Repetitive, nonconcussive head impacts in collision sports are associated with lasting neurophysiological effects. This study investigates region-specific changes in neocortical mean diffusivity (MD) and resting-state functional magnetic resonance imaging (fMRI) power spectral density (fMRI-PSD) that correlate with cumulative nonconcussive linear risk-weighted exposure (RWE-Lin) sustained over one high school football season. Pre- to postseason percent changes in MD (%ΔMD) and fMRI-PSD (%ΔfMRI-PSD) were calculated for football players without diagnosed concussions during the season of observation (n = 87 player-seasons). Voxelwise linear regression analyses examined relationships between RWE-Lin with neocortical %ΔMD and %ΔfMRI-PSD. False discovery rate-corrected alpha thresholds of 0.0125 accounted for multiple comparisons and directionality within each test. While controlling for age, body mass index, days between scans, position group (skill vs. line), level (junior varsity vs. varsity), and concussion history, RWE-Lin was significantly positively correlated with %ΔMD (p = 1.12 × 10-5) and inversely correlated with %ΔfMRI-PSD in the frontal cortex (p = 7.36 × 10-4). Football players were stratified into high RWE-Lin (n = 13) and low RWE-Lin (n = 37) groups using the Jenks natural breaks algorithm. Noncollision athletes (NCAs, n = 11) served as external controls. When comparing imaging measures across the three groups, the high RWE-Lin football group showed significant differences from both NCA and low RWE-Lin football groups in frontal %ΔMD and %ΔfMRI-PSD (p < 0.05). No significant imaging differences were observed between NCA and low RWE-Lin football groups. Biomechanical modeling localized high-risk impact regions that have high spatial correspondence to the observed imaging abnormalities. Exploratory post hoc voxelwise analyses of magnetoencephalography spectral power detected no significant voxelwise associations with RWE-Lin. In the absence of diagnosed concussion, high-impact football players exhibit abnormal structural and neurovascular changes in the frontal cortex. These regions overlap with those identified to be at greatest risk from biomechanical modeling and those implicated in the pathogenesis of chronic traumatic encephalopathy. Importantly, these imaging abnormalities were not generally observed in football players with lower RWE-Lin. These findings suggest that limiting the number and severity of head impacts may be an effective strategy to mitigate subclinical brain injury in American football.

This study investigated how vehicle front-end geometry, impact speed, and vehicle category influence injury risk to a midsize male pedestrian. Eighty-one generic vehicle (GV) models representing sedans, sport utility vehicles (SUVs), pickup trucks, and minivans sold in the United States were developed by morphing three base models using an automated pipeline. Front-end parameters that were varied included ground clearance (GC), bumper height (BH), hood leading-edge (HLE) height, hood length (HL), bumper lead angle (BLA), hood angle (HA), and windshield angle (WSA). Each vehicle impacted the Global Human Body Models Consortium 50th percentile male simplified pedestrian (GHBMC M50-PS) model at 30, 40, and 50 kph, totaling 243 simulations. Boundary conditions followed the European New Car Assessment Program (Euro NCAP) pedestrian test protocol. Thirty-five injury metrics were extracted across the head, neck, thorax, abdomen, pelvis, and lower extremities. Linear mixed-effects regression models assessed relationships between vehicle front-end geometry, impact speed, and injury outcomes, with predictor selection guided by principal component analysis (PCA) and collinearity diagnostics. Impact speed was the strongest predictor of injury severity across all body regions. GC and HLE height were also dominant predictors. Wrap-type trajectories were common at lower speeds and in SUVs, trucks, and minivans, while sedans and minivans showed roof vaulting at higher speeds. Head injury severity increased with speed and was influenced by HA and BLA. Minivans showed elevated brain injury criterion (BrIC) and cumulative strain damage measure (CSDM25) values, indicating increased diffuse brain injury risk. Trucks produced the highest thoracoabdominal injury metrics, which correlated with HL, HA, femur forces than SUVs and minivans, and lowest tibia moments. Trucks had greater tibia bending moments, while SUVs and minivans had higher left femur moments compared to sedans. GC and impact speed exacerbated lower extremity injuries, varying by vehicle category. These effects are driven by geometry: Higher GC increases the unsupported span below the knee, promoting tibial bending, while lower HLE heights shift impact forces above the knee, elevating femur injury risk.

