The Interaction of Intramuscular Ketorolac (Toradol) and Concussion in a Rat Model.

The purpose of this study was to examine the interaction of a single dose of Toradol and head impact in an in vivo rat model for sport-related concussion using a validated rat concussion model. Thirty-five Sprague-Dawley rats were placed into one of four groups: (1) Control, (2) Impact Only, (3) Toradol Only, (4) Impact and Toradol. Animals in the impact groups were subjected to a single head impact. Animals in the Toradol group received a single intramuscular injection of Toradol prior to impact. We examined magnetic resonance imaging, serum S100-B and cognitive function using a Morris Water Maze. In the control group, latency decreased significantly from day 0 (74.9 s) to 24 h (57.4 s) after anesthesia. There was no statistically significant difference between time zero and 24 h after impact in the Impact only or Impact and Toradol group. Our findings indicate that there were no differences between cognitive ability, MRI findings or S100B in rats that were administered a single dose of Toradol and subjected to a single impact and rats that were subjected to a single impact only. In both impact groups there were transient changes in cognitive ability as measured by the Morris Water Maze.

A biomechanical evaluation of skull-brain surrogates to blunt high-rate impacts to postmortem human subjects.

The field of forensic injury biomechanics is an emerging field. Biomechanically validated tools may assist interdisciplinary teams of investigators in assessing mechanisms of blunt head trauma resulting in skull fractures. The objective of this study is to assess the biofidelity of spherical, frangible skull-brain (SB) surrogates. Blunt impacts were conducted at 20 m/s, using an instrumented 103 g rigid impactor, to the temporo-parietal region of four defleshed cephalic postmortem human subjects (PMHS). Force-deformation response, fracture tolerance, and fracture patterns were recorded for comparison to spherical skull-brain surrogates. Three brain substitutes were assessed: 10% gelatin, lead shot with Styrofoam and water. Force-deformation response of the skull-brain surrogates was similar to defleshed PMHS up to the point of fracture; however, none of the surrogates fractured at tolerance levels comparable to the PMHS. Fracture patterns of the skull-brain surrogates were linear and radiating, while PMHS fractures were all depressed, comminuted.

Review of Canine Deaths While in Service in US Civilian Law Enforcement (2002-2012).

BACKGROUND: Working dogs have been proven effective in multiple military and law enforcement applications. Similar to their human counterparts, understanding mortality while still in service can help improve treatment of injuries, and improve equipment and training, to potentially reduce deaths. This is a retrospective study to characterize mortality of working dogs used in civilian law enforcement. METHODS: Reported causes of death were gathered from two working dog and law enforcement officer memorial websites. RESULTS: Of the 867 civilian law enforcement dogs reported to these memorial websites from 2002 to 2012 with reported causes of death while in service, the deaths of 318 were categorized as traumatic. The leading reported causes of traumatic death or euthanasia include trauma as a result of a vehicle strike, 25.8% (n=82); heatstroke, 24.8% (n=79); and penetrating ballistic trauma, 23.0% (n=73). CONCLUSION: Although the information gathered was from online sources, this study casts some light on the risks that civilian law enforcement dogs undergo as part of the tasks to which they are assigned. These data underscore the need for a comprehensive database for this specialized population of working dogs to provide the robust, reliable data needed to develop prevention and treatment strategies for this valuable resource.

Martial arts striking hand peak acceleration, accuracy and consistency.

The goal of this paper was to investigate the possible trade-off between peak hand acceleration and accuracy and consistency of hand strikes performed by martial artists of different training experiences. Ten male martial artists with training experience ranging from one to nine years volunteered to participate in the experiment. Each participant performed 12 maximum effort goal-directed strikes. Hand acceleration during the strikes was obtained using a tri-axial accelerometer block. A pressure sensor matrix was used to determine the accuracy and consistency of the strikes. Accuracy was estimated by the radial distance between the centroid of each subject's 12 strikes and the target, whereas consistency was estimated by the square root of the 12 strikes mean squared distance from their centroid. We found that training experience was significantly correlated to hand peak acceleration prior to impact (r(2)=0.456, p =0.032) and accuracy (r(2)=0. 621, p=0.012). These correlations suggest that more experienced participants exhibited higher hand peak accelerations and at the same time were more accurate. Training experience, however, was not correlated to consistency (r(2)=0.085, p=0.413). Overall, our results suggest that martial arts training may lead practitioners to achieve higher striking hand accelerations with better accuracy and no change in striking consistency.

