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Zuleger TM, Slutsky-Ganesh AB, Grooms DR, Yuan W, Barber Foss KD, Howell DR, Myer GD, Diekfuss JA. High magnitude exposure to repetitive head impacts alters female adolescent brain activity for lower extremity motor control. Brain Res 2024; 1828:148785. [PMID: 38272157 PMCID: PMC11110884 DOI: 10.1016/j.brainres.2024.148785] [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: 10/27/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Contact and collision sport participation among adolescent athletes has raised concerns about the potential negative effects of cumulative repetitive head impacts (RHIs) on brain function. Impairments from RHIs and sports-related concussions (SRC) may propagate into lingering neuromuscular control. However, the neural mechanisms that link RHIs to altered motor control processes remain unknown. The purpose of this study was to isolate changes in neural activity for a lower extremity motor control task associated with the frequency and magnitude of RHI exposure. A cohort of fifteen high school female soccer players participated in a prospective longitudinal study and underwent pre- and post-season functional magnetic resonance imaging (fMRI). During fMRI, athletes completed simultaneous bilateral ankle, knee, and hip flexion/extension movements against resistance (bilateral leg press) to characterize neural activity associated with lower extremity motor control. RHI data were binned into continuous categories between 20 g - 120 g (defined by progressively greater intervals), with the number of impacts independently modeled within the fMRI analyses. Results revealed that differential exposure to high magnitude RHIs (≥90 g - < 110 g and ≥ 110 g) was associated with acute changes in neural activity for the bilateral leg press (broadly inclusive of motor, visual, and cognitive regions; all p < 0.05 & z > 3.1). Greater exposure to high magnitude RHIs may impair lower extremity motor control through maladaptive neural mechanisms. Future work is warranted to extend these mechanistic findings and examine the linkages between RHI exposure and neural activity as it relates to subsequent neuromuscular control deficits.
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Affiliation(s)
- Taylor M Zuleger
- 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; University of Cincinnati, Neuroscience Graduate Program, Cincinnati, OH, USA.
| | - Alexis B Slutsky-Ganesh
- 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; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D Barber Foss
- 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
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, 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; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK; The Micheli Center for Sports Injury Prevention, Waltham, MA, 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.
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Glendon K, Pain MTG, Hogervorst E, Belli A, Blenkinsop G. Musculoskeletal injury or Sports-Related Concussion (SRC) in a season of rugby union does not affect performance on concussion battery testing in university-aged student-athletes. Phys Ther Sport 2024; 65:137-144. [PMID: 38181564 DOI: 10.1016/j.ptsp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Sub-concussive and concussive impacts sustained during contact sports such as rugby may affect neurocognitive performance, vestibular-ocular-motor function, symptom burden and academic ability. METHOD Student-athletes (n = 146) participating in rugby union British Universities or domestic competitions were assessed on the Immediate Post-Concussion and Cognitive Test, Post-Concussion Symptom Scale, vestibular-oculo-motor screening tool and revised perceived academic impact tool. Individual change from pre-season (July-September 2021) to 2-weeks following last exposure to contact (April-July 2022) was analysed. RESULTS Symptom burden significantly worsened (p=0.016) over the season. Significant improvements on verbal memory (p=0.016), visual memory (p=0.008) and motor processing speed (p=0.001) suggest a possible learning effect. Surprisingly, the number of days lost to concussion significantly and positively affected performance on verbal memory (p = 0.018) and reaction time (p = 0.027). Previous concussive events significantly predicted a worsening in symptom burden (p < 0.028), as did in-season concussive events, predicting improved verbal memory (p = 0.033) and symptom burden change (p = 0.047). Baseline performance significantly affected change on several neurocognitive tests, with low-scorers showing more improvement over the season. CONCLUSION Participation in rugby union was not associated with deleterious effects on brain function. Previous concussive events and in-season factors, possibly related to learning effects, may explain improvement in cognitive function across the season.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - M T G Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - E Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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Walter AE, Wilkes JR, Scaramuzzo M, Johns-Bostick T, Lynch S, Sebastianelli W, Seidenberg P, Bream T, Slobounov SM. Head acceleration event exposure and cognitive and functional outcomes: a comparison of multiple football seasons. Res Sports Med 2024; 32:122-131. [PMID: 35708219 DOI: 10.1080/15438627.2022.2090249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/11/2022] [Indexed: 10/18/2022]
Abstract
Athletes in contact sports are exposed to repetitive impacts as an inherent part of sport. There is concern over the accumulative effect; however, much is still unknown regarding their short-term effects. This study investigated impact accumulation and outcomes over three seasons (2015, 2017, 2019) in NCAA Football Bowl Subdivision players. Impacts were recorded using helmet accelerometers, and virtual reality testing (VR) was done across the season. Incidence rates for impacts (total; ≥25 G to <80 G; ≥80 G) all significantly differed by season (p < 0.05). VR scores changed across the seasons, specifically significant decreases in spatial memory (p < 0.05) in 2015, significant changes in balance and spatial memory (p < 0.05) in 2017, and no significant changes in 2019. Linear regressions predicting VR change score by impact incidence rate were nonsignificant. Monitoring exposure to impacts and changes in outcomes is useful; however, results are fluid, and many factors could indirectly have protective effects on athletes.
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Affiliation(s)
- Alexa E Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine Philadelphia, PA, USA
| | - James R Wilkes
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Madeleine Scaramuzzo
- Intercollegiate Athletics, The Pennsylvania State University, University Park, PA, USA
- Intercollegiate Athletics, Southeastern Louisiana University, Hammond, LA, USA
| | - Tesa Johns-Bostick
- Intercollegiate Athletics, The Pennsylvania State University, University Park, PA, USA
| | - Scott Lynch
- Department of Orthopaedics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Wayne Sebastianelli
- Department of Orthopaedics and Rehabilitation, the Pennsylvania State University, Penn State College of Medicine, State College, PA, USA
| | - Peter Seidenberg
- Department of Orthopaedics and Rehabilitation and Family and Community Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Family Medicine, Louisiana State University Health School of Medicine, Shreveport, LA, USA
| | - Tim Bream
- Intercollegiate Athletics, The Pennsylvania State University, University Park, PA, USA
- SAFR Sport Technologies, Chester Springs, PA, USA
| | - Semyon M Slobounov
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
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Jones CMA, Kamintsky L, Parker E, Kureshi N, Audas L, Wilson L, Champagne AA, Boulanger MM, DiStefano V, Fenerty L, Bowen C, Beyea S, Atkinson C, Clarke DB, Friedman A. Blood-Brain Barrier Dysfunction and Exposure to Head Impacts in University Football Players. Clin J Sport Med 2024; 34:61-68. [PMID: 37285595 DOI: 10.1097/jsm.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the link between dysfunction of the blood-brain barrier (BBB) and exposure to head impacts in concussed football athletes. DESIGN This was a prospective, observational pilot study. SETTING Canadian university football. PARTICIPANTS The study population consisted of 60 university football players, aged 18 to 25. Athletes who sustained a clinically diagnosed concussion over the course of a single football season were invited to undergo an assessment of BBB leakage. INDEPENDENT VARIABLES Head impacts detected using impact-sensing helmets were the measured variables. MAIN OUTCOME MEASURES Clinical diagnosis of concussion and BBB leakage assessed using dynamic contrast-enhanced MRI (DCE-MRI) within 1 week of concussion were the outcome measures. RESULTS Eight athletes were diagnosed with a concussion throughout the season. These athletes sustained a significantly higher number of head impacts than nonconcussed athletes. Athletes playing in the defensive back position were significantly more likely to sustain a concussion than remain concussion free. Five of the concussed athletes underwent an assessment of BBB leakage. Logistic regression analysis indicated that region-specific BBB leakage in these 5 athletes was best predicted by impacts sustained in all games and practices leading up to the concussion-as opposed to the last preconcussion impact or the impacts sustained during the game when concussion occurred. CONCLUSIONS These preliminary findings raise the potential for the hypothesis that repeated exposure to head impacts may contribute to the development of BBB pathology. Further research is needed to validate this hypothesis and to test whether BBB pathology plays a role in the sequela of repeated head trauma.