The current study examines head impact exposure in youth soccer and quantifies the relationship between impact location, impact magnitude and brain deformation using data previously collected with an instrumented mouthpiece in combination with a high-resolution brain finite element (FE) model. This study demonstrates that maximum principal strain (MPS) varies by impact source. The largest strains were observed when the ball was kicked prior to the header and the smallest strains were observed resulting from impacts when the headed ball was received from another header.

OBJECTIVE:Between the 2023 and 2024 NASCAR racing seasons, a track configuration change to a section of the Watkins Glen International track, known as the bus stop, was made in response to head acceleration data measured in the 2023 season. The objective of this study was to evaluate the effect of this change on head acceleration events (HAEs) among drivers. METHODS:Mouthpiece (MP) sensor data was collected and analyzed from eight NASCAR Cup Series drivers in 2023 and 2024 at the Watkins Glen race. Each MP was tightly coupled to the upper dentition and collected linear and rotational head kinematics using a 4 g single-axis trigger threshold. All HAEs were visually verified as racing events (i.e., during the race, not associated with a crash). HAEs associated with the bus stop were identified using timing and scoring data and analyzed. Peak linear acceleration (PLA), rotational acceleration (PRA), and rotational velocity (PRV) were calculated for each HAE. The number of HAEs and HAEs per lap were calculated for each driver-race. Linear mixed effects models and Poisson models were used to determine significant changes year to year. Mixed effects models were used to evaluate the relationship between head surround gap and kinematic metrics. RESULTS:Overall, there were 693 HAEs in 2023; and 333 HAEs in 2024 across the eight drivers. Track changes to the bus stop from 2023 to 2024 reduced the mean events/lap by ∼53% (0.96 to 0.45, respectively). Mean resultant PLA, PRA, and PRV decreased by 6%, 27%, and 10%, respectively. Across individual drivers, decreases in event rate ranged from 25% to 98% for drivers instrumented in both seasons. Individually, mean PLA decreased by as much as 20%, PRA as much as 41%, and PRV as much as 25%. CONCLUSIONS:Drivers were exposed to a substantially lower HAE rate and significantly lower magnitude HAEs at the bus stop in 2024 compared to 2023. This shows that the track change between 2023 and 2024 in the Watkins Glen bus stop reduced driver head acceleration exposure. This work demonstrates the value of biomechanics data to motivate changes in track configuration and improve driver safety based on biomechanics.

