Concussion Prevention Research Articles

Multiangle, self-powered sensor array for monitoring head impacts.

Mild concussions occur frequently and may come with long-term cognitive, affective, and physical sequelae. However, the diagnosis of mild concussions lacks objective assessment and portable monitoring techniques. Here, we propose a multiangle self-powered sensor array for real-time monitoring of head impact to further assist in clinical analysis and prevention of mild concussions. The array uses triboelectric nanogenerator technology, which converts impact force from multiple directions into electrical signals. With an average sensitivity of 0.214 volts per kilopascal, a response time of 30 milliseconds, and a minimum resolution of 1.415 kilopascals, the sensors exhibit excellent sensing capability over a range of 0 to 200 kilopascals. Furthermore, the array enables reconstructed head impact mapping and injury grade assessment via a prewarning system. By gathering standardized data, we expect to build a big data platform that will permit in-depth research of the direct and indirect effects between head impacts and mild concussions in the future.

Higher hazard of concussion combined with recurrent concussion in female youth ice hockey compared with males: An opportunity for concussion prevention

Higher hazard of concussion combined with recurrent concussion in female youth ice hockey compared with males: An opportunity for concussion prevention

Diagnosis, Treatment, and Prevention of Sport-related Concussion

Concussion is a serious injury with potential long-term cognitive complications. Due to the prevalence of undiagnosed concussions and their detriments to health, concussion treatment and prevention are important topics of exploration. By investigating concussion diagnosis and management, the types of treatment, and preventive methods, this study demonstrates the positive role of active rehabilitation in concussion management. It presents opportunities for future studies to focus on more specific types of exercise and possible rule regulations. Results show that concussion symptoms may vary according to severity, from minor headaches and loss of concentration to depression, dementia, and impaired cognitive function. Clinical or syndromic concussion diagnosis is the most used and reliable subjective assessment method in the contemporary health and scientific field. Immediate removal from sport and vigorous exercise is crucial after athletes experience a concussion to avoid exacerbating the symptoms or causing an additional concussion. Contrary to the belief of complete rest after a concussion, early sub-symptom aerobic exercise and a gradual return to sports participation are important and effective measures for concussion treatment. Patients experiencing prolonged symptoms may also benefit from aerobic exercises. Additionally, there is no effective equipment for preventing concussions in the current sports world. Sports rule changes and education could be efficacious in preventing concussions.

Prevention of sports-related concussion in soccer: a comprehensive review of the literature

We performed a literature search on PubMed, EBSCO (Elton B. Stephens Company), DOAJ (Directory of Open Access Journals), and Cochrane for the past 20 years. The search strategy was using Boolean terms based on any of the search terms of sports-related-concussion, soccer, and prevention. The studies were included based on inclusion and exclusion criteria. This research identified three systematic reviews, seven literature reviews, five cross-sectional studies, one randomized controlled trial, three prospective studies, and one retrospective study. As concussion prevention measures in soccer, several strategies can be implemented, including concussion education, rule/regulation changes, proper heading technique, behavioral skills training, vision training to improve sensory and anticipation, the use of supplements to prevent severe concussion and accelerate recovery, as well as prevention in youth sports and head impact detection. Good education, good technique, good training, and a good strengthening program can be implemented to prevent concussions in soccer. To determine the relationship between prevention and concussion, however, additional research is required.

A Helmet of Her Own?: A Qualitative Study of Key Stakeholder Perspectives on Headgear in Girls’ Lacrosse

