The effects of repetitive head impacts associated with soccer heading, especially in the youth population, are unknown. The purpose of this study was to examine balance, neurocognitive function, and head impact biomechanics after an acute bout of heading before and after the Get aHEAD Safely in Soccer™ program intervention. Twelve youth female soccer players wore a Triax SIM-G head impact sensor during two bouts of heading, using a lightweight soccer ball, one before and one after completion of the Get aHEAD Safely in Soccer™ program intervention. Participants completed balance (BESS and SWAY) and neurocognitive function (ImPACT) tests at baseline and after each bout of heading. There were no significant changes in head impact biomechanics, BESS, or ImPACT scores pre- to post-season. Deficits in three of the five SWAY positions were observed from baseline to post-season. Although we expected to see beneficial changes in head impact biomechanics following the intervention, the coaches and researchers observed an improvement in heading technique/form. Lightweight soccer balls would be a beneficial addition to header drills during training as they are safe and help build confidence in youth soccer players.

Since the implementation of the US Soccer heading guidelines released in 2015, little to no research on ball-head impact exposure in the United States youth soccer population has been conducted. The purpose was to compare ball-head impact exposure across sex and age in youth soccer players over a weekend tournament. Ten male and female games for each age group (Under-12 [U12], U13, and U14) were video recorded at a weekend tournament for a total of 60 games. Ball-head impact exposure for each game was then coded following a review of each recording. Male players were 2.8 times more likely to have ball-head impacts than female players, (p < 0.001) particularly in the U14 age group when compared to the U12 age group (p = 0.012). Overall 92.4% of players experienced 0-1 ball-head impacts per game with the remaining players experiencing 2+ ball-head impacts per game. Ball-head impact exposure levels are low in the youth players. Most youth soccer players do not head the soccer ball during match play and those that did, only headed the ball on average once per game. Overall, the difference in ball-head impact exposure per player was less than 1 between all the groups, which may have no clinical meaning.

Purposeful heading, in which players may use their heads to advance the ball in play, is a unique part of soccer. Clinical outcome measures used to aid in the diagnosis of a concussion have long been a cornerstone of the contemporary measurements associated with the short- and long-term effects of monitoring repetitive head impacts (RHI) and soccer heading exposure. The effects of RHI in the youth population are still unknown, therefore, the purpose of this study was to examine if heading exposure is predictive of changes in self-reported symptoms, neurocognitive functioning, gait, and balance in female youth soccer players over the course of one soccer season. Small improvements in neurocognitive functioning and gait and slight deficits in balance were observed from pre- to post-season. All changes were not clinically relevant and likely due to a practice effect. The low heading exposure in our cohort of youth soccer players was likely not enough to elicit any changes in clinical measures. In general, our clinical outcomes did not change after a season of soccer play and change scores were not predicted by heading exposure.

Introduction: Computerized neuropsychological testing is a cornerstone of sport-related concussion assessment. Female soccer players are at an increased risk for concussion as well as exposures to repetitive head impacts from heading a soccer ball. Our primary aim was to examine factorial validity of the Automated Neuropsychological Assessment Metrics (ANAM) neuropsychological test battery in computing the multiple neurocognitive constructs it purports to measure in a large cohort of interscholastic female soccer players.Methods: Study participants included 218 interscholastic female soccer players (age = 17.0±0.7 year; mass = 55.5±6.8 kg; height = 164.7±6.6 cm) drawn from a large (850+) prospective database examining purposeful heading from four area high schools over a 10-year period. The ANAM-2001 measured neurocognitive performance. Three methods were used to identify integral constructs underlying the ANAM: (a) exploratory factor analysis (EFA), (b) first-order confirmatory factor analysis (CFA), and (c) hierarchical CFA.Results: Neuropsychological phenomena measured by the ANAM-2001 were best reproduced by a hierarchical CFA organization, composed of two lower level factors (Simple Reaction Time, Mental Efficiency) and a single, general composite. Although the ANAM was multidimensional, only the composite was found to possess sufficient construct dimensionality and reliability for clinical score interpretation. Findings failed to uphold suppositions that the ANAM measures seven distinct constructs, or that any of its seven tests provide unique information independent of other constructs, or the composite, to support individual interpretation.Conclusions: Outcomes infer the ANAM possesses factorial-validity evidence, but only scores from the composite appear to sufficiently internally valid, and reliable, to support applied use by practitioners.