bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-linear correlation between cumulative sub-concussive head impact trauma and severity of localised brain white matter changes in college athletes
Authors: John Ralston , Jason Thibado , Woodard Jonathan , Cieslak Matthew , Alex Asturias , Scott Grafton 
Published: November 2017

ObjectiveTest for a dose dependent relationship between cumulative sub-concussive head trauma loading and localised changes of brain white matter in college athletes.DesignProspective cohort studySettingNCAA Division I Women’s SoccerParticipants10 players were monitored for head impacts throughout a soccer season using wearable sensors. Linear and rotational accelerations recorded during impacts were processed to calculate the cumulative impact power. Diffusion spectrum imaging (DSI) data were acquired at season start and at 3 additional intervals. 11 age and gender matched control data sets were acquired.InterventionOne athlete suffered a concussion, was removed from play for neurocognitive testing, and entered a supervised return-to-play protocol.Outcome measuresCumulative impact power was used as a measure of the head trauma load accumulated prior to each MRI. Multi-dimensional anisotropy (MDA) values assessed localised severity of white matter changes. Session specific differences between each player’s MDA values and those of the control population were used to relate cumulative impact power and the severity of white matter changes.Main resultsHighly significant clusters of abnormal voxels were observed in athletes with no diagnosed concussion symptoms. Injury severity correlated with cumulative head impact power and demonstrated a pronounced threshold behaviour. MDA diffusion changes were located mainly within the frontal and occipital cortex at the gray-white boundary, and to a lesser degree in deep subcortical areas where there is a higher proportion of crossing fibres.ConclusionsThis cohort demonstrates dose dependent changes in white matter integrity as a function of cumulative sub-concussive head trauma.Competing interestsSG is supported, in part, by a research grant from X2 Biosystems and a General Electric-National Football League Head Health Challenge award.
Concussion knowledge, attitudes, and perceived level of involvement by american youth sport coaches in concussion management
Authors: Kay Melissa C , Williams Richelle M , Valovich McLeod Tamara C , Register-Mihalik Johna K 
Published: November 2017

ObjectiveTo describe concussion knowledge and attitudes of youth sport coaches and relationships among knowledge, attitudes, and perceptions of coach involvement in concussion management.DesignCross-sectional survey.SettingYouth sport coaches in North Carolina and Arizona.Subjects81 youth sport coaches (males: n=69; females: n=11; age=42, IQR=33,45).InterventionA validated survey identifying demographics, concussion knowledge, attitudes, and beliefs.Outcome measuresThe primary outcome was perceived level of coach involvement in concussion management. Descriptive and univariable statistics were used to examine knowledge and attitude differences by demographic factors and perceived involvement. Multivariable logistic regression examined associations between knowledge and attitude and perceived level of coach involvement (lower agreement vs. higher agreement).ResultsKnowledge was low-moderate (Median=13/23, IQR=11,14.5), with 75% indicating a loss of consciousness always occurs with concussion. Attitudes were positive (Median=42/42, IQR=40,42). Forty-seven (58%) strongly agreed or agreed that coaches should be involved in clinical decision-making. There were no differences in knowledge or attitudes across gender, age, previous concussion education, or previous concussion history. Knowledge and attitude were not correlated (r=0.114; p=0.343). There were no knowledge (Median=13, IQR=12,15 vs. Median = 12, IQR=11,14) or attitude (Median=42, IQR=41,42 vs. Median = 42, IQR=39,42) differences between lower and higher perceived involvement, respectively. No associations were observed in the multivariable model with perceived coach involvement (p>0.05).ConclusionsCoaches had limited knowledge, but expressed positive attitudes towards concussion. Educational efforts should target both knowledge and attitudes, as these constructs are not related, but are both key to improving the culture concerning concussion.Competing interestsThe project was funded in part by a grant from the National Operating Committee on Standards for Athletic Equipment.
Effect of protective helmets on vision and sensory performance
Authors: Kramer Michelle R , Wasserman Erin B , Teel Elizabeth F , Mihalik Jason P 
Published: November 2017

