The Acute Neuropsychological Effects of Heading in Soccer: A Pilot Study Relationship of soccer heading to computerized neurocognitive performance and symptoms among female and male youth soccer players MEASUREMENT OF HEAD IMPACTS IN COLLEGIATE FOOTBALL PLAYERS: RELATIONSHIP BETWEEN HEAD IMPACT BIOMECHANICS AND ACUTE CLINICAL OUTCOME AFTER CONCUSSION Does Visual Performance Influence Head Impact Severity Among High School Football Athletes? The relationship between impact force, neck strength, and neurocognitive performance in soccer heading in adolescent females. Effect of soccer heading ball speed on S100B, sideline concussion assessments and head impact kinematics Evaluation of Neuropsychological Domain Scores and Postural Stability Following Cerebral Concussion in Sports Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion. Effects of pacing, status and unbalance in time motion variables, heart rate and tactical behaviour when playing 5-a-side football small-sided games. The reliability and validity of video analysis for the assessment of the clinical signs of concussion in Australian football. Effect of an acute bout of soccer heading on postural control and self-reported concussion symptoms. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Exploring differences in computerized neurocognitive concussion testing between African American and White athletes. Immediate Neurocognitive Effects of Concussion The assessment of orientation following concussion in athletes. Head Impact Exposure During a Weekend Youth Soccer Tournament
Objective The main objective of this study was to prospect ively examine the acute effects of heading in soccer on cognitive function . Design This was a prospect i ve cross-over study using a brief neuropsychological battery to assess cognitive function . The tests were performed before and after two separate practice sessions , with athletes serving as their own controls . Setting Male and female Division I college athletes . Participants Members of the men 's and women 's varsity collegiate Penn State University soccer teams . Forty-four males and 56 females entered and finished the study . All athletes had a normal physical examination . Interventions Before and after both practice sessions , all athletes had a brief battery of neuropsychological tests and a symptom checklist . Main Outcome Measures Neuropsychological tests symptom checklist compared at baseline with those after the practice sessions . Results There were no significant differences in pretest scores between groups and no difference on posttest scores between heading and nonheading groups . A significant difference was detected using MANOVA ( p = < 0.001 ) between pre- and posttest scores for measures of attention and concentration , indicating a practice effect . A gender-specific effect in one test measuring attention and concentration was found . There was no difference in symptoms before and after heading as compared with exertional controls . Conclusions In this study , soccer players heading the ball does not appear to lead to acute changes in cognitive function as assessed by a brief neuropsychological battery . There are practice effects that occur with repetitive neuropsychological testing and gender differences with certain tests Primary objective : The purpose of this study was to investigate the relationship between soccer heading and computerized neurocognitive performance and symptoms in female and male youth soccer players . Research design : Cross-sectional and prospect i ve design . Methods and procedures : A total of 63 ( 27 females , 36 males ) youth soccer players aged 13–18 years ( M = 15.89 , SD = 1.17 ) participated in the study . Participants completed the Immediate Post-concussion Assessment and Cognitive Test ( ImPACT ) and symptom report . Main outcomes : Computerized neurocognitive performance ( e.g. , verbal and visual memory , motor processing , and reaction time ) and symptoms . Results : There were no differences in neurocognitive performance or symptoms among low- , moderate- , and high-exposure header groups . The current sample outperformed the 10th percentile norms for neurocognitive and symptom scores . Males headed the ball more frequently and reported lower verbal and visual memory and motor processing speed scores than females . Conclusion : The current findings did not support a relationship between soccer heading and computerized neurocognitive performance and symptoms . The research ers suggest that any purported effects of soccer heading in youth are subtle and may affect only a small number of athletes . The reported sex differences in heading exposure warrant further attention OBJECTIVE To determine the relationship between recorded head accelerations and impact locations and acute clinical outcome of symptomatology , neuropsychological , and postural stability tests after cerebral concussion in Division I collegiate football players . METHODS A prospect i ve field study was used in which accelerometers were embedded in the football helmets of 88 collegiate football players .  