbia Injury Research and Prevention Unit, University of British Columbia, Vancouver, Canada
| | - Martin Mrazik
- Faculty of Education, University of Alberta, Edmonton, Canada
| | - Stephan Bonfield
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
| | - Kathryn J Schneider
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Ezzat B, Lemonick MB, Kalagara R, Schüpper AJ, Carr MT, Gometz A, Lovell M, Choudhri T. Beyond the Impact: Football versus Other Sports in Adolescent Concussion Recovery. World Neurosurg 2024; 189:483-484. [PMID: 38909750 DOI: 10.1016/j.wneu.2024.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
- Bahie Ezzat
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael B Lemonick
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schüpper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew T Carr
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Gometz
- Concussion Management of New York, New York, New York, USA
| | - Mark Lovell
- Lovell Healthcare Foundation, Pittsburgh, Pennsylvania, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Boltz AJ, Garcia RE, Alexander AS, Mihalik JP, Collins CL, Chandran A. Body Checking Injuries in National Collegiate Athletic Association Men's Ice Hockey: Findings From the NCAA Injury Surveillance Program 2009/10 to 2019/20. Clin J Sport Med 2024:00042752-990000000-00213. [PMID: 38980686 DOI: 10.1097/jsm.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/31/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE To describe the epidemiology of body checking injuries in the National Collegiate Athletic Association (NCAA) Men's Ice Hockey. DESIGN Secondary data analysis of historical cohort data. SETTING A convenience sample of injuries in NCAA Men's Ice Hockey during the 2009/10 to 2019/20 academic years. PATIENTS OR PARTICIPANTS NCAA student-athletes. INDEPENDENT VARIABLES Event type, season, time loss, body part, diagnosis, player position, and mechanism. MAIN OUTCOME MEASURES This study examined injuries that occurred during practice or competition, regardless of time loss, reported to the NCAA Injury Surveillance Program. Injury counts, rates, and proportions were used. The injury rate and proportion ratios with 95% confidence intervals were also constructed. Three independent logistic regression models were constructed to examine differential odds of time loss (≥1 day; TL) injury and the 2 most common injuries, between body checking injuries and all other injuries. RESULTS Overall, 1290 body checking injuries (rate = 1.59/1000 athlete-exposures) were reported during the study period. Most were attributed to the upper extremity (42%) or head/neck (27%). The competition injury rate generally decreased after 2012/13. After adjusting for covariates, odds of (1) a TL injury was lower and (2) an acromioclavicular sprain was higher among body checking injuries as compared with injuries attributed to all other activities. Odds of concussion was not associated with body checking injuries. CONCLUSIONS Body checking injuries were frequently attributed to the head/neck and upper extremities, and the rate of these injuries during competition appeared to be decreasing. Still, improvements in helmet and shoulder pad technology may further improve health and safety.
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Affiliation(s)
- Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan
| | - Reagan E Garcia
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
| | - Andrew S Alexander
- Mayo Clinic Department of Physical Medicine & Rehabilitation, Rochester, Minnesota; and
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
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Tucker R, Hester B, Hendricks S, Brown J, Falvey ÉC. Sanctioned illegal high tackles significantly increase concussion risk to both tacklers and ball carriers in elite men's Rugby Union. BMJ Open Sport Exerc Med 2024; 10:e001932. [PMID: 38974094 PMCID: PMC11227814 DOI: 10.1136/bmjsem-2024-001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives Tackles making contact above the sternum increase concussion and head injury assessment (HIA) risk in Rugby Union. The sport has introduced harsher sanctions to change tackler behaviours to reduce this risk. This increased high tackle sanction numbers, though it is unknown whether sanction severity is associated with injury risk. Methods The sanction decision made by match officials for tackles resulting in 157 HIA1 removals, of which 91 were confirmed concussions, was evaluated. The propensity of sanction types, ranging from no foul play to red card, was compared after calculating concussion and HIA1 numbers per 1000 tackles of each sanction, using total tackle number of each sanction type from one season of two elite professional competitions. Results HIA1 removal and concussion risk increased as sanction severity increased. Red-carded tackles were 271.5 (95% CI 143.8 to 512.6) times more likely to result in concussions than legal tackles. Tacklers and ball carriers were more likely to experience concussions from sanctioned high tackles, with tackler risk 28.5 (95% CI 13.5 to 59.9) times higher for sanctioned high tackles compared with legal tackles, and ball carrier risk elevated 133.7-fold (95% CI 65.5 to 272.8) after sanctioned high tackles. Conclusion Sanctioned high tackles significantly increase concussion and HIA1 risk to both tacklers and ball carriers. Current decision-making frameworks that guide sanction decisions do identify tackle behaviours that elevate clinical risk. Both tacklers and ball carriers would be less likely to experience concussions and head injuries if the frequency of illegal high tackles is decreased.
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Affiliation(s)
- Ross Tucker
- Institute of Sport and Exercise Medicine, Department of Exercise, University of Stellenbosch, Stellenbosch, South Africa
- World Rugby, Dublin, Ireland
| | | | - Sharief Hendricks
- Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport, Department of Human Biology, University of Cape Tow, Observatory, Western Cape, South Africa
| | - James Brown
- Institute of Sport and Exercise Medicine, Department of Exercise, University of Stellenbosch, Stellenbosch, South Africa
| | - Éanna C Falvey
- World Rugby, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
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Tuttle MC, Power CJ, Dalbo VJ, Scanlan AT. Intensity Zones and Intensity Thresholds Used to Quantify External Load in Competitive Basketball: A Systematic Review. Sports Med 2024:10.1007/s40279-024-02058-5. [PMID: 38888854 DOI: 10.1007/s40279-024-02058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Despite widespread use of intensity zones to quantify external load variables in basketball research, the consistency in identifying zones and accompanying intensity thresholds using predominant monitoring approaches in training and games remains unclear. OBJECTIVES The purpose of this work was to examine the external load intensity zones and thresholds adopted across basketball studies using video-based time-motion analysis (TMA), microsensors, and local positioning systems (LPS). METHODS PubMed, MEDLINE, and SPORTDiscus databases were searched from inception until 31 January 2023 for studies using intensity zones to quantify external load during basketball training sessions or games. Studies were excluded if they examined players participating in recreational or wheelchair basketball, were reviews or meta-analyses, or utilized monitoring approaches other than video-based TMA, microsensors, or LPS. RESULTS Following screening, 86 studies were included. Video-based TMA studies consistently classified jogging, running, sprinting, and jumping as intensity zones, but demonstrated considerable variation in classifying low-intensity (standing and walking) and basketball-specific activities. Microsensor studies mostly utilized a single, and rather consistent, threshold to identify only high-intensity activities (> 3.5 m·s-2 for accelerations, decelerations, and changes-in-direction or > 40 cm for jumps), not separately quantifying lower intensity zones. Similarly, LPS studies predominantly quantified only high-intensity activities in a relatively consistent manner for speed (> 18.0 m·s-1) and acceleration/deceleration zones (> 2.0 m·s-2); however, the thresholds adopted for various intensity zones differed greatly to those used in TMA and microsensor research. CONCLUSIONS Notable inconsistencies were mostly evident for low-intensity activities, basketball-specific activities, and between the different monitoring approaches. Accordingly, we recommend further research to inform the development of consensus guidelines outlining suitable approaches when setting external load intensity zones and accompanying thresholds in research and practice.
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Affiliation(s)
- Matthew C Tuttle
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.
| | - Cody J Power
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Vincent J Dalbo
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Aaron T Scanlan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
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deWeber K, Parlee L, Nguyen A, Lenihan MW, Goedecke L. Headguard use in combat sports: position statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024; 52:229-238. [PMID: 37559553 DOI: 10.1080/00913847.2023.2242415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Headguard use is appropriate during some combat sports activities where the risks of injury to the face and ears are elevated. Headguards are highly effective in reducing the incidence of facial lacerations in studies of amateur boxers and are just as effective in other striking sports. They should be used in scenarios - especially sparring prior to competitions - where avoidance of laceration and subsequent exposure to potential blood-borne pathogens is important. Headguards are appropriate where avoidance of auricular injury is deemed important; limited data show a marked reduction in incidence of auricular injury in wrestlers wearing headguards.Headguards should not be relied upon to reduce the risk of concussion or other traumatic brain injury. They have not been shown to prevent these types of injuries in combat sports or other sports, and human studies on the effect of headguards on concussive injury are lacking. While biomechanical studies suggest they reduce linear and rotational acceleration of the cranium, changes in athlete behavior to more risk-taking when wearing headguards may offset any risk reduction. In the absence of high-quality studies on headguard use, the Association of Ringside Physicians recommends that further research be conducted to clarify the role of headguards in all combat sports, at all ages of participation. Furthermore, in the absence of data on gender differences, policies should be standardized for men and women.