ObjectiveThe purpose of this study was to determine the effect of protective helmets (i.e., football, lacrosse, and ice hockey helmets) on vision and sensory performance.DesignExperimental cross-over study.SettingClinical research centre.SubjectsA convenience sample of 24 healthy college-aged males who played American football (n=14), lacrosse (n=5), or ice hockey (n=5) at a minimum of a high school level.InterventionParticipants completed vision and sensory performance assessments under two counterbalanced conditions: helmeted and unhelmeted.Outcome measuresThe Senaptec Sensory Station assesses visual clarity (LogMAR), contrast sensitivity (logarithm of contrast sensitivity), depth perception (arcsec), near-far quickness (# cycles complete), target capture (threshold response time), perception span (# correct responses), multiple object tracking (tracking capacity), eye-hand coordination (average response time), go/no go (correct minus incorrect hits), and hand reaction time (average reaction time). The overall helmet effect and helmet-by-sport interactions were assessed.ResultsParticipants performed 40.7ms slower on eye-hand coordination (95% Confidence Interval [CI]: −66.64, −14.83; p<0.01) and 3.4 points lower on go/no go (95% CI: 1.56, 5.32; p<0.01) when wearing a helmet. Hockey helmets significantly affected visual clarity (95% CI: −0.3701, −0.0883; p=0.01) and hand reaction time (95% CI: −38.67, −9.73; p<0.01), but football and lacrosse helmets did not.ConclusionsVision and sensory performance was negatively impacted by wearing a helmet. This inability to see and respond to visual stimuli could have implications for athlete safety and performance, and should be explored further in other at-risk populations such as youth and female athletes.Competing interestsKramer: None.Wasserman: None.Teel: None.Mihalik: Dr. Mihalik has an equity interest in Senaptec LLCKeywords: Concussion, Injury prevention, Vision, Helmet, Facemask
Normative performance on cleveland clinic concussion application for youth, high school and college athletes
Authors: Figler Rick , Linder Susan , Russman Andrew , Cruickshank Jason , Grey Bob , Ozinga Sarah , Lally Maureen , Day Tanujit , Alberts Jay 
Published: November 2017

ObjectiveThe utilisation of a multi-factorial approach to evaluating relevant neuro-cognitive and motor function is a critical element in effective and comprehensive concussion management. In this project, normative data were gathered utilising the Cleveland Clinic Concussion (C3) iPad Application in youth, high school and college athletes.DesignProspective normative study.SettingField-based.ParticipantsPre-season C3 data were collected in more the 6,500 youth (N=607), high school (N=5415) and college (N=744) athletes; approximately 32% females. Data were collected between Fall 2014 and Spring 2015.InterventionsNA.Outcome measuresNeurocognitive assessment modules of C3 include information processing (simple and choice reaction time), attention and working memory (Trail Making Test) and postural stability. Balance is quantified through biomechanical processing of accelerometer and gyroscope data gathered from the iPad during performance of the BESS.Main resultsNo gender effects were present for performance on the neurocognitive modules; however, postural stability was significantly worse for youth males compared to female peers (P<0.01). Youth were significantly slower in performance of neurocognitive modules (simple and choice reaction time and Trails; (P<0.0001)). Neurocognitive and postural stability measures were similar across high school and college athletes.ConclusionsSlower neurocognitive performance in youth relative to older athletes underscores the need to utilise age appropriate normative data in the management of concussion, particularly if no baseline is acquired. The control of postural stability develops at different rates as a function of age and gender, therefore balance assessment across the injury spectrum must utilise specific age-gender normative values.Competing interestsJLA, SML and SBO have authored intellectual property associated with the mobile application presented in this study.
Level of knowledge and attitude towards sport-related concussion among the general?public
Authors: Gardner Andrew J , Kay-Lambkin Frances , Shultz Sandy R , Iverson Grant L 
Published: November 2017

