The effect of safety modifications on head kinematics experienced during common skills in women's artistic gymnastics.

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills.

On-Field Evaluation of Mouthpiece-and-Helmet-Mounted Sensor Data from Head Kinematics in Football.

PURPOSE: Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system. METHODS: Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes. RESULTS: A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively. CONCLUSION: If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.

Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football.

BACKGROUND AND PURPOSE: During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex. MATERIALS AND METHODS: Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study. RESULTS: Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04). CONCLUSIONS: Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.

Assessing the association between on-field heading technique and head impact kinematics in a cohort of female youth soccer players.

There is concern that exposure to soccer headers may be associated with neurological sequelae. Training proper heading technique represents a coachable intervention that may reduce head acceleration exposure. The objective was to assess relationships between heading technique and head kinematics in female youth soccer players. Fourteen players (mean age = 14.4 years) wore instrumented mouthpieces during practices and games. Headers were reviewed by three raters to assign a technique score. Mixed models and LASSO regression evaluated associations of technique with peak linear acceleration (PLA), rotational acceleration (PRA), rotational velocity (PRV), and head impact power ratio (HIP Ratio) while adjusting for session type and ball delivery. Two hundred eighty-nine headers (n = 212 standing, n = 77 jumping) were analyzed. Technique score (p = 0.043) and the technique score - session type interaction (p = 0.004) were associated with PRA of standing headers, whereby each 10-unit increase in technique score was associated with an 8.6% decrease in PRA during games but a 5.1% increase in PRA during practices. Technique was not significantly associated with any other kinematic metrics; however, peak kinematics tended to decrease as technique score increased. LASSO regression identified back extension and shoulder/hip alignment as important predictors of peak kinematics. Additional research on heading technique and head acceleration is recommended.

Integrating biomechanics with stakeholder perspectives to inform safety in grassroots dirt track racing.

Grassroots dirt track racing is a foundational part of motorsports with a high risk of severe injury. This study aimed to gather perspectives and experiences of motorsports drivers surrounding safety and head acceleration events experienced during grassroots dirt track racing to inform strategies to improve driver safety. Thirteen drivers (n=9 who primarily race on dirt tracks; n=4 who primarily race on pavement tracks) with prior dirt track racing experience participated in separate, group-specific focus groups and/or one-on-one interviews where video, simulations of head motion, and head acceleration data were shared. Peak kinematics of laps and crash contact scenarios were recorded, and head perturbations (i.e., deviations in head motion relative to its moving-average trajectory) were quantified for each lap and presented through guided discussion. Responses were summarized using Rapid Assessment Process. Audio recordings and field notes were collected from focus groups and interviews and analyzed across 25 domains. Drivers described dirt track racing as short, fast bursts of racing. Benefits of dirt track racing for driver development were described, including learning car control. Drivers acknowledged risks of racing and expressed confidence in safety equipment but identified areas for improvement. Drivers observed lateral bouncing of the head in video and simulations but recognized that such motions were not noticed while racing. Track conditions and track type were identified as factors influencing head perturbations. Mean PLA (5.5 g) and PRV (3.07 rad/s) of perturbations experienced during racing laps and perturbation frequencies of 5 and 7 perturbations per second were reported. Generally, drivers accurately estimated the head acceleration magnitudes but were surprised by the frequency and maximum magnitude of perturbations. Maximum perturbation magnitudes (26.8 g and 19.0 rad/s) were attributed to hitting a "rut" in the dirt. Drivers described sudden stops, vertical loads due to landing from a large height, and impacts to the vehicle frame as crash events they physically feel the most. Summary statistics for crashes (medians = 7.30 g, 6.94 rad/s) were reported. Typical impact magnitudes measured in other sports (e.g., football) were provided for context. Upon reviewing the biomechanics, drivers were surprised that crash accelerations were relatively low compared to other contact/collision sports. Pavement drivers noted limited safety features in dirt track racing compared to pavement, including rigidity of vehicle frames, seat structure, seatbelt integration, and lack of oversight from sanctioning bodies. Most drivers felt seat inserts and head and neck restraints are important for injury prevention; however, usage of seat inserts and preferred head and neck restraint system differed among drivers. Drivers described their perspectives and experiences related to safety and identified strategies to improve safety in grassroots dirt track racing. Drivers expressed support for future safety research.

Driver head kinematics in grassroots dirt track racing crashes: A pilot analysis.

