Concussion Prevention Research Articles

Hockey referees: are they part of the solution for concussions in youth hockey?

ABSTRACT Rationale/purpose Concussions pose short – and long-term risks for youth athletes. To mitigate these risks, sport organizations must find ways to enhance athlete safety, including prompt removal of athletes who display signs and symptoms of concussions. Some sport organizations have incorporated officials in concussion prevention and management strategies. The purpose of this study was to gain sport officials’ perspectives of being able to remove athletes with suspected concussion from games. Design/methodology/approach We conducted a qualitative study using semi-structured interviews with 10 ice hockey officials from across Canada. We implemented a pragmatic approach with a reflexive thematic analysis to maintain the participants’ truths and perspectives within the results. Findings Our analysis resulted in the four themes: (a) Considerations and Importance of the Protocol, (b) Officials’ Knowledge of Concussions, (c) Required Training, and (d) Barriers. Practical Implications Removing athletes with suspected concussions could be added to officials’ duties; however, hesitancy exists regarding implementation and effectiveness of the protocol. Focus on the implementation and education of the officials is required. Research Contribution This study contributes to the growing literature on sport officials and their role with respect to concussions in youth ice hockey.

Incidence and Prevalence of Concussion in Denmark from 1999-2018: A Nationwide Cohort Study.

Concussion is a common diagnosis in emergency rooms, yet contemporary incidence and prevalence estimates are sparse and rely on self-reported data. A nationwide cohort study was conducted to provide up-to-date information, covering the entire Danish population from 1999 to 2018. Hospital contacts with a concussion diagnosis, including emergency room visits, hospital admissions, and outpatient contacts, were retrieved from the Danish National Patient Registry (DNPR), and incidence rates were age-standardized and stratified. The 20-year prevalence was defined as the percentage of Danes alive in 2018 who had experienced a concussion since 1999. The diagnostic codes used were the ICD-10 code S06.0 and a local Danish code for 'observation for concussion' (DZ033D). Additional data on activities related to concussion injuries were obtained from the Accident Analysis Group at Odense University Hospital through DNPR. Findings from the study indicated that during the period 1999-2018, the total age-standardized concussion incidence rate increased by 10% to 308 per 100,000 person-years (95% confidence interval (CI): 304-313). Notable time trends included 1) a reduced sex difference from 40% to 6% (95% CI: 3%-9%), 2) a doubled incidence rate in children aged 0-1 and in seniors aged over 80, 3) an increased utilization of head imaging across all age groups, except children, 4) a decline in the proportion of traffic-related concussions, and 5) a prevalence of concussion of 4.9% (95% CI: 4.89% - 4.93%) in 2018. The increasing incidence of concussions among the elderly is concerning in light of an aging population, and warrants further investigation, as evidence-based preventive interventions for falls exist. Additionally, the increased utilization of head imaging across all age groups except children calls for attention toward avoidance of unnecessary radiation exposure. Despite a drop in traffic-related cases, concussions remain highly prevalent. In conclusion, these findings indicate that concussions are an important public health concern, necessitating ongoing surveillance, research, and targeted resource allocation to address concussion management and prevention effectively.

Concussion prevention starts in the gym

Concussions are common in combat sports such as boxing and mixed martial arts (MMA). In these sports every punch thrown to the opponent’s head is thrown with the intention of winning by causing a knockout (KO) which is nothing but a concussive head injury. Other acute traumatic brain injuries such as traumatic subdural hematoma (SDH), epidural hematoma (EDH), intracranial hematoma (ICH), subarachnoid hemorrhage (SAH) remain an omnipresent danger. Traumatic SDH is the most common boxing related mortality reported in medical literature. These combatants either collapse in the ring/cage or soon thereafter. Many perish due to the TBI. Others may survive due to a timely decompressive craniectomy but are left behind with severe and persistent neurological deficits. Analysis of some of these combat sports related mortalities suggest that the combatant may have suffered a concussion while sparring in training camp. A concussed boxer entering the ring is vulnerable to another concussive injury and second impact syndrome. It is thus imperative that concussions in training camps and gyms be recognized and attended to in a timely fashion.

Concussions in Soccer.

