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Helmet Technology, Head Impact Exposure, and Cortical Thinning Following a Season of High School Football

  • S.I. : Concussions
  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

The purpose of this study was to compare the effects of wearing older, lower-ranked football helmets (LRank) to wearing newer, higher-ranked football helmets (HRank) on pre- to post-season changes in cortical thickness in response to repetitive head impacts and assess whether changes in cortical thickness are associated with head impact exposure for either helmet type. 105 male high-school athletes (NHRank = 52, NLRank = 53) wore accelerometers affixed behind the left mastoid during all practices and games for one regular season of American football to monitor head impact exposure. Pre- and post-season magnetic resonance imaging (MRI) were completed to assess longitudinal changes in cortical thickness. Significant reductions in cortical thickness (i.e., cortical thinning) were observed pre- to post-season for each group, but these longitudinal alterations were not significantly different between the LRank and HRank groups. Further, significant group-by-head impact exposure interactions were observed when predicting changes in cortical thickness. Specifically, a greater frequency of high magnitude head impacts during the football season resulted in greater cortical thinning for the LRank group, but not for the HRank group. These data provide preliminary in vivo evidence that HRank helmets may provide a buffer between the specific effect of high magnitude head impacts on regional thinning by dissipating forces more evenly throughout the cortex. However, future research with larger sample sizes, increased longitudinal measures and additional helmet technologies is warranted to both expand upon and further validate the present study findings.

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Abbreviations

LRank:

Lower-ranked football helmets

HRank:

Higher-ranked football helmets

SRC:

Sports-related concussion

DTI:

Diffusion tensor imaging

fMRI:

Functional magnetic resonance imaging

NOCSAE:

National Operating Committee on Standards for Athletic Equipment

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Acknowledgments

The authors would like to thank our outstanding collaborators and support staff that made this large-scale investigation possible. While it would be difficult to acknowledge all that contributed to the success with the project, there are those with specific contributions we would like to mention. At Cincinnati Children's Hospital Medical Center we would like to thank faculty members, Brian Coley, Charles Dumoulin, Kim Cecil, Megan Narad, and Paul Gubanich; MRI technologists Lacey Haas, Brynne Williams, Matthew Lanier, Kaley Bridgewater, Elizabeth Fugate, and Marty Jones; MRI engineering and technical support Hui Wang, Zach Heeger, Dennis Flage; staff members Staci Thomas, Sarah Orban, John Simon, Ryan MacPherson, Katie Kitchen, Katherine Kinsella, James Lynch, and Brooke Gadd. We also express our sincere gratitude to the University of Cincinnati medical student interns, Anna Saltman, Brent Waibel, Madeline Engeler, and Ramsey Sabbagh; undergraduate/graduate student interns from various universities including, Dan Braswell, Nicholas Slaboden, Emma Hansen, Ashley Doud, Lila Wright, Nicholas Zenger, Omar Brijawi, Austin Tiernan, Jennifer Shine, Sydney Hamilton, Saed Mustif, Bradley Jacobs, Enna Selmanovic, Kia Hreno, Emily Hornback, Meghan Swearingen, Kristen Jansen, Savannah Bacon, Nicole Veselitis, Samantha Simms, Cody McMillian, Daniel Riveros Molina, Morgan Froelich, Eric Schmitz, Jordan Maxwell, Philip Wienkamp, Teresa Rust, Courtney Johnson, Walker Engelhard, Kelsey Laizure, John Rizk, Victoria Colacicco, Megan Sloboda, Jessica Culbertson, Elizabeth Reddington, Dylan Kirby, Brady Tincher, Abby Odachowski, Hima Devgan. Importantly we want to acknowledge and thank student advisors Dan Carl and Susan Kotowski who were critical to help manage and facilitate the student opportunities to participate on this project. We also express our thanks to the school athletic trainers Mike McCafferty, Craig Lindsey, Dan Forcum, Alex Popken, Katie Taylor, James Muncy, Nathalie Towchik, Alli King, Cindy Busse, Kayla Taske, Becky White, Rebecca Lemmel, Joe Lucas, Mike Gordon, Ken Rushford and Al Ducker; the school athletic directors Rob Heise, Mike Asbeck, Keith Pantling, Tony Hemmelgarn, Steve Ellison, Jan Wilking, Wendy Smith, Kim Gunning, Diane Redmond, Mark Schenkel, Eric Taylor, and Brian Reinhart; school coaches Mike Orlando, Doug Rosfeld, Patrick McLaughlin, Kevin Spraul, Gerry Beauchamp, Tino Mam, Aaron Hancock, Karen Wood, Marissa Wolf, Dave Ruehl, Keith Schaeper, Kiersten Johnson, Heather Vibberts, Mark Mueller, and Steve Spect; team physicians Dr. Stanfield, Dr. Kremcheck, Dr. Buerger, D. Argo, Dr. Rice, Dr. Altenau, Dr. Kevin Reilly, Dr. Eugene Reilly, Dr. Patrick Reilly, Dr. Noyes, Dr, Galloway, Dr. Cha, and Dr. Linz. We also express our thanks to Ed Lodge who helped with accelerometers and Jamison Float for neck collar fitting. Lastly, we express our appreciation to the football players and families from the following high schools for being supportive of our mission to keep athletes safe during sport by engaging and participating in this research project: McNicholas, Archbishop Moeller, LaSalle, Oak Hills, Walnut Hills, Wyoming, Seton, St. Ursula Academy, Ursuline Academy, Mount Notre Dame, St. Xavier, and Cincinnati Hills Christian Academy.

