Understanding the neurodevelopmental effects of youth tackle football participation

摘要 铲球足球和其他接触性运动的潜在长期影响已经造成了重大的公共健康问题 关注儿童参与的风险。考虑到本报告的回顾性和跨部门性质， 在之前的工作中，关于青少年参与足球比赛的因果关系存在严重的知识差距， 随后的临床结果，排除在病人和政策层面的决策。此外，可修改 风险因素（例如，神经肌肉控制）可能会影响接触足球相关的结果， 神经创伤，但预防仍然研究不足。在这里，我们克服了一些以前的障碍，以取得进展 在这一领域，在运动员开始第一个赛季的铲球足球之前， 在参与的第一年纵向跟踪他们。我们得到了俄亥俄州慢性病研究所的资助 脑损伤计划，并成功收集了50名青少年铲球足球运动员（8-12岁）的试点数据; 这些数据是我们现时建议的基础。目标1将确定更多接触足球的风险因素- 相关神经损伤我们将测量第一年青少年铲球足球相关的神经创伤暴露 球员在所有的练习和比赛中使用仪器护齿。我们将使用手持式测力仪， 测量颈部力量，并将通过视觉、前庭和反应时间测量神经肌肉控制 试验.目的2将确定足球相关的神经创伤暴露对神经发育的影响， 没有接触过橄榄球的孩子。我们将招收已注册但尚未注册的儿童 还没有开始参加青少年铲球足球，以及儿童登记为非接触性运动和儿童 不做任何运动。目标2a将确定认知功能和大脑结构的短期变化， 从赛季前到赛季后，与足球相关的神经创伤暴露所引起的功能。目标2b将 通过在休赛期检查球员来确定第一年的长期变化 就在下个赛季开始之前。目标2c将确定哪些因素（例如，足球相关神经损伤 暴露、暴露于不良童年事件、既存神经发育障碍）有助于 与典型发展的差异。我们假设，青少年铲球足球暴露儿童重复 在快速神经发育期间的神经创伤，导致可观察到的认知障碍， 大脑的结构和功能变化，最有可能是注意力控制网络。我们的建议结合了 一种确定足球相关神经创伤对神经发育影响的最先进方法， 与俄亥俄州的青年体育项目进行了富有成效的合作，社区参与和推广，以及 多学科专家团队。这些发现的社会和临床影响不能被夸大。在 量化足球相关的神经创伤暴露（目标1）及其对神经发育的影响（目标2） 在青少年参与足球运动的第一年，我们的预期成果将告知社区利益相关者 以及政策制定者对儿童参加青少年足球比赛的成本和收益的评估。

ABSTRACT Potential long-term effects of tackle football and other contact sports have created significant public health concerns about the risk of childhood participation. Considering the retrospective and cross-sectional nature of prior work, there are critical knowledge gaps regarding the causality of youth tackle football participation and subsequent clinical outcomes that preclude decision-making at the patient and policy level. Further, modifiable risk factors (e.g., neuromuscular control) may influence exposure to and thus, outcomes from football-related neurotrauma, but prevention remains understudied. Here we overcome some of the previous barriers to progress in this field by acquiring a “true baseline” for athletes before they begin their first season of tackle football and following them longitudinally across the first year of participation. We received funding from Ohio State’s Chronic Brain Injury Program and successfully collected pilot data on 50 youth tackle football players (ages 8-12 years); these data form the basis of our current proposal. Aim 1 will identify risk factors for higher exposure to football- related neurotrauma. We will measure football-related neurotrauma exposure in first-year youth tackle football players during all practices and games using instrumented mouthguards. We will use handheld dynamometry to measure neck strength and will measure neuromuscular control through visual, vestibular, and reaction time testing. Aim 2 will determine the effects of football-related neurotrauma exposure on neurodevelopment in children with no previous tackle football exposure. We will enroll children who are registered for, but have not yet begun participating in youth tackle football, as well as children registered for non-contact sports and children not playing any sports. Aim 2a will determine short-term changes in cognitive function and brain structure and function caused by football-related neurotrauma exposure from pre-season to post-season. Aim 2b will determine longer-term changes across the first year of participation by examining players during the off-season just prior to the start of the next season. Aim 2c will determine what factors (e.g., football-related neurotrauma exposure, exposure to adverse childhood events, pre-existing neurodevelopmental disorders) contribute to differences from typical development. We hypothesize that youth tackle football exposes children to repetitive neurotrauma during a period of rapid neurodevelopment, resulting in observable cognitive impairments and structural and functional changes in the brain, most likely in attentional control networks. Our proposal combines a state-of-the-art approach to determining the effects of football-related neurotrauma on neurodevelopment, a productive collaboration with youth sports programs in Ohio, community engagement and outreach, and a multidisciplinary team of experts. The societal and clinical impact of these findings cannot be overstated. In quantifying football-related neurotrauma exposure (Aim 1) and its effects on neurodevelopment (Aim 2) across the first year of youth tackle football participation, our expected outcomes will inform community stakeholders and policy-makers in their appraisal of the cost and benefit of children participating in youth tackle football.