OBJECTIVES:The overarching objective of this study was to reconstruct five real-world pedestrian crashes using data from the Vulnerable Road User In-Depth Crash Investigation Study (VICIS) database, the Global Human Body Models Consortium (GHBMC) simplified pedestrian models, and morphed generic vehicle (GV) models reflecting U.S. vehicle front-end geometry to investigate pedestrian injury risks, compare simulated injury outcomes and contact kinematics with real-world observations, and evaluate the suitability of these simplified models for crash reconstruction. METHODS:Five real-world pedestrian crashes from VICIS were reconstructed based on injury distribution and test data availability. Cases included four males (ages 14, 48, 56, and 64) and one female (age 57). Vehicles included three sport utility vehicles (SUVs) and two sedans, impacting at an average speed of 47 kph (range: 16-65 kph). Sedan and SUV GVs were morphed using computer-aided design (CAD) models to match front-end geometry. The windshield was modeled as a three-layer structure with fracture-enabled outer glass layers. Morphed models were validated against Euro New Car Assessment Program (NCAP) headform, upper legform, and lower legform tests using correlation and analysis (CORA) ratings. The models were used to reconstruct crashes by applying initial velocity and scaling GHBMC pedestrian models to match the case pedestrian height and weight. The contact points from simulations were compared with real-world crash evidence. AIS2+ injuries from the cases were compared to reconstructed results using injury metrics and risk functions. RESULTS:The average ± SD CORA score for all pedestrian NCAP validation tests was 0.72 ± 0.1, indicating a good rating. Contact points from reconstructions closely matched real-world crashes. Brain injury criterion (BrIC) and cumulative strain damage measure (CSDM) injury risks (>90%) predicted cerebral injuries, while the Head Injury Criterion (HIC) injury risks remained low in two cases (<5%), underpredicting skull fractures. Chest deflection predicted thorax injury (injury risk >73%), whereas thoracic trauma index (TTI) risks were low (<50%). Tibia fractures from the cases were confirmed by injury risk estimations (>90%) using the revised tibia index (RTI). CONCLUSIONS:The GV-based pedestrian crash reconstruction framework demonstrated strong potential for real-world crash studies. CAD-based morphing enabled close matching of case vehicle front geometry, and material/structural tuning enhanced model responses aligned with physical vehicle data. The results of the reconstruction matched well with the actual crash data.

Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system. Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes. A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively. If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.

The goal of this work was to collect on-track driver head kinematics using instrumented mouthpieces and characterize environmental exposure to accelerations and vibrations. Six NASCAR drivers were instrumented with custom-fit mouthpieces to collect head kinematic data. Devices were deployed at four tracks during practice and testing environments and configured to collect approximately 11 min of linear acceleration and rotational velocity data at 200 Hz. This continuous data collection, combined with film review, allowed extraction of complete laps of data. In addition to typical data processing methods, a moving-point average was calculated and subtracted from the overall signal for both linear acceleration and rotational velocity to determine the environmental component of head motion. The current analysis focuses on 42 full laps of data collected at four data collection events. The number of laps per track ranged from 2 to 23. Linear acceleration magnitudes for all 42 laps ranged from 2.46 to 7.48 g and rotational velocity ranged from 1.25 to 3.35 rad/s. After subtracting the moving average, linear acceleration ranged from 0.92 to 5.45 g and rotational velocity ranged from 0.57 to 2.05 rad/s. This study has established the feasibility of using an instrumented mouthpiece to measure head kinematics in NASCAR and presented a technique for isolating head motion due to cornering acceleration from those due to short-term perturbations experienced by the driver.

Soccer is a popular youth sport in the United States, but the effect of repetitive head impacts experienced during training on neurocognitive outcomes is not well understood. Modifying practice structure may be an avenue for reducing head impact exposure and concussion risk in soccer, but research has yet to characterize head impact exposure across common soccer activities. The objective of this study was to compare head impact exposure across common training activities in soccer. Eight female soccer players practicing on an age 15 and under (U15) club team participated in this study for two soccer seasons. Players wore an instrumented mouthpiece sensor during all practice and game sessions. Research personnel recorded duration of all activities performed by each player to characterize player-specific exposure time. Film review was performed to identify head contact events during each session and classify events according to the activity and drill the player was performing. Head impact exposure for each athlete was quantified in terms of peak kinematics and impact rate. Mixed effects models were used to compare peak kinematics and generalized linear models were used to compare impact rates across drills and activity type. Drill and activity type were associated with peak kinematics and impact rate. Technical training activities accounted for the second-highest exposure time and were associated with higher impact rates and lower mean kinematics than other activity types. Team interaction activities and game play were associated with the highest rotational kinematics but the lowest impact rates. Head impact exposure in female youth soccer is influenced by the type of activity in which the athlete is engaged. Interventions designed to reduce head impact frequency in female youth soccer can benefit from targeting technical training activities; whereas, interventions designed to reduce head impact magnitude should target team interaction and game activities.