Methodology and evaluation of intracranial pressure response in rats exposed to complex shock waves.

Studies on blast neurotrauma have focused on investigating the effects of exposure to free-field blast representing the simplest form of blast threat scenario without considering any reflecting surfaces. However, in reality personnel are often located within enclosures or nearby reflecting walls causing a complex blast environment, that is, involving shock reflections and/or compound waves from different directions. The purpose of this study was to design a complex wave testing system and perform a preliminary investigation of the intracranial pressure (ICP) response of rats exposed to a complex blast wave environment (CBWE). The effects of head orientation in the same environment were also explored. Furthermore, since it is hypothesized that exposure to a CBWE would be more injurious as compared to a free-field blast wave environment (FFBWE), a histological comparison of hippocampal injury (cleaved caspase-3 and glial fibrillary acidic protein (GFAP)) was conducted in both environments. Results demonstrated that, regardless of orientation, peak ICP values were significantly elevated over the peak static air overpressure. Qualitative differences could be noticed compared to the ICP response in rats exposed to simulated FFBWE. In the CBWE scenario, after the initial loading the skull/brain system was not allowed to return to rest and was loaded again reaching high ICP values. Furthermore, results indicated consistent and distinct ICP-time profiles according to orientation, as well as distinctive values of impulse associated with each orientation. Histologically, cleaved caspase-3 positive cells were significantly increased in the CBWE as compared to the FFBWE. Overall, these findings suggest that the geometry of the skull and the way sutures are distributed in the rats are responsible for the difference in the stresses observed. Moreover, this increase stress contributes to correlation of increased injury in the CBWE.

Head orientation affects the intracranial pressure response resulting from shock wave loading in the rat.

Since an increasing number of returning military personnel are presenting with neurological manifestations of traumatic brain injury (TBI), there has been a great focus on the effects resulting from blast exposure. It is paramount to resolve the physical mechanism by which the critical stress is being inflicted on brain tissue from blast wave encounters with the head. This study quantitatively measured the effect of head orientation on intracranial pressure (ICP) of rats exposed to a shock wave. Furthermore, the study examined how skull maturity affects ICP response of animals exposed to shock waves at various orientations. Results showed a significant increase in ICP values in larger rats at any orientation. Furthermore, when side-ICP values were compared to the other orientations, the peak pressures were significantly lower suggesting a relation between ICP and orientation of the head due to geometry of the skull and location of sutures. This finding accentuates the importance of skull dynamics in explaining possible injury mechanisms during blast. Also, the rate of pressure change was measured and indicated that the rate was significantly higher when the top of the head was facing the shock front. The results confirm that the biomechanical response of the superior rat skull is distinctive compared to other areas of the skull, suggesting a skull flexure mechanism. These results not only present insights into the mechanism of brain injury, but also provide information which can be used for designing more effective protective head gear.

Blast-induced neurotrauma leads to neurochemical changes and neuronal degeneration in the rat hippocampus.

Blast-induced neurotrauma is a major concern because of the complex expression of neuropsychiatric disorders after exposure. Disruptions in neuronal function, proximal in time to blast exposure, may eventually contribute to the late emergence of clinical deficits. Using magic angle spinning ¹H MRS and a rodent model of blast-induced neurotrauma, we found acute (24-48 h) decreases in succinate, glutathione, glutamate, phosphorylethanolamine and γ-aminobutyric acid, no change in N-acetylaspartate and increased glycerophosphorylcholine, alterations consistent with mitochondrial distress, altered neurochemical transmission and increased membrane turnover. Increased levels of the apoptotic markers Bax and caspase-3 suggested active cell death, consistent with increased FluoroJade B staining in the hippocampus. Elevated levels of glial fibrillary acidic protein suggested ongoing inflammation without diffuse axonal injury measured by no change in ß-amyloid precursor protein. In conclusion, blast-induced neurotrauma induces a metabolic cascade associated with neuronal loss in the hippocampus in the acute period following exposure.

Real-time head acceleration measurement in girls' youth soccer.

