Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes

Objective: To determine whether exposure to repetitive head impacts over a single season affects white matter diffusion measures in collegiate contact sport athletes. Methods: A prospective cohort study at a Division I NCAA athletic program of 80 nonconcussed varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration time history of the head following impact, and 79 non–contact sport athletes. Assessment occurred preseason and shortly after the season with diffusion tensor imaging and neurocognitive measures. Results: There was a significant (p 5 0.011) athlete-group difference for mean diffusivity (MD) in the corpus callosum. Postseason fractional anisotropy (FA) differed (p 5 0.001) in the amygdala (0.238 vs 0.233). Measures of head impact exposure correlated with white matter diffusivity measures in several brain regions, including the corpus callosum, amygdala, cerebellar white matter, hippocampus, and thalamus. The magnitude of change in corpus callosum MD postseason was associated with poorer performance on a measure of verbal learning and memory. Conclusion: This study suggests a relationship between head impact exposure, white matter diffusion measures, and cognition over the course of a single season, even in the absence of diagnosed concussion, in a cohort of college athletes. Further work is needed to assess whether such effects are short term or persisten

THE EFFECTS OF HEIGHT AND DISTANCE ON THE FORCE PRODUCTION AND ACCELERATION IN MARTIAL ARTS STRIKES

Almost all cultures have roots in some sort of self defence system and yet there is relatively little research in this area, outside of a sports related environment. This project investigated different applications of strikes from Kung Fu practitioners that have not been addressed before in the literature. Punch and palm strikes were directly compared from different heights and distances, with the use of a load cell, accelerometers, and high speed video. The data indicated that the arm accelerations of both strikes were similar, although the force and resulting acceleration of the target were significantly greater for the palm strikes. Additionally, the relative height at which the strike was delivered was also investigated. The overall conclusion is that the palm strike is a more effective strike for transferring force to an object. It can also be concluded that an attack to the chest would be ideal for maximizing impact force and moving an opponent off balanc

Characterization of the Relative Change in Objective and Subjective Metrics by Baselining Patients Who have Wearable Technology Prior to Total Knee Arthroplasty

Wearable sensors and associated supporting technologies (i.e., patient applications) can provide both objective (joint position, step counts, etc.) and subjective data (i.e., pain scores and patient-reported outcome measures) to track a patient's episode of care. Establishing a subjective and objective baseline of a patient's experience may arguably be beneficial for multiple reasons, including setting recovery expectations for the patient and demonstrating the effectiveness or success of the intervention. In this pilot study, we characterized a subset of patients (n = 82 from 7 surgeons) using a wearable sensor system at least 6 days prior to total knee arthroplasty and provided post-surgical data up to 50 days post-intervention. The 5-day average prior to surgery for total step counts (activity), achieved flexion and extension on a progress test (functional limit) and visual analog scale (VAS) daily pain score were calculated. The difference from baseline was then calculated for each patient for each day post-surgery and reported as averages. On average, a patient will experience a relative deficit of 4,000 steps immediately following surgery that will return to near-baseline levels 50 days post-intervention. A 30-degree deficit in flexion and a 10-degree deficit in extension will return at a similar rate as steps. Relative pain scores will worsen with an increase of approximately 3 points immediately following surgery. However, pain will decrease by two points relative to baseline between 40 and 50 days. The results of this pilot study demonstrate a method to baseline a patient's presurgical subjective and objective data and to provide a reference for postsurgical recovery expectations. Applications for this data include benchmarking for evaluating intervention success as well as setting patient expectations

Group-wise evaluation and comparison of white matter fiber strain and maximum principal strain in sports-related concussion

Sports-related concussion is a major public health problem in the United States and yet its biomechanical mechanisms remain unclear. In vitro studies demonstrate axonal elongation as a potential injury mechanism; however, current response-based injury predictors (e.g., maximum principal strain, ε(ep)) typically do not incorporate axonal orientations. We investigated the significance of white matter (WM) fiber orientation in strain estimation and compared fiber strain (ε(n)) with ε(ep) for 11 athletes with a clinical diagnosis of concussion. Geometrically accurate subject-specific head models with high mesh quality were created based on the Dartmouth Head Injury Model (DHIM), which was successfully validated (performance categorized as "good" to "excellent"). For WM regions estimated to be exposed to high strains using a range of injury thresholds (0.09-0.28), substantial differences existed between ε(n) and ε(ep) in both distribution (Dice coefficient of 0.13-0.33) and extent (∼ 5-10-fold differences), especially at higher threshold levels and higher rotational acceleration magnitudes. For example, an average of 3.2% vs. 29.8% of WM was predicted above an optimal threshold of 0.18 established from an in vivo animal study using ε(n) and ε(ep), respectively, with an average Dice coefficient of 0.14. The distribution of WM regions with high ε(n) was consistent with typical heterogeneous patterns of WM disruptions in diffuse axonal injury, and the group-wise extent at the optimal threshold matched well with the percentage of WM voxels experiencing significant longitudinal changes of fractional anisotropy and mean diffusivity (3.2% and 3.44%, respectively) found from a separate independent study. These results suggest the significance of incorporating WM microstructural anisotropy in future brain injury studies