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Peveler WW, Schoffstall J, Coots J, Kilian J, Glauser J. The Effects of Boxing Glove Design on Thumb Position When Making a Fist for Striking. J Strength Cond Res 2024; 38:948-950. [PMID: 38662886 DOI: 10.1519/jsc.0000000000004699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
ABSTRACT Peveler, WW, Schoffstall, J, Coots, J, Kilian, J, and Glauser, J. The effects of boxing glove design on thumb position when making a fist for striking. J Strength Cond Res 38(5): 948-950, 2024-It has been suggested that boxing glove design alters thumb position increasing the risk of injury. The purpose of this study was to determine the effects of boxing glove design on thumb joint angles when making a fist. Ten experienced fighters participated in this study. A DEXA scan was used to produce an x-ray image of thumb position for all conditions (no gloves and 10-oz boxing gloves). Mean values for dependent measures were compared using a paired-sample T test and an alpha of 0.05. The carpometacarpal (CMC) joint angle was significantly different between no glove (14.1 ± 6.54°) and boxing glove (34.2 ± 7.60°) at p ≤ 0.001. The metacarpophalangeal (MP) joint angle was significantly different between no glove (132.6 ± 12.74°) and boxing glove (149.40 ± 8.15°) at p ≤ 0.001. The IP joint angle was not significantly different between no glove (135.50 ± 19.12°) and boxing glove (144.40 ± 17.39°) at p = 0.269. The perpendicular distance from the second metacarpal of the hand to the center of the MP joint was significantly different between no glove (0.48 ± 0.54 cm) and boxing glove (1.84 ± 0.29 cm) at p ≤ 0.001. Use of a boxing glove resulted in abduction of the thumb away from the hand and increased CMC and MP joint angles that were significantly different in relation to making a fist without a glove. Information from this study may provide insight into the high rate of thumb injury and provide insight for future boxing glove design.
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Affiliation(s)
- Willard W Peveler
- Human Performance Laboratory, Department of Allied Health Professions, Liberty University, Lynchburg, Virginia
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Barnes-Wood M, McCloskey H, Connelly S, Gilchrist MD, Annaidh AN, Theobald PS. Investigation of Head Kinematics and Brain Strain Response During Soccer Heading Using a Custom-Fit Instrumented Mouthguard. Ann Biomed Eng 2024; 52:934-945. [PMID: 38243139 PMCID: PMC10940496 DOI: 10.1007/s10439-023-03430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Association football, also known as soccer in some regions, is unique in encouraging its participants to intentionally use their head to gain a competitive advantage, including scoring a goal. Repetitive head impacts are now being increasingly linked to an inflated risk of developing long-term neurodegenerative disease. This study investigated the effect of heading passes from different distances, using head acceleration data and finite element modelling to estimate brain injury risk. Seven university-level participants wore a custom-fitted instrumented mouthguard to capture linear and angular acceleration-time data. They performed 10 headers within a laboratory environment, from a combination of short, medium, and long passes. Kinematic data was then used to calculate peak linear acceleration, peak angular velocity, and peak angular acceleration as well as two brain injury metrics: head injury criterion and rotational injury criterion. Six degrees of freedom acceleration-time data were also inputted into a widely accepted finite element brain model to estimate strain-response using mean peak strain and cumulative strain damage measure values. Five headers were considered to have a 25% concussion risk. Mean peak linear acceleration equalled 26 ± 7.9 g, mean peak angular velocity 7.20 ± 2.18 rad/s, mean peak angular acceleration 1730 ± 611 rad/s2, and 95th percentile mean peak strain 0.0962 ± 0.252. Some of these data were similar to brain injury metrics reported from American football, which supports the need for further investigation into soccer heading.
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Affiliation(s)
- M Barnes-Wood
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - H McCloskey
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - S Connelly
- Football Association of Wales (FIFA Medical Centre of Excellence), Hensol, Pontyclun, CF72 8JY, UK
| | - M D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Ni Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - P S Theobald
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK.
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Miyata M, Takahata K, Sano Y, Yamamoto Y, Kurose S, Kubota M, Endo H, Matsuoka K, Tagai K, Oya M, Hirata K, Saito F, Mimura M, Kamagata K, Aoki S, Higuchi M. Association between mammillary body atrophy and memory impairment in retired athletes with a history of repetitive mild traumatic brain injury. Sci Rep 2024; 14:7129. [PMID: 38531908 DOI: 10.1038/s41598-024-57383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
Cognitive dysfunction, especially memory impairment, is a typical clinical feature of long-term symptoms caused by repetitive mild traumatic brain injury (rmTBI). The current study aims to investigate the relationship between regional brain atrophy and cognitive impairments in retired athletes with a long history of rmTBI. Overall, 27 retired athletes with a history of rmTBI (18 boxers, 3 kickboxers, 2 wrestlers, and 4 others; rmTBI group) and 23 age/sex-matched healthy participants (control group) were enrolled. MPRAGE on 3 T MRI was acquired and segmented. The TBV and TBV-adjusted regional brain volumes were compared between groups, and the relationship between the neuropsychological test scores and the regional brain volumes were evaluated. Total brain volume (TBV) and regional brain volumes of the mammillary bodies (MBs), hippocampi, amygdalae, thalami, caudate nuclei, and corpus callosum (CC) were estimated using the SPM12 and ITK-SNAP tools. In the rmTBI group, the regional brain volume/TBV ratio (rmTBI vs. control group, Mann-Whitney U test, p < 0.05) underwent partial correlation analysis, adjusting for age and sex, to assess its connection with neuropsychological test results. Compared with the control group, the rmTBI group showed significantly lower the MBs volume/TBV ratio (0.13 ± 0.05 vs. 0.19 ± 0.03 × 10-3, p < 0.001). The MBs volume/TBV ratio correlated with visual memory, as assessed, respectively, by the Rey-Osterrieth Complex Figure test delayed recall (ρ = 0.62, p < 0.001). In conclusion, retired athletes with rmTBI have MB atrophy, potentially contributing to memory impairment linked to the Papez circuit disconnection.
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Affiliation(s)
- Mari Miyata
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Keisuke Takahata
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan.
| | - Yasunori Sano
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Yasuharu Yamamoto
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Shin Kurose
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Manabu Kubota
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hironobu Endo
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Kiwamu Matsuoka
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Kenji Tagai
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Masaki Oya
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Kosei Hirata
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Fumie Saito
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
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Delteil C, Manlius T, Marle O, Godio-Raboutet Y, Bailly N, Piercecchi-Marti MD, Tuchtan L, Thollon L. Head injury: Importance of the deep brain nuclei in force transmission to the brain. Forensic Sci Int 2024; 356:111952. [PMID: 38350415 DOI: 10.1016/j.forsciint.2024.111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/20/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Finite element modeling provides a digital representation of the human body. It is currently the most pertinent method to study the mechanisms of head injury, and is becoming a scientific reference in forensic expert reports. Improved biofidelity is a recurrent aim of research studies in biomechanics in order to improve earlier models whose mechanical properties conformed to simplified elastic behavior and mechanic laws. We aimed to study force transmission to the brain following impacts to the head, using a finite element head model with increased biofidelity. To the model developed by the Laboratory of Applied Biomechanics of Marseille, we added new brain structures (thalamus, central gray nuclei and ventricular systems) as well as three tracts involved in the symptoms of head injury: the corpus callosum, uncinate tracts and corticospinal tracts. Three head impact scenarios were simulated: an uppercut with the prior model and an uppercut with the improved model in order to compare the two models, and a lateral impact with an impact velocity of 6.5 m/s in the improved model. In these conditions, in uppercuts the maximum stress values did not exceed the injury risk threshold. On the other hand, the deep gray matter (thalamus and central gray nuclei) was the region at highest risk of injury during lateral impacts. Even if injury to the deep gray matter is not immediately life-threatening, it could explain the chronic disabling symptoms of even low-intensity head injury.
