Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football.
BACKGROUND
Historical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season.


METHODS
A prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome.


RESULTS
With similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05).


CONCLUSIONS
Reduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts.


BACKGROUND
NCT02696200.
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Gregory D
GD
Myer
Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Weihong
W
Yuan
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Health Sciences, Department of Athletic Training, Mount St. Joseph University, Cincinnati, Ohio, USA Rocky Mountain University of Health Professions, Provo, Utah, USA.
Kim D
KD
Barber Foss
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Staci
S
Thomas
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
David
D
Smith
Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
James
J
Leach
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA Department of Psychology, Center for Cognition, Action and Perception, University of Cincinnati, Cincinnati, Ohio, USA.
Adam W
AW
Kiefer
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Chris
C
Dicesare
Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Janet
J
Adams
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
Paul J
PJ
Gubanich
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Katie
K
Kitchen
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Daniel K
DK
Schneider
Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Daniel
D
Braswell
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Darcy
D
Krueger
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Mekibib
M
Altaye
D061725:Accelerometry; D000293:Adolescent; D001265:Athletic Injuries / Q000517:prevention & control*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D056324:Diffusion Tensor Imaging; D005538:Football / Q000293:injuries*; D006257:Head; D006801:Humans; D007601:Jugular Veins; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging; D059906:Neuroimaging; D011446:Prospective Studies; D011482:Protective Devices; D014465:Ultrasonics
Blood; Brain; Concussion; Injury prevention; MRI