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      Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football

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          Abstract

          Background

          Historical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season.

          Methods

          A prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome.

          Results

          With similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05).

          Discussion

          Reduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts.

          Trial registration number

          NCT02696200.

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          Most cited references42

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          The epidemiology of sport-related concussion.

          Daniel Daneshvar, Christopher J Nowinski, Ann McKee … (2011)
          Concussions and head injuries may never be completely eliminated from sports. However, with better data comes an improved understanding of the types of actions and activities that typically result in concussions. With this knowledge can come improved techniques and rule changes to minimize the rate and severity of concussions in sports. This article identifies the factors that affect concussion rate. Copyright © 2011 Elsevier Inc. All rights reserved.
          Article 0 comments Cited 165 times – based on 0 reviews     Review now
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            A decade of DTI in traumatic brain injury: 10 years and 100 articles later.

            M.B. Hulkower, D.B. Poliak, S.B. Rosenbaum … (2013)
            The past decade has seen an increase in the number of articles reporting the use of DTI to detect brain abnormalities in patients with traumatic brain injury. DTI is well-suited to the interrogation of white matter microstructure, the most important location of pathology in TBI. Additionally, studies in animal models have demonstrated the correlation of DTI findings and TBI pathology. One hundred articles met the inclusion criteria for this quantitative literature review. Despite significant variability in sample characteristics, technical aspects of imaging, and analysis approaches, the consensus is that DTI effectively differentiates patients with TBI and controls, regardless of the severity and timeframe following injury. Furthermore, many have established a relationship between DTI measures and TBI outcomes. However, the heterogeneity of specific outcome measures used limits interpretation of the literature. Similarly, few longitudinal studies have been performed, limiting inferences regarding the long-term predictive utility of DTI. Larger longitudinal studies, using standardized imaging, analysis approaches, and outcome measures will help realize the promise of DTI as a prognostic tool in the care of patients with TBI.
            Article 0 comments Cited 133 times – based on 0 reviews     Review now
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              A prospective diffusion tensor imaging study in mild traumatic brain injury.

              C Gasparovic, Ross R Reichard, M Mannell … (2010)
              Only a handful of studies have investigated the nature, functional significance, and course of white matter abnormalities associated with mild traumatic brain injury (mTBI) during the semi-acute stage of injury. The present study used diffusion tensor imaging (DTI) to investigate white matter integrity and compared the accuracy of traditional anatomic scans, neuropsychological testing, and DTI for objectively classifying mTBI patients from controls. Twenty-two patients with semi-acute mTBI (mean = 12 days postinjury), 21 matched healthy controls, and a larger sample (n = 32) of healthy controls were studied with an extensive imaging and clinical battery. A subset of participants was examined longitudinally 3-5 months after their initial visit. mTBI patients did not differ from controls on clinical imaging scans or neuropsychological performance, although effect sizes were consistent with literature values. In contrast, mTBI patients demonstrated significantly greater fractional anisotropy as a result of reduced radial diffusivity in the corpus callosum and several left hemisphere tracts. DTI measures were more accurate than traditional clinical measures in classifying patients from controls. Longitudinal data provided preliminary evidence of partial normalization of DTI values in several white matter tracts. Current findings of white matter abnormalities suggest that cytotoxic edema may be present during the semi-acute phase of mild traumatic brain injury (mTBI). Initial mechanical damage to axons disrupts ionic homeostasis and the ratio of intracellular and extracellular water, primarily affecting diffusion perpendicular to axons. Diffusion tensor imaging measurement may have utility for objectively classifying mTBI, and may serve as a potential biomarker of recovery.
              Article 0 comments Cited 115 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Sports Med
                Journal ID (iso-abbrev): Br J Sports Med
                Journal ID (hwp): bjsports
                Journal ID (publisher-id): bjsm
                Title: British Journal of Sports Medicine
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0306-3674
                ISSN (Electronic): 1473-0480
                Publication date (Print): October 2016
                Publication date (Electronic): 15 June 2016
                Volume: 50
                Issue: 20
                Pages: 1276-1285
                Affiliations
                [1 ]Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [2 ]Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [3 ]Department of Pediatrics, University of Cincinnati, College of Medicine , Cincinnati, Ohio, USA
                [4 ]Department of Orthopaedics, University of Pennsylvania , Philadelphia, Pennsylvania, USA
                [5 ]The Micheli Center for Sports Injury Prevention , Waltham, Massachusetts, USA
                [6 ]Department of Orthopaedic Surgery, University of Cincinnati , Cincinnati, Ohio, USA
                [7 ]Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [8 ]College of Medicine, University of Cincinnati , Cincinnati, Ohio, USA
                [9 ]Division of Health Sciences, Department of Athletic Training, Mount St. Joseph University , Cincinnati, Ohio, USA
                [10 ]Rocky Mountain University of Health Professions , Provo, Utah, USA
                [11 ]Division of Radiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [12 ]Department of Psychology, Center for Cognition, Action and Perception, University of Cincinnati , Cincinnati, Ohio, USA
                [13 ]College of Medicine, University of Cincinnati, Cincinnati , Ohio, USA
                [14 ]Division of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [15 ]Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                Author notes
                [Correspondence to ] Dr Gregory D Myer, Cincinnati Children's Hospital, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA; Greg.Myer@ 123456cchmc.org
                Article
                Publisher ID: bjsports-2016-096134
                DOI: 10.1136/bjsports-2016-096134
                PMC ID: 5099231
                PubMed ID: 27307271
                SO-VID: 7ce6a6cf-db47-4ab4-9a96-c63cd03c4211
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date accepted : 21 May 2016
                Categories
                Subject: 1506
                Subject: Original Article
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Sports medicine
                Keywords: concussion,brain,injury prevention,blood,mri
                Data availability:
                ScienceOpen disciplines: Sports medicine
                Keywords: concussion, brain, injury prevention, blood, mri

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