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Affiliation(s)
- Clémence Delteil
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Thais Manlius
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Oceane Marle
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | | | - Nicolas Bailly
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Marie-Dominique Piercecchi-Marti
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lucile Tuchtan
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
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Viano DC. Frontal NCAP performance and field injury over 40 years. TRAFFIC INJURY PREVENTION 2024; 25:297-312. [PMID: 38415693 DOI: 10.1080/15389588.2024.2315890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Vehicle and occupant responses in 35 mph NCAP tests were determined for small-midsize passenger cars grouped around model year (MY) 1980, 1990, 2000, 2010 and 2020. A baseline was established with 1980 vehicles not designed for NCAP. The results of four decades of vehicles designed for NCAP were compared to the baseline. The study also determined the risk for serious injury (MAIS 3 + F) by vehicle model year (MY) using 1989-2015 NASS and 2017-2020 CISS. It explored safety trends in frontal crashes over 50 MYs of vehicles. METHODS The 1980 baseline group was established with 10 1979-1983 MY passenger cars weighing <1,500 kg. Four decades of vehicle crash tests from five manufacturers established trends in vehicle dynamics and dummy responses over four decades of vehicles designed for NCAP. Triaxial acceleration of the head and chest were reanalyzed for each test to have a consistent set of responses over five decades. The risk for serious injury (MAIS 3 + F) to the driver and front passenger was determined by vehicle MY using 1989-2015 NASS and 2017-2020 CISS with belted and unbelted drivers and right-front passengers. The data was sorted in four MY groups 1961-1989 MY, 1990-1999 MY, 2000-2009 MY and 2010 MY-2021 MY. The risk for MAIS 3 + F injury was determined with standard errors using weighted data. RESULTS The 1980 NCAP tests brought about changes in vehicle structures and occupant restraints by 1990; however, HIC15 and 3 ms chest acceleration have not changed much the past 20 years since the use of advanced airbags and seatbelts with pretensioner and load-limiters. For the driver, HIC15 dropped 40 ± 19% from the 1980 to 1990 NCAP tests and dropped further to 76 ± 32% in 2020. The percentage drops after 1990 were not statistically significant. The driver 3 ms chest acceleration dropped 18 ± 5% from 1980 to 1990 and plateaued with 22 ± 6% in 2020. For the front passenger, HIC15 dropped 68 ± 52% from the 1980 to 1990 NCAP tests and plateaued at 71 ± 49% in 2020. The passenger 3 ms chest acceleration dropped 13 ± 5% from 1980 to 1990 and has fluctuated with minimal change. Injury risks based on responses show the same initial drop in 1990 and have remained essentially constant. Nothing meaningful has changed in dummy responses in the past 20 years of NCAP testing. The field data found the belted driver MAIS 3 + F risk was 1.66 ± 0.37% in 1961-1989 MY vehicles and 1.39 ± 0.33% in 2010-2021 MY vehicles. For belted right-front passengers, the risk was 1.52 ± 0.39% in 1961-1989 MY vehicles and 1.42 ± 0.46% in 2010-2021 MY vehicles. The field data shows no meaningful change in injury risk in 50 MYs of vehicles. NCAP involves 35-40 mph delta-V, which represents a small fraction, 0.33%, of belted occupant exposure and only 8.6% of severe injury based on 1994-2015 NASS. CONCLUSIONS The NCAP test lacks field relevance. Manufacturers are merely "tuning" the restraint systems for star ratings without meaningful changes in field injury risks the past 20 years. There are disbenefits of "tuning" safety for a single, high-severity crash when most of the severe injury occurs in lower severity crashes. NHTSA should reevaluate plans to change the dummy to Thor and add BrIC injury criteria to assess NCAP responses. These changes would cause manufacturers to further "tune" structures, restraints and interiors without meaningful effects in real-world crashes.
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Da Broi M, Al Awadhi A, Voruz P, Nouri A, Schaller K. The spectrum of acute and chronic consequences of neurotrauma in professional and amateur boxing - A call to action is advocated to better understand and prevent this phenomenon. BRAIN & SPINE 2023; 4:102743. [PMID: 38510617 PMCID: PMC10951782 DOI: 10.1016/j.bas.2023.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
Introduction Despite changes in regulations, boxing-related injuries and fatalities are still occurring. The numbers available in the literature regarding mortality and long-term consequences may not accurately represent the actual situation. Indeed, the real extent of this phenomenon remains poorly known. Research question Delineating the spectrum of acute and chronic consequences of boxing-related traumatic brain injuries (TBI). Material and methods Narrative review of the literature concerning acute and chronic boxing-related TBI. Keywords such as mortality, boxing, subdural hematoma were used to search in PubMed and Google scholar. An updated analysis of the Velazquez fatalities collection in boxing was undertaken. Results The Velazquez collection includes 2076 fatalities from 1720 to the present with a death rate of 10 athletes per year. More than half of the deaths (N = 1354, 65.2%) occurred after a knock-out, and nearly 75% happened during professional bouts. In Australia, from 1832 to 2020, 163 fatalities were recorded (75% professional). In Japan, from 1952 to 2016, 38 deaths were recorded with a mean age of 23.9 years. Up to 40% of retired professional boxers in the United States were diagnosed with symptoms of chronic brain injury. Clinical dementia is far more prevalent among professional boxers than in amateurs with an incidence of 20%. Discussion and conclusions A concerted effort to raise awareness and shed light on boxing-related neuro-trauma is required. Similar considerations can be made for other combat sports or contact sports. A call to action to address this knowledge gap, decrease and prevent this phenomenon is advocated.
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Affiliation(s)
- Michele Da Broi
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Abdullah Al Awadhi
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Voruz
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
| | - Aria Nouri
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
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Graillon N, Foletti JM, Godio-Raboutet Y, Guyot L, Varazzani A, Thollon L. Mandibular Titanium Miniplates Change the Biomechanical Behaviour of the Mandible in the Case of Facial Trauma: A Three-Dimensional Finite Element Analysis. Bioengineering (Basel) 2023; 10:994. [PMID: 37760096 PMCID: PMC10525150 DOI: 10.3390/bioengineering10090994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.
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Affiliation(s)
- Nicolas Graillon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Jean-Marc Foletti
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Yves Godio-Raboutet
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
| | - Laurent Guyot
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Andrea Varazzani
- Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital—Claude-Bernard Lyon 1 University, 69310 Pierre-Benite, France;
| | - Lionel Thollon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
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Jones CM, Austin K, Augustus SN, Nicholas KJ, Yu X, Baker C, Chan EYK, Loosemore M, Ghajari M. An Instrumented Mouthguard for Real-Time Measurement of Head Kinematics under a Large Range of Sport Specific Accelerations. SENSORS (BASEL, SWITZERLAND) 2023; 23:7068. [PMID: 37631606 PMCID: PMC10457941 DOI: 10.3390/s23167068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Head impacts in sports can produce brain injuries. The accurate quantification of head kinematics through instrumented mouthguards (iMG) can help identify underlying brain motion during injurious impacts. The aim of the current study is to assess the validity of an iMG across a large range of linear and rotational accelerations to allow for on-field head impact monitoring. METHODS Drop tests of an instrumented helmeted anthropometric testing device (ATD) were performed across a range of impact magnitudes and locations, with iMG measures collected concurrently. ATD and iMG kinematics were also fed forward to high-fidelity brain models to predict maximal principal strain. RESULTS The impacts produced a wide range of head kinematics (16-171 g, 1330-10,164 rad/s2 and 11.3-41.5 rad/s) and durations (6-18 ms), representing impacts in rugby and boxing. Comparison of the peak values across ATD and iMG indicated high levels of agreement, with a total concordance correlation coefficient of 0.97 for peak impact kinematics and 0.97 for predicted brain strain. We also found good agreement between iMG and ATD measured time-series kinematic data, with the highest normalized root mean squared error for rotational velocity (5.47 ± 2.61%) and the lowest for rotational acceleration (1.24 ± 0.86%). Our results confirm that the iMG can reliably measure laboratory-based head kinematics under a large range of accelerations and is suitable for future on-field validity assessments.
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Affiliation(s)
- Chris M. Jones
- Sports and Wellbeing Analytics, Swansea SA7 0AJ, UK; (K.A.)
- Institute of Sport and Exercise Health (ISEH), Division Surgery Interventional Science, University College London, London W1T 7HA, UK
| | - Kieran Austin
- Sports and Wellbeing Analytics, Swansea SA7 0AJ, UK; (K.A.)
