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Succop B, Thompson NJ, Dedmon MM, Gelinne A, Selleck A, Reed S, Sindelar MBD. Noninvasive Treatment of Venous Pulsatile Tinnitus with an Internal Jugular Vein Compression Collar. Laryngoscope 2024; 134:3342-3348. [PMID: 38345081 DOI: 10.1002/lary.31326] [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: 10/24/2023] [Revised: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE The study was conducted to evaluate the safety and efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus. METHODS This is a prospective study that recruited 20 adult patients with venous pulsatile tinnitus. Participants completed the Tinnitus Handicap Inventory (THI), were fitted with the collar, and rated symptom intensity on a 10-point tinnitus intensity scale before and during collar use. Once weekly for 4 weeks, they answered a survey quantifying days used, average tinnitus intensity before and after wearing the collar each day of use, and any safety concerns. Lastly, they completed an exit interview. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric testing. RESULTS 18 participants completed the study, and 276 paired daily before use/during use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4, 7), whereas with the collar it was 3 (IQR 2, 5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting, frequency, or time on symptomatic relief with the collar. There were no adverse safety events reported aside from minor discomfort upon initial application. CONCLUSIONS Venous compression collars offer acute symptom relief for patients with venous pulsatile tinnitus. Further study is needed to assess safety and efficacy of longitudinal use. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3342-3348, 2024.
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Affiliation(s)
- Benjamin Succop
- Chapel Hill School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicholas J Thompson
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew M Dedmon
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anne Selleck
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maj Brian D Sindelar
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Urbanik A, Guz W, Brożyna M, Ostrogórska M. Changes in the central nervous system in football players: an MRI study. Acta Radiol 2024:2841851241248410. [PMID: 38767036 DOI: 10.1177/02841851241248410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Football (soccer) is the world's most popular team sport. PURPOSE To comprehensively examine the brain in football (soccer) players, with the use of magnetic resonance imaging (MRI) techniques. MATERIAL AND METHODS The study involved 65 football players and 62 controls. The MR examinations were performed using MR 1.5-T system (Optima MR 360; GE Medical Systems). The examinations were carried out in the 3D Bravo, CUBE, FSEpropeller, and diffusion-weighted imaging (DWI) sequences. The 1HMRS signal was obtained from the volume of interest in the frontal and occipital lobes on both sides. RESULTS The present study, based on structural MRI, shows some changes in the brains of the group of football players. The findings show asymmetry of the ventricular system in four football players, arachnoid cysts in the parieto-occipital region, and pineal cysts. NAA/Cr concentration in the right frontal lobe was lower in the football players than in the controls, and the Glx/Cr concentration in the right occipital lobe was higher. The apparent diffusion coefficient value is lower in football players in the occipital lobes. CONCLUSION Playing football can cause measurable changes in the brain, known to occur in patients diagnosed with traumatic brain injury. The present findings fill the gap in the literature by contributing evidence showing that playing football may lead to changes in the brain, without clinical symptoms of concussion.
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Affiliation(s)
- Andrzej Urbanik
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Wiesław Guz
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Maciej Brożyna
- Institute of Physical Culture Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Monika Ostrogórska
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
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Lember LM, Ntikas M, Mondello S, Wilson L, Di Virgilio TG, Hunter AM, Kobeissy F, Mechref Y, Donaldson DI, Ietswaart M. The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review. SPORTS MEDICINE - OPEN 2024; 10:12. [PMID: 38270708 PMCID: PMC10811313 DOI: 10.1186/s40798-023-00665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. OBJECTIVE This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. METHODS PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. RESULTS Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers-such as NfL-appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. CONCLUSION Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers' utility.
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Affiliation(s)
- Liivia-Mari Lember
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Michail Ntikas
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
- The School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Stefania Mondello
- Biomedical and Dental Sciences and Morphofunctional Imaging, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - Lindsay Wilson
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Thomas G Di Virgilio
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Angus M Hunter
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Department of Sports Science, Nottingham Trent University, Nottingham, UK
| | - Firas Kobeissy
- Center for Neurotrauma, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine (MSM), Multiomics & Biomarkers, Atlanta, GA, 30310, USA
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, USA
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, UK
| | - Magdalena Ietswaart
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
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Reeschke R, Haase FK, Dautzenberg L, Krutsch W, Reinsberger C. Training matters: Heading incidence and characteristics in children's and youth football (soccer) players. Scand J Med Sci Sports 2023; 33:1821-1830. [PMID: 37259619 DOI: 10.1111/sms.14408] [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: 01/18/2023] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Concerns about short- and long-term consequences of repetitive heading contributed to heading restrictions in youth football in some countries. This prospective longitudinal cohort study aims to describe heading exposure in children's and youth football over two seasons using standardized video analysis. METHODS All matches and training sessions of a male Under-11 (n = 29), Under-15 (n = 28), Under-19 (n = 38), and female Under-17 (n = 39) team were videotaped during the seasons 2019-2020 and 2020-2021. Heading frequencies and characteristics were analyzed. Individual heading exposure is presented as average incidence rates (IR) per 1000 match/training hours. RESULTS In 275 matches and 673 training sessions, 22 921 headers were observed. Heading IR per player in matches was 1256 (Under-11 m), 1608 (Under-15 m), 1050 (Under-17 f), and 1966 (Under-19 m). In training sessions, IR per player was 739 (Under-11 m), 2206 (Under-15 m), 1661 (Under-17 f), and 1419 (Under-19 m). Five Under-15 males headed the ball five to eight times per training on average. Most headers were performed without heading duels. Flight distance was predominantly 5-20 m (54%) in matches and <5 m (65%) in training. While head impact location most frequently was at frontal areas, one-third of all headers in Under-11 in matches hit temporal, parietal, and occipital parts of the head. CONCLUSION Heading incidence was low in the youngest age group, whereas (predominantly five) Under-15 males showed very high heading exposures in training. In assessment and regulation of heading burden, training sessions and individual heading behavior should specifically be addressed. Recommendations for heading the ball in practice should account for individual and age-related differences.
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Affiliation(s)
- Rebecca Reeschke
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | | | - Lena Dautzenberg
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
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Advances in applications of head mounted devices (HMDs): Physical techniques for drug delivery and neuromodulation. J Control Release 2023; 354:810-820. [PMID: 36709924 DOI: 10.1016/j.jconrel.2023.01.061] [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: 11/30/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
Head-mounted medical devices (HMDs) are disruptive inventions representing laboratories and clinical institutions worldwide are climbing the apexes of brain science. These complex devices are inextricably linked with a wide range knowledge containing the Physics, Imaging, Biomedical engineering, Biology and Pharmacology, particularly could be specifically designed for individuals, and finally exerting integrated bio-effect. The salient characteristics of them are non-invasive intervening in human brain's physiological structures, and alterating the biological process, such as thermal ablating the tumor, opening the BBB to deliver drugs and neuromodulating to enhance cognitive performance or manipulate prosthetic. The increasing demand and universally accepted of them have set off a dramatic upsurge in HMDs' studies, seminal applications of them span from clinical use to psychiatric disorders and neurological modulation. With subsequent pre-clinical studies and human trials emerging, the mechanisms of transcranial stimulation methods of them were widely studied, and could be basically came down to three notable approach: magnetic, electrical and ultrasonic stimulation. This review provides a comprehensive overviews of their stimulating mechanisms, and recent advances in clinic and military. We described the potential impact of HMDs on brain science, and current challenges to extensively adopt them as promising alternative treating tools.
