The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players

McGill Sport Medicine Clinic, 475 Pine Ave. West, Montreal, Quebec, Canada.
British Journal of Sports Medicine (Impact Factor: 5.03). 03/2008; 42(2):110-5; discussion 115. DOI: 10.1136/bjsm.2007.037689
Source: PubMed


To examine the effects of protective headgear in adolescent football (soccer) players.
Cross-sectional study.
Oakville Soccer Club, Oakville, Canada.
Football players aged 12-17 years.
A questionnaire examining the 2006 football season using self-reported symptoms.
The number of concussions experienced during the current football season, the duration of symptoms, injuries to the head and face and any associated risk factors for these injuries.
In the population studied, 47.8% had experienced symptoms of a concussion during the current football year. 26.9% of athletes who wore headgear (HG) and 52.8% of those who did not wear headgear (No-HG) had concussions. Approximately 4 out of 5 athletes in each group did not realize they had suffered a concussion. More than one concussion was experienced by 50.0% of the concussed HG athletes and 69.3% of the concussed No-HG group. 23.9% of all concussed players experienced symptoms for at least 1 day or longer. Variables that increased the risk of suffering a concussion during the 2006 football year included being female and not wearing headgear. Being female and not wearing football headgear increased the risk of suffering an abrasion, laceration or contusion on areas of the head covered by football headgear.
Adolescent football players experience a significant number of concussions. Being female may increase the risk of suffering a concussion and injuries on the head and face, while the use of football headgear may decrease the risk of sustaining these injuries.

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    ABSTRACT: Les commotions cérébrales subies en contexte sportif constituent un sujet préoccupant. Il est estimé qu’aux États-Unis, environ cinq pourcent de l’ensemble des athlètes subiront une commotion cérébrale. Celle-ci est considérée comme une blessure transitoire dans la majorité des cas. Dans le domaine de la commotion cérébrale sportive, le phénomène de risque accru chez des athlètes ayant subi préalablement des commotions cérébrales est bien documenté. Cet aspect remet en question l’aspect transitoire de la blessure. Les techniques d’imagerie fonctionnelle offrent un grand potentiel dans la compréhension de cette pathologie en montrant notamment les différences fonctionnelles chez des participants ayant subi un traumatisme crânio-cérébral léger en l’absence de résultats comportementaux. Il est probable que des altérations fonctionnelles persistent au-delà de la phase de récupération postsymptômes. L’électrophysiologie, en particulier les potentiels évoqués cognitifs sont un outil de choix pour étudier la question en raison de leur sensibilité et de la mesure fonctionnelle qu’ils permettent d’obtenir. Les potentiels évoqués cognitifs consistent en une réponse électrique cérébrale moyenne générée lors de l’accomplissement d’une tâche. Il est possible d’identifier différentes composantes dans le tracé d’un potentiel évoqué; ces composantes sont associées à différents aspects de l’activité électrique cérébrale durant le traitement perceptuel et cognitif.Les articles scientifiques inclus dans cette thèse se penchent sur les effets de commotions cérébrales multiples chez des athlètes plusieurs mois après la dernière commotion. Dans un premier temps, l’aspect temporel est évalué par le biais de la mesure de la P3a et la P3b dans différents groupes d’athlètes. Ces composantes sont liées aux processus de mémoire et d’attention. Les résultats suggèrent que, malgré un fonctionnement normal, les athlètes ayant subi des commotions cérébrales éprouveraient de probables changements cognitifs sous-cliniques persistants se traduisant par une atténuation des P3a et P3b. Des altérations seraient aussi présentes quelques années après la dernière commotion, mais de façon plus subtile. La deuxième étude soumise s’intéresse aux processus électrophysiologiques liés au maintien de l’information en mémoire de travail visuel chez des athlètes ayant subi plusieurs commotions cérébrales. La mesure utilisée est la SPCN (sustained posterior controlateral negativity), une composante ERP spécifique au processus cognitif étudié. Les résultats montrent non seulement une composante atténuée chez les athlètes ayant subi trois commotions cérébrales ou plus, mais aussi une modulation de la composante en fonction du nombre de commotions cérébrales subies. Ces résultats pourraient contribuer à expliquer le risque accru de subir des commotions cérébrales subséquentes observées chez ces athlètes. En lien avec la littérature, ces données pourraient s’expliquer par la présence de déficits cognitifs sous-cliniques ou encore par la mise en place de mécanismes compensatoires. Enfin, ces résultats invitent à une grande prudence dans la gestion des cas de commotions cérébrales ainsi qu’à un effort d’éducation plus poussé chez les jeunes athlètes afin qu’ils puissent prendre les meilleures décisions concernant leur avenir. Concussions sustained in sporting contexts are a major concern. In United States only, it has been estimated that among all athletes in college teams, 5% will be concussed. According to an agreement following an international symposium on concussion in sport, in most cases, this is a transient injury. Within the field, it is known that the likelihood of sustaining a concussion increased as a function of the number of past concussions. This aspect challenges the transient conception of the injury. Functional imaging techniques such as functional magnetic resonance imaging (fMRI) or eventrelated potentials (ERP) showed functional alterations in absence of any behavioral changes within concussed athlete groups. ERP consist in the averaged cerebral electrical signal recorded on the scalp during a given stimulation or task. Many components may be identified within the signal, each associated to specific perceptual and cognitive functioning. In concussed athletes, it is possible that functional alterations persist well beyond the acute period. ERP have been chosen to study this topic because of their sensitivity. Scientific papers included in this thesis discuss the effects of multiple concussions among young adult athletes months after the last concussion. The first study investigates two groups of athletes with multiple concussions at different time points. P3a and P3b were used as electrophysiological markers. These components are known to be related to attention and memory functions. Results demonstrate that, despite normal neuropsychological evaluation, attenuation is present on both P3. Those changes were still present years after, but in a more subtle manner. The second study describes the effect of multiple concussions on sustained posterior contralateral negativity (SPCN), an ERP component specifically related to information maintenance in visual working memory. Results showed that athletes who sustained three concussions or more display an attenuated SPCN. Also, a modulation of the SPCN as a function of the number of concussions was point out. Overall, these results might help to explain the increased risk of further concussions among concussed athletes. It is possible that results are explained by subclinical cognitive deficits and/or compensatory mechanisms. Finally, such data invites extra precaution in the management of concussions. Also, it seems important to give young athletes plenty of information to allow them to make more enlightened decisions about their future.
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