- Institute of Sport, Nursing and Allied Health, University of Chichester, Chichester PO19 6PE, UK
| | - Simon N. Augustus
- Department of Applied and Human Sciences, Kingston University London, London KT1 2EE, UK
| | | | - Xiancheng Yu
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Claire Baker
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Emily Yik Kwan Chan
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Mike Loosemore
- Institute of Sport and Exercise Health (ISEH), Division Surgery Interventional Science, University College London, London W1T 7HA, UK
- English Institute of Sport, Manchester M11 3BS, UK
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
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Mao Y, Zhao D, Li J, Fu W. Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century. Orthop J Sports Med 2023; 11:23259671221127669. [PMID: 37025124 PMCID: PMC10071201 DOI: 10.1177/23259671221127669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 04/08/2023] Open
Abstract
Background To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed. Purpose To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century. Study Design Systematic review; Level of evidence, 3. Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IRN), per 1000 competition exposures (IRE), and per 1000 minutes of competition (IRC) or training (IRT) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs. Results Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IRN in overall injuries was 223.9 (95% CI, 157.5-290.4), the IRE was 233.3 (95% CI, 161.3-305.2), and the IRC was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IRN (399.8), IRE (379.8), and IRC (23.9) were all significantly higher than in the amateur and female groups. The IRE (76.6 vs 250.6; P < .000) and IRC (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture. Conclusion IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies. Registration CRD42021289993 (PROSPERO).
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Dongmei Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
- Weili Fu, MD, Department of Orthopedics, Orthopedic Research
Institute, West China Hospital, Sichuan University, No. 37, Guoxue Alley,
Chengdu 610041, China ()
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10
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Sifuentes-Cervantes JS, Muzzi D, Castro-Núñez J, Guerrero LM, Cunningham LL. Maxillofacial Trauma Patterns in Bare-Knuckle Fighting. J Oral Maxillofac Surg 2022; 80:1663-1669. [DOI: 10.1016/j.joms.2022.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
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11
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Lota KS, Malliaropoulos N, Blach W, Kamitani T, Ikumi A, Korakakis V, Maffulli N. Rotational head acceleration and traumatic brain injury in combat sports: a systematic review. Br Med Bull 2022; 141:33-46. [PMID: 35107134 PMCID: PMC9351374 DOI: 10.1093/bmb/ldac002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds. SOURCES OF DATA PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies. AREAS OF AGREEMENT RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately. AREAS OF CONTROVERSY Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious. GROWING POINTS RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.
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Affiliation(s)
- Kabir Singh Lota
- Barts and The London School of Medicine and Dentistry, London, E1 2AD, UK.,Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK
| | - Nikos Malliaropoulos
- Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK.,Sports and Exercise Medicine Clinic, Asklipiou 17, 54639 Thessaloniki, Greece.,Rheumatology Department, Sports Clinic, Barts Health NHS Trust, London, E1 4DG, UK
| | - Wiesław Blach
- Department of Physical Education and Sport, University School of Physical Education, Wrocław 51-612, Poland
| | - Takeshi Kamitani
- School of Sport and Health Science, Tokai Gakuen University, 21-233 Nishinohora, Ukigai, Miyoshi, Aichi, 470-0207, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, 3-2-7 Miyamachi, Mito, Ibaraki 310-0015, Japan
| | | | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno 84081, Italy.,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke-on-Trent, ST4 7QB, UK
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12
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Omalu B, Hammers J. In Reply: Recommendation to Create New Neuropathologic Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy. Neurosurgery 2022; 90:e21-e23. [PMID: 34982893 DOI: 10.1227/neu.0000000000001768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine , University of California, Davis, Davis , California , USA
| | - Jennifer Hammers
- Forensic Science and Law Program , Bayer School of Natural and Environmental Sciences , Duquesne University, Pittsburgh , Pennsylvania , USA
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13
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Menzel T, Potthast W. Application of a Validated Innovative Smart Wearable for Performance Analysis by Experienced and Non-Experienced Athletes in Boxing. SENSORS 2021; 21:s21237882. [PMID: 34883881 PMCID: PMC8659887 DOI: 10.3390/s21237882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
An athlete's sporting performance depends to a large extent on the technical execution of the athletic motion in order to achieve maximum effectiveness in physical performance. Performance analysis provides an important means of classifying and quantifying athletic prowess in terms of the significant performance aspects of the sport to provide objective feedback. This study aimed to analyze technical execution in terms of punch trajectory, force, velocity and time, considering the expert-novice paradigm by investigating the technical execution of 31 experienced and non-experienced athletes for the four main punching techniques of the cross, jab, uppercut and hook strike. The kinetic and kinematic data were collected by means of a boxing monitoring system developed and validated for in-field use. The research revealed significant correlation for executed punching trajectory and punch force in intragroup comparison and significant differences in intergroup comparison. No significant differences were detected for punch velocity in either inter- or intra-group paradigms. This study, through use of the sensor system, aligns with the results of existing publications conducted in laboratory conditions, in the assessment of punch force, punch speed and punch time and thus extends the state of research by use of a smart wearable in field method.
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14
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N-3 Polyunsaturated Fatty Acids Ameliorate Neurobehavioral Outcomes Post-Mild Traumatic Brain Injury in the Fat-1 Mouse Model. Nutrients 2021; 13:nu13114092. [PMID: 34836347 PMCID: PMC8620437 DOI: 10.3390/nu13114092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022] Open
Abstract
Concussions and mild traumatic brain injury (m-TBI) have been identified as a consequential public health concern because of their potential to cause considerable impairments in physical, cognitive, behavioral, and social functions. Given their prominent structural and functional roles in the brain, n-3 polyunsaturated fatty acids (PUFA) have been identified as a potentially viable prophylactic agent that may ameliorate the deleterious effects of m-TBI on brain function. The purpose of the present pilot study was to investigate the effect of n-3 PUFA on neurologic function using a weight drop injury (WDI) model. Fat-1 mice, capable of synthesizing n-3 PUFA endogenously from n-6 PUFA, and their wild-type (WT) counterparts, were subjected to a mild low-impact WDI on the closed cranium, and recovery was evaluated using the neurological severity score (NSS) to assess the motor and neurobehavioral outcomes. In comparison to the WT mice, the fat-1 mice had a significantly (p ≤ 0.05) lower NSS at all time points post-WDI, and significantly greater neurological restoration measured as the time to first movement. Overall, these findings demonstrate the protective effect of n-3 PUFA against mild brain injury.
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15
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Fares MY, Salhab HA, Fares J, Khachfe HH, Fares Y, Baydoun H, Abboud JA, Alaaeddine N. Craniofacial and traumatic brain injuries in mixed martial arts. PHYSICIAN SPORTSMED 2021; 49:420-428. [PMID: 33151104 DOI: 10.1080/00913847.2020.1847623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: Mixed-Martial-Arts (MMA) has witnessed a rapid growth over the recent years. This study aims to explore the patterns and trends of head injuries in MMA.Design: Descriptive epidemiological study.Setting: Ringside physician reports of the Ultimate Fighting Championship (UFC) fights between 2016 and 2019 (inclusive) were screened. Data were extracted from the Nevada State Athletic Commission (NSAC) database. Play-by-play video analysis was also conducted.Participants: UFC fighters involved in fights sanctioned by the NSAC, between 2016 and the end of 2019 (N = 816).Independent variables: Sex, location of head injury, type of head injury, injury mechanism, number of significant head strikes, type of finish, and weight division.Main outcome measures: Head injury rates were calculated. A one-way analysis of variance (ANOVA) was used to explore any statistically significant differences between injury rates of different locations, types, and types of finishes. An independent t-test was used to determine whether any significant differences existed between the two sexes, and a Joinpoint regression analysis was used to determine the statistical significance of the trends of head injury rates across different weight divisions. P-values <0.05 were considered significant (95% CI).Results: A total of 288 head injuries in 408 fights were recorded during our study period. Head injury rate constituted 35 injuries per 100 athletic-exposures (AE) in sanctioned fights. Traumatic brain injuries (TBI) were the most common type of injury, with a rate of 16 per 100AE, significantly greater than that of fractures (p = 0.003). Males had a head injury rate of 37 per 100AE, higher than that of females which was 23 per 100AE. Technical Knockout (TKO)/ Knockout(KO) was the type of finish with the highest rate of head injuries, significantly greater than that of decision or submission (p < 0.001). In general, head injury rates were higher as weight divisions increased.Conclusion: Head injuries are prevalent in MMA. Preventive measures need to be implemented to ensure fighter safety and limit injury risk.
