Hostname: page-component-77f85d65b8-8wtlm Total loading time: 0 Render date: 2026-04-12T07:49:17.637Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological Change After a Single Season of Head Impact Exposure in Youth Football

Published online by Cambridge University Press:  07 August 2020

Arthur Maerlender Open the ORCID record for Arthur Maerlender [Opens in a new window] ,
Eric Smith ,
P. Gunnar Brolinson ,
Joseph Crisco ,
Jillian Urban ,
Amaris Ajamil ,
Steven Rowson ,
Eamon T. Campolettano ,
Ryan A. Gellner  and
Srinidhi Bellamkonda
...Show all authors
Arthur Maerlender*
Affiliation:
University of Nebraska-Lincoln, Lincoln, NE 68588, USA
Eric Smith
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
P. Gunnar Brolinson
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA Department of Family and Sports Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA 24060, USA
Joseph Crisco
Affiliation:
Department of Orthopedics, Brown University, Providence, RI 02912, USA
Jillian Urban
Affiliation:
School of Biomedical Engineering and Sciences, Wake Forest University, Winston-Salem, NC 27109, USA
Amaris Ajamil
Affiliation:
Simbex, Inc., Lebanon, NH 03766, USA
Steven Rowson
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
Eamon T. Campolettano
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
Ryan A. Gellner
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
Srinidhi Bellamkonda
Affiliation:
Department of Orthopedics, Brown University, Providence, RI 02912, USA
Emily Kieffer
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
Mireille E. Kelley
Affiliation:
School of Biomedical Engineering and Sciences, Wake Forest University, Winston-Salem, NC 27109, USA
Derek Jones
Affiliation:
School of Biomedical Engineering and Sciences, Wake Forest University, Winston-Salem, NC 27109, USA
Alex Powers
Affiliation:
Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
Jonathan Beckwith
Affiliation:
Simbex, Inc., Lebanon, NH 03766, USA
Joel Stitzel
Affiliation:
School of Biomedical Engineering and Sciences, Wake Forest University, Winston-Salem, NC 27109, USA
Richard M. Greenwald
Affiliation:
Simbex, Inc., Lebanon, NH 03766, USA
Stefan Duma
Affiliation:
Virginia Polytechnic Institute and State University, Center for Injury Biomechanics, Blacksburg, VA 24060, USA
*
*Correspondence and reprint requests to: Arthur Maerlender, Center for Brain, Biology and Behavior, University of Nebraska, LincolnEast Stadium, Lincoln, NE 68588, USA. E-mail: amaerlender2@unl.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Head impact exposure (HIE) in youth football is a public health concern. The objective of this study was to determine if one season of HIE in youth football was related to cognitive changes.

Method:

Over 200 participants (ages 9–13) wore instrumented helmets for practices and games to measure the amount of HIE sustained over one season. Pre- and post-season neuropsychological tests were completed. Test score changes were calculated adjusting for practice effects and regression to the mean and used as the dependent variables. Regression models were calculated with HIE variables predicting neuropsychological test score changes.

Results:

For the full sample, a small effect was found with season average rotational values predicting changes in list-learning such that HIE was related to negative score change: standardized beta (β) = -.147, t(205) = -2.12, and p = .035. When analyzed by age clusters (9–10, 11–13) and adding participant weight to models, the R2 values increased. Splitting groups by weight (median split), found heavier members of the 9–10 cohort with significantly greater change than lighter members. Additionaly, significantly more participants had clinically meaningful negative changes: X2 = 10.343, p = .001.

Conclusion:

These findings suggest that in the 9–10 age cluster, the average seasonal level of HIE had inverse, negative relationships with cognitive change over one season that was not found in the older group. The mediation effects of age and weight have not been explored previously and appear to contribute to the effects of HIE on cognition in youth football players.

