Correlation of Head Impacts to Change in Balance Error Scoring System Scores in Division I Men’s Lacrosse Players

Abstract

Background:Investigation into the effect of cumulative subconcussive head impacts has yielded various results in the literature, with many supporting a link to neurological deficits. Little research has been conducted on men’s lacrosse and associated balance deficits from head impacts.Hypotheses:(1) Athletes will commit more errors on the postseason Balance Error Scoring System (BESS) test. (2) There will be a positive correlation to change in BESS scores and head impact exposure data.Study Design:Prospective longitudinal study.Level of Evidence:Level 3.Methods:Thirty-four Division I men’s lacrosse players (age, 19.59 ± 1.42 years) wore helmets instrumented with a sensor to collect head impact exposure data over the course of a competitive season. Players completed a BESS test at the start and end of the competitive season.Results:The number of errors from pre- to postseason increased during the double-leg stance on foam (P < 0.001), tandem stance on foam (P = 0.009), total number of errors on a firm surface (P = 0.042), and total number of errors on a foam surface (P = 0.007). There were significant correlations only between the total errors on a foam surface and linear acceleration (P = 0.038, r = 0.36), head injury criteria (P = 0.024, r = 0.39), and Gadd Severity Index scores (P = 0.031, r = 0.37).Conclusion:Changes in the total number of errors on a foam surface may be considered a sensitive measure to detect balance deficits associated with cumulative subconcussive head impacts sustained over the course of 1 lacrosse season, as measured by average linear acceleration, head injury criteria, and Gadd Severity Index scores. If there is microtrauma to the vestibular system due to repetitive subconcussive impacts, only an assessment that highly stresses the vestibular system may be able to detect these changes.Clinical Relevance:Cumulative subconcussive impacts may result in neurocognitive dysfunction, including balance deficits, which are associated with an increased risk for injury. The development of a strategy to reduce total number of head impacts may curb the associated sequelae. Incorporation of a modified BESS test, firm surface only, may not be recommended as it may not detect changes due to repetitive impacts over the course of a competitive season.

Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion

“…As such, it is possible that some of the balance deficits attributed to concussion in the current results may be due to differences from previous concussions or related to contact versus non-contact sports. Specifically, such effects, if present within this data, may be due to sub-concussive head trauma 42 that may have exaggerated the reported differences between concussed and control subjects. Third, while the instrumented measures were based on 30 s of sway according to standard measurements of postural sway, the clinically scored mBESS was based on the standard 20 s clinical assessment.…”

Comparing fMRI activation during smooth pursuit eye movements among contact sport athletes, non-contact sport athletes, and non-athletes

“…Studies on cognition examine a variety of neurocognitive functions, including: verbal learning, verbal recognition, spatial recognition, visual working memory, visual-motor speed, impulse inhibition, visual attention, and concentration. Using athletes from a variety of sports but primarily soccer, some studies find an effect on cognition ( Downs and Abwender, 2002 ; Ellemberg et al, 2007 ; Killam et al, 2005 ; Matser et al, 1999 , Matser et al, 2001 , Matser et al, 1998 ; McAllister et al, 2012a ; Miyashita et al, 2017 ; Straume-Naesheim et al, 2009 ; Talavage et al, 2014 ; Tsushima et al, 2016 ; Tysvaer and Løchen, 1991 ; Witol and Webbe, 2003 ; Zhang et al, 2013 ), while others find no effect ( Abreau et al, 1990 ; Guskiewicz et al, 2002 ; Janda et al, 2002 ; Kaminski et al, 2008 ; Kemp et al, 2016 ; Miller et al, 2007 ; Putukian et al, 2000 ; Rutherford et al, 2009 ; Salinas et al, 2009 ; Stephens et al, 2010 ; Straume-Naesheim, 2005 ; Vann Jones et al, 2014 ). The subconcussive effect of hits on balance is also inconclusive with some reporting a positive effect ( Haran et al, 2013 ; Miyashita et al, 2017 ), and others reporting no effect ( Broglio et al, 2004 ; Gysland et al, 2012 ; Mangus et al, 2004 ; Schmitt et al, 2004 ).…”

Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers

“…The Balance Error Scoring System (BESS; Finnoff et al, 2009;Yengo-Kahn et al, 2016;Miyashita et al, 2017) is an observational diagnostic tool frequently used to test static balance post-mTBI on firm and foam surfaces with the eyes closed. The BESS is the most commonly used balance metric for sideline concussion diagnosis despite concerns that it does not adequately assess vestibular function (Kalajainen, 2015) and issues about learning effects with repeated testing (Valovich et al, 2004;Mulligan et al, 2013).…”

“…The greatest risk of sustaining an mTBI exists among males playing American football or Australian rugby, females playing soccer (Giza et al, 2013;Kutcher and Giza, 2014), and both genders playing ice hockey (Simmons et al, 2017). Athletes participating in lacrosse were recently shown to have a high risk for mTBIs, although fewer studies have been conducted in terms of injury consequences in lacrosse compared to other high impact sports (Reynolds et al, 2016;Miyashita et al, 2017;O'connor et al, 2017). Athletes playing baseball, softball, volleyball, and gymnastics reportedly have a lower risk for sustaining mTBIs compared to other contact sports (Giza et al, 2013).…”