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  • 1
    In: Biomedical Sciences Instrumentation, International Academic Express, Vol. 57, No. 2 ( 2021-04-01), p. 106-113
    Abstract: Previous studies have investigated the head impact kinematics of purposeful heading in youth soccer; however, less than a third of all head injuries in youth soccer have been found to involve ball contact. The aim of the current study was to identify the head impact kinematics and exposure not associated with purposeful heading of the ball in male youth soccer. Headband-mounted sensors were used to monitor the head kinematics of male junior varsity and middle school teams during games. Video analysis of sensor-recorded events was used to code impact mechanism, surface and site. Junior varsity players had non-header impact rates of 0.28 per athlete-exposure (AE) and 0.37 per player-hour (PH), whereas middle school players had relatively lower non-header impact rates of 0.16 per AE and 0.25 per PH. Such impact rates fell within the large range of values reported by previous studies, which is likely affected by sensor type and recording trigger threshold. The most common non-header impact mechanism in junior varsity soccer was player contact, whereas ball-to-head was the most common non-header impact mechanism in middle school soccer. Non-header impacts for junior varsity players had median peak kinematics of 31.0 g and 17.4 rad/s. Non-header impacts for middle school players had median peak kinematics of 40.6 g and 16.2 rad/s. For non-header impacts, ball impacts to the rear of the head the highest peak kinematics recorded by the sensor. Such data provide targets for future efforts in injury prevention, such as officiating efforts to control player-to-player contact.
    Type of Medium: Online Resource
    ISSN: 1938-1158
    URL: Issue
    Language: Unknown
    Publisher: International Academic Express
    Publication Date: 2021
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  • 2
    In: Optometry and Vision Science, Ovid Technologies (Wolters Kluwer Health), Vol. 99, No. 8 ( 2022-8), p. 616-625
    Abstract: Eye tracking assessments that include pupil metrics can supplement current clinical assessments of vision and autonomic dysfunction in concussed adolescents. PURPOSE This study aimed to explore the utility of a 220-second eye tracking assessment in distinguishing eye position, saccadic movement, and pupillary dynamics among uninjured adolescents, those with acute post-concussion symptoms (≤28 days since concussion), or those with persistent post-concussion symptoms ( 〉 28 days since concussion). METHODS Two hundred fifty-six eye tracking metrics across a prospective observational cohort of 180 uninjured adolescents recruited from a private suburban high school and 224 concussed adolescents, with acute or persistent symptoms, recruited from a tertiary care subspecialty concussion care program, 13 to 17 years old, from August 2017 to June 2021 were compared. Kruskal-Wallis tests were used, and Bonferroni corrections were applied to account for multiple comparisons and constructed receiver operating characteristic curves. Principal components analysis and regression models were applied to determine whether eye tracking metrics can augment clinical and demographic information in differentiating uninjured controls from concussed adolescents. RESULTS Two metrics of eye position were worse in those with concussion than uninjured adolescents, and only one metric was significantly different between acute cases and persistent cases. Concussed adolescents had larger left and right mean, median, minimum, and maximum pupil size than uninjured controls. Concussed adolescents had greater differences in mean, median, and variance of left and right pupil size. Twelve metrics distinguished female concussed participants from uninjured; only four were associated with concussion status in males. A logistic regression model including clinical and demographics data and transformed eye tracking metrics performed better in predicting concussion status than clinical and demographics data alone. CONCLUSIONS Objective eye tracking technology is capable of quickly identifying vision and pupillary disturbances after concussion, augmenting traditional clinical concussion assessments. These metrics may add to existing clinical practice for monitoring recovery in a heterogeneous adolescent concussion population.