Keywords

Youth footballHead impact exposureNeuropsychological testCognitionNIH ToolboxReliable change

Information

Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 27 , Issue 2 , February 2021 , pp. 113 - 123
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Alosco, M.L., Kasimis, A.B., Stamm, J.M., Chua, A.S., Baugh, C.M., Daneshvar, D.H.,… Stern, R. A. (2017). Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Translational Psychiatry, 7(9), e1236. doi: 10.1038/tp.2017.197.CrossRefGoogle ScholarPubMed
Bahrami, N., Sharma, D., Rosenthal, S., Davenport, E.M., Urban, J.E., Wagner, B., Jung, Y., Vaughan, C.G., Gioia, G.A., Stitzel, J.D., Whitlow, C.T., & Maldjian, J.A. (2016). Subconcussive head impact exposure and white matter tract changes over a single season of youth football. Radiology , 281(3), 919–926. doi: 10.1148/radiol.2016160564.CrossRefGoogle Scholar
Bazarian, J.J., Zhong, J., Blyth, B., Zhu, T., Kavcic, V., & Peterson, D. (2007). Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: a pilot study. Journal of Neurotrauma, 24(September), 1447–1459. doi: 10.1089/neu.2007.0241.CrossRefGoogle ScholarPubMed
Bazarian, J.J., Zhu, T., Zhong, J., Janigro, D., Rozen, E., Roberts, A., …Blackman, E.G. (2014). Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS ONE, 9(4). doi: 10.1371/journal.pone.0094734.CrossRefGoogle ScholarPubMed
Beckwith, J.G., Greenwald, R.M., & Chu, J.J. (2012). Measuring head kinematics in football: correlation between the head impact telemetry system and hybrid III headform. Annals of Biomedical Engineering, 40(1), 237–248. doi: 10.1007/s10439-011-0422-2.CrossRefGoogle ScholarPubMed
Brennan, J.H., Mitra, B., Synnot, A., McKenzie, J., Willmott, C., McIntosh, A.S.,…Rosenfeld, J.V. (2017). Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Medicine, 47(3), 469–478. doi: 10.1007/s40279-016-0582-1.CrossRefGoogle ScholarPubMed
Broglio, S.P., Eckner, J.T., Martini, D., Sosnoff, J.J., Kutcher, J.S., & Randolph, C. (2011). Cumulative head impact burden in high school football. Journal of Neurotrauma, 28(10), 2069–2078. doi: 10.1089/neu.2011.1825.CrossRefGoogle ScholarPubMed
Broglio, S.P., Surma, T., & Ashton-Miller, J.A. (2012). High school and collegiate football athlete concussions: a biomechanical review. Annals of Biomedical Engineering, 40(1), 37–46. doi: 10.1007/s10439-011-0396-0.CrossRefGoogle ScholarPubMed
Carlozzi, N.E., Beaumont, J.L., Tulsky, D.S., & Gershon, R.C. (2017). The NIH toolbox pattern comparison processing speed test: normative data. Mongraphs of the Society for Research in Child Development, 30(May 2015), 359–368. doi: 10.1093/arclin/acv031.Google Scholar
Carlozzi, N.E., Tulsky, D.S., Kail, R.V., & Beaumont, J.L. (2013). NIH toolbox cognition battery(CB): measuring processing speed. Mongraphs of Thw Society for Research in Child Development, 78(4), 88–102. doi: 10.1111/mono.12036.VI.CrossRefGoogle ScholarPubMed
Carman, A.J., Ferguson, R., Cantu, R., Comstock, R.D., Dacks, P.A., DeKosky, S.T.,… Fillit, H.M. (2015). Expert consensus document: mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions. Nature Reviews Neurology, 11(4), 230–244. doi: 10.1038/nrneurol.2015.30.CrossRefGoogle ScholarPubMed
Casey, B.J., & Jones, R. M. (2010). Neurobiology of the adolescent brain and behavior: implications for substance use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 49(12), 1189–1285.Google Scholar
Casey, B.J., Tottenham, N., Liston, C., & Durston, S. (2005). Imaging the developing brain: what have we learned about cognitive development? Trends in Cognitive Sciences, 9(3), 104–110.CrossRefGoogle Scholar
Chelune, G. (2003). Assessing reliable neuropsychological change, In Franklin, R.D. (Ed.), Predictio in forensics and neuropsychology:sound statostocal practices, (pp. 123–147). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