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Affiliation(s)
- Casey M A Jones
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ellen Parker
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lorelei Audas
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | | | | | - Vincent DiStefano
- School of Applied Child Psychology, McGill University, Montréal, QC, Canada
| | - Lynne Fenerty
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Steven Beyea
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Christina Atkinson
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; and
| | - David B Clarke
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Brett BL, Cohen AD, McCrea MA, Wang Y. Longitudinal alterations in cerebral perfusion following a season of adolescent contact sport participation compared to non-contact athletes. Neuroimage Clin 2023; 40:103538. [PMID: 37956583 PMCID: PMC10666028 DOI: 10.1016/j.nicl.2023.103538] [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: 01/08/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cerebral blood flow (CBF) change, a non-invasive marker of head injury, has yet to be thoroughly investigated as a potential consequence of repetitive head impacts (RHI) via contact sport participation in youth athletes. We examined pre-to post-season differences in relative CBF (rCBF), arterial transit time (ATT), and neurocognition between adolescent contact sport (CS; 79.4% of which were football players) and non-contact sport (NCS) athletes. METHODS Adolescent athletes (N = 57; age = 14.70 ± 1.97) completed pre- and post-season clinical assessments and neuroimaging. Brain perfusion was evaluated using an advanced 3D pseudo-continuous ASL sequence with Hadamard encoded multiple post-labeling delays. Mixed-effect models tested group-by-time interactions for rCBF, ATT, and neurocognition. RESULTS A significant group-by-time interaction was observed for rCBF in a cluster consisting primarily of frontal and parietal lobe regions, with regional rCBF increasing in CS and decreasing among NCS athletes. No significant interaction was observed for ATT. A significant group-by-time interaction was observed for verbal memory and visual motor speed, with NCS athletes improving and CS athletes exhibiting lower performance from pre-to post-season in comparison. CONCLUSIONS Alterations in rCBF and variability in cognition, not purported neurovasculature changes (measured by ATT), were observed following one season of CS participation. Further study surrounding the clinical meaningfulness of these findings, as they related to adverse long-term outcomes, is needed.
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Affiliation(s)
- Benjamin L Brett
- Medical College of Wisconsin, Department of Neurosurgery, United States.
| | - Alex D Cohen
- Medical College of Wisconsin, Department of Radiology, United States
| | - Michael A McCrea
- Medical College of Wisconsin, Department of Neurosurgery, United States
| | - Yang Wang
- Medical College of Wisconsin, Department of Radiology, United States.
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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Sattari S, Kenny R, Liu CC, Hajra SG, Dumont GA, Virji-Babul N. Blink-related EEG oscillations are neurophysiological indicators of subconcussive head impacts in female soccer players: a preliminary study. Front Hum Neurosci 2023; 17:1208498. [PMID: 37538402 PMCID: PMC10394644 DOI: 10.3389/fnhum.2023.1208498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Repetitive subconcussive head impacts can lead to subtle neural changes and functional consequences on brain health. However, the objective assessment of these changes remains limited. Resting state blink-related oscillations (BROs), recently discovered neurological responses following spontaneous blinking, are explored in this study to evaluate changes in BRO responses in subconcussive head impacts. Methods We collected 5-min resting-state electroencephalography (EEG) data from two cohorts of collegiate athletes who were engaged in contact sports (SC) or non-contact sports (HC). Video recordings of all on-field activities were conducted to determine the number of head impacts during games and practices in the SC group. Results In both groups, we were able to detect a BRO response. Following one season of games and practice, we found a strong association between the number of head impacts sustained by the SC group and increases in delta and beta spectral power post-blink. There was also a significant difference between the two groups in the morphology of BRO responses, including decreased peak-to-peak amplitude of response over left parietal channels and differences in spectral power in delta and alpha frequency range post-blink. Discussion Our preliminary results suggest that the BRO response may be a useful biomarker for detecting subtle neural changes resulting from repetitive head impacts. The clinical utility of this biomarker will need to be validated through further research with larger sample sizes, involving both male and female participants, using a longitudinal design.
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Affiliation(s)
- Sahar Sattari
- School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Kenny
- Department of Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Careesa Chang Liu
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL, United States
| | - Sujoy Ghosh Hajra
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL, United States
| | - Guy A. Dumont
- School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Naznin Virji-Babul
- Department of Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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Dulle JF, Moore ML, Brinkman JC, Pollock JR, Dulle DL, Jenkins AS, Chhabra A. The Most Cited and Influential Publications Relating to Ice Hockey Since 2000 Focus Primarily on Concussion and Traumatic Brain Injuries. Arthrosc Sports Med Rehabil 2023; 5:e613-e622. [PMID: 37388886 PMCID: PMC10300535 DOI: 10.1016/j.asmr.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/26/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine the most frequently cited articles relating to ice hockey since 2000 and conduct a bibliometric analysis of these publications. Methods The Clarivate Web of Knowledge database was used to gather data and generate a list of publications relating to "ice hockey" on June 20, 2022. Articles were filtered by the total number of citations accrued and were included or excluded on the basis of relevance to ice hockey; no date of publication, language, or journal restrictions. After the 50 most highly cited articles were identified, articles published before the year 2000 were excluded to avoid bias. The information analyzed from each article included author name (first and last), publication year, country of origin, institutional affiliation (of the first and last author), journal name, research design, main research topic, competition level, and the level of evidence. Results Ultimately, 46 studies were included in this analysis. The total number of citations was 8,267 times with an average of 179.7 citations per article. The most cited article was cited 926 times. The articles came from 5 different countries, with the United States and Canada comprising 27 and 13 articles, respectively. All articles were published in English. The American Journal of Sports Medicine published the greatest number of articles. The most studied topic was concussion/traumatic brain injury (n = 26). Professional hockey was the most studied level of competition (n = 15), while college followed (n = 13). Three institutions, University of Calgary, Dartmouth School of Medicine, and University of North Carolina at Chapel Hill were responsible for 32.6% of the top articles (n = 15). Conclusions The majority of the most cited articles relating to ice hockey are cohort studies, review articles, and epidemiological studies originating from the United States or Canada. The majority of publications included in the analysis focused on concussion and traumatic brain injury prevalence, identification, diagnosis, outcomes, and prevention, as well as the most studied level of competition was professional, but the greatest number of participants arose from the youth and high school level. Level of Evidence Level IV, cross-sectional study.
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Affiliation(s)
- Jamie F. Dulle
- University of Redlands, Biology Department, Redlands, California
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | | | - Jordan R. Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Donald L. Dulle
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Anna S. Jenkins
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Holcomb TD, Marks ME, Stewart Pritchard N, Miller L, Espeland MA, Miles CM, Moore JB, Foley KL, Stitzel JD, Urban JE. Characterization of Head Acceleration Exposure During Youth Football Practice Drills. J Appl Biomech 2023; 39:157-168. [PMID: 37105545 PMCID: PMC10809728 DOI: 10.1123/jab.2022-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023]
Abstract
Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11-13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices.
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Affiliation(s)
- Ty D. Holcomb
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Madison E. Marks
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - N. Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Logan Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Mark A. Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kristie L. Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
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10
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Dairi I, Brown C, DiGregorio H, Wasfy M, Baggish A, Pitler L, Copen WA, Doyle M, Wu O, Zafonte R, Tenforde AS. A Case Report of Reversible Cognitive Decline in a Former Professional American-Style Football Player: Findings from the Football Players Health Study In-Person Assessments. Curr Sports Med Rep 2023; 22:154-157. [PMID: 37141607 DOI: 10.1249/jsr.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Heather DiGregorio
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | | | | | - Linda Pitler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - William A Copen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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11
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Ye C, Behnke JA, Hardin KR, Zheng JQ. Drosophila melanogaster as a model to study age and sex differences in brain injury and neurodegeneration after mild head trauma. Front Neurosci 2023; 17:1150694. [PMID: 37077318 PMCID: PMC10106652 DOI: 10.3389/fnins.2023.1150694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Repetitive physical insults to the head, including those that elicit mild traumatic brain injury (mTBI), are a known risk factor for a variety of neurodegenerative conditions including Alzheimer's disease (AD), Parkinson's disease (PD), and chronic traumatic encephalopathy (CTE). Although most individuals who sustain mTBI typically achieve a seemingly full recovery within a few weeks, a subset experience delayed-onset symptoms later in life. As most mTBI research has focused on the acute phase of injury, there is an incomplete understanding of mechanisms related to the late-life emergence of neurodegeneration after early exposure to mild head trauma. The recent adoption of Drosophila-based brain injury models provides several unique advantages over existing preclinical animal models, including a tractable framework amenable to high-throughput assays and short relative lifespan conducive to lifelong mechanistic investigation. The use of flies also provides an opportunity to investigate important risk factors associated with neurodegenerative conditions, specifically age and sex. In this review, we survey current literature that examines age and sex as contributing factors to head trauma-mediated neurodegeneration in humans and preclinical models, including mammalian and Drosophila models. We discuss similarities and disparities between human and fly in aging, sex differences, and pathophysiology. Finally, we highlight Drosophila as an effective tool for investigating mechanisms underlying head trauma-induced neurodegeneration and for identifying therapeutic targets for treatment and recovery.
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Affiliation(s)
- Changtian Ye
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joseph A. Behnke
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Katherine R. Hardin
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - James Q. Zheng
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, United States
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12
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Roby PR, Metzger KB, McDonald CC, Corwin DJ, Huber CM, Patton DA, Margulies SS, Grady MF, Master CL, Arbogast KB. Pre- and post-season visio-vestibular function in healthy adolescent athletes. PHYSICIAN SPORTSMED 2022; 50:522-530. [PMID: 34521303 PMCID: PMC8934744 DOI: 10.1080/00913847.2021.1980744] [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] [Received: 04/15/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. METHODS This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). RESULTS Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). CONCLUSIONS Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.