    Type of Medium: Online Resource
    ISSN: 1538-9235 , 1040-5488
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2083924-8
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  • 3
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 2 ( 2022-03), p. 108-113
    Abstract: To evaluate the discriminatory ability of different repetition increments of saccades and gaze stability testing for diagnosing concussion in adolescents. Design: Cross-sectional. Setting: Suburban high school and academic pediatric tertiary care center. Participants: Sixty-nine adolescent athletes within 28 days of a sports- or recreation-related concussion and 69 adolescent athletes without recent concussion. Assessment of Independent Variables: Symptom provocation with horizontal and vertical saccades and gaze stability testing performed up to 30 repetitions. Main Outcome Measures: Sensitivity and specificity at 10-repetition increments (≤10, ≤20, ≤30) and area under the receiver operating characteristic curves (AUC) of a visio-vestibular examination (VVE) subscore, scored 0 to 4 based on the number of assessments with symptom provocation, at each repetition increment. Results: Sensitivity improved when increasing from ≤10 to ≤20 to ≤30 repetitions for horizontal (25% to 50% to 69%) and vertical (32% to 52% to 74%) saccades and horizontal (19% to 45% to 71%) and vertical (23% to 45% to 72%) gaze stability. Specificity was comparable at ≤10 and ≤20 repetitions, but decreased at ≤30 repetitions across assessments. For a VVE subscore (0-4) based on the number of symptomatic assessments, the discriminatory ability of the test was highest at ≤20 repetitions (AUC of 0.79) with an optimal subscore of one (sensitivity 59%, specificity 96%). Conclusions: A VVE including a higher threshold level of repetitions for saccades and gaze stability has improved discriminatory ability for concussion, with an optimized AUC of 0.79 at ≤20 repetitions. Clinical Relevance: The findings in this study suggest that a higher threshold level of repetitions of 2 commonly used visio-vestibular assessments enables clinicians to more accurately diagnose youth concussion.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2045233-0
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  • 4
    In: JAMA Ophthalmology, American Medical Association (AMA), Vol. 138, No. 11 ( 2020-11-01), p. 1135-
    Type of Medium: Online Resource
    ISSN: 2168-6165
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
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  • 5
    In: Biomedicines, MDPI AG, Vol. 11, No. 7 ( 2023-06-25), p. 1816-
    Abstract: Auditory and visually evoked potentials (EP) have the ability to monitor cognitive changes after concussion. In the literature, decreases in EP are commonly reported; however, a subset of studies shows increased cortical activity after injury. We studied auditory and visual EP in 4-week-old female Yorkshire piglets (N = 35) divided into anesthetized sham, and animals subject to single (sRNR) and repeated (rRNR) rapid non-impact head rotations (RNR) in the sagittal direction. Two-tone auditory oddball tasks and a simple white-light visual stimulus were evaluated in piglets pre-injury, and at days 1, 4- and 7 post injury using a 32-electrode net. Traditional EP indices (N1, P2 amplitudes and latencies) were extracted, and a piglet model was used to source-localize the data to estimate brain regions related to auditory and visual processing. In comparison to each group’s pre-injury baselines, auditory Eps and brain activity (but not visual activity) were decreased in sham. In contrast, sRNR had increases in N1 and P2 amplitudes from both stimuli. The rRNR group had decreased visual N1 amplitudes but faster visual P2 latencies. Auditory and visual EPs have different change trajectories after sRNR and rRNR, suggesting that injury biomechanics are an important factor to delineate neurofunctional deficits after concussion.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2720867-9
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  • 6
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  Annals of Biomedical Engineering Vol. 48, No. 11 ( 2020-11), p. 2497-2507
    In: Annals of Biomedical Engineering, Springer Science and Business Media LLC, Vol. 48, No. 11 ( 2020-11), p. 2497-2507
    Type of Medium: Online Resource
    ISSN: 0090-6964 , 1573-9686
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1477155-X
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  • 7
    Online Resource
    Online Resource
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 5 ( 2020-04), p. 1246-1253
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 5 ( 2020-04), p. 1246-1253
    Abstract: Recent advances in technology have enabled the development of head impact sensors, which provide a unique opportunity for sports medicine researchers to study head kinematics in contact sports. Studies have suggested that video or observer confirmation of head impact sensor data is required to remove false positives. In addition, manufacturer filtering algorithms may be ineffective in identifying true positives and removing true negatives. Purpose: To (1) identify the percentage of video-confirmed events recorded by headband-mounted sensors in high school soccer through video analysis, overall and by sex; (2) compare video-confirmed events with the classification by the manufacturer filtering algorithms; and (3) quantify and compare the kinematics of true- and false-positive events. Study Design: Cohort study; Level of evidence, 2. Methods: Adolescent female and male soccer teams were instrumented with headband-mounted impact sensors (SIM-G; Triax Technologies) during games over 2 seasons of suburban high school competition. Sensor data were sequentially reduced to remove events recorded outside of game times, associated with players not on the pitch (ie, field) and players outside the field of view of the camera. With video analysis, the remaining sensor-recorded events were identified as an impact event, trivial event, or nonevent. The mechanisms of impact events were identified. The classifications of sensor-recorded