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Head Impact Burden and Change in Neurocognitive Function During a Season of Youth Football

Rose, Sean C., MD; Yeates, Keith O., PhD; Fuerst, Darren R., PhD; Ercole, Patrick M., PhD; Nguyen, Joseph T., MPH; Pizzimenti, Natalie M., MS

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p 87–95
doi: 10.1097/HTR.0000000000000441
Pediatric TBI 2019

Objective: To determine the association of repetitive subconcussive head impacts with functional outcomes in primary and high school tackle football players.

Setting: Youth football fields and an outpatient sports neurology clinic.

Participants: A total of 112 primary school (n = 55, age 9-12 years) and high school (n = 57, age 15-18 years) football players.

Design: A prospective cohort study.

Main Measures: Helmet-based sensors were used to record head impacts during practices and games during the 2016 football season. Impact g-forces were summed to yield a measure of cumulative impact. History of self-reported premorbid medical diagnoses was obtained preseason. Players completed assessments of a variety of outcomes both pre- and postseason: neuropsychological test performance, symptoms, vestibular and ocular-motor screening, balance, parent-completed attention-deficit hyperactivity disorder (ADHD) symptoms, and self-reported behavioral adjustment.

Results: Average cumulative impact was 3700 (standard deviation = 2700) g-forces for the season and did not differ between age groups (P = .594). Cumulative impact did not predict pre- to postseason change scores on any outcome measures (all P > .05). Instead, younger age group and reported history of premorbid ADHD predicted change scores on several cognitive testing measures and parent-reported ADHD symptoms, while reported history of premorbid anxiety and depression predicted change scores on symptom reporting.

Conclusions: In youth tackle football, subconcussive head impacts sustained over the course of a single season may not be associated with neurocognitive functional outcomes. The absence of a significant association may reflect the relatively short follow-up interval, and signals the need for studies across multiple seasons.

Division of Child Neurology, Nationwide Children's Hospital, and The Ohio State University, Columbus, Ohio (Dr Rose); Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (Dr Yeates); Wayne State University and Department of Physical Medicine and Rehabilitation Beaumont, Detroit, Michigan (Dr Fuerst); Sansom Consulting, Phoenix, Arizona (Dr Ercole and Mr Nguyen); and MORE Foundation, Phoenix, Arizona (Ms Pizzimenti).

Corresponding Author: Sean C. Rose, MD, Department of Neurology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (

We thank The Sports Neurology Clinic and MORE Foundation for their help in conducting the study. We thank the following individuals at The Sports Neurology Clinic for their help with data collection: Matthew McCarthy, MD, Erik Beltran, MD, Anthony Savino, MD, Jacob Greer, Ashley Dunn, and Shirley King. We thank the following individuals at Brighton High School for their help with data collection: Andrew Cavey, Brian Lemons. We thank the following individuals at Brighton Bulldogs Football and Cheer for their help with data collection: Patrick Seremet, Joe Gabriel, Scott McKernan, Dean Ditto, Ron Bellar, and Mark Velarde.

Riddell (Rosemont, Illinois) and ElMindA (Tel Aviv, Israel) provided funding and equipment for this study. S Dallas Rowe and Associates (Phoenix, Arizona) provided equipment for this study. None of these groups contributed to the design of the study, data collection, analysis and interpretation of data, writing of the manuscript, or the decision to submit the manuscript for publication. Simbex (Lebanon, New Hampshire), who has a product development partnership with Riddell, aided with database management of the raw helmet impact data. Both Riddell and ElMindA reviewed the final manuscript for technical accuracy relevant to their technology used in the study (ElMindA's technology is not presented in this article).

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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