The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players.


Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: pre-season (PRE) and post-season (POST). The outcome measures consisted of Tandem Gait (TG), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), King-Devick (KD), Clinical Reaction Time (CRT), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). RHI during the season was quantified using the Head Impact Telemetry System (HITS; Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts >98g.


Results from direct-entry multiple regression analyses suggest significant associations between RHI and both Visual Memory (R=0.670, F=6.487, p=0.002) and TG (R=0.636, F=3.841, p=0.029) for WSOC and between RHI and KD (R=0.756, F=5.579, p=0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant.


These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and Visual Memory/TG among WSOC, RHI and KD among FB.

Summary Points

  • The overall association between head impact exposure and KD was significant for football whereby those with greater exposure performed worse.
  • The only predictors that made significant, unique contributions to the estimation of KD was number of impacts ≥98g, whereby participants with more impacts ≥98g performed worse.
  • Analysis showed that pre to post-season assessments differed across groups. Specifically, TG and KD improved more among WSOC than FB from pre- to post-season.
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