Emerging evidence indicates that repetitive head impacts, even at a sub-concussive level, may result in exacerbated or prolonged neurological deficits in athletes. This study aimed to: 1) quantify the effect of repetitive head impacts on the alteration of neuronal activity based on functional magnetic resonance imaging (fMRI) of working memory after a high school football season; and 2) determine whether a neck collar that applies mild jugular vein compression designed to reduce brain energy absorption in head impact through "slosh" mitigation can ameliorate the altered fMRI activation during a working memory task. Participants were recruited from local high school football teams with 27 and 25 athletes assigned to the non-collar and collar group, respectively. A standard N-Back task was used to engage working memory in the fMRI at both pre- and post-season. The two study groups experienced similar head impact frequency and magnitude during the season (all p > 0.05). fMRI blood oxygen level dependent (BOLD) signal response (a reflection of the neuronal activity level) during the working memory task increased significantly from pre- to post-season in the non-collar group (corrected p < 0.05), but not in the collar group. Areas displaying less activation change in the collar group (corrected p < 0.05) included the precuneus, inferior parietal cortex, and dorsal lateral prefrontal cortex. Additionally, BOLD response in the non-collar group increased significantly in direct association with the total number of impacts and total g-force (p < 0.05). Our data provide initial neuroimaging evidence for the effect of repetitive head impacts on the working memory related brain activity, as well as a potential protective effect that resulted from the use of the purported brain slosh reducing neck collar in contact sports.
Trial registration: ClinicalTrials.gov NCT02696200.
Keywords: N-Back task; fMRI; football head impact; neck collar; working memory.