Linear and rotational accelerations of all head impacts sustained over the course of 2004 to 2006 National Collegiate Athletic Association football seasons were collected in real-time . Change scores were calculated on clinical measures from the players ' preseason baseline to postinjury ( within 48 h ) and regressed against the recorded linear and rotational accelerations of the head at the time of the concussion . RESULTS Thirteen concussions were recorded ranging in impact magnitudes of 60.51 to 168.71 g. Linear regression showed no significant relationships between impact magnitude ( linear or rotational acceleration ) or impact location and change scores for symptom severity , postural stability , or neurocognitive function ( P > 0.05 ) . CONCLUSION Our findings suggest that football players are concussed by impacts to the head that occur at a wide range of magnitudes and that clinical measures of acute symptom severity , postural stability , and neuropsychological function all appear to be largely independent of impact magnitude and location . Because of the varying magnitudes and locations of impacts result ing in concussion as well as other factors such as the frequency of subconcussive impacts and number of previous concussions , it may be difficult to establish a threshold for concussive injury that can be applied to all football players Objective : To compare the odds of sustaining moderate and severe head impacts , rather than mild , between high school football players with high and low visual performance . Design : Prospect i ve quasi-experimental . Setting : Clinical Research Center/On-field . Participants : Thirty-seven high school varsity football players . Interventions : Athletes completed the Nike SPARQ Sensory Station visual assessment before the season . Head impact biomechanics were captured at all practice s and games using the Head Impact Telemetry System . Main Outcome Measures : Each player was classified as either a high or low performer using a median split for each of the following visual performance measures : visual clarity , contrast sensitivity , depth perception , near – far quickness , target capture , perception span , eye – h and coordination , go/no go , and reaction time . We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures . Results : Players with better near – far quickness had increased odds of sustaining moderate [ odds ratios ( ORs ) , 1.27 ; 95 % confidence intervals ( CIs ) , 1.04 - 1.56 ] and severe head impacts ( OR , 1.45 ; 95 % CI , 1.05 - 2.01 ) as measured by Head Impact Technology severity profile . High and low performers were at equal odds on all other measures . Conclusions : Better visual performance did not reduce the odds of sustaining higher magnitude head impacts . Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players . Further research is needed to determine whether visual performance influences concussion risk . Clinical Relevance : Based on our results , we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts Head impacts are common in contact sports , but only recently has there been a rising awareness of the effects of subconcussive impacts in adolescent athletes . A better underst and ing of how to attenuate head impacts is needed and therefore , this study investigated the relationship between neck strength , impact , and neurocognitive function in an acute bout of soccer heading in a sample of female high school varsity soccer players . Seventeen participants completed the ImPACT neurocognitive test and had their isometric neck strength tested ( flexion , extension , and bilateral flexion ) before heading drills . Each participant was outfitted with custom headgear with timing switches and a three-dimensional accelerometer affixed to the back of the head , which allowed for measurement of impact during heading . Participants performed a series of 15 directional headers , including 5 forward , 5 left and 5 right headers in a r and om order , then completed the ImPACT test again . Neurocognitive tests revealed no significant changes following heading . However , there were statistically significant , moderate , negative correlations ( r = -0.500:-0.757 , p < .05 ) between neck strength and result ant header acceleration , indicating that those with weaker necks sustained greater impacts . This suggests neck strengthening may be an important component of any head injury prevention/reduction program Abstract Objective : To examine the effect of soccer heading ball speed on S-100B serum concentration , concussion sideline assessment s and linear head impact acceleration . Methods : Sixteen division I soccer players participated in this pre-test post-test design study . Athletes performed five st and ing headers over a 10 minute period at 30 ( n = 5 ) , 40 ( n = 5 ) or 50 ( n = 6 ) miles per hour ( mph ) ( r and omized ) . S-100B serum concentration ( ng mL−1 ) and sideline concussion assessment s were measured prior to and post-heading . Peak result ant linear head acceleration ( gravitational units ; g ) was measured during soccer heading . Results : No statistically significant interaction effects were identified between ball velocity groups over time on S100B ( effect sizes ranged from 0.03–0.23 ) or concussion assessment s tests . There was a non-significant increase ( p = 0.06 ) in head impact acceleration from the 30 ( 30.6 ; SD = 6.2 g ) to 50 mph ( 50.7 ; SD = 7.7 g ) ball speed . Conclusions : In this controlled setting , an acute bout of soccer heading across various ball velocities did not affect S100B or concussion assessment test scores . These findings are preliminary , as the small sample size in each group may have played a role in the lack of significant findings Context With increasing knowledge and research about concussion , there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion . Objective To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing . Design A prospect i ve epidemiological model was used for the course of the study . Setting Division I intercollegiate athletics . Participants Athletes participating in football , soccer , basketball , softball , and cheerleading . Main Outcome Measures  Neuropsychological scores and posturography measures  were obtained preseason and serially at day 1 , day 2 , day 3 , and day 10 postconcussion .  