ObjectiveTo investigate attitudes and knowledge of concussion.DesignOnline survey.SettingOnline questionnaire for the general public.ParticipantsAthletes, coaches, parents, sports administrators, and fans, aged 18–80 years.AssessmentA 75 question survey about the respondents’ concussion knowledge, sources of that knowledge, and attitudes toward injury.Outcome measuresFrequency of responses.Main resultsOf the 210 respondents who initiated the survey, there were 146 complete datasets. Respondents identified themselves as fans (46%), athletes (43%), coaches (20%), parents (18%), and administrators (13%). Most (85%) claimed to have little to average level of knowledge regarding concussion, the main source of knowledge for 26% of respondents was the media, and 59% had no knowledge of concussion guidelines (only 21% of respondents had heard of the Consensus Statement on Concussion in Sport), although 74% claimed to have knowledge of return-to-play guidelines. When considering reporting a concussion during a game, 77% considered it to be important, 77% beneficial, 74% valuable, 49% brave, and 21% easy. Most respondents indicated that it was extremely serious to experience headaches or dizziness after a blow to the head (54%), extremely important not to participate in physical activity when experiencing signs of concussion (67%), and extremely important to report concussion signs (77%). Respondents’ indicated that it was extremely important for players to be informed about: how concussions occur (67%), concussion prevention (67%), and what to do following concussion (82%). Some respondents (34%) strongly agreed that athletes are undereducated about concussion.ConclusionsPublic knowledge about concussion is modest.Competing interestsAndrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He serves, in a voluntary capacity, as a member of the Australia Rugby Union (ARU) concussion advisory group. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas. He is currently funded through the HMRI, supported by Anne Greaves.Frances Kay-Lambkin: None.Sandy Shultz: None.Grant Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes).
Racial disparities in concussion knowledge and awareness in american adolescent athletes
Authors: Wallace Jessica , Covassin Tracey , Nogle Sally , Gould Daniel , Kovan Jeffrey 
Published: November 2017

ObjectiveTo examine if concussion knowledge and awareness disparities exists between underserved African American (AA) adolescent athletes and Caucasian athletes; and, if disparities exist between AAs with and without access to a full-time athletic trainer (AT).DesignCross-sectional.SettingParticipants from 14 US high schools (9 within underserved, AA communities and 5 within predominantly Caucasian communities) completed a one-time paper and pencil knowledge of concussion questionnaire.Participants577 athletes (372 AA, 205 Caucasian). All participants completed concussion education mandated by the government; participants without documentation of completion were excluded.InterventionRace and AT access were the independent variables.Outcome measuresKnowledge of concussion was examined using a validated instrument that included 35 questions. Participants were instructed to identify signs and symptoms of concussion, complications of multiple concussions, and answer questions pertaining to general concussion awareness among distractors. Total knowledge was calculated by summing the number of correct answers out of 35. Scores could range from 0 to 35. Scores closer to 35 represented greater knowledge. Data were analysed with frequency statistics and independent t-tests. Knowledge score was the dependent variable; p=0.05.Main resultsCaucasian adolescents have greater concussion knowledge than AA adolescents (t (2, 575)=5.47, p<0.001). AA adolescents with access to an AT have more knowledge than AAs lacking access to an AT (t (2, 370)=2.58, p=0.01).ConclusionsParticipation of AA adolescents in concussion-risk sports, such as football, is very high; therefore, education efforts in underserved communities must address the knowledge gap and disparity of care.Competing interestsNone.
Tackle technique and body position of the tackler and ball carrier significantly influences head injury risk in rugby union
Authors: Tucker Ross , Hester Ben , Cross Matthew , Kemp Simon , Raftery Martin 
Published: November 2017

