Cumulative Sub-concussive Impacts in a Single Season of Youth Football


 Researchers Find No Association With Decline in Neurocognitive Measures

October 15, 2018

COLUMBUS, Ohio – In an investigation of head impact burden and change in neurocognitive function during a season of youth football, researchers find that sub-concussive impacts are not correlated with worsening performance in neurocognitive function.

Each year, more than 3 million children in primary and high school play tackle football in the United States. Growing concern about the possible negative effects of repetitive sub-concussive head impacts led to an increased number of physicians and parents who counsel against youth participation in full-contact sports.

A research team, led by Sean Rose, MD, pediatric sports neurologist and co-director of the Complex Concussion Clinic at Nationwide Children’s Hospital, followed 112 youth football players age 9-18 during the 2016 season in a prospective study.

“When trying to determine the chronic effects of repetitive sub-concussive head impacts, prospective outcomes studies are an important complement to the existing retrospective studies,” says Dr. Rose. “In this study of primary school and high school football players, a battery of neurocognitive outcomes tests did not detect any worsening of performance associated with cumulative head impacts.”

The pre- and post-season assessments used to measure outcomes included:

  • Neuropsychological testing
  • Symptoms assessment
  • Vestibular and ocular-motor screening
  • Balance testing
  • Parent-reported ADHD symptoms
  • Self-reported behavioral adjustment

Sensors placed in the helmets recorded sub-concussive head impacts during practices and games. Researchers added the impact g-forces to yield a cumulative impact measure. According to the study, cumulative impact did not predict changes (from pre-season to post-season) in any of the outcome measures.

Additionally, Dr. Rose notes, having sustained one or more concussions prior to entering the study was not associated with worse pre-season testing. 

In their secondary analysis, they found that younger age and reported history of attention deficit hyperactivity disorder (ADHD) predicted score changes on several cognitive testing measures and parent-reported ADHD symptoms. Additionally, a reported history of anxiety or depression predicted changes in scores of symptom reporting.

“We expected repetitive impacts to correlate with worsening neurocognitive function, but we found that sub-concussive head impacts sustained over the course of a single season were not associated with neurocognitive functional outcomes. And also surprising, sustaining isolated high g-force impacts was also not associated with worse outcome,” says Dr. Rose. “The lack of a significant association may reflect the need for longer follow up – so we are continuing to follow kids across multiple seasons.”

This publication is the first analysis in a four-year prospective cohort study. Dr. Rose will be presenting data from the second year of the study at the upcoming Child Neurology Society meeting in mid-October. The team is currently collecting data for a third year.

Reference:

Rose SC, Yeates KO, Fuerst DR, Ercole PM, Nguyen JT, Pizzimenti NM. Head impact burden and change in neurocognitive function during a season of youth football. The Journal of Head Trauma Rehabilitation. [Epub ahead of print.]

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Sean Rose
Sean C. Rose, MD
Pediatrics

About Nationwide Children's Hospital

Named to the Top 10 Honor Roll on U.S. News & World Report ‘s 2018-19 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit freestanding pediatric health care systems providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children and adolescents, as well as adult patients with congenital disease. Nationwide Children’s has a staff of more than 13,000 providing state-of-the-art pediatric care during more than 1.4 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded freestanding pediatric research facilities. More information is available at NationwideChildrens.org.