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Reeder EL, O'Connell CJ, Collins SM, Traubert OD, Norman SV, Cáceres RA, Sah R, Smith DW, Robson MJ. Increased Carbon Dioxide Respiration Prevents the Effects of Acceleration/Deceleration Elicited Mild Traumatic Brain Injury. Neuroscience 2023; 509:20-35. [PMID: 36332692 DOI: 10.1016/j.neuroscience.2022.10.016] [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: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
Acceleration/deceleration forces are a common component of various causes of mild traumatic brain injury (mTBI) and result in strain and shear forces on brain tissue. A small quantifiable volume dubbed the compensatory reserve volume (CRV) permits energy transmission to brain tissue during acceleration/deceleration events. The CRV is principally regulated by cerebral blood flow (CBF) and CBF is primarily determined by the concentration of inspired carbon dioxide (CO2). We hypothesized that experimental hypercapnia (i.e. increased inspired concentration of CO2) may act to prevent and mitigate the actions of acceleration/deceleration-induced TBI. To determine these effects C57Bl/6 mice underwent experimental hypercapnia whereby they were exposed to medical-grade atmospheric air or 5% CO2 immediately prior to an acceleration/deceleration-induced mTBI paradigm. mTBI results in significant increases in righting reflex time (RRT), reductions in core body temperature, and reductions in general locomotor activity-three hours post injury (hpi). Experimental hypercapnia immediately preceding mTBI was found to prevent mTBI-induced increases in RRT and reductions in core body temperature and general locomotor activity. Ribonucleic acid (RNA) sequencing conducted four hpi revealed that CO2 exposure prevented mTBI-induced transcriptional alterations of several targets related to oxidative stress, immune, and inflammatory signaling. Quantitative real-time PCR analysis confirmed the prevention of mTBI-induced increases in mitogen-activated protein kinase kinase kinase 6 and metallothionein-2. These initial proof of concept studies reveal that increases in inspired CO2 mitigate the detrimental contributions of acceleration/deceleration events in mTBI and may feasibly be translated in the future to humans using a medical device seeking to prevent mTBI among high-risk groups.
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Affiliation(s)
- Evan L Reeder
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Christopher J O'Connell
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Sean M Collins
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Owen D Traubert
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Sophia V Norman
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Román A Cáceres
- University of Cincinnati College of Medicine, Department of Cancer and Cell Biology Cincinnati, OH 45267, USA
| | - Renu Sah
- University of Cincinnati College of Medicine, Department of Pharmacology and Systems Physiology, Cincinnati, OH 45267, USA
| | | | - Matthew J Robson
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA.
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Pratt RG, Lee G, McAllister AS, Smith DR, Myer GD, Ireland CM, Loew WM, Lanier M, Wang H, Diekfuss JA, Yuan W, Dumoulin CL. A Weighted Head Accelerator Mechanism (WHAM) for visualizing brain rheology using magnetic resonance imaging. J Neurosci Methods 2022; 382:109728. [PMID: 36244524 DOI: 10.1016/j.jneumeth.2022.109728] [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: 03/30/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A device for moving the head during MR imaging, called a Weighted Head Accelerator Mechanism (WHAM), rotates the head of a supine subject within programmable rotation limits and acceleration profiles. The WHAM can be used with custom MRI sequences to visualize the deformation and recoil of in vivo brain parenchyma with high temporal resolution, allowing element-wise calculation of strain and shear forces in the brain. Unlike previous devices, the WHAM can be configured to provide a wide range of motion and acceleration profiles. NEW METHOD The WHAM was calibrated using a high-speed camera on a laboratory bench and in 1.5 Tesla and 3.0 Tesla MRI scanners using gel phantoms and human subjects. The MR imaging studies employed a spatial spin-saturation tagging sub-sequence, followed by serial image acquisition. In these studies, 256 images were acquired with a temporal resolution of 2.56 ms. Deformation of the brain was quantified by following the spatial tags in the images. RESULTS MR imaging showed that the WHAM drove quantifiable brain motions using g forces less than those typically observed in day-to-day activities, with peak accelerations of ∼250 rad/sec2. COMPARISON WITH EXISTING METHODS The peak pre-contact accelerations and velocities achieved by the WHAM device in this study are both higher than devices used in previous studies, while also allowing for modification of these factors. CONCLUSIONS MR imaging performed with the WHAM provides a direct method to visualize and quantify "brain slosh" in response to rotational acceleration. Consequently, this approach might find utility in evaluating strategies to protect the brain from mild traumatic brain injury (mTBI).
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Affiliation(s)
- Ronald G Pratt
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Aaron S McAllister
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel R Smith
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Christopher M Ireland
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Wolfgang M Loew
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Matt Lanier
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hui Wang
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Philips Healthcare, Cincinnati, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Weihong Yuan
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Charles L Dumoulin
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Kepka S, Lersy F, Godet J, Blanc F, Bilger M, Botzung A, Kleitz C, Merignac J, Ohrant E, Garnier F, Pietra F, Noblet V, Deck C, Willinger R, Kremer S. Cerebral and cognitive modifications in retired professional soccer players: TC-FOOT protocol, a transverse analytical study. BMJ Open 2022; 12:e060459. [PMID: 36351716 PMCID: PMC9664284 DOI: 10.1136/bmjopen-2021-060459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Soccer is the most popular sport in the world. This contact sport carries the risk of exposure to repeated head impacts in the form of subconcussions, defined as minimal brain injuries following head impact, with no symptom of concussion. While it has been suggested that exposure to repetitive subconcussive events can result in long-term neurophysiological modifications, and the later development of chronic traumatic encephalopathy, the consequences of these repeated impacts remain controversial and largely unexplored in the context of soccer players. METHODS AND ANALYSIS This is a prospective, single-centre, exposure/non-exposure, transverse study assessing the MRI and neuropsychological abnormalities in professional retired soccer players exposed to subconcussive impacts, compared with high-level athletes not exposed to head impacts. The primary outcome corresponds to the results of MRI by advanced MRI techniques (diffusion tensor, cerebral perfusion, functional MRI, cerebral volumetry and cortical thickness, spectroscopy, susceptibility imaging). Secondary outcomes are the results of the neuropsychological tests: number of errors and time to complete tests. We hypothesise that repeated subconcussive impacts could lead to morphological lesions and impact on soccer players' cognitive skills in the long term. ETHICS AND DISSEMINATION Ethics approval has been obtained and the study was approved by the Comité de Protection des Personnes (CPP) No 2021-A01169-32. Study findings will be disseminated by publication in a high-impact international journal. Results will be presented at national and international imaging meetings. TRIAL REGISTRATION NUMBER NCT04903015.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, University Hospital Centre Strasbourg, Strasbourg, France
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - François Lersy
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Julien Godet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Public Health Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Mathias Bilger
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Anne Botzung
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Kleitz
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Jeanne Merignac
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | | | - Franck Garnier
- School of Osteopathy, College COS Strasbourg, Strasbourg, France
- Medical Sport Center of Strasbourg, CMSM, Strasburg, France
| | | | - Vincent Noblet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Caroline Deck
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Remy Willinger
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Stéphane Kremer
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