Conflict of interest

Q30 Sports Innovations, LLC funded Cincinnati Children’s Hospital Medical Center for the parent Clinical Trial testing the effects of the jugular vein compression on brain health. Vicis Inc. Funded Cincinnati Children’s Hospital Medical Center to undertake the secondary analyses of neuroimaging data for comparison of helmet technologies not included in the intervention arm (collar) of the parent clinical trial. Gregory D. Myer consults with Commercial entities to support application to the US Food and Drug Administration but has no financial interest in the commercialization of the products. Dr. Myer’s institutions receive current and ongoing grant funding from National Institutes of Health/NIAMS Grants U01AR067997, R01 AR070474, R01AR055563, R01AR076153, R01 AR077248, and industry sponsored research funding related to brain injury prevention and assessment with Q30 Innovations, LLC and ElMinda, Ltd. Dr. Myer receives author royalties from Human Kinetics and Wolters Kluwer. Dr. Myer is also an inventor of biofeedback technologies (2017 Non provisional Patent Pending- Augmented and Virtual reality for Sport Performance and Injury Prevention Application filed 11/10/2016 (62/420,119), Software Copyrighted.) designed to enhance rehabilitation and prevent injuries and has potential for future licensing royalties.

Author information

Authors and Affiliations

  1. Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, 3333 Burnet AveMLC 5033, Cincinnati, OH, 45229-3039, USA

    Jonathan A. Dudley & Weihong Yuan

  2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jonathan A. Dudley, Weihong Yuan & Brynne Williams

  3. Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA, USA

    Alexis B. Slutsky-Ganesh, Jed A. Diekfuss, Destin Hill & Gregory D. Myer

  4. Emory Sports Medicine Center, Atlanta, GA, USA

    Alexis B. Slutsky-Ganesh, Jed A. Diekfuss, Destin Hill & Gregory D. Myer

  5. Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA

    Alexis B. Slutsky-Ganesh, Jed A. Diekfuss, Destin Hill & Gregory D. Myer

  6. Department of Kinesiology, University of North Carolina Greensboro, Greensboro, NC, USA

    Alexis B. Slutsky-Ganesh

  7. Clemson University Athletic Department, Clemson, SC, USA

    Jason M. Avedesian

  8. Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA

    Christopher A. DiCesare

  9. Boston Children’s Hospital, Boston, MA, USA

    William P. Meehan III

  10. The Micheli Center for Sports Injury Prevention, Waltham, MA, USA

    William P. Meehan III & Gregory D. Myer

  11. Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA

    Matthew B. Panzer

  12. Department of Bioengineering, Clemson University, Clemson, SC, USA

    John D. DesJardins

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  1. Jonathan A. Dudley
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  12. Gregory D. Myer
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Correspondence to Jonathan A. Dudley.

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Dudley, J.A., Slutsky-Ganesh, A.B., Diekfuss, J.A. et al. Helmet Technology, Head Impact Exposure, and Cortical Thinning Following a Season of High School Football. Ann Biomed Eng 50, 1608–1619 (2022). https://doi.org/10.1007/s10439-022-03023-x

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