Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football

Breedlove, Evan L.; Robinson, Meghan E.; Talavage, Thomas M.; Morigaki, Katherine E.; Yoruk, Umit; O’Keefe, Kyle; King, Jeff; Leverenz, Larry J.; Gilger, Jeffrey W.; Nauman, Eric A.

doi:10.1016/j.jbiomech.2012.01.034

Cited by 247 publications

(224 citation statements)

References 40 publications

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“…Subsequent work by the same investigators suggests that it is the accumulation of multiple blows to the head, rather than a single event, that can produce neurological impairments. 10 Additionally, their work implies that the sequence of blows experienced by a player can mediate the severity of the observed symptoms that lead to the clinical diagnosis of concussion, or the absence thereof (for example, in the case of FOI+). The potential for accumulated damage would also probably involve biochemical factors of the period of cellular vulnerability, a hypermetabolic state, or vascular dysautoregulation as the pathophysiological mechanisms of mTBI.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,11,18,32,33,50,64,70,72,79 We stress that not all head impacts should be considered potentially harmful. An athlete's risk of experiencing long-standing effects of repetitive subconcussive blows is probably measured as a cumulative dose over a lifetime and could include factors such as age at exposure, type and magnitude of exposure, recovery periods, differential rates of recovery, genotype, individual vulnerability, and others.…”

Section: Discussionmentioning

confidence: 99%

“…60,61,63 A follow-up study by Breedlove et al demonstrated that the fMRI changes in many regions of the brain statistically correlated with the number and (spatial) distribution of hits received after beginning contact practices. 10 Critically, regression models constructed to relate the hits experienced to the observed fMRI changes were found to explain an even greater proportion of the variance for the concussed group (COI+) than the asymptomatic group (COI-). The COI-group exhibited substantial hit-correlated involvement of the visual processing systems in the upper parietal and occipital lobes.…”

Section: 75mentioning

confidence: 92%

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Role of subconcussion in repetitive mild traumatic brain injury

Bailes

Petraglia

Omalu

et al. 2013

JNS

443

340

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Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as measured by neuropsychological testing and functional MRI. Such findings have been corroborated by diffusion tensor imaging studies demonstrating axonal injury in asymptomatic athletes at the end of a season. Recent autopsy data have shown that there are subsets of athletes in contact sports who do not have a history of known or identified concussions but nonetheless have neurodegenerative pathology consistent with chronic traumatic encephalopathy. Finally, emerging laboratory data have demonstrated significant axonal injury, blood-brain barrier permeability, and evidence of neuroinflammation, all in the absence of behavioral changes. Such data suggest that subconcussive level impacts can lead to significant neurological alterations, especially if the blows are repetitive. The authors propose “subconcussion” as a significant emerging concept requiring thorough consideration of the potential role it plays in accruing sufficient anatomical and/or physiological damage in athletes and military personnel, such that the effects of these injuries are clinically expressed either contemporaneously or later in life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 75mentioning

confidence: 92%

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Role of subconcussion in repetitive mild traumatic brain injury

Bailes

Petraglia

Omalu

et al. 2013

JNS

443

340

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“…Significant associations were found between pre-and postseason fMRI changes, number of head blows, and functional impairment (change in ImPACT testing in at least one domain). 35,36 Remarkably, 50% of nonconcussed players were found to have functional impairments. In a study relating HITS findings to DTI, 10 football and ice hockey players were imaged at baseline and within 10 days postconcussion.…”

mentioning

confidence: 99%

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Whitlow

Urban

et al. 2014

Journal of Neurotrauma

196

155

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The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITSÔ) during all practices and games. All players received pre-and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWE Linear ), rotational (RWE Rotational ), and combined components (RWE CP ), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, C L , C P , and C S , respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N = 24). Regression analysis revealed a statistically significant linear relationship between RWE CP and FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWE CP and RWE Linear ) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

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“…Interestingly, studies by Breedlove et al 1 and Talavage et al, 2 which included preseason assessments and in-season monitoring of head impacts and brain function, revealed that only the number and location of hits predict neurophysiological changes. At first glance, these findings support the idea that brain tissue fatigues or becomes susceptible during repetitive impacts-like the rotator cuff in baseball pitchers.…”

Section: Northshore University Health System and University Of Chicagmentioning

confidence: 99%

Editorial: Subconcussion in traumatic brain injury

Sagher¹

2013

JNS

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Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football

Cited by 247 publications

References 40 publications

Role of subconcussion in repetitive mild traumatic brain injury

Role of subconcussion in repetitive mild traumatic brain injury

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Editorial: Subconcussion in traumatic brain injury

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