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Affiliation(s)
- Kevin deWeber
- Sports Medicine, SW Washington Sports Medicine Fellowship, Vancouver, Wa, USA
| | - Lindsay Parlee
- Family Medicine, SW Washington Family Medicine Residency, Vancouver, Wa, USA
| | - Alexander Nguyen
- Family Medicine, Memorial Healthcare System, Fort Lauderdale, Fl, USA
| | | | - Leah Goedecke
- Neuromuscular Medicine, Michigan State University, East Lansing, Mi, USA
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Pensato U, Cortelli P. Soccer (football) and brain health. J Neurol 2024; 271:3019-3029. [PMID: 38558150 PMCID: PMC11136867 DOI: 10.1007/s00415-024-12320-5] [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: 02/21/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
Soccer is one of the most popular sports worldwide, played by over 270 million people and followed by many more. Several brain health benefits are promoted by practising soccer and physical exercise at large, which helps contrast the cognitive decline associated with ageing by enhancing neurogenesis processes. However, sport-related concussions have been increasingly recognised as a pressing public health concern, not only due to their acute impact but also, more importantly, due to mounting evidence indicating an elevated risk for the development of neurological sequelae following recurrent head traumas, especially chronic traumatic encephalopathy (CTE). While soccer players experience less frequent concussions compared with other contact or combat sports, such as American football or boxing, it stands alone in its purposeful use of the head to hit the ball (headings), setting its players apart as the only athletes exposed to intentional, sub-concussive head impacts. Additionally, an association between soccer and amyotrophic lateral sclerosis has been consistently observed, suggesting a potential "soccer-specific" risk factor. In this review, we discuss the neurological sequelae related to soccer playing, the emerging evidence of a detrimental effect related to recurrent headings, and the need for implementation of comprehensive strategies aimed at preventing and managing the burden of head impact in soccer.
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Affiliation(s)
- Umberto Pensato
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy.
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Al Attar WSA, Mahmoud H, Alfadel A, Faude O. Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours. Sports Health 2024; 16:473-480. [PMID: 37204092 PMCID: PMC11025511 DOI: 10.1177/19417381231174461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
CONTEXT A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use. OBJECTIVE The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports. DATA SOURCES A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included. STUDY DESIGN Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1a. DATA EXTRACTION Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours. RESULTS The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79). CONCLUSION This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.
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Affiliation(s)
- Wesam Saleh A. Al Attar
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | - Hayam Mahmoud
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Abdulaziz Alfadel
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Hrabarchuk EI, Hannah T, Kalagara R, Li AY, Schupper AJ, McCarthy L, Ali M, Quinones A, Gometz A, Lovell M, Choudhri TF. Baseline ImPACT Composite Scores in Student-Athletes With Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol 2024; 39:347-354. [PMID: 37824213 DOI: 10.1093/arclin/acad076] [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] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Athletes who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion compared to other athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used concussion tool, but it relies on pre-injury baseline testing that can be affected by psychiatric conditions. This research aims to determine if there are differences in pre-injury testing composite scores in student-athletes with ADHD compared to those without ADHD diagnosis. METHODS We obtained 11,563 pre-season ImPACT assessments of 7,454 student-athletes (ages: 12-22) from 2009 to 2019. After exclusions, there were 6,920 control and 276 ADHD subjects. Multivariable linear regression analyses compared the independent effect of ADHD on the six ImPACT composite score metrics with Bonferroni correction for multiple comparisons with a = 0.008. RESULTS Univariate analyses indicated ADHD is associated with more symptoms as measured by the Post-Concussion Symptom Scale (PCSS) (β = 2.67, 95% CI: 1.47-3.87, p < .0001) and worse Impulse Control scores (β = 0.93, 95% CI: 0.33-1.53, p = .002). In multivariate analysis, this association was the same for symptom score (β = 2.48, 95% CI: 1.22-3.74, p < .0001), but Impulse Control was not significantly different after multiple comparison adjustment (β = 0.87, 95% CI: 0.22-1.15, p = .009). CONCLUSIONS The ADHD subjects reported worse symptoms at baseline and had worse Impulse Control in univariate analysis, but not multivariate analysis. These results can further guide clinicians in concussion diagnosis and test interpretations for student-athletes with ADHD, considering the symptom burden at baseline.
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Affiliation(s)
- Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore Hannah
- Department of Neurosurgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Y Li
- Department of Neurosurgery, University of Rochester School of Medicine, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Physical Medicine and Rehabilitation, Concussion Management of New York, NY, USA
| | - Mark Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Crotti M, Heering T, Lander N, Fox A, Barnett LM, Duncan MJ. Extrinsic Risk Factors for Primary Noncontact Anterior Cruciate Ligament Injury in Adolescents Aged between 14 and 18 years: A Systematic Review. Sports Med 2024; 54:875-894. [PMID: 38236505 DOI: 10.1007/s40279-023-01975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Adolescents present a high incidence of ACL injury compared with other age groups. Examining the risk factors that predispose adolescents to primary noncontact ACL injury is a key strategy to decrease the number of injuries in this population. OBJECTIVE The aim of this systematic review was to summarise the existing literature investigating extrinsic risk factors that have been linked with primary noncontact ACL injury risk (identified either using ACL injury occurrence or using screening tests measuring biomechanical mechanisms for noncontact ACL injury) in adolescents including research investigating: (1) the association between extrinsic risk factors and primary noncontact ACL injury risk; and (2) whether primary noncontact ACL injury risk was different in populations or groups exposed to different extrinsic risk factors in adolescents. METHODS The same search strategy was used in MEDLINE, SPORTDiscus, CINAHL, PubMed and Embase. Articles were included if: written in English; published in peer-reviewed journals; investigating and discussing primary noncontact ACL injury risk associated with extrinsic risk factors; they were original research articles with an observational design; and participants presented a mean age ranging between 14 and 18 years. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) was used to assess the quality and risk of bias of the articles included in this systematic review. RESULTS The systematic review included 16 eligible articles published up to August 2022 about extrinsic risk factors for primary noncontact ACL injury including: sport (8 studies); sport exposure amount (5); sport level (3); sport season (1); environment (2); equipment (1). Differences in biomechanical risk factors predisposing to ACL injury were reported by sport in female adolescents playing basketball and soccer; however, no good evidence of differences in primary noncontact ACL injury rate by sport was reported in both male and female adolescents. There was contrasting evidence about associations between sport exposure and biomechanical and neuromuscular risk factors predisposing to ACL injury or primary noncontact ACL injury rate in both male and female adolescent players from different sports. There was weak evidence of differences in biomechanical risk factors predisposing to ACL injury by environmental condition in both male and female adolescents playing soccer and season phase in male adolescents playing basketball. Lastly, few good-quality articles suggested that higher sport level might be associated with increased primary noncontact ACL injury rate in female adolescents playing basketball and floorball and that bracing might not prevent primary noncontact ACL injuries in both male and female adolescent players from different sports. DISCUSSION The findings emphasise the need for further research to clarify the evidence about extrinsic risk factors and primary noncontact ACL injury in adolescents to develop ACL injury prevention guidelines that would help practitioners and researchers identify adolescents at risk and design future interventions. Future epidemiological studies should collect data about extrinsic factors as well as data about primary noncontact injury separately from secondary injuries or contact injuries to better inform primary noncontact ACL injury prevention in adolescents. REGISTRATION https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021).
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Affiliation(s)
- Matteo Crotti
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK.
| | - Theresa Heering
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Melbourne, VIC, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Michael J Duncan
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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Sunderland PJ, Davis GA, Hearps SJC, Anderson HH, Gastin TJ, Green BD, Makdissi M. Concussion incidence and mechanisms differ between elite females and males in Australian Football. J Sci Med Sport 2024; 27:214-219. [PMID: 38195367 DOI: 10.1016/j.jsams.2023.12.003] [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: 09/20/2022] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To investigate the incidence and the game circumstances of concussion in the professional female (AFLW) and male (AFL) competitions of Australian Football, to identify potential targets for risk reduction. DESIGN Retrospective cohort. METHODS Concussion data were obtained from the AFL injury database, which included all concussions sustained by AFL (Male) players from 2015 to 18 and AFLW (Female) players from 2017 to 19. Concussions were diagnosed by experienced clinicians utilising standardised concussion assessment tools and injury definitions, as well as video review. Video footage was analysed to determine the circumstances each concussion occurred, which included the action and the contact-point of impact. RESULTS The incidence of concussion was higher in the AFLW (Female) compared to the AFL (Male) (IRR = 2.12, 95 %CI 1.54 to 2.92). Video footage was available for 194/252 (77 %) concussions in the AFL and 35/44 (80 %) concussions in the AFLW. Male players were most frequently concussed during marking contests (28 %) with primary impact from the upper limb (22 %) or the shoulder (19 %). Conversely, being bumped (23 %) or tackled (20 %) were the main actions associated with concussion in female players, with the head (29 %) or the ground (23 %) the most common contact-points of impact. CONCLUSIONS In elite Australian Football a higher incidence of concussion was demonstrated in female compared to male players. The mechanisms associated with concussion were also found to differ between male and female competitions, suggesting that different injury prevention interventions may be beneficial. In particular, a review of tackling and bumping skills training and education in the AFLW may reduce the risk of concussion.
