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Relationship Between Time-Weighted Head Impact Exposure on Directional Changes in Diffusion Imaging in Youth Football Players

  • Concussions in Sports
  • Published:
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Abstract

Approximately 3.5 million youth and adolescents in the US play football, a sport with one of the highest rates of concussion. Repeated subconcussive head impact exposure (HIE) may lead to negative neurological sequelae. To understand HIE as an independent predictive variable, quantitative cumulative kinematic metrics have been developed to capture the volume (i.e., number), severity (i.e., magnitude), and frequency (i.e., time-weighting by the interval between head impacts). In this study, time-weighted cumulative HIE metrics were compared with directional changes in diffusion tensor imaging (DTI) metrics. Changes in DTI conducted on a per-season, per-player basis were assessed as a dependent variable. Directional changes were defined separately as increases and decreases in the number of abnormal voxels relative to non-contact sport controls. Biomechanical and imaging data from 117 athletes (average age 11.9 ± 1.0 years) enrolled in this study was analyzed. Cumulative HIE metrics were more strongly correlated with increases in abnormal voxels than decreases in abnormal voxels. Additionally, across DTI sub-measures, increases and decreases in mean diffusivity (MD) had the strongest relationships with HIE metrics (increases in MD: average R2 = 0.1753, average p = 0.0002; decreases in MD: average R2 = 0.0997, average p = 0.0073). This encourages further investigation into the physiological phenomena represented by directional changes.

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Acknowledgments

Funding was provided by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health via Grants R01NS094410 and R01NS082453. The authors would also like to thank Brian Tomblin as well as the youth football organizations, the Childress Institute for Pediatric Trauma, and the Wake Forest School of Medicine Dean’s Award for supporting this study.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Suraj K. Puvvada, Logan E. Miller, Christopher T. Whitlow, Joel D. Stitzel & Jillian E. Urban

  2. Department of Radiology, University of Texas Southwestern, Dallas, TX, USA

    Elizabeth M. Davenport, James M. Holcomb & Joseph A. Maldjian

  3. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Alexander K. Powers

  4. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Christopher T. Whitlow

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  1. Suraj K. Puvvada
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Puvvada, S.K., Davenport, E.M., Holcomb, J.M. et al. Relationship Between Time-Weighted Head Impact Exposure on Directional Changes in Diffusion Imaging in Youth Football Players. Ann Biomed Eng 49, 2852–2862 (2021). https://doi.org/10.1007/s10439-021-02862-4

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