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Design of helmets used in contact sports has been driven by the necessity of preventing severe head injuries. Manufacturing standards and pass or fail grading systems ensure protective headgear built to withstand large impacts, but design standards do no account for impacts resulting in subconcussive episodes and the effects of cumulative impacts on its user. Thus, it is important to explore new design parameters, such as the frequency-domain measures of transmissibility and mechanical impedance that are based on energy absorption from a range of impact loads. Within the experimentally determined frequency range of interest (FROI), transmissibilities above unity were found in the 0–40 Hz range with the magnitude characteristics varying considerably with impact location. A similar variability with location was observed for the mechanical impedance, which ranged from 9 N/m to 50 N/m. Additional research is required to further understand how changes in the components or materials of the components will affect the performance of helmets, and how they may be used to reduce both transmissibility and dynamic impedance.

Background Head impacts have been studied extensively in football, but little similar research has been conducted in men's lacrosse. It is important to understand the location and magnitude of head impacts during men's lacrosse to recognize the risk of head injury. Methods Descriptive epidemiology study set on collegiate lacrosse fields. Eleven men's lacrosse players (age=20.9±1.13years, mass=83.91±9.04kg, height=179.88±5.99cm) volunteered to participate. We applied X2 sensors behind the right ear of participants for games and practices. Sensors recorded data on linear and rotational accelerations and the location of head impacts. We calculated incidence rates per 1000 exposures with 95% confidence intervals for impact locations and compared the effect of impact location on linear and rotational accelerations with Kruskal-Wallis tests. Findings We verified 167 head impacts (games=112; practices=55). During games, the incidence rate was 651.16 (95% confidence interval=530.57–771.76). The high and low incidence rates for head impact locations during games were: side=410.7 (95% confidence interval=292.02–529.41) and top=26.79 (95% confidence interval=3.53–57.10). For games and practices combined, the impact locations did not significantly affect linear ( χ 2 3 =6.69, P =0.08) or rotational acceleration ( χ 2 3 =6.34, P =0.10). Interpretation We suggest further research into the location of head impacts during games and practices. We also suggest player and coach education on head impacts as well as behavior modification in men's lacrosse athletes to reduce the incidence of impacts to the side of the head in an effort to reduce potential injury.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has developed impact attenuation thresholds that protective helmets worn in sport must meet to be commercially available in an attempt to prevent injury. It remains unknown how normal helmet use in athletic activity alters the force attenuation ability of lacrosse helmets. We tested 3 new and 3 randomly selected used helmets from 2 popular lacrosse models (Cascade Pro7, Cascade CPXR). All used helmets had been worn for 3 collegiate seasons prior to testing and had never been refurbished. Helmets were drop-tested using 3 prescribed impact velocities at 6 locations according to the NOCSAE lacrosse helmet standard, and we compared the Gadd Severity Index (GSI) scores between new and used helmets using a repeated measure ANOVA with location as the repeated variable and data separated by impact velocity. All 12 helmets passed the NOCSAE GSI threshold for all testing conditions; however 1 used helmet shell cracked resulting in a failed test. We found a significant main effect for helmet age at the low (F5,50=2.98, P=.02), medium (F5,50=3.71, P=.006), and high (F5,50=2.70, P=.03) velocities. We suspect that helmet use can degrade materials under some conditions, but improve performance in others due to changes in helmet composition from use. The clinical implications of the differences in GSI scores noted remain unclear. Because one helmet shell cracked resulting in a failed test, used helmets should be regularly inspected for cracks or other signs of mechanical fatigue that may weaken helmet integrity.

Magnetic resonance spectroscopy and helmet telemetry were used to monitor the neural metabolic response to repetitive head collisions in 25 high school American football athletes. Specific hit characteristics were determined highly predictive of metabolic alterations, suggesting that sub-concussive blows can produce biochemical changes and potentially lead to neurological problems.

