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subconcussive impacts and concussion

Meeryo C Choe
Concussion is a significant issue in medicine and the media today. With growing interest on the long-term effects of sports participation, it is important to understand what occurs in the brain after an impact of any degree. While some of the basic pathophysiology has been elucidated, much is still unknown about what happens in the brain after traumatic brain injury, particularly with milder injuries where no damage can be seen at the structural level on standard neuroimaging. Understanding the chain of events from a cellular level using studies investigating more severe injuries can help to drive research efforts in understanding the symptomatology that is seen in the acute phase after concussion, as well as point to mechanisms that may underlie persistent post-concussive symptoms...
June 2016: Current Pain and Headache Reports
Jaclyn B Caccese, Thomas W Kaminski
Physicians and healthcare professionals are often asked for recommendations on how to keep athletes safe during contact sports such as soccer. With an increase in concussion awareness and concern about repetitive subconcussion, many parents and athletes are interested in mitigating head acceleration in soccer, so we conducted a literature review on factors that affect head acceleration in soccer. We searched electronic databases and reference lists to find studies using the keywords 'soccer' OR 'football' AND 'head acceleration'...
May 3, 2016: Sports Medicine
Ana Carolina Rodrigues, Rodrigo Pace Lasmar, Paulo Caramelli
Soccer is the most popular sport in the world, with more than 265 million players worldwide, including professional and amateur ones. Soccer is unique in comparison to other sports, as it is the only sport in which participants purposely use their head to hit the ball. Heading is considered as an offensive or defensive move whereby the player's unprotected head is used to deliberately impact the ball and direct it during play. A soccer player can be subjected to an average of 6-12 incidents of heading the ball per competitive game, where the ball reaches high velocities...
2016: Frontiers in Neurology
Elizabeth M Davenport, Kalyna Apkarian, Christopher T Whitlow, Jillian E Urban, Jens H Jensen, Eliza Szuch, Mark A Espeland, Youngkyoo Jung, Daryl A Rosenbaum, Gerry Gioia, Alexander K Powers, Joel D Stitzel, Joseph A Maldjian
The purpose of this study is to determine if the effects of cumulative head impacts during a season of high school football produce changes in diffusional kurtosis imaging (DKI) metrics in the absence of clinically diagnosed concussion. Subjects were recruited from a high school football team and were outfitted with the Head Impact Telemetry System (HITs) during all practices and games. Biomechanical head impact exposure metrics were calculated including: total impacts, summed acceleration, and Risk Weighted cumulative Exposure (RWE)...
April 4, 2016: Journal of Neurotrauma
Philip Homes Montenigro, Michael L Alosco, Brett Martin, Daniel H Daneshvar, Jesse Mez, Christine Chaisson, Christopher J Nowinski, Rhoda Au, Ann C McKee, Robert C Cantu, Michael D McClean, Robert A Stern, Yorghos Tripodis
Repetitive head impacts (RHI) refer to the cumulative exposure to concussive and subconcussive events. Although RHI is believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined due to the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, that we term the cumulative head impact index (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and (3) to evaluate its predictive properties relative to other exposure metrics (i...
March 30, 2016: Journal of Neurotrauma
William T Tsushima, Olga Geling, Monica Arnold, Ross Oshiro
This exploratory study was designed to examine the neuropsychological effects of sports-related head trauma-specifically, repetitive subconcussive impacts or head blows that do not result in a diagnosable concussion. The researchers compared the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test scores of 2 groups of nonconcussed youth athletes (n = 282), grouped according to the frequency of concussions in their respective sports, with the assumption that more subconcussive impacts occur in sports in which there are more reported concussions...