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Affiliation(s)
- Patrick J Sunderland
- Essendon Football Club, Australia; Epworth Sports and Exercise Medicine Group, Australia.
| | - Gavin A Davis
- Murdoch Children's Research Institute, Australia; Neurosurgery Department, Austin and Cabrini Hospitals, Australia
| | - Stephen J C Hearps
- Murdoch Children's Research Institute, Australia; Department of Critical Care, The University of Melbourne, Australia
| | | | | | - Brady D Green
- School of Health Sciences and Physiotherapy, The University of Notre Dame, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Australia
| | - Michael Makdissi
- Australian Football League; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Florey Institute of Neuroscience and Mental Health, Australia
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12
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Sturesson V, Marforio P, Reuter A, Johansson K, Ageberg E. Youth handball concussion prevention strategies: a workshop-based study with experts and end users. BMJ Open Sport Exerc Med 2024; 10:e001877. [PMID: 38495959 PMCID: PMC10941137 DOI: 10.1136/bmjsem-2023-001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Sport-related concussion (SRC) is a serious injury in youth team sports, including handball. While research on the prevention of SRC has made progress over the past 5 years, prevention strategies are lacking in handball. The aim was to explore and develop strategies focusing on information, rules and training that may prevent concussion in youth handball by incorporating knowledge from experts and end users. Using a participatory methodology, experts (physiotherapy, biomechanics: n=3) and end users (players, coaches, referees, coach educators: n=7) contributed their experience and knowledge in a 2-hour online workshop. Participants were given three videos illustrating typical high-risk concussion scenarios from handball games and a youth player's accompanying fictional written scenario. In group discussions inspired by the brainwriting method, participants were asked to provide ideas for possible SRC prevention strategies related to information, rules and/or training. Data were collected on a digital whiteboard and analysed using reflexive thematic analysis. Three themes were derived: (1) 'Coaches' responsibility: raise awareness of the risk of injury and act to promote safe environments'; (2) 'Players' responsibility: safe defence and attack'; and (3) 'Improvement of personal skills'. Experts and end users found information about high-risk situations and SRC symptoms, stricter rules and safe playing strategy training for goalkeepers, attacking and defending players, respectively, may effectively reduce SRC in handball. Information and stricter rules could be delivered through education and dissemination activities, whereas safe playing strategies should be trained at regular handball practice.
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Affiliation(s)
| | - Peter Marforio
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Arlind Reuter
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kajsa Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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McNamee M, Anderson LC, Borry P, Camporesi S, Derman W, Holm S, Knox TR, Leuridan B, Loland S, Lopez Frias FJ, Lorusso L, Malcolm D, McArdle D, Partridge B, Schramme T, Weed M. Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy. JOURNAL OF MEDICAL ETHICS 2024:jme-2022-108812. [PMID: 36868564 DOI: 10.1136/jme-2022-108812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.
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Affiliation(s)
- Mike McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | | | - Pascal Borry
- Department of Public Health and Primary Care, Leuven, Leuven, Belgium
| | - Silvia Camporesi
- Global Health & Social Medicine, King's College London, London, UK
- Department of Political Sciences, University of Vienna, Wien, Austria
| | - Wayne Derman
- Institute of Sport & Exercise Medicine, Dept of Exercise, Sport & Lifestyle Medicine, Facuty of Medicine & Health Science, Stellenbosch University, Stellenbosch, South Africa
- IOC Research Center, Stellenbosch, South Africa
| | - Soren Holm
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | | | - Bert Leuridan
- Centre for Philosophical Psychology, University of Antwerp, Antwerpen, Belgium
| | - Sigmund Loland
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Ludovica Lorusso
- Departament de Psicologia Social, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Brad Partridge
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Thomas Schramme
- Department of Philosophy, University of Liverpool Faculty of Humanities and Social Sciences, Liverpool, UK
| | - Mike Weed
- Centre for Sport, Physical Education & Activity Research (spear), Canterbury Christ Church University, Canterbury, UK
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14
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Daugherty J, Yuan K, Sarmiento K, Law R. Are there seasonal patterns for emergency department visits for head injuries in the USA? Findings from the National Electronic Injury Surveillance System-All Injury Program. Inj Prev 2024; 30:46-52. [PMID: 37802643 PMCID: PMC10844889 DOI: 10.1136/ip-2023-044971] [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: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Previous international research suggests that the incidence of head injuries may follow seasonal patterns. However, there is limited information about how the numbers and rates of head injuries, particularly sports- and recreation-related head injuries, among adults and children evaluated in the emergency department (ED) vary by month in the USA. This information would provide the opportunity for tailored prevention strategies. METHODS We analysed data from the National Electronic Injury Surveillance System-All Injury Program from 2016 to 2019 to examine both monthly variation of ED visit numbers and rates for head injuries overall and those due to sports and recreation. RESULTS The highest number of head injuries evaluated in the ED occurred in October while the lowest number occurred in February. Among males, children ages 0-4 years were responsible for the highest rates of head injury-related ED visits each year, while in females the highest rates were seen in both children ages 0-4 and adults ages 65 and older. The highest number of head injuries evaluated in the ED due to sports and recreation were seen in September and October. Head injury-related ED visits due to sports and recreation were much more common in individuals ages 5-17 than any other age group. CONCLUSION This study showed that head injury-related ED visits for all mechanisms of injury, as well as those due to sports- and recreation-related activities, followed predictable patterns-peaking in the fall months. Public health professionals may use study findings to improve prevention efforts and to optimise the diagnosis and management of traumatic brain injury and other head injuries.
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Affiliation(s)
- Jill Daugherty
- Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Keming Yuan
- Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Royal Law
- Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Burma JS, Lapointe AP, Wilson M, Penner LC, Kennedy CM, Newel KT, Galea OA, Miutz LN, Dunn JF, Smirl JD. Adolescent Sport-Related Concussion and the Associated Neurophysiological Changes: A Systematic Review. Pediatr Neurol 2024; 150:97-106. [PMID: 38006666 DOI: 10.1016/j.pediatrneurol.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/20/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Sport-related concussion (SRC) has been shown to induce cerebral neurophysiological deficits, quantifiable with electroencephalography (EEG). As the adolescent brain is undergoing rapid neurodevelopment, it is fundamental to understand both the short- and long-term ramifications SRC may have on neuronal functioning. The current systematic review sought to amalgamate the literature regarding both acute/subacute (≤28 days) and chronic (>28 days) effects of SRC in adolescents via EEG and the diagnostic accuracy of this tool. METHODS The review was registered within the Prospero database (CRD42021275256). Search strategies were created and input into the PubMed database, where three authors completed all screening. Risk of bias assessments were completed using the Scottish Intercollegiate Guideline Network and Methodological Index for Non-Randomized Studies. RESULTS A total of 128 articles were identified; however, only seven satisfied all inclusion criteria. The studies ranged from 2012 to 2021 and included sample sizes of 21 to 81 participants, albeit only ∼14% of the included athletes were females. The studies displayed low-to-high levels of bias due to the small sample sizes and preliminary nature of most investigations. Although heterogeneous methods, tasks, and analytical techniques were used, 86% of the studies found differences compared with control athletes, in both the symptomatic and asymptomatic phases of SRC. One study used raw EEG data as a diagnostic indicator demonstrating promise; however, more research and standardization are a necessity. CONCLUSIONS Collectively, the findings highlight the utility of EEG in assessing adolescent SRC; however, future studies should consider important covariates including biological sex, maturation status, and development.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.
| | - Andrew P Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megan Wilson
- Faculty of Arts and Social Sciences, Carleton University, Ottawa, Ontario, Canada; Faculty of Arts, University of Alberta, Edmonton, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Kailey T Newel
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Olivia A Galea
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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16
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Moore S, Musgrave C, Sandler J, Bradley B, Jones JRA. Early intervention treatment in the first 2 weeks following concussion in adults: A systematic review of randomised controlled trials. Phys Ther Sport 2024; 65:59-73. [PMID: 38065015 DOI: 10.1016/j.ptsp.2023.11.005] [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: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE International guidelines support a repertoire of therapeutic interventions that may assist recovery following concussion. We aimed to systematically review the efficacy of early pharmacological and non-pharmacological interventions initiated within two weeks of injury on symptoms and functional recovery of adults with concussion. METHODS We conducted a Systematic Review (SR) of Randomised Controlled Trials (RCTs) without meta-analysis utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed of four databases. Study inclusion criteria were adult participants diagnosed with concussion and commencing active intervention within 14 days of injury. RESULTS AND CONCLUSIONS Of 7531 studies identified, 11 were included in the final review. Six studies were rated as high-risk of bias, three with some concerns and two as low-risk of bias. We found no evidence to support specific pharmacotherapeutic management to hasten the natural recovery time-course. Two studies reported significant improvement in selected concussion symptoms following manual therapy (at 48-72 hours post-treatment) or telephone counselling interventions (at 6 months post-injury). No high quality RCTs demonstrate superior effects of early therapeutic interventions on concussion recovery in the first 2 weeks. We advocate future research to examine impacts of health-clinician contact points aligned with symptom-specific interventions.
