Correlation of Concussion Symptom Profile with Head Impact Biomechanics: A Case for Individual-Specific Injury Tolerance.

Concussion is a brain injury induced by biomechanical forces that is broadly defined as a complex pathophysiological process affecting the brain. The intricate link between biomechanical input and concussion injury response is poorly understood. We aimed to test the hypothesis that greater biomechanical forces would result in the presentation of more concussion-related symptoms that would take longer to resolve. The objective of this study was to investigate the relationship between an array of biomechanical parameters measured for concussive impacts and the presentation and resolution of concussion symptoms. A total of 319 collegiate football players from six universities were recruited to participate in this study. Certified athletic trainers and/or team physicians at each site diagnosed and treated concussions sustained by subjects through participation in football. The subjects' helmets were instrumented with accelerometer arrays that measured linear and rotational head accelerations for each impact experienced during games and practices. Correlations between biomechanical measurements associated with concussion symptom presentation and recovery were quantified. A total of 22 subjects collectively sustained 25 concussions, with three subjects sustaining two concussions each. Biomechanical measures associated with injury were not found to be correlated with number of symptoms, Sport Concussion Assessment Tool 3 Symptom Severity Score, or time to symptom resolution. Linear and rotational accelerations associated with injury were not correlated with symptom severity for any of the 22 individual symptoms evaluated. Further, we found no association between impact location and presence of any individual symptom when ignoring severity grade. While concussive impacts did not stand out relative to impacts that did not result in injury, concussive impacts were among the most severe for each individual player. This suggests tolerance to head acceleration might be individual-specific, meaning similar biomechanical inputs can produce different injury presentations between individuals. Future investigations should consider individual-specific analyses of tolerance to head acceleration and injury response.

[1]  K. Chinzei,et al.  Mechanical properties of brain tissue in tension. , 2002, Journal of biomechanics.

[2]  K. Guskiewicz,et al.  Epidemiology of Concussion in Collegiate and High School Football Players , 2000, The American journal of sports medicine.

[3]  T A Gennarelli,et al.  Acceleration induced head injury in the monkey.I. The model, its mechanical and physiological correlates. , 1981, Acta neuropathologica. Supplementum.

[4]  Stefan M. Duma,et al.  Brain Injury Prediction: Assessing the Combined Probability of Concussion Using Linear and Rotational Head Acceleration , 2013, Annals of Biomedical Engineering.

[5]  A. Ommaya,et al.  Protection from brain injury: the relative significance of translational and rotational motions of the head after impact , 1970 .

[6]  J. Crisco,et al.  Rotational Head Kinematics in Football Impacts: An Injury Risk Function for Concussion , 2011, Annals of Biomedical Engineering.

[7]  A. Kemper,et al.  Biomechanical response of human liver in tensile loading. , 2010, Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference.

[8]  Christine M Baugh,et al.  Frequency of head-impact-related outcomes by position in NCAA division I collegiate football players. , 2015, Journal of neurotrauma.

[9]  Tawfik B. Khalil,et al.  The Role of Impact Location in Reversible Cerebral Concussion , 1983 .

[10]  Scott Tashman,et al.  A study of the response of the human cadaver head to impact. , 2007, Stapp car crash journal.

[11]  E. H. Harris,et al.  Scaling of Experimental Data on Cerebral Concussion in Sub-Human Primates to Concussion Threshold for Man , 1967 .

[12]  J. Crisco,et al.  A proposed method to reduce underreporting of brain injury in sports. , 2012, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[13]  Joel D Stitzel,et al.  Age and gender based biomechanical shape and size analysis of the pediatric brain. , 2008, Stapp car crash journal.

[14]  J Dvorak,et al.  Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. , 2005, British journal of sports medicine.

[15]  R. Cantu,et al.  Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. , 2009, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[16]  Steven P. Broglio,et al.  High School and Collegiate Football Athlete Concussions: A Biomechanical Review , 2011, Annals of Biomedical Engineering.

[17]  A. Gordon Concussion in professional football: reconstruction of game impacts and injuries. , 2004, Neurosurgery.

[18]  Michael McCrea,et al.  Unreported Concussion in High School Football Players: Implications for Prevention , 2004, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[19]  S. Marshall,et al.  MEASUREMENT OF HEAD IMPACTS IN COLLEGIATE FOOTBALL PLAYERS: RELATIONSHIP BETWEEN HEAD IMPACT BIOMECHANICS AND ACUTE CLINICAL OUTCOME AFTER CONCUSSION , 2007, Neurosurgery.

[20]  King H. Yang,et al.  A proposed injury threshold for mild traumatic brain injury. , 2004, Journal of biomechanical engineering.

[21]  Joseph Cormier,et al.  The tolerance of the maxilla to blunt impact. , 2011, Journal of biomechanical engineering.

[22]  W Langburt,et al.  Incidence of Concussion in High School Football Players of Ohio and Pennsylvania , 2001, Journal of child neurology.

[23]  A. Ommaya,et al.  The role of whiplash in cerebral concussion , 1966 .

[24]  F J Unterharnscheidt,et al.  Translational versus rotational acceleration: animal experiments with measured input. , 1971, Scandinavian journal of rehabilitation medicine.

[25]  J. Funk,et al.  Head and Neck Loading in Everyday and Vigorous Activities , 2011, Annals of Biomedical Engineering.

[26]  J. Adams,et al.  Diffuse axonal injury and traumatic coma in the primate , 1982, Annals of neurology.

[27]  J. Beckwith,et al.  Measuring Head Kinematics in Football: Correlation Between the Head Impact Telemetry System and Hybrid III Headform , 2011, Annals of Biomedical Engineering.

[28]  Stephen W Marshall,et al.  Laboratory Validation of Two Wearable Sensor Systems for Measuring Head Impact Severity in Football Players , 2015, Annals of Biomedical Engineering.

[29]  R. Cantu Biomechanical Properties of Concussions in High School Football , 2011 .

[30]  Priya Prasad,et al.  Biomechanical and scaling bases for frontal and side impact injury assessment reference values. , 2003, Stapp car crash journal.

[31]  Stephen W Marshall,et al.  Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. , 2003, JAMA.

[32]  A. Ommaya,et al.  Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. , 1974, Brain : a journal of neurology.

[33]  Megan L. Bland,et al.  Biomechanical Perspectives on Concussion in Sport , 2016, Sports medicine and arthroscopy review.

[34]  Joseph A. Maldjian,et al.  Head Impact Exposure in Youth Football: Elementary School Ages 9–12 Years and the Effect of Practice Structure , 2013, Annals of Biomedical Engineering.

[35]  Stefan M. Duma,et al.  Development of the STAR Evaluation System for Football Helmets: Integrating Player Head Impact Exposure and Risk of Concussion , 2011, Annals of Biomedical Engineering.

[36]  Joseph J Crisco,et al.  Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article. , 2012, Journal of neurosurgery.

[37]  Joseph J Crisco,et al.  Head impact exposure sustained by football players on days of diagnosed concussion. , 2013, Medicine and science in sports and exercise.

[38]  Jiri Dvorak,et al.  Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. , 2009, Journal of athletic training.

[39]  Joseph J Crisco,et al.  An algorithm for estimating acceleration magnitude and impact location using multiple nonorthogonal single-axis accelerometers. , 2004, Journal of biomechanical engineering.

[40]  M. Lafave Consensus statement on concussion. , 2009, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.