2016: Applied Neuropsychology. Child
Sara P D Chrisman, Christine L Mac Donald, Seth Friedman, Jalal Andre, Ali Rowhani-Rahbar, Sara Drescher, Elizabeth Stein, Matthew Holm, Nicole Evans, Andrew V Poliakov, Randal P Ching, Christina C Schwien, Monica S Vavilala, Frederick P Rivara
Concussion is a known risk in youth soccer, but little is known about subconcussive head impacts. The authors provided a prospective cohort study measuring frequency and magnitude of subconcussive head impacts using accelerometry in a middle school-age soccer tournament, and association between head impacts and changes in (1) symptoms, (2) cognitive testing, and (3) advanced neuroimaging. A total of 17 youth completed the study (41% female, mean 12.6 years). There were 73 head impacts >15g measured (45% headers) and only 2 had a maximum peak linear acceleration >50g No youth reported symptoms consistent with concussion...
July 2016: Journal of Child Neurology
Alexander D Wright, Michael Jarrett, Irene Vavasour, Elham Shahinfard, Shannon Kolind, Paul van Donkelaar, Jack Taunton, David Li, Alexander Rauscher
Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite 'compromised white matter integrity' often being described as a consequence of mTBI...
2016: PloS One
Sungjae Hwang, Lei Ma, Keisuke Kawata, Ryan Tierney, John Jeka
Current thinking views mild head impact (i.e., subconcussion) as an under-recognized phenomenon that has the ability to cause significant current and future detrimental neurological effects. However, repeated mild impacts to the head often display no observable behavioral deficits based on standard clinical tests, which may lack sensitivity. The current study investigates the effects of sub-concussive impacts from soccer heading with innovative measures of vestibular function and walking stability in a pre-, 0-2 hour post-, 24 hour post-heading repeated measures design...
February 17, 2016: Journal of Neurotrauma
Rachel E Ventura, Laura J Balcer, Steven L Galetta, Janet C Rucker
Mild head injury such as concussions and subconcussive repetitive impact may lead to subtle changes in brain function and it is imperative to find sensitive and reliable tests to detect such changes. Tests involving the visual system, in particular eye movements, can incorporate higher cortical functioning and involve diffuse pathways in the brain, including many areas susceptible to head impact. With concussions, the clinical neuro-ophthalmic exam is important for detecting abnormalities in vergence, saccades, pursuit, and visual fixation...
February 15, 2016: Journal of the Neurological Sciences
Matthew J Wilson, Ashley W Harkrider, Kristin A King
OBJECTIVES: In this preliminary study, the auditory P3b response, when measured during a visually distracting task, was investigated as an index of change in cognitive function resulting from exposure to subconcussive impacts (SCIs) in collision sports over time. METHODS: Both pre- and postseason P3b responses were examined in seven first-year collegiate-level American football players. Comparisons were made between a group of seven third- and fourth-year players and a control group of seven noncontact athletes...
September 2015: Southern Medical Journal
Meghan E Robinson, Trey E Shenk, Evan L Breedlove, Larry J Leverenz, Eric A Nauman, Thomas M Talavage
Monte-Carlo permutation analysis was used to identify sets of head impacts most predictive of functional magnetic resonance imaging (fMRI) changes in football players. The relative distribution of impact location was found to be more predictive of brain activation changes than the number of impacts, suggesting that fMRI changes are related to systematic playing style.
2015: Developmental Neuropsychology
Heather G Belanger, Rodney D Vanderploeg, Thomas McAllister
BACKGROUND: Given questions about "lower thresholds" for concussion, as well as possible effects of repetitive concussion and chronic traumatic encephalopathy (CTE), and associated controversy, there is increasing interest in "subconcussive" blows and their potential significance. OBJECTIVE: A formative review with critical examination of the developing literature on subconcussive blows in athletes with an emphasis on clinical outcomes. METHODS: Studies of biomechanical, performance and/or symptom-based, and neuroimaging data were identified via PubMed search and critically reviewed...