events by the SIM-G algorithm were analyzed. Results: A total of 6796 sensor events were recorded during scheduled varsity game times, of which 1893 (20%) were sensor-recorded events associated with players on the pitch in the field of view of the camera during verified game times. Most video-confirmed events were impact events (n = 1316, 70%), followed by trivial events (n = 396, 21%) and nonevents (n = 181, 10%). Female athletes had a significantly higher percentage of trivial events and nonevents with a significantly lower percentage of impact events. Most impact events were head-to-ball impacts (n = 1032, 78%), followed by player contact (n = 144, 11%) and falls (n = 129, 10%) with no significant differences between male and female teams. The SIM-G algorithm correctly identified 70%, 52%, and 66% of video-confirmed impact events, trivial events, and nonevents, respectively. Conclusion: Video confirmation is critical to the processing of head impact sensor data. Percentages of video-confirmed impact events, trivial events, and nonevents vary by sex in high school soccer. Current manufacturer filtering algorithms and magnitude thresholds are ineffective at correctly classifying sensor-recorded events and should be used with caution.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 8
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 3 ( 2021-03-01), p. 232596712098442-
    Abstract: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6] ), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 9
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0048-
    Abstract: A potential objective measure that may assist in identifying vision disorders after concussion is the pupillary light reflex (PLR), which is under autonomic control and contributes to normal convergence and accommodative function which is altered after concussion. This study sought to compare pupillometry measures in adolescents with concussion initially presenting for care in the early acute time frame (≤ 2 weeks post-concussion) to those presenting in the later acute time frame (4 ± 1 weeks). Hypothesis: To determine whether PLR metrics are similar or different between athletes with concussion presenting earlier (≤ 2 weeks post-concussion) for care vs. those presenting later for care (4 ± 1 weeks). Methods: Athletes, ages 12-18 years, with a diagnosis of sport-related concussion (n = 110) were recruited. 89 concussed subjects had their PLR assessment performed at an early acute time point ≤ 2 weeks after concussion, while 21 concussed subjects had their first assessment at a later acute time point (4 week±1 week). Pupillary dynamics were measured in response to a brief, step-input, white light stimulus (154 ms duration; 180 micro watts power) via a Neuroptics PLR-3000 hand-held, infrared, automated, monocular pupillometer (Neuroptics, Irvine, CA). The means of the PLR metrics were compared between groups with one-way Student’s t test. Bonferroni correction was applied. Results: The baseline pupil diameter (mean ± SD) was significantly larger (p 〈 0.05) for the subjects seen later 4 ± 1 week (5.09 mm ± 0.63) as compared to the cohort of subjects who presented earlier within 2 weeks after injury (4.72 ± 0.79mm). Average constriction velocity ACV for the later-presenting cohort (3.35±0.45 mm/s) was significantly faster compared to the early-presenting cohort (3.04±0.59 mm/s). Similarly, maximum constriction velocity for the groups were significantly different (early 4.82±0.90 versus late 5.31±0.70 mm/s), even after Bonferroni correction (p 〈 0.05), with alpha of 0.025. All the other pupillometric parameters were not different from each other. Conclusion: When comparing adolescents with concussion presenting early in the acute phase ≤ 2 weeks after concussion to those presenting later in the acute timeframe to care 4±1 weeks, those presenting later demonstrate enhancement of certain PLR metrics, namely larger baseline pupil diameter and faster average constriction velocity (ACV) and maximum constriction velocity (MCV). Differences in these PLR metrics in those presenting later in the acute timeframe may represent findings in those who are more likely to have persisting post-concussion symptoms, potentially shedding light on pathophysiological underpinnings of lingering symptoms.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 10
    Online Resource
    Online Resource
    Human Kinetics ; 2021
    In:  Journal of Applied Biomechanics Vol. 37, No. 6 ( 2021-12-1), p. 573-577
    In: Journal of Applied Biomechanics, Human Kinetics, Vol. 37, No. 6 ( 2021-12-1), p. 573-577
    Abstract: Field studies have evaluated the accuracy of sensors to measure head impact exposure using video analysis, but few have studied false negatives. Therefore, the aim of the current study was to investigate the proportion of potential false negatives in high school soccer head impact data. High school athletes (23 females and 31 males) wore headband-mounted Smart Impact Monitor-G impact sensors during competitive soccer games. Video footage from 41 varsity games was analyzed by 2 independent reviewers to identify head contact events, which were defined as visually observed contact to the head. Of the 1991 video-identified head contact events for which sensors were functioning and worn by the players, 1094 (55%) were recorded by the sensors. For female players, 45% of video-identified head contact events were recorded by the sensor compared with 59% for male players. For both females and males, sensitivity varied by impact mechanism. By quantifying the proportion of potential false negatives, the sensitivity of a sensor can be characterized, which can inform the interpretation of previous studies and the design of future studies using head impact sensors. Owing to the difficulty in obtaining ground truth labels of head impacts, video review should be considered a complementary tool to head impact sensors.
    Type of Medium: Online Resource
    ISSN: 1065-8483 , 1543-2688
    Language: Unknown
    Publisher: Human Kinetics
    Publication Date: 2021
    SSG: 12
    SSG: 31
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