Bantam Players Research Articles

Subconcussive brain vital signs changes predict head-impact exposure in ice hockey players.

The brain vital signs framework is a portable, objective, neurophysiological evaluation of brain function at point-of-care. We investigated brain vital signs at pre- and post-season for age 14 or under (Bantam) and age 16–20 (Junior-A) male ice hockey players to (i) further investigate previously published brain vital sign results showing subconcussive cognitive deficits and (ii) validate these findings through comparison with head-impact data obtained from instrumented accelerometers. With a longitudinal study design, 23 male ice hockey players in Bantam (n = 13; age 13.63 ± 0.62) and Tier II Junior-A (n = 10; age 18.62 ± 0.86) divisions were assessed at pre- and post-season. None were diagnosed with a concussion during the season. Cognitive evoked potential measures of Auditory sensation (N100), Basic attention (P300) and Cognitive processing (N400) were analysed as changes in peak amplitudes and latencies (six standard scores total). A regression analysis examined the relationship between brain vital signs and the number of head impacts received during the study season. Significant pre/post differences in brain vital signs were detected for both groups. Bantam and Junior-A players also differed in number of head impacts (Bantam: 32.92 ± 17.68; Junior-A: 195.00 ± 61.08; P < 0.001). Importantly, the regression model demonstrated a significant linear relationship between changes in brain vital signs and total head impacts received (R = 0.799, P = 0.007), with clear differences between the Bantam and Junior-A groups. In the absence of a clinically diagnosed concussion, the brain vital sign changes appear to have demonstrated the compounding effects of repetitive subconcussive impacts. The findings underscored the importance of an objective physiological measure of brain function along the spectrum of concussive impacts.

A comparison of frequency and magnitude of head impacts between Pee Wee And Bantam youth ice hockey

ABSTRACT The purpose of this research was to compare the frequency and magnitude of head impact events between Pee Wee and Bantam ice hockey players. Videos of Pee Wee and Bantam boys’ ice hockey were analysed to determine the frequency and type of head impact events. The head impact events were then reconstructed in the laboratory using physical and finite element models to determine the magnitude of strain in the brain tissues. The results showed that Pee Wee boys experienced more head impacts from elbows and boards, while Bantam players had more head impacts to the glass. Pee Wee and Bantam players experienced similar frequency and magnitudes of very low, low, and medium and above (med+) levels of strain to the brain. This research suggests to ice hockey leagues and coaches that to reduce the incidence of these levels of brain trauma, consideration must be given to either reducing the level of contact along the boards or the removal of body checking. In addition, companies who innovate in ice hockey should develop protective devices and equipment strategies that aim to reduce the risk of head injury from shoulder and glass impacts for Bantam players.

THE EFFECT OF A BODY CHECKING RULE CHANGE ON HEAD IMPACT BIOMECHANICS IN BANTAM ICE HOCKEY ATHLETES

Background:Body checking is the most common injury mechanism in ice hockey. Rule changes have sought to mitigate body checking exposure among youth players. In 2011, USA Hockey changed the legal body checking age from Pee Wee (11/12-year-olds) to Bantam (13/14-year-olds). Interestingly, Bantam players with checking experience during Pee Wee had a lower concussion risk relative to Bantam players without checking experience in a sample of Canadian youth hockey players. Understanding the head impact biomechanics underlying these findings could further elucidate the consequences of this rule change.Purpose:To determine the association between Pee Wee checking exposure and head impact biomechanics in a cohort of Bantam players.Methods:We prospectively collected data on Bantam ice hockey players during the 2006/07-2009/10 seasons and the 2012-2013 season. The 2006/07-2009/10 cohort (n= 61, age=13.9±0.5 years, height=168.2±8.7 cm, mass=59.9±10.4 kg) was allowed to body check (BC) as a Pee Wee player. The 2012-2013 cohort (n=15, age=13.3±0.4 years, height=167.5±7.4 cm, mass=57.5±8.6 kg) was not permitted to body check (NBC) as a Pee Wee player. Over the course of each season, head impacts were measured using in-helmet accelerometers. Only head impacts with linear acceleration ≥10 g were included in our analysis. Main outcome measures were mean linear acceleration (g) and rotational acceleration (rad/s2). Levene’s tests assessed equality of variance between groups. We employed mixed effects models to assess group differences in mean linear and rotational acceleration between BC and NBC groups.Results:The BC and NBC groups did not differ in height (t74=0.28, p=0.78) or mass (t74=0.84, p=0.40). When assessing group differences in head impact biomechanics, the NBC experienced significantly greater linear acceleration (F1,74=4.36, p=0.04) and greater rotational acceleration (F1,74=21.2, p<0.001) relative to the BC group. On average, the NBC group experienced 23.1 ± 0.87 g linear acceleration and 1993.5 ± 68.4 rad/s2 rotational acceleration compared to the BC group, which experienced 21.2 ± 0.30 g linear acceleration and 1615.9 ± 45.2 rad/s2 rotational acceleration.Conclusions:Bantam ice hockey players without body checking experience during their Pee Wee years experienced greater average linear and rotational acceleration relative to players with Pee Wee body checking experience. While removing body checking from Pee Wee ice hockey may reduce short-term injury risk, these athletes may demonstrate more high-risk head impact biomechanics when legally allowed to body check. Future research should continue to examine the influence of policy changes on head impact biomechanics and injury risk in youth ice hockey.Figure 1.Comparison of average linear acceleration and rotational acceleration of Bantam ice hockey players who have body checking experience and those who do not have body checking experience.