Motorsport athletes experience head acceleration loading during crashes; however, there is limited literature quantifying the frequency and magnitude of these loads, particularly at the grassroots level of the sport. Understanding head motion experienced during crash events in motorsport is necessary to inform interventions to improve driver safety. This study aimed to quantify and characterize driver head and vehicle kinematics during crashes in open-wheel grassroots dirt track racing. Seven drivers (ages 16-22, n = 2 female) competing in a national midget car series were enrolled in this study over two racing seasons and were instrumented with custom mouthpiece sensors. Drivers' vehicles were outfitted with an incident data recorder (IDR) to measure vehicle acceleration. Forty-one crash events were verified and segmented into 139 individual contact scenarios via film review. Peak resultant linear acceleration (PLA) of the vehicle and PLA, peak rotational acceleration (PRA), and peak rotational velocity (PRV) of the head were quantified and compared across the part of the vehicle contacted (i.e., tires or chassis), the vehicle location contacted (e.g., front, left, bottom), the external object contacted (i.e., another vehicle, wall, or the track), and the principal direction of force (PDOF). The median (95th percentile) PLA, PRA, and PRV of the head and PLA of the vehicle were 12.3 (37.3) g, 626 (1799) rad/s2, 8.92 (18.6) rad/s, and 23.2 (88.1) g, respectively. Contacts with a non-horizontal PDOF (n = 98, 71%) and contact with the track (n = 96, 70%) were common in the data set. Contact to the left side of the vehicle, with the track, and with a non-horizontal PDOF tended to have the greatest head kinematics compared to other factors in each sub-analysis. Results from this pilot study can inform larger studies of head acceleration exposure during crashes in the grassroots motorsports environment and may ultimately support evidence-based driver safety interventions.

Head Impact Exposure in Female Collegiate Soccer by Activity Type.

Soccer, one of the most popular sports in the world, has one of the highest rates of sports-related concussions. Additionally, soccer players are frequently exposed to nonconcussive impacts from intentionally heading the ball, a fundamental component of the sport. There have been many studies on head impact exposure in soccer, but few focus on soccer practices or practice activities. This study aimed to characterize the frequency and magnitude of head impacts in National Collegiate Athletic Association Division I female soccer practice activities using a custom-fit instrumented mouthpiece. Sixteen players were instrumented over the course of 54 practice sessions. Video analysis was performed to verify all mouthpiece-recorded events and classify practice activities. Category groupings of practice activities include technical training, team interaction, set pieces, position-specific, and other. Differences in head impact rates and peak resultant kinematics were observed across activity types and category groupings. Technical training had the highest impact rate compared to other category groupings. Impacts occurring during set piece activities had the highest mean kinematic values. Understanding drill exposure can help inform coaches on training plans aimed to reduce head impact exposure for their athletes.

Characterization of Head Acceleration Exposure During Youth Football Practice Drills.

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.

Characterization of head impact exposure in boys' youth ice hockey.

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.

Evaluation of Deep Brain Stimulation (DBS) Lead Biomechanical Interaction with Brain Tissue.

The current study aims to examine the effect of material properties on implanted leads used for deep brain stimulation (DBS) using finite element (FE) analysis to investigate brain deformation around an implanted DBS lead in response to daily head accelerations. FE analysis was used to characterize the relative motion of the DBS lead in a suite of fifteen cases sampled from a previously derived kinematic envelope representative of everyday activities describing translational and rotational pulse shape, magnitude, and duration. Load curves were applied to the atlas-based brain model (ABM) with a scaled Haversine acceleration pulse in four directions of rotation: + X, - Y, + Y, and + Z. In addition to the fifteen sampled cases, six experimental cases taken from a previous literature review were also simulated for comparison. The current investigation found that there was very little difference in brain response for the DBS leads with two different material properties. In general, the brain and DBS lead experienced the greatest deformation during rotation about the Z axis for similar load cases. In conclusion, this study showed that there was no significant difference in implanted DBS lead deformation based on lead material properties.

Pilot Collection and Evaluation of Head Kinematics in Stock Car Racing.

The goal of this work was to collect on-track driver head kinematics using instrumented mouthpieces and characterize environmental exposure to accelerations and vibrations. Six NASCAR drivers were instrumented with custom-fit mouthpieces to collect head kinematic data. Devices were deployed at four tracks during practice and testing environments and configured to collect approximately 11 min of linear acceleration and rotational velocity data at 200 Hz. This continuous data collection, combined with film review, allowed extraction of complete laps of data. In addition to typical data processing methods, a moving-point average was calculated and subtracted from the overall signal for both linear acceleration and rotational velocity to determine the environmental component of head motion. The current analysis focuses on 42 full laps of data collected at four data collection events. The number of laps per track ranged from 2 to 23. Linear acceleration magnitudes for all 42 laps ranged from 2.46 to 7.48 g and rotational velocity ranged from 1.25 to 3.35 rad/s. After subtracting the moving average, linear acceleration ranged from 0.92 to 5.45 g and rotational velocity ranged from 0.57 to 2.05 rad/s. This study has established the feasibility of using an instrumented mouthpiece to measure head kinematics in NASCAR and presented a technique for isolating head motion due to cornering acceleration from those due to short-term perturbations experienced by the driver.