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Raikes AC, Hernandez GD, Mullins VA, Wang Y, Lopez C, Killgore WDS, Chilton FH, Brinton RD. Effects of docosahexaenoic acid and eicosapentaoic acid supplementation on white matter integrity after repetitive sub-concussive head impacts during American football: Exploratory neuroimaging findings from a pilot RCT. Front Neurol 2022; 13:891531. [PMID: 36188406 PMCID: PMC9521411 DOI: 10.3389/fneur.2022.891531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Context Repetitive sub-concussive head impacts (RSHIs) are common in American football and result in changes to the microstructural integrity of white matter. Both docosahexaenoic acid (DHA) and eicosapentaoic acid (EPA) supplementation exerted neuroprotective effects against RSHIs in animal models and in a prior study in football players supplemented with DHA alone. Objective Here, we present exploratory neuroimaging outcomes from a randomized controlled trial of DHA + EPA supplementation in American football players. We hypothesized that supplementation would result in less white matter integrity loss on diffusion weighted imaging over the season. Design setting participants We conducted a double-blind placebo-controlled trial in 38 American football players between June 2019 and January 2020. Intervention Participants were randomized to the treatment (2.442 g/day DHA and 1.020 g/day EPA) or placebo group for five times-per-week supplementation for 7 months. Of these, 27 participants were included in the neuroimaging data analysis (n = 16 placebo; n = 11 DHA + EPA). Exploratory outcome measures Changes in white matter integrity were quantified using both voxelwise diffusion kurtosis scalars and deterministic tractography at baseline and end of season. Additional neuroimaging outcomes included changes in regional gray matter volume as well as intra-regional, edge-wise, and network level functional connectivity. Serum neurofilament light (NfL) provided a peripheral biomarker of axonal damage. Results No voxel-wise between-group differences were identified on diffusion tensor metrics. Deterministic tractography using quantitative anisotropy (QA) revealed increased structural connectivity in ascending corticostriatal fibers and decreased connectivity in long association and commissural fibers in the DHA+EPA group compared to the placebo group. Serum NfL increases were correlated with increased mean (ρ = 0.47), axial (ρ = 0.44), and radial (ρ = 0.51) diffusivity and decreased QA (ρ = -0.52) in the corpus callosum and bilateral corona radiata irrespective of treatment group. DHA + EPA supplementation did preserve default mode/frontoparietal control network connectivity (g = 0.96, p = 0.024). Conclusions These exploratory findings did not provide strong evidence that DHA + EPA prevented or protected against axonal damage as quantified via neuroimaging. Neuroprotective effects on functional connectivity were observed despite white matter damage. Further studies with larger samples are needed to fully establish the relationship between omega-3 supplementation, RSHIs, and neuroimaging biomarkers. Trial registration ClinicalTrials.gov-NCT04796207.
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Affiliation(s)
- Adam C. Raikes
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Gerson D. Hernandez
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Veronica A. Mullins
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States
| | - Yiwei Wang
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Claudia Lopez
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - William D. S. Killgore
- Social, Cognitive, and Affective Neuroscience Lab, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Floyd H. Chilton
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States
| | - Roberta D. Brinton
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
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Repeated Sub-Concussive Impacts and the Negative Effects of Contact Sports on Cognition and Brain Integrity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127098. [PMID: 35742344 PMCID: PMC9222631 DOI: 10.3390/ijerph19127098] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
Sports are yielding a wealth of benefits for cardiovascular fitness, for psychological resilience, and for cognition. The amount of practice, and the type of practiced sports, are of importance to obtain these benefits and avoid any side effects. This is especially important in the context of contact sports. Contact sports are not only known to be a major source of injuries of the musculoskeletal apparatus, they are also significantly related to concussion and sub-concussion. Sub-concussive head impacts accumulate throughout the active sports career, and thus can cause measurable deficits and changes to brain health. Emerging research in the area of cumulative sub-concussions in contact sports has revealed several associated markers of brain injury. For example, recent studies discovered that repeated headers in soccer not only cause measurable signs of cognitive impairment but are also related to a prolonged cortical silent period in transcranial magnetic stimulation measurements. Other cognitive and neuroimaging biomarkers are also pointing to adverse effects of heading. A range of fluid biomarkers completes the picture of cumulating effects of sub-concussive impacts. Those accumulating effects can cause significant cognitive impairment later in life of active contact sportswomen and men. The aim of this review is to highlight the current scientific evidence on the effects of repeated sub-concussive head impacts on contact sports athletes’ brains, identify the areas in need of further investigation, highlight the potential of advanced neuroscientific methods, and comment on the steps governing bodies have made to address this issue. We conclude that there are indeed neural and biofluid markers that can help better understand the effects of repeated sub-concussive head impacts and that some aspects of contact sports should be redefined, especially in situations where sub-concussive impacts and concussions can be minimized.
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11
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Basinas I, McElvenny DM, Pearce N, Gallo V, Cherrie JW. A Systematic Review of Head Impacts and Acceleration Associated with Soccer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095488. [PMID: 35564889 PMCID: PMC9100160 DOI: 10.3390/ijerph19095488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Epidemiological studies of the neurological health of former professional soccer players are being undertaken to identify whether heading the ball is a risk factor for disease or premature death. A quantitative estimate of exposure to repeated sub-concussive head impacts would provide an opportunity to investigate possible exposure-response relationships. However, it is unclear how to formulate an appropriate exposure metric within the context of epidemiological studies. We have carried out a systematic review of the scientific literature to identify the factors that determine the magnitude of head impact acceleration during experiments and from observations during playing or training for soccer, up to the end of November 2021. Data were extracted from 33 experimental and 27 observational studies from male and female amateur players including both adults and children. There was a high correlation between peak linear and angular accelerations in the observational studies (p < 0.001) although the correlation was lower for the experimental data. We chose to rely on an analysis of maximum or peak linear acceleration for this review. Differences in measurement methodology were identified as important determinants of measured acceleration, and we concluded that only data from accelerometers fixed to the head provided reliable information about the magnitude of head acceleration from soccer-related impacts. Exposures differed between men and women and between children and adults, with women on average experiencing higher acceleration but less frequent impacts. Playing position appears to have some influence on the number of heading impacts but less so on the magnitude of the head acceleration. Head-to-head collisions result in high levels of exposure and thus probably risk causing a concussion. We concluded, in the absence of evidence to the contrary, that estimates of the cumulative number of heading impacts over a playing career should be used as the main exposure metric in epidemiological studies of professional players.
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Affiliation(s)
- Ioannis Basinas
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Damien M. McElvenny
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Valentina Gallo
- Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands;
| | - John W. Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh EH14 4AS, UK
- Correspondence:
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12
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Hollin G. Consider the woodpecker: The contested more-than-human ethics of biomimetic technology and traumatic brain injury. SOCIAL STUDIES OF SCIENCE 2022; 52:149-173. [PMID: 34657493 PMCID: PMC8978470 DOI: 10.1177/03063127211052513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chronic Traumatic Encephalopathy, or CTE, is a neurodegenerative disease caused by traumatic brain injury and most frequently associated with contact sports such as American Football. Perhaps surprisingly, the woodpecker - an animal apparently immune to the effects of head impacts - has increasingly figured into debates surrounding CTE. On the one hand, the woodpecker is described as being contra-human and used to underscore the radical inappropriateness of humans playing football. On the other, there have been attempts to mitigate against the risk of CTE through the creation of biomimetic technologies inspired by woodpeckers. In this article I examine the highly politicized encounters between humans and woodpeckers and discuss how the politics of re-/dis-/en-tanglement during these interspecies relations is rendered meaningful. I show here, first, that those who seek to keep the human and the woodpecker apart envisage social overhaul while biomimetic technologies are put to work for the status quo. Second, I stress that different forms of entanglement have diverse sociopolitical consequences. I conclude by suggesting that the case of the woodpecker troubles a strand of contemporary scholarship in Science and Technology Studies that argues that biotechnologies are inherently transformatory and that foregrounding entanglement and interspecies relations is ethically generative. Instead, a discursive separation of nature and culture may be innovative.
