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Background Sensor devices have enabled estimations of head impact kinematics across contact sports. Objectives To quantitatively report the magnitude (linear and rotational acceleration) and frequency of game-related head impacts recorded in male contact sports athletes. Methods A systematic review was conducted in June 2017. Inclusion criteria were English-language in vivo studies published after 1990 with a study population of male athletes aged ≥ 16 years, in any sport, where athletes were instrumented with an accelerometer device for measuring head impacts. Study populations were not limited to players with a clinical diagnosis of concussion. Results Twenty-one studies met the inclusion criteria with 12 conducted on American Football athletes. Six of these studies were included for meta-analysis. At a threshold of 10 g , amateur rugby players sustained the most impacts per player per game (mean = 77, SD = 42), followed by amateur Australian Football (mean = 29, SD = 37) and collegiate lacrosse athletes (mean = 11.5, SD = 3.6). At thresholds of greater than 14.4 g , high school American Football athletes sustained between 19 (SD = 19.1) and 24.4 (SD = 22.4) impacts per player per game. Statistically significant heterogeneity was observed among the included studies, and meta-analysis of impact magnitude was limited. Conclusions The frequency of “head acceleration events” was quantified and demonstrated substantial variation in methodology and reporting of results. Future research with standardised reporting of head impacts and inclusion of non-helmeted sports is warranted to enable more robust comparisons across sports. Prospero ID CRD42017070065.

Background Concussion is common in the sporting arena and is often challenging to diagnose. The development of wearable head impact measurement systems has enabled measurement of head kinematics in contact sports. Objectives The objective of this systematic review was to determine the characteristics of head kinematics measured by an accelerometer system among male athletes diagnosed with concussion. Methods A systematic search was conducted in July 2015. Inclusion criteria were English-language studies published after 1990 with a study population of male athletes, in any sport, where objectively measured biomechanical forces were reported in the setting of a concussive event. The random effects meta-analysis model was used to combine estimates of biomechanical force measurements in concussed athletes. Results Thirteen studies met the inclusion criteria, the majority of which were conducted with high school and college football teams in the US. Included studies measured a combination of linear and rotational acceleration. The meta-analysed mean peak linear head acceleration associated with a concussive episode was 98.68 g (95 % CI 82.36–115.00) and mean peak rotational head acceleration was 5776.60 rads/s 2 (95 % CI 4583.53–6969.67). The estimates of the biomechanical forces were consistent across studies, with I 2 values of 0 % for both meta-analyses. Conclusions Head impact monitoring through accelerometery has been shown to be useful with regard to characterising the kinematic load to the head associated with concussion. Future research with improved clinical outcome measures and head kinematic data may improve accuracy when evaluating concussion, and may assist with both interpretation of biomechanical data and the development and utilisation of implementation strategies for the technology.

The objective of this systematic scoping review is to understand the extent and scope of evidence regarding neurodiversity in elite sport. This systematic scoping review considered epidemiological studies, commentary and viewpoints papers, systematic review and meta-analyses, and any intervention or clinical treatment, management and practice studies in relation to neurodiversity in elite sport. Case studies and grey literature were ineligible for review. Neurodivergence included neurodevelopmental disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD) and specific learning disorders. Elite sport was defined as Olympic, Paralympic, national, international, professional and semiprofessional sport. The final 23 studies included in this review comprised 10 observational studies, 4 systematic/narrative reviews, 6 commentary/position statements and 3 qualitative studies. The literature reflected a major focus on ADHD as a risk factor for concussion and prognosis for postconcussion recovery. Further, there was a focus on the medical management of ADHD, regarding adherence to sporting antidoping regulations. One study focused on the experience of autism in athletes in elite sport settings through qualitative interviews. One study focused on anxiety disorders in elite athletes, with ADHD emerging as a major risk factor. There is a strong rationale for future research to build on the evidence for neurodiversity in elite sport to foster supportive and inclusive elite sporting environments.

ObjectivesTo assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users.DesignA systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth <18, English language, in vivo studies published after 1980 that evaluated SRC and other injury incidence in HG users compared with non-users.Outcome measuresIncidence rates of SRC, superficial head injury or other injuries.ResultsEight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (risk ratio (RR) 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50).ConclusionsHG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted.PROSPERO registration numberCRD42018115310.

ObjectiveJunior Australian football players with sport-related concussion (SRC) often do not access optimal healthcare. We aimed to evaluate the feasibility of an industry-supported healthcare programme that removed financial and logistical barriers to accessing care for SRC and adherence to the Australian Football League’s (AFL) SRC management guidelines.MethodsJunior Australian football players (from a Melbourne-based league of 9852; under 8–18 competitions) who sustained a suspected or diagnosed SRC during the 2023 season were recruited. Players underwent assessment and management for SRC by a sport and exercise medicine registrar, including return to school and play planning in accordance with the AFL guidelines. Outcomes included programme demand, implementation, acceptability and adherence to the AFL’s guidelines (median, (range) days for return to school, training and play).ResultsFrom 154 eligible players, 58 (37.7%) participated, resulting in a weekly demand of 4.1 players (95% CI 3.1 to 5.2). 49 players were diagnosed with an SRC, and 9 players were cleared for SRC at their initial appointment. 44 players with SRC (89.8%) adhered to all medical advice and returned to play after receiving a medical clearance. All players returned to school (1 (0–10) days), unrestricted training (16 (2–53) days) and play (21 (7–63) days).ConclusionThe low programme demand indicates financial constraints and/or access to medical practitioners are not the main barriers for players with suspected SRC to formally seek healthcare in a metropolitan context. Those who did participate demonstrated high levels of appointment attendance, acceptability and adherence to AFL guidelines.