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Affiliation(s)
- Mohamad Y Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Hamza A Salhab
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Youssef Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hasan Baydoun
- Department of Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph A Abboud
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nada Alaaeddine
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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16
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Glass JD. Re: The Second NINDS/NIBIB Consensus Meeting to Define Neuropathological Criteria for the Diagnosis of Chronic Traumatic Encephalopathy. J Neuropathol Exp Neurol 2021;80(3):210-9. J Neuropathol Exp Neurol 2021; 80:1007-1008. [PMID: 34718653 DOI: 10.1093/jnen/nlab066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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18
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Acute and Chronic Effects of Multiple Concussions on Midline Brain Structures. Neurology 2021; 97:e1170-e1181. [PMID: 34433678 PMCID: PMC8480483 DOI: 10.1212/wnl.0000000000012580] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that a history of concussion (HOC) causes greater disturbances in cerebral blood flow (CBF) and white matter microstructure of midline brain structures after subsequent concussions, during the acute and chronic phases of recovery. METHODS In this longitudinal MRI study, 61 athletes with uncomplicated concussion (36 with HOC) were imaged at the acute phase of injury (1-7 days after injury), the subacute phase (8-14 days), medical clearance to return to play (RTP), 1 month after RTP, and 1 year after RTP. A normative group of 167 controls (73 with HOC) were also imaged. Each session assessed CBF of the cingulate cortex, along with fractional anisotropy (FA) and mean diffusivity (MD) of the corpus callosum. Linear mixed models tested for interactions of HOC with time since injury. The Sport Concussion Assessment Tool (SCAT) was also used to evaluate effects of HOC on symptoms, cognition, and balance. RESULTS Athletes with HOC had significantly greater declines in midcingulate CBF subacutely (z = -3.29, p = 0.002) and greater declines in posterior cingulate CBF at 1 year after RTP (z = -2.42, p = 0.007). No significant effects of HOC were seen for FA, whereas athletes with HOC had higher MD of the splenium at RTP (z = 2.54, p = 0.008). These effects were seen in the absence of significant differences in SCAT domains (|z| ≤ 1.14, p ≥ 0.256) or time to RTP (z = 0.23, p = 0.818). DISCUSSION Results indicate subacute and chronic effects of HOC on cingulate CBF and callosal microstructure in the absence of differences in clinical indices. These findings provide new insights into physiologic brain recovery after concussion, with cumulative effects of repeated injury detected among young, healthy athletes.
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Affiliation(s)
- Nathan W Churchill
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael G Hutchison
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Simon J Graham
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tom A Schweizer
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.
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19
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Banman CJ, Schneider KJ, Cluff T, Peters RM. Altered Vestibular Balance Function in Combat Sport Athletes. J Neurotrauma 2021; 38:2291-2300. [PMID: 33752455 DOI: 10.1089/neu.2020.7432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Combat sports pose a risk for accumulative injuries to the nervous system, yet fighters have remained an understudied population. Here, our purpose was to determine whether repetitive blows to the head have an effect on vestibular balance reflexes in combat sports athletes. We compared lower-limb muscle responses evoked with electrical vestibular stimuluation (EVS) between fighters (boxing/muay thai) and non-fighter controls. Each participant received stochastic vestibular stimulation (0-25 Hz, ±3 mA) over their mastoid processes while they stood relaxed with their head to the left or right. Surface electromyography was recorded from the medial gastrocnemius and soleus muscles bilaterally. Short and medium latency response (SLR/MLR) peaks were significantly delayed in the fighter group compared to controls. SLR and MLR peak amplitudes were also significantly lower in fighters. Fighter-estimated cumulative repetitive head impact (RHI) events demonstrated strong positive correlations with the timing of SLR and MLR peaks. Cumulative RHI events also negatively correlated with peak MLR amplitude and response gain at frequencies above 5 Hz. Our results provide evidence of a progressive vestibular impairment in combat sports athletes, potentially resulting from blows to the head accumulated in sparring practice and competitive bouts throughout their careers. Taken together, EVS-based vestibular assessments may provide a valuable clinical diagnostic tool and help better inform "return-to-play" and career-length decisions for not only combat sports athletes, but potentially other populations at risk of RHIs.
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Affiliation(s)
- Christopher J Banman
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Cumming School of Medicine, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Evidence Sport and Spinal Therapy, Calgary, Alberta, Canada
| | - Tyler Cluff
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan M Peters
- Faculty of Kinesiology, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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20
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Tuchtan L, Delteil C, Godio-Raboutet Y, Kolopp M, Léonetti G, Thollon L, Piercecchi-Marti MD. Sudden death after facial impacts: Is the brainstem involved? Morphologie 2021; 106:217-223. [PMID: 34400063 DOI: 10.1016/j.morpho.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
Three deaths following facial impacts in the presence of witnesses and resulting in brain lesions that were visualized only on pathological examination were studied at the forensic medicine institute of Marseille. Craniofacial impacts, even of low intensity, received during brawls may be associated with brain lesions ranging from a simple knock-out to fatal injuries. In criminal cases that are brought to court, even by autopsy it is still difficult to establish a direct link between the violence of the impact and the injuries that resulted in death. During a facial impact, the head undergoes a movement of violent forced hyperextension. Death may thus be secondary to the transmission of forces to the brain, either by a mechanism involving nerve conduction that may be termed a reflex mechanism (for example by vagal hyperstimulation) or by injury to the central nervous system (axonal damage). In such situations, autopsy does not make it possible to determine the cause of death, but only to suspect it in a context of voluntary violence in the presence of witnesses, with or without violent injury observed on external examination or on superficial incisions to determine the extent of bruises or hematoma. Systemic and comprehensive investigation involving pathology and toxicology is essential in any medicolegal case for positive interpretation and discrimination of other causes of death.
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Affiliation(s)
- L Tuchtan
- Forensic Department, APHM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; CNRS, EFS, ADES, Aix-Marseille University, 27, avenue Jean-Moulin, 13385 Marseille, France.
| | - C Delteil
- Forensic Department, APHM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; CNRS, EFS, ADES, Aix-Marseille University, 27, avenue Jean-Moulin, 13385 Marseille, France
| | - Y Godio-Raboutet
- IFSTTAR, LBA, Aix-Marseille University, boulevard Pierre-Bramard, 13015 Marseille, France; iLab - Spine (International Laboratory - Spine Imaging and Biomechanics), boulevard Pierre-Bramard, 13015 Marseille, France
| | - M Kolopp
- Forensic Department, APHM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Léonetti
- Forensic Department, APHM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; CNRS, EFS, ADES, Aix-Marseille University, 27, avenue Jean-Moulin, 13385 Marseille, France
| | - L Thollon
- IFSTTAR, LBA, Aix-Marseille University, boulevard Pierre-Bramard, 13015 Marseille, France; iLab - Spine (International Laboratory - Spine Imaging and Biomechanics), boulevard Pierre-Bramard, 13015 Marseille, France
| | - M-D Piercecchi-Marti
- Forensic Department, APHM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; CNRS, EFS, ADES, Aix-Marseille University, 27, avenue Jean-Moulin, 13385 Marseille, France
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21
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Sifuentes-Cervantes JS, Yamamoto-Valenzuela K, Autran-Martínez J, Castro-Núñez J, Guerrero LM. Maxillofacial Trauma in the Ultimate Fighting Championship. J Oral Maxillofac Surg 2021; 79:1921.e1-1921.e7. [PMID: 34153246 DOI: 10.1016/j.joms.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The Ultimate Fighting Championship (UFC) is an American mixed martial art (MMA) company. This study aims to characterize patterns and trends of maxillofacial injuries in MMA. MATERIALS AND METHODS The study design is a retrospective cohort study. Study sample consisted of fighters that suffered injuries during the matches from January 2015 to December 2019 (N = 259). The Athletic Commissions and corresponding fighting regulatory departments from 16 states and 24 countries were screened for medical reports released by UFC ringside physicians. Predictor variables were sex, weight division, injury location, injury type, and fight outcome (i.e., Technical Knockout/Knockout, Submission, Decision). Primary outcome variables were need for medical suspension and duration of medical suspension, secondary outcome variable was frequency of injury. Chi-square test was used to determine any statistical significance between predictor variables. One-way analysis of variance was used to determine any statistically significant differences between medical suspension times, sex, injury location, type of injury, weight divisions and fight outcome throughout the years. P value less than .05 (95% confidence interval [CI]) was considered statistically significant. RESULTS A total of 259 fighters suffered injuries. Of the 319 total injuries, 291 (91.2%) occurred in male fighters, and 28 (8.8%) in females. Middle facial third injuries were the most common for both males and females; lower facial third injuries were proportionally similar. The male weight division with the longest medical suspensions were the light heavyweight (110.68 days) and welterweight (108.25 days) (P < .10166); the female weight division with the longest medical suspension was strawweight (88.92 days) and shortest was bantamweight (81.75 days) (P < .921123). CONCLUSIONS Upper and midface trauma was predominant with fractures concentrated in the light heavyweight and welterweight divisions. Medical suspensions duration were longer in the light heavyweight and welterweight divisions.