Motorsport athletes experience head acceleration loading during crashes; however, there is limited literature quantifying the frequency and magnitude of these loads, particularly at the grassroots level of the sport. Understanding head motion experienced during crash events in motorsport is necessary to inform interventions to improve driver safety. This study aimed to quantify and characterize driver head and vehicle kinematics during crashes in open-wheel grassroots dirt track racing. Seven drivers (ages 16-22, n = 2 female) competing in a national midget car series were enrolled in this study over two racing seasons and were instrumented with custom mouthpiece sensors. Drivers' vehicles were outfitted with an incident data recorder (IDR) to measure vehicle acceleration. Forty-one crash events were verified and segmented into 139 individual contact scenarios via film review. Peak resultant linear acceleration (PLA) of the vehicle and PLA, peak rotational acceleration (PRA), and peak rotational velocity (PRV) of the head were quantified and compared across the part of the vehicle contacted (i.e., tires or chassis), the vehicle location contacted (e.g., front, left, bottom), the external object contacted (i.e., another vehicle, wall, or the track), and the principal direction of force (PDOF). The median (95th percentile) PLA, PRA, and PRV of the head and PLA of the vehicle were 12.3 (37.3) g, 626 (1799) rad/s2, 8.92 (18.6) rad/s, and 23.2 (88.1) g, respectively. Contacts with a non-horizontal PDOF (n = 98, 71%) and contact with the track (n = 96, 70%) were common in the data set. Contact to the left side of the vehicle, with the track, and with a non-horizontal PDOF tended to have the greatest head kinematics compared to other factors in each sub-analysis. Results from this pilot study can inform larger studies of head acceleration exposure during crashes in the grassroots motorsports environment and may ultimately support evidence-based driver safety interventions.

Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11-13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices.

Soccer, one of the most popular sports in the world, has one of the highest rates of sports-related concussions. Additionally, soccer players are frequently exposed to nonconcussive impacts from intentionally heading the ball, a fundamental component of the sport. There have been many studies on head impact exposure in soccer, but few focus on soccer practices or practice activities. This study aimed to characterize the frequency and magnitude of head impacts in National Collegiate Athletic Association Division I female soccer practice activities using a custom-fit instrumented mouthpiece. Sixteen players were instrumented over the course of 54 practice sessions. Video analysis was performed to verify all mouthpiece-recorded events and classify practice activities. Category groupings of practice activities include technical training, team interaction, set pieces, position-specific, and other. Differences in head impact rates and peak resultant kinematics were observed across activity types and category groupings. Technical training had the highest impact rate compared to other category groupings. Impacts occurring during set piece activities had the highest mean kinematic values. Understanding drill exposure can help inform coaches on training plans aimed to reduce head impact exposure for their athletes.

Abstract Objective The objective of this study was to utilize an instrumented mouthpiece sensor to characterize head kinematics experienced by grassroots dirt track race car drivers. Methods Four dirt track race car drivers (ages 16–19) were instrumented with custom mouthpiece sensors capable of accurately measuring head motion during racing. Sensors were deployed before races and recorded tri-axial linear acceleration and rotational velocity for approximately 10 min at 200 Hz. Film review was performed to identify data associated with racing laps. For each lap, moving average kinematics were computed and subtracted from the head motion signals to obtain ‘adjusted’ head motion accounting for lower frequency variance due to periodic motion around the track. From adjusted data, linear and angular head perturbations (i.e., deviations from moving average) were extracted using a custom algorithm. Results Data was collected during 400 driver-races. A total of 2438 laps were segmented from mouthpiece recordings. The median (95th percentile) peak linear acceleration, rotational velocity, and rotational acceleration of all laps were 5.33 (8.28) g, 2.89 (4.60) rad/s, and 179 (310) rad/s2, respectively. Angular perturbations occurred most frequently about the anterior-posterior axis (median lap frequency = 6.39 Hz); whereas linear perturbations occurred most frequently in the inferior-superior direction (7.96 Hz). Nine crash events were recorded by the mouthpiece sensors. The median (95th percentile) peak head kinematics of these events were 13.4 (36.6) g, 9.67 (21.9) rad/s, and 630 (1330) rad/s2. Conclusions Mouthpiece sensors can be used to measure head kinematics during active racing. Laps, head perturbations, and crashes may be useful units of observation to describe typical head kinematic exposure experienced by drivers while racing. Subsequent research is needed to understand the associations between repetitive racing exposure and neurological function. Higher magnitude events (i.e., crashes) are not uncommon and may result in concussion or more severe injury. Results represent novel characterizations of head kinematic exposure experienced in a dirt track racing environment. This information may inform evidence-based strategies (e.g., vehicle/seat design) to improve driver safety.

