THE EFFECTS OF INTERNAL JUGULAR VEIN COMPRESSION FOR PRESERVING WHITE MATTER INTEGRITY IN HIGH SCHOOL FOOTBALL PLAYERS COMPARISON OF HIGH VS LOW

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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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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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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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.

Journal of Neurotrauma ◽

10.1089/neu.2021.0078 ◽

2021 ◽

Author(s):

Megan E. Narad ◽

Jeffery Epstein ◽

James Peugh ◽

Kim D. Barber Foss ◽

Jed A Diekfuss ◽

...

Keyword(s):

High School ◽

Jugular Vein ◽

Head Impact ◽

Cognitive Outcomes ◽

High School Football ◽

Prospective Longitudinal

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The effects of internal jugular vein compression for modulating and preserving white matter following a season of American tackle football: A prospective longitudinal evaluation of differential head impact exposure

Journal of Neuroscience Research ◽

10.1002/jnr.24727 ◽

2020 ◽

Vol 99 (2) ◽

pp. 423-445

Author(s):

Jed A. Diekfuss ◽

Weihong Yuan ◽

Kim D. Barber Foss ◽

Jonathan A. Dudley ◽

Christopher A. DiCesare ◽

...

Keyword(s):

White Matter ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Head Impact ◽

Longitudinal Evaluation ◽

Tackle Football ◽

Prospective Longitudinal

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Quantifying the association between white matter integrity changes and subconcussive head impact exposure from a single season of youth and high school football using 3D convolutional neural networks

Medical Imaging 2018: Computer-Aided Diagnosis ◽

10.1117/12.2293023 ◽

2018 ◽

Cited By ~ 1

Author(s):

Behrouz Saghafi ◽

Gowtham Krishnan Murugesan ◽

Alexander Powers ◽

Elizabeth Davenport ◽

Ben Wagner ◽

...

Keyword(s):

High School ◽

Neural Networks ◽

White Matter ◽

Convolutional Neural Networks ◽

Head Impact ◽

White Matter Integrity ◽

High School Football

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Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099571 ◽

2018 ◽

Vol 53 (24) ◽

pp. 1539-1551 ◽

Cited By ~ 12

Author(s):

Gregory D Myer ◽

Kim Barber Foss ◽

Staci Thomas ◽

Ryan Galloway ◽

Christopher A DiCesare ◽

...

Keyword(s):

High School ◽

Diffusion Tensor ◽

Jugular Vein ◽

Mean Diffusivity ◽

Head Impact ◽

Longitudinal Change ◽

Microstructural Changes ◽

Head Impacts ◽

Female High School

PurposeTo (1) quantify white matter (WM) alterations in female high school athletes during a soccer season and characterise the potential for normalisation during the off-season rest period, (2) determine the association between WM alterations and exposure to repetitive subconcussive head impacts, and (3) evaluate the efficacy of a jugular vein compression collar to prevent WM alterations associated with head impact exposure.MethodsDiffusion tensor imaging (DTI) data were prospectively collected from high school female soccer participants (14–18 years) at up to three time points over 9 months. Head impacts were monitored using accelerometers during all practices and games. Participants were assigned to a collar (n=24) or non-collar group (n=22). The Tract-Based Spatial Statistics approach was used in the analysis of within-group longitudinal change and between-group comparisons.ResultsDTI analyses revealed significant pre-season to post-season WM changes in the non-collar group in mean diffusivity (2.83%±2.46%), axial diffusivity (2.58%±2.34%) and radial diffusivity (3.52%±2.60%), but there was no significant change in the collar group despite similar head impact exposure. Significant correlation was found between head impact exposure and pre-season to post-season DTI changes in the non-collar group. WM changes in the non-collar group partially resolved at 3 months off-season follow-up.DiscussionMicrostructural changes in WM occurred during a season of female high school soccer among athletes who did not wear the collar device. In comparison, there were no changes in players who wore the collar, suggesting a potential prophylactic effect of the collar device in preventing changes associated with repetitive head impacts. In those without collar use, the microstructural changes showed a reversal towards normal over time in the off-season follow-up period.

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Comparison of Head Impact Exposure Between Male and Female High School Ice Hockey Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546518777244 ◽

2018 ◽

Vol 46 (9) ◽

pp. 2253-2262 ◽

Cited By ~ 8

Author(s):

James T. Eckner ◽

Kathryn L. O’Connor ◽

Steven P. Broglio ◽

James A. Ashton-Miller

Keyword(s):

High School ◽

Angular Acceleration ◽

Sports Participation ◽

Head Impact ◽

Ice Hockey ◽

Mastoid Process ◽

Male And Female ◽

Head Impacts ◽

Female High School ◽

The Impact

Background: Concussion incidence rates are higher among female than male athletes in sports played by both sexes. Biomechanical factors may play a role in observed sex-based differences in concussion incidence. Purpose: To compare head impact counts and magnitudes during sports participation between male and female high school ice hockey athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Over 2 seasons, a total of 21 male and 19 female ice hockey athletes from a single high school were instrumented with impact-sensing adhesive skin patches worn over the mastoid process while participating in games and practices. The impact sensors recorded the number, magnitude (peak linear acceleration [PLA, g] and peak angular acceleration [PAA, rad/s2] of the head; Head Impact Telemetry severity profile [HITsp]), and location of impacts sustained during each instrumented session. Head impact counts, magnitudes, and locations were compared between the sexes. Results: Males experienced more head impacts than females during games (mean ± SD: 7.7 ± 3.0 vs 5.3 ± 2.0, P < .001) as well as practices (4.3 ± 1.6 vs 3.8 ± 1.1, P = .002). Mean impact magnitudes were greater for females for PLA (18.8 g ± 1.7 g vs 17.1 g ± 1.6 g, P < .001) and HITsp (19.7 ± 1.5 vs 17.7 ± 1.4, P < .001), while mean PAA was greater for males (3057.6 ± 2.0 rad/s2 vs 2778.3 ± 2.7 rad/s2, P < .001). Female athletes experienced higher PLA, PAA, and HITsp magnitudes for the top 10%, 5%, and 1% of impacts (all P < .050). Males experienced more impacts to the front (34.3%) and back (31.7%) of the head, while females experienced more impacts to the side (43.1%) and top (4.1%) (χ2 = 295.70, df = 3, P < .001). Conclusion: While male high school ice hockey athletes experienced more head impacts than females, impact magnitudes tended to be higher for females.

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