Characterizing Exposure to Head Acceleration Events in Youth Football Using an Instrumented Mouthpiece.

Understanding characteristics of head acceleration events (HAEs) in youth football is vital in developing strategies to improve athlete safety. This study aimed to characterize HAEs in youth football using an instrumented mouthpiece. Youth football athletes (ages 11-13) participating on two teams were enrolled in this study for one season. Each athlete was instrumented with a mouthpiece-based sensor throughout the season. HAEs were verified on film to ensure that mouthpiece-based sensors triggered during contact. The number of HAEs, peak resultant linear and rotational accelerations, and peak resultant rotational velocity were quantified. Mixed effects models were used to evaluate differences in mean kinematic metrics among all HAEs for session type, athlete position, and contact surface. A total of 5,292 HAEs were collected and evaluated from 30 athletes. The median (95th percentile) peak resultant linear acceleration, rotational acceleration, and rotational velocity was 9.5 g (27.0 g), 666.4 rad s-2 (1863.3 rad s-2), and 8.5 rad s-1 (17.4 rad s-1), respectively. Athletes experienced six (22) HAEs per athlete per session (i.e., practice, game). Competition had a significantly higher mean number of HAEs per athlete per session and mean peak rotational acceleration. Peak resultant rotational kinematics varied significantly among athlete positions. Direct head impacts had higher mean kinematics compared to indirect HAEs, from body collisions. The results of this study demonstrate that session type, athlete position, and contact surface (i.e., direct, indirect) may influence HAE exposure in youth football.

MEG measured delta waves increase in adolescents after concussion.

INTRODUCTION: The purpose of this study is to determine if delta waves, measured by magnetoencephalography (MEG), increase in adolescents due to a sports concussion. METHODS: Twenty-four adolescents (age 14-17) completed pre- and postseason MRI and MEG scanning. MEG whole-brain delta power was calculated for each subject and normalized by the subject's total power. In eight high school football players diagnosed with a concussion during the season (mean age = 15.8), preseason delta power was subtracted from their postseason scan. In eight high school football players without a concussion (mean age = 15.7), preseason delta power was subtracted from postseason delta power and in eight age-matched noncontact controls (mean age = 15.9), baseline delta power was subtracted from a 4-month follow-up scan. ANOVA was used to compare the mean differences between preseason and postseason scans for the three groups of players, with pairwise comparisons based on Student's t-test method. RESULTS: Players with concussions had significantly increased delta wave power at their postseason scans than nonconcussed players (p = .018) and controls (p = .027). CONCLUSION: We demonstrate that a single concussion during the season in adolescent subjects can increase MEG measured delta frequency power at their postseason scan. This adds to the growing body of literature indicating increased delta power following a concussion.

Pilot characterization of head kinematics in grassroots dirt track racing.

OBJECTIVE: The objective of this study was to utilize an instrumented mouthpiece sensor to characterize head kinematics experienced by grassroots dirt track race car drivers. METHODS: Four dirt track race car drivers (ages 16-19) were instrumented with custom mouthpiece sensors capable of accurately measuring head motion during racing. Sensors were deployed before races and recorded tri-axial linear acceleration and rotational velocity for approximately 10 min at 200 Hz. Film review was performed to identify data associated with racing laps. For each lap, moving average kinematics were computed and subtracted from the head motion signals to obtain 'adjusted' head motion accounting for lower frequency variance due to periodic motion around the track. From adjusted data, linear and angular head perturbations (i.e., deviations from moving average) were extracted using a custom algorithm. RESULTS: Data was collected during 400 driver-races. A total of 2438 laps were segmented from mouthpiece recordings. The median (95th percentile) peak linear acceleration, rotational velocity, and rotational acceleration of all laps were 5.33 (8.28) g, 2.89 (4.60) rad/s, and 179 (310) rad/s2, respectively. Angular perturbations occurred most frequently about the anterior-posterior axis (median lap frequency = 6.39 Hz); whereas linear perturbations occurred most frequently in the inferior-superior direction (7.96 Hz). Nine crash events were recorded by the mouthpiece sensors. The median (95th percentile) peak head kinematics of these events were 13.4 (36.6) g, 9.67 (21.9) rad/s, and 630 (1330) rad/s2. CONCLUSIONS: Mouthpiece sensors can be used to measure head kinematics during active racing. Laps, head perturbations, and crashes may be useful units of observation to describe typical head kinematic exposure experienced by drivers while racing. Subsequent research is needed to understand the associations between repetitive racing exposure and neurological function. Higher magnitude events (i.e., crashes) are not uncommon and may result in concussion or more severe injury. Results represent novel characterizations of head kinematic exposure experienced in a dirt track racing environment. This information may inform evidence-based strategies (e.g., vehicle/seat design) to improve driver safety.