Despite the high incidence rate of concussions in women's lacrosse, there is substantial push back against the use of helmets at the secondary educational and collegiate levels in the U.S. This study examines the social factors influencing the controversy surrounding the use of protective headgear and how the recent development of headgear specific to the women's game has shaped ongoing debates. Purposeful sampling was used to recruit interviewees with research knowledge or firsthand experience with injury and protective headgear in girls' lacrosse. Semistructured interviews were conducted and subsequently coded using qualitative research software to identify key themes and patterns. Sixteen respondents participated in this study; 4 players, 4 coaches, 3 researchers, and 5 administrators were represented in this sample. Overarching themes identified across these interviews included playing through pain, health consequences of concussions, concussion prevention strategies and the potential role of headgear, symbolism of headgear, gender dynamics, autonomy, and decision making. This qualitative study shows the importance of attention to the unique history of girls' lacrosse and current narratives surrounding headgear in the sport. There is a need for greater collaboration and consensus between all relevant groups to ensure that headgear best addresses the concerns of the people who will ultimately be using it. Future qualitative research should build on this preliminary study with a larger and more diverse sample to follow up on key themes and ultimately inform effective safety measures to protect athletes.

A mixed methods investigation into athletic trainer and dietitian's nutrition practices for sport-related concussion patients

Background Nutrients may have implications following concussion, such as inflammation reduction or neuroprotection. The purpose of this study was to describe nutrition practices of athletic trainers (AT) and dietitians for patients regarding sport-related concussion, with respect to prevention, recommendations, and barriers to implementation. Hypotheses Due to the descriptive nature of this study, hypotheses were not warranted. Study Design Mixed methods. Level of Evidence Level 3. Methods A survey was distributed through professional memberships and included multiple-choice and open-ended items about nutritional practices regarding concussions. Participants included 1465 ATs and 51 dietitians accessing the survey (AT: age = 35.7 ± 11.4 years, females = 43.1%; dietitians: age = 31.8 ± 8.17 years, females = 45.1%). Open-ended survey responses regarding nutritional practices for concussion prevention, recommendations, and changes following concussion were analyzed by identifying key words or repeating phrases, theme development and categories into an initial codebook, using the codebook on responses, and coding all responses with the finalized codebook. Barriers to implementation was analyzed with descriptive statistics. Results Themes were identified for prevention strategies, and recommendations and changes following concussion. For concussion prevention, ATs noted overall health, specific target nutrients, barriers and limited research support, while dietitians identified overall health, specific target nutrients, recommendations/guidelines as themes. Post-injury themes for patient recommendations and changes were noted as overall health, specific target nutrients, resources, interprofessional collaboration by ATs, whereas dietitians identified overall health, specific target nutrients, interprofessional collaboration. ATs and dietitians noted numerous barriers including the lack of clinician knowledge and athlete compliance. Conclusions and Clinical Relevance ATs and dietitians are utilizing nutritional practices regarding concussion in numerous ways by focusing on use for whole body, brain health and specific targets such as omega fatty acids, hydration, micronutrients/supplements, and macronutrients. With these findings and the barriers listed by respondents, we can use this information to design focused research to influence evidence-based nutritional practices and concussion.

Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey.

To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football. Online survey. Junior and youth athletes in Australia. Australian football players aged U8 to U18. Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity. Rates of padded HG use, and beliefs associated with HG use. A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer ( P < 0.001) and being able to play harder while wearing HG ( P < 0.001). Median responses were "disagree" on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019). Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.

Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs.

Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.

A Description of Suspected Concussions in Football-Related Activities among K-12 Students in Utah.

The circumstances and nature of concussions among youth who play tackle, flag, or touch football are not well understood. This study used data from Utah's Student Injury Reporting System (SIRS) to explore suspected concussions among K-12 students sustained during participation in football-related activities (tackle, flag, or touch football). Descriptive statistics and chi-square analyses showed that 54.7% of suspected concussions due to football-related activity were among elementary and middle school and 41.3% were among high school students. Most suspected concussions resulted from being struck by or against something (81.9%) and occurred during school-sanctioned games and practices (37.9%), lunch, lunch recess, and recess (34.8%), or physical education class (22.7%). The type of school activity and context for suspected concussions varied by school level. School nurses and others in Utah may use study findings to customize concussion prevention efforts by school level and activity.