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Affiliation(s)
- Gregory Hollin
- Gregory Hollin, School of Sociology
and Social Policy, University of Leeds, Leeds LS2 9JT, UK.
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13
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Neal J, Hutchings PB, Phelps C, Williams D. Football and Dementia: Understanding the Link. Front Psychiatry 2022; 13:849876. [PMID: 35693952 PMCID: PMC9184440 DOI: 10.3389/fpsyt.2022.849876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Football, also known as soccer or association football, is popular but has a potential link with dementia developing in retired players. The FA and soccer regulators in the USA have imposed guidelines limiting players exposure to heading, despite controversy whether this dementia is caused by heading the ball, a form of mild repetitive head injury (RHI), over many years. Substantial data exist showing that many ex-North American Football players develop a specific neurodegenerative disease: chronic traumatic encephalopathy (CTE), the neuropathological disorder of boxers. In the United Kingdom evidence for the neuropathological basis of footballers' dementia has been slow to emerge. A 2017 study revealed that in six ex-soccer players four had CTE with Alzheimer's disease (AD) and two had AD. A 2019 study showed that ex-footballers were 3.5 times more likely to die from dementia or other neuro-degenerative diseases than matched controls. We argue that in childhood and adolescence the brain is vulnerable to heading, predicated on its disproportionate size and developmental immaturity. RHI in young individuals is associated with early neuroinflammation, a potential trigger for promoting neurodegeneration in later life. Evidence is available to support the guidelines limiting heading for players of all ages, while professional and non-players should be included in prospective studies to investigate the link between soccer and dementia.
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Affiliation(s)
- James Neal
- Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Paul B Hutchings
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
| | - Ceri Phelps
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
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14
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Dinsmore M, Hajat Z, Brenna CT, Fisher J, Venkatraghavan L. Effect of a neck collar on brain turgor: a potential role in preventing concussions? Br J Sports Med 2021; 56:605-607. [PMID: 34824061 DOI: 10.1136/bjsports-2021-103961] [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: 11/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mild internal jugular vein (IJV) compression, aimed at increasing intracranial fluid volume to prevent motion of the brain relative to the skull, has reduced brain injury markers in athletes suffering repeated traumatic brain injuries. However, an increase in intracranial volume with IJV compression has not been well demonstrated. This study used transorbital ultrasound to identify changes in optic nerve sheath diameter (ONSD) as a direct marker of accompanying changes in intracranial volume. METHODS Nineteen young, healthy adult volunteers (13 males and 6 females) underwent IJV compression of 20 cm H2O low in the neck, while in upright posture. IJV cross-sectional area at the level of the cricoid cartilage, and the change in right ONSD 3 mm behind the papillary segment of the optic nerve, were measured by ultrasound. Statistical analysis was performed using a paired t-test with Bonferroni correction. RESULTS Mean (SD) cross-sectional area for the right IJV before and after IJV compression was 0.10 (0.05) cm2 and 0.57 (0.37) cm2, respectively (p=0.001). ONSD before and after IJV compression was 4.6 (0.5) mm and 4.9 (0.5) mm, respectively (p=0.001). CONCLUSIONS These data verify increased cerebral volume following IJV compression, supporting the potential for reduced brain 'slosh' as a mechanism connecting IJV compression to possibly reducing traumatic brain injury following head trauma.
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Affiliation(s)
- Michael Dinsmore
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Zakir Hajat
- Department of Anaesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Connor Ta Brenna
- Department of Anaesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Fisher
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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15
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Narad ME, Epstein J, Peugh J, Barber Foss KD, Diekfuss JA, Bonnette S, Orban S, Yuan W, Dudley J, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer J, Avedesian JM, Slutsky-Ganesh AB, Lloyd RS, Howell D, Myer GD. The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial. J Neurotrauma 2021; 39:49-57. [PMID: 34779241 DOI: 10.1089/neu.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This prospective longitudinal trial aimed to 1) determine the role of head impact exposure on behavioral/cognitive outcomes, and 2) assess the protective effect(s) of a jugular vein compression (JVC) collar on behavioral/cognitive outcomes following one season of high-school football. Participants included 284 male high-school football players aged 13-18 years enrolled from seven midwestern high-schools. Schools were allocated to the JVC collar intervention(four teams, 140 players) or non-collar/no intervention control (three teams, 144 players) condition. Head impact exposure was measured throughout the season using CSx accelerometers. Outcome measures included post season parent and adolescent report on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN) and Post-Concussion Symptom Inventory (PCSI), as well as adolescent performance on Attention Network Task (ANT), digital Trail Making Task (dTMT), and Cued Switching task. No significant effect of head impact exposure or JVC collar use on post-season SWAN or PCSI scores or performance on dTMT and Cued Switching task were noted. There was no effect of head impact exposure on ANT performance; however, the JVC collar group had greater post-season Alerting network scores than the non-collar group (p=.026, d=.22). Findings provide preliminary evidence that the JVC collar may provide some protection to the alerting attention system. These findings should be interpreted cautiously as a greater understanding of the long-term sequalae of head impact exposure and the role of cumulative head impact exposure behavioral/cognitive outcomes is required.