Cobb, B.R., Urban, J.E., Davenport, E.M., Rowson, S., Duma, S.M., Maldjian, J.A., Whitlow, C.T., … Stitzel, J.D. (2013). Head impact exposure in youth football: elementary school ages 9-12 years and the effect of practice structure. Annals of Biomedical Engineering, 41(12), 2463–2473. doi: 10.1007/s10439-013-0867-6.CrossRefGoogle ScholarPubMed
Crisco, J.J., Wilcox, B.J., Beckwith, J.G., Chu, J.J., Duhaime, A.-C., Rowson, S., Duma, S.M., … Greenwald, R.M. (2011). Head impact exposure in collegiate football players. Journal of Biomechanics, 44(15). doi: 10.1016/j.jbiomech.2011.08.003.CrossRefGoogle ScholarPubMed
Crisco, J.J., Chu, J.J., & Greenwald, R.M. (2018). An algorithm for estimating acceleration magnitude and impact location using multiple nonorthogonal single-axis accelerometers. Journal of Biomechanical Engineering, 126(December 2004), 849–854. doi: 10.1115/1.1824135.CrossRefGoogle Scholar
Daniel, R.W., Rowson, S., & Duma, S.M. (2012). Head impact exposure in youth football. Annals of Biomedical Engineering, 40(4), 976–981. doi: 10.1007/s10439-012-0530-7.CrossRefGoogle ScholarPubMed
Davenport, E.M., Whitlow, C.T., Urban, J.E., Espeland, M.A., Jung, Y., Rosenbaum, D.A., Gioia, G.A., Powers, A.K., Stitzel, J.D., & Maldjian, J.A. (2014). Abnormal white matter integrity related to head impact exposure in a season of high school varsity football. Journal of Neurotrauma, 31(19), 1617–1624. doi: 10.1089/neu.2013.3233.CrossRefGoogle Scholar
Duma, S.M., Manoogian, S.J., Bussone, W.R., Brolinson, P.G., Goforth, M.W., Donnenwerth, J.J., … Crisco, J.J. (2005). Analysis of real-time head accelerations in collegiate football players. Clinical Journal of Sport Medicine, 15(1), 3–8. doi: 10.1097/00042752-200501000-00002.CrossRefGoogle ScholarPubMed
Funk, J.R., Duma, S.M., Manoogian, S.J., & Rowson, S. (2007). Biomechanical risk estimates for mild traumatic brain injury. Annual Proceedings/Association for the Advancement of Automotive Medicine, 51, 343–361.Google ScholarPubMed
Funk, J.R., Rowson, S., Daniel, R.W., & Duma, S. (2012). Validation of concussion risk curves for collegiate football players derived from HITS data. Annals of Biomedical Engineering, 40(1), 79–89. doi: 10.1007/s10439-011-0400-8.CrossRefGoogle ScholarPubMed
Greenwald, R.M., Gwin, J.T., Chu, J.J., & Crisco, J.J. (2008). Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery, 62(4), 789–798. doi: 10.1227/01.NEU.0000311244.05104.96.CrossRefGoogle ScholarPubMed
Gysland, S.M., Mihalik, J.P., Register-Mihalik, J.K., Trulock, S.C., Shields, E.W., & Guskiewicz, K.M. (2012). The relationship between subconcussive impacts and concussion history on clinical measures of neurologic function in collegiate football players. Annals of Biomedical Engineering, 40(1), 14–22. doi: 10.1007/s10439-011-0421-3.CrossRefGoogle ScholarPubMed
Heilbronner, R.L., Sweet, J.J., Attix, D.K., Krull, K.R., Henry, G.K., & Hart, R.P. (2010). Official position of the American academy of clinical neuropsychology on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts. Clinical Neuropsychologist, 24(8), 1267–1278. doi: 10.1080/13854046.2010.526785.CrossRefGoogle ScholarPubMed
Institute of Medicine (IOM) and National Research Council (NRC). (2014). Sports-related concussions in youth: improving the science, changing the culture. Washington, DC: The National Academies Press.Google Scholar
Jacobson, N.S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. doi: 10.1037/0022-006X.59.1.12.CrossRefGoogle ScholarPubMed
Johnson, E.K., Dow, C., Lynch, R.T., & Hermann, B.P. (2006). Measuring clinical significance in rehabilitation research. Rehabilitation Counseling Bulletin, 50(1), 35–45. doi: 10.1177/00343552060500010501.CrossRefGoogle Scholar
