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Machine Learning Classification of Verified Head Impact Exposure Strengthens Associations with Brain Changes

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Abstract

Cumulative exposure to head impacts during contact sports can elicit potentially deleterious brain white matter alterations in young athletes. Head impact exposure is commonly quantified using wearable sensors; however, these sensors tend to overestimate the number of true head impacts that occur and may obfuscate potential relationships with longitudinal brain changes. The purpose of this study was to examine whether data-driven filtering of head impact exposure using machine learning classification could produce more accurate quantification of exposure and whether this would reveal more pronounced relationships with longitudinal brain changes. Season-long head impact exposure was recorded for 22 female high school soccer athletes and filtered using three methods—threshold-based, heuristic filtering, and machine learning (ML) classification. The accuracy of each method was determined using simultaneous video recording of a subset of the sensor-recorded impacts, which was used to confirm which sensor-recorded impacts corresponded with true head impacts and the ability of each method to detect the true impacts. Each filtered dataset was then associated with the athletes’ pre- and post-season MRI brain scans to reveal longitudinal white matter changes. The threshold-based, heuristic, and ML approaches achieved 22.0% accuracy, 44.6%, and 83.5% accuracy, respectively. ML classification also revealed significant longitudinal brain white matter changes, with negative relationships observed between head impact exposure and reductions in mean and axial diffusivity and a positive relationship observed between exposure and fractional anisotropy (all p < 0.05).

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Abbreviations

Unit:

Description

AD:

Axial diffusivity; a DTI measure of brain WM integrity

CG:

Control group; the non-experimental group in the present study

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy; a DTI measure of brain WM integrity

MD:

Mean diffusivity; a DTI measure of brain WM integrity

ML:

Machine learning

MRI:

Magnetic resonance imaging

RD:

Radial diffusivity; a DTI measure of brain WM integrity

ROC:

Receiver operating characteristic

mTBI:

Sports-related mild traumatic brain injury

SCI:

Sub-concussive head impacts, or head impacts that do not result in overt clinical symptoms that lead to a clinical diagnosis of concussion

SVM:

Support vector machine

TG:

Training group; the experimental group in the present study

WM:

(Brain) white matter

XGBoost:

Extreme gradient boosted classification model

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Acknowledgments

The authors would acknowledge the coaching and training staff from Seton High School: Ron Quinn, Lisa Larosa, Holly Laiveling and the entire soccer coaching staff, athletic trainer Cindy Busse, the Seton administration and athletic director Wendy Smith; and from Madeira High School: Dan Brady, athletic trainer Glenna Knapp, athletic director Joe Kimling, and principal David Kennedy for their support and assistance to conduct this study. The authors would also like to thank Danielle Reddington and Casey McCall for their daily accelerometer tracking and work in reviewing video and coding impacts, as well as Lacey Haas, Brynne Williams, Kaley Bridgewater and Matt Lanier in the Cincinnati Children’s Hospital Imaging Research Center as their support made this study possible. Finally, the authors would also like to acknowledge that, while Q30 Innovations, LLC provided funding for the parent study, no funding sources were included for the present study.

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Correspondence to Christopher A. DiCesare.

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DiCesare, C.A., Green, B., Yuan, W. et al. Machine Learning Classification of Verified Head Impact Exposure Strengthens Associations with Brain Changes. Ann Biomed Eng 48, 2772–2782 (2020). https://doi.org/10.1007/s10439-020-02662-2

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