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Affiliation(s)
- Jose S Sifuentes-Cervantes
- PGY 1, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico.
| | | | - Jorge Autran-Martínez
- PGY 2, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jaime Castro-Núñez
- PGY 3, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico; Research Department, Institución Universitaria Colegios de Colombia, Bogota, Colombia
| | - Lidia M Guerrero
- Professor and Program Director, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico
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22
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Lenetsky S, Uthoff A, Coyne J, Cronin J. A Review of Striking Force in Full-Contact Combat Sport Athletes. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Li H, Lu RJ, Wu P, Yuan Y, Yang S, Zhang FF, Jiang J, Tan Y. Numerical simulation and analysis of midfacial impacts and traumatic brain injuries. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:459. [PMID: 33850856 PMCID: PMC8039671 DOI: 10.21037/atm-21-134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Backgrounds The maxillofacial region is the exposed part of the human body and is susceptible to injury due to the limited protective equipment. Due to anatomic proximity of the maxillofacial skeleton and cranium, the force can be transmitted directly to the brain in case of maxillofacial impact, maxillofacial injuries are often accompanied with craniocerebral trauma. Therefore, it is necessary to study the biomechanical response mechanism of trauma to improve prevention of traumatic brain injury (TBI). Methods To investigate the biomechanical mechanism between the two injuries, a finite element (FE) head model including skull, midfacial bones and detailed anatomical intracranial features was successfully developed based on CT/MRI data. The model was validated by comparing it with one classical cadaver experiment. During the simulations, three different load forces were used to simulate common causes of injury seen in the clinic including boxing-type impact injury and car accident-type impact injury, and four locations on the model were considered as common injury sites in the midface. Results Twelve common impact scenarios were reproduced by FE simulation successfully. Simulations showed that there was a linear relationship between the severity of TBI and the collision energy. The location of TBI was directly related to the location of the impact site, and a lateral impact was more injurious to the brain than an anterior-posterior impact. The relative movement between the skull and brain could cause physical damage to the brain. The study indicated that the midfacial bones acted as a structure capable of absorbing energy and protecting the brain from impact. Conclusions This biomechanical information may assist surgeons better understand and diagnose brain injuries accompanied by midfacial fractures.
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Affiliation(s)
- Hao Li
- Department of Oral and Maxillofacial Surgery, Xinqiao Hospital, Army Military Medical University (Third Military Medical University), Chongqing, China.,Department of Oral and Maxillofacial Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Rong-Jian Lu
- Department of Stomatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Po Wu
- Department of Oral and Maxillofacial Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Yuan Yuan
- Department of Oral and Maxillofacial Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Shuyong Yang
- Department of Oral and Maxillofacial Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Fang-Fang Zhang
- Department of Stomatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ji Jiang
- Department of Oral and Maxillofacial Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Yinghui Tan
- Department of Oral and Maxillofacial Surgery, Xinqiao Hospital, Army Military Medical University (Third Military Medical University), Chongqing, China
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Bourke NJ, Yanez Lopez M, Jenkins PO, De Simoni S, Cole JH, Lally P, Mallas EJ, Zhang H, Sharp DJ. Traumatic brain injury: a comparison of diffusion and volumetric magnetic resonance imaging measures. Brain Commun 2021; 3:fcab006. [PMID: 33981994 PMCID: PMC8105496 DOI: 10.1093/braincomms/fcab006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/14/2022] Open
Abstract
Cognitive impairment after traumatic brain injury remains hard to predict. This is partly because axonal injury, which is of fundamental importance, is difficult to measure clinically. Advances in MRI allow axonal injury to be detected after traumatic brain injury, but the most sensitive approach is unclear. Here, we compare the performance of diffusion tensor imaging, neurite orientation dispersion and density-imaging and volumetric measures of brain atrophy in the identification of white-matter abnormalities after traumatic brain injury. Thirty patients with moderate-severe traumatic brain injury in the chronic phase and 20 age-matched controls had T1-weighted and diffusion MRI. Neuropsychological tests of processing speed, executive functioning and memory were used to detect cognitive impairment. Extensive abnormalities in neurite density index and orientation dispersion index were observed, with distinct spatial patterns. Fractional anisotropy and mean diffusivity also indicated widespread abnormalities of white-matter structure. Neurite density index was significantly correlated with processing speed. Slower processing speed was also related to higher mean diffusivity in the corticospinal tracts. Lower white-matter volumes were seen after brain injury with greater effect sizes compared to diffusion metrics; however, volume was not sensitive to changes in cognitive performance. Volume was the most sensitive at detecting change between groups but was not specific for determining relationships with cognition. Abnormalities in fractional anisotropy and mean diffusivity were the most sensitive diffusion measures; however, neurite density index and orientation dispersion index may be more spatially specific. Lower neurite density index may be a useful metric for examining slower processing speed.
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Affiliation(s)
- Niall J Bourke
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - Maria Yanez Lopez
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - Peter O Jenkins
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - Sara De Simoni
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - James H Cole
- UCL Department of Computer Science, Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - Pete Lally
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - Emma-Jane Mallas
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
| | - Hui Zhang
- UCL Department of Computer Science, Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - David J Sharp
- Division of Brain Sciences, Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London, UK
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25
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Shah BR, Holcomb JM, Davenport EM, Lack CM, McDaniel JM, Imphean DM, Xi Y, Rosenbaum DA, Urban JE, Wagner BC, Powers AK, Whitlow CT, Stitzel JD, Maldjian JA. Prevalence and Incidence of Microhemorrhages in Adolescent Football Players. AJNR Am J Neuroradiol 2020; 41:1263-1268. [PMID: 32661051 DOI: 10.3174/ajnr.a6618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE SWI is an advanced imaging modality that is especially useful in cerebral microhemorrhage detection. Such microhemorrhages have been identified in adult contact sport athletes, and the sequelae of these focal bleeds are thought to contribute to neurodegeneration. The purpose of this study was to utilize SWI to determine whether the prevalence and incidence of microhemorrhages in adolescent football players are significantly greater than those of adolescent noncontact athletes. MATERIALS AND METHODS Preseason and postseason SWI was performed and evaluated on 78 adolescent football players. SWI was also performed on 27 adolescent athletes who reported no contact sport history. Two separate one-tailed Fisher exact tests were performed to determine whether the prevalence and incidence of microhemorrhages in adolescent football players are greater than those of noncontact athlete controls. RESULTS Microhemorrhages were observed in 12 football players. No microhemorrhages were observed in any controls. Adolescent football players demonstrated a significantly greater prevalence of microhemorrhages than adolescent noncontact controls (P = .02). Although 2 football players developed new microhemorrhages during the season, microhemorrhage incidence during 1 football season was not statistically greater in the football population than in noncontact control athletes (P = .55). CONCLUSIONS Adolescent football players have a greater prevalence of microhemorrhages compared with adolescent athletes who have never engaged in contact sports. While microhemorrhage incidence during 1 season is not significantly greater in adolescent football players compared to adolescent controls, there is a temporal association between playing football and the appearance of new microhemorrhages.
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Affiliation(s)
- B R Shah
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - J M Holcomb
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - E M Davenport
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - C M Lack
- Departments of Radiology (C.M.L., C.T.W.)
| | - J M McDaniel
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - D M Imphean
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Y Xi
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - J E Urban
- Biomedical Engineering (J.E.U., J.D.S.)