PURPOSE: The purpose of the current study was to collect real-time head acceleration data for soccer impacts during girls' youth (U14) soccer play. METHODS: Linear and angular head accelerations were collected during girls' youth soccer scrimmages using a wireless head acceleration measurement device (the Head Impact Telemetry System). After field data collection, each individual impact was analyzed. The type of impact, header or nonheader, was determined, and nonheader impacts were further assessed by the category of impact. The head injury criterion and resultant linear and angular accelerations were analyzed and compared with current injury tolerance values for all impacts. RESULTS: A total of 47 header and 20 nonheader impacts were observed during the study. The front of the head experienced more headers than the other locations (n = 17). Header impacts ranged in peak linear acceleration from 4.5 g to 62.9 g and in peak angular head acceleration from 444.8 to 8869.1 rad·s(-2). The majority of the nonheader impacts (40%) were player collisions with other players. Only one goalpost collision occurred, but it resulted in the highest peak angular acceleration (5179.5 rad·s(-2)) and was the only nonheader impact to exceed any of the tolerance levels. CONCLUSIONS: Head accelerations were found to exceed the majority of previous laboratory studies. None of the impacts exceeded linear acceleration tolerance values for concussion, but angular accelerations did exceed the suggested limits. Three angular acceleration measurements for heading events (4509.8, 5298.3, and 8869.1 rad·s(-2)) exceeded the concussion tolerance values, but no concussions were diagnosed during the study.

Skin penetration surrogate for the evaluation of less lethal kinetic energy munitions.

Although the benefits of the use of less lethal kinetic energy munitions are numerous, there is a need to evaluate the munitions prior to deployment to ensure their intended effect. The objective of the current research was to validate a surrogate that could be used to predict the risk of penetration of these devices. Existing data from biomechanical testing with post-mortem human specimens (PMHS) served as the foundation for this research. Development of the surrogate involved simulating the various layers of the skin and underlying soft tissues using a combination of materials. A standardized 12-gauge impactor was used to assess each combination. The energy density that resulted in a 50% risk of penetration for the anterior thorax region (23.99 J/cm(2)) from the previous research was matched using a specific combination of layers. Twelve various combinations of materials were tested with the 50% risk of penetration determined. The final validated surrogate consisted of a Laceration Assessment Layer (LAL) of natural chamois and .6 cm of closed-cell foam over a Penetration Assessment Layer (PAL) of 20% ordnance gelatin. This surrogate predicted a 50% risk of penetration at 23.88 J/cm(2). Injury risk curves for the PMHS and surrogate development work are presented.

Epidemiology of cheerleading injuries presenting to NEISS hospitals from 2002 to 2007.

BACKGROUND: Cheerleading has developed into a complex sport utilizing aspects of dance, gymnastics/tumbling, single- and multiple-partner stunts, and tosses in complex displays. Stunting and tosses elevates one or multiple participants into the air supported by teammates putting all at significant injury risk. METHODS: We reviewed all cheerleading injuries captured by the US Consumer Product Safety Commission National Electronic Injury Surveillance System from 2002 to 2007 that presented to US Emergency Departments and used the new narrative feature added in 2002 to better differentiate injury context and severity. RESULTS: There were 4,245 cases of cheerleaders presenting to National Electronic Injury Surveillance System Emergency Departments from 2002 to 2007 with an average age of 14.6 years, and 96.3% were female. Most of these injuries could be treated as outpatients (97.9%). The extremities were most likely affected, 2,610 (61.5%), with further distribution breakdown as follows: upper extremity 1,339 (31.5%), lower extremity 1,271 (29.9%), head and neck 1,085 (25.6%), trunk 491 (11.6%), and other 48.0 (1.1%). The type of injury sustained in descending order is as follows: sprains/strains 1,871 (44.1%), fractures 709 (16.7%), and contusions 684 (16.1%). The most common mechanism of injury was a collision between two or more cheerleaders (1,242; 29.3% overall), followed by stunting (841; 19.8% overall), tumbling (478, 11.3% overall), and tossing (105, 2.5% overall). Subset analysis was performed on fracture, admit, and severe injury groups. CONCLUSIONS: The upper extremity was the most commonly injured part of the body and sustained a significantly greater number of fractures. However, head injuries were more likely to be severe. The value of a more detailed database specific to cheerleading could be invaluable in identifying risk factors and activity-specific injury patterns and facilitate implementing safety measures. LEVEL OF EVIDENCE: III.

