Dataset Information

High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video.

ABSTRACT: The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40-100 g, 3.3-7.0 m/s and 35-118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts.

SUBMITTER: Bartsch AJ

PROVIDER: S-EPMC7674260 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video.

Bartsch Adam J AJ Bartsch Adam J AJ Hedin Daniel D Alberts Jay J Benzel Edward C EC Cruickshank Jason J Gray Robert S RS Cameron Kenneth K Houston Megan N MN Rooks Tyler T McGinty Gerald G Kozlowski Erick E Rowson Steven S Maroon Joseph C JC Miele Vincent J VJ Ashton J Chris JC Siegmund Gunter P GP Shah Alok A McCrea Michael M Stemper Brian B

Annals of biomedical engineering 20201027 11

The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published O ...[more]

PMID: 33111969

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Project description:BackgroundWhile changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized.PurposeTo investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar.Study typeProspective controlled trial.SubjectsA total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group).Field strength/sequence3 Tesla/T1-weighted gradient echo, 1H point resolved spectroscopy, acquired between August and November 2018.AssessmentHead impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined.Statistical testsGroup-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05.ResultsIn participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10-3 to 0.227 ± 1.47 × 10-7) and increase in Glx/tCr (1.60 ± 8.75 × 10-3 to 1.63 ± 1.08 × 10-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 β ranged from 3.9 × 10-3 to 2.1 × 10-3; ACC β ranged from 2.7 × 10-3 to 2.1 × 10-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (β = 3.6 × 10-3) and >110 g (β = 2.9 × 10-3) in participants with concussion. Significant associations between ∆myoI/tCr in ACC and mean g-force >110 g (β = -1.1 × 10-3) and >120 g (β = -1.1 × 10-3) were observed in the collar group only.Data conclusionDiagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts.Level of evidence2 TECHNICAL EFFICACY: Stage 3.

Project description:ContextVideo feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance.ObjectiveTo determine the effect of video feedback in the instruction of tackling form.DesignControlled laboratory study.SettingLaboratory.Patients or other participantsA total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test.Intervention(s)Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment.Main outcome measure(s)Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time.ResultsFor the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance.ConclusionsCombined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.

Project description:Introduction: Concern has grown over the potential long-term effects of repeated head impacts and concussions in American football. Recent advances in impact engineering have yielded the development of soft, collapsible, liquid shock absorbers, which have demonstrated the ability to dramatically attenuate impact forces relative to existing helmet shock absorbers. Methods: To further explore how liquid shock absorbers can improve the efficacy of an American football helmet, we developed and optimized a finite element (FE) helmet model including 21 liquid shock absorbers spread out throughout the helmet. Using FE models of an anthropomorphic test headform and linear impactor, a previously published impact test protocol representative of concussive National Football League impacts (six impact locations, three velocities) was performed on the liquid FE helmet model and four existing FE helmet models. We also evaluated the helmets at three lower impact velocities representative of subconcussive football impacts. Head kinematics were recorded for each impact and used to compute the Head Acceleration Response Metric (HARM), a metric factoring in both linear and angular head kinematics and used to evaluate helmet performance. The head kinematics were also input to a FE model of the head and brain to calculate the resulting brain strain from each impact. Results: The liquid helmet model yielded the lowest value of HARM at 33 of the 36 impact conditions, offering an average 33.0% (range: -37.5% to 56.0%) and 32.0% (range: -2.2% to 50.5%) reduction over the existing helmet models at each impact condition in the subconcussive and concussive tests, respectively. The liquid helmet had a Helmet Performance Score (calculated using a summation of HARM values weighted based on injury incidence data) of 0.71, compared to scores ranging from 1.07 - 1.21 from the other four FE helmet models. Resulting brain strains were also lower in the liquid helmet. Discussion: The results of this study demonstrate the promising ability of liquid shock absorbers to improve helmet safety performance and encourage the development of physical prototypes of helmets featuring this technology. The implications of the observed reductions on brain injury risk are discussed.

Project description:BackgroundExposure to repetitive head impacts (RHI) is associated with an increased risk of later-life neurobehavioral dysregulation and neurodegenerative disease. The underlying pathomechanisms are largely unknown.PurposeTo investigate whether RHI exposure is associated with later-life corpus callosum (CC) microstructure and whether CC microstructure is associated with plasma total tau and neuropsychological/neuropsychiatric functioning.Study typeRetrospective cohort study.PopulationSeventy-five former professional American football players (age 55.2 ± 8.0 years) with cognitive, behavioral, and mood symptoms.Field strength/sequenceDiffusion-weighted echo-planar MRI at 3 T.AssessmentSubjects underwent diffusion MRI, venous puncture, neuropsychological testing, and completed self-report measures of neurobehavioral dysregulation. RHI exposure was assessed using the Cumulative Head Impact Index (CHII). Diffusion MRI measures of CC microstructure (i.e., free-water corrected fractional anisotropy (FA), trace, radial diffusivity (RD), and axial diffusivity (AD)) were extracted from seven segments of the CC (CC1-7), using a tractography clustering algorithm. Neuropsychological tests were selected: Trail Making Test Part A (TMT-A) and Part B (TMT-B), Controlled Oral Word Association Test (COWAT), Stroop Interference Test, and the Behavioral Regulation Index (BRI) from the Behavior Rating Inventory of Executive Function, Adult version (BRIEF-A).Statistical testsDiffusion MRI metrics were tested for associations with RHI exposure, plasma total tau, neuropsychological performance, and neurobehavioral dysregulation using generalized linear models for repeated measures.ResultsRHI exposure was associated with increased AD of CC1 (correlation coefficient (r) = 0.32, P < 0.05) and with increased plasma total tau (r = 0.34, P < 0.05). AD of the anterior CC1 was associated with increased plasma total tau (CC1: r = 0.30, P < 0.05; CC2: r = 0.29, P < 0.05). Higher trace, AD, and RD of CC1 were associated with better performance (P < 0.05) in TMT-A (trace, r = 0.33; AD, r = 0.31; and RD, r = 0.28) and TMT-B (trace, r = 0.31; RD, r = 0.34). Higher FA and AD of CC2 were associated with better performance (P < 0.05) in TMT-A (FA, r = 0.36; AD, r = 0.28), TMT-B (FA, r = 0.36; AD, r = 0.27), COWAT (FA, r = 0.36; AD, r = 0.32), and BRI (AD, r = 0.29).Data conclusionThese results suggest an association among RHI exposure, CC microstructure, plasma total tau, and clinical functioning in former professional American football players.Level of evidence3 Technical Efficacy Stage: 1.

Project description:IntroductionRepetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players.MethodsIn this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration.Results4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g's higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g's higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g's higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g's higher (0.8), p<0.001].ConclusionIncluding screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.

Project description:ImportanceLong-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada.ObjectiveTo assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality.Design, setting, and participantsThis retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference.ExposuresThe main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies.Main outcomes and measuresDemographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height.ResultsAmong 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased.Conclusions and relevanceThe findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.

Dataset Information

High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video.

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High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video.

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