The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial.

Background: Repetitive head impacts experienced during competitive sports contribute to neurologic changes over the course of a season. Internal jugular vein compression, by means of an externally worn neck collar device has shown efficacy in mitigating white matter (WM) alterations following repeated head impact exposure. However, its relative effectiveness in high versus low head impact exposures is unknown. Hypothesis/Purpose: The purpose of this study was to investigate the effectiveness of an externally worn neck collar device in limiting WM alterations over a season of high school football in players who receive high and low cumulative head impact exposures over 90 g. Methods: 213 male high-school football athletes were prospectively assigned to two study groups: a control group (non-collar; n=106) and an experimental group who wore the jugular vein compression collar during all practices and games (collar; n=107). MRI data was collected from all participants pre- and post-season. Fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) were calculated to assess WM integrity at both time points. Cumulative head impact exposure was monitored by accelerometers attached to each athlete’s left mastoid process during every exposure. Participants were dichotomized into subgroups based on accumulated exposures to hits over 90 g, which divided the entire cohort into four subgroups, using a cut-off of 40 hits : (1) non-collar group (≥40 hits, n=57); (2) collar group (≥40 hits, n=51); (3) non-collar group (<40 hits, n=49); (4) collar group (<40 hits, n=56). Results: As seen in Table 1, in athletes with ≥40 hits, both the non-collar and collar group showed significant pre- to post- season reductions in MD, AD, and/or RD. The non-collar group with ≥40 hits also showed a significant increase in FA, MD, and AD. RD, FA, and MD changes were greater in the non-collar group compared to the control group with ≥40 hits, while AD changes were greater in the collar group compared to the non-collar group with ≥ 40 hits. The non-collar group with <40 hits presented significant pre- to post-season reductions in MD, AD, and RD that were greater than the collar group with < 40 hits (whom did not show pre-to post-season changes). Discussion & Conclusion: The present results provide support for internal jugular vein compression to protect the brain from both low- and high-level repeated head impact exposure. However, less consistent changes were observed for athletes exposed to repeated, high-level head impacts, warranting further investigation. [Table: see text]

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Reducing Head Impact Exposure in Hawaii High School Football

Case Medical Research ◽

10.31525/ct1-nct04020874 ◽

2019 ◽

Author(s):

Keyword(s):

High School ◽

Head Impact ◽

High School Football

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Identifying Risk Factors For Head Impact Exposure In High School Football Using A Validated Instrumented Mouthguard

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000760836.87607.b6 ◽

2021 ◽

Vol 53 (8S) ◽

pp. 148-148

Author(s):

Nicholas J. Cecchi ◽

August G. Domel ◽

Yuzhe Liu ◽

Samuel J. Raymond ◽

Michael Zeineh ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Head Impact ◽

High School Football

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Repeated Sport-Related Concussion Shows Only Minimal White Matter Differences Many Years After Playing High School Football

Journal of the International Neuropsychological Society ◽

10.1017/s1355617719000754 ◽

2019 ◽

Vol 25 (09) ◽

pp. 950-960 ◽

Cited By ~ 2

Author(s):

Douglas P. Terry ◽

Catherine M. Mewborn ◽

L. Stephen Miller

Keyword(s):

High School ◽

White Matter ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Region Of Interest ◽

Internal Capsule ◽

Later Life ◽

Cognitive Outcomes ◽

High School Football ◽

Former Athletes

AbstractObjective: Multiple concussions sustained in youth sport may be associated with later-life brain changes and worse cognitive outcomes. We examined the association between two or more concussions during high school football and later-life white matter (WM) microstructure (i.e., 22–47 years following football retirement) using diffusion tensor imaging (DTI). Method: Forty former high school football players aged 40–65 who received 2+ concussions during high school football (N = 20), or denied concussive events (N = 20) were recruited. Participants underwent neurocognitive testing and DTI scanning. Results: Groups did not statistically differ on age, education, or estimated pre-morbid intelligence. Tract-based Spatial Statistics (TBSS) correcting for Family-Wise Error (FWE)(p < .05) did not yield differences between groups at the whole-brain level. Region of interest analyses showed higher mean diffusivity (MD) in the anterior limb of the internal capsule (ALIC) in the concussed group compared to the non-concussed former players. More liberal analyses (i.e., p < .001, uncorrected for multiple comparisons, ≥8 voxels) also revealed that former players endorsing 2+ concussions had higher MD in the ALIC. Analyses that covaried for age did not reveal differences at either threshold. Concussive histories were not associated with worse cognitive functioning, nor did it impact the relationship between neuropsychological scores and DTI metrics. Discussion: Results suggest only minimal neuroanatomical brain differences in former athletes many years following original concussive injuries compared to controls.

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Does Visual Performance Influence Head Impact Severity Among High School Football Athletes?

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000143 ◽

2014 ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Julianne D. Schmidt ◽

Kevin M. Guskiewicz ◽

Jason P. Mihalik ◽

J. Troy Blackburn ◽

Gunter P. Siegmund ◽

...