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Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, 3333 Burnet Ave, mlc 10006, Cincinnati, Ohio, United States, 45229;
| | - Jeffery Epstein
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, United States;
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, 2518, Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, United States;
| | - Kim D Barber Foss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Jed A Diekfuss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Scott Bonnette
- Cincinnati Children's Hospital Medical Center, 2518, The SPORT Center, Division of Sports Medicine, Cincinnati, Ohio, United States;
| | - Sarah Orban
- University of Tampa, Department of psychology, Tampa, FL, United States;
| | - Weihong Yuan
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnew Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Jonathan Dudley
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnet Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Christopher A DiCesare
- University of Michigan, 1259, Department of Mechanical engineering, Ann Arbor, Michigan, United States;
| | - Danielle L Reddington
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | - Wen Zhong
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Jessica Shafer
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Alexis B Slutsky-Ganesh
- The University of North Carolina at Greensboro, Department of Kinesiology, Greensboro, North Carolina, United States;
| | - Rhodri S Lloyd
- Cardiff Metropolitan University, 11352, Cardiff, Cardiff, United Kingdom of Great Britain and Northern Ireland.,AUT University, Auckland, New Zealand.,Waikato Institute of Technology, 3715, Hamilton, New Zealand;
| | - David Howell
- University of Colorado Denver School of Medicine, 12225, Department of Orthopedics , Aurora, Colorado, United States;
| | - Greg D Myer
- Emory University School of Medicine, 12239, Atlanta, Georgia, United States.,the Micheli Center for Sports Injury Prevention, Waltham, Ma, United States;
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16
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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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17
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Yuan W, Diekfuss JA, Barber Foss KD, Dudley JA, Leach JL, Narad ME, DiCesare CA, Bonnette S, Epstein JN, Logan K, Altaye M, Myer GD. High School Sports-Related Concussion and the Effect of a Jugular Vein Compression Collar: A Prospective Longitudinal Investigation of Neuroimaging and Neurofunctional Outcomes. J Neurotrauma 2021; 38:2811-2821. [PMID: 34375130 DOI: 10.1089/neu.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes. We aimed to quantify the alterations in white matter (WM) microstructure and global network organization, and the decrements in behavioral and cognitive outcomes from pre-season to post-concussion in youth athletes who experienced SRC. We also aimed to evaluate whether wearing a jugular compression neck collar, a device designed to mitigate brain "slosh" injury, would mitigate the pre-season to post-concussion alterations in neuroimaging, behavioral, and cognitive outcomes. A total of 488 high school football and soccer athletes (14-18 years old) were prospectively enrolled and assigned to the non-collar group (n = 237) or the collar group (n = 251). The outcomes of the study were the pre-season to post-concussion neuroimaging, behavioral, and cognitive alterations. Forty-six participants (non-collar: n = 24; collar: n = 22) were diagnosed with a SRC during the season. Forty of these 46 athletes (non-collar: n = 20; collar: n = 20) completed neuroimaging assessment. Significant pre-season to post-concussion alterations in WM microstructural integrity and brain network organization were found in these athletes (corrected p < 0.05). The alterations were significantly reduced in collar-wearing athletes compared to non-collar-wearing athletes (corrected p < 0.05). Concussion and collar main effects were identified for some of the behavioral and cognitive outcomes, but no collar by SRC interaction effects were observed in any outcomes. In summary, young athletes exhibited significant WM microstructural and network organizational, and cognitive alterations following SRC. The use of the jugular vein compression collar showed promising evidence to reduce these alterations in high school contact sport athletes.
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Affiliation(s)
- Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Megan E Narad
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher A DiCesare
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffery N Epstein
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelsey Logan
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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18
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Gilbert AW, Bering JM, Anderson LC. Addressing head injury risk in youth football: are heading guidelines the answer? SCI MED FOOTBALL 2021; 6:340-346. [DOI: 10.1080/24733938.2021.1967435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alexander W. Gilbert
- 133 Union Street East, Dunedin
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
| | - Jesse M. Bering
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
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19
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Walter AE, Wilkes JR, Arnett PA, Miller SJ, Sebastianelli W, Seidenberg P, Slobounov SM. The accumulation of subconcussive impacts on cognitive, imaging, and biomarker outcomes in child and college-aged athletes: a systematic review. Brain Imaging Behav 2021; 16:503-517. [PMID: 34308510 DOI: 10.1007/s11682-021-00489-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
Examine the effect of subconcussive impact accumulation on cognitive/functional, imaging, and biomarker outcomes over the course of a single season, specifically in contact sport athletes at collegiate level or younger. Systematic review following PRISMA guidelines and using Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence and Newcastle Ottawa Assessment Scale. PubMed MEDLINE, PsycInfo, SPORT-Discus, Web of Science. Original research in English that addressed the influence of subconcussive impacts on outcomes of interest with minimum preseason and postseason measurement in current youth, high school, or college-aged contact sport athletes. 796 articles were initially identified, and 48 articles were included in this review. The studies mostly involved male football athletes in high school or college and demonstrated an underrepresentation of female and youth studies. Additionally, operationalization of previous concussion history and concussion among studies was very inconsistent. Major methodological differences existed across studies, with ImPACT and diffusion tensor imaging being the most commonly used modalities. Biomarker studies generally showed negative effects, cognitive/functional studies mostly revealed no effects, and advanced imaging studies showed generally negative findings over the season; however, there was variability in the findings across all types of studies. This systematic review revealed growing literature on this topic, but inconsistent methodology and operationalization across studies makes it challenging to draw concrete conclusions. Overall, cognitive measures alone do not seem to detect changes across this timeframe while imaging and biomarker measures may be more sensitive to changes following subconcussive impacts.
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Affiliation(s)
- Alexa E Walter
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA.
| | - James R Wilkes
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
| | - Peter A Arnett
- Department of Psychology, Penn State University, University Park, PA, 16802, USA
| | - Sayers John Miller
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
| | - Wayne Sebastianelli
- Deparetment of Orthopaedics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Peter Seidenberg
- Department of Orthopaedics and Rehabilitation and Family and Community Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
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20
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Johnson B, Walter AE, Wilkes JR, Papa L, Slobounov SM. Changes in White Matter of the Cervical Spinal Cord after a Single Season of Collegiate Football. Neurotrauma Rep 2021; 2:84-93. [PMID: 34223548 PMCID: PMC8240824 DOI: 10.1089/neur.2020.0035] [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] [Indexed: 12/16/2022] Open
Abstract
The involvement of the central nervous system (CNS), specifically the white matter tracts in the cervical spinal cord, was examined with diffusion tensor imaging (DTI) following exposure to repetitive head acceleration events (HAEs) after a single season of collegiate football. Fifteen National Collegiate Athletic Association (NCAA) Division 1 football players underwent DTI of the cervical spinal cord (vertebral level C1–4) at pre-season (before any contact practices began) and post-season (within 1 week of the last regular season game) intervals. Helmet accelerometer data were also collected in parallel throughout the season. From pre-season to post-season, a significant decrease (p < 0.05) of axial diffusivity was seen within the right spino-olivary tract. In addition, a significant decrease (p < 0.05) in global white matter fractional anisotropy (FA) along with increases (p < 0.05) in global white matter mean diffusivity (MD) and radial diffusivity (RD) were found. These changes in FA from pre-season to post-season were significantly moderated by previous concussion history (p < 0.05) and number of HAEs over 80 g (p < 0.05). Despite the absence of sports-related concussion (SRC), we present measurable changes in the white matter integrity of the cervical spinal cord suggesting injury from repetitive HAEs, or SRC, may include the entirety of the CNS, not just the brain.
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Affiliation(s)
- Brian Johnson
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexa E Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - James R Wilkes
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Semyon M Slobounov
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
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21
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Development of brain atlases for early-to-middle adolescent collision-sport athletes. Sci Rep 2021; 11:6440. [PMID: 33742031 PMCID: PMC7979742 DOI: 10.1038/s41598-021-85518-6] [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] [Received: 06/02/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Human brains develop across the life span and largely vary in morphology. Adolescent collision-sport athletes undergo repetitive head impacts over years of practices and competitions, and therefore may exhibit a neuroanatomical trajectory different from healthy adolescents in general. However, an unbiased brain atlas targeting these individuals does not exist. Although standardized brain atlases facilitate spatial normalization and voxel-wise analysis at the group level, when the underlying neuroanatomy does not represent the study population, greater biases and errors can be introduced during spatial normalization, confounding subsequent voxel-wise analysis and statistical findings. In this work, targeting early-to-middle adolescent (EMA, ages 13-19) collision-sport athletes, we developed population-specific brain atlases that include templates (T1-weighted and diffusion tensor magnetic resonance imaging) and semantic labels (cortical and white matter parcellations). Compared to standardized adult or age-appropriate templates, our templates better characterized the neuroanatomy of the EMA collision-sport athletes, reduced biases introduced during spatial normalization, and exhibited higher sensitivity in diffusion tensor imaging analysis. In summary, these results suggest the population-specific brain atlases are more appropriate towards reproducible and meaningful statistical results, which better clarify mechanisms of traumatic brain injury and monitor brain health for EMA collision-sport athletes.