Kelley, M.E., Urban, J.E., Miller, L.E., Jones, D.A., Espeland, M.A., Davenport, E.M., … Stitzel, J.D. (2017). Head Impact Exposure in Youth Football: Comparing Age- and Weight-Based Levels of Play. Journal of Neurotrauma, 34(11), 1939–1947. doi: 10.1089/neu.2016.4812.CrossRefGoogle Scholar
Kerr, Z.Y., Yeargin, S., Valovich McLeod, T.C., Nittoli, V.C., Mensch, J., Dodge, T., … Dompier, T.P. (2015). Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthopaedic Journal of Sports Medicine, 3(7), 1–8. doi: 10.1177/2325967115594578.CrossRefGoogle ScholarPubMed
Koo, T.K., & Li, M.Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163. doi: 10.1016/j.jcm.2016.02.012.CrossRefGoogle ScholarPubMed
Kuczmarski, R.J., Ogden, C.L., Guo, S.S., Grummer-Strawn, L.M., Flegal, K.M., Mei, Z., Wei, R., Curtin, L.R., Roche, A.F., Johnson, C.L. (2002). 2000 CDC growth charts for the United States: methods and development. Vital Health Statistics, 11(246), 1–190.Google Scholar
Len, T, Neary, J.P., Asmundson, G., Goodman, D., Bjornson, B., Bhambani, Y. (2011). Cerebrovascular reactivity impairment after sport-induced concussion. Medicine & Science in Sports & Exercise, 43(12), 2241–2248. doi: 10.1249/MSS.0b013e3182249539. CrossRefGoogle ScholarPubMed
Manoogian, S., McNeely, D., Duma, S., & Brolinson, P.G. (2006). Head acceleration is than less than 10 percent of helmet acceleration in football impacts. Biomedical Sciences Instrumentation, 42, 383–388.Google ScholarPubMed
McAllister, T., & McCrea, M. (2017). Long-term cognitive and neuropsychiatric consequences of repetitive concussion and head-impact exposure. Journal of Athletic Training, 52(3), 309–317. doi: 10.4085/1062-6050-52.1.14.CrossRefGoogle ScholarPubMed
McAllister, T.W., Flashman, L.A., Maerlender, A., Greenwald, R.M., Beckwith, J.G., Tosteson, T.D., …Turco, J.H. (2012). Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology, 78(22). doi: 10.1212/WNL.0b013e3182582fe7.CrossRefGoogle Scholar
McAllister, T.W., Ford, J.C., Flashman, L.A., Maerlender, A., Greenwald, R.M., Beckwith, J.G., … & Jain, S. (2014). Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology, 82(1). doi: 10.1212/01.wnl.0000438220.16190.42.CrossRefGoogle Scholar
McDonald, B.C., Saykin, A.J., & McAllister, T.W. (2012). Functional MRI of mild traumatic brain injury (mTBI): progress and perspectives from the first decade of studies. Brain Imaging and Behavior, 6(2), 193–207. doi: 10.1007/s11682-012-9173-4.CrossRefGoogle ScholarPubMed
Montenigro, P.H., Alosco, M.L., Martin, B.M., Daneshvar, D.H., Mez, J., Chaisson, C.E., … Triposdis, Y. (2016). Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. Journal of Neurotrauma, 34, 328–340.CrossRefGoogle ScholarPubMed
Munce, T.A., Dorman, J.C., Thompson, P.A., Valentine, V.D., & Bergeron, M.F. (2014). Head impact exposure and neurologic function of youth football players. Medicine and Science in Sports and Exercise, 14, 1567–1576. doi: 10.1249/MSS.0000000000000591.Google Scholar
National Institutes of Health and Northwestern University. (2017). NIH toolbox ® for assessment of neurological and behavioral function administrator’s manual. Evanston, IL: Northwestern University Press.Google Scholar
Nauman, E.A., Breedlove, K.M., Breedlove, E.L., Talavage, T.M., Robinson, M.E., & Leverenz, L.J. (2015). Post-season neurophysiological deficits assessed by ImPACT and fMRI in athletes competing in American football. Developmental Neuropsychology, 40(2), 85–91. doi: 10.1080/87565641.2015.1016161.CrossRefGoogle ScholarPubMed
Rose, S.C., Yeates, K.O., Fuerst, D.R., Ercole, P.M., Nguyen, J.T., & Pizzimenti, N.M. (2018). Head impact burden and change in neurocognitive function during a season of youth football. Journal of Head Trauma Rehabilitation, 34(2), 87–95. doi: 10.1097/HTR.0000000000000441.CrossRefGoogle Scholar