The identification, management, and prevention of concussion across all competitive sports and athletic populations has been a notable topic of research over the last decade. Soccer is no exception, with over a billion participants worldwide. In soccer, 3 distinct subsets of head injuries are often the contributors to concussion: head-to-equipment, head-to-surface, and head-to-player collisions. Recognition of concussion is crucial, and ideally made on the sideline during competitive play. Recently updated screening tools include the SCAT6 and ChildSCAT6, which are widely utilized at all levels of play. Management of concussion is divided into on-field and in clinic management. Initial management includes removal from the field of play. There is increased emphasis on earlier incorporation of exercise prescription as a means to improve recovery in the concussed athlete. While few objective diagnostic tests exist to identify concussion, many are in development, most notably advanced imaging and biomarker modalities.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

What are the Protocols and Resources for Sport-Related Concussion Among Top National Collegiate Athletic Association Football Programs? A Cross-Sectional Survey of A5 Schools.

This study summarizes findings from a cross-sectional survey conducted among National Collegiate Athletic Association (NCAA) Division 1 football programs, focusing on sport-related concussion (SRC) protocols for the 2018 season. Cross-sectional survey study. 65 football programs within the Autonomy Five (A5) NCAA conferences. Athletic trainers and team physicians who attended a football safety meeting at the NCAA offices June 17 to 18, 2019, representing their respective institutions. Electronic surveys were distributed on June 14, 2019, before the football safety meeting. Results for 16 unique questions involving SRC protocols and resources were summarized and evaluated. The survey garnered responses from 46 of 65 programs (response rate = 71%). For baseline testing, 98% measured baseline postural stability and balance, 87% used baseline neurocognitive testing, while only 61% assessed baseline vestibular and/or ocular function. Regarding concussion prevention, 51% did not recommend additional measures, while 4% and 24% recommended cervical compression collars and omega-3 supplementation, respectively. In postconcussion treatment, 26% initiated aerobic exercise 1 day postconcussion if symptoms were stable, 24% waited at least 48 hours, 4% waited for the athlete to return to baseline, 11% waited until the athlete became asymptomatic, and 35% determined procedures on a case-by-case basis. Most institutions assessed postural stability/balance and neurocognitive functioning at baseline and introduced light aerobic exercise within 48 h postconcussion. There was variation in baseline assessment methods and concussion prevention recommendations. These survey findings deepen our understanding of diverse SRC protocols in NCAA football programs.

High school rugby coaches’ knowledge and opinions of concussion in KwaZulu Natal province in South Africa: an ecological cross-sectional study

BackgroundConcussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management.MethodsThis cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge.ResultsMore participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43).ConclusionThese results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.

Litigation and liability in concussion research and collaboration

ABSTRACT This paper explores, first, the common law principles of personal injury litigation explored through court decisions relating to sports injuries in (primarily) England and Wales and, second, the statutory schemes relating to concussion liability and young players in the United States. It explores the difficulties of using those strategies as a means of establishing liability for injuries arising from sports-related concussion (SRC) and explains why they are of such limited utility. While proposed class actions over historically acquired injuries or individual litigation over recent catastrophic injury may have some merit, and while future amendments to the US laws might remove some of their inherent flaws, the difficulties in establishing liability for personal injury will always be exacerbated by the specific characteristics of SRC and the legal, factual and evidential issues that arise. For those reasons, the paper considers the potential benefits of other means of concussion prevention and mitigation, including no-fault compensation and mandatory insurance, the more widespread use of effective, nuanced concussion protocols, and inter-disciplinary research that engages with doctrinal legal research.

Sport-related concussion (SCR) prevention and the nature of sport: possibilities and limitations

ABSTRACT Concussions are traumatic brain injuries that can result from a blow to the head or a jolt to the body. Athletes in many sports are exposed to concussion risks. There is a growing concern in sport and society about sport-related concussions (SRC) and an increasing awareness of the importance of proper diagnosis, treatment, and prevention. A traditional, reactive approach emphasizes sound protocols in cases of suspected SRC. A proactive approach involves identifying various causes of SRC and implementing preventive measures. For example, to reduce SRC prevalence in Canadian youth ice hockey, a ban on body checking has been introduced. When a preventive SRC measure implies a change in the main rules of a sport, it impacts its nature and alters how it is played. This can lead to tensions between SRC prevention and sporting concerns. By employing an extended consequentialist framework that includes normative analyses of the values of sport, I will examine the possibilities and limitations of preventive SRC measures in terms of constitutive rule changes. More specifically, I will propose a consequentialist framework to determine the conditions under which athlete exposure to SRC risks in a given sport can be considered unacceptable, acceptable, and even valuable.