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Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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13
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Consensus Head Acceleration Measurement Practices (CHAMP): Study Design and Statistical Analysis. Ann Biomed Eng 2022; 50:1346-1355. [PMID: 36253602 PMCID: PMC9652215 DOI: 10.1007/s10439-022-03101-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Abstract
Head impact measurement devices enable opportunities to collect impact data directly from humans to study topics like concussion biomechanics, head impact exposure and its effects, and concussion risk reduction techniques in sports when paired with other relevant data. With recent advances in head impact measurement devices and cost-effective price points, more and more investigators are using them to study brain health questions. However, as the field's literature grows, the variance in study quality is apparent. This brief paper aims to provide a high-level set of key considerations for the design and analysis of head impact measurement studies that can help avoid flaws introduced by sampling biases, false data, missing data, and confounding factors. We discuss key points through four overarching themes: study design, operational management, data quality, and data analysis.
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14
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Wilson A, Stevens WD, Sergio L, Wojtowicz M. Altered Brain Functional Connectivity in Female Athletes Over the Course of a Season of Collision or Contact Sports. Neurotrauma Rep 2022; 3:377-387. [PMID: 36204391 PMCID: PMC9531888 DOI: 10.1089/neur.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision (N = 12) and contact (N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe (p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.
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Affiliation(s)
- Alyssia Wilson
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - W. Dale Stevens
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lauren Sergio
- School of Kinesiology, York University, Toronto, Ontario, Canada
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15
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Seifert J, Shah AS, Harezlak J, Rowson S, Mihalik JP, Riggen L, Duma S, Brooks A, Cameron KL, Giza CC, Goldman J, Guskiewicz KM, Houston MN, Jackson JC, McGinty G, Pasquina P, Broglio SP, McAllister TW, McCrea MA, Stemper BD. Time Delta Head Impact Frequency: An Analysis on Head Impact Exposure in the Lead Up to a Concussion: Findings from the NCAA-DOD Care Consortium. Ann Biomed Eng 2022; 50:1473-1487. [PMID: 35933459 PMCID: PMC9652163 DOI: 10.1007/s10439-022-03032-w] [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: 10/20/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Sport-related concussions can result from a single high magnitude impact that generates concussive symptoms, repeated subconcussive head impacts aggregating to generate concussive symptoms, or a combined effect from the two mechanisms. The array of symptoms produced by these mechanisms may be clinically interpreted as a sport-related concussion. It was hypothesized that head impact exposure resulting in concussion is influenced by severity, total number, and frequency of subconcussive head impacts. The influence of total number and magnitude of impacts was previously explored, but frequency was investigated to a lesser degree. In this analysis, head impact frequency was investigated over a new metric called ‘time delta’, the time difference from the first recorded head impact of the day until the concussive impact. Four exposure metrics were analyzed over the time delta to determine whether frequency of head impact exposure was greater for athletes on their concussion date relative to other dates of contact participation. Those metrics included head impact frequency, head impact accrual rate, risk weighted exposure (RWE), and RWE accrual rate. Athletes experienced an elevated median number of impacts, RWE, and RWE accrual rate over the time delta on their concussion date compared to non-injury sessions. This finding suggests elevated frequency of head impact exposure on the concussion date compared to other dates that may precipitate the onset of concussion.
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Affiliation(s)
- Jack Seifert
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Alok S Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Larry Riggen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Stefan Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Alison Brooks
- Department of Orthopedics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, USA
| | - Christopher C Giza
- Departments of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, David Geffem School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua Goldman
- Departments of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, David Geffem School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, USA
| | - Jonathan C Jackson
- Department of Sports Medicine, United States Air Force Academy, Colorado Springs, CO, USA
| | - Gerald McGinty
- Department of Sports Medicine, United States Air Force Academy, Colorado Springs, CO, USA
| | - Paul Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA
| | - Brian D Stemper
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA. .,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA. .,Neuroscience Research Labs, Clement J. Zablocki Veterans Affairs Medical Center, Research 151, 5000 W. National Ave., Milwaukee, WI, 53295, USA.
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16
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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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17
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Stemper BD, Shah A, Chiariello R, McCarthy C, Jessen K, Sarka B, Seifert J, Budde MD, Wang K, Olsen CM, McCrea M. A Preclinical Rodent Model for Repetitive Subconcussive Head Impact Exposure in Contact Sport Athletes. Front Behav Neurosci 2022; 16:805124. [PMID: 35368301 PMCID: PMC8965565 DOI: 10.3389/fnbeh.2022.805124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Repetitive subconcussive head impact exposure has been associated with clinical and MRI changes in some non-concussed contact sport athletes over the course of a season. However, analysis of human tolerance for repeated head impacts is complicated by concussion and head impact exposure history, genetics, and other personal factors. Therefore, the objective of the current study was to develop a rodent model for repetitive subconcussive head impact exposure that can be used to understand injury mechanisms and tolerance in the human. This study incorporated the Medical College of Wisconsin Rotational Injury Model to expose rats to multiple low-level head accelerations per day over a 4-week period. The peak magnitude of head accelerations were scaled from our prior human studies of contact sport athletes and the number of exposures per day were based on the median (moderate exposure) and 95th percentile (high exposure) number of exposures per day across the human sample. Following the exposure protocol, rats were assessed for cognitive deficits, emotional changes, blood serum levels of axonal injury biomarkers, and histopathological evidence of injury. High exposure rats demonstrated cognitive deficits and evidence of anxiety-like behaviors relative to shams. Moderate exposure rats did not demonstrate either of those behaviors. Similarly, high exposure rats had histopathological evidence of gliosis [i.e., elevated Iba1 intensity and glial fibrillary acidic protein (GFAP) volume relative to shams] in the basolateral amygdala and other areas. Blood serum levels of neurofilament light (NFL) demonstrated a dose response relationship with increasing numbers of low-level head acceleration exposures with a higher week-to-week rate of NFL increase for the high exposure group compared to the moderate exposure group. These findings demonstrate a cumulative effect of repeated low-level head accelerations and provide a model that can be used in future studies to better understand mechanisms and tolerance for brain injury resulting from repeated low-level head accelerations, with scalable biomechanics between the rat and human.
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Affiliation(s)
- Brian D. Stemper
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Stemper,
| | - Alok Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Rachel Chiariello
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Cassandra McCarthy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Kristin Jessen
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bailey Sarka
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jack Seifert
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kevin Wang
- Gryphon Bio, Inc., South San Francisco, CA, United States
| | - Christopher M. Olsen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
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18
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Boucher ML, Conley G, Nowlin J, Qiu J, Kawata K, Bazarian JJ, Meehan WP, Mannix R. Titrating the Translational Relevance of a Low-Level Repetitive Head Impact Model. Front Neurol 2022; 13:857654. [PMID: 35785366 PMCID: PMC9246060 DOI: 10.3389/fneur.2022.857654] [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: 01/18/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Recently, there has been increased attention in the scientific community to the phenomenon of sub-concussive impacts, those hits to the head that do not cause the signs and symptoms of a concussion. Some authors suggest that sub-concussive impacts may alter behavior and cognition, if sustained repetitively, but the mechanisms underlying these changes are not well-defined. Here, we adapt our well-established weight drop model of repetitive mild traumatic brain injury (rmTBI) to attempt to produce a model of low-level repetitive head impacts (RHI). The model was modified to eliminate differences in latency to right following impact and gross behavioral changes after a single cluster of hits. Further, we varied our model in terms of repetition of impact over a 4-h span to mimic the repeated sub-concussive impacts that may be experienced by an athlete within a single day of play. To understand the effects of a single cluster of RHIs, as well as the effect of an increased impact frequency within the cluster, we evaluated classical behavioral measures, serum biomarkers, cortical protein quantification, and immunohistochemistry both acutely and sub-acutely following the impacts. In the absence of gross behavioral changes, the impact protocol did generate pathology, in a dose-dependent fashion, in the brain. Evaluation of serum biomarkers revealed limited changes in GFAP and NF-L, which suggests that their diagnostic utility may not emerge until the exposure to low-level head impacts reaches a certain threshold. Robust decreases in both IL-1β and IL-6 were observed in the serum and the cortex, indicating downregulation of inflammatory pathways. These experiments yield initial data on pathology and biomarkers in a mouse model of low-level RHIs, with relevance to sports settings, providing a starting point for further exploration of the potential role of anti-inflammatory processes in low-level RHI outcomes, and how these markers may evolve with repeated exposure.
