Effect of Impact Mechanism on Head Accelerations in Men's Lacrosse Athletes.

Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men's lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s2) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15-147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0-8.80) (incidence rate ratio = 32.00; 95% CI, 67.83-130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F10,306 = 1.79, P = .06, η2 = .06, 1-ß = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men's lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement.

The effects of socioeconomic status on baseline neurocognitive testing scores.

Baseline neurocognitive testing has been recommended to provide a more accurate representation of the pre-concussion cognitive status of individual athletes. Socioeconomic status is not typically controlled for when obtaining baseline scores, which may lead to inaccurate findings if post-injury scores are compared to normative data. Understanding the role of socioeconomic status in baseline testing is important for the accurate analysis of test scores and proper evaluation of patients if individualized baseline data are not available. Our purpose was to investigate the effects of socioeconomic status, as determined by eligibility for free or reduced cost lunch on baseline neurocognitive test scores in secondary school athletes. 1,788 secondary school athletes (females = 778, males = 1,010, age = 14.96 ± 1.11 years, height = 171.25 ± 17.83 cm, mass = 66.82 ± 21.63 kg) completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) upon starting scholastic athletics. ImPACT components (symptom severity scores and composite scores of verbal memory, visual memory, visual motor speed, and reaction time) served as the dependent variables. School administration coded free or reduced cost lunch eligibility (N = 1255 not eligible, N = 563 eligible) for each participant (group), which served as the independent variable. Free or reduced cost lunch eligibility significantly altered the combined dependent variables (multivariate F5,1780=14.41, p < .001, ɳ2 = .04) when sex and age were controlled. Follow up ANOVAs showed that participants eligible for free or reduced cost lunch scored significantly worse on verbal memory (F1,1784 = 24.81, p < .001, ɳ2 = .01), visual memory (F1,1784 = 24.90, p < .001, ɳ2 = .01), and visual motor speed (F1,1784 = 50.54, p < .001, ɳ2 = .03). In addition, slower reaction times (F1,1784 = 35.10, p < .001, ɳ2 = .02) and higher symptom severity scores (F1,1784 = 10.37, p < .01, ɳ2 = .01) were observed in those eligible for free or reduced cost lunch. If normative data are used instead of individual baselines, potential modifiers such as socioeconomic status should be taken into account when analyzing concussion scores to provide accurate diagnoses.

Sex differences in mechanisms of head impacts in collegiate soccer athletes.

BACKGROUND: There has been growing interest in head impacts related to sports participation due to potential long- and short-term consequences of head injuries. Our purpose was to compare head impact magnitude and frequency between men's and women's intercollegiate soccer players based on head impact mechanism. METHODS: 28 collegiate soccer players (16 women: age = 19.94 (1.06) years, height = 163.75 (5.15) cm, mass = 61.21 (5.09) kg; 12 men: age = 20.25 (1.14) years, height = 180.34 (6.03) cm, mass = 74.09 (9.32) kg) wore xPatch (X2 Biosystems, Seattle, WA) head impact sensors. Each practice and game was video recorded in order to confirm head impacts. The independent variable was impact mechanism (head to head, head to body (other than head), head to ground, ball to head, goal to head, and combination). Sensors collected linear and rotational accelerations and frequency of head impacts per 1000 athlete exposures. FINDINGS: Men were more likely to sustain head impacts than women (IRR = 1.74, CI95 = 1.59-1.92). The highest head impact incidence rate for men was head to body (IR = 611.68, CI95 = 553.11-670.25) while the highest impact incidence rate for women was ball to head (IR = 302.29, CI95 = 270.93-333.64). The interaction between sex and mechanism was significant for rotational accelerations (F4, 1720 = 3.757, P = .005, ω2 = 0.013) but not for linear accelerations (F4,1720 = 0.680, P = .606, ω2 < 0.001, 1 - ß = 0.223). INTERPRETATION: To reduce the frequency of head impacts in men, perhaps rules governing player to player contact should be more strictly enforced as these data confirm frequent player-to-head contact during soccer practices and games. Prevention efforts for women should be focused on limiting the amount of purposeful heading (planned contact between the head and ball) occurring during play especially since these impacts had higher magnitudes compared to men.

Differences in the Mechanism of Head Impacts Measured Between Men's and Women's Intercollegiate Lacrosse Athletes.