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Affiliation(s)
- Sonya Moore
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
| | - Chris Musgrave
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Sandler
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Ben Bradley
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia; Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
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17
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Sherman K, Tyree P, Ford AI, Mazur A, Nolan D, Hartwell M. Association between steroid use and concussions among high school athletes: a cross-sectional analysis of the Youth Risk Behavior Surveillance System. J Osteopath Med 2024; 124:27-34. [PMID: 37852286 DOI: 10.1515/jom-2023-0133] [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: 06/15/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT In 2017, there were almost 2.5 million high school students who experienced a concussion while playing a sport, raising concern for the neurologic problems that they could face. Some of these athletes may seek to gain a competitive advantage in their sport by utilizing substances like steroids. However, steroid use can cause increased aggression and body mass index (BMI), which might lead to heightened risk for concussions. Despite extensive research, we found no previous evidence linking these two factors. OBJECTIVES This analysis aims to investigate steroid use trends in high school athletes and to determine whether there is an association between steroid use and concussions in these athletes. METHODS We conducted a cross-sectional analysis of the cumulative Youth Risk Behavior Surveillance System (YRBSS). Respondents were added if they participated in sports and answered the steroid and concussion prompts. Demographic variables were assessed including age, grade, BMI, gender, and race/ethnicity. RESULTS We found that 3.7 % (n=2991) of high school athletes reported previous steroid use and that 20.7 % (n=2273) reported having sustained a concussion. There was a statistically significant difference in steroid use by race/ethnicity (p<0.001), with the highest rate of use (7.2 %) among American Indian/Alaska Natives (AI/AN). A significantly higher prevalence of steroid use occurred in athletes who were males (4.7 %) than females (2.5 %) and in athletes with a BMI>95 % (5.2 %) compared with those with a BMI between 85 and 95 % (3.9 %) and <85 % (3.5 %) (χ2=135.1, p<0.001 and χ2=16.3, p<0.001, respectively). Further, our results showed that the prevalence of steroid use among high school athletes decreased from 3.4 % in 1999 to 1.9 % in 2019, with the most drastic drop occurring between 2015 and 2019-declining 1.9 %. Whereas 19.6 % of athletes reported a concussion without steroid use, 54.6 % of steroid-utilizing athletes reported having experienced a concussion-a statistically significant finding (adjusted odds ratio [AOR]=4.3; 95 % CI: 3.2-5.9). Finally, compared with White athletes, we found that AI/AN athletes were significantly more likely to have sustained a concussion (AOR=2.3; 95 % CI=1.2-4.3). CONCLUSIONS Although our study found decreasing rates of steroid use among high school athletes from 1999 through 2019, our results also show that steroid use is significantly associated with sustaining a concussion. Additionally, the data from YRBSS also demonstrates that AI/AN high school athletes are more likely to utilize steroids and sustain a concussion. Given the long-term consequences of traumatic brain injuries, we recommend that coaches should be aware of potential steroid use among players, and that coaches, athletic trainers, and physicians should all be aware of concussion protocols and remove players from games for evaluation when a concussion is suspected.
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Affiliation(s)
- Kennedy Sherman
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Phillip Tyree
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Alicia Ito Ford
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Anna Mazur
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Douglas Nolan
- Department of Family Medicine, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
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18
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Smoliga JM, Deshpande SK, Binney ZO. Interaction of Surface Type, Temperature, and Week of Season on Concussion Risk in the National Football League: A Bayesian Analysis. Epidemiology 2023; 34:807-816. [PMID: 37732833 DOI: 10.1097/ede.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Artificial turf fields and environmental conditions may influence sports concussion risk, but existing research is limited by uncontrolled confounding factors, limited sample size, and the assumption that risk factors are independent of one another. The purpose of this study was to examine how playing surface, time of season, and game temperature relate to diagnosed concussion risk in the National Football League (NFL). METHODS This retrospective cohort study examined data from the 2012 to the 2019 NFL regular season. We fit Bayesian negative binomial regression models to relate how playing surface, game temperature, and week of the season independently related to diagnosed concussion risk and any interactions among these factors. RESULTS We identified 1096 diagnosed concussions in 1830 games. There was a >99% probability that concussion risk was reduced on grass surface (median incidence rate ratio [IRR] = 0.78 [95% credible interval: 0.68, 0.89]), >99% probability that concussion risk was lower at higher temperatures (IRR = 0.85 [0.76,0.95] for each 7.9 °C), and >91% probability that concussion risk increased with each week of the season (IRR = 1.02 [1.00,1.04]). There was an >84% probability for a surface × temperature interaction (IRR = 1.01 [0.96, 1.28]) and >75% probability for a surface × week interaction (IRR = 1.02 [0.99, 1.05]). CONCLUSIONS Diagnosed concussion risk is increased on artificial turf compared with natural grass, and this is exacerbated in cold weather and, independently, later in the season. The complex interplay between these factors necessitates accounting for multiple factors and their interactions when investigating sports injury risk factors and devising mitigation methods.
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Affiliation(s)
- James M Smoliga
- From the Department of Physical Therapy, One University Parkway, High Point University, High Point, NC
- Doctor of Physical Therapy Program (Seattle), Tufts University School of Medicine, Boston, MA
| | - Sameer K Deshpande
- Department of Statistics, University of Wisconsin, 7225B Medical Sciences Center, Madison, WI
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Hutchison MG, Di Battista AP, Meeuwisse W, Bruce JM, Echemendia RJ, Delaney JS, Comper P. Concussion Characteristics in the National Hockey League Before and After the Introduction of Rule 48. JAMA Netw Open 2023; 6:e2344399. [PMID: 37991764 PMCID: PMC10665971 DOI: 10.1001/jamanetworkopen.2023.44399] [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: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
Importance A rule prohibiting a direct hit to the lateral side of the head (ie, Rule 48-Illegal Check to the Head) was introduced in the National Hockey League (NHL) in the 2010-2011 season and refined in the 2011-2012 season to widen the application to include direct contact to all areas of the head. Objective To compare the incidence and proportion of concussions that occurred following hits to the head before and after the implementation of Rule 48. Design, Setting, and Participants This retrospective cohort study used a before and after design to evaluate concussions among NHL players in regular season games. Data from the 4 seasons preceding the implementation of Rule 48 (2006-2007 to 2009-2010) were compared with data from 5 seasons following its implementation (2014-2015 to 2018-2019). Data were analyzed from October 31, 2021, to November 30, 2022. Main Outcomes and Measures The incidence and relative proportion of concussion characteristics and mechanisms before and after the introduction of Rule 48. Results In the analysis of 688 concussions for NHL seasons spanning 2006 to 2010 (n = 231) and 2014 to 2019 (n = 457), there was an overall increase in the incidence of concussion between the 2 time frames, although the incidence of concussions due to hits to the lateral aspect of the head decreased from 1.6/100 games to 1.0/100 games (estimated difference, 0.6/100 games [90% credible interval (CrI), 0.30/100 games to 0.90/100 games). There was also a reduction of 18.8 (90% CrI, 13.0-23.7) percentage points in the proportion of concussions due to hits to the lateral aspect of the head from 80 of 231 concussions (34.6%) to 61 of 457 concussions (13.3%). The incidence of concussions following hits to the head from body checks using the shoulder, arm, and glove was similar before and following the implementation of Rule 48. However, the proportion was reduced 14.7 percentage points from 113 of 231 concussions (48.9%) before to 149 of 457 concussions (32.6%) after implementation of Rule 48 (90% CrI of the difference, 8.9-20.7 percentage points). Conclusions and Relevance The findings of this cohort study of NHL players suggest that after the introduction of Rule 48, the incidence rate and proportion of concussions from contact to the lateral aspect of the head decreased, as did the proportion of concussions following direct hits to the head.
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Affiliation(s)
- Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alex P Di Battista
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | | | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine
- Department of Neurology, University of Missouri-Kansas City School of Medicine
- Department of Psychiatry, University of Missouri-Kansas City School of Medicine
| | - Ruben J Echemendia
- Concussion Care Clinic, University Orthopedic Center, University of Missouri-Kansas City
| | - J Scott Delaney
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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20
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Beauchamp MH, Dégeilh F, Rose SC. Improving outcome after paediatric concussion: challenges and possibilities. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:728-740. [PMID: 37734775 DOI: 10.1016/s2352-4642(23)00193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
The term concussion has permeated mainstream media and household vocabulary mainly due to awareness regarding the risks of concussion in professional contact sports, yet it occurs across a variety of settings and ages. Concussion is prevalent in infants, preschoolers, children, and adolescents, and is a common presentation or reason for referral to primary care providers, emergency departments, and specialised trauma clinics. Its broad range of symptoms and sequelae vary according to multiple individual, environmental, and clinical factors and can lead to health and economic burden. More than 20 years of research into risk factors and consequences of paediatric concussion has revealed as many questions as answers, and scientific work and clinical cases continue to expose its complexity and heterogeneity. In this Review, we present empirical evidence for improving outcome after paediatric concussion. We consider work pertaining to both sports and other injury mechanisms to provide a perspective that should be viewed as complementary to publications focused specifically on sports concussion. Contemporary challenges in prevention, diagnosis, prognosis, and intervention are discussed alongside pathways and future directions for improving outcome.
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Affiliation(s)
- Miriam H Beauchamp
- Sainte-Justine Research Center, University of Montreal, Montréal, QC, Canada; Department of Psychology, University of Montreal, Montréal, QC, Canada.
| | - Fanny Dégeilh
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN ERL U-1228, Rennes, France
| | - Sean C Rose
- Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA; Ohio State University College of Medicine, Columbus, OH, USA
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21
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McLarnon M, Heron N. How to identify and manage sports related concussions in primary care. BMJ 2023; 382:e073161. [PMID: 37722751 DOI: 10.1136/bmj-2022-073161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
| | - Neil Heron
- Centre for Public Health, Queen's University Belfast, Belfast
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
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22
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Tsutsumi S, Sasadai J, Maeda N, Shimizu R, Suzuki A, Fukui K, Arima S, Tashiro T, Kaneda K, Yoshimi M, Mizuta R, Ishihara H, Esaki H, Tsuchida K, Terada T, Komiya M, Urabe Y. Head Impact in Blind Football During the Tokyo Paralympics: Video-Based Observational Study. Am J Phys Med Rehabil 2023; 102:836-839. [PMID: 36757853 DOI: 10.1097/phm.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ABSTRACT Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football.