Mild neurotrauma indicates a range-specific pressure response to low level shock wave exposure.

Identifying the level of overpressure required to create physiological deficits is vital to advance prevention, diagnostic, and treatment strategies for individuals exposed to blasts. In this study, a rodent model of primary blast neurotrauma was employed to determine the pressure at which acute neurological alterations occurred. Rats were exposed to a single low intensity shock wave at a pressure of 0, 97, 117, or 153 kPa. Following exposure, rats were assessed for acute cognitive alterations using the Morris water maze and motor dysfunction using the horizontal ladder test. Subsequently, histological analyses of three brain regions (primary motor cortex, the hippocampal dentate gyrus region, and the posteromedial cortical amygdala) were conducted. Histological parameters included measuring the levels of glial fibrillary acidic protein (GFAP) to identify astrocyte activation, cleaved caspase-3 for early apoptosis identification and Fluoro-Jade B (FJB) which labels degenerating neurons within the brain tissue. The results demonstrated that an exposure to a single 117 kPa shock wave revealed a significant change in overall neurological deficits when compared to controls and the other pressures. The animals showed significant alterations in water maze parameters and a histological increase in the number of GFAP, caspase-3, and FJB-positive cells. It is suggested that when exposed to a low level shock wave, there may be a biomechanical response elicited by a specific pressure range which can cause low level neurological deficits within the rat. These data indicate that neurotrauma induced from a shock wave may lead to cognitive deficits in short-term learning and memory of rats. Additional histological evidence supports significant and diffuse glial activation and cellular damage. Further investigation into the biomechanical aspects of shock wave exposure is required to elucidate this pressure range-specific phenomenon.

The effect of hand dominance on martial arts strikes.

The main goal of this study was to compare dominant and non-dominant martial arts palm strikes under different circumstances that usually happen during martial arts and combative sports applications. Seven highly experienced (10±5 years) right hand dominant Kung Fu practitioners performed strikes with both hands, stances with left or right lead legs, and with the possibility or not of stepping towards the target (moving stance). Peak force was greater for the dominant hand strikes (1593.76±703.45 N vs. 1042.28±374.16 N; p<.001), whereas no difference was found in accuracy between the hands (p=.141). Additionally, peak force was greater for the strikes with moving stance (1448.75±686.01 N vs. 1201.80±547.98 N; p=.002) and left lead leg stance (1378.06±705.48 N vs. 1269.96±547.08 N). Furthermore, the difference in peak force between strikes with moving and stationary stances was statistically significant only for the strikes performed with a left lead leg stance (p=.007). Hand speed was higher for the dominant hand strikes (5.82±1.08 m/s vs. 5.24±0.78 m/s; p=.001) and for the strikes with moving stance (5.79±1.01 m/s vs. 5.29±0.90 m/s; p<.001). The difference in hand speed between right and left hand strikes was only significant for strikes with moving stance. In summary, our results suggest that the stronger palm strike for a right-handed practitioner is a right hand strike on a left lead leg stance moving towards the target.

Intracranial pressure increases during exposure to a shock wave.

Traumatic brain injuries (TBI) caused by improvised explosive devices (IEDs) affect a significant percentage of surviving soldiers wounded in Iraq and Afghanistan. The extent of a blast TBI, especially initially, is difficult to diagnose, as internal injuries are frequently unrecognized and therefore underestimated, yet problems develop over time. Therefore it is paramount to resolve the physical mechanisms by which critical stresses are inflicted on brain tissue from blast wave encounters with the head. This study recorded direct pressure within the brains of male Sprague-Dawley rats during exposure to blast. The goal was to understand pressure wave dynamics through the brain. In addition, we optimized in vivo methods to ensure accurate measurement of intracranial pressure (ICP). Our results demonstrate that proper sealing techniques lead to a significant increase in ICP values, compared to the outside overpressure generated by the blast. Further, the values seem to have a direct relation to a rat's size and age: heavier, older rats had the highest ICP readings. These findings suggest that a global flexure of the skull by the transient shockwave is an important mechanism of pressure transmission inside the brain.

Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events.