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Brett BL, Koch KM, Muftuler LT, Budde M, McCrea MA, Meier TB. Association of Head Impact Exposure with White Matter Macrostructure and Microstructure Metrics. J Neurotrauma 2021; 38:474-484. [PMID: 33003979 PMCID: PMC7875606 DOI: 10.1089/neu.2020.7376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Prior studies have reported white matter abnormalities associated with a history of cumulative concussion and/or repetitive head impacts (RHI) in contact sport athletes. Growing evidence suggests these abnormalities may begin as more subtle changes earlier in life in active younger athletes. We investigated the relationship between prior concussion and contact sport exposure with multi-modal white matter microstructure and macrostructure using magnetic resonance imaging. High school and collegiate athletes (n = 121) completed up to four evaluations involving neuroimaging. Linear mixed-effects models examined associations of years of contact sport exposure (i.e., RHI proxy) and prior concussion across multiple metrics of white matter, including total white matter volume, diffusion tensor imaging (DTI) metrics, diffusion kurtosis imaging (DKI) metrics, and quantitative susceptibility mapping (QSM). A significant inverse association between cumulative years of contact sport exposure and QSM was observed, F(1, 237.77) = 4.67, p = 0.032. Cumulative contact sport exposure was also associated with decreased radial diffusivity, F(1, 114.56) = 5.81, p = 0.018, as well as elevated fractional anisotropy, F(1, 115.32) = 5.40, p = 0.022, and radial kurtosis, F(1, 113.45) = 4.03, p = 0.047. In contrast, macroscopic white matter volume was not significantly associated with cumulative contact sport exposure (p > 0.05). Concussion history was not significantly associated with QSM, DTI, DKI, or white matter volume (all, p > 0.05). Cumulative contact sport exposure is associated with subtle differences in white matter microstructure, but not gross white matter macrostructure, in young active athletes. Longitudinal follow-up is required to assess the progression of these findings to determine their contribution to potential adverse effects later in life.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin M. Koch
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Imaging Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - L. Tugan Muftuler
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Budde
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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23
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The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes. Sports Med 2020; 51:825-835. [PMID: 33332015 DOI: 10.1007/s40279-020-01395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery. OBJECTIVE To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegiate athletes following concussion. METHODS Collegiate athletes (n = 187; age = 19.7 ± 1.4 years; male = 70.6%) underwent baseline assessments across 30 universities and experienced a concussion in this retrospective cohort study. Altitude (m) and heat index (°C) at the time and location of injury were determined using valid online database tools. Acute concussion assessments included the Sport Concussion Assessment Tool (SCAT) symptom inventory, Balance Error Scoring System (BESS), and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We used multiple linear regression models to determine whether heat index and altitude predicted each acute assessment outcome, days-to-asymptomatic, and days-to-return-to-play. RESULTS Collegiate athletes were concussed at a 181.1 m (range - 0.6 to 2201.9 m) median altitude and 17.8 °C (range - 6.1 to 35.6 °C) median heat index. Altitude did not predict (p ≥ 0.265) any outcomes. Every one-degree increase in heat index reduced days-to-asymptomatic (p = 0.047; R2 = 0.06) and days-to-return-to-play (p = 0.006; R2 = 0.09) by 0.05 and 0.14 days, respectively. Heat index and altitude did not explain significant variance in SCAT, BESS, and ImPACT composite scores (p's = 0.20-0.922). CONCLUSION Our findings suggest that on-field altitude and heat index at the time of injury do not contribute to clinically meaningful changes on acute assessments or concussion recovery. On-field altitude and heat index do not appear to significantly alter assessment outcomes or clinical recovery, suggesting that environmental factors at altitudes below < 2500 m are negligible outcomes for researchers and clinicians to consider post-concussion.
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24
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Smoliga JM. Interpreting Biomarker Data After Concussion and Repeated Subconcussive Head Impacts: Challenges in Evaluating Brain Protection. JAMA Neurol 2020; 77:1477-1478. [PMID: 33017015 DOI: 10.1001/jamaneurol.2020.3467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- James M Smoliga
- Department of Physical Therapy, High Point University, High Point, North Carolina
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25
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de Souza NL, Dennis EL, Brown AM, Singh S, Wilde EA, Buckman JF, Esopenko C. Relation between Isometric Neck Strength and White Matter Organization in Collegiate Athletes. Neurotrauma Rep 2020; 1:232-240. [PMID: 34223543 PMCID: PMC8240886 DOI: 10.1089/neur.2020.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soccer athletes frequently experience repetitive head impacts (RHI) during games and practices, which may affect neural integrity over time and lead to altered brain structure. Neck strength is hypothesized to limit the transfer of force to the brain and decrease the effect of RHI on brain structure. The goal of our work was to examine whether greater neck strength is associated with more intact white matter organization (WMO) in collegiate athletes exposed to RHI. Collegiate soccer (n = 17) and limited/non-contact sport (n = 39) athletes were assessed prior to their athletic seasons. Participants completed neck strength assessments using handheld dynamometry in six test positions and diffusion tensor imaging. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated for 20 white matter (WM) regions. A multi-variate approach was used to examine the relationship between neck strength and diffusion measures in soccer and limited/non-contact athletes. Neck strength was positively associated with FA and negatively associated with RD across several WM regions in soccer players only. Neck strength was not significantly associated with MD or AD in either group. Greater neck strength was related to more intact WMO in athletes with high exposure to RHI, particularly in regions prone to damage from brain trauma such as the basal ganglia, superior longitudinal fasciculus, and frontoparietal WM. Future studies should examine neck strength as a factor to moderate neural outcomes in athletes with exposure to RHI.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Allison M Brown
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Sasha Singh
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, Piscataway, New Jersey, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
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26
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DiCesare CA, Green B, Yuan W, Diekfuss JA, Barber Foss KD, Dudley J, Qin Y, Wang P, Myer GD. Machine Learning Classification of Verified Head Impact Exposure Strengthens Associations with Brain Changes. Ann Biomed Eng 2020; 48:2772-2782. [PMID: 33111970 DOI: 10.1007/s10439-020-02662-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022]
Abstract
Cumulative exposure to head impacts during contact sports can elicit potentially deleterious brain white matter alterations in young athletes. Head impact exposure is commonly quantified using wearable sensors; however, these sensors tend to overestimate the number of true head impacts that occur and may obfuscate potential relationships with longitudinal brain changes. The purpose of this study was to examine whether data-driven filtering of head impact exposure using machine learning classification could produce more accurate quantification of exposure and whether this would reveal more pronounced relationships with longitudinal brain changes. Season-long head impact exposure was recorded for 22 female high school soccer athletes and filtered using three methods-threshold-based, heuristic filtering, and machine learning (ML) classification. The accuracy of each method was determined using simultaneous video recording of a subset of the sensor-recorded impacts, which was used to confirm which sensor-recorded impacts corresponded with true head impacts and the ability of each method to detect the true impacts. Each filtered dataset was then associated with the athletes' pre- and post-season MRI brain scans to reveal longitudinal white matter changes. The threshold-based, heuristic, and ML approaches achieved 22.0% accuracy, 44.6%, and 83.5% accuracy, respectively. ML classification also revealed significant longitudinal brain white matter changes, with negative relationships observed between head impact exposure and reductions in mean and axial diffusivity and a positive relationship observed between exposure and fractional anisotropy (all p < 0.05).