Relationship between cervical spine function and concussion-related symptoms in combat sport athletes

Introduction: Combat sport athletes are exposed to intentional strikes to the head. These strikes result in height linear and rotational acceleration forces that can result in concussion and neck injury. Despite experiencing ongoing post-concussion symptoms, combat sport athletes continue to participate in their sport. Neck muscle strength has been described as a modifiable risk factor for the prevention of concussion, but neck strength has been found to be reduced in the presence of concussion symptoms, including neck pain in non-combat sport populations.

Exploring the Effects of a Neck Strengthening Program on Purposeful Soccer Heading Biomechanics and Neurocognition.

BackgroundCervical (neck) strengthening has been proposed as an important factor in concussion prevention. The purpose of the study was to determine if a six-week cervical strengthening program affected neurocognition and purposeful soccer heading biomechanics. The hypothesis was that the neck strengthening program would improve strength, maintain neurocognition, and alter purposeful soccer heading biomechanics.Study DesignRandomized controlled trial.MethodsTwenty collegiate soccer athletes (8 males, 12 females, age=20.15±1.35 years, height=171.67±9.01 cm, mass=70.56±11.03 kg) volunteered to participate. Time (pre, post) and group (experimental, control) served as the independent variables. Four composite scores from the CNS Vital Signs computer based neurocognitive test (CNSVS; verbal memory, visual memory, executive function, reaction time) and aspects of heading biomechanics from inertial measurement units (xPatch; peak linear acceleration, peak rotational acceleration, duration, Gadd Severity Index [GSI]) served as the dependent variables. Each athlete completed a baseline measure of neck strength (anterior neck flexors, bilateral anterolateral neck flexors, bilateral cervical rotators) and CNSVS after heading 10 soccer balls at two speeds (11.18 and 17.88 m/s) while wearing the xPatch. The experimental group completed specific cervical neck strengthening exercises twice a week for six weeks using a Shingo Imara™ cervical neck resistance apparatus while the control group did not. After six weeks, the participants completed the same heading protocol followed by measurement of the same outcome variables. The alpha value was set to p<0.05 a priori.ResultsThe interaction between time and group was significant for visual memory (F1,17=5.16, p=0.04, η2=0.23). Interestingly, post hoc results revealed visual memory decreased for the control group from pretest (46.90±4.46) compared to posttest (43.00±4.03; mean difference=3.90, 95% CI=0.77-7.03, p=0.02). Interactions for all other dependent variables were not statistically significant (p>0.05).ConclusionsThe cervical neck strengthening protocol allowed maintenance of visual memory scores but did not alter other neurocognitive measures or heading biomechanics. The link between cervical neck strengthening and concussion predisposition should continue to be explored.Level of EvidenceLevel 1b

Concussions in Collegiate Club Sports: Investigating Concussion Education, Knowledge, and Attitudes

Approximately 9 million college students participate in organized sports, with 460,000 college athletes participating at the collegiate level (e.g., NCAA, NAIA) and the remaining 8.5 million playing club and intramural teams. Nationally, an estimated 1.7 to 3 million sports-related concussions (SRCs) occur per year. Despite the overwhelming number of student-athletes participating in collegiate club sports, literature on SRC education, knowledge and attitudes is limited when looking at collegiate club athletes. The purpose of this study is to explore current concussion education given to collegiate club sports athletes and understand players' concussion knowledge and attitudes. A cross-sectional study design using a modified version of Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version (RoCKAS-ST) was emailed to all members within the 33 student-led club sport organizations at a Southeastern university. Seventy-one club athletes from 22 of the club sport organizations responded to the survey. Thirty-two participants (45.1%) reported that they have received at least one sports-related concussion and 39 (54.9%) reported never receiving a SRC. Fifty-five participants (77.5%) reported not receiving a concussion education. Total knowledge was found to have significant differences between participants who received a concussion education and participants who did not (t[69] = 1.135; p = 0.048). No significant differences were found in attitude between collegiate club sport athletes who received a concussion education and players who did not receive a concussion education (t[68] = 0.37; p = 0.700). The study indicated that a majority of collegiate club sport athletes do not receive a concussion education, which impacts their knowledge of concussions. Further research is needed to determine effective concussion prevention education for this population.