Anti-vehicular (AV) landmines and improvised explosive devices (IED) have accounted for more than half of the United States military hostile casualties and wounded in Operation Iraqi Freedom (OIF) (Department of Defense Personnel & Procurement Statistics, 2009). The lower extremity is the predominantly injured body region following an AV mine or IED blast accounting for 26 percent of all combat injuries in OIF (Owens et al., 2007). Detonations occurring under the vehicle transmit high amplitude and short duration axial loads onto the foot-ankle-tibia region of the occupant causing injuries to the lower leg. The current effort was initiated to develop lower extremity injury criteria for occupants involved in underbelly blast impacts. Eighteen lower extremity post mortem human specimens (PMHS) were instrumented with an implantable load cell and strain gages and impacted at one of three incrementally severe AV axial loading conditions. Twelve of the 18 PMHS specimens sustained fractures of the calcaneus, talus, fibula and/or tibia. The initiation of skeletal injury was precisely detected by strain gages and corresponded with local peak axial tibia force. Survival analysis identified peak axial tibia force and impactor velocity as the two best predictors of incapacitating injury. A tibia axial force of 5,931 N and impactor velocity of 10.8 m/s corresponds with a 50 percent risk of an incapacitating injury. The criteria may be utilized to predict the probability of lower extremity incapacitating injury in underbelly blast impacts.

The effects of height and distance on the force production and acceleration in martial arts strikes.

Almost all cultures have roots in some sort of self defence system and yet there is relatively little research in this area, outside of a sports related environment. This project investigated different applications of strikes from Kung Fu practitioners that have not been addressed before in the literature. Punch and palm strikes were directly compared from different heights and distances, with the use of a load cell, accelerometers, and high speed video. The data indicated that the arm accelerations of both strikes were similar, although the force and resulting acceleration of the target were significantly greater for the palm strikes. Additionally, the relative height at which the strike was delivered was also investigated. The overall conclusion is that the palm strike is a more effective strike for transferring force to an object. It can also be concluded that an attack to the chest would be ideal for maximizing impact force and moving an opponent off balance. Key PointsIt has been determined that the palm strike is more effective than the punch for developing force and for transferring momentum, most likely the result of a reduced number of rigid links and joints.A strike at head level is less effective than a strike at chest level for developing force and transferring momentum.Distance plays an effect on the overall force and momentum changes, and most likely is dependent on the velocity of the limb and alignment of the bones prior to impact.The teaching of self defence for novices and law enforcement would benefit from including the palm strike as a high priority technique.

The physiologic effects of a conducted electrical weapon in swine.

STUDY OBJECTIVE: By using an animal model, we determine whether repeated exposures to a conducted electrical weapon could have physiologic consequences. METHODS: Exposures to the Stinger S-400 conducted electrical weapon were applied to 10 healthy, anesthetized, Yorkshire-cross, male swine by attaching probes from the cartridge to the sternal notch and anterolateral thorax at a distance of 21.5 cm. The standard pulse generated by the Stinger S-400 during the normal application was applied 20 times during 31 minutes. To evaluate the health effects of the exposures, key physiologic characteristics were evaluated, including arterial pH, PCO2, PO2, blood lactate, cardiac output, ECG, pulse rate, mean arterial pressure, central venous pressure, pulmonary artery pressure and airway pressure, and the cardiac marker troponin I. RESULTS: There were notable changes in pH, PCO2, blood lactate, cardiac output, and mean arterial pressure after 1 or more sets of exposures, all of which normalized during the next few hours. Troponin I, PO2, pulse rate, mean arterial pressure, central venous pressure, pulmonary artery pressure, and airway pressure did not change markedly during or after the shocks. Three premature ventricular contractions occurred in one animal; all other ECG results were normal. CONCLUSION: Repeated exposures to a conducted electrical weapon result in respiratory acidosis, metabolic vasodilation, and an increase in blood lactate level. These effects were transient in this study, with full recovery by 4 hours postexposure. The Stinger S-400 appears to have no serious adverse physiologic effects on healthy, anesthetized swine.

Concussion in professional football: helmet testing to assess impact performance--part 11.

