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Clinical Trial
. 2020 Nov;48(11):2667-2677.
doi: 10.1007/s10439-020-02640-8. Epub 2020 Oct 27.

High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video

Adam J Bartsch  1 , Daniel Hedin  2 , Jay Alberts  3 , Edward C Benzel  3 , Jason Cruickshank  3 , Robert S Gray  3 , Kenneth Cameron  4 , Megan N Houston  4 , Tyler Rooks  5 , Gerald McGinty  6 , Erick Kozlowski  6 , Steven Rowson  7 , Joseph C Maroon  8 , Vincent J Miele  8 , J Chris Ashton  9 , Gunter P Siegmund  10 , Alok Shah  11 , Michael McCrea  11 , Brian Stemper  11
Affiliations
Clinical Trial

High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video

Adam J Bartsch et al. Ann Biomed Eng. 2020 Nov.

Abstract

The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40-100 g, 3.3-7.0 m/s and 35-118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts.

Keywords: American football; Concussion; Head impact sensor; Mouthguard; Obvious performance decrement; Video review.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of the manuscript. Cleveland Clinic has entered into an exclusive license agreement with Prevent Biometrics for instrumented mouthguard technology on which AB, EB and VM are inventors. AB is also an employee of Prevent Biometrics. The conflicts disclosed here are managed by the Cleveland Clinic Conflict Management Board. Complete details can be found at https://my.clevelandclinic.org/ccf/media/files/About/COI.pdf

Figures

Fig. 1a
Fig. 1a
Distribution of n=1716 video-verified head impacts with Peak CG Linear Acceleration (PLA) >10g from current study.
Fig. 1b
Fig. 1b
Peak Angular Acceleration (PAA) head impact distribution.
Fig. 1c
Fig. 1c
Peak Linear Velocity (PLV) head impact distribution.
Fig. 1d
Fig. 1d
Peak Angular Velocity (PAV) head impact distribution.
Fig. 1e
Fig. 1e
Estimated Kinetic Energy Transfer (KET) head impact distribution.
Fig. 1f
Fig. 1f
Head impact locations for current study.
Fig. 2a
Fig. 2a
Video-verified impacts (hollow squares) and clinician verified ‘Questionable’ (filled diamonds) and ‘Likely’ OPD impacts (filled circles) as quantified by PLA and PAA.
Fig. 2b
Fig. 2b
Video-verified impacts (hollow squares) and clinician verified Questionable (filled diamonds) and Likely OPD impacts (filled circles) as quantified by PLV and PAV.
See this image and copyright information in PMC

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