LO47: Concussions in minor hockey players before and after implementation of a policy to limit body checking

Introduction: Concussions are one of the most common sports-related injuries presenting to emergency departments (EDs), and are particularly frequent among players of contact sports such as ice hockey (hockey). Studies of youth hockey players report increased concussion incidence when participating in levels of hockey that allow body-checking. In 2016, an Edmonton minor hockey organization implemented a policy to remove body checking from play for non-elite levels of Bantam (13-14 years) and Midget (15-17 years). This study aimed to evaluate the effect of this policy on occurrence of concussions in male minor hockey players. Methods: Alberta Health Services Sport and Recreation codes (SR = 54) were used to identify Bantam and Midget hockey players presenting to Edmonton Zone emergency departments (ED) during the 2013/2014 to 2016/2017 hockey seasons from the National Ambulatory Care Record System. Injured hockey players with a concussion were identified using International Classification of Diseases 10-CA diagnosis code S06.0. Odds ratios (OR) of concussions among total hockey injuries before (2013-2016) and after (2016-2017) the policy are reported with 95% confidence intervals (CIs). Differences were assessed using Pearson's χ2 test. Results: During the study period, 1978 minor hockey players presented to an Edmonton Zone ED with a hockey-related injury, including 272 players with a concussion (14%). Most of the injuries occurred to Midget players (n = 1274). The proportions of concussion were similar before and after the policy change for players of all ages (OR = 0.78; 95% CI: 0.37 to 0.92) and for injured Bantam players (OR = 0.97; 95% CI: 0.59 to 1.55); however, there was a significant reduction in concussions as a proportion of all injuries for Midget players before and after the policy change (OR = 0.61; 95% CI: 0.36 to 1.00). Conclusion: In the initial year of implementation, the policy to limit body-checking to elite levels of play had mixed results. While the policy change did not result in a significant reduction in concussions overall, or for Bantam players, Midget players did experience a significant reduction in concussions after the policy change. The reasons behind these age-related differences require further investigation. Moreover, further evaluation of the policy using additional years of post-policy data, as well as hockey registration numbers, is needed to evaluate the sustainability of its effect.

Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada

ObjectiveTo examine the association between meeting physical activity (PA) volume recommendations and concussion rates in male ice hockey players aged 11–17 years.DesignPooled prospective injury surveillance cohort data from the 2011–2012,...

The Impact of Body Checking on Youth Ice Hockey Injuries.

Background:Body checking is a common cause of youth ice hockey injuries. Consequently, USA Hockey raised the minimum age at which body checking is permitted from the Pee Wee level (11-12 years old) to the Bantam level (13-14 years old) in 2011.Purpose/Hypothesis:The purpose of this investigation was to determine the impact of body checking on the distribution of injuries reported in youth ice hockey players. We hypothesized that the elimination of body checking at the Pee Wee level would lower the frequency of serious injuries, particularly concussions.Study Design:Descriptive epidemiology study.Methods:Injury data from the National Electronic Injury Surveillance System (NEISS), a United States Consumer Product Safety Commission database, were analyzed for Pee Wee and Bantam players between January 1, 2008 and December 31, 2010 and again between January 1, 2013 and December 31, 2015. Data on the location of injury, diagnosis, and mechanism of injury were collected. The location of injury was categorized into 4 groups: head and neck, upper extremity, lower extremity, and core. Diagnoses investigated included concussions, fractures, lacerations, strains or sprains, internal organ injuries, and other. The mechanism of injury was broken down into 2 categories: checking and other.Results:Between the 2008-2010 and 2013-2015 seasons, overall injuries decreased by 16.6% among Pee Wee players, with injuries caused by body checking decreasing by 38.2% (P = .012). There was a significant change in the distribution of diagnoses in the Pee Wee age group during this time frame (P = .007): strains or sprains, internal organ injuries, and fractures decreased in frequency, while the number of concussions increased by 50.0%. In the Bantam age group, recorded injuries decreased by 6.8%, and there was no change in the distribution of the location of injury, diagnosis, or mechanism of injury (P > .05).Conclusion:There was an observed reduction in the total number, mechanism, and type of injuries when body checking was eliminated from the Pee Wee level. There was, however, an unexpected increase in the number of concussions.