BACKGROUND: Lacrosse is a rapidly growing sport in the United States. Comparing the magnitude and frequency of head impact mechanisms between sexes will provide data for injury prevention techniques and risk reduction of head injuries. PURPOSE: To compare sex-specific differences in the magnitude and frequency of head impact mechanisms in National Collegiate Athletic Association (NCAA) Division III intercollegiate lacrosse athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 31 NCAA Division III intercollegiate lacrosse athletes (16 men [mean age, 21 ± 1 years; mean height, 179.70 ± 5.82 cm; mean weight, 80.71 ± 6.33 kg] and 15 women [mean age, 20 ± 1 years; mean height, 165.43 ± 5.25 cm; mean weight, 64.08 ± 7.59 kg]) voluntarily participated in this study. Participants wore xPatch sensors at every event during the 2015 spring season. Sensors recorded the magnitude, frequency, and location of head impacts over 10g. Linear (g) and rotational (deg/s2) acceleration determined impact magnitudes. We calculated incidence rates (IRs; per 1000 athlete-exposures [AEs]) and incidence rate ratios (IRRs) with 95% CIs to determine frequency differences. Film footage from each event was synchronized with the time of each head impact for verification and mechanism coding. Sex and impact mechanism served as the independent variables. RESULTS: A significant interaction was found between impact mechanism and sex (P < .001) and main effects for impact mechanism (P < .001) and sex (P < .001). The most common mechanism in men's lacrosse was head to body (IR, 970.55/1000 AEs [95% CI, 266.14-331.98]), and in women's lacrosse, stick to head (IR, 289.87/1000 AEs [95% CI, 124.32-184.55]) was most common. Only 9 of 419 impermissible head impacts in men's lacrosse games were classed as penalties (2%); 7 of 25 impermissible head impacts in women's lacrosse games were called as penalties (28%). CONCLUSION: The impact mechanisms of head to body in men's lacrosse and stick to head in women's lacrosse are penalties but occur frequently, suggesting that a focus on stressing rule enforcement is warranted. Because mechanism and sex affect the magnitude of head impacts, proper offensive and defensive techniques against opponents should be encouraged to reduce head impacts.

Lacrosse helmet facemask removal.

CONTEXT: Facemask removal (FMR) is required to access the airway of a catastrophically injured football or ice hockey athlete. However, the best method of caring for the helmeted lacrosse athlete with suspected catastrophic injury remains unclear. OBJECTIVE: To evaluate the effects of sex and grip strength on the speed and ease of use of various FMR methods across different lacrosse helmet types. DESIGN: Cross-sectional study. Setting : Athletic training laboratory. PATIENTS OR OTHER PARTICIPANTS: Fourteen athletic trainers (7 men, 7 women). INTERVENTION(S): Removal method (cordless screwdriver [CSD], Face Mask Extractor 2 [FMX], pruner, Trainer's Angel [TA]), helmet type (Cascade CPX, Cascade Pro7, Riddell Revolution, Brine Triumph, Warrior Venom), and sex. MAIN OUTCOME MEASURE(S): Facemask removal time and participant-reported ease of use of the removal method (6-point Likert scale). RESULTS: We found a 2-way interaction for removal method and sex only for the ease-of-use scores (F3,246 = 4.67, P = .01). A main effect for removal method for time (F3,200 = 19.41, P < .001) and ease of use (F3,200 = 53.78, P < .001) was seen. The fastest times (32.32 ± 11.70 seconds) and highest ease-of-use scores (4.94 ± 0.30) were recorded for the CSD. We noted a main effect for helmet type only for time (F4,200 = 5.34, P < .001), with the fastest removal times (72.75 ± 74.67 seconds) recorded for the CPX. We discovered a main effect for sex only for time (F1,200 = 17.57, P < .001), with slower times recorded for women (115.51 ± 110.80 seconds) than men (75.71 ± 83.87 seconds). We found correlations between FMR time and grip strength only when using the FMX (r = -0.40, P = .001), pruner (r = -0.26, P = .04), and TA (r = -0.26, P = .047). CONCLUSIONS: Based on our results, FMR of lacrosse helmets should be attempted with a CSD. We recommend carrying a pruner as a backup cutting tool in case the CSD fails, practicing FMR regularly, and inspecting helmets for faulty hardware to reduce the chance of CSD failure.

Leadership behaviors of athletic training leaders compared with leaders in other fields.

CONTEXT: Athletic trainers are in positions of leadership. OBJECTIVE: To determine self-reported leadership practices of head athletic trainers (HATCs) and program directors (PDs). DESIGN: Cross-sectional study. SETTING: Respondents' academic institutions. PATIENTS OR OTHER PARTICIPANTS: A total of 238 athletic training leaders completed the Leadership Practices Inventory. Of these, 50.4% (n = 120) were HATCs and 49.6% (n = 118) were PDs; 69.3% (n = 165) were men and 30.7% (n = 73) were women; almost all respondents (97.1%, n = 231) were white. Respondents typically reported having 11 to 15 years of experience as an athletic trainer (n = 57, 23.9%) and being between the ages of 30 and 39 years (n = 109, 45.8%). MAIN OUTCOME MEASURE(S): Categories of leadership behaviors (ie, Model, Inspire, Challenge, Encourage, and Enable) were scored from 1 (almost never) to 10 (almost always). Item scores were summed to compute mean category scores. We analyzed demographic information; used t ratios to compare the data from athletic training leaders (PDs and HATCs) with normative data; compared sex, age, position, ethnicity, and years of experience with leadership practices; and computed mean scores. RESULTS: Athletic training leaders reported using leadership behaviors similar to those of other leaders. The PDs reported using inspiring, challenging, enabling, and encouraging leadership behaviors more often than did the HATCs. No differences were found by ethnicity, age, years of experience, or leadership practices. CONCLUSIONS: Athletic training leaders are transformational leaders. Athletic training education program accreditation requirements likely account for the difference in leadership practices between PDs and HATCs.