Control participants  were tested at the same intervals .  Neuropsychological scores were converted to st and ards score and then into domains of attention , learning , speed of information processing , concentration , memory , and verbal fluency . Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed . Results Significant group differences were found for self reported symptoms ( P = 0.001 ) , speed of information processing ( P = 0.005 ) , mean stability ( P = 0.002 ) , and vestibular function ( P = 0.003 ) between injured and control participants . A group , by day , planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury , while symptoms and the vestibular ratio remained significant only through day 3 . Conclusions The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury . A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions Objective : To determine whether exposure to repetitive head impacts over a single season negatively affects cognitive performance in collegiate contact sport athletes . Methods : This is a prospect i ve cohort study at 3 Division I National Collegiate Athletic Association athletic programs . Participants were 214 Division I college varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration-time history of the head following impact , and 45 noncontact sport athletes . All athletes were assessed prior to and shortly after the season with a  cognitive screening battery ( ImPACT ) and a subgroup of athletes also were assessed with 7 measures from a neuropsychological test battery . Results : Few cognitive differences were found between the athlete groups at the preseason or postseason assessment s. However , a higher percentage of the contact sport athletes performed more poorly than predicted postseason on a measure of new learning ( California Verbal Learning Test ) compared to the noncontact athletes ( 24 % vs 3.6 % ; p < 0.006 ) . On 2 postseason cognitive measures ( ImPACT Reaction Time and Trails 4/B ) , poorer performance was significantly associated with higher scores on several head impact exposure metrics . Conclusion : Repetitive head impacts over the course of a single season may negatively impact learning in some collegiate athletes . Further work is needed to assess whether such effects are short term or persistent STUDY DESIGN Prospect i ve cohort . OBJECTIVES To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition . BACKGROUND Neurocognitive testing , balance assessment s , and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected . Previous literature suggests many concussions go unreported . Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider . METHODS Forty-five Division IA collegiate football players participated in this study . Preseason baseline scores using the  Balance Error Scoring System , the Immediate Post-Concussion Assessment and Cognitive Testing , and the Postconcussion Symptom Scale  were compared to posttest results obtained 48 hours following a game . Prevalence of symptoms was analyzed and reported . RESULTS Thirty-two ( 71 % ) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale , Balance Error Scoring System , or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing . Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function . CONCLUSION In a cohort of football players tested 48 hours following their last game of the season , who did not seek medical attention related to a concussion , a significant number demonstrated limitations in neurocognitive and balance performance , suggesting that further research may need to be performed to improve recognition of an athlete 's deficits and to improve the ability to assess concussion . LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence , level 3b OBJECTIVES To compare time-motion variables , heart rate and players ' tactical behaviour according to game pace ( slow , normal or fast ) , status ( winning and losing ) and team unbalance ( superiority and inferiority ) in football 5-a-side small-sided games .  To identify the most discriminating variables in classifying performances according to these constraints . DESIGN Cross-sectional field study . METHODS The data were gathered using global positioning systems ( 5 Hz ) in 5-a-side small-sided games ( 7 × 5 min ) played by twenty-four footballers .  