| | - B C Wagner
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - A K Powers
- Neurosurgery (A.K.P.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - J A Maldjian
- From the Department of Radiology (B.R.S., J.M.H., E.M.D., J.M.M., D.M.I., Y.X., B.C.W., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas
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Rowson B, Duma SM. A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies. Ann Biomed Eng 2020; 48:2734-2750. [PMID: 33200263 DOI: 10.1007/s10439-020-02684-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
This review paper summarizes the scientific advancements in the field of concussion biomechanics in American football throughout the past five decades. The focus is on-field biomechanical data collection, and the translation of that data to injury metrics and helmet evaluation. On-field data has been collected with video analysis for laboratory reconstructions or wearable head impact sensors. Concussion biomechanics have been studied across all levels of play, from youth to professional, which has allowed for comparison of head impact exposure and injury tolerance between different age groups. In general, head impact exposure and injury tolerance increase with increasing age. Average values for concussive head impact kinematics are lower for youth players in both linear and rotational acceleration. Head impact data from concussive and non-concussive events have been used to develop injury metrics and risk functions for use in protective equipment evaluation. These risk functions have been used to evaluate helmet performance for each level of play, showing substantial differences in the ability of different helmet models to reduce concussion risk. New advances in head impact sensor technology allow for biomechanical measurements in helmeted and non-helmeted sports for a more complete understanding of concussion tolerance in different demographics. These sensors along with advances in finite element modeling will lead to a better understanding of the mechanisms of injury and human tolerance to head impact.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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Bioinspired material architectures from bighorn sheep horncore velar bone for impact loading applications. Sci Rep 2020; 10:18916. [PMID: 33144662 PMCID: PMC7642289 DOI: 10.1038/s41598-020-76021-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 11/12/2022] Open
Abstract
Rocky Mountain bighorn sheep rams (Ovis canadensis canadensis) routinely conduct intraspecific combat where high energy cranial impacts are experienced. Previous studies have estimated cranial impact forces to be up to 3400 N during ramming, and prior finite element modeling studies showed the bony horncore stores 3 × more strain energy than the horn during impact. In the current study, the architecture of the porous bone within the horncore was quantified, mimicked, analyzed by finite element modeling, fabricated via additive manufacturing, and mechanically tested to determine the suitability of the novel bioinspired material architecture for use in running shoe midsoles. The iterative biomimicking design approach was able to tailor the mechanical behavior of the porous bone mimics. The approach produced 3D printed mimics that performed similarly to ethylene–vinyl acetate shoe materials in quasi-static loading. Furthermore, a quadratic relationship was discovered between impact force and stiffness in the porous bone mimics, which indicates a range of stiffness values that prevents impact force from becoming excessively high. These findings have implications for the design of novel bioinspired material architectures for minimizing impact force.
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Tiernan S, Meagher A, O'Sullivan D, O'Kelly E. Finite element simulation of head impacts in mixed martial arts. Comput Methods Biomech Biomed Engin 2020; 24:278-288. [PMID: 33017178 DOI: 10.1080/10255842.2020.1826457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thirteen MMA athletes were fitted with the MiG2.0 Stanford instrumented mouthguard. 451 video confirmed impacts were recoded during sparring sessions and competitive events. The competitive events resulted in five concussions. The impact with the highest angular acceleration from each event was simulated using the GHBMC head model. Average strain in the corpus callosum of concussed fighters was 0.27, which was 87.9% higher than uninjured fighters and was the best strain indicator of concussion. The best overall predictor of concussion found in this study was shear stress in the corpus callosum which differed by 111.4% between concussed and uninjured athletes.
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Affiliation(s)
| | - Aidan Meagher
- Technological University Dublin, Tallaght, Dublin, Ireland
| | - David O'Sullivan
- Division of Sports Science, Pusan National University, Busan, Republic of Korea
| | - Eoin O'Kelly
- Department of Neurology, Health Care Centre, St James Hospital, Dublin, Ireland
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29
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Casson IR, Viano DC. Long-Term Neurological Consequences Related to Boxing and American Football: A Review of the Literature. J Alzheimers Dis 2020; 69:935-952. [PMID: 31156163 DOI: 10.3233/jad-190115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The long-term effects of repetitive head trauma on the brain have often been studied in boxers and American football players. The medical literature on this topic was reviewed in order to compare the findings related to boxing with those related to football. The evidence gathered from this review indicates that there are significant differences between the clinical and neuropathological descriptions of the chronic brain damage reported in retired boxers compared to those reported in retired football players. Differing biomechanics of head impacts in the two sports may help explain the different clinical and neuropathological consequences of participation in boxing versus football.
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Affiliation(s)
- Ira R Casson
- Department of Neurology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
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30
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Pirruccio K, Parisien RL, Olsen C, Kelly JD. Wrestling-related concussions and closed head injuries predominantly occur in high school age athletes. J Sports Med Phys Fitness 2020; 61:407-412. [PMID: 32880134 DOI: 10.23736/s0022-4707.20.11194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sports-related concussions (SRC) and closed head injuries (CHI) have recently garnered national attention given mounting concern for long-term neurological sequelae resulting from repetitive head trauma. Despite historically dangerous techniques in wrestling that involve impacts to the head, there is a paucity of epidemiologic data in regard to wrestling-related concussions (WRCs) in the United States (USA). METHODS The National Electronic Injury Surveillance System (NEISS) database was queried (2000-2018) to report national estimates and demographic characteristics of patients 6-25 years of age presenting to US emergency departments (EDs) with WRCs and CHIs. RESULTS The average annual number of patients presenting to US EDs with WRCs or CHIs was 3465 (95% confidence interval [CI]: 2489-4441). Over one-third of patients were between 15 (17.7%; 95% CI: 15.8%-19.7%) and 16 (17.0%; 95% CI: 14.9%-19.1%) years of age, which comprised the peak age groups during which such head injuries were sustained. The vast majority of patients were male (96.3%; 95% CI: 94.8%-97.7%). Lastly, 6.2% (95% CI: 4.3-8.2%) of patients did not present to the ED on the same day that the injury was sustained. CONCLUSIONS Due to the unique nature and culture of the sport, wrestlers may be more likely to attribute SRC or CHI symptoms to normal training-related fatigue, which can lead to underreporting or delayed diagnosis. It is therefore imperative that appropriate safety initiatives and concussion awareness campaigns be implemented in youth wrestling to decrease the incidence of SRCs at local and national levels.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA -
| | - Robert L Parisien
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Corey Olsen
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - John D Kelly
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Tiernan S, Meagher A, O'Sullivan D, O'Keeffe E, Kelly E, Wallace E, Doherty CP, Campbell M, Liu Y, Domel AG. Concussion and the severity of head impacts in mixed martial arts. Proc Inst Mech Eng H 2020; 234:1472-1483. [PMID: 32799750 DOI: 10.1177/0954411920947850] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Concern about the consequences of head impacts in US football has motivated researchers to investigate and develop instrumentation to measure the severity of these impacts. However, the severity of head impacts in unhelmeted sports is largely unknown as miniaturised sensor technology has only recently made it possible to measure these impacts in vivo. The objective of this study was to measure the linear and angular head accelerations in impacts in mixed martial arts, and correlate these with concussive injuries. Thirteen mixed martial arts fighters were fitted with the Stanford instrumented mouthguard (MiG2.0) participated in this study. The mouthguard recorded linear acceleration and angular velocity in 6 degrees of freedom. Angular acceleration was calculated by differentiation. All events were video recorded, time stamped and reported impacts confirmed. A total of 451 verified head impacts above 10g were recorded during 19 sparring events (n = 298) and 11 competitive events (n = 153). The average resultant linear acceleration was 38.0624.3g while the average resultant angular acceleration was 256761739 rad/s2. The competitive bouts resulted in five concussions being diagnosed by a medical doctor. The average resultant acceleration (of the impact with the highest angular acceleration) in these bouts was 86.7618.7g and 756163438 rad/s2. The average maximum Head Impact Power was 20.6kW in the case of concussion and 7.15kW for the uninjured athletes. In conclusion, the study recorded novel data for sub-concussive and concussive impacts. Events that resulted in a concussion had an average maximum angular acceleration that was 24.7% higher and an average maximum Head Impact Power that was 189% higher than events where there was no injury. The findings are significant in understanding the human tolerance to short-duration, high linear and angular accelerations.
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Affiliation(s)
| | | | - David O'Sullivan
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Eoin O'Keeffe
- Division of Sports Science, Pusan National University, Busan, Republic of Korea
| | - Eoin Kelly
- Department of Neurology, Health Care Centre, Hospital 5, St James's Hospital, Dublin, Ireland
| | - Eugene Wallace
- Department of Neurology, Health Care Centre, Hospital 5, St James's Hospital, Dublin, Ireland
| | - Colin P Doherty
- Department of Neurology, Health Care Centre, Hospital 5, St James's Hospital, Dublin, Ireland.,Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Matthew Campbell
- Division of Sports Science, Pusan National University, Busan, Republic of Korea
| | - Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - August G Domel
- Department of Bioengineering, Stanford University, Stanford, CA, USA
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Abstract
Repeated purposeful heading in soccer has come under increased scrutiny as concerns surrounding the association with long-term neurodegenerative disorders in retired players continue to grow. Although a causal link between heading and brain health has not been established, the "precautionary principle" supports the notion that soccer governing bodies and associations should consider implementing pragmatic strategies that can reduce head impact during purposeful heading in youth soccer while this relationship is being investigated. This Viewpoint discusses the current evidence to support low-risk head impact reduction strategies during purposeful heading to protect young, developing players, and how such strategies could be implemented now while research and debate continue on this topic. J Orthop Sports Phys Ther 2020;50(8):415-417. doi:10.2519/jospt.2020.0608.