THE EFFECT OF BODY CHECKING POLICY CHANGE ON CONTACT MECHANISMS IN 13 AND 14 YEAR OLD YOUTH ICE HOCKEY PLAYERS

BackgroundA 2015, Hockey Calgary body checking (BC) policy change disallowed BC from non-elite Bantam (ages 13–14, lower 60% of divisions). This was informed by evidence that disallowing BC in Pee...

THE EFFECT OF BODY CHECKING POLICY CHANGE ON OFFENSIVE GAME SKILL PERFORMANCE IN 13–14 YEAR OLD ICE HOCKEY PLAYERS

BackgroundPolicy allowing body checking (BC) increases injury and concussion risk in youth ice hockey players. Hockey Calgary introduced BC policy change in 2015 that disallows BC at the Bantam (ages...

The Effect of the “Zero Tolerance for Head Contact” Rule Change on the Risk of Concussions in Youth Ice Hockey Players

Background: Ice hockey is a popular winter sport in Canada. Concussions account for the greatest proportion of all injuries in youth ice hockey. In 2011, a policy change enforcing “zero tolerance for head contact” was implemented in all leagues in Canada. Purpose: To determine if the risk of game-related concussions and more severe concussions (ie, resulting in >10 days of time loss) and the mechanisms of a concussion differed for Pee Wee class (ages 11-12 years) and Bantam class (ages 13-14 years) players after the 2011 “zero tolerance for head contact” policy change compared with players in similar divisions before the policy change. Study Design: Cohort study; Level of evidence, 3. Methods: The retrospective cohort included Pee Wee (most elite 70%, 2007-2008; n = 891) and Bantam (most elite 30%, 2008-2009; n = 378) players before the rule change and Pee Wee (2011-2012; n = 588) and Bantam (2011-2012; n = 242) players in the same levels of play after the policy change. Suspected concussions were identified by a team designate and referred to a sport medicine physician for diagnosis. Incidence rate ratios (IRRs) were estimated based on multiple Poisson regression analysis, controlling for clustering by team and other important covariates and offset by game-exposure hours. Incidence rates based on the mechanisms of a concussion were estimated based on univariate Poisson regression analysis. Results: The risk of game-related concussions increased after the head contact rule in Pee Wee (IRR, 1.85; 95% CI, 1.20-2.86) and Bantam (IRR, 2.48; 95% CI, 1.17-5.24) players. The risk of more severe concussions increased after the head contact rule in Pee Wee (IRR, 4.12; 95% CI, 2.00-8.50) and Bantam (IRR, 7.91; 95% CI, 3.13-19.94) players. The rates of concussions due to body checking and direct head contact increased after the rule change. Conclusion: The “zero tolerance for head contact” policy change did not reduce the risk of game-related concussions in Pee Wee or Bantam class ice hockey players. Increased concussion awareness and education after the policy change may have contributed to the increased risk of concussions found after the policy change.

The Impact of a Concussion-U Educational Program on Knowledge of and Attitudes about Concussion.

The diagnosis of a sports-related concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving youth athlete knowledge and attitudes toward concussion may increase self-reporting behaviour. The objective of this study was to determine if a novel Concussion-U educational program improves knowledge of and attitudes about concussion among a cohort of elite male Bantam and Midget AAA hockey players. Fifty-seven male Bantam and Midget AAA-level hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of the Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version immediately before and after a Concussion-U educational presentation. Follow-up sessions were arranged 4 to 6 months after the presentation, and assessed retention of knowledge and attitude changes. Forty-three players completed all three surveys. Concussion knowledge and attitude scores significantly (p<0.01) increased from pre- to post-presentation by 12.79 and 8.41%, respectively. At long-term follow-up, knowledge levels remained significantly (p<0.01) higher than baseline by 8.49%. Mean attitude scores were also increased at follow-up; however, this increase was not statistically significant. A Concussion-U educational program led to an immediate improvement in concussion knowledge and attitudes among elite male Bantam and Midget AAA hockey players. Increased knowledge was maintained at long-term follow-up, but improved attitude was not. Future studies should investigate whether similar educational programs influence symptom reporting and concussion incidence. In addition, they should focus on how to maintain improved concussion attitudes.