ObjectiveInterventions to reduce head injury range from law changes to technique training and education. The effective targeting of such interventions requires that the mechanism of injury be well understood. This study describes the events contributing to head injuries in Rugby Union.DesignAn observational study with a cohort comprised of six professional Rugby Union competitions. Every Head Injury Assessment (HIA) reported during a three-year period was documented and described according to 15 descriptive criteria.Outcome measuresDescriptive criteria, and combinations thereof, including preceding and inciting event, tackle type, speed, direction and technique-related variables. The incidence of head injury was calculated per 1,000 events for each variableMain results611 HIAs were performed in 1,516 matches. 464 HIAs occurred after tackles (1.94 HIAs/1000 tackles). Active shoulder tackles, front-on tackles and high speed tackles have the greatest incidence of head injuries. For any tackle type and tackler position, the lowest incidence of HIAs occurs when the ball carrier is bent at the waist (1.2 HIAs/1000 tackles vs 2.4 and 9.8 HIAs/1000 tackles for upright and falling positions, respectively). For any ball carrier position, the greatest risk of head injury exists when the tackler is upright (2.7 HIAs/1000 tackles vs 1.9 and 1.2 HIAs/1000 tackles for bent at waist and diving, respectively).ConclusionsTechnique components of the tackle, related primarily to the body position adopted by the tackler and ball carrier, significantly influence head injury risk. Interventions may be targeted at improving these variables to reduce head injury incidence in the sport.Competing interestsThe primary author is employed in a scientific and research role by World Rugby (Pty) Ltd, who also funded the research study.
The incidence of concussion and risk of subsequent concussions in professional rugby league
Authors: Hodgson Lisa , Gissane Conor , Walker Peter , Maruff Paul , Darby David 
Published: November 2017

ObjectiveRecognition and management of concussion within sport is a hot topic as research suggests that the mismanagement can lead to extended time out of play and morbidity after retirement. This study aimed to identify the incidence and risk following concussion within the Rugby Football League and if full recovery from concussion increases the risk of subsequent concussions.DesignRetrospective studyMethodParticipant players were those who held a professional contract between 2006–2012. It is mandatory to provide an annual baseline test and following any diagnosed concussion, with full symptom resolution, a valid return to play test. Concussion test data was provided by CogState Australia from tests performed over 7 seasons.ResultsOver the 7 seasons 4762 players suffered 470 concussion (2.65/1000 hours, 95% Confidence Interval 2.4 to 2.9). The odds of sustaining 1 concussion was 7%, the odds of receiving 2 or more was 1%, and 0.3% 3 or more concussions. The time between concussions for any individual who suffered two or more concussions was on average 355 days. The average return to play time was 1.46 days following the first return to play test.ConclusionsThis report is the first to follow rugby league players over a prolonged period and, the first to demonstrate the risk of subsequent concussions. In rugby league, concussions managed correctly and fully resolved were not shown to have detrimental effects on future concussions, and in general there is a lack of evidence linking appropriately managed concussions in other sports to detrimental future effects.Competing interestsLisa Hodgson, Conor Gissane, Peter Walker David Darby – None.Paul Maruff – Full time employee of CogState.David Darby – Former Founder and Director of Cogstate.
The incidence, risk factors predicting injury and severity of injuries sustained during professional mixed martial arts (mma) competition in africa
Authors: Venter Santa-Marie , Grant CC , Fletcher Lizelle 
Published: November 2017

ObjectiveTo determine the incidence of injuries and associated risk factors, as well as the severity of injuries sustained by professional male MMA athletes competing at the Extreme Fighting Championships Africa (EFC Africa) from 2010 to June.DesignResults from this descriptive study were compared to a similar study done in the United States of America (USA).SettingMedical records of all professional events (2010–2014) were obtained from EFC Africa (custodian).ParticipantsData was obtained from 173 male competitors aged 18 to 44 years, participating in 300 professional MMA fights.Outcome measuresStatistical analyses include descriptive statistics and a stepwise logistic regression. The odds of an injury were predicted with six independent variables: fight outcome, age, weight division, number of fights, injuries in preceding fight and years of fighter experience.Main resultsInjuries to the head, face and neck were most common (45.9%), followed by traumatic brain injuries (knock-outs) (16.6%) and hypoxic brain injuries (chokes) (10.2%). Losing a fight was a significant predictor of injury when a stepwise logistic regression model was employed (p=0.040). The odds ratio indicated that preceding fight injury almost doubled the risk of sustaining an injury in following fight (1.91; p=0.163). TBI in the SA group (16.6%) was substantially higher than the USA group (1.8%).ConclusionThe high rate of TBI’s in SA competition is concerning. This could reflect superior refereeing in the USA group, as fights may be ended sooner by referee stoppage, versus allowing fights to continue until one fighter is knocked-out.Competing interestsNone.
The online concussion awareness training tool (catt)
Authors: Babul Shelina , Pike Ian 
Published: November 2017

ObjectiveTo support standardise concussion recognition, diagnosis, treatment and management through an evaluated online resource based upon the Zurich Consensus Statement on Concussion in Sport and other evidence-based resources. The online Concussion Awareness Training Tool (CATT–www.cattonline.com) includes three free toolkits providing training for: Medical Professionals–MP; Parents, Players and Coaches–PPC; School Professionals–SP.DesignPre-post intervention survey with sample size of at least 33 for power to detect a large effect size of 0.5.SettingBritish Columbia, Canada.ParticipantsMP: 42 physicians and 33 nurses practising in BC; PPC: 35 parents in BC with a child registered in organised sport; SP: 43 K-12 teachers working in BC.InterventionCATT MP aims to standardise practice in a clinical setting with a focus on the paediatric patient. CATT PPC speaks to concussion identification and management, with Smartphone accessible resources:Concussion Response ToolandQuestions to Ask Your Doctor. CATT SP includesReturn-to-Learnprotocol and resources for teachers, administrators, counsellors and others in the school setting.Outcome measuresChange in knowledge, attitudes and practices.ResultsCATT MP was launched April 2013. Physicians demonstrated significant positive change in concussion practices (p=0.001), and significant change in knowledge by those treating more than 10 concussions per year (p=0.039). Nurses had significant positive change in practices (p=0.005) and attitudes (p=0.035). CATT PPC was launched June 2014. Parents demonstrated significant positive change in concussion knowledge (p=0.002). CATT SP was launched February 2016; evaluation in process.ConclusionsCATT increases concussion knowledge and awareness among target audiences.Competing interestsNone.
Profiling head accelerations using triaxial accelerometery during ‘bodies in front’ training play: a preliminary study of the sport of rugby league
Authors: Atkins Stephen J , Bentley Ian , Hurst Howard T , Mark E Mark E , Richardson Cassandra , Sinclair Jonathan K 
Published: November 2017

ObjectiveTo provide unique descriptive information on head accelerations, both linear and rotational, during ‘bodies in front’ training play.DesignA convenience sample were tested using a cross-sectional design. Players wore a triaxial accelerometer (XPatch, X2 Biosystems, Seattle) during two sessions of training gameplay (session duration 142±26 min). Accelerometers were affixed on the left side of the head, at a point approximate to the external occipital protuberance.SettingTesting was undertaken at an elite performance training centre.Participants20 elite, professional, rugby league players.Main outcome measuresMinimum recordable accelerations were set at 10 g (linear acceleration) and 25 rads s-2(rotational acceleration).ResultsA total of 1256 recorded ‘hits’ were analysed, excluding evident artefacts. No player was reported to have suffered a concussion. Player ‘loading’ was 46±33 hits per session (range 7–170). Average linear (14.9±8.8 g) and rotational (532±347 rads s-2) accelerations were not significantly different between training sessions (P>0.05). Frequency of hits are summarised in the table below.Abstact 20 Table 1Linear acceleration (g)Cumulative%Rotational acceleration (rads s–2)Cumulative%10–2092.625–50064.721–405.4501–100027.541–600.71001–20005.461–800.52001–30001.681–1000.43001–40000.8>1010.4>40010ConclusionsThe majority of head accelerations occurred within lower ‘sub-concussive’ zones. This confirms existing research findings from other sports. Whilst few accelerations occurred in higher zones, there were a number of very high loading impacts observed in ‘hit up forward’ positions. Our research confirms the suitability of using portable accelerometers in determining head accelerations in full-contact, ‘armourless’, invasion games.Competing interestsNone.