Background The consequences of exposure to head acceleration events (HAEs) in collision sports, including Australian Rules football, are a growing concern. Instrumented mouthguards (iMGs) now enable accurate quantification of HAEs in sport; however, little is known about HAE incidence and mechanisms in Australian Rules football. We aimed to measure HAEs in elite Australian Rules football players, and evaluate the influence of playing position and match event on the incidence and magnitude of HAEs in men and women. iMG data were collected from Australian Football League (AFL) and AFL Women’s (AFLW) players in 2023 utilising the HIT-IQ Nexus Gen III iMG, targeting 500 player-matches per sex. Match footage was synchronised with iMG data for video verification and match play coding. Results Three hundred and eleven players contributed iMG data in the analyses, including 126 men (median matches per player: 3 (interquartile range [IQR: 2–6]) and 185 women (median: 3 [IQR: 1–4]). Men had a higher mean incidence of HAEs ≥ 8 g per match than women (5.7 [95% confidence interval CI: 5.0–6.4] vs. 3.0 [95% CI: 2.8–3.3]), however the incidence was comparable when adjusted for time (3.6/hour [95% CI: 3.2–4.1] vs. 3.1/hour [95% CI: 2.9–3.4]). Men recorded higher maximum single-impact peak linear acceleration (PLA; median 31 g vs. women: median 22 g; p  < 0.001) and peak rotational acceleration (PRA; median 3.0 krad/s² vs. women: 2.4 krad/s²; p  < 0.001) per match. Conversely, women experienced greater PRA per impact (median 1.4 krad/s² vs. men: 1.2 krad/s²; p  < 0.001), while PLA was similar (men: median 14 g, women: median 13 g; p  = 0.330). The leading match events resulting in HAEs were marking contests (1.0/hour) in men and contested ball situations (0.8/hour) in women. HAE incidence and magnitude were generally comparable across playing positions, except for men’s rucks, who experienced significantly higher incidence of HAEs (6.5/hour) than forwards (3.6/hour), midfielders (3.2/hour), and defenders (2.7/hour). Conclusions This study highlights differences in HAE incidence, magnitude, and mechanisms by sex, playing position, and match events in elite-level Australian Rules football. These findings provide insight into impact exposure patterns and may inform targeted skill development and policy adjustments to enhance player safety. Key Points In elite-level Australian Rules football, men sustained more instrumented mouthguard-measured head acceleration events (HAEs) per match compared to women; however, incidence was similar after adjusting for time played. Men experienced higher maximum single-impact peak linear and rotational accelerations values per match, while women experienced greater peak rotational acceleration per HAE. Men’s rucks had a significantly higher incidence of HAEs than defenders, midfielders, and forwards, primarily due to more frequent low-magnitude impacts from ruck and marking contests.

Background Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. Methods Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. Discussion Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. Trial registration ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118

ObjectiveTo assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users.DesignA systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth.Outcome MeasuresIncidence rates of SRC, superficial head injury or other injuries.Main ResultsEight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (RR 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50).ConclusionsHG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted.

ObjectiveTo assess the incidence of, and mechanisms causing concussion in elite male (AFL) and female (AFLW) Australian football, to identify potential targets for risk reduction.DesignRetrospective study.Setting/ParticipantsConcussion data was obtained from the AFL medical database, which included all concussions sustained by AFL (male) players from 2015–18 and AFLW (female) players from 2017–19. All concussions were diagnosed by experienced clinicians utilising standardised concussion assessment tools and injury definitions, as well as video review.InterventionsWhere available, video footage of each incident was obtained and analysed to determine the circumstances in which each concussion occurred, including the mechanism and the contact point of impact.Main ResultsOverall, 252 concussions (6.72 per 1,000 player hours, 95%CI: 5.89–7.55) were reported in 779 matches in the AFL competition, compared to 44 concussions in 96 matches (14.61 per 1,000 player hours, 95%CI: 10.38–18.85) in the AFLW competition. Video footage was available for 194/252 (77%) concussions in the AFL and 35/44 (80%) concussions in the AFLW. Video analysis determined that players ‘being bumped’ (23%) and ‘being tackled’ (20%) were the most prevalent mechanisms in the AFLW, compared with the AFL in which ‘marking contests’ (multiple players attempting to catch the football, 28%) were most commonly associated with diagnosed concussion.ConclusionsThese findings confirm that there is a higher incidence of concussion in females compared to males in elite Australian football. The study also suggests that the mechanisms associated with concussion differ across the male and female competitions, potentially requiring individualised injury prevention efforts.

There is significant variability in long-term outcomes after traumatic brain injury (TBI), making accurate prognosis difficult. In seeking to enhance understanding of outcomes, this study aimed to investigate whether COMT Val158Met allele status was associated with performance on neuropsychological measures of attention and working memory, executive functioning, learning and memory, and speed of information processing in the early rehabilitation phase. The study also aimed to examine whether the COMT polymorphism was associated with longer-term functional outcomes. A total of 223 participants (71.3% male) with moderate-to-severe TBI were recruited as rehabilitation inpatients to participate in a prospective, longitudinal head injury outcome study. The three COMT genotype groups (Val/Val, Val/Met, and Met/Met) were well matched for estimated full-scale IQ, years of education, age at injury, and injury severity. Results showed no significant difference between genotypes on neuropsychological measures (all p>0.05) or functional outcome, as measured by the Glasgow Outcome Scale-Extended (GOS-E), after controlling for age, education, and severity of injury. The presence of frontal lobe pathology was also not associated with cognitive performance. Those with greater injury severity (i.e., longer duration of post-traumatic amnesia) performed more poorly on measures of processing speed and verbal new learning and recall. It was concluded that there was little support for the influence of COMT Val158Met on cognitive function, or functional outcome measures, in the acute rehabilitation phase after TBI.