The tactical performance was measured using dynamical  positioning variables , processed by non-linear signal processing techniques ( approximate entropy ) . ANOVA models were used to compare between constraints and discriminant analyses to identify the variables that best discriminate between pacing and status × unbalance constraints . RESULTS The fast paced games had the highest mean speed value , followed by normal and slow paced games ( 8.2 ± 0.6 km h(-1 ) , 7.8 ± 0.5 km h(-1 ) and 6.2 ± 0.4 km h(-1 ) , respectively ) . The stronger predictor variables of pacing were the r and omness in distance to team centroid and the distances covered above 13 km h(-1 ) . The results also changed according to game status and team unbalance . The strongest predictor variables were the distance covered below 6.9 km h(-1 ) , distance and r and omness to team centroid , with higher values when winning in superiority conditions . CONCLUSIONS Practice task design manipulating game pace , status and team unbalance significantly influenced the emergent behavioural dynamics . Collective positioning variables were more accurate in discriminating these constraints and , therefore , need to be considered when planning and monitoring performance OBJECTIVES The objective of this study was to determine the reliability and validity of identifying clinical signs of concussion using  video analysis in Australian football . DESIGN Prospect i ve cohort study . METHODS All impacts and collisions potentially result ing in a concussion were identified during 2012 and 2013 Australian Football League seasons . Consensus definitions were developed for clinical signs associated with concussion . For intra- and inter-rater reliability analysis , two experienced clinicians independently assessed 102 r and omly selected videos  on two occasions . Sensitivity , specificity , positive and negative predictive values were calculated based on the diagnosis provided by team medical staff . RESULTS 212 incidents result ing in possible concussion were identified in 414 Australian Football League games . The intra-rater reliability of the  video-based identification of signs associated with concussion was good to excellent . Inter-rater reliability was good to excellent for impact seizure , slow to get up , motor incoordination , ragdoll appearance ( 2 of 4 analyses ) , clutching at head and facial injury . Inter-rater reliability for loss of responsiveness and blank and vacant look was only fair and did not reach statistical significance . The feature with the highest sensitivity was slow to get up ( 87 % ) , but this sign had a low specificity ( 19 % ) . Other video signs had a high specificity but low sensitivity . Blank and vacant look ( 100 % ) and motor incoordination ( 81 % ) had the highest positive predictive value . CONCLUSIONS Video analysis may be a useful adjunct to the side-line assessment of a possible concussion . Video analysis however should not replace the need for a thorough multimodal clinical assessment Our purpose was to determine if an acute bout of heading soccer balls adversely affected postural control and self-reported symptoms of cerebral concussion .  Thirty-one college-aged soccer players were r and omly placed into either a kicking group or a heading group . Subjects either kicked or headed 18 soccer balls over the course of 40 minutes . Subjects had their  postural control assessed while st and ing on a force plate and completed a  concussion symptoms checklist  on three separate occasions : prior to , immediately following , and 24 hours after kicking or heading . There were no significant differences between the heading and kicking groups on the postural control measures prior to , immediately following , and 24 hours after kicking/heading . The heading group did , however , report significantly more concussion symptoms than the kicking group immediately after heading , but not 24 hours after heading . The number of previous concussions sustained by subjects did not influence the effects of heading . An acute bout of soccer heading appears to cause an increase in self-reported symptoms of cerebral concussion lasting less than 24 hours but no quantifiable deficits in postural control . Further research is needed to investigate the cumulative effects of soccer heading on postural control and other objective measures of brain function OBJECTIVE This study prospect ively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities . The study was design ed to determine the presence and duration of neuropsychological symptoms after mild head injury . METHODS A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players ( n = 183 ) with those of gender , age , and education matched controls . A number of neuropsychological tests , including the Paced Auditory Serial Addition Test , the Digit Symbol Test , and the Trail Making Test , as well as a symptom checklist  were used . TECHNIQUE Players and controls were assessed before engaging in game activity and 24 hours , 5 days , and 10 days after injury , using the st and ardized test battery and symptom checklist . RESULTS Players with head injuries displayed impaired performance and increased symptoms in comparison to controls , but this impairment resolved within 5 days in most players . Players with head injuries showed significant improvement between 24 hours and 5 days , as well as between 5 and 10 days . CONCLUSION Although single , uncomplicated mild head injuries do cause limited neuropsychological impairment , injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae The purpose of the current study was to explore potential differences in pre- and post-concussion performance on a computerized neurocognitive concussion test between African American and White high-school and collegiate student-athletes . A prospect i ve case-control design was used to compare baseline and 2- and 7-day post-concussion computerized neurocognitive performance and symptoms between 48 White and 48 African American athletes matched for age , gender , and concussion history . The Immediate Post-Concussion Assessment Cognitive Test ( ImPACT ) version 2.0 ( NeuroHealth System , LLC , Pittsburgh , PA , USA ) computer software program was used to assess neurocognitive function ( i.e. , verbal and visual memory , motor processing speed , and reaction time ) and concussion symptoms . Regardless of race/ethnicity , there were significant decrements in computerized neurocognitive performance and increased symptoms following a concussion for the entire sample . African Americans and Whites did not differ significantly on baseline or post-concussion verbal memory , visual memory , reaction time , and total reported symptoms . However , African American participants were 2.4 × more likely to have at least one clinical ly significant cognitive decline on ImPACT at 7 days post-concussion and scored lower at 7 days post-concussion compared with baseline on processing speed than White participants . The authors concluded that the baseline ImPACT test was culturally equivalent and construct valid for use with these two racial/ethnic groups . However , in contrast , the findings support deleterious performance for the African American athletes compared with the White athletes on the ImPACT post-concussion evaluation that is of critical clinical relevance and warrants further research OBJECTIVE To prospect ively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness ( LOC ) and posttraumatic amnesia ( PTA ) on the severity of neurocognitive impairment immediately after concussion . METHODS A sports-related concussion research model was used to allow prospect i ve immediate evaluation of concussion . A total of 2385 high school and college football players were studied . Ninety-one players ( 3.8 % ) sustained concussions during the study . A brief neurocognitive and neurological screening measure , the St and ardized Assessment of Concussion  , was used to assess cognitive functioning before the football season , immediately after injury , and 15 minutes , 48 hours , and 90 days after injury . RESULTS St and ardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean , even for injured subjects without LOC or PTA . Subjects with LOC were most severely impaired immediately after injury , whereas those without LOC or PTA were least impaired . Significant impairment was also detected 15 minutes after injury , but all three groups returned to baseline levels of cognitive functioning within 48 hours . CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC The purpose of this study was to investigate the sensitivity of  orientation and recent memory questions  in the diagnosis of concussion . In a prospect i ve study over 7 consecutive years ( 1985 - 1991 ) , all players at a professional Australian Rules Football club who sustained a concussive injury ( n = 28 ) were administered a set of questions evaluating orientation and recent memory .  Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms . A control group of age-matched nonconcussed players was administered the same set of questions . The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than st and ard orientation items . The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport Concussion is a known risk in youth soccer , but little is known about subconcussive head impacts . The authors provided a prospect i ve cohort study measuring frequency and magnitude of subconcussive head impacts using accelerometry in a middle school – age soccer tournament , and association between head impacts and changes in ( 1 ) symptoms , ( 2 ) cognitive testing , and ( 3 ) advanced neuroimaging .  A total of 17 youth completed the study ( 41 % female , mean 12.6 years ) . There were 73 head impacts > 15 g measured ( 45 % headers ) and only 2 had a maximum peak linear acceleration > 50 g . No youth reported symptoms consistent with concussion . After correction for multiple comparisons and a sensitivity analysis excluding clear outliers , no significant associations were found between head impact exposure and neuropsychological testing or advanced neuroimaging . The authors conclude that head impacts were relatively uncommon and low in acceleration in youth playing a weekend soccer tournament . This study adds to the limited data regarding head impacts in youth soccer
The overall results of r and om effects modelling of football heading were found to be inconclusive across all outcomes , groups and time points .
No moderating variables related to method ological , sample or study characteristics were supported in the analysis ; age was a potential moderating variable .
Summary / conclusions We provide the first meta-analytical review of football heading effects aggregated from multiple studies and extended findings from a recent systematic review of the effects of football heading .
Our analysis indicates no overall effect for heading a football on adverse outcomes
Aim / objective The objective of this study was to provide a meta- analysis examining the effects of football heading .
Design Meta-analytical review on football heading effects on neurocognitive performance , cognition and symptom reports .