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Effects of Repetitive Head Impacts on a Concussion Assessment Battery

Caccese, Jaclyn B.1; Best, Chelsea2; Lamond, Lindsey C.3; DiFabio, Melissa1; Kaminski, Thomas W.1; Watson, Dan4; Getchell, Nancy1; Buckley, Thomas A.1

Medicine & Science in Sports & Exercise: January 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1249/MSS.0000000000001905
Original Investigation: PDF Only

Purpose The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women’s soccer (WSOC) players.

Methods Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: pre-season (PRE) and post-season (POST). The outcome measures consisted of Tandem Gait (TG), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), King-Devick (KD), Clinical Reaction Time (CRT), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). RHI during the season was quantified using the Head Impact Telemetry System (HITS; Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts >98g.

Results Results from direct-entry multiple regression analyses suggest significant associations between RHI and both Visual Memory (R2=0.670, F=6.487, p=0.002) and TG (R2=0.636, F=3.841, p=0.029) for WSOC and between RHI and KD (R2=0.756, F=5.579, p=0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant.

Conclusions These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and Visual Memory/TG among WSOC, RHI and KD among FB.

1University of Delaware, Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, Newark, DE;

2Indiana University Athletics, Bloomington, IN;

3Wake Forest Baptist Health, Department of Family Medicine, Winston-Salem, NC;

4University of Delaware Athletics, Newark, DE

Corresponding Author: Thomas A. Buckley, 100 Discovery Blvd, Newark, DE 19713. Telephone: 302-831-4783. Email:

This publication was made possible, in part, with support from the Grand Alliance CARE Consortium, funded by the NCAA and the DoD. The USAMRAA, Ford Detrick, MD, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the DoD (DHP funds).

Conflict of Interests: The authors have no conflicts of interest to disclose. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Accepted for publication: 9 January 2019.

© 2019 American College of Sports Medicine