Repetitive Head Impacts in Youth Football: Description and Relationship to White Matter Structure

Abstract

Background:

Few studies have examined white matter with diffusion tensor imaging in 8- to 12-year-old collision sport (CS) athletes.

Hypothesis:

Youth CS athletes will demonstrate change in brain fractional anisotropy (FA) after a season of CS compared with an age-matched noncollision sport (NCS) cohort, and the number, magnitude, and location of hits will correlate with changes in the brain determined via FA for CS athletes.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

Thirty-five 8- to 12-year-old males in a youth tackle football league (CS) and 12 males from local swim teams (NCS) were recruited. Participants underwent brain magnetic resonance imaging with FA before and after the football season. Number, magnitude, and direction of head impacts were recorded for CS participants throughout the season.

Results:

A total of 1905 hits were recorded in the CS group for the season, 341 (17.9%) collected during 7 games and 1564 (82.1%) observed during 31 practices. No significant interaction between group (CS and NCS) and time (pre- and postseason) was observed for FA (P > 0.05). Correlation analysis revealed a significantly positive and moderate relationship between increase of left cingulate cortex (CgC) FA from pre- to postseason and the total magnitude of lateral head impacts (r = 0.40; P = 0.03).

Conclusion:

There was no significant change in FA measurement of white matter integrity in a cohort of 8- to 12-year-old males after a season of youth football, nor was any difference detected in FA between youth football players and an age-matched cohort of swimmers. There was a significant correlation between total magnitude of hits sustained by youth football players and an increase in FA in the left CgC; whether this is adaptive or pathologic remains unknown.

Clinical Relevance:

These data can be used within the body of knowledge to counsel patients regarding the known risks of youth tackle football regarding brain health.

Keywords

youth sports football repetitive head impact diffusion tensor imaging (DTI)

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References

Alosco

Kasimis

Stamm

, et al. Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry. 2017;7:e1236.

Bahrami

Sharma

Rosenthal

, et al. Subconcussive head impact exposure and white matter tract changes over a single season of youth football. Radiology. 2016;281:919-926.

Basser

Jones

. Diffusion-tensor MRI: theory, experimental design and data analysis—a technical review. NMR Biomed. 2002;15:456-467.

Bazarian

Zhu

Zhong

, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9:e94734.

Bigler

Bazarian

. Diffusion tensor imaging: a biomarker for mild traumatic brain injury? Neurology. 2010;74:626-627.

Brander

Kataja

Saastamoinen

, et al. Diffusion tensor imaging of the brain in a healthy adult population: normative values and measurement reproducibility at 3 T and 1.5 T. Acta Radiol. 2010;51:800-807.

Breedlove

Robinson

Talavage

, et al. Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. J Biomech. 2012;45:1265-1272.

Centers for Disease Control and Prevention. NHANES National Youth Fitness Survey: Physical Activity—PAQ. https://www.cdc.gov/nchs/data/nnyfs/paq.pdf. Accessed February 1, 2016.

Cobb

Rowson

Duma

. Age-related differences in head impact exposure of 9-13 year old football players. Biomed Sci Instrum. 2014;50:285-290.

10.

Cobb

Urban

Davenport

, et al. Head impact exposure in youth football: elementary school ages 9-12 years and the effect of practice structure. Ann Biomed Eng. 2013;41:2463-2473.

11.

Daniel

Rowson

Duma

. Head impact exposure in youth football. Ann Biomed Eng. 2012;40:976-981.

12.

Duma

Manoogian

Bussone

, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15:3-8.

13.

Eierud

Craddock

Fletcher

, et al. Neuroimaging after mild traumatic brain injury: review and meta-analysis. Neuroimage Clin. 2014;4:283-294.

14.

Frollo

. Pop Warner eliminates kickoffs for ages 10 and younger. USA Football. https://blogs.usafootball.com/blog/1388/pop-warner-eliminates-kickoffs-for-ages-10-and-younger. Accessed July 12, 2019.

15.

Gessel

Fields

Collins

Dick

Comstock

. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42:495-503.

16.

Lincoln

Caswell

Almquist

Dunn

Norris

Hinton

. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med. 2011;39:958-963.

17.

Marar

McIlvain

Fields

Comstock

. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40:747-755.

18.

McAllister

Ford

Flashman

, et al. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology. 2014;82:63-69.

19.

Mez

Daneshvar

Kiernan

, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318:360-370.

20.

Mills

Tamnes

. Methods and considerations for longitudinal structural brain imaging analysis across development. Dev Cogn Neurosci. 2014;9:172-190.

21.

Montenigro

Alosco

Martin

, et al. Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J Neurotrauma. 2017;34:328-340.

22.

O’Connor

Peeters

Szymanski

Broglio

. Individual impact magnitude vs. cumulative magnitude for estimating concussion odds. Ann Biomed Eng. 2017;45:1985-1992.

23.

Roberts

Mathias

Rose

. Diffusion tensor imaging (DTI) findings following pediatric non-penetrating TBI: a meta-analysis. Dev Neuropsychol. 2014;39:600-637.

24.

Roberts

Mathias

Rose

. Relationship between diffusion tensor imaging (DTI) findings and cognition following pediatric TBI: a meta-analytic review. Dev Neuropsychol. 2016;41:176-200.

25.

Schmithorst

Wilke

Dardzinski

Holland

. Correlation of white matter diffusivity and anisotropy with age during childhood and adolescence: a cross-sectional diffusion-tensor MR imaging study. Radiology. 2002;222:212-218.

26.

Sensors. SSH. Football helmet sensors. http://www.theshockbox.com/football-sensors. Accessed April 15, 2018.

27.

Stamm

Koerte

Muehlmann

, et al. Age at first exposure to football is associated with altered corpus callosum white matter microstructure in former professional football players. J Neurotrauma. 2015;32:1768-1776.

28.

Stern

Riley

Daneshvar

Nowinski

Cantu

McKee

. Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy. PM R. 2011;3(10)(suppl 2):S460-S467.

29.

Talavage

Nauman

Breedlove

, et al. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. J Neurotrauma. 2014;31:327-338.

30.

Tsushima

Geling

Arnold

Oshiro

. Are there subconcussive neuropsychological effects in youth sports? An exploratory study of high- and low-contact sports. Appl Neuropsychol Child. 2016;5:149-155.

31.

Wong

Bailes

. Frequency, magnitude, and distribution of head impacts in Pop Warner football: the cumulative burden. Clin Neurol Neurosurg. 2014;118:1-4.

32.

Yallampalli

Wilde

Bigler

, et al. Acute white matter differences in the fornix following mild traumatic brain injury using diffusion tensor imaging. J Neuroimaging. 2013;23:224-227.

33.

Young

Daniel

Rowson

Duma

. Head impact exposure in youth football: elementary school ages 7-8 years and the effect of returning players. Clin J Sport Med. 2014;24:416-421.

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