The Incidence and Types of Physical Contact Associated with Body Checking Regulation Experience in 13-14 Year Old Ice Hockey Players.

Background: Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury in leagues in which it is permitted. The objectives of this study were to determine whether the incidence and types of physical contact differ for Bantam players (aged 13–14 years) who were exposed to BC at Pee Wee level (aged 11–12 years) in Calgary, Alberta versus Bantam players who were not exposed to BC at Pee Wee level in Québec City, Québec. All teams were exposed to BC at bantam level; Methods: A cohort study was conducted in Québec City and Calgary. Sixteen games for Calgary and 15 for Québec City were randomly selected and analysed with a validated observation system to quantify five intensities of physical contact and to observe different types of physical contact such as slashing and holding; Results: A total of 5610 incidences of physical contact with the trunk and 3429 other types of physical contact were observed. Very light intensity trunk contact was more frequent in Calgary (adjusted incidence RR (ARR): 1.71; 95% CI: 1.28–2.29). Holding (ARR: 1.04; 95% CI: 1.02–1.07) and slashing (ARR: 1.38; 95% CI: 1.07–1.77) were more frequent in Calgary; Conclusion: Results suggest that players’ physical contacts differ between Bantam leagues in which BC was permitted at Pee Wee level and leagues in which it was not permitted until Bantam level.

Psychosocial Outcomes of Sport Concussions in Youth Hockey Players.

The objective is to evaluate the psychological outcomes arising from sport concussions. Participants included AA and AAA level Bantam and Midget hockey players (n = 672) between 12 and 17 years of age (mean = 15.0 years; SD = 1.2) enrolled in a large cohort study. All participants completed baseline tests including the Behavior Assessment System for Children, 2nd Edition (BASC2) and a pre-season medical questionnaire (PSQ) completed by parents that included a retrospective report of prior concussions and injuries. Players were assigned to 4 groups: no injury (NONE), concussion (CO) and musculoskeletal (MSK) injuries or both (COMB). Participants in the CO and COMB groups demonstrated significantly higher rates of psychological difficulties compared with other groups [F(63, 1800) = 1.43, p = .016, partial η(2) = 0.05) and on select clinical scales measuring atypicality, locus of control, anxiety, depression, sense of inadequacy, somatization, and attention. In addition, results from the composite clinical scales reached statistical significance for internalizing problems and emotional symptom index. Effect sizes were minimal with the exception of comparisons between the NONE and COMB groups where effect sizes were medium to large. Proportions above clinical cut-off scores set by the BASC2 were higher for the COMB group compared with CO, MSK, or NONE groups. Results suggest smaller percentage of youth may be more prone to psychological sequelae following concussion.

The effectiveness of a concussion-u educational presentation on knowledge and attitudes of concussion amongst elite bantam and midget hockey players

Background: The diagnosis of a concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving athlete’s knowledge and attitudes towards concussions may increase self-reporting behavior; however, research in this area is inconclusive. The objective of this study is to determine if a Concussion-U educational presentation improves knowledge and attitudes of youth hockey players towards concussions. This is part of a larger study designed to determine the impact of an informational presentation on the knowledge and attitudes over a full hockey season. Methods: 56 elite male Bantam and Midget hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey (RoCKAS) questionnaire immediately before and after a Concussion-U educational presentation on the subject. Results: Concussion knowledge and attitude scores significantly (p&lt;.001) increased from pre-presentation to post-presentation by 13.1% and 8.7%, respectively. Discussion: A Concussion-U educational presentation designed to improve concussion knowledge and attitudes in youth hockey players resulted in increased knowledge and improved attitudes towards concussion in elite male Bantam and Midget hockey players. Future research should examine the long-term effects of such presentations.

Exploring Minor Hockey Players' Knowledge and Attitudes Toward Concussion

To evaluate minor hockey players' attitudes and knowledge about sport concussions. Male and female Pee Wee, Bantam, and Midget level players (n = 183) participating in minor hockey and a comparison group of non-hockey players (n = 57). Survey. Player knowledge and attitudes were evaluated with a standardized questionnaire developed for the purpose of this study. Descriptive statistics including cross-tabulations and proportion comparisons were used to report the data. Players had foundational knowledge about concussions; however, more than half underestimated the prevalence and more than 30% were unaware of return to play protocols. Although nearly all players knew what they "should" do when concussed, 33% did not follow recommendations. Players reported more concern and appreciation of the seriousness of concussion than non-players, but they tended to minimize their vulnerability. The most common and helpful information sources were parents, doctors, and coaches, and therefore knowledge translation efforts should target theses audiences. Young athletes continue to demonstrate gaps in their knowledge of concussions. In addition, attitudes toward concussion suggest a developmental trajectory with younger athletes being most likely to ignore current recommended guidelines.