Context: The Guardian Cap provides a soft covering intended to mitigate energy transfer to the head during football contact. Yet how well it attenuates impacts remains unknown. Objective: To evaluate the changes in the Gadd Severity Index (GSI) and linear acceleration during drop tests on helmeted headforms with or without Guardian Caps. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Nine new football helmets sent directly from the manufacturer. Intervention(s): We dropped the helmets at 3 velocities on 6 helmet locations (front, side, right front boss, top, rear right boss, and rear) as prescribed by the National Operating Committee on Standards for Athletic Equipment. Helmets were tested with facemasks in place but no Guardian Cap and then retested with the facemasks in place and the Guardian Cap affixed. Main Outcome Measure(s): The GSI scores and linear accelerations measured in g forces. Results: For the GSI, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F10,50 = 3.01, P = .005) but not at the low (F3.23,16.15 = 0.84, P = .50) or medium (F10,50 = 1.29, P = .26) velocities. Similarly for linear accelerations, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F10,50 = 3.01, P = .002, ω2 = 0.05) but not at the low (F10,50 = 0.49, P = .89, ω2 < 0.01, 1–β = 0.16) or medium (F5.20,26.01 = 2.43, P = .06, ω2 < 0.01, 1–β = 0.68) velocities. Conclusions: The Guardian Cap failed to significantly improve the helmets' ability to mitigate impact forces at most locations. Limited evidence indicates how a reduction in GSI would provide clinically relevant benefits beyond reducing the risk of skull fracture or a similar catastrophic event.

Head trauma and concussion in football players have recently received considerable media attention. Postmortem evidence suggests that accrual of damage to the brain may occur with repeated blows to the head, even when the individual blows fail to produce clinical symptoms. There is an urgent need for improved detection and characterization of head trauma to reduce future injury risk and promote development of new therapies. In this study we examined neurological performance and health in the presence of head collision events in high school football players, using longitudinal measures of collision events (the HIT(™) System), neurocognitive testing (ImPACT(™)), and functional magnetic resonance imaging MRI (fMRI). Longitudinal assessment (including baseline) was conducted in 11 young men (ages 15-19 years) participating on the varsity and junior varsity football teams at a single high school. We expected and observed subjects in two previously described categories: (1) no clinically-diagnosed concussion and no changes in neurological behavior, and (2) clinically-diagnosed concussion with changes in neurological behavior. Additionally, we observed players in a previously undiscovered third category, who exhibited no clinically-observed symptoms associated with concussion, but who demonstrated measurable neurocognitive (primarily visual working memory) and neurophysiological (altered activation in the dorsolateral prefrontal cortex [DLPFC]) impairments. This new category was associated with significantly higher numbers of head collision events to the top-front of the head, directly above the DLPFC. The discovery of this new category suggests that more players are suffering neurological injury than are currently being detected using traditional concussion-assessment tools. These individuals are unlikely to undergo clinical evaluation, and thus may continue to participate in football-related activities, even when changes in brain physiology (and potential brain damage) are present, which will increase the risk of future neurological injury.

Although the National Operating Committee on Standards for Athletic Equipment (NOCSAE) standards are similar for football and lacrosse helmets, it remains unknown how helmets for each sport compare on drop tests. Due to the increased concern over head injury in sport and the rapid growth in lacrosse participation, it is useful to compare the performance of various football and lacrosse helmets. Therefore, the goal of this study was to document the impact attenuation properties of football and lacrosse helmets and to identify the relative performance between helmets for the two sports. Six models of football and six models of lacrosse helmets were tested using a drop tower at three prescribed velocities and six locations on the helmets. A repeated measures ANOVA was conducted to determine the effect of sport on Gadd Severity Index (GSI) scores and linear accelerations. The interaction between location and sport was significant at the low (F2.64,89.71=7.68, P

Neurocognitive assessment, functional magnetic resonance imaging, and head impact monitoring were used to evaluate neurological changes in high school football players throughout competitive seasons. A substantial number of asymptomatic athletes exhibited neurophysiological changes that persisted post-season, with abnormal measures significantly more common in athletes receiving 50 or more hits per week during the season.