Understanding characteristics of head acceleration events (HAEs) in youth football is vital in developing strategies to improve athlete safety. This study aimed to characterize HAEs in youth football using an instrumented mouthpiece. Youth football athletes (ages 11–13) participating on two teams were enrolled in this study for one season. Each athlete was instrumented with a mouthpiece-based sensor throughout the season. HAEs were verified on film to ensure that mouthpiece-based sensors triggered during contact. The number of HAEs, peak resultant linear and rotational accelerations, and peak resultant rotational velocity were quantified. Mixed effects models were used to evaluate differences in mean kinematic metrics among all HAEs for session type, athlete position, and contact surface. A total of 5,292 HAEs were collected and evaluated from 30 athletes. The median (95th percentile) peak resultant linear acceleration, rotational acceleration, and rotational velocity was 9.5 g (27.0 g), 666.4 rad s−2 (1863.3 rad s−2), and 8.5 rad s−1 (17.4 rad s−1), respectively. Athletes experienced six (22) HAEs per athlete per session (i.e., practice, game). Competition had a significantly higher mean number of HAEs per athlete per session and mean peak rotational acceleration. Peak resultant rotational kinematics varied significantly among athlete positions. Direct head impacts had higher mean kinematics compared to indirect HAEs, from body collisions. The results of this study demonstrate that session type, athlete position, and contact surface (i.e., direct, indirect) may influence HAE exposure in youth football.

Interventions designed to reduce head impact frequency in soccer may benefit from targeting technical training activities; whereas, interventions designed to reduce head impact magnitude may benefit from targeting team interaction and game activities.

The current study aims to examine the effect of material properties on implanted leads used for deep brain stimulation (DBS) using finite element (FE) analysis to investigate brain deformation around an implanted DBS lead in response to daily head accelerations. FE analysis was used to characterize the relative motion of the DBS lead in a suite of fifteen cases sampled from a previously derived kinematic envelope representative of everyday activities describing translational and rotational pulse shape, magnitude, and duration. Load curves were applied to the atlas-based brain model (ABM) with a scaled Haversine acceleration pulse in four directions of rotation: + X, − Y, + Y, and + Z. In addition to the fifteen sampled cases, six experimental cases taken from a previous literature review were also simulated for comparison. The current investigation found that there was very little difference in brain response for the DBS leads with two different material properties. In general, the brain and DBS lead experienced the greatest deformation during rotation about the Z axis for similar load cases. In conclusion, this study showed that there was no significant difference in implanted DBS lead deformation based on lead material properties.