Development of a concussion public policy on prevention, management and education for schools using expert consensus

ObjectivesConcussions are a major public health concern, and, thus, specific policies have been developed for implementation targeting vulnerable populations such as school-aged children and youth in the school setting, in...

Avenues for Sport-Related Concussion Prevention in High School Football: Effect of Limiting Collision Practices.

Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices. To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons. Retrospective cohort study. Michigan high school football. High school (9th-12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events. Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015-2016 through 2019-2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season. A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017-2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018-2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019-2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015-2016. We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015-2016.

Same-Year Repeat Concussions in the National Football League: Trends from 2015 Through 2019

Sport-related concussion (SRC) prevention and management is a focus of the National Football League (NFL). While most prior reports evaluated sport-related concussion incidence, few have studied same-year repeat concussions. This study aimed to evaluate the frequency of same-year repeat concussions in the NFL. A retrospective, observational cohort study of same-year repeat concussions in the NFL from 2015 to 2019 was performed. The NFL's electronic health record was reviewed for players sustaining concussions and same-year repeat concussions. Wilcoxon rank sum tests were used to calculate same-year repeat concussion rates, and risk ratios and 95% confidence intervals were estimated using log-binomial regression. From 2015 to 2019, the risk of sustaining a same-year repeat concussion in the NFL was 0.38%-0.69% per season. Among players who sustained a concussion, the risk of a same-year repeat concussion was 5.3%-8.3%, which did not differ significantly from the risk of sustaining a single concussion (6.2%-8.3%). There was a median of 38 participation days between initial and same-year repeat concussion. Players missed more time from same-year repeat concussions (median 12 days) compared with both single (median 9 days; P < 0.0001) and initial (median 9.5 days; P= 0.002) concussions. The risk of a repeat concussion was similar to the risk of sustaining a single concussion among NFL players. More time was missed following a same-year repeat concussion compared with single or initial concussions. Further research is needed to maximize player safety and minimize same-year repeat concussions.

Sports Concussions: A Webliography

A concussion is a type of brain injury caused by a direct or indirect blow to the head or body causing the brain to move rapidly within the skull, resulting in immediate, but temporary, brain dysfunction. Concussions can happen when playing sports, during recreation, because of a fall or accident, or from an act of violence. Every year, approximately 42 million people worldwide, including at least 3 million in the United States, suffer from concussion, making it a public health issue. Persons of all ages, from the youngest children to the most aged adults, and from all walks of life can be affected by concussion. Identifying and understanding the best evidence for prevention and treatment of concussion can be challenging due to the vast amount of information available on the Internet.

Symptom Recovery and Return to Participation Timelines of Patients With Concussion at a Community Physiotherapy Clinic Based on Injury Mechanism

To compare patient demographics, injury phase (IP; time-to-assessment), total symptom severity score (TSS) changes and return to participation (RTP; cognitive/physical) to mechanism of injury (MOI). Secondary concussion prevention includes timely assessment and treatment to decrease TSS and maximize RTP. One community physiotherapy clinic. Retrospective chart review (September 1, 2016-August 8, 2018). Two hundred thirty-four patients with concussion (male: n = 85; female: n = 149) from various MOIs. Age groups (years): children 8-12, youth 13-17, young adult 18-29, adult 30-64, senior 65+. IP: acute (<72 hours), subacute (72 hours-2 weeks adults, 72 hours-4 weeks children/youth), persistent (2 weeks-3 months adults, 4 weeks-3 months children/youth), chronic (>3 months). multimodal physiotherapy (cervico-vestibular, exertion, education), referral to specialist, psychology and/or neuropsychology. treatment (number, timeframe) and weeks to recovery (WTR) vs MOI; TSS changes and RTP rates. All acute IP had sport MOI, with WTR consistent with current literature. For all others, WTR was longer regardless of age or MOI. MVC and other MOIs were primarily patients in persistent or chronic IP (80% and 71%, respectively). MVC had the longest recovery (12.28 ± 8.21 treatments over 21.03 weeks 95% CI [17.05, 25.01], 44.94 WTR 95% CI [36.38, 53.51]); p < 0.05). Sport MOI received 5.50 ± 3.62 treatments over 7.49 (95% CI [5.59, 9.40]) weeks and 19.07 (95% CI [13.72, 24.42]) WTR. No significant statistical difference was observed between sport and other MOI recovery. TSS decreased in 85% of all patients. Full cognitive RTP was achieved by 75% of patients, and full physical RTP by 68%. Concussion patients experienced symptom and participation recovery, with IP and MOI related to WTR. Treatment/recovery timeframes were longer than previously reported for subacute, persistent, and chronic IPs. These results will inform secondary prevention strategies and knowledge translation underscoring the need for timely assessment and treatment. It also draws attention to RTP in MOIs other than sport.