Assessment and management of sport-related concussion in general practice.

Sport-related concussion (SRC) is a traumatic brain injury that occurs during sport or exercise activity. SRC is a growing health concern in Australia, withincreasing public awareness and presentations to general practitioners being increasingly common. This article will focus on the assessment and management of SRC in general practice, including guidance for returning patients to sport. Concussion prevention, potential long-term complications, and the decision-making process regarding retirement from sport are beyond the scope of this article. Recognising concussion can be difficult, asclinical symptoms and signs of SRC can evolve over a period of hours to days. General practitioners should be aware of the range of clinical concussion presentations. The key principles of management include relative rest, followed by a graduated return to cognitive and physical activity. Involvement of a multidisciplinary team can improve symptoms for those patients whose concussion symptoms are prolonged.

Youth handball concussion prevention strategies: a workshop-based study with experts and end users

Sport-related concussion (SRC) is a serious injury in youth team sports, including handball. While research on the prevention of SRC has made progress over the past 5 years, prevention strategies...

Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care.

Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.

Differences in injury and concussion rates in a cohort of Canadian female and male youth Rugby Union: a step towards targeted prevention strategies

ObjectiveTo examine differences in match and training musculoskeletal injury and concussion rates and describe mechanisms of concussion while considering previous playing experience in female and male Canadian high school Rugby...

Navigating Concussions: Empowering Strength and Conditioning Professionals for Optimal Recovery and Performance

Concussions and their impact on athletes are a major concern within the realm of strength and conditioning. This article delves into the significance of concussions, exploring their implications for athletes, coaches, and strength and conditioning professionals. Emphasizing the necessity of evidence-based practices in concussion management and prevention, this piece highlights recent developments in research and technology that shed new light on concussions. Furthermore, it presents promising advancements in early detection and improved management that ensure the safety and optimal performance of athletes.

Efficacy of Guardian Cap Soft-Shell Padding on Head Impact Kinematics in American Football: Pilot Findings.

Sport-related concussion prevention strategies in collision sports are a primary interest for sporting organizations and policy makers. After-market soft-shell padding purports to augment the protective capabilities of standard football helmets and to reduce head impact severity. We compared head impact kinematics [peak linear acceleration (PLA) and peak rotational acceleration (PRA)] in athletes wearing Guardian Cap soft-shell padding to teammates without soft-shell padding. Ten Division I college football players were enrolled [soft-shell padding (SHELL) included four defensive linemen and one tight end; non-soft-shell (CONTROL) included two offensive linemen, two defensive linemen, and one tight end]. Participants wore helmets equipped with the Head Impact Telemetry System to quantify PLA (g) and PRA (rad/s2) during 14 practices. Two-way ANOVAs were conducted to compare log-transformed PLA and PRA between groups across helmet location and gameplay characteristics. In total, 968 video-confirmed head impacts between SHELL (n = 421) and CONTROL (n = 547) were analyzed. We observed a Group x Stance interaction for PRA (F1,963 = 7.21; p = 0.007) indicating greater PRA by SHELL during 2-point stance and lower PRA during 3- or 4-point stances compared to CONTROL. There were no between-group main effects. Protective soft-shell padding did not reduce head impact kinematic outcomes among college football athletes.

Concussion in Kids

Abstract The incidence of concussions in kids has increased over the past decade. Concussions occur from blunt force trauma and are often caused by sports-related head injuries. Clinical presentation varies by individual, and symptoms typically resolve within a couple of weeks from the injury. Key domains for diagnosis, clinical presentation, and clinical management include somatic, cognitive, emotional, and sleep-related disturbances. Patient education is an essential component of care for concussion prevention and recovery. Pediatric nurses play a pivotal role in patient education and optimizing care for kids suffering from a concussion and associated complications. Most concussions resolve without complications over time, but with continued education and research, a mild traumatic brain injury will become less problematic through continued prevention methods and early diagnosis.

Factors That Reduce Parental Concern for Concussion Risks in Youth Tackle Football

This study sought to identify factors that reduce parental concern of concussion risks for children who play youth tackle American football. Interviews were conducted with parents who allowed children between the ages of 10 and 15 years to play on tackle football teams. Factors that reduced parental concern included advances in equipment safety and helmet technology, active parental monitoring and relationship building with coaches, and social comparisons to other youth athletes regarding their own child’s athleticism and ability to avoid injury. Although these factors reduced parents’ concern for concussion risks, the findings highlight biases that influence parental risk judgments, suggest that interventions to reduce concussions must account for competing narratives of concussion prevention, and offer recommendations for improving education efforts focused on player safety in contact sports.