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Affiliation(s)
- Shogo Tsutsumi
- From the Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (ST, NM, KF, SA, T Tashiro, KK, MY, RM, HI, HE, KT, T Terada, MK, YU); and Sports Medical Center, Japan Institute of Sports Sciences (JISS), Tokyo, Japan (JS, RS, AS)
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23
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Eliason P, Galarneau JM, Shill I, Kolstad A, Babul S, Mrazik M, Lebrun C, Dukelow S, Schneider K, Hagel B, Emery C. Factors Associated With Concussion Rates in Youth Ice Hockey Players: Data From the Largest Longitudinal Cohort Study in Canadian Youth Ice Hockey. Clin J Sport Med 2023; 33:497-504. [PMID: 37432327 DOI: 10.1097/jsm.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To examine factors associated with rates of game and practice-related concussion in youth ice hockey. DESIGN Five-year prospective cohort (Safe2Play). SETTING Community arenas (2013-2018). PARTICIPANTS Four thousand eighteen male and 405 female ice hockey players (6584 player-seasons) participating in Under-13 (ages 11-12), Under-15 (ages 13-14), and Under-18 (ages 15-17) age groups. ASSESSMENT OF RISK FACTORS Bodychecking policy, age group, year of play, level of play, previous injury in the previous year, lifetime concussion history, sex, player weight, and playing position. MAIN OUTCOME MEASUREMENTS All game-related concussions were identified using validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician for diagnosis and management. Multilevel Poisson regression analysis including multiple imputation of missing covariates estimated incidence rate ratios (IRRs). MAIN RESULTS A total of 554 game and 63 practice-related concussions were sustained over the 5 years. Female players (IRR Female/Male = 1.79; 95% CI: 1.26-2.53), playing in lower levels of play (IRR = 1.40; 95% CI: 1.10-1.77), and those with a previous injury (IRR = 1.46; 95% CI: 1.13, 1.88) or lifetime concussion history (IRR = 1.64; 95% CI: 1.34-2.00) had higher rates of game-related concussion. Policy disallowing bodychecking in games (IRR = 0.54; 95% CI: 0.40-0.72) and being a goaltender (IRR Goaltenders/Forwards = 0.57; 95% CI: 0.38-0.87) were protective against game-related concussion. Female sex was also associated with a higher practice-related concussion rate (IRR Female/Male = 2.63; 95% CI: 1.24-5.59). CONCLUSIONS In the largest Canadian youth ice hockey longitudinal cohort to date, female players (despite policy disallowing bodychecking), players participating in lower levels of play, and those with an injury or concussion history had higher rates of concussion. Goalies and players in leagues that disallowed bodychecking had lower rates. Policy prohibiting bodychecking remains an effective concussion prevention strategy in youth ice hockey.
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Affiliation(s)
- Paul Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Isla Shill
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ash Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Shelina Babul
- British Columbia Injury Research and Prevention Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Mrazik
- Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Constance Lebrun
- Family Medicine, Faculty of Medicine and Dentistry and Glen Sather Sport Medicine Clinic, University of Alberta, Edmonton, AB, Canada
| | - Sean Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences and Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brent Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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24
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Holcomb TD, Marks ME, Stewart Pritchard N, Miller L, Espeland MA, Miles CM, Moore JB, Foley KL, Stitzel JD, Urban JE. Characterization of Head Acceleration Exposure During Youth Football Practice Drills. J Appl Biomech 2023; 39:157-168. [PMID: 37105545 PMCID: PMC10809728 DOI: 10.1123/jab.2022-0196] [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: 07/25/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023]
Abstract
Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11-13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices.
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Affiliation(s)
- Ty D. Holcomb
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Madison E. Marks
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - N. Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Logan Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Mark A. Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kristie L. Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
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26
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Kolstad AT, Eliason PH, Galarneau JM, Black AM, Hagel BE, Emery CA. Protective equipment in youth ice hockey: are mouthguards and helmet age relevant to concussion risk? Br J Sports Med 2023; 57:571-577. [PMID: 36918257 PMCID: PMC10176392 DOI: 10.1136/bjsports-2022-105585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age. MATERIALS AND METHODS Within a 5-year longitudinal cohort (2013/2014 to 2017/2018) of male and female ice hockey players (ages 11-18; n=3330 players) in Alberta (Canada), we analysed the relationship of equipment and concussion in both a prospective cohort and nested case (concussion) control (acute musculoskeletal injury) approach. The prospective cohort included baseline assessments documenting reported mouthguard use (yes/sometimes, no use), helmet age (newer/<2 years old, older/≥2 years old) and important covariables (weight, level of play, position of play, concussion history, body checking policy), with weekly player participation throughout the season. The nested case-control component used injury reports to document equipment (mouthguard use, helmet age) and other information (eg, mechanism and type of injury) for the injury event. Multivariable mixed effects negative binomial regression (prospective cohort, incidence rate ratios (IRRs)) and multivariable mixed effects logistic regression (nested case-control, odds ratios (OR)) examined the association between equipment and concussion. RESULTS Players who reported wearing a mouthguard had a 28% lower concussion rate (IRR=0.72, 95% CI 0.56 to 0.93) and 57% lower odds of concussion (OR=0.43, 95% CI 0.27 to 0.70) compared with non-wearers. There were no associations in the concussion rate (IRR=0.94, 95% CI 0.75 to 1.15) and odds (OR=1.16, 95% CI 0.73 to 1.86) between newer and older helmets. CONCLUSIONS Wearing a mouthguard was associated with a lower concussion rate and odds. Policy mandating use should be considered in youth ice hockey. More research is needed to identify other helmet characteristics (eg, quality, fit) that could lower concussion risk.
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Affiliation(s)
- Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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27
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Makovec Knight J, Mitra B, McIntosh A, Clifton P, Makdissi M, Rosenfeld JV, Harcourt P, Howard TS, Willmott C. Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey. Clin J Sport Med 2023; 33:252-257. [PMID: 36729021 DOI: 10.1097/jsm.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football. DESIGN Online survey. SETTING Junior and youth athletes in Australia. PARTICIPANTS Australian football players aged U8 to U18. ASSESSMENT OF VARIABLES Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity. MAIN OUTCOME MEASURES Rates of padded HG use, and beliefs associated with HG use. RESULTS A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer ( P < 0.001) and being able to play harder while wearing HG ( P < 0.001). Median responses were "disagree" on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019). CONCLUSIONS Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.
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Affiliation(s)
- Jennifer Makovec Knight
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew McIntosh
- School of Engineering, Edith Cowan University, Joondalup, Australia
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | | | - Michael Makdissi
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Victoria, Australia
- Olympic Park Sports Medicine Centre, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
- Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Surgery, Monash University, Melbourne, Australia
| | | | - Teresa S Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia; and
| | - Catherine Willmott
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
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28
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Roberts HW. Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs. Dent Traumatol 2023; 39:101-108. [PMID: 36436198 DOI: 10.1111/edt.12809] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022]
Abstract
Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.
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29
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Henley S, Andrews K, Kabaliuk N, Draper N. Soft-shell headgear in rugby union: a systematic review of published studies. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
To review the rate of soft-shell headgear use in rugby union, consumer knowledge of the protection potential of soft-shell headgear, incidence of concussion reported in rugby headgear studies, and the capacity of soft-shell headgear to reduce acceleration impact forces.
Design
A systematic search was conducted in July and August 2021 using the databases SPORT Discus, PubMed, MEDLINE, CINAHL (EBSCO), Scopus, and Science Direct. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this systematic review was registered on PROSPERO (registration number: CRD42021239595).
Outcome measures
Rates of headgear use, reports of estimated protection of headgear against head injury, incidence of concussion and magnitude of impact collisions with vs. without headgear, impact attenuation of headgear in lab studies.
Results
Eighteen studies were identified as eligible: qualitative (N = 4), field (N = 7), and lab (N = 7). Qualitative studies showed low rates of headgear use and varying understanding of the protection afforded by headgear. Field studies showed negligible association of headgear use with reduced impact magnitude in headgear vs. non-headgear cohorts. Lab studies showed increased energy attenuation for thicker headgear material, poorer performance of headgear after repetitive impacts and increased drop heights, and promising recent results with headgear composed of viscoelastic polymers.
Conclusions
Rates of adoption of soft-shell headgear remain low in rugby and any association between its use and reduction in acceleration impact forces remains unclear. Lab results indicating improved impact attenuation need to be validated in the field. Further headgear-related research is needed with youth and female rugby players.
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Gerschman T, Brooks BL, Mrazik M, Eliason PH, Bonfield S, Yeates KO, Emery CA, Schneider KJ. Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players? Clin J Sport Med 2023; 33:130-138. [PMID: 36731042 DOI: 10.1097/jsm.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players. DESIGN Secondary analyses of 2 prospective cohort studies. SETTING Canadian youth ice hockey teams. PARTICIPANTS Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season). ASSESSMENT OF RISK FACTORS Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition. MAIN OUTCOME MEASURES Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression. RESULTS When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRR SELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRR PARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion. CONCLUSIONS Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.
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Affiliation(s)
- Tommy Gerschman
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital, Neurosciences Program, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephan Bonfield
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Keith O Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Sport Medicine Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; and.,Evidence Sport and Spinal Therapy, Calgary, AB, Canada
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31
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Powell DRL, Petrie FJ, Docherty PD, Arora H, Williams EMP. Development of a Head Acceleration Event Classification Algorithm for Female Rugby Union. Ann Biomed Eng 2023; 51:1322-1330. [PMID: 36757631 PMCID: PMC10172216 DOI: 10.1007/s10439-023-03138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/25/2022] [Indexed: 02/10/2023]
Abstract
Instrumented mouthguards have been used to detect head accelerations and record kinematic data in numerous sports. Each recording requires validation through time-consuming video verification. Classification algorithms have been posed to automatically categorise head acceleration events and spurious events. However, classification algorithms must be designed and/or validated for each combination of sport, sex and mouthguard system. This study provides the first algorithm to classify head acceleration data from exclusively female rugby union players. Mouthguards instrumented with kinematic sensors were given to 25 participants for six competitive rugby union matches in an inter-university league. Across all instrumented players, 214 impacts were recorded from 460 match-minutes. Matches were video recorded to enable retrospective labelling of genuine and spurious events. Four machine learning algorithms were trained on five matches to predict these labels, then tested on the sixth match. Of the four classifiers, the support vector machine achieved the best results, with area under the receiver operator curve (AUROC) and area under the precision recall curve (AUPRC) scores of 0.92 and 0.85 respectively, on the test data. These findings represent an important development for head impact telemetry in female sport, contributing to the safer participation and improving the reliability of head impact data collection within female contact sport.