Relationship between Aggressiveness, Self-Confidence, and Perceived Coach Support and Head Impact Exposure in Youth Football.

This study evaluated head impact exposure (HIE) metrics in relation to individual-level determinants of HIE. Youth (n = 13) and high school (n = 21) football players were instrumented with the Head Impact Telemetry (HIT) system during one season. Players completed the Trait-Robustness of Self-Confidence Inventory (TROSCI), Sports Climate Questionnaire (SCQ), and Competitive Aggressiveness and Anger Scale (CAAS), measuring self-confidence, perceived coach support, and competitive aggressiveness, respectively. Relationships between HIE metrics (number of impacts, median and 95th percentile accelerations, and risk-weighted exposure (RWE)) and survey scores were evaluated using linear regression analysis. For middle school athletes, TROSCI scores were significantly negatively associated with the number of competition impacts and the mean number of impacts per player per competition. SCQ scores were significantly positively associated with median linear acceleration during practice. CAAS scores were not significantly associated with biomechanical metrics at either level of play. Perceived coach support and self-confidence might influence HIE among middle school football players. Football athletes' competitive aggressiveness may have less influence their HIE than other factors.

Head Kinematics in Youth Ice Hockey by Player Speed and Impact Direction.

Hockey is a fast-paced sport known for body checking, or intentional collisions used to separate opponents from the puck. Exposure to these impacts is concerning, as evidence suggests head impact exposure (HIE), even if noninjurious, can cause long-term brain changes. Currently, there is limited understanding of the effect of impact direction and collision speed on HIE. Video analysis was used to determine speed and direction for 162 collisions from 13 youth athletes. These data were paired with head kinematic data collected with an instrumented mouthpiece. Relationships between peak resultant head kinematics and speeds were evaluated with linear regression. Mean athlete speeds and relative velocity between athletes ranged from 2.05 to 2.76 m/s. Mean peak resultant linear acceleration, rotational velocity, and rotational acceleration were 13.1 g, 10.5 rad/s, and 1112 rad/s2, respectively. Significant relationships between speeds and head kinematics emerged when stratified by contact characteristics. HIE also varied by direction of collision; most collisions occurred in the forward-oblique (ie, offset from center) direction; frontal collisions had the greatest magnitude peak kinematics. These findings indicate that HIE in youth hockey is influenced by speed and direction of impact. This study may inform future strategies to reduce the severity of HIE in hockey.

Head Impact Exposure in Youth and Collegiate American Football.

The relationship between head impact and subsequent brain injury for American football players is not well-defined, especially for youth. The objective of this study is to quantify and assess Head Impact Exposure (HIE) metrics among youth and collegiate football players. This multi-season study enrolled 639 unique athletes (354 collegiate; 285 youth, ages 9-14), recording 476,209 head impacts (367,337 collegiate; 108,872 youth) over 971 sessions (480 collegiate; 491 youth). Youth players experienced 43 and 65% fewer impacts per competition and practice, respectively, and lower impact magnitudes compared to collegiate players (95th percentile peak linear acceleration (PLA, g) competition: 45.6 vs 61.9; 95th percentile PLA practice: 42.6 vs 58.8; 95th percentile peak rotational acceleration (PRA, rad·s-2) competition: 2262 vs 4422; 95th percentile PRA practice: 2081 vs 4052; 95th percentile HITsp competition: 25.4 vs 32.8; 95th percentile HITsp practice: 23.9 vs 30.2). Impacts during competition were more frequent and of greater magnitude than during practice at both levels. Quantified comparisons of head impact frequency and magnitude between youth and collegiate athletes reveal HIE differences as a function of age, and expanded insight better informs the development of age-appropriate guidelines for helmet design, prevention measures, standardized testing, brain injury diagnosis, and recovery management.

Head Impact Kinematics and Brain Deformation in Paired Opposing Youth Football Players.