DO RISK FACTORS DIFFER FOR CONCUSSION AND PROLONGED RECOVERY FOLLOWING CONCUSSION IN ELITE YOUTH ICE HOCKEY PLAYERS?

BackgroundPediatric concussion risk factor identification will facilitate targeted injury prevention strategy development.ObjectiveTo examine risk factors for concussion and prolonged recovery amongst elite youth ice hockey players.DesignCohort study.SettingCommunity ice rinks and...

EFFECT OF PREVIOUS CONCUSSION OR INJURY ON SPORT-SPECIFIC SKILLS IN ELITE YOUTH ICE HOCKEY: A PILOT STUDY

BackgroundConcussions can lead to cognitive or neuromotor impairments which may influence skill performance. No published research has investigated the effect of previous concussions on sport-specific skill performance. Skill performance may...

Subjective, but not Objective, Lingering Effects of Multiple Past Concussions in Adolescents

The existing literature on lingering effects from concussions in children and adolescents is limited and mixed, and there are no clear answers for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are lingering effects of past concussions in adolescent athletes. Participants in this study included 643 competitive Bantam and Midget hockey players (most elite 20% by division of play) between 13 and 17 years of age (mean age=15.5, SD=1.2). Concussion history at baseline assessment was retrospectively documented using a pre-season questionnaire (PSQ), which was completed at home by parents and players in advance of baseline testing. Players with English as a second language, self-reported attention or learning disorders, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Demographically adjusted standard scores for the five composites/domains and raw symptom ratings from the brief Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized battery were analyzed. Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions. There were significantly more symptoms reported in those with two or more prior concussions than in those with no or one prior concussion. Adolescents with multiple previous concussions had higher levels of baseline symptoms, but there were not group differences in neurocognitive functioning using this brief computerized battery.

Are clinical measures of cervical flexor endurance, divided attention and dynamic visual acuity different in elite youth ice hockey players who report a previous history of concussion compared to those who do not?

ObjectiveTo evaluate differences in baseline measures of cervical flexor endurance (CFE), walking while talking (WWTT) and computerised dynamic visual acuity (cDVA) in elite youth ice hockey players who do and...

What factors increase the risk of concussion in elite youth ice hockey players?

ObjectiveTo examine the risk of concussion amongst elite youth male and female ice hockey players.DesignProspective cohort study.SettingCommunity ice rinks and sport medicine clinics.Participants764 Bantam (12–14 years) and Midget (15–17 years)...

Risk of injury associated with bodychecking experience among youth hockey players

In a previous prospective study, the risk of concussion and all injury was more than threefold higher among Pee Wee ice hockey players (ages 11-12 years) in a league that allows bodychecking than among those in a league that does not. We examined whether two years of bodychecking experience in Pee Wee influenced the risk of concussion and other injury among players in a Bantam league (ages 13-14) compared with Bantam players introduced to bodychecking for the first time at age 13. We conducted a prospective cohort study involving hockey players aged 13-14 years in the top 30% of divisions of play in their leagues. Sixty-eight teams from the province of Alberta (n = 995), whose players had two years of bodychecking experience in Pee Wee, and 62 teams from the province of Quebec (n = 976), whose players had no bodychecking experience in Pee Wee, participated. We estimated incidence rate ratios (IRRs) for injury and for concussion. There were 272 injuries (51 concussions) among the Bantam hockey players who had bodychecking experience in Pee Wee and 244 injuries (49 concussions) among those without such experience. The adjusted IRRs for game-related injuries and concussion overall between players with bodychecking experience in Pee Wee and those without it were as follows: injury overall 0.85 (95% confidence interval [CI] 0.63 to 1.16); concussion overall 0.84 (95% CI 0.48 to 1.48); and injury resulting in more than seven days of time loss (i.e., time between injury and return to play) 0.67 (95% CI 0.46 to 0.99). The unadjusted IRR for concussion resulting in more than 10 days of time loss was 0.60 (95% CI 0.26 to 1.41). The risk of injury resulting in more than seven days of time loss from play was reduced by 33% among Bantam hockey players in a league where bodychecking was allowed two years earlier in Pee Wee compared with Bantam players introduced to bodychecking for the first time at age 13. In light of the increased risk of concussion and other injury among Pee Wee players in a league where bodychecking is permitted, policy regarding the age at which hockey players are introduced to bodychecking requires further consideration.