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Affiliation(s)
- David R L Powell
- ZCCE, Faculty of Science and Engineering, Swansea University, Wales, UK.,Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Freja J Petrie
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Paul D Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.,Institute for Technical Medicine (ITeM), Furtwangen University, Villingen Schwenningen, Germany
| | - Hari Arora
- ZCCE, Faculty of Science and Engineering, Swansea University, Wales, UK
| | - Elisabeth M P Williams
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK.
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32
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Bullock GS, Emery CA, Nelson VR, Prats-Uribe A, Gilliland RG, Thigpen CA, Shanley E. Higher rates of concussion following COVID-19 infection in high school athletes. Br J Sports Med 2023; 57:590-594. [PMID: 36754589 DOI: 10.1136/bjsports-2022-106436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To compare concussion rates (CRs) over one academic year in high school athletes with and without a COVID-19 infection prior to concussion. METHODS Illness and concussion were prospectively reported for male and female high school athletes across six states over one academic year in the Players Health Rehab surveillance system. Concussion was truncated to 60 days following recovery and return to sport from COVID-19. CRs were estimated per 1000 athletes per academic year and stratified by those who tested positive for COVID-19 infection (with COVID-19) and those who did not (no COVID-19). Poisson regression analyses estimated rate ratio (RR) of concussion controlling for state, gender and an offset of the log athlete participation (with COVID-19 and no COVID-19). RESULTS Of 72 522 athletes, 430 COVID-19 infections and 1273 concussions were reported. The CR was greater in athletes who reported COVID-19 (CR=74.4/1000 athletes/year, 95% CI 49.6 to 99.3) compared with those who did not (CR=17.2, 95% CI 16.3 to 18.2). Athletes with recent COVID-19 had a threefold higher rate of concussion (RR=3.1, 95% CI 2.0 to 4.7). CONCLUSION Athletes returning from COVID-19 had higher CRs than those who did not experience COVID-19. This may be related to ongoing COVID-19 sequelae or deconditioning related to reduced training and competition load during the illness and when returning to sport. Further research is needed to understand the association of recent COVID-19 infection and concussion in order to inform preventive strategies.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Vicki R Nelson
- Sports Medicine, Prisma Health, Greenville, South Carolina, USA
| | | | | | - Charles A Thigpen
- Clinical Excellence, ATI Physical Therapy, Greenville, Illinois, USA
| | - Ellen Shanley
- Sports Medicine, ATI Physical Therapy, Bolingbrook, Illinois, USA.,Clinical Excellence, ATI Physical Therapy, Greenville, Illinois, USA
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Farooqi A, Talwar D, Tata R, Harwood K, Maguire K. Comparison of pediatric performance athlete injuries presenting to emergency departments. PHYSICIAN SPORTSMED 2023; 51:64-72. [PMID: 34696657 DOI: 10.1080/00913847.2021.1996863] [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: 01/25/2023]
Abstract
OBJECTIVE Pediatric injuries in performance sports represent a significant healthcare burden and account for over 50,000 annual Emergency Department (ED) visits in the United States. The objective of this study was to characterize and compare pediatric injury presentation across the most common performance sports. METHODS The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed for pediatric injuries (3-18 years) related to gymnastics, dance, or cheerleading from 2015-2019. Cases were categorized as children (˂11 years) or adolescent (≥11 years). Injuries were categorized as orthopedic (fractures, dislocations, sprain, strains), non-orthopedic (contusion, internal injury, laceration), concussion, or other/unknown. Case narratives were used to categorize mechanism of injury as contact or non-contact. Appropriate sample NEISS weights estimation was applied for statistical analysis and Confidence Intervals (CI). RESULTS A total of 393,110 injuries were observed over the five-year study period, with a mean of 78,622 annual injuries. Gymnastics, dance, and cheerleading accounted for 136,422 injuries, 96,416 injuries, and 160,272 injuries, respectively. Most cases were adolescent (71%; 95% CI: 68-74%) and occurred in a sports-related setting (65%, 95% CI: 57-72%). Gymnastics had the highest proportion of injuries among children (50%) as compared to dancers (25%) or cheerleaders (12%) (p < 0.01). Non-contact injuries most affected the lower extremity (43-68%) and resulted in an orthopedic diagnosis (63-71%), and contact injuries had a higher proportion of injuries affecting the head, neck, and face (29-51%) and non-orthopedic diagnoses (29-38%). Gymnastics had the most upper extremity non-contact injuries (42%) and dance the most lower extremity non-contact injuries (68%) (p < 0.01). Cheerleading had the highest incidence of overall concussions (8%), contact injuries (47%), and concussions due to contact injury (15%). CONCLUSION Pediatric gymnasts, cheerleaders, and dancers have important similarities and differences in injury pattern which may lead to the development of sport-specific injury prevention programs for pediatric performance athletes.
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Affiliation(s)
- Ali Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Divya Talwar
- Department of Orthopaedics, Clinical Orthopaedic Surgery, Children's Hospital of Pennsylvania, Philadelphia, PA, United States
| | - Ravi Tata
- Drexel School of Medicine, Philadelphia, Unites States
| | - Kathleen Harwood
- Department of Orthopaedics, Clinical Orthopaedic Surgery, Children's Hospital of Pennsylvania, Philadelphia, PA, United States
| | - Kathleen Maguire
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States.,Department of Orthopaedics, Clinical Orthopaedic Surgery, Children's Hospital of Pennsylvania, Philadelphia, PA, United States
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Rhea CK, Yamada M, Kuznetsov NA, Jakiela JT, LoJacono CT, Ross SE, Haran FJ, Bailie JM, Wright WG. Neuromotor changes in participants with a concussion history can be detected with a custom smartphone app. PLoS One 2022; 17:e0278994. [PMID: 36520862 PMCID: PMC9754195 DOI: 10.1371/journal.pone.0278994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Neuromotor dysfunction after a concussion is common, but balance tests used to assess neuromotor dysfunction are typically subjective. Current objective balance tests are either cost- or space-prohibitive, or utilize a static balance protocol, which may mask neuromotor dysfunction due to the simplicity of the task. To address this gap, our team developed an Android-based smartphone app (portable and cost-effective) that uses the sensors in the device (objective) to record movement profiles during a stepping-in-place task (dynamic movement). The purpose of this study was to examine the extent to which our custom smartphone app and protocol could discriminate neuromotor behavior between concussed and non-concussed participants. Data were collected at two university laboratories and two military sites. Participants included civilians and Service Members (N = 216) with and without a clinically diagnosed concussion. Kinematic and variability metrics were derived from a thigh angle time series while the participants completed a series of stepping-in-place tasks in three conditions: eyes open, eyes closed, and head shake. We observed that the standard deviation of the mean maximum angular velocity of the thigh was higher in the participants with a concussion history in the eyes closed and head shake conditions of the stepping-in-place task. Consistent with the optimal movement variability hypothesis, we showed that increased movement variability occurs in participants with a concussion history, for which our smartphone app and protocol were sensitive enough to capture.
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Affiliation(s)
- Christopher K. Rhea
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, United States of America
- * E-mail:
| | - Masahiro Yamada
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, United States of America
| | - Nikita A. Kuznetsov
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jason T. Jakiela
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Department of Physical Therapy, University of Delaware, Newark, Delaware, United States of America
| | - Chanel T. LoJacono
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Department of Kinesiology, Missouri Southern State University, Joplin, Missouri, United States of America
| | - Scott E. Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
| | - F. J. Haran
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Jason M. Bailie
- Naval Hospital Camp Pendleton, Oceanside, California, United States of America
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, Maryland, United States of America
- General Dynamics Information Technology, Falls Church, Virginia, United States of America
| | - W. Geoffrey Wright
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, United States of America
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Eliason P, Hagel BE, Palacios-Derflingher L, Warriyar K V V, Bonfield S, Black AM, Babul S, Mrazik M, Lebrun C, Emery C. No association found between body checking experience and injury or concussion rates in adolescent ice hockey players. Br J Sports Med 2022; 56:1337-1344. [PMID: 35168958 DOI: 10.1136/bjsports-2021-104691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare rates of injury and concussion among U-15 (ages 13-14 years) ice hockey players playing in leagues allowing body checking, but who have a varying number of years of body checking experience. METHODS This 5-year longitudinal cohort included U-15 ice hockey players playing in leagues where policy allowed body checking. Years of body checking experience were classified based on national/local body checking policy. All ice hockey game-related injuries were identified using a validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician. Multiple multilevel Poisson regression analysis was performed, adjusting for important covariates and a random effect at a team level (offset by game exposure hours), to estimate injury and concussion incidence rate ratios (IRRs). RESULTS In total, 1647 players participated, contributing 1842 player-seasons (195 players participating in two seasons). Relative to no body checking experience, no significant differences were found in the adjusted IRRs for game-related injury for players with 1 year (IRR=1.06; 95% CI: 0.77 to 1.45) or 2+ years (IRR=1.16; 95% CI: 0.74 to 1.84) body checking experience. Similarly, no differences were found in the rates of concussion for players with 1 year (IRR=0.92; 95% CI: 0.59 to 1.42) or 2+ years (IRR=0.69; 95% CI: 0.38 to 1.25) body checking experience. CONCLUSIONS Among ice hockey players aged 13-14 years participating in leagues permitting body checking, the adjusted rates of all injury and concussion were not significantly different between those that had body checking experience and those that did not. Based on these findings, no association was found between body checking experience and rates of injury or concussion specifically in adolescent ice hockey.
