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Accumulation of high magnitude acceleration events predicts cerebrovascular reactivity changes in female high school soccer athletes


Mitigating the effects of repetitive exposure to head trauma has become a major concern for the general population, given the growing body of evidence that even asymptomatic exposure to head accelerations is linked with increased risk for negative life outcomes and that risk increases as exposure is prolonged over many years. Among women's sports, soccer currently exhibits the highest growth in participation and reports the largest number of mild traumatic brain injuries annually, making female soccer athletes a relevant population in assessing the effects of repetitive exposure to head trauma. Cerebrovascular biomarkers may be useful in assessing the effects of repetitive head trauma, as these are thought to contribute directly to neurocognitive symptoms associated with mild traumatic brain injury. Here we use fMRI paired with a hypercapnic breath hold task along with monitoring of head acceleration events, to assess the relationship between cerebrovascular brain changes and exposure to repetitive head trauma over a season of play in female high school soccer athletes. We identified longitudinal changes in cerebrovascular reactivity that were significantly associated with prolonged accumulation to high magnitude (> 75th percentile) head acceleration events. Findings argue for active monitoring of athletes during periods of exposure to head acceleration events, illustrate the importance of collecting baseline (i.e., pre-exposure) measurements, and suggest modeling as a means of guiding policy to mitigate the effects of repetitive head trauma.

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This work was funded in part by support from the BrainScope Company, as part of a grant obtained from the GE-NFL Head Health Initiative, and by General Electric Healthcare.


This study was funded in part by the Indiana Clinical and Translational Sciences Institute Spinal Cord and Brain Injury Research Fund (Grant #SCBI 207–32), and the BrainScope Company (as part of a grant from the GE-NFL Head Health Initiative).

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Correspondence to Diana O. Svaldi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Purdue Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants of 18 years and above, and parental consent and participant assent were obtained for all participants under the age of 18.

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Fig. S1

Distributions of estimated nCPTA coefficient \( \left({\widehat{x}}_{1, Th,j}\right) \) at each follow up session. Distributions were computed by generating 10,000 bootstrapped randomly sampled observations and fitting the model for each sample. Distributions outlined in red delineate distributions that are significantly different from zero (α = 0.05, non-parametric 95% CI, 10,000 bootstraps) (EPS 12938 kb)

Fig. S2

Distributions of estimated \( {\widehat{R^2}}_{Th,j} \) value at each follow-up session. Distributions were computed by generating 10,000bootstrapped randomly sampled observations and fitting the model for each sample. Distributions outlined in red delineate distributions that are significantly different from zero (α = 0.05, non-parametric 95% CI, 10,000 bootstraps) (EPS 13264 kb)

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Svaldi, D.O., Joshi, C., McCuen, E.C. et al. Accumulation of high magnitude acceleration events predicts cerebrovascular reactivity changes in female high school soccer athletes. Brain Imaging and Behavior 14, 164–174 (2020). https://doi.org/10.1007/s11682-018-9983-0

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  • Cerebrovascular Reactivity
  • Functional magnetic resonance imaging
  • Concussion
  • Mild traumatic brain injury
  • Subconcussive injury
  • Soccer