Nonsteroidal anti-inflammatory drug use and concussions in adolescent athletes: incidence, severity, and recovery.

Given concerns about the potential long-term effects of concussion in young athletes, concussion prevention has become a major focus for amateur sports leagues. Athletes have been known to frequently use anti-inflammatory medications to manage injuries, expedite return to play, and treat concussion symptoms. However, the effects of baseline nonsteroidal anti-inflammatory drug (NSAID) use on the susceptibility to head injury and concussion remain unclear. This study aims to assess the effects of preinjury NSAID use on concussion incidence, severity, and recovery in young athletes. Data from 25,815 ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) tests were obtained through a research agreement with ImPACT Applications Inc. Subjects ranged in age from 12 to 22 years old. Those who reported NSAID use at baseline were assigned to one (anti-inflammatory [AI]) cohort, whereas all others were assigned to the control (CT) cohort. Differences in head trauma and concussion incidence, severity, and recovery were assessed using chi-square tests, unpaired t-tests, and Kaplan-Meier plots. The CT cohort comprised a higher percentage (p < 0.0001) of males (66.30%) than the AI cohort (44.16%) and had a significantly greater portion of athletes who played football (p = 0.004). However, no statistically significant differences were found between the two cohorts in terms of the incidence of head trauma (CT = 0.489, AI = 0.500, p = 0.9219), concussion incidence (CT = 0.175, AI = 0.169, p = 0.7201), injury severity, or median concussion recovery time (CT = 8, AI = 8, p = 0.6416). In a multivariable analysis controlling for baseline differences between the cohorts, no association was found between NSAID use and concussion incidence or severity. In this analysis, the authors found no evidence that preinjury use of NSAIDs affects concussion risk in adolescent athletes. They also found no indication that preinjury NSAID use affects the severity of initial injury presentation or concussion recovery.

Headgear in prevention of sports related concussion- A literature review across various sports

Sports related concussion (SRC) remains a challenge for sports physicians to identify because of varied presentation and lack of diagnostic tool. Keeping in mind its long term effect various sports bodies introduced different preventive strategies to reduce incidence of SRC. Commercial headgear is currently being used by players of all ages and skill levels in certain sports to protect themselves from heading and direct impact, even though the protective effect on concussion has not been conclusively demonstrated and limited research has been done. Electronic databases and grey literatures were used to search the evidence using Medical Subject Headings sports headgear, concussion, helmet, cricket, soccer, American Football, boxing for the available research studies from 1990 up to April 2020. The wide variety of prospective surveillance as well as lab studies made the case even more confusing as the simulation model may not actually replicate the on field scenario. Moreover the type and component of the headgear need to be subjected based on sports specific demand. Hence this literature review is aimed at available evidences in different sports to find any consensus between use of headgear and prevention of SRC.

Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics

PurposeTo analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions.MethodsThe Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence.ResultsThe top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each.ConclusionsWe identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion.Clinical RelevanceThis study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.