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Affiliation(s)
- Masen L Boucher
- Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Grace Conley
- Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jordan Nowlin
- Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jianhua Qiu
- Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington, IN, United States
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - William P Meehan
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Harvard Medical School, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Rebekah Mannix
- Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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19
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Gallagher VT, Murthy P, Stocks J, Vesci B, Mjaanes J, Chen Y, Breiter HC, LaBella C, Herrold AA, Reilly JL. Eye Movements Detect Differential Change after Participation in Male Collegiate Collision versus Non-Collision Sports. Neurotrauma Rep 2021; 2:440-452. [PMID: 34901940 PMCID: PMC8655805 DOI: 10.1089/neur.2021.0030] [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] [Indexed: 11/13/2022] Open
Abstract
Although neuroimaging studies of collision (COLL) sport athletes demonstrate alterations in brain structure and function from pre- to post-season, reliable tools to detect behavioral/cognitive change relevant to functional networks associated with participation in collision sports are lacking. This study evaluated the use of eye-movement testing to detect change in cognitive and sensorimotor processing among male club collegiate athletes after one season of participation in collision sports of variable exposure. We predicted that COLL (High Dose [hockey], n = 8; Low Dose [rugby], n = 9) would demonstrate longer reaction times (antisaccade and memory-guided saccade [MGS] latencies), increased inhibitory errors (antisaccade error rate), and poorer spatial working memory (MGS spatial accuracy) at post-season, relative to pre-season, whereas non-collision collegiate athletes (NON-COLL; n = 17) would remain stable. We also predicted that whereas eye-movement performance would detect pre- to post-season change, ImPACT (Immediate Post-Concussion Assessment and Cognitive Test) performance would remain stable. Our data showed that NON-COLL had shorter (improved performance) post- versus pre-season antisaccade and MGS latencies, whereas COLL groups showed stable, longer, or attenuated reduction in latency (ps ≤ 0.001). Groups did not differ in antisaccade error rate. On the MGS task, NON-COLL demonstrated improved spatial accuracy over time, whereas COLL groups showed reduced spatial accuracy (p < 0.05, uncorrected). No differential change was observed on ImPACT. This study provides preliminary evidence for eye-movement testing as a sensitive marker of subtle changes in attentional control and working memory resulting from participation in sports with varying levels of subconcussive exposure.
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Affiliation(s)
| | - Prianka Murthy
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Vesci
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Yufen Chen
- Center for Translational Imaging, Northwestern University, Evanston, Illinois, USA
| | - Hans C Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia LaBella
- Division of Orthopedics and Sports Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy A Herrold
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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20
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Rose SC, Yeates KO, Nguyen JT, Pizzimenti NM, Ercole PM, McCarthy MT. Exposure to Head Impacts and Cognitive and Behavioral Outcomes in Youth Tackle Football Players Across 4 Seasons. JAMA Netw Open 2021; 4:e2140359. [PMID: 34967882 PMCID: PMC8719231 DOI: 10.1001/jamanetworkopen.2021.40359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Repetitive head impacts have been posited to contribute to neurocognitive and behavioral difficulties in contact sport athletes. OBJECTIVE To identify associations between cognitive and behavioral outcomes and head impacts measured in youth tackle football players over 4 seasons of play. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from July 2016 through January 2020, spanning 4 football seasons. The setting was a youth tackle football program and outpatient medical clinic. Players were recruited from 4 football teams composed of fifth and sixth graders, and all interested players who volunteered to participate were enrolled. Data analysis was performed from March 2020 to June 2021. EXPOSURES Impacts were measured using helmet-based sensors during practices and games throughout 4 consecutive seasons of play. Impacts were summed to yield cumulative head impact gravitational force equivalents per season. MAIN OUTCOMES AND MEASURES Ten cognitive and behavioral measures were completed before and after each football season. RESULTS There were 70 male participants aged 9 to 12 years (mean [SD] age, 10.6 [0.64] years), with 18 completing all 4 years of the study. At the post-season 1 time point, higher cumulative impacts were associated with lower self-reported symptom burden (β = -0.6; 95% CI, -1.0 to -0.2; P = .004). After correcting for multiple comparisons, no other associations were found between impacts and outcome measures. At multiple times throughout the study, premorbid attention-deficit/hyperactivity disorder, anxiety, and depression were associated with worse cognitive or behavioral scores, whereas a premorbid headache disorder or history of concussion was less often associated with outcomes. CONCLUSIONS AND RELEVANCE In this cohort of youth tackle football players, premorbid conditions, including attention-deficit/hyperactivity disorder, anxiety, and depression, were associated with cognitive and behavioral outcomes more often than cumulative impact.
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Affiliation(s)
- Sean C. Rose
- Child Neurology, Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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21
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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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22
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Swenson AG, Pritchard NS, Miller LE, Urban JE, Stitzel JD. Characterization of head impact exposure in boys' youth ice hockey. Res Sports Med 2021:1-11. [PMID: 34689676 DOI: 10.1080/15438627.2021.1989433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.
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Affiliation(s)
- Abigail G Swenson
- Department of Neuroscience, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - N Stewart Pritchard
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
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23
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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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24
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Takao H, Watanabe D, Tani S, Ohashi H, Ishibashi T, Takeshita K, Murakami S, Nishimoto T, Yuge K, Karagiozov K, Abe T, Murayama Y. Use of a Simulation Model to Investigate the Mechanisms of Sports-related Head Injuries. Neurol Med Chir (Tokyo) 2021; 62:13-18. [PMID: 34645717 PMCID: PMC8754681 DOI: 10.2176/nmc.oa.2021-0149] [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] [Indexed: 11/20/2022] Open
Abstract
A simulation model was developed to better understand the mechanisms of brain injuries in sports. A three-dimensional model comprising approximately 1.22 million elements was constructed from cranial computed tomography images of adult male volunteers by the voxel method. To simulate contact sports that permit actions such as tackling, a sinusoidal wave with duration of 10 ms and maximum acceleration of 2000 m/s2 was applied to the lowest point of the model to apply rotational acceleration to the head from different directions. The von Mises stress was then observed at five points in the coronal plane of the brain: cingulate gyrus (CG), corpus callosum (CC), brain stem (BS), lateral temporal lobe (LT), and medial temporal lobe (MT). LS-DYNA universal finite element analysis software with explicit time integration was used for the analysis. Concentrations of stress started to appear in the CC and BS at 10 ms post-impact, after which they also became evident in the CG and MT. The maximum changes in stress at each location occurred 10–15 ms post-impact. The von Mises stress was 9–14 kPa in the CG, 8–24 kPa in the CC, 12–24 kPa in the BS, 7–12 kPa in the LT, and 12–18 kPa in the MT. The highest stress in every part of the brain occurred after lateral impact, followed by oblique impact and sagittal impact. Such simulations may help elucidate the mechanisms of brain injuries in sports and help develop measures to prevent chronic traumatic encephalopathy.
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Affiliation(s)
- Hiroyuki Takao
- Department of Neurosurgery, The Jikei University School of Medicine.,Department of Innovation for Medical Information Technology, The Jikei University School of Medicine
| | - Dai Watanabe
- Department of Systems Engineering and Science, Shibaura Institute of Technology
| | - Satoshi Tani
- Department of Neurosurgery, The Jikei University School of Medicine
| | - Hiroki Ohashi
- Department of Neurosurgery, The Jikei University School of Medicine
| | | | - Kohei Takeshita
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine
| | | | - Tetsuya Nishimoto
- Biomechanics Research Unit, College of Engineering, Nihon University
| | - Kohei Yuge
- Faculty of Science and Technology, Seikei University
| | | | - Toshiaki Abe
- Department of Neurosurgery, The Jikei University School of Medicine
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine
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25
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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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26
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Rajič Bumber J, Pilipović K, Janković T, Dolenec P, Gržeta N, Križ J, Župan G. Repetitive Traumatic Brain Injury Is Associated With TDP-43 Alterations, Neurodegeneration, and Glial Activation in Mice. J Neuropathol Exp Neurol 2021; 80:2-14. [PMID: 33212475 DOI: 10.1093/jnen/nlaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Increasing evidence points to a relationship between repetitive mild traumatic brain injury (mTBI), the Tar DNA binding protein 43 (TDP-43) pathology and some neurodegenerative diseases, but the underlying pathophysiological mechanisms are still unknown. We examined TDP-43 regulation, neurodegeneration, and glial responses following repetitive mTBI in nontransgenic mice and in animals with overexpression of human mutant TDP-43 protein (TDP-43G348C). In the frontal cortices of the injured nontransgenic animals, early TDP-43 cytoplasmatic translocation and overexpression of the protein and its pathological forms were detected. In the injured animals of both genotypes, neurodegeneration and pronounced glial activity were detected in the optic tract. In TDP-43G348C mice, these changes were significantly higher at day 7 after the last mTBI compared with the values in the nontransgenic animals. Results of this study suggest that the changes in the TDP-43 regulation in the frontal cortices of the nontransgenic animals were a transient stress response to the brain injury. Repetitive mTBI did not produce additional TDP-43 dysregulation or neurodegeneration or pronounced gliosis in the frontal cortex of TDP-43G348C mice. Our research also suggests that overexpression of mutated human TDP-43 possibly predisposes the brain to more intense neurodegeneration and glial activation in the optic tract after repetitive mTBI.
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Affiliation(s)
- Jelena Rajič Bumber
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Kristina Pilipović
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tamara Janković
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Petra Dolenec
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nika Gržeta
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Jasna Križ
- Department of Psychiatry and Neuroscience, Faculty of Medicine, University of Laval, Quebec, QC, Canada
| | - Gordana Župan
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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27
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Espinoza TR, Hendershot KA, Liu B, Knezevic A, Jacobs BB, Gore RK, Guskiewicz KM, Bazarian JJ, Phelps SE, Wright DW, LaPlaca MC. A Novel Neuropsychological Tool for Immersive Assessment of Concussion and Correlation with Subclinical Head Impacts. Neurotrauma Rep 2021; 2:232-244. [PMID: 34223554 PMCID: PMC8240822 DOI: 10.1089/neur.2020.0022] [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: 11/26/2022] Open
Abstract
Mild traumatic brain injury (mTBI) remains a diagnostic challenge and therefore strategies for objective assessment of neurological function are key to limiting long-term sequelae. Current assessment methods are not optimal in austere environments such as athletic fields; therefore, we developed an immersive tool, the Display Enhanced Testing for Cognitive Impairment and mTBI (DETECT) platform, for rapid objective neuropsychological (NP) testing. The objectives of this study were to assess the ability of DETECT to accurately identify neurocognitive deficits associated with concussion and evaluate the relationship between neurocognitive measures and subconcussive head impacts. DETECT was used over a single season of two high school and two college football teams. Study participants were instrumented with Riddell Head Impact Telemetry (HIT) sensors and a subset tested with DETECT immediately after confirmed impacts for different combinations of linear and rotational acceleration. A total of 123 athletes were enrolled and completed baseline testing. Twenty-one players were pulled from play for suspected concussion and tested with DETECT. DETECT was 86.7% sensitive (95% confidence interval [CI]: 59.5%, 98.3%) and 66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying athletes with concussions (15 of 21). Weak but significant correlations were found between complex choice response time (processing speed and divided attention) and both linear (Spearman rank correlation coefficient 0.262, p = 0.02) and rotational (Spearman coefficient 0.254, p = 0.03) acceleration on a subset of 76 players (113 DETECT tests) with no concussion symptoms. This study demonstrates that DETECT confers moderate to high sensitivity in identifying acute cognitive impairment and suggests that football impacts that do not result in concussion may negatively affect cognitive performance immediately following an impact. Specificity, however, was not optimal and points to the need for additional studies across multiple neurological domains. Given the need for more objective concussion screening in triage situations, DETECT may provide a solution for mTBI assessment.
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Affiliation(s)
- Tamara R Espinoza
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristopher A Hendershot
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Liu
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - Andrea Knezevic
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Breanne B Jacobs
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, North Carolina, USA
| | - Jeffery J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Shean E Phelps
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - David W Wright
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, USA
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28
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Porfido T, de Souza NL, Brown AM, Buckman JF, Fanning BD, Parrott JS, Esopenko C. The relation between neck strength and psychological distress: preliminary evidence from collegiate soccer athletes. Concussion 2021; 6:CNC91. [PMID: 34084557 PMCID: PMC8162191 DOI: 10.2217/cnc-2020-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
AIM To examine whether neck strength and symmetry are associated with psychological function in athletes with exposure to repetitive head impacts. METHODS Collegiate soccer (n = 29) and limited/noncontact (n = 63) athletes without a history of concussion completed the Brief Symptom Inventory 18 and assessments of isometric neck strength. Neck strength symmetry was calculated as the difference in strength between opposing muscle groups. RESULTS The results demonstrated that lower neck strength was associated with more symptoms of anxiety, whereas asymmetry in neck strength was associated with more symptoms of somatization and depression in soccer athletes only. CONCLUSION These preliminary results suggest that greater neck strength/symmetry is related to better psychological function in athletes who have higher exposure to repetitive head impacts.
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Affiliation(s)
- Tara Porfido
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Allison M Brown
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology & Health, Rutgers–New Brunswick, Piscataway, NJ, USA
| | - Brian D Fanning
- Department of Intercollegiate Athletics & Recreation, Rutgers–Newark, Newark, NJ, USA
| | - James S Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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29
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Xu X, Cowan M, Beraldo F, Schranz A, McCunn P, Geremia N, Brown Z, Patel M, Nygard KL, Khazaee R, Lu L, Liu X, Strong MJ, Dekaban GA, Menon R, Bartha R, Daley M, Mao H, Prado V, Prado MAM, Saksida L, Bussey T, Brown A. Repetitive mild traumatic brain injury in mice triggers a slowly developing cascade of long-term and persistent behavioral deficits and pathological changes. Acta Neuropathol Commun 2021; 9:60. [PMID: 33823944 PMCID: PMC8025516 DOI: 10.1186/s40478-021-01161-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
We have previously reported long-term changes in the brains of non-concussed varsity rugby players using magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI) and functional magnetic imaging (fMRI). Others have reported cognitive deficits in contact sport athletes that have not met the diagnostic criteria for concussion. These results suggest that repetitive mild traumatic brain injuries (rmTBIs) that are not severe enough to meet the diagnostic threshold for concussion, produce long-term consequences. We sought to characterize the neuroimaging, cognitive, pathological and metabolomic changes in a mouse model of rmTBI. Using a closed-skull model of mTBI that when scaled to human leads to rotational and linear accelerations far below what has been reported for sports concussion athletes, we found that 5 daily mTBIs triggered two temporally distinct types of pathological changes. First, during the first days and weeks after injury, the rmTBI produced diffuse axonal injury, a transient inflammatory response and changes in diffusion tensor imaging (DTI) that resolved with time. Second, the rmTBI led to pathological changes that were evident months after the injury including: changes in magnetic resonance spectroscopy (MRS), altered levels of synaptic proteins, behavioural deficits in attention and spatial memory, accumulations of pathologically phosphorylated tau, altered blood metabolomic profiles and white matter ultrastructural abnormalities. These results indicate that exceedingly mild rmTBI, in mice, triggers processes with pathological consequences observable months after the initial injury.
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30
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Abstract
OBJECTIVES Head impact exposure (HIE) in youth football is a public health concern. The objective of this study was to determine if one season of HIE in youth football was related to cognitive changes. METHOD Over 200 participants (ages 9-13) wore instrumented helmets for practices and games to measure the amount of HIE sustained over one season. Pre- and post-season neuropsychological tests were completed. Test score changes were calculated adjusting for practice effects and regression to the mean and used as the dependent variables. Regression models were calculated with HIE variables predicting neuropsychological test score changes. RESULTS For the full sample, a small effect was found with season average rotational values predicting changes in list-learning such that HIE was related to negative score change: standardized beta (β) = -.147, t(205) = -2.12, and p = .035. When analyzed by age clusters (9-10, 11-13) and adding participant weight to models, the R2 values increased. Splitting groups by weight (median split), found heavier members of the 9-10 cohort with significantly greater change than lighter members. Additionaly, significantly more participants had clinically meaningful negative changes: X2 = 10.343, p = .001. CONCLUSION These findings suggest that in the 9-10 age cluster, the average seasonal level of HIE had inverse, negative relationships with cognitive change over one season that was not found in the older group. The mediation effects of age and weight have not been explored previously and appear to contribute to the effects of HIE on cognition in youth football players.
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31
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Heary RF, Majmundar N, Nagurka R. Is Youth Football Safe? An Analysis of Youth Football Head Impact Data. Neurosurgery 2021; 87:377-382. [PMID: 31993634 DOI: 10.1093/neuros/nyz563] [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: 06/12/2019] [Accepted: 11/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The issue of whether sports-related head trauma at the youth level can result in long-term sequelae that may negatively impact the participant has been widely debated. OBJECTIVE To investigate head impacts in the Summit Youth Football League equipped with helmets using the Riddell InSite impact monitoring system. The monitoring system allowed for analysis of the number of impacts and severity of impacts by player. METHODS Data were obtained for all 20 members of the youth football team. Impacts were recorded as "low," "medium," and "high" intensity. RESULTS All 20 players participated in all practices and games throughout the season. No player suffered a concussion throughout the entire season. There were 817 recorded impacts throughout the season. This was an average of 41 impacts per player over the course of the season and fewer than 4 impacts per player per week. Only one impact registered as "high." CONCLUSION We demonstrate that there are few head impacts over the course of an entire season at the middle school level. Guardian Caps, safe tackling techniques, and the age of participants may have contributed to the very low number of impacts recorded and the complete lack of injuries. This study only provides data demonstrating that youth football, when Guardian Caps and safe tackling techniques are enforced, does not appear to result in significant head impacts causing immediate head injuries. This study cannot comment on the safety of playing football at the collegiate or professional level.
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Effect of subconcussive impacts on functional outcomes over a single collegiate football season. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220983165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context In collision sports, particularly American football, athletes can accumulate thousands of subconcussive impacts, or head acceleration events (HAEs), across a single season; however, the short-term consequences of these impacts are not well understood. Objective To investigate the effects of the accumulation of impacts during practices on cognitive functions over a single football season. Design Prospective observational study. Setting Athletic training room and University laboratory. Participants Twenty-three NCAA Football Bowl Subdivision players. Main outcome measures Helmet accelerometers during practices and virtual reality testing (VR; balance, reaction time, spatial memory) before and after the season. Results Preseason had the majority of ≥80 G impacts while during the season had the majority of ≥25 G to <80 G impacts and positional differences showed that linemen had the majority of both types. Virtual reality analysis revealed that scores significantly decreased after the season for spatial navigation ( p < 0.05) but not for balance or reaction time. Significant correlations ( p < 0.05) were found between cognitive measures and player demographic variables. Conclusions Even in the absence of clinical symptoms and concussion diagnosis, repetitive impacts may cause cognitive alterations. Documenting the distribution of impact quantity and intensity as a function of time and position may be considered by coaches and clinicians to reduce the accumulation of impacts in athletes exposed in contact sports.
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Gallagher VT, Murthy P, Stocks J, Vesci B, Colegrove D, Mjaanes J, Chen Y, Breiter H, LaBella C, Herrold AA, Reilly JL. Differential Change in Oculomotor Performance among Female Collegiate Soccer Players versus Non-Contact Athletes from Pre- to Post-Season. Neurotrauma Rep 2020; 1:169-180. [PMID: 33274345 PMCID: PMC7703496 DOI: 10.1089/neur.2020.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sensitive and reliable tools are needed to evaluate potential behavioral and cognitive changes following head impact exposure in contact and collision sport participation. We evaluated change in oculomotor testing performance among female, varsity, collegiate athletes following variable exposure to head impacts across a season. Female, collegiate, contact sport (soccer, CONT) and non-contact sport (NON-CONT) athletes were assessed pre-season and post-season. Soccer athletes were grouped according to total season game headers into low dose (≤40 headers; CONT-Low Dose) or high dose (>40 headers; CONT-High Dose) groups. Performance on pro-saccade (reflexive visual response), anti-saccade (executive inhibition), and memory-guided saccade (MGS, spatial working memory) computer-based laboratory tasks were assessed. Primary saccade measures included latency/reaction time, inhibition error rate (anti-saccade only), and spatial accuracy (MGS only). NON-CONT (n = 20), CONT-Low Dose (n = 17), and CONT-High Dose (n = 7) groups significantly differed on pre-season versus post-season latency on tasks with executive functioning demands (anti-saccade and MGS, p ≤ 0.001). Specifically, NON-CONT and CONT-Low Dose demonstrated shorter (i.e., faster) anti-saccade (1.84% and 2.68%, respectively) and MGS (5.74% and 2.76%, respectively) latencies from pre-season to post-season, whereas CONT-High Dose showed 1.40% average longer anti-saccade, and 0.74% shorter MGS, latencies. NON-CONT and CONT-Low Dose demonstrated reduced (i.e., improved) inhibition error rate on the anti-saccade task at post-season versus pre-season, whereas CONT-High Dose demonstrated relative stability (p = 0.021). The results of this study suggest differential exposure to subconcussive head impacts in collegiate female athletes is associated with differential change in reaction time and inhibitory control performances on executive saccadic oculomotor testing.
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Affiliation(s)
- Virginia T Gallagher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Prianka Murthy
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Vesci
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Yufen Chen
- Center for Translational Imaging, Northwestern University, Chicago, Illinois, USA
| | - Hans Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia LaBella
- Division of Orthopedics and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy A Herrold
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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Roby PR, Duquette P, Kerr ZY, Register-Mihalik J, Stoner L, Mihalik JP. Repetitive Head Impact Exposure and Cerebrovascular Function in Adolescent Athletes. J Neurotrauma 2020; 38:837-847. [PMID: 33081565 DOI: 10.1089/neu.2020.7350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to determine how subconcussive head impact exposure in high school collision sport student-athletes influenced cerebrovascular function. Transcranial Doppler was used to assess pre- to post-season changes in: (1) resting middle (MCA) and posterior cerebral arteries (PCA), (2) cerebrovascular reactivity (CVR) via breath-holding index (BHI), vasomotor reactivity response (VMRr) and overall MCA response curve, and (3) neurovascular coupling (NVC) via NVC response magnitude and overall PCA response curve. Fifty-three high school-aged athletes (age = 15.8 ± 1.2years, height = 175.8 ± 8.1cm, mass = 69.4 ± 13.5kg) were recruited into two groups (collision vs. non-collision sport). All participants completed a pre-season cerebrovascular function assessment. Following a 4- to 5-month window (118.6 ± 12.2 days), 48 athletes from the original sample (age = 16.0 ± 1.2 years, height = 175.5 ± 8.1 cm, mass = 68.6 ± 4.0 kg) repeated the cerebrovascular assessment. There were no group differences in any cerebrovascular measures at pre-season testing (p > 0.05). At post-season testing, collision sport athletes demonstrated greater positive change in BHI (t44 = -2.21, p = 0.03) while non-collision sport athletes demonstrated greater negative change in the NVC response magnitude to the reading task (t44 = 1.98, p = 0.048), and lower overall PCA response curve to the reading task (F1,2710 = 101.54, p < 0.001). All other pre- to post-season change values were non-significant (p > 0.05). Our data indicate that single-season changes in cerebrovascular outcomes may differ between collision and non-collision sport athletes. Although the clinical interpretation is still unclear, our study demonstrates that CVR and NVC assessments may be sensitive to the dynamic cerebrovascular changes occurring in adolescent athletes. Future research should continue to assess these outcomes following both subconcussive head impact exposure and throughout the recovery trajectory following concussion.
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Affiliation(s)
- Patricia R Roby
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter Duquette
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- UNC Cardiometabolic Laboratory, Department of Exercise and Sport Science, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Rowson B, Duma SM. A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies. Ann Biomed Eng 2020; 48:2734-2750. [PMID: 33200263 DOI: 10.1007/s10439-020-02684-w] [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: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
This review paper summarizes the scientific advancements in the field of concussion biomechanics in American football throughout the past five decades. The focus is on-field biomechanical data collection, and the translation of that data to injury metrics and helmet evaluation. On-field data has been collected with video analysis for laboratory reconstructions or wearable head impact sensors. Concussion biomechanics have been studied across all levels of play, from youth to professional, which has allowed for comparison of head impact exposure and injury tolerance between different age groups. In general, head impact exposure and injury tolerance increase with increasing age. Average values for concussive head impact kinematics are lower for youth players in both linear and rotational acceleration. Head impact data from concussive and non-concussive events have been used to develop injury metrics and risk functions for use in protective equipment evaluation. These risk functions have been used to evaluate helmet performance for each level of play, showing substantial differences in the ability of different helmet models to reduce concussion risk. New advances in head impact sensor technology allow for biomechanical measurements in helmeted and non-helmeted sports for a more complete understanding of concussion tolerance in different demographics. These sensors along with advances in finite element modeling will lead to a better understanding of the mechanisms of injury and human tolerance to head impact.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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Chiasseu M, Fesharaki-Zadeh A, Saito T, Saido TC, Strittmatter SM. Gene-environment interaction promotes Alzheimer's risk as revealed by synergy of repeated mild traumatic brain injury and mouse App knock-in. Neurobiol Dis 2020; 145:105059. [PMID: 32858147 PMCID: PMC7572902 DOI: 10.1016/j.nbd.2020.105059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
There is a strong unmet need for translational progress towards Alzheimer's disease (AD) modifying therapy. Unfortunately, preclinical modeling of the disease has been disappointing, relying primarily on transgenic mouse overexpression of rare dominant mutations. Clinical manifestation of AD symptoms is known to reflect interaction between environmental and genetic risks. Mild traumatic brain injury (mTBI) is an environmental risk for dementia, including Alzheimer's, but there has been limited mechanistic analysis of mTBI contribution to AD. Here, we investigate the interplay between mTBI and Aβ precursor protein gene mutation in AD pathogenesis. We employed a knock-in (KI) model of AD that expresses the Aß-containing exons from human APP bearing the Swedish and Iberian mutations, namely AppNL-F/NL-F mice. Without environmental risk, this genetic variation yields minimal mouse symptomatology. Anesthetized 4-month-old KI mice and their age-matched wild type (WT) controls were subjected to repeated mild closed head injury (rmCHI), once daily for 14 days. Anesthetized, uninjured genotype- and age-matched mice were used as sham controls. At 3- and 8-months post-injury, amyloid-β, phospho-tau and Iba1 expression in the injured KI cortices were assessed. Our data reveal that rmCHI enhances accumulation of amyloid-β and hyperphosphorylated tau inclusions, as well as neuroinflammation in AppNL-F/NL-F mice. Furthermore, novel object recognition and Morris water maze tests demonstrated that rmCHI greatly exacerbates persistent cognitive deficits in APPNL-F/NL-F mice. Therefore, study of gene-environment interaction demonstrates that combining risk factors provides a more robust model for AD, and that repeated mTBI substantially accelerates AD pathology in a genetically susceptible situation.
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Affiliation(s)
- Marius Chiasseu
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Arman Fesharaki-Zadeh
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Takashi Saito
- Laboratory for Proteolytic Neuroscience, RIKEN Center for Brain Science, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan; Department of Neurocognitive Science, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-ku, Mizuho-cho, Nagoya, Aichi 467-8601, Japan
| | - Takaomi C Saido
- Laboratory for Proteolytic Neuroscience, RIKEN Center for Brain Science, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Stephen M Strittmatter
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA; Departments of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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38
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Rawlings S, Takechi R, Lavender AP. Effects of sub-concussion on neuropsychological performance and its potential mechanisms: A narrative review. Brain Res Bull 2020; 165:56-62. [PMID: 33011196 DOI: 10.1016/j.brainresbull.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/12/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Concussion and mild traumatic brain injury (mTBI) are recognised as serious medical events that are relatively common in contact sports. Recently, the seemingly non-injurious phenomenon of sub-concussion has gained interest among neuroscience researchers and early studies are showing that there may be some acute and chronic effects on brain health and function with repeated sub-concussive events of the type seen in soccer, where players strike the ball with the head, and collision sports like the rugby codes. The aim of this narrative review is to describe sub-concussion and the current understanding of short and long term effects of repeated minor impacts that have been found to occur in human and animal models. Here, potential mechanisms for cognitive dysfunction following sub-concussion and recommend directions for future research are discussed. The Potential mechanisms of injuries resulting from sub-concussion such as changes in blood brain barrier integrity, neuroinflammation, cognitive impairment, and oxidative stress damage, among other changes in central nervous system function vary considerably making understanding of the underlying causative mechanism challenging for researchers. Some evidence suggests a link between impaired cerebrovascular function and cognitive impairment which poses a potential mechanism linking the two. It is hoped that this review helps guide researchers toward a potential direction of investigations.
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Affiliation(s)
- Samuel Rawlings
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Ryusuke Takechi
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia; School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Andrew P Lavender
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia; School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia.
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39
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Chao LL, Barlow C, Karimpoor M, Lim L. Changes in Brain Function and Structure After Self-Administered Home Photobiomodulation Treatment in a Concussion Case. Front Neurol 2020; 11:952. [PMID: 33013635 PMCID: PMC7509409 DOI: 10.3389/fneur.2020.00952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a common neurological disorder among athletes. Although there are no widely accepted treatments for TBI, new investigational approaches, such as photobiomodulation (PBM), are being tested. PBM is a light therapy that uses red to near-infrared (NIR) light to stimulate, heal, and protect tissue that has been injured or is at risk of dying. Benefits following transcranial PBM treatments in animal models of acute TBI and a small number of chronic TBI patients have been reported. However, the human PBM TBI studies published to date have been based on behavioral assessments. This report describes changes in behavioral and neuroimaging measures after 8 weeks of PBM treatments. The subject was a 23-year professional hockey player with a history of concussions, presumed to have caused his symptoms of headaches, mild anxiety, and difficulty concentrating. He treated himself at home with commercially available, low-risk PBM devices that used light-emitting diodes (LEDs) to emit 810-nm light pulsing at 10 or 40 Hz delivered by an intranasal and four transcranial modules that targeted nodes of the default mode network (DMN) with a maximum power density of 100 mW/cm2. After 8 weeks of PBM treatments, increased brain volumes, improved functional connectivity, and increased cerebral perfusion and improvements on neuropsychological test scores were observed. Although this is a single, sport-related case with a history of concussions, these positive findings encourage replication studies that could provide further validation for this non-invasive, non-pharmacological modality as a viable treatment option for TBI.
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Affiliation(s)
- Linda L Chao
- Departments of Radiology & Biomedical Imaging and Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,VA Advanced Imaging Research Center, San Francisco VA Health Care System, San Francisco, CA, United States
| | - Cody Barlow
- VA Advanced Imaging Research Center, San Francisco VA Health Care System, San Francisco, CA, United States
| | | | - Lew Lim
- Vielight Inc., Toronto, ON, Canada
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40
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Black SE, Follmer B, Mezzarane RA, Pearcey GEP, Sun Y, Zehr EP. Exposure to impacts across a competitive rugby season impairs balance and neuromuscular function in female rugby athletes. BMJ Open Sport Exerc Med 2020; 6:e000740. [PMID: 32617174 PMCID: PMC7319707 DOI: 10.1136/bmjsem-2020-000740] [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] [Accepted: 05/24/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives We used objective assessment tools to detect subtle neurological deficits that accompany repetitive and mild head impacts in contact sport across a season. Methods Female participants (n=13, 21±1.8 years old; 167.6±6.7 cm; 72.8±6.1 kg) completed assessments pre and post the varsity rugby season. A commercial balance board was used to assess static balance and response to dynamic postural challenge. Spinal cord excitability via the soleus H-reflex was assessed in both legs. Video analysis was used to identify head impact exposures. Results A total of 172 potential concussive events were verified across 11 athletes (15.6±11; 95% CI: 6.5 to 19.8). Balance performance was worse at post-season for total centre of pressure which increased by 26% in the double stance on a stable surface (t(12)=-2.33; p=0.03; d=0.6) and by 140% in the tandem stance on a foam surface (t(12)=-3.43; p<0.01; d=0.9). Despite that, dynamic postural performance was improved after the season (p<0.01). Spinal cord excitability in rugby athletes did not change across the season but deviated from normative values at baseline. Conclusion Quantitative measures revealed that exposure to impacts across a competitive rugby season impair balance in two specific stances in female rugby athletes. Tandem-leg stance on an unstable surface and double-leg stance on firm surface are useful assessment conditions when performed over a low-cost balance board, even without clinically diagnosed concussion.
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Affiliation(s)
- Stephanie E Black
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.,School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Bruno Follmer
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.,School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Rinaldo André Mezzarane
- Laboratory of Signal Processing and Motor Control, Faculty of Physical Education, University of Brasilia, Brasilia, DF, Brazil
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.,School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.,School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada.,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
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41
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Rebchuk AD, Brown HJ, Koehle MS, Blouin JS, Siegmund GP. Using Variance to Explore the Diagnostic Utility of Baseline Concussion Testing. J Neurotrauma 2020; 37:1521-1527. [PMID: 31928134 DOI: 10.1089/neu.2019.6829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and King-Devick Test (KDT) are considered important components of concussion assessment. Whether baseline testing improves the diagnostic utility of these tests remains unclear. We performed an observational cohort study to investigate the within-subject and between-subjects variability of these tests over repeated assessments during two football seasons to examine whether baseline testing reduces variability in test performance. Thirty-five male collegiate football players completed weekly clinical concussion assessments over two seasons. Within-subject (week-to-week) and between-subjects (player-to-player) variability for each test were compared using a bootstrap analysis. Within-subject and between-subjects proportions of overall variance for each test score were calculated. Mixed-model analyses were used to quantify practice effects resulting from repeated testing. For the GSC and BESS, within-subject and between-subjects variability did not significantly differ. For the KDT, the proportion of within-subject variance (20.2%) was significantly less than the between-subjects variance (79.8%). For SAC, however, the proportion of within-subject variance (66.8%) was significantly greater than the between-subjects variance (33.8%). A small, but significant, practice effect was observed for the BESS and KDT tests. When athletes are evaluated during a football season for concussion using the GSC, SAC, and BESS, comparing their scores to baseline performance is likely no more beneficial than comparing them to normative population data for identifying neurological changes associated with concussion. For the KDT, comparison to baseline testing is likely beneficial because of significantly higher between-subjects variability.
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Affiliation(s)
- Alexander D. Rebchuk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harrison J. Brown
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S. Koehle
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Sport and Exercise Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gunter P. Siegmund
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- MEA Forensic Engineers and Scientists, Richmond, British Columbia, Canada
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Manning KY, Brooks JS, Dickey JP, Harriss A, Fischer L, Jevremovic T, Blackney K, Barreira C, Brown A, Bartha R, Doherty T, Fraser D, Holmes J, Dekaban GA, Menon RS. Longitudinal changes of brain microstructure and function in nonconcussed female rugby players. Neurology 2020; 95:e402-e412. [PMID: 32554762 PMCID: PMC7455316 DOI: 10.1212/wnl.0000000000009821] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/05/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To longitudinally assess brain microstructure and function in female varsity athletes participating in contact and noncontact sports. Methods Concussion-free female rugby players (n = 73) were compared to age-matched (ages 18–23) female swimmers and rowers (n = 31) during the in- and off-season. Diffusion and resting-state fMRI (rs-fMRI) measures were the primary outcomes. The Sports Concussion Assessment Tool and head impact accelerometers were used to monitor symptoms and impacts, respectively. Results We found cross-sectional (contact vs noncontact) and longitudinal (in- vs off-season) changes in white matter diffusion measures and rs-fMRI network connectivity in concussion-free contact athletes relative to noncontact athletes. In particular, mean, axial, and radial diffusivities were increased with decreased fractional anisotropy in multiple white matter tracts of contact athletes accompanied with default mode and visual network hyperconnectivity (p < 0.001). Longitudinal diffusion changes in the brainstem between the in- and off-season were observed for concussion-free contact athletes only, with progressive changes observed in a subset of athletes over multiple seasons. Axial diffusivity was significantly lower in the genu and splenium of the corpus callosum in those contact athletes with a history of concussion. Conclusions Together, these findings demonstrate longitudinal changes in the microstructure and function of the brain in otherwise healthy, asymptomatic athletes participating in contact sport. Further research to understand the long-term brain health and biological implications of these changes is required, in particular to what extent these changes reflect compensatory, reparative, or degenerative processes.
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Affiliation(s)
- Kathryn Y Manning
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Jeffrey S Brooks
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - James P Dickey
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Alexandra Harriss
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Lisa Fischer
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Tatiana Jevremovic
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Kevin Blackney
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Christy Barreira
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Arthur Brown
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Robert Bartha
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Tim Doherty
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Douglas Fraser
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Jeff Holmes
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Gregory A Dekaban
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
| | - Ravi S Menon
- From Medical Biophysics (K.Y.M., R.B., R.S.M.), School of Kinesiology (J.S.B., J.P.D.), Microbiology and Immunology (K.B.), Health and Rehabilitation Sciences (A.H.), Anatomy and Cell Biology (A.B.), Physical Medicine and Rehabilitation (T.D.), and School of Occupational Therapy (J.H.), Western University; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine Research Laboratories (K.B., C.B., A.B., G.A.D.), Robarts Research Institute; Primary Care Sport Medicine (L.F., T.J.), Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.F.), London Health Sciences Centre, Ontario, Canada
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Lavender AP, Rawlings S, Warnock A, McGonigle T, Hiles-Murison B, Nesbit M, Lam V, Hackett MJ, Fitzgerald M, Takechi R. Repeated Long-Term Sub-concussion Impacts Induce Motor Dysfunction in Rats: A Potential Rodent Model. Front Neurol 2020; 11:491. [PMID: 32547485 PMCID: PMC7274030 DOI: 10.3389/fneur.2020.00491] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023] Open
Abstract
Whilst detrimental effects of repeated sub-concussive impacts on neurophysiological and behavioral function are increasingly reported, the underlying mechanisms are largely unknown. Here, we report that repeated sub-concussion with a light weight drop (25 g) in wild-type PVG rats for 2 weeks does not induce detectable neuromotor dysfunction assessed by beamwalk and rotarod tests. However, after 12 weeks of repeated sub-concussion, the rats exhibited moderate neuromotor dysfunction. This is the first study to demonstrate development of neuromotor dysfunction following multiple long-term sub-concussive impacts in rats. The outcomes may offer significant opportunity for future studies to understand the mechanisms of sub-concussion-induced neuropsychological changes.
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Affiliation(s)
- Andrew P Lavender
- School of Health and Life Sciences, Federation University, Ballarat, VIC, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Samuel Rawlings
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Andrew Warnock
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia
| | - Terry McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia
| | - Bailey Hiles-Murison
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Michael Nesbit
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Virginie Lam
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Mark J Hackett
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,School of Molecular and Life Science, Faculty of Science and Engineering, Curtin University, Perth, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia.,Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
| | - Ryusuke Takechi
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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44
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Gallant C, Barry N, Good D. Physiological arousal in athletes following repeated subconcussive impact exposure. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-018-9780-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Correlation of Head Impact Exposures With Vestibulo-Ocular Assessments. J Sport Rehabil 2020; 29:310-314. [PMID: 30676193 DOI: 10.1123/jsr.2017-0282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Managing a concussion injury should involve the incorporation of a multifaceted approach, including a vision assessment. The frontoparietal circuits and subcortical nuclei are susceptible to trauma from a concussion injury, leading to dysfunction of the vestibulo-ocular system. Research investigating the effect of cumulative subconcussive impacts on neurological function is still in its infancy, but repetitive head impacts may result in vestibular system dysfunction. This dysfunction could create visual deficits, predisposing the individual to further head trauma. OBJECTIVE The purpose of this study was to investigate the cumulative effect of subconcussive impacts on minimum perception time, static visual acuity, gaze stability, and dynamic visual acuity scores. DESIGN Prospective cohort. SETTING Division I university. PATIENTS Thirty-three Division I men's lacrosse players (age = 19.52 [1.20] y). INTERVENTION Competitive lacrosse season. MAIN OUTCOME MEASURES At the beginning and end of the season, the players completed a vestibulo-ocular reflex assessment, using the InVision™ system by Neurocom® to assess perception, static acuity, gaze stability, and dynamic visual acuity. Score differentials were correlated with the head impact exposure data collected via instrumented helmets. RESULTS A significant correlation was found between change in perception scores and total number of head impacts (r = .54), and between changes in dynamic visual acuity loss scores on the rightside and maximum rotational acceleration (r = .36). No statistical differences were found between preseason and postseason vestibulo-ocular reflex variables. CONCLUSIONS Cumulative subconcussive impacts may negatively affect vestibulo-ocular reflex scores, resulting in decreased visual performance. This decrease in vestibulo-ocular function may place the athlete at risk of sustaining additional head impacts or other injuries.
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Caccese JB, Best C, Lamond LC, Difabio M, Kaminski TW, Watson D, Getchell N, Buckley TA. Effects of Repetitive Head Impacts on a Concussion Assessment Battery. Med Sci Sports Exerc 2020; 51:1355-1361. [PMID: 30649104 DOI: 10.1249/mss.0000000000001905] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players. METHODS Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: preseason (PRE) and postseason (POST). The outcome measures consisted of tandem gait (TG), Standardized Assessment of Concussion, Balance Error Scoring System, King-Devick (KD), clinical reaction time, and Immediate Post-Concussion Assessment and Cognitive Testing. Repetitive head impact during the season was quantified using the Head Impact Telemetry System (Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, Norwalk, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts ≥98g. RESULTS Results from direct-entry multiple regression analyses suggest significant associations between RHI and both visual memory (R = 0.670, F = 6.487, P = 0.002) and TG (R = 0.636, F = 3.841, P = 0.029) for WSOC and between RHI and KD (R = 0.756, F = 5.579, P = 0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant. CONCLUSIONS These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and visual memory/TG among WSOC, RHI, and KD among FB.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | | | - Lindsey C Lamond
- Department of Family Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Melissa Difabio
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Dan Watson
- University of Delaware Athletics, Newark, DE
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
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Abstract
OBJECTIVE The aim of this research was to develop preliminary norms for the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) administered to a large sample of adolescent athletes from diverse ethnic backgrounds. DESIGN A retrospective records review. SETTING Middle and high school athletic departments. PARTICIPANTS A total of 5741 male and female adolescent athletes in Hawaii, aged 13 to 18 years, in grades 9 to 12 were included in the study. INDEPENDENT VARIABLES Age, sex, ethnicity, and sport. MAIN OUTCOME MEASURES ImPACT Composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control) and Total Symptom score from baseline testing. RESULTS The results indicated statistically significant differences between age and sex groups, as well as between ethnic and sport groups. CONCLUSIONS The findings support the continued use of stratified norms for age and sex for ethnically diverse adolescent athletes. Comparisons of ethnic and sport groups deserve further investigation. When baseline scores are not available for postconcussion comparison, present observations tentatively support the cautious use of standard ImPACT norms with ethnically diverse athletes.
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Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football. Clin J Sport Med 2019; 29:442-450. [PMID: 31688173 DOI: 10.1097/jsm.0000000000000753] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. DESIGN Prospective cohort. SETTING One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). PATIENTS OR OTHER PARTICIPANTS Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. INTERVENTIONS Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. MAIN OUTCOME MEASURES Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. CONCLUSIONS Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.
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Eckner JT, Wang J, Nelson LD, Bancroft R, Pohorence M, He X, Broglio SP, Giza CC, Guskiewicz KM, Kutcher JS, McCrea M. Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes. Sports Med 2019; 50:1027-1038. [PMID: 31637659 DOI: 10.1007/s40279-019-01200-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare pre-season to post-season changes on a battery of clinical neurological outcome measures between non-contact, contact, and collision sport athletes over multiple seasons of play. METHODS 244 high school and collegiate athletes participating in multiple non-contact, contact, and collision sports completed standardized annual pre-season and post-season assessments over 1-4 years. Pre/post-season changes in 10 outcome measures assessing concussion symptoms, neurocognitive performance, and balance were compared between the groups using linear mixed models. RESULTS Small, but statistically significant overall pre/post-season change differences were present between the groups for Axon computerized neurocognitive test processing speed, attention, and working memory speed scores (Axon-PS, Axon-Att, Axon-WMS), as well as Balance Error Scoring System (BESS) total score. Small seasonal declines not exceeding reliable-change thresholds were observed in the collision sport group relative to the contact and non-contact groups for Axon-PS and Axon-Att scores. The collision and contact sport groups demonstrated less pre-/post-season improvement than the non-contact sport group for Axon-WMA and BESS, with less BESS improvement also observed in the collision sport group relative to the contact sport group. Overall, longitudinal performance on all 10 outcome measures remained stable in all 3 groups over 4 years. CONCLUSION Our findings do not necessarily support the notion that participation in sports associated with exposure to repetitive head impacts has clinically meaningful cumulative effects over the course of a season, nor over four consecutive seasons in high school and collegiate athletes.
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Affiliation(s)
- James T Eckner
- Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Ann Arbor, MI, 48108, USA.
| | | | | | | | | | - Xuming He
- Statistics, University of Michigan, Ann Arbor, USA
| | | | | | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina, Chapel Hill, USA
| | - Jeffrey S Kutcher
- Neurology, University of Michigan, Ann Arbor, USA.,The Sports Neurology Clinic, Brighton, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
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50
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Rose SC, Yeates KO, Nguyen JT, McCarthy MT, Ercole PM, Pizzimenti NM. Neurocognitive Function and Head Impact Burden over Two Seasons of Youth Tackle Football. J Neurotrauma 2019; 36:2803-2809. [DOI: 10.1089/neu.2019.6519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Sean C. Rose
- Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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