Structure-property relationships of velar bone tissue from the energy absorbing horncore of bighorn sheep rams.

Velar bone is the material that fills the horncore of bighorn sheep rams. The architectural dimensions of velar bone are orders of magnitude larger than trabecular bone, and velae are more sail-like compared to strut-like trabeculae. Velar bone is important for energy absorption and reduction of brain cavity accelerations during high energy head impacts, but velar bone material properties were previously unknown. It was hypothesized that velar bone tissue would have properties that are beneficial for increased energy absorption at the material level. Solid velar bone beams were tested using dynamic mechanical analysis and three-point bending to quantify mechanical properties. Additionally, the porosity, osteon population density, and mineral content of the solid velar sails were quantified. The velar bone damping factor (∼0.03 - 0.06) and modulus of toughness (3.9 ± 0.4 MJ/m3) were lower than other mammalian cortical bone tissues. The solid bony sails have a bending modulus (8.6 ± 0.5 GPa) that lies within the range of bending moduli values previously reported for individual trabecular struts and cortical bone tissue. The solid velar bone sails had porosity (6.7 ± 0.9 %) and bone mineral content (66 ± 1 %) in the range of cortical bone values. Interestingly, velar sails contained osteons, which are rarely found in trabecular struts. The velar bone osteon population density (5.8 ± 0.9 osteons/mm2) is in the low end of the range of values reported for cortical bone in other mammals. STATEMENT OF SIGNIFICANCE: Bighorn sheep rams sustain high energy head impacts during intraspecific combat without overt signs of brain injury. Previous studies have shown that the bony horncore plays a critical role in energy absorption and reduction of brain cavity accelerations post impact, which has implications for concussion prevention in humans. However, the material properties of the horncore velar bone were previously unknown. This study quantified the material properties and structure-property relationships of the horncore velar bone at the tissue level. Results from this study will improve our understanding of how bighorn sheep mitigate brain injury during head-to-head impacts and may inspire the design of novel materials for energy absorption applications (i.e., helmets materials that reduce concussion occurrence in humans).

Factors Associated With Concussion Rates in Youth Ice Hockey Players: Data From the Largest Longitudinal Cohort Study in Canadian Youth Ice Hockey.

To examine factors associated with rates of game and practice-related concussion in youth ice hockey. Five-year prospective cohort (Safe2Play). Community arenas (2013-2018). Four thousand eighteen male and 405 female ice hockey players (6584 player-seasons) participating in Under-13 (ages 11-12), Under-15 (ages 13-14), and Under-18 (ages 15-17) age groups. Bodychecking policy, age group, year of play, level of play, previous injury in the previous year, lifetime concussion history, sex, player weight, and playing position. All game-related concussions were identified using validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician for diagnosis and management. Multilevel Poisson regression analysis including multiple imputation of missing covariates estimated incidence rate ratios (IRRs). A total of 554 game and 63 practice-related concussions were sustained over the 5 years. Female players (IRR Female/Male = 1.79; 95% CI: 1.26-2.53), playing in lower levels of play (IRR = 1.40; 95% CI: 1.10-1.77), and those with a previous injury (IRR = 1.46; 95% CI: 1.13, 1.88) or lifetime concussion history (IRR = 1.64; 95% CI: 1.34-2.00) had higher rates of game-related concussion. Policy disallowing bodychecking in games (IRR = 0.54; 95% CI: 0.40-0.72) and being a goaltender (IRR Goaltenders/Forwards = 0.57; 95% CI: 0.38-0.87) were protective against game-related concussion. Female sex was also associated with a higher practice-related concussion rate (IRR Female/Male = 2.63; 95% CI: 1.24-5.59). In the largest Canadian youth ice hockey longitudinal cohort to date, female players (despite policy disallowing bodychecking), players participating in lower levels of play, and those with an injury or concussion history had higher rates of concussion. Goalies and players in leagues that disallowed bodychecking had lower rates. Policy prohibiting bodychecking remains an effective concussion prevention strategy in youth ice hockey.

Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis

ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted...