Postural control testing is often used by clinicians and athletic trainers to assess the health of athletes during recovery from a concussion. Characterization of postural control as a clinical tool for use with youth athletes is limited though. The objective of this study was to compare performance on the Balance Error Scoring System (BESS) and a force plate protocol at the beginning and end of a season of football within a cohort of 34 healthy youth football players (average age of 9.9 ± 0.6 y). A secondary aim was to investigate if changes in measures of balance from the postseason to the preseason were correlated with head impact exposure. Players completed testing at the beginning and end of the youth football season. There were no significant differences between BESS scores before the season and after the season (P = .54). Performance on the BESS was not associated with any of the center of pressure metrics considered in this study. No correlation was observed between measures of balance and head impact exposure for the season. Further research is required to determine the viability of postural control testing with this population.
Eamon T. Campolettano, Gunnar Brolinson and Steven Rowson
Abigail M. Tyson, Stefan M. Duma and Steven Rowson
Advances in low-cost wearable head impact sensor technology provide potential benefits regarding sports safety for both consumers and researchers. However, previous laboratory evaluations are not directly comparable and do not incorporate test conditions representative of unhelmeted impacts. This study addresses those limitations. The xPatch by X2 Biosystems and the SIM-G by Triax Technologies were placed on a National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform with a Hybrid III neck which underwent impact tests using a pendulum. Impact conditions included helmeted, padded impactor to bare head, and rigid impactor to bare head to represent long- and short-duration impacts seen in helmeted and unhelmeted sports. The wearable sensors were evaluated on their kinematic accuracy by comparing results to reference sensors located at the headform center of gravity. Statistical tests for equivalence were performed on the slope of the linear regression between wearable sensors and reference. The xPatch gave equivalent measurements to the reference in select longer-duration impacts, whereas the SIM-G had large variance leading to no equivalence. For the short-duration impacts, both wearable sensors underpredicted the reference. This error can be improved with increases in sampling rate from 1 to 1.5 kHz. Follow-up evaluations should be performed on the field to identify error in vivo.
Steven Rowson, Jonathan G. Beckwith, Jeffrey J. Chu, Daniel S. Leonard, Richard M. Greenwald and Stefan M. Duma
The high incidence rate of concussions in football provides a unique opportunity to collect biomechanical data to characterize mild traumatic brain injury. The goal of this study was to validate a six degree of freedom (6DOF) measurement device with 12 single-axis accelerometers that uses a novel algorithm to compute linear and angular head accelerations for each axis of the head. The 6DOF device can be integrated into existing football helmets and is capable of wireless data transmission. A football helmet equipped with the 6DOF device was fitted to a Hybrid III head instrumented with a 9 accelerometer array. The helmet was impacted using a pneumatic linear impactor. Hybrid III head accelerations were compared with that of the 6DOF device. For all impacts, peak Hybrid III head accelerations ranged from 24 g to 176 g and 1,506 rad/s2 to 14,431 rad/s2. Average errors for peak linear and angular head acceleration were 1% ± 18% and 3% ± 24%, respectively. The average RMS error of the temporal response for each impact was 12.5 g and 907 rad/s2.
Srinidhi Bellamkonda, Samantha J. Woodward, Eamon Campolettano, Ryan Gellner, Mireille E. Kelley, Derek A. Jones, Amaris Genemaras, Jonathan G. Beckwith, Richard M. Greenwald, Arthur C. Maerlender, Steven Rowson, Stefan M. Duma, Jillian E. Urban, Joel D. Stitzel and Joseph J. Crisco
This study aimed to compare head impact exposures between practices and games in football players ages 9 to 14 years, who account for approximately 70% of all football players in the United States. Over a period of 2 seasons, 136 players were enrolled from 3 youth programs, and 49,847 head impacts were recorded from 345 practices and 137 games. During the study, individual players sustained a median of 211 impacts per season, with a maximum of 1226 impacts. Players sustained 50th (95th) percentile peak linear acceleration of 18.3 (46.9) g, peak rotational acceleration of 1305.4 (3316.6) rad·s−2, and Head Impact Technology Severity Profile of 13.7 (24.3), respectively. Overall, players with a higher frequency of head impacts at practices recorded a higher frequency of head impacts at games (P < .001, r 2 = .52), and players who sustained a greater average magnitude of head impacts during practice also recorded a greater average magnitude of head impacts during games (P < .001). The youth football head impact data quantified in this study provide valuable insight into the player exposure profile, which should serve as a key baseline in efforts to reduce injury.
Joseph J. Crisco, Bethany J. Wilcox, Jason T. Machan, Thomas W. McAllister, Ann-Christine Duhaime, Stefan M. Duma, Steven Rowson, Jonathan G. Beckwith, Jeffrey J. Chu and Richard M. Greenwald
The purpose of this study was to quantify the severity of head impacts sustained by individual collegiate football players and to investigate differences between impacts sustained during practice and game sessions, as well as by player position and impact location. Head impacts (N = 184,358) were analyzed for 254 collegiate players at three collegiate institutions. In practice, the 50th and 95th percentile values for individual players were 20.0 g and 49.5 g for peak linear acceleration, 1187 rad/s2 and 3147 rad/s2 for peak rotational acceleration, and 13.4 and 29.9 for HITsp, respectively. Only the 95th percentile HITsp increased significantly in games compared with practices (8.4%, p = .0002). Player position and impact location were the largest factors associated with differences in head impacts. Running backs consistently sustained the greatest impact magnitudes. Peak linear accelerations were greatest for impacts to the top of the helmet, whereas rotational accelerations were greatest for impacts to the front and back. The findings of this study provide essential data for future investigations that aim to establish the correlations between head impact exposure, acute brain injury, and long-term cognitive deficits.