Soccer is the source of the highest concussion rates among female athletes and is associated with neurological deficits at many levels of play. Despite its importance to our understanding of head trauma in female athletes, little is known about the number and magnitude of head impacts experienced by female soccer players. Head impacts experienced by high school and collegiate athletes were quantified using xPatch sensors (X2 Biosystems) affixed behind the right ear of each player. The average peak translational acceleration (PTA) sustained by players at the high school level was significantly lower than that of the collegiate players, but the average peak angular accelerations (PAA) were not significantly different. Given that the collegiate players took many more impacts throughout the season, their mean cumulative exposure to translational (cPTA) and angular accelerations (cPAA) were significantly higher than those of the high school players. Additional research is required to determine whether the differences in cumulative exposure are responsible for the elevated risk of concussion in collegiate soccer players or if there are additional risk factors.

Long-term neurological damage as a result of head trauma while playing sports is a major concern for football athletes today. Repetitive concussions have been linked to many neurological disorders. Recently, it has been reported that repetitive subconcussive events can be a significant source of accrued damage. Since football athletes can experience hundreds of subconcussive hits during a single season, it is of utmost importance to understand their effect on brain health in the short and long term. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) was used to study changes in the default mode network (DMN) after repetitive subconcussive mild traumatic brain injury. Twenty-two high school American football athletes, clinically asymptomatic, were scanned using the rs-fMRI for a single season. Baseline scans were acquired before the start of the season, and follow-up scans were obtained during and after the season to track the potential changes in the DMN as a result of experienced trauma. Ten noncollision-sport athletes were scanned over two sessions as controls. Overall, football athletes had significantly different functional connectivity measures than controls for most of the year. The presence of this deviation of football athletes from their healthy peers even before the start of the season suggests a neurological change that has accumulated over the years of playing the sport. Football athletes also demonstrate short-term changes relative to their own baseline at the start of the season. Football athletes exhibited hyperconnectivity in the DMN compared to controls for most of the sessions, which indicates that, despite the absence of symptoms typically associated with concussion, the repetitive trauma accrued produced long-term brain changes compared to their healthy peers.

With growing evidence of long-term neurological damage in individuals enduring repetitive head trauma, it is critical to detect lower-level damage accumulation for the early diagnosis of injury in at-risk populations. Proton magnetic resonance spectroscopic scans of the dorsolateral prefrontal cortex and primary motor cortex were collected from high school American (gridiron) football athletes, prior to and during their competition seasons. Although no concussions were diagnosed, significant metabolic deviations from baseline and non-collision sport controls were revealed. Overall the findings indicate underlying biochemical changes, consequential to repetitive hits, which have previously gone unnoticed due to a lack of traditional neurological symptoms.

Background Recent work suggests that repetitive sub-concussive head impacts may contribute to long-term neurodegeneration; however, the risk thresholds for sub-concussive injury are unknown. Objective To evaluate the risk of developing abnormal neurophysiology due to repetitive impacts to the head. Hypothesis: the number of head impacts is predictive of neurological impairment. Design ImPACT, fMRI, and head impact telemetry (HIT) was employed in baseline tests, pre-season and in-season. The number and magnitude of head impacts were collected for practices and games. Setting American high school football. Participants 13 high school American football players age 14–18. Those diagnosed with a concussion were excluded. Risk factor assessment The number of head impacts during the season. Main outcome measurements Pre-season and in-season ImPACT, MRI, and fMRI. Results The players experienced an average of 17.7 to 45.5 hits/week with a mean and standard deviation of 71.7±39.3. The corresponding cumulative number of hits for the season ranged from 86 to 1996 with a mean and standard deviation of 582.8±444.3. Twenty-two in-season ImPACT tests were administered during the season. Twelve (54.5%) showed a minimum of one composite score flagged, the fMRI analysis showed 16 (72.7%) in-season assessments flagged, and seven subjects were flagged by both the ImPACT and fMRI. Groups were divided based on number of head impacts; those above & below 500 cumulative hits/season and above and below 65 hits/week. Above 500 cumulative hits/season and 65 hits/week, all examinations were flagged. Conclusions A number of asymptomatic athletes exhibited neurophysiological changes. The number of head impacts is a risk factor for the development of neurophysiological changes. The medical staff should monitor players who are taking large numbers of hits, consider using neurocognitive testing on an annual basis, and promote proper technique and skill development for the players.