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Affiliation(s)
- Paul Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luz Palacios-Derflingher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Vineetha Warriyar K V
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
| | - Stephan Bonfield
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelina Babul
- British Columbia Injury Research and Prevention Unit, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Mrazik
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Constance Lebrun
- Family Medicine, Faculty of Medicine and Dentistry and Glen Sather Sport Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Albert, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Evaluating the Effect of Policy Prohibiting Body Checking on Physical Contacts in U15 and U18 Youth Ice Hockey Leagues. Clin J Sport Med 2022; 32:e614-e619. [PMID: 35878886 DOI: 10.1097/jsm.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare physical contacts (PCs) and head contacts (HCs) in nonelite U15 (ages 13-14) and U18 (ages 15-17) ice hockey players in body checking (BC) and non-BC leagues. DESIGN Cohort video analysis study. SETTING Ice hockey arenas in Calgary, Canada. PARTICIPANTS Players from 13 BC and 13 non-BC games at the nonelite U15 and U18 levels (n = 52 total games). ASSESSMENT OF RISK FACTORS Games were videotaped and analyzed to compare PC variables between leagues allowing and prohibiting BC. MAIN OUTCOME MEASURES Validated methodology for PC type (trunk PC and other types of PC with limb/stick/head), intensity (low and high intensity), and HC. Incidence rate ratios (IRRs) were estimated using Poisson regression (controlling for cluster by team game and offset by player minutes) to compare the incidence of PCs in BC and non-BC games. RESULTS The rate of trunk PCs was lower in the non-BC leagues for both U15 (IRR = 0.50, 99% confidence interval [CI]: 0.43-0.58) and U18 (IRR = 0.56, 99% CI: 0.46-0.67) players. This was most significant for BC contacts (U15: IRR = 0.18, 99% CI: 0.11-0.29; U18: IRR = 0.16, 99% CI: 0.08-0.34), although also significant for body contacts (U15: IRR = 0.54, 99% CI: 0.46-0.64; U18: IRR = 0.58, 99% CI: 0.48-0.70), other PCs, (U15: IRR = 0.60, 99% CI: 0.45-0.78; U18: IRR = 0.71, 99% CI: 0.58-0.88), and HCs (U15: IRR = 0.40, 99% CI: 0.22-0.71; U18: IRR = 0.37, 99% CI: 0.25-0.57). CONCLUSIONS The incidence of BC was 82% lower in the U15 and 84% lower in U18 levels not allowing BC, with lower HC and other PC rates also in non-BC leagues. These findings demonstrate high adherence with BC policy change in youth ice hockey.
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West SW, Pankow MP, Gibson ES, Eliason PH, Black AM, Emery CA. Injuries in Canadian high school boys’ collision sports: insights across football, ice hockey, lacrosse, and rugby. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Background
Collision sport participation rates among high school youth in Canada are high. While participation is beneficial for physical and mental well-being, the rates of injury in these sports are high.
Aims
This study aims to compare injury rates and profiles across four common youth collision sports (ice hockey, tackle football, lacrosse, rugby).
Methods
Data from a cross-sectional questionnaire of 2029 high school youth were used to identify male collision sport participants to be included in this secondary analysis (n = 360).
Results
Of the 2029 students who completed the questionnaire, 360 participated in collision-based sports [Ages: 14 (5%), 15 (41%), 16 (25%), 17 (26%), 18 (3%)]. The rates of injury ranged from 12.7 injuries/100 participants/year (rugby) to 33.1 injuries/100 participants/year (ice hockey). Concussion rates ranged from 12.4 (football) to 15.8 (ice hockey) concussions/100 participants/year. Similarities existed in the profile of injuries between sports, with most injuries occurring due to contact with another player (range 57.0% to 87.5%). Injuries to the head (33.3%), wrist/hand (16.0%), shoulder (12.8%), and knee (12.0%) were the most prevalent injury type. Substantial differences in previous playing experience existed between sports.
Discussion
The high rate of injury and concussion reported across each of these sports highlights the need for the introduction of primary prevention strategies in these sports aimed to reduce the risk of injury.
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Injuries and Concussions in Female High School Rugby: Prevention is Worth a Try. Clin J Sport Med 2022; 32:508-516. [PMID: 34759178 DOI: 10.1097/jsm.0000000000000993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe injury and concussion rates and mechanisms in female high school rugby players. DESIGN Two-year prospective cohort study. SETTING High school rugby. PARTICIPANTS Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition. INTERVENTION None. MAIN OUTCOME MEASURES Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates. RESULTS A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6). CONCLUSIONS Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.
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Ha S, Kim MJ, Jeong HS, Lee I, Lee SY. Mechanisms of Sports Concussion in Taekwondo: A Systematic Video Analysis of Seven Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10312. [PMID: 36011947 PMCID: PMC9407910 DOI: 10.3390/ijerph191610312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Sports-related traumatic brain injuries are the most common injury in adolescents and young adults due to recurrent concussion experiences and head shock. Therefore, this study was designed to describe player characteristics and situational factors associated with concussions in the World Taekwondo Championships using systematic video analysis. Athlete injury data were collected using a web-based injury surveillance system at the World Taekwondo Championships organized by World Taekwondo from 2017 to 2019. Seven video footage were independently analyzed by four analysts using a modified Heads-Up Checklist. Descriptive statistical analysis was used. The incidence of concussion was 3.21 per 1000 games. Most players with concussions were shorter than their opponents, and most concussions were caused by a roundhouse kick on the front of the face. Regarding the acceleration direction of the head after the impact, transverse and multiplane directions were the most common. Most players with a concussion have used a closed stance and did not use blocking techniques during the defense. The rate of concussions caused by penalties was 42.9%. Based on our findings, no other injury mechanisms, except for direct blows to the head, were observed. Therefore, education on the risk and symptoms of concussion, the appropriate management and blocking techniques should be emphasized in TKD-S to reduce incidence of concussion.
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Affiliation(s)
- Sunghe Ha
- Department of Physical Education, Yonsei University, Seoul 03722, Korea
- International Olympic Committee Research Centre KOREA, Seoul 03722, Korea
| | - Min Jin Kim
- Department of Physical Education, Yonsei University, Seoul 03722, Korea
- International Olympic Committee Research Centre KOREA, Seoul 03722, Korea
| | - Hee Seong Jeong
- International Olympic Committee Research Centre KOREA, Seoul 03722, Korea
- Department of Sports and Health Management, Mokwon University, Daejeon 35349, Korea
| | - Inje Lee
- International Olympic Committee Research Centre KOREA, Seoul 03722, Korea
- Department of Sports Rehabilitation Medicine, Kyungil University, Gyeongsan 38428, Korea
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, Seoul 03722, Korea
- International Olympic Committee Research Centre KOREA, Seoul 03722, Korea
- Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
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The implementation of a neck strengthening exercise program in elite rugby union: A team case study over one season. Phys Ther Sport 2022; 55:248-255. [DOI: 10.1016/j.ptsp.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
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Sports training auxiliary decision support system based on neural network algorithm. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-07137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Waltzman D, Daugherty J, Sarmiento K, Haarbauer-Krupa J, Campbell H, Ferrell D. Prevalence of Suspected Concussions Among K-12 Students in Utah: Findings From Utah's Student Injury Reporting System. THE JOURNAL OF SCHOOL HEALTH 2022; 92:241-251. [PMID: 34927246 PMCID: PMC8831567 DOI: 10.1111/josh.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K-12 schools in Utah. METHODS Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011-2012 to 2018-2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K-12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi-square (χ2 ) analysis looking at characteristics by school level was also conducted. RESULTS Over 63,000 K-12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports- and recreation-related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Mail Stop: F62, Atlanta, GA, 30341
| | - Jill Daugherty
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Chamblee Campus, Bldg. 106/9110.17, Atlanta, GA, 30341
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Mail Stop: F62, Atlanta, GA, 30341
| | - Juliet Haarbauer-Krupa
- Traumatic Brain Injury Team, Applied Sciences Branch Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE | MS S106-9, Atlanta, GA, 30341
| | - Hillary Campbell
- Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT
| | - Deanna Ferrell
- Violence and Injury Prevention Program (VIPP), Utah Department of Health, 288 North 1460 West, PO Box 142106, Salt Lake City, UT, 84114-2106
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An acute bout of controlled subconcussive impacts can alter dynamic cerebral autoregulation indices: a preliminary investigation. Eur J Appl Physiol 2022; 122:1059-1070. [PMID: 35171333 DOI: 10.1007/s00421-022-04908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There is growing concern repetitive head contacts sustained by soccer players may lead to long-term health ramifications. Therefore, this preliminary investigation examined the impact an acute soccer heading bout has on dynamic cerebral autoregulation (dCA) metrics. METHODS In this preliminary investigation, 40 successful soccer headers were performed in 20 min by 7 male elite soccer players (24.1 ± 1.5 years). Soccer balls were launched at 77.5 ± 3.7 km/h from JUGS soccer machine, located 35 m away from participants. Linear and rotational head accelerations impacts were measured using an accelerometer (xPatch). The SCAT3 indexed concussion symptom score and severity before and after: soccer headers, sham (body contact only), and control conditions. Squat-stand maneuvers were performed at 0.05 Hz and 0.10 Hz to quantity dCA through measures of coherence, phase, and gain. RESULTS Cumulative linear and rotational accelerations during soccer headers were 1574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively. SCAT3 symptom severity was elevated after the soccer heading bout (pre 3.7 ± 3.6, post 9.4 ± 7.6: p = 0.030) and five of the seven participants reported an increase in concussion-like symptoms (pre: 2.6 ± 3.0, post: 6.7 ± 6.2; p = 0.078). Phase at 0.10 Hz was elevated following soccer heading (p = 0.008). No other dCA metric differed following the three conditions. CONCLUSION These preliminary results indicate an acute bout of soccer heading resulted in alterations to dCA metrics. Therefore, future research with larger sample sizes is warranted to fully comprehend short- and long-term physiological changes related to soccer heading.