OBJECTIVE: National Football League (NFL) concussions occur at an impact velocity of 9.3 +/- 1.9 m/s (20.8 +/- 4.2 mph) oblique on the facemask, side, and back of the helmet. There is a need for new testing to evaluate helmet performance for impacts causing concussion. This study provides background on new testing methods that form a basis for supplemental National Operating Committee on Standards for Athletic Equipment (NOCSAE) helmet standards. METHODS: First, pendulum impacts were used to simulate 7.4 and 9.3 m/s impacts causing concussion in NFL players. An instrumented Hybrid III head was helmeted and supported on the neck, which was fixed to a sliding table for frontal and lateral impacts. Second, a linear pneumatic impactor was used to evaluate helmets at 9.3 m/s and an elite impact condition at 11.2 m/s. The upper torso of the Hybrid III dummy was used. It allowed interactions with shoulder pads and other equipment. The severity of the head responses was measured by a severity index, translational and rotational acceleration, and other biomechanical responses. High-speed videos of the helmet kinematics were also recorded. The tests were evaluated for their similarity to conditions causing NFL concussions. Finally, a new linear impactor was developed for use by NOCSAE. RESULTS: The pendulum test closely simulated the conditions causing concussion in NFL players. Newer helmet designs and padding reduced the risk of concussion in 7.4 and 9.3 m/s impacts oblique on the facemask and lateral on the helmet shell. The linear impactor provided a broader speed range for helmet testing and more interactions with safety equipment. NOCSAE has prepared a draft supplemental standard for the 7.4 and 9.3 m/s impacts using a newly designed pneumatic impactor. No helmet designs currently address the elite impact condition at 11.2 m/s, as padding bottoms out and head responses dramatically increase. CONCLUSIONS: The proposed NOCSAE standard is the first to address helmet performance in reducing concussion risks in football. Helmet performance has improved with thicker padding and fuller coverage by the shell. However, there remains a challenge for innovative designs that reduce risks in the 11.2 m/s elite impact condition.

Concussion in professional football: comparison with boxing head impacts--part 10.

OBJECTIVE: This study addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions. METHODS: Eleven Olympic boxers weighing 51 to 130 kg (112-285 lb) delivered 78 blows to the head of the Hybrid III dummy, including hooks, uppercuts and straight punches to the forehead and jaw. Instrumentation included translational and rotational head acceleration and neck loads in the dummy. Biaxial acceleration was measured in the boxer's hand to determine punch force. High-speed video recorded each blow. Hybrid III head responses and finite element (FE) brain modeling were compared to similarly determined responses from reconstructed NFL concussions. RESULTS: The hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts. However, the head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head cg, which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle. CONCLUSION: Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.

Skin penetration assessment of less lethal kinetic energy munitions.

The development of less-lethal technologies has provided law enforcement personnel with an alternative to lethal force. Although the less lethal projectile was produced to engender non-penetrating wounds, case studies show that there have been a number of reported penetrating injuries ranging from minor to significant in morbidity. The objective of this study was to determine the energy per unit area required to penetrate various regions of the body. Eight unembalmed postmortem human specimens were procured for this testing. Each specimen sustained a maximum of 25 impacts consisting of shots to the anterior and posterior thorax, abdomen, and legs. A 12-gauge, fin-stabilized, rubber rocket round was used as the impactor for all of the conducted tests. The energy density required for 50% risk of penetration varied from 23.99 J/cm2 for the location on the anterior rib (p = 0.000) to 52.74 J/cm2 for the location on the posterior rib (p = 0.001).

An evaluation of the cumulative concussive effect of soccer heading in the youth population.

Soccer is the most popular team sport in the world, with 120 million individuals participating and 16 million of these individuals being based in the United States. In addition, soccer has become the fastest growing team sport in the United States over the past 10 years. Head impact injuries have been cited as comprising 15% of all injuries related to soccer. Previous studies have identified the technique of heading as being a significant factor in head impact injuries. In fact, 85% of various subgroups of participants, 19 years of age and older, have had a diminution in cognitive function abilities on a permanent basis. It was the purpose of this study to evaluate the effect of repetitive head impacts due to heading in 57 youth soccer players with a mean age of 11.5 years. The data were collected over three seasons during the first year, which correlated to approximately 60 games and/or practices. One team of 18 boys was followed for an additional year. The data collected included a cognitive function test, as well as documentation of concussive symptoms. These cognitive evaluations, conducted at both periods of time, revealed that statistically significant differences were not evident when compared to standardized norms with the exception of verbal learning. There was an inverse relationship between the number of ball impacts and verbal learning. Of note, however, is that 49% of the year-one study group did complain of headaches after heading the ball.