Rose, S.C., Yeates, K.O., Nguyen, J.T., McCarthy, M.T., Ercole, P.M., & Pizzimenti, N.M. (2019). Neurocognitive function and head impact burden over two seasons of youth tackle football. Journal of Neurotrauma, 36(19), 2803–2809. doi: 10.1089/neu.2019.6519.CrossRefGoogle ScholarPubMed
Rosenthal, J.A., Foraker, R.E., Collins, C.L., & Comstock, R.D. (2014). National high school athlete concussion rates from 2005–2006 to 2011–2012. American Journal of Sports Medicine , 42(7), 1710–1715. doi: 10.1177/0363546514530091.CrossRefGoogle ScholarPubMed
Schatz, P., & Maerlender, A. (2013). A two-factor theory for concussion assessment using impact: memory and speed. Archives of Clinical Neuropsychology, 28(8). doi: 10.1093/arclin/act077.CrossRefGoogle ScholarPubMed
Shrout, P., & Fleiss, J. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–428.CrossRefGoogle ScholarPubMed
Slotkin, J. (2017). NIH toolbox equivalency study. Retrieved from http://www.healthmeasures.net/images/LearnMore/2017_User_Conference_Slides/Track_D/Breakout_2/D2.4_-_Equivalency_Toolbox_Slotkin.pdf.Google Scholar
Solomon, G.S., Kuhn, A.W., Zuckerman, S.L., Casson, I.R., Viano, D., Lovell, M.R., & Sills, A.K. (2016). Participation in pre –high school football and neurological, neuroradiological, and neuropsychological findings in later life a study of 45 retired national football league players. American Journal of Sports Medicine, 44. doi: 10.1177/0363546515626164.CrossRefGoogle ScholarPubMed
Talavage, T.M., Nauman, E.A, & Yoruk, U. (2014). Functionally-detected cognitive impairment in high school football players without clinically diagnosed concussion. Journal of Neurotrauma, 31(4), 327–338. doi: 10.1089/neu.2010.1512.CrossRefGoogle ScholarPubMed
Tarnutzer, A.A., Straumann, D., Brugger, P., & Feddermann-Demont, N. (2017). Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature. British Journal of Sports Medicine, 51(22), 1592–1604. doi: 10.1136/bjsports-2016-096593.CrossRefGoogle ScholarPubMed
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: a comparison of four models. Journal of the International Neuropsychological Society, 5(4), 357–369. doi: 10.1017/S1355617799544068.CrossRefGoogle ScholarPubMed
Tsushima, W.T., Geling, O., Arnold, M., & Oshiro, R. (2016). Are there subconcussive neuropsychological effects in youth sports? an exploratory study of high- and low-contact sports. Applied Neuropsychology: Child, 5(2), 149–155. doi: 10.1080/21622965.2015.1052813.CrossRefGoogle ScholarPubMed
Tulsky, D., Carlozzi, N., Beaumont, J., & Mugas, . (2013). NIH toolbox cognitive functioning battery: measuring working memory. Mongraphs of the Society for Research in Child Development, 78(4), 70–87. doi: 10.1111/mono.12035.NIH.CrossRefGoogle Scholar
Tulsky, D., Carlozzi, N., Holdnack, J., Heaton, R., Wong, A., Goldsmith, A., & Heinemann, A. (2017). Using the NIH toolbox cognition battery (NIHTB-CB) in individuals with traumatic brain injury. Rehabilitation Psychology, 62, 413–424.CrossRefGoogle ScholarPubMed
Urban, J.E., Davenport, E.M., Golman, A.J., Maldjian, J.A., Whitlow, C.T., Powers, A.K., … Rose, K.L. (2013). Head impact exposure in youth football: high school ages 14 to 18 years and cumulative impact analysis. Annals of Biomedical Engineering, 41(12), 2474–2487. doi: 10.1007/s10439-013-0861-z.CrossRefGoogle ScholarPubMed
Wilcox, B.J., Beckwith, J.G., Greenwald, R.M., Chu, J.J., McAllister, T.W., Flashman, L.A., … Crisco, J.J. (2014). Head impact exposure in male and female collegiate ice hockey players. Journal of Biomechanics, 47(1). doi: 10.1016/j.jbiomech.2013.10.004.CrossRefGoogle ScholarPubMed
Zelazo, P.D., Anderson, J.E., Richler, J., Wallner-allen, K., Beaumont, J.L., & Weintraub, S. (2013). II. NIH toolbox cognition battery (CB): measuring executive function and attention. Mongraphs of the Society for Research in Child Development, 78, 16–33.CrossRefGoogle ScholarPubMed