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Pankow MP, Syrydiuk RA, Kolstad AT, Hayden AK, Dennison CR, Mrazik M, Hagel BE, Emery CA. Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football. Sports Med 2021; 52:1259-1272. [PMID: 34894348 DOI: 10.1007/s40279-021-01609-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. METHODS Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. MAIN RESULTS After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67-0.89] for high school football (ages 13-19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89-1.41) for minor football players (ages 5-15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). CONCLUSIONS This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.
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Affiliation(s)
- Mark Patrick Pankow
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada. .,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - R A Syrydiuk
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A T Kolstad
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A K Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - C R Dennison
- Department of Mechanical Engineering, University of Victoria, Victoria, Canada.,Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - M Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - B E Hagel
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Gallagher J, Fine P, Ashley P, Needleman I. Developing the role of the sports dentist. Br Dent J 2021; 231:544-546. [PMID: 34773016 DOI: 10.1038/s41415-021-3612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/09/2022]
Abstract
Sports dentistry has traditionally focused on orofacial trauma. There is now increasing evidence that participation in sport, particularly at elite level, may significantly increase the risks to oral health. The negative impact of poor oral health on athlete-reported wellbeing and performance is clear. The risks to athlete oral health can and should be mitigated and the role of the sports dentist is evolving to meet these new challenges. Custom-made mouthguards provide protection against orofacial trauma and potentially, concussion. Oral health screening should be included in athlete pre-season preparation. As integrated members of the athlete support team, dentists and dental care professionals can provide sport-specific oral health advice, encouraging athletes to take ownership of their oral health. The potential for translational health and wellbeing benefits to the wider population is also substantial, particularly with youth groups and recreational athletes. Sports dentistry requires distinctive skills. A UK-wide network of dentists and other oral health professionals with an interest in sport is important, to ensure that both appropriate advice and treatment is evidence-based and to further develop the research and clinical foundations.
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Affiliation(s)
- Julie Gallagher
- University College London, Eastman Dental Institute, Centre for Oral Health and Performance, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK.
| | - Peter Fine
- University College London, Eastman Dental Institute, Centre for Continuing Professional Development, London, UK
| | - Paul Ashley
- University College London, Eastman Dental Institute, Centre for Oral Health and Performance, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Ian Needleman
- University College London, Eastman Dental Institute, Centre for Oral Health and Performance, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
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Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure. Sports Med 2021; 52:481-504. [PMID: 34677820 DOI: 10.1007/s40279-021-01574-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number and magnitude of head impacts have been assessed in-vivo using inertial sensors to characterise the exposure in various sports and to help understand their potential relationship to concussion. OBJECTIVES We aimed to provide a comprehensive review of the field of in-vivo sensor acceleration event research in sports via the summary of data collection and processing methods, population demographics and factors contributing to an athlete's exposure to sensor acceleration events. METHODS The systematic search resulted in 185 cohort or cross-sectional studies that recorded sensor acceleration events in-vivo during sport participation. RESULTS Approximately 5800 participants were studied in 20 sports using 18 devices that included instrumented helmets, headbands, skin patches, mouthguards and earplugs. Female and youth participants were under-represented and ambiguous results were reported for these populations. The number and magnitude of sensor acceleration events were affected by a variety of contributing factors, suggesting sport-specific analyses are needed. For collision sports, being male, being older, and playing in a game (as opposed to a practice), all contributed to being exposed to more sensor acceleration events. DISCUSSION Several issues were identified across the various sensor technologies, and efforts should focus on harmonising research methods and improving the accuracy of kinematic measurements and impact classification. While the research is more mature for high-school and collegiate male American football players, it is still in its early stages in many other sports and for female and youth populations. The information reported in the summarised work has improved our understanding of the exposure to sport-related head impacts and has enabled the development of prevention strategies, such as rule changes. CONCLUSIONS Head impact research can help improve our understanding of the acute and chronic effects of head impacts on neurological impairments and brain injury. The field is still growing in many sports, but technological improvements and standardisation of processes are needed.
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Lochner A, Bazzi A, Guyer C, Brackney A. Acute Concussion Assessment and Management in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tomat N, Perovnik M, Vidmar G, van Midden V, Fabjan S, Hawlina H, Trol D, Holnthaner A, Krajnc S, Grešak M, Žerdin L, Vidmar J, Bresjanac M. Lay Public View of Neuroscience and Science-Based Brain Health Recommendations in Slovenia. Front Public Health 2021; 9:690421. [PMID: 34277550 PMCID: PMC8281117 DOI: 10.3389/fpubh.2021.690421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Brain health is one of the cornerstones of a long and full life. Active care for brain health and reduction of lifestyle-related risks for brain disorders may be a key strategy in tackling the growing prevalence of mental and neurological illnesses. Public knowledge, perception, and preventive behavior need to be considered in the planning of effective strategies for brain health promotion. Our research is the first effort aimed at assessing Slovenian lay public knowledge, search and use of scientific information about the brain, and care for brain health. Methods: An online survey was used to gather data for descriptive and associative statistical analyses of a sample of the Slovenian public (n = 2568) in August 2017. Participants with formal brain-related education were excluded, leaving the remaining sample of the lay public (n = 1012). Demographic characteristics and information regarding the perceived importance and knowledge of brain health and engagement in preventive behaviors of participants were collected, and key associative analyses were carried out. Results: The majority of respondents (89%) considered brain health to be important. Over one-third (39%) considered their knowledge of the brain as sufficient relative to their needs. Most of the respondents identified science-recommended practices to be important for brain health. No recommendation was followed daily by the majority of the respondents, primarily due to declared lack of time (59%), and lack of information (32%). Information was obtained primarily from television (38%), followed by newspapers and magazines (31%), the Internet (31%), and direct conversations (27%). However, the highest-rated, preferred source of information was lectured by experts. One-third of our sample struggled with the trustworthiness of information sources. Female gender and older age were associated with a higher frequency of healthy practices. Personal or familial diagnoses of brain disorders were not associated with a higher frequency of the behavior in favor of brain health, but did affect available time and perceived value of preventive practices. Conclusions: Our research provides an initial insight into the perceptions, knowledge, and brain health-promoting behavior of the Slovenian lay public. Our findings can inform future strategies for science communication, public education and engagement, and policy-making to improve lifelong active care for brain health.
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Affiliation(s)
- Nastja Tomat
- Institute for the Deaf and Hard of Hearing Ljubljana, Ljubljana, Slovenia.,SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | - Matej Perovnik
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gaj Vidmar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,University Rehabilitation Institute, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Sciences, and Information Technologies, University of Primorska, Koper, Slovenia
| | - Vesna van Midden
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia.,Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - Sara Fabjan
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia.,Department of Applied Kinesiology, Faculty of Health Sciences, University of Primorska, Koper, Slovenia
| | - Hana Hawlina
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | - Dolores Trol
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | - Alina Holnthaner
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | | | - Maruša Grešak
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | - Liza Žerdin
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia
| | | | - Mara Bresjanac
- SiNAPSA, Slovenian Neuroscience Association, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Falla KA, Randall S, DeMatteo C. Brain smart – Let's play safely: Evaluation of a concussion education program in schools. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211024447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives There are two objectives for this paper. First, to determine effects of a concussion education program in a local school board in terms of concussion-specific knowledge in children and confidence in identifying and managing concussion in adults. Second, to identify differences and similarities in concussion knowledge between children who participate in sports and those who do not and between children with a history of one or more concussions and those without. Design A cross sectional survey regarding concussion knowledge was distributed randomly to students and adults at both pre- and posteducation timepoints. A concussion education program was disseminated across the school board for students between the distribution survey timepoints. Following the education program, adults and students completed their respective post-test surveys. Chi-squared tests in SPSS determined the significance of between-group differences. Results All 17 adults (100.0%) who had received concussion education recently reported confidence in their knowledge of concussion management, compared to 35.7% adults who had not received education for over a year (p = 0.020). For students, all of whom completed the concussion education training between the pre- and post-tests, there were no significant differences in concussion knowledge scores between athletes and non-athletes (either in or outside of school) or between those with a history of concussion and those without. There were no significant changes in concussion knowledge between the pre- and post-tests, except for one question. Conclusion Concussion education programs increase confidence of concussion management protocols in adults involved in sport, but they require improvements to better support knowledge amelioration, particularly for target groups that are at high risk of sustaining another injury.
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Affiliation(s)
- Katie Alison Falla
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada Canada
| | - Sarah Randall
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Carol DeMatteo
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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