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Koebli JR, Balasubramanian V, Zipp GP. An exploration of higher-level language comprehension deficits and factors influencing them following blast TBI in US veterans. Brain Inj 2020; 34:630-641. [PMID: 32126837 DOI: 10.1080/02699052.2020.1725845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to investigate the factors that might have a negative influence on auditory processing and higher-level language processing in the US veterans of the recent foreign wars (Iraq and Afghanistan). RESEARCH DESIGN Exploratory, cross-sectional, correlational, prospective, cohort-design. METHODS AND PROCEDURES The experimental group consisted of 12 US veterans of war (10 males and 2 females) with blast exposure. The control group consisted of six US veterans (5 males and 1 female) without the history of blast exposure. Both groups were matched in mean age. Both groups were tested on Boston Assessment of Traumatic Brain Injury, Consonant Trigrams Test, Symbol Digit Modality Test, Trail Making Test, SCAN-3, CELF-5-Metalinguistics, CASL, and an unpublished test on the processing of sentence prosody. MAIN OUTCOMES AND RESULTS Significant group differences in attention, and time-compressed sentence processing were found. For those veterans (in the experimental group) who were not wearing their helmets at the time of blast, additional significant differences were noted with inferencing and auditory figure-ground tasks. CONCLUSIONS Findings support the importance of including speech/language pathologists in all stages of recovery for veterans post-blast exposure.
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Affiliation(s)
- Judith R Koebli
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA
| | - Venugopal Balasubramanian
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA
| | - Genevieve Pinto Zipp
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA
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Tuchtan L, Godio-Raboutet Y, Delteil C, Léonetti G, Piercecchi Marti MD, Thollon L. Study of cerebrospinal injuries by force transmission secondary to mandibular impacts using a finite element model. Forensic Sci Int 2019; 307:110118. [PMID: 31869653 DOI: 10.1016/j.forsciint.2019.110118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.
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Affiliation(s)
- Lucile Tuchtan
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Yves Godio-Raboutet
- Aix Marseille Univ, IFSTTAR, LBA, Marseille, France; iLab-Spine (International Laboratory - Spine Imaging and Biomechanics), France
| | - Clémence Delteil
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Georges Léonetti
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marie-Dominique Piercecchi Marti
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix Marseille Univ, IFSTTAR, LBA, Marseille, France; iLab-Spine (International Laboratory - Spine Imaging and Biomechanics), France
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Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review. J Sci Med Sport 2019; 23:453-462. [PMID: 31780360 DOI: 10.1016/j.jsams.2019.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/27/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically review the literature to investigate the potential relationship between neck strength and head acceleration during purposeful heading in soccer. DESIGN Systematic review. METHODS Comprehensive search of five electronic databases: EMBASE, MEDLINE, CINAHL, SportsDiscus and Web of Science. Studies were included if they reported data on the relationship between neck strength and head impact and/or acceleration during purposeful soccer heading, published in English (or translation available). RESULTS From an initial search of 1174 potentially eligible papers, five cross-sectional studies met the eligibility criteria for inclusion in this review. Data from cross-sectional studies indicate that higher neck strength is associated with lower head acceleration during purposeful heading in soccer (p=<0.05; r<-0.5). CONCLUSION This review provides evidence that higher neck strength may lower head acceleration during purposeful heading in soccer. Further research is required to determine the most effective method to strengthen the neck musculature in soccer players.
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Taylor K, Hoshizaki TB, Gilchrist M. The influence of impact force redistribution and redirection on maximum principal strain for helmeted head impacts. Comput Methods Biomech Biomed Engin 2019; 22:1047-1060. [DOI: 10.1080/10255842.2019.1626840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Karen Taylor
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, Canada
| | | | - Michael Gilchrist
- School of Mechanical and Materials Engineering, University College of Dublin, Room 226, UCD Engineering and Materials Science Centre, University College Dublin, Belfield, Ireland
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Hirad AA, Bazarian JJ, Merchant-Borna K, Garcea FE, Heilbronner S, Paul D, Hintz EB, van Wijngaarden E, Schifitto G, Wright DW, Espinoza TR, Mahon BZ. A common neural signature of brain injury in concussion and subconcussion. SCIENCE ADVANCES 2019; 5:eaau3460. [PMID: 31457074 PMCID: PMC6685720 DOI: 10.1126/sciadv.aau3460] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
The midbrain is biomechanically susceptible to force loading from repetitive subconcussive head impacts (RSHI), is a site of tauopathy in chronic traumatic encephalopathy (CTE), and regulates functions (e.g., eye movements) often disrupted in concussion. In a prospective longitudinal design, we demonstrate there are reductions in midbrain white matter integrity due to a single season of collegiate football, and that the amount of reduction in midbrain white matter integrity is related to the amount of rotational acceleration to which players' brains are exposed. We then replicate the observation of reduced midbrain white matter integrity in a retrospective cohort of individuals with frank concussion, and further show that variance in white matter integrity is correlated with levels of serum-based tau, a marker of blood-brain barrier disruption. These findings mean that noninvasive structural MRI of the midbrain is a succinct index of both clinically silent white matter injury as well as frank concussion.
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Affiliation(s)
- Adnan A. Hirad
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Clinical and Translational Science, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Kian Merchant-Borna
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Frank E. Garcea
- Center for Visual Sciences, University of Rochester, Rochester, NY 14642, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
| | - Sarah Heilbronner
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - David Paul
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Eric B. Hintz
- Division of Neurosurgery, San Antonio Military Medical Center, San Antonio, TX 78234, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Tamara R. Espinoza
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bradford Z. Mahon
- Center for Visual Sciences, University of Rochester, Rochester, NY 14642, USA
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Dallmeier JD, Meysami S, Merrill DA, Raji CA. Emerging advances of in vivo detection of chronic traumatic encephalopathy and traumatic brain injury. Br J Radiol 2019; 92:20180925. [PMID: 31287716 DOI: 10.1259/bjr.20180925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that is of epidemic proportions in contact sports athletes and is linked to subconcussive and concussive repetitive head impacts (RHI). Although postmortem analysis is currently the only confirmatory method to diagnose CTE, there has been progress in early detection techniques of fluid biomarkers as well as in advanced neuroimaging techniques. Specifically, promising new methods of diffusion MRI and radionucleotide PET scans could aid in the early detection of CTE.The authors examine early detection methods focusing on various neuroimaging techniques. Advances in structural and diffusion MRI have demonstrated the ability to measure volumetric and white matter abnormalities associated with CTE. Recent studies using radionucleotides such as flortaucipir and 18F-FDDNP have shown binding patterns that are consistent with the four stages of neurofibrillary tangle (NFT) distribution postmortem. Additional research undertakings focusing on fMRI, MR spectroscopy, susceptibility-weighted imaging, and singlephoton emission CT are also discussed as are advanced MRI methods such as diffusiontensor imaging and arterial spin labeled. Neuroimaging is fast becoming a key instrument in early detection and could prove essential for CTE quantification. This review explores a global approach to in vivo early detection.Limited data of in vivo CTE biomarkers with postmortem confirmation are available. While some data exist, they are limited by selection bias. It is unlikely that a single test will be sufficient to properly diagnosis and distinguish CTE from other neurodegenerative diseases such as Alzheimer disease or Frontotemporal Dementia. However, with a combination of fluid biomarkers, neuroimaging, and genetic testing, early detection may become possible.