Head impact exposure is often quantified using peak resultant kinematics. While kinematics describes the inertial response of the brain to impact, they do not fully capture the dynamic brain response. Strain, a measure of the tissue-level response of the brain, may be a better predictor of injury. In this study, kinematic and strain metrics were compared to contact characteristics in youth football. Players on 2 opposing teams were instrumented with head impact sensors to record impact kinematics. Video was collected to identify contact scenarios involving opposing instrumented players (ie, paired contact scenarios) and code contact characteristics (eg, player role, impact location). A previously validated, high-resolution brain finite element model, the atlas-based brain model, was used to simulate head impacts and calculate strain metrics. Fifty-two paired contact scenarios (n = 105 impacts) were evaluated. Lighter players tended to have greater biomechanical metrics compared to heavier players. Impacts to the top of the helmet were associated with lower strain metrics. Overall, strain was better correlated with rotational kinematics, suggesting these metrics may be better predictors of the tissue-level brain response than linear kinematics. Understanding the effect of contact characteristics on brain strain will inform future efforts to improve sport safety.

Cumulative strain-based metrics for predicting subconcussive head impact exposure-related imaging changes in a cohort of American youth football players.

OBJECTIVE: Youth football athletes are exposed to repetitive subconcussive head impacts during normal participation in the sport, and there is increasing concern about the long-term effects of these impacts. The objective of the current study was to determine if strain-based cumulative exposure measures are superior to kinematic-based exposure measures for predicting imaging changes in the brain. METHODS: This prospective, longitudinal cohort study was conducted from 2012 to 2017 and assessed youth, male football athletes. Kinematic data were collected at all practices and games from enrolled athletes participating in local youth football organizations in Winston-Salem, North Carolina, and were used to calculate multiple risk-weighted cumulative exposure (RWE) kinematic metrics and 36 strain-based exposure metrics. Pre- and postseason imaging was performed at Wake Forest School of Medicine, and diffusion tensor imaging (DTI) measures, including fractional anisotropy (FA), and its components (CL, CP, and CS), and mean diffusivity (MD), were investigated. Included participants were youth football players ranging in age from 9 to 13 years. Exclusion criteria included any history of previous neurological illness, psychiatric illness, brain tumor, concussion within the past 6 months, and/or contraindication to MRI. RESULTS: A total of 95 male athletes (mean age 11.9 years [SD 1.0 years]) participated between 2012 and 2017, with some participating for multiple seasons, resulting in 116 unique athlete-seasons. Regression analysis revealed statistically significant linear relationships between the FA, linear coefficient (CL), and spherical coefficient (CS) and all strain exposure measures, and well as the planar coefficient (CP) and 8 strain measures. For the kinematic exposure measures, there were statistically significant relationships between FA and RWE linear (RWEL) and RWE combined probability (RWECP) as well as CS and RWEL. According to area under the receiver operating characteristic (ROC) curve (AUC) analysis, the best-performing metrics were all strain measures, and included metrics based on tensile, compressive, and shear strain. CONCLUSIONS: Using ROC curves and AUC analysis, all exposure metrics were ranked in order of performance, and the results demonstrated that all the strain-based metrics performed better than any of the kinematic metrics, indicating that strain-based metrics are better discriminators of imaging changes than kinematic-based measures. Studies relating the biomechanics of head impacts with brain imaging and cognitive function may allow equipment designers, care providers, and organizations to prevent, identify, and treat injuries in order to make football a safer activity.

Characterization of Head Impact Exposure in Women's Collegiate Soccer.

Soccer players are regularly exposed to head impacts by intentionally heading the ball. Evidence suggests repetitive subconcussive head impacts may affect the brain, and females may be more vulnerable to brain injury than males. This study aimed to characterize head impact exposure among National Collegiate Athletic Association women's soccer players using a previously validated mouthpiece-based sensor. Sixteen players were instrumented during 72 practices and 24 games. Head impact rate and rate of risk-weighted cumulative exposure were compared across session type and player position. Head kinematics were compared across session type, impact type, player position, impact location, and ball delivery method. Players experienced a mean (95% confidence interval) head impact rate of 0.468 (0.289 to 0.647) head impacts per hour, and exposure rates varied by session type and player position. Headers accounted for 89% of head impacts and were associated with higher linear accelerations and rotational accelerations than nonheader impacts. Headers in which the ball was delivered by a long kick had greater peak kinematics (all P < .001) than headers in which the ball was delivered by any other method. Results provide increased understanding of head impact frequency and magnitude in women's collegiate soccer and may help inform efforts to prevent brain injury.