When to Pull the Trigger: Conceptual Considerations for Approximating Head Acceleration Events Using Instrumented Mouthguards

James Tooby, Kevin Till, Andrew Gardner, Keith Stokes, Gregory Tierney, Daniel Weaving, Steve Rowson, Mazdak Ghajari, Carolyn Emery, Melanie Dawn Bussey, Ben Jones

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)

Abstract

Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.

Original languageEnglish
Pages (from-to)1361-1369
Number of pages9
JournalSports Medicine
Volume54
Issue number6
Early online date9 Mar 2024
DOIs
Publication statusPublished - 30 Jun 2024

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated or analysed in its preparation.

Funding

James Tooby was a co-author on a validation study comparing the validity and feasibility of instrumented mouthguards and is a research team member on current research projects using Prevent Biometrics mouthguards. Kevin Till was a co-author on a validation study comparing the validity and feasibility of instrumented mouthguards. Melanie Dawn Bussey has received funding from World Rugby and Prevent Biometrics (instrumented mouthguard provider). Carolyn Emery is a member of the external advisory board for HitIQ (instrumented mouthguard provider). Andrew Gardner serves as a scientific advisor for HitIQ (an instrumented mouthguard provider). He has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He has been a contracted concussion consultant to Rugby Australia since July 2016. He is a member of the World Rugby Concussion Working Group and a member of the AFL’s Concussion Scientific Advisory group. He has received travel funding or been reimbursed by professional sporting bodies, and commercial organisations for discussing or presenting sport-related concussion research at meetings, scientific conferences, workshops and symposiums. He has received research support from the Nick Tooth Foundation. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation (Australia), an Australian-American Fulbright Commission Postdoctoral Award, an NHMRC early research career fellowship, a Hunter New England Local Health District, Research, Innovation and Partnerships Health Research & Translation Centre and Clinical Research Fellowship Scheme and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas, and the HMRI, supported by Anne Greaves. Keith Stokes is employed by the Rugby Football Union, which is the governing body for rugby union in England. Gregory Tierney has received research funding from World Rugby and Prevent Biometrics (instrumented mouthguard provider). Daniel Weaving, Mazdak Ghajari and Steve Rowson have no conflicts of interest that are directly relevant to the content of this article. Ben Jones was the lead author on a validation study comparing the validity and feasibility of instrumented mouthguards.

FundersFunder number
Hunter New England Local Health District, Research, Innovation and Partnerships Health Research & Translation Centre
Jennie Thomas
Nick Tooth Foundation
World Rugby and Prevent Biometrics
National Health and Medical Research Council
Cambridge University Hospitals NHS Foundation Trust
Fulbright Australia
Hunter Medical Research Institute

    ASJC Scopus subject areas

    • Orthopedics and Sports Medicine
    • Physical Therapy, Sports Therapy and Rehabilitation

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