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There is growing concern for the resulting neurological and physiological outcomes from repeated head impacts in sports that do not manifest into traditional concussion symptoms. Specifically, there is evidence of immediate physiological deficits following controlled soccer heading. This study will compare the physiological changes of adolescents completing a set of soccer headers to those randomized to a set of soccer kicks to evaluate the effect of repetitive head impacts.
There is limited data relating head impact biomechanics to neurological outcomes in humans. Concussion occurs from rotational loading of the head giving rise to diffuse stresses and strains in the brain tissue leading to autonomic and physiological dysfunction. Repeated head loading is common in contact sports and an integral part of soccer. It is unknown whether the same biomechanical forces from lower severity head impacts such as typical soccer heading cause temporary physiological deficits as well. Advancement of objective physiological function assessment devices allow measurement of neurological effects in the absence of diagnosed concussion. Recent soccer heading studies have evaluated neurophysiological changes pre- and post-repetitive heading. These studies have found conflicting results for the effect on neurocognitive performance immediately following a bout of heading, but consistent changes were observed in measures of vestibular balance, ocular function, and neurochemical biomarkers.
Soccer heading biomechanics studies showed that females experienced higher severity head loading, and in equivalent sports such as soccer and basketball, females have higher concussion rates. This study will compare the physiological changes of male and female adolescents completing one of two soccer heading paradigms to those randomized to kicking to evaluate the effect of repetitive head impacts. This study will relate biomechanical measures of head loading with physiological function changes associated with repeated head impacts, and compare sex-differences in biomechanical measures and physiological changes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Kicking | Sham Comparator | Subjects will complete a suite of clinical and neurophysiological assessments at 3 timepoints (Pre, 0-hour post, and 16-72 hour post soccer kicking intervention). |
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| Soccer Heading (Frontal) | Experimental | Subjects will complete a suite of clinical and neurophysiological assessments at 3 timepoints (Pre, 0-hour post, and 16-72 hour post soccer heading intervention). |
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| Soccer Heading (Oblique) | Experimental | Subjects will complete a suite of clinical and neurophysiological assessments at 3 timepoints (Pre, 0-hour post, and 16-72 hour post soccer heading intervention). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Soccer Kicking | Other | Subjects assigned to the soccer kicking arm will complete 10 soccer kicks in 10 minutes. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in Clinical Concussion Exam immediately post intervention | A standard concussion physical exam includes smooth pursuits, horizontal and vertical saccades, horizontal and vertical gaze stability, visual motion sensitivity, convergence and divergence, and tandem walk. | Pre-intervention to 0 hours post intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Head linear acceleration | Linear acceleration (g) of the head will be measured during soccer heading via an instrumented mouthguard equipped with a 3-axis accelerometer. | During Intervention |
| Head angular velocity |
| Measure | Description | Time Frame |
|---|---|---|
| King-Devick Test | The test assesses saccadic eye movement based on rapidly naming single-digit numbers from left to right on test cards, a laptop, or a tablet. | Pre-intervention, 0 hours post and up to 72 hours post intervention |
| Pupillary Light Reflex |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kristy B Arbogast, PhD | Children's Hospital of Philadelphia | Principal Investigator |
| Christina L Master, MD | Children's Hospital of Philadelphia | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's Hospital of Philadelphia | Philadelphia | Pennsylvania | 19104 | United States |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| ICF | No | No | Yes | Informed Consent Form | Dec 16, 2020 | Oct 27, 2022 | ICF_000.pdf |
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| Soccer Heading (Frontal) | Other | Subjects assigned to the soccer heading (frontal) arm will complete 10 frontal soccer headers (ball headed directly back to launch direction) in 10 minutes. Soccer balls will be projected at 10-17.5 m/s from approximately 10-15 m with a JUGS ball launcher. |
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| Soccer Heading (Oblique) | Other | Subjects assigned to the soccer heading (oblique) arm will complete 10 oblique soccer headers (ball headed 90° to the right from ball launch direction) in 10 minutes. Soccer balls will be projected at 10-17.5 m/s from approximately 10-15 m with a JUGS ball launcher. |
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Angular velocity (radians/second) of the head will be measured during soccer heading via an instrumented mouthguard equipped with a 3-axis gyroscope.
| During Intervention |
| Change in Clinical Concussion Exam at up to 72 hours post intervention | A standard concussion physical exam includes smooth pursuits, horizontal and vertical saccades, horizontal and vertical gaze stability, visual motion sensitivity, convergence and divergence, and tandem walk. | Pre-intervention to between 16 and 72 hours post intervention |
The dilation of the pupil in response to a visual stimulus
| Pre-intervention, 0 hours post and up to 72 hours post intervention |
| Visual Evoked Potential | The electrical brain activity in the entire vision system measured via surface electrodes following a reverse pattern visual stimulus. | Pre-intervention, 0 hours post and up to 72 hours post intervention |
| Balance | Static balance will be assessed by the Biodex BioSway while standing on firm and foam surfaces with eyes open and closed. | Pre-intervention, 0 hours post and up to 72 hours post intervention |
| Neck Strength | Maximum isometric voluntary contraction for neck flexion | Pre-intervention, 0 hours post and up to 72 hours post intervention |
| Muscle Activation | Electromyography of the sternocleidomastoid and trapezius muscle activation during maximum isometric voluntary contraction and soccer kicking/heading. | Pre-intervention, 0 hours post and up to 72 hours post intervention |