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Affiliation(s)
- Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA.
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Brittany Green
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Weihong Yuan
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
| | - Jon Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yichen Qin
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Peng Wang
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-10001, Cincinnati, OH, 45229, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
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27
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Diekfuss JA, Yuan W, Barber Foss KD, Dudley JA, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer JL, Leach JL, Bonnette S, Logan K, Epstein JN, Clark J, Altaye M, Myer GD. The effects of internal jugular vein compression for modulating and preserving white matter following a season of American tackle football: A prospective longitudinal evaluation of differential head impact exposure. J Neurosci Res 2020; 99:423-445. [PMID: 32981154 DOI: 10.1002/jnr.24727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/17/2023]
Abstract
The purpose of this clinical trial was to examine whether internal jugular vein compression (JVC)-using an externally worn neck collar-modulated the relationships between differential head impact exposure levels and pre- to postseason changes in diffusion tensor imaging (DTI)-derived diffusivity and anisotropy metrics of white matter following a season of American tackle football. Male high-school athletes (n = 284) were prospectively assigned to a non-collar group or a collar group. Magnetic resonance imaging data were collected from participants pre- and postseason and head impact exposure was monitored by accelerometers during every practice and game throughout the competitive season. Athletes' accumulated head impact exposure was systematically thresholded based on the frequency of impacts of progressively higher magnitudes (10 g intervals between 20 to 150 g) and modeled with pre- to postseason changes in DTI measures of white matter as a function of JVC neck collar wear. The findings revealed that the JVC neck collar modulated the relationships between greater high-magnitude head impact exposure (110 to 140 g) and longitudinal changes to white matter, with each group showing associations that varied in directionality. Results also revealed that the JVC neck collar group partially preserved longitudinal changes in DTI metrics. Collectively, these data indicate that a JVC neck collar can provide a mechanistic response to the diffusion and anisotropic properties of brain white matter following the highly diverse exposure to repetitive head impacts in American tackle football. Clinicaltrials.gov: NCT# 04068883.
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Affiliation(s)
- Jed A Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Danielle L Reddington
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Wen Zhong
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katharine S Nissen
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica L Shafer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelsey Logan
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffery N Epstein
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Joseph Clark
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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28
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Dudley J, Yuan W, Diekfuss J, Barber Foss KD, DiCesare CA, Altaye M, Logan K, Leach JL, Myer GD. Altered Functional and Structural Connectomes in Female High School Soccer Athletes After a Season of Head Impact Exposure and the Effect of a Novel Collar. Brain Connect 2020; 10:292-301. [DOI: 10.1089/brain.2019.0729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jed Diekfuss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kim D. Barber Foss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher A. DiCesare
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kelsey Logan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L. Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, USA
| | - Gregory D. Myer
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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29
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Mooney J, Self M, ReFaey K, Elsayed G, Chagoya G, Bernstock JD, Johnston JM. Concussion in soccer: a comprehensive review of the literature. Concussion 2020; 5:CNC76. [PMID: 33005435 PMCID: PMC7506470 DOI: 10.2217/cnc-2020-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
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30
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Silverstein SM, Demmin DL, Schallek JB, Fradkin SI. Measures of Retinal Structure and Function as Biomarkers in Neurology and Psychiatry. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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31
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Nardone M, Guzman J, Harvey PJ, Floras JS, Edgell H. Effect of a neck compression collar on cardiorespiratory and cerebrovascular function in postural orthostatic tachycardia syndrome (POTS). J Appl Physiol (1985) 2020; 128:907-913. [PMID: 32163327 DOI: 10.1152/japplphysiol.00040.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) is accompanied by reduced brain blood flow, autonomic dysfunction, and orthostatic intolerance. We hypothesized that wearing a neck compression collar would attenuate orthostatic symptoms, increase brain blood flow, and influence autonomic reflexes. Ten participants with POTS (9 women, age: 36 ± 10) underwent two trials of supine rest, paced deep breathing (6 breaths/min), Valsalva maneuver (40 mmHg for 15 s), and 70° upright tilt. For one trial, participants wore a neck compression device (Q30 Innovations). Blood pressure, heart rate (HR), brain blood flow velocity, stroke volume, respiratory rate, and end-tidal gases were continuously measured. The Vanderbilt Orthostatic Symptom Score was compiled at the end of tilt. The use of the collar reduced the orthostatic symptom score of participants with POTS during upright tilt (26.9 ± 12.5 to 18.7 ± 13.1, P = 0.04). Collar compression in the supine condition reduced the low-frequency domain of HR variability (60 ± 18 to 51 ± 23 normalized units, P = 0.04) and increased the change in HR (15 ± 5 to 17 ± 6 bpm, P = 0.02) and E:I ratio (1.2 ± 0.1 to 1.3 ± 0.1, P = 0.01) during paced deep breathing. Throughout tilt, wearing the collar reduced respiratory rate (baseline: 13 ± 3 to 12 ± 4 breath/min; tilt: 18 ± 5 to 15 ± 5 breath/min; main effect of collar P = 0.048), end-tidal oxygen (baseline: 115 ± 5 to 112 ± 5 mmHg; tilt: 122 ± 10 to 118 ± 11 mmHg; main effect of collar P = 0.026). In participants with POTS, wearing the Q-collar reduced orthostatic symptoms, increased the HR response to deep breathing, and decreased resting ventilation.NEW & NOTEWORTHY We found that using a neck compression collar alleviated orthostatic symptoms in upright posture in participants with postural orthostatic tachycardia syndrome (POTS). This could be due to compression of the baroreceptors and subsequent changes in autonomic function. Indeed, we observed increased heart rate responsiveness to paced deep breathing and reductions of respiratory rate and end-tidal O2 (suggesting reduced ventilation). Further, wearing the collar reduced mean blood velocity in the brain during Valsalva perhaps due to higher brain blood volume.
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Affiliation(s)
- Massimo Nardone
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Juan Guzman
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paula J Harvey
- Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John S Floras
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network and Mount Sinai Hospital Division of Cardiology, Toronto, Ontario, Canada
| | - Heather Edgell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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32
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Orlando A, Rubin B, Panchal R, Tanner A, Hudson J, Harken K, Madayag R, Berg G, Bar-Or D. In Patients Over 50 Years, Increased Age Is Associated With Decreased Odds of Documented Loss of Consciousness After a Concussion. Front Neurol 2020; 11:39. [PMID: 32082248 PMCID: PMC7005230 DOI: 10.3389/fneur.2020.00039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Advanced aged adults have the highest rate of traumatic brain injury (TBI) related hospital admissions, compared to younger age groups. Data were published in 2014 indicating differential injury and neurological responses to a TBI by age categories. In a recent article examining patients with mTBI and isolated subdural hematoma, it was found that older patients had a decreased risk of documented loss of consciousness (LOC). The primary objective was to determine the extent to which the odds of documented LOC changes with increasing age in a population of older adults suffering an isolated concussion and uncomplicated mTBI. Methods: This was a retrospective study utilizing 6 years (2010–2015) of National Trauma Data Bank data. This study included patients with (1) diagnosis of concussion; (2) positive or negative loss of consciousness; (3) loss of consciousness durations no longer than 59 min or undefined; (4) age ≥50 years; (5) had a “fall” mechanism of injury; and (6) a valid emergency department Glasgow coma scale 13–15. We excluded patients (1) with any intracranial hemorrhage or intracranial injury of other and unspecified nature; (2) skull fracture; (3) an injury severity scale score >17; (4) a concussion with “unspecified” LOC (ICD-9: 850.9). Results: There were 7,466 patients included in the study; the median (IQR) age was 70 (60–80) years. The risk of documented LOC was 71% (n = 5,319). An 80-year-old had 72% decreased odds of having a documented LOC, compared to a 50-year-old (OR = 0.28, 99.5%CI [0.23–0.34], P < 0.001). This association held when controlling for multiple demographic, comorbid, and clinical variables, and in sensitivity analyses. Conclusion: These nationwide data suggest that in patients aged ≥50 years, a significant inverse association exists between age and odds of documented LOC after sustaining a fall-related concussion. Additional studies are needed to validate these findings and to investigate the triad of age, documented LOC, and intracranial hemorrhage. Clinical diagnostic criteria relying on LOC might be at risk of being modified by the association between increasing age and decreasing odds of LOC.