Hockey is a fast-paced sport known for body checking, or intentional collisions used to separate opponents from the puck. Exposure to these impacts is concerning, as evidence suggests head impact exposure (HIE), even if noninjurious, can cause long-term brain changes. Currently, there is limited understanding of the effect of impact direction and collision speed on HIE. Video analysis was used to determine speed and direction for 162 collisions from 13 youth athletes. These data were paired with head kinematic data collected with an instrumented mouthpiece. Relationships between peak resultant head kinematics and speeds were evaluated with linear regression. Mean athlete speeds and relative velocity between athletes ranged from 2.05 to 2.76 m/s. Mean peak resultant linear acceleration, rotational velocity, and rotational acceleration were 13.1 g, 10.5 rad/s, and 1112 rad/s2, respectively. Significant relationships between speeds and head kinematics emerged when stratified by contact characteristics. HIE also varied by direction of collision; most collisions occurred in the forward-oblique (ie, offset from center) direction; frontal collisions had the greatest magnitude peak kinematics. These findings indicate that HIE in youth hockey is influenced by speed and direction of impact. This study may inform future strategies to reduce the severity of HIE in hockey.

Head impact exposure is often quantified using peak resultant kinematics. While kinematics describes the inertial response of the brain to impact, they do not fully capture the dynamic brain response. Strain, a measure of the tissue-level response of the brain, may be a better predictor of injury. In this study, kinematic and strain metrics were compared to contact characteristics in youth football. Players on 2 opposing teams were instrumented with head impact sensors to record impact kinematics. Video was collected to identify contact scenarios involving opposing instrumented players (ie, paired contact scenarios) and code contact characteristics (eg, player role, impact location). A previously validated, high-resolution brain finite element model, the atlas-based brain model, was used to simulate head impacts and calculate strain metrics. Fifty-two paired contact scenarios (n = 105 impacts) were evaluated. Lighter players tended to have greater biomechanical metrics compared to heavier players. Impacts to the top of the helmet were associated with lower strain metrics. Overall, strain was better correlated with rotational kinematics, suggesting these metrics may be better predictors of the tissue-level brain response than linear kinematics. Understanding the effect of contact characteristics on brain strain will inform future efforts to improve sport safety.

OBJECTIVE Youth football athletes are exposed to repetitive subconcussive head impacts during normal participation in the sport, and there is increasing concern about the long-term effects of these impacts. The objective of the current study was to determine if strain-based cumulative exposure measures are superior to kinematic-based exposure measures for predicting imaging changes in the brain. METHODS This prospective, longitudinal cohort study was conducted from 2012 to 2017 and assessed youth, male football athletes. Kinematic data were collected at all practices and games from enrolled athletes participating in local youth football organizations in Winston-Salem, North Carolina, and were used to calculate multiple risk-weighted cumulative exposure (RWE) kinematic metrics and 36 strain-based exposure metrics. Pre- and postseason imaging was performed at Wake Forest School of Medicine, and diffusion tensor imaging (DTI) measures, including fractional anisotropy (FA), and its components (CL, CP, and CS), and mean diffusivity (MD), were investigated. Included participants were youth football players ranging in age from 9 to 13 years. Exclusion criteria included any history of previous neurological illness, psychiatric illness, brain tumor, concussion within the past 6 months, and/or contraindication to MRI. RESULTS A total of 95 male athletes (mean age 11.9 years [SD 1.0 years]) participated between 2012 and 2017, with some participating for multiple seasons, resulting in 116 unique athlete-seasons. Regression analysis revealed statistically significant linear relationships between the FA, linear coefficient (CL), and spherical coefficient (CS) and all strain exposure measures, and well as the planar coefficient (CP) and 8 strain measures. For the kinematic exposure measures, there were statistically significant relationships between FA and RWE linear (RWEL) and RWE combined probability (RWECP) as well as CS and RWEL. According to area under the receiver operating characteristic (ROC) curve (AUC) analysis, the best-performing metrics were all strain measures, and included metrics based on tensile, compressive, and shear strain. CONCLUSIONS Using ROC curves and AUC analysis, all exposure metrics were ranked in order of performance, and the results demonstrated that all the strain-based metrics performed better than any of the kinematic metrics, indicating that strain-based metrics are better discriminators of imaging changes than kinematic-based measures. Studies relating the biomechanics of head impacts with brain imaging and cognitive function may allow equipment designers, care providers, and organizations to prevent, identify, and treat injuries in order to make football a safer activity.