Keyword(s):

High School ◽

Head Impact ◽

Visual Performance ◽

High School Football

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Subconcussive head impact exposure differences between drill intensities in U.S. high school football

10.1101/2020.03.29.20047167 ◽

2020 ◽

Author(s):

Kyle Kercher ◽

Jesse A. Steinfeldt ◽

Jonathan T. Macy ◽

Keisuke Ejima ◽

Keisuke Kawata

Keyword(s):

High School ◽

Linear Acceleration ◽

Head Impact ◽

Football Players ◽

Impact Frequency ◽

High School Football ◽

Head Impacts ◽

Air Bags ◽

Frequency Peak ◽

Impact Data

ABSTRACTPurposeUSA Football established five levels of contact (LOC) to guide the intensity of high school football practices. However, it remains unclear whether head impact exposure differs by LOC. The purpose of this study was to examine head impact frequency and magnitude by LOC in the overall sample and three position groups.MethodsThis longitudinal observational study included 24 high school football players during all practices and games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational head acceleration (PRA). Practice/game drills were filmed and categorized into 5 LOCs (air, bags, control, thud, live), and head impact data were assigned into 5 LOCs. Player position was categorized into linemen, hybrid, and skill.ResultsA total of 6016 head impacts were recorded during 5 LOCs throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in an incremental manner (air<bags<control<thud<live), with the most head impacts in live (113.7±17.8 hits/player) and the least head impacts in air (7.7±1.9 hits/player). The linemen and hybrid groups had consistently higher impact exposure than the skill group. Average head impact magnitudes by position group were higher during live drills (PLA (41.0-45.9g) and PRA (3.3-4.6 krad/s2) per head impact), whereas other LOCs had lower magnitudes (PLA (18.2-23.2g) and PRA (1.6-2.3krad/s2) per impact).ConclusionOur data suggest that LOC may influence cumulative head impact exposure in high school football, with players incurring frequent head impacts during live, thud, and control. The data indicate the importance of considering LOCs to refine practice guidelines and policies to minimize head impact burden in high school football athletes.

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Head Impact Exposure in American High School Football and Ice Hockey: A Longitudinal Prospective Cohort Study

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2021.07.773 ◽

2021 ◽

Vol 102 (10) ◽

pp. e99

Author(s):

Danielle Ransom ◽

Luis Ahumada ◽

Jennifer Katzenstein ◽

Neil Goldenberg ◽

P Patrick Mularoni

Keyword(s):

High School ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Head Impact ◽

Ice Hockey ◽

High School Football

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BIOMECHANIC DATA-DRIVEN BEHAVIOR MODIFICATION TO REDUCE CONCUSSION RISK IN HIGH SCHOOL FOOTBALL ATHLETES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00105 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0010 ◽

Cited By ~ 1

Author(s):

Patricia R. Combs ◽

Cassie B. Ford ◽

Maryalice Nocera ◽

Kody R. Campbell ◽

Stephen W. Marshall ◽

...

Keyword(s):

High School ◽

High Risk ◽

Intervention Program ◽

Head Impact ◽

Impact Frequency ◽

High School Football ◽

Post Intervention ◽

Head Impacts ◽

High Magnitude ◽

Impact Data

Background: Each year, between 1.1 and 1.9 million sports and recreation-related concussions occur annually in US children aged =18 years. Football has a high concussion incidence relative to other youth sports. This is particularly concerning given recent evidence suggesting sport-related concussions are associated with late-life cognitive and psychological dysfunction in former athletes. Unfortunately, there are currently few proven interventions to prevent concussion in football. The purpose of this study was to evaluate a mentored intervention program designed to teach safe play techniques and thereby reduce head impact frequency and severity in high school football players. Methods: In a clustered quasi-experimental study design, the player education intervention program was provided to two out of three teams in year one, two out of four teams in year two, and all four teams in year three. Head impacts were measured using in-helmet accelerometers worn by all players. Head impact data and game video were used to identify “high risk” players on intervention teams to receive individualized mentoring. Players were identified as candidates for intervention based on three criteria: 1) greater than 20% of head impacts sustained to the top of the head, 2) greater than 7% of impacts exceeded 60 g in peak linear acceleration, and 3) player sustained a concussion. High-risk players attended 3 individual or small-group education sessions over 3 weeks with a mentor who analyzed game film to teach safer playing techniques. Intervention effects were evaluated by comparing post-intervention to pre-intervention head impact data. Coach and player satisfaction were assessed to evaluate the program’s acceptability and impact. Results: 220 athletes (143 intervention; 77 control) participated. Of these, 32 (14%) were classified “high risk” with playing techniques amenable to intervention. Overall, 21 (66%) of mentored athletes demonstrated a reduction in top-of-head impacts (considered a high-risk impact zone) and 17 (53%) of mentored athletes demonstrated a reduction in high magnitude (>60 g) hits. On average, the proportion of top-of-head impacts dropped 2.75% in mentored players, and 2.04% in non-mentored players. The proportion of head impacts classified as high-magnitude (>60 g) dropped 1.07% from pre- to post-intervention in mentored players. There was minimal (<1%) change in high magnitude impacts in non-mentored players. In post-season exit surveys, most mentored players “agreed” (n=18, 69%) that his playing behaviors improved because of the study. Most intervention team coaches thought the study was “effective” (n=31, 97%). Conclusions/Significance: Mentoring effects were modest; however, athletes and coaches viewed the program as effective. Behavioral interventions have potential to reduce head impact frequency and severity in football but may require more intensive mentoring than the 3-session model tested in this study. Tables/Figures: [Table: see text][Table: see text]

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