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Affiliation(s)
- Alessandro Orlando
- Department of Trauma Research, Swedish Medical Center, Englewood, CO, United States.,Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, United States.,Department of Trauma Research, Medical City Plano, Plano, TX, United States.,Department of Trauma Research, St. Anthony Hospital, Lakewood, CO, United States.,Department of Trauma Research, Research Medical Center, Kansas City, MO, United States.,Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
| | - Benjamin Rubin
- Department of Neurosurgery, Swedish Medical Center, Englewood, CO, United States
| | - Ripul Panchal
- Department of Neurosurgery, Medical City Plano, Plano, TX, United States
| | - Allen Tanner
- Department of Trauma Services, Penrose Hospital, Colorado Springs, CO, United States
| | - John Hudson
- Department of Neurosurgery, St. Anthony Hospital, Lakewood, CO, United States
| | - Kyle Harken
- Department of Trauma Services, Research Medical Center, Kansas City, MO, United States
| | - Robert Madayag
- Department of Trauma Services, St. Anthony Hospital, Lakewood, CO, United States
| | - Gina Berg
- Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
| | - David Bar-Or
- Department of Trauma Research, Swedish Medical Center, Englewood, CO, United States.,Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, United States.,Department of Trauma Research, Medical City Plano, Plano, TX, United States.,Department of Trauma Research, St. Anthony Hospital, Lakewood, CO, United States.,Department of Trauma Research, Research Medical Center, Kansas City, MO, United States.,Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
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Hunter LE, Freudenberg-Hua Y, Davies P, Kim M, Fleysher R, Stewart WF, Lipton RB, Lipton ML. BDNF Val 66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism. Front Neurol 2019; 10:1297. [PMID: 31920921 PMCID: PMC6918922 DOI: 10.3389/fneur.2019.01297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to examine the potential effect modifying role of the BDNF Val66Met polymorphism on the association of soccer heading with white matter microstructure. We studied 312 players enrolled in the ongoing Einstein Soccer Study, a longitudinal study of amateur soccer player in New York City and surrounding areas. At enrollment and 2 years later, total heading in the prior 12 months (12-mo.) was estimated using an established self-report instrument and diffusion tensor imaging (DTI) was performed. Generalized Estimating Equations (GEE) logistic regression models were employed to test effect modification by the BDNF Val66Met polymorphism on the association between 12-mo. heading exposure and DTI. We identified a significant interaction of 12-mo heading*BDNF Val66Met genotype on the presence of low Radial Diffusivity, a DTI marker associated with myelination. Only Met (+) players demonstrated significantly reduced odds of low RD [OR (95 % CI): -2.36 (-3.53, -1.19)] associated with the highest vs. lowest quartile of 12-mo heading exposure. BDNF Val66Met (+) soccer players with long-term exposure to high levels of heading exhibit less low Radial Diffusivity, suggesting impaired re-myelination may be a substrate of the previously reported association between heading and poor functional outcomes in soccer players.
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Affiliation(s)
- Liane E. Hunter
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Yun Freudenberg-Hua
- Division of Geriatric Psychiatry, Northwell Health, Glen Oaks, NY, United States
- Litwin-Zucker Center for the Study of Alzheimer's Disease, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Peter Davies
- Division of Geriatric Psychiatry, Northwell Health, Glen Oaks, NY, United States
| | - Mimi Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Roman Fleysher
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | | | - Richard B. Lipton
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Michael L. Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
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Influence of a neck compression collar on cerebrovascular and autonomic function in men and women. PLoS One 2019; 14:e0225868. [PMID: 31790493 PMCID: PMC6886761 DOI: 10.1371/journal.pone.0225868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neck compression collars have been proposed to reduce injury to the brain caused by head impacts. Our objective was to test if compression of the carotid artery affected the baroreflex and influenced blood pressure control. METHODS Cerebrovascular and autonomic responses of healthy young men and women (n = 8 each) to paced deep breathing, Valsalva, and 70o head-up tilt with or without use of a Q-collar were determined. Continuous measurements of heart rate, beat-to-beat blood pressure, transcranial Doppler, and end-tidal gases were obtained. Heart rate variability was measured during supine rest and head-up tilt. Carotid artery and jugular vein cross-sectional area were measured at end-inhalation and end-exhalation using cross-sectional ultrasound images at diastole. RESULTS Wearing the collar reduced carotid cross-sectional area (CSA; P = 0.022; η2 = 0.03) and increased jugular CSA (P = 0.001; η 2 = 0.30). In both men and women, wearing the collar increased systolic blood pressure during Valsalva (P<0.05; η 2 = 0.38). In only men, wearing the collar resulted in prolonged pressure recovery time during Valsalva (P = 0.02; η 2 = 0.05). In only women, wearing the collar increased baseline diastolic (P = 0.026; η 2 = 0.09) and mean (P = 0.041; η 2 = 0.06) middle cerebral artery (MCA) blood flow velocity, which attenuated the normal increase of diastolic (P = 0.01; η 2 = 0.03) and mean (P = 0.038; η 2 = 0.02) MCA blood flow velocity during Valsalva. There were no effects of sex or collar on the responses to deep breathing (P>0.05), and there were no effects of the collar on cerebrovascular function, hemodynamics, cardiovagal baroreceptor sensitivity, or heart rate variability (P>0.05) during upright tilt. CONCLUSION Use of the Q-collar compresses both the jugular vein and carotid artery influencing sympathetic nerve activity in both men and women while influencing brain blood flow in women.
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Jang I, Chun IY, Brosch JR, Bari S, Zou Y, Cummiskey BR, Lee TA, Lycke RJ, Poole VN, Shenk TE, Svaldi DO, Tamer GG, Dydak U, Leverenz LJ, Nauman EA, Talavage TM. Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure. NEUROIMAGE-CLINICAL 2019; 24:101930. [PMID: 31630026 PMCID: PMC6807364 DOI: 10.1016/j.nicl.2019.101930] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction. Brain volumes evidencing injury are larger in football athletes than controls. Spatial extent of decreased FA correlates with head acceleration event exposure. Spatial extent of increased MD correlates with head acceleration event exposure.
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Affiliation(s)
- Ikbeom Jang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America.
| | - Il Yong Chun
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sumra Bari
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Yukai Zou
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States of America
| | - Brian R Cummiskey
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Roy J Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Victoria N Poole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Trey E Shenk
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Diana O Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Gregory G Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Thomas M Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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