Biomechanical comparison of concussions with and without a loss of consciousness in elite American football: implications for prevention

Loss of consciousness (LOC) associated with concussion is no longer considered an indicator of severity of injury in concussion management protocols. Studies investigating the association between LOC and recovery time or neurophysiological performance have reported ambiguous findings and resulted in...

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Bibliographic Details
Published in:Sports biomechanics 2021-09, Vol.20 (6), p.751-767
Main Authors: Cournoyer, Janie, Hoshizaki, T. Blaine
Format: Article
Language:English
Subjects:
Brain injury
Brain stem
brain tissue deformation
Cerebral cortex
Concussion
Consciousness
Corpus callosum
Fainting
Football
head accelerations
return-to-play
Severity
Substantia alba
Thalamus
Velocity
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Summary:Loss of consciousness (LOC) associated with concussion is no longer considered an indicator of severity of injury in concussion management protocols. Studies investigating the association between LOC and recovery time or neurophysiological performance have reported ambiguous findings and resulted in a limited understanding of the severity of LOC-inducing head impacts. Concussive injuries with and without LOC from helmet-to-helmet and shoulder collisions and falls in elite American football were reconstructed in laboratory using a hybrid III headform and finite element model to obtain peak linear and rotational acceleration and brain tissue deformation metrics in the cerebral cortex, the cerebral white matter, the corpus callosum, the thalamus and the brainstem. Impact velocity, peak linear and rotational acceleration were significantly greater in the LOC group than the no LOC group. The brain tissue deformation metrics were greater in the LOC group than the no LOC group. The best overall predictor for LOC was impact velocity. Concussions with LOC are characterised by greater magnitudes of brain tissue deformation. This was mainly the result of higher impact velocities in the LOC group providing league decision-makers with an understanding of the importance of managing impact velocity through athlete education and rule enforcement or change.
ISSN:1476-3141
1752-6116
DOI:10.1080/14763141.2019.1600004