The effects of repetitive head impacts on postural control: A systematic review

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Objectives: The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. Design: Systematic review. Methods: PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. Results: All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n = 8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n = 13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. Conclusions: Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI.

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