May 2016: Journal of Head Trauma Rehabilitation
Inga K Koerte, Alexander P Lin, Marc Muehlmann, Sai Merugumala, Huijun Liao, Tyler Starr, David Kaufmann, Michael Mayinger, Denise Steffinger, Barbara Fisch, Susanne Karch, Florian Heinen, Birgit Ertl-Wagner, Maximilian Reiser, Robert A Stern, Ross Zafonte, Martha E Shenton
Soccer is played by more than 250 million people worldwide. Repeatedly heading the ball may place soccer players at high risk for repetitive subconcussive head impacts (RSHI). This study evaluates the long-term effects of RSHI on neurochemistry in athletes without a history of clinically diagnosed concussion, but with a high exposure to RSHI. Eleven former professional soccer players (mean age 52.0±6.8 years) and a comparison cohort of 14 age- and gender-matched, former non-contact sport athletes (mean age 46...
September 1, 2015: Journal of Neurotrauma
Harvey S Levin, Ramon R Diaz-Arrastia
Concussion and mild traumatic brain injury (TBI) are interchangeable terms to describe a common disorder with substantial effects on public health. Advances in brain imaging, non-imaging biomarkers, and neuropathology during the past 15 years have required researchers, clinicians, and policy makers to revise their views about mild TBI as a fully reversible insult that can be repeated without consequences. These advances have led to guidelines on management of mild TBI in civilians, military personnel, and athletes, but their widespread dissemination to clinical management in emergency departments and community-based health care is still needed...
May 2015: Lancet Neurology
Daniel H Daneshvar, Lee E Goldstein, Patrick T Kiernan, Thor D Stein, Ann C McKee
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease...
May 2015: Molecular and Cellular Neurosciences
D C Tong, T J Winter, J Jin, A C Bennett, J N Waddell
Concussive and subconcussive head injury is a global phenomenon that affects millions of people each year. Concussive injury has been extensively studied in sport, which has led to a greater understanding of the biomechanical forces involved and guidelines aimed at preventing athletes from playing while concussed. Subconcussive forces by definition do not meet the threshold for concussion but nonetheless may have significant long term consequences due to the repetitive pattern of injury to the head. Quantifying these impact forces using a forensic head model provides the groundwork for future studies by establishing a range or threshold of subconcussive impact forces that could be correlated with clinical assessments...
April 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Zachary Y Kerr, Ashley C Littleton, Leah M Cox, J D DeFreese, Eleanna Varangis, Robert C Lynall, Julianne D Schmidt, Stephen W Marshall, Kevin M Guskiewicz
Over the past decade, there has been significant debate regarding the effect of cumulative subconcussive head impacts on short and long-term neurological impairment. This debate remains unresolved, because valid epidemiological estimates of athletes' total contact exposure are lacking. We present a measure to estimate the total hours of contact exposure in football over the majority of an athlete's lifespan. Through a structured oral interview, former football players provided information related to primary position played and participation in games and practice contacts during the pre-season, regular season, and post-season of each year of their high school, college, and professional football careers...
July 15, 2015: Journal of Neurotrauma
Philip H Montenigro, Christine M Baugh, Daniel H Daneshvar, Jesse Mez, Andrew E Budson, Rhoda Au, Douglas I Katz, Robert C Cantu, Robert A Stern
The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma...
2014: Alzheimer's Research & Therapy
Thayne A Munce, Jason C Dorman, Paul A Thompson, Verle D Valentine, Michael F Bergeron
UNLABELLED: Football players are subjected to repetitive impacts that may lead to brain injury and neurologic dysfunction. Knowledge about head impact exposure (HIE) and consequent neurologic function among youth football players is limited. PURPOSE: This study aimed to measure and characterize HIE of youth football players throughout one season and explore associations between HIE and changes in selected clinical measures of neurologic function. METHODS: Twenty-two youth football players (11-13 yr) wore helmets outfitted with a head impact telemetry (HIT) system to quantify head impact frequency, magnitude, duration, and location...
August 2015: Medicine and Science in Sports and Exercise
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