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Affiliation(s)
- Julian D Dallmeier
- 1Department of Neuroscience, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Somayeh Meysami
- 2Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David A Merrill
- 3Psychiatry and Biobehavioral Sciences and Pacific Brain Health Center, UCLA and Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Cyrus A Raji
- 4Radiology, Washington University Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
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Cournoyer J, Hoshizaki TB. Head dynamic response and brain tissue deformation for boxing punches with and without loss of consciousness. Clin Biomech (Bristol, Avon) 2019; 67:96-101. [PMID: 31082637 DOI: 10.1016/j.clinbiomech.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Loss of consciousness is a poorly understood indicator of concussion severity. Conflicting results have been published supporting loss of consciousness as a severe concussion as well as having no relationship with severity. Understanding how loss of consciousness relates to brain trauma severity will provide useful insights to guide rule changes and return to sport protocols. The purpose of this study was to compare magnitudes of head acceleration and brain tissue deformation for punches resulting in a loss of consciousness and punches that do not. METHODS Physical representations of boxing punches presenting with and without loss of consciousness were performed using an anthropometric headform and finite element model. The variables measured were peak linear and rotational acceleration, maximum principal strain, cumulative strain damage 10%, and strain rate in five regions of the brain. FINDINGS Loss of consciousness in boxing resulted from hooks to the side of the mandible creating high levels of rotational acceleration and increased magnitudes of brain trauma in all regions of the brain. Differences between punches resulting in loss of consciousness and no loss of consciousness were distinguished by maximum principal strain for each of the brain region analyzed. INTERPRETATION This research supports the notion that loss of consciousness in boxing is caused by higher levels of brain trauma and may require a longer recovery time.
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Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020254. [PMID: 30658408 PMCID: PMC6352039 DOI: 10.3390/ijerph16020254] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 01/22/2023]
Abstract
Chronic traumatic encephalopathy (CTE) was first discovered in professional boxers after they exhibited memory impairments, mood and behavioral changes after years of boxing. However, there is now a growing acceptance that CTE can develop in athletes of other sports due to the repetitive head trauma they receive. We present a case of a middle-aged male who presented with worsening memory, poor concentration, and behavioral changes for a year. On further cognitive testing, it was revealed that he had difficulties with short-term memory and processing speed as well as difficulties in organizing and multitasking. He had been practicing mixed martial arts (MMA) for 10 years, and later was an instructor of the sport. Through a detailed examination of his history, it was discovered that he sustained recurrent minor head concussions due to his line of work. To date, there has been limited large-scale research on head trauma in MMA. There is thus an urgent need for more studies in this area as CTE can be a chronic and debilitating illness with incapacitating neuropsychiatric sequelae. This case highlights the importance of public awareness of the risks of MMA and the dangers it poses to the brain, especially with more young people being attracted to this sport.
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41
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Alosco ML, Stern RA. The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:337-355. [PMID: 31753141 DOI: 10.1016/b978-0-12-804766-8.00018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). Although described in boxers for almost a century, scientific and public interest in CTE grew tremendously following a report of postmortem evidence of CTE in the first former professional American football player in 2005. Neuropathologic diagnostic criteria for CTE have been defined, with abnormal perivascular deposition of hyperphosphorylated tau at the sulcal depths as the pathognomonic feature. CTE can currently only be diagnosed postmortem, but clinical research criteria for the in vivo diagnosis of CTE have been proposed. The clinical phenotype of CTE is still ill-defined and there are currently no validated biomarkers to support an in-life diagnosis of "Probable CTE." Many knowledge gaps remain regarding the neuropathologic and clinical make-up of CTE. An increased understanding of CTE is critical given the millions that could potentially be impacted by this disease. This chapter describes the state of the literature on CTE. The historical origins of CTE are first presented, followed by a comprehensive description of the neuropathologic and clinical features. The chapter concludes with discussion on future research directions, emphasizing the importance of diagnosing CTE during life to facilitate development of preventative and intervention strategies.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States; Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States.
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Stanley E, Thomson E, Smith G, Lamb KL. An analysis of the three-dimensional kinetics and kinematics of maximal effort punches among amateur boxers. INT J PERF ANAL SPOR 2018. [DOI: 10.1080/24748668.2018.1525651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Edward Stanley
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Edward Thomson
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Grace Smith
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Kevin L. Lamb
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
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Oliver JM, Anzalone AJ, Stone JD, Turner SM, Blueitt D, Garrison JC, Askow AT, Luedke JA, Jagim AR. Fluctuations in blood biomarkers of head trauma in NCAA football athletes over the course of a season. J Neurosurg 2018; 130:1655-1662. [PMID: 29807487 DOI: 10.3171/2017.12.jns172035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Repetitive subconcussive head trauma is a consequence of participation in contact sports and may be linked to neurodegenerative diseases. The degree of neurological injury caused by subconcussive head trauma is not easily detectible, and this injury does not induce readily identifiable clinical signs or symptoms. Recent advancements in immunoassays make possible the detection and quantification of blood biomarkers linked to head trauma. Identification of a blood biomarker that can identify the extent of neurological injury associated with subconcussive head trauma may provide an objective measure for informed decisions concerning cumulative exposure to subconcussive head trauma. The purpose of the current study was to examine changes in the blood biomarkers of subconcussive head trauma over the course of an American football season. METHODS Thirty-five National Collegiate Athletic Association (NCAA) American football athletes underwent blood sampling throughout the course of a football season. Serial samples were obtained throughout the 2016 season, during which the number and magnitude of head impacts changed. Blood samples were analyzed for plasma concentrations of tau and serum concentrations of neurofilament light polypeptide (NF-L). Athletes were grouped based on their starter status, because athletes identified as starters are known to sustain a greater number of impacts. Between-group differences and time-course differences were assessed. RESULTS In nonstarters, plasma concentrations of tau decreased over the course of the season, with lower values observed in starters; this resulted in a lower area under the curve (AUC) (starters: 416.78 ± 129.17 pg/ml/day; nonstarters: 520.84 ± 163.19 pg/ml/day; p = 0.050). Plasma concentrations of tau could not be used to discern between starters and nonstarters. In contrast, serum concentrations of NF-L increased throughout the season as head impacts accumulated, specifically in those athletes categorized as starters. The higher serum concentrations of NF-L observed in starters resulted in a larger AUC (starters: 1605.03 ± 655.09 pg/ml/day; nonstarters: 1067.29 ± 272.33 pg/ml/day; p = 0.007). The AUC of the receiver operating characteristic curve analyses displayed fair to modest accuracy to identify athletes who were starters with the use of serum NF-L following periods of repetitive impacts. CONCLUSIONS The different patterns observed in serum NF-L and plasma tau concentrations provide preliminary evidence for the use of blood biomarkers to detect the neurological injury associated with repetitive subconcussive head trauma. Although further investigation is necessary, such findings might lay the foundation for the further development of an objective measure for the detection of neurological injury caused by subconcussive head trauma.
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Affiliation(s)
- Jonathan M Oliver
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - Anthony J Anzalone
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - Jason D Stone
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - Stephanie M Turner
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - Damond Blueitt
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - J Craig Garrison
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 2Texas Health Sports Medicine Concussion Center; and
- 3Texas Health Sports Medicine, Fort Worth, Texas; and
| | - Andrew T Askow
- 1Sports Concussion Research Group, Department of Kinesiology, Texas Christian University
- 4Exercise & Sport Science Department and
| | - Joel A Luedke
- 5Athletics Department, University of Wisconsin-La Crosse, Wisconsin
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Tarazi A, Tator CH, Wennberg R, Ebraheem A, Green REA, Collela B, Saverino C, Khodadadi M, Misquitta K, Tartaglia MC. Motor Function in Former Professional Football Players with History of Multiple Concussions. J Neurotrauma 2018; 35:1003-1007. [DOI: 10.1089/neu.2017.5290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Apameh Tarazi
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Concussion Research Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Charles H. Tator
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Concussion Research Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Concussion Research Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ahmed Ebraheem
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robin E. A. Green
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Brenda Collela
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Mozghan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Concussion Research Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Karen Misquitta
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Concussion Research Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
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D'Ascanio S, Alosco ML, Stern RA. Chronic traumatic encephalopathy: clinical presentation and in vivo diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:281-296. [PMID: 30482356 DOI: 10.1016/b978-0-444-63954-7.00027-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exposure to repetitive head impacts from contact sport participation (e.g., American football, boxing, soccer) is associated with the neurodegenerative disorder known as chronic traumatic encephalopathy (CTE). The neuropathology of CTE is becoming well defined, and diagnostic criteria have been developed and are being refined. The critical next step in this emerging field is the diagnosis of CTE during life. The objective of this chapter is to describe what is currently known about the clinical presentation and in vivo diagnosis of CTE. This chapter reviews studies in which clinical manifestation of CTE was examined through retrospective telephone interviews with informants of individuals whose brains were donated and were diagnosed with CTE through neuropathologic examination. In vivo research examining the long-term neurobehavioral consequences of repetitive head impacts is also reviewed, followed by a comparison of the existing provisional clinical diagnostic criteria for CTE, as well as preliminary research on possible fluid and neuroimaging biomarkers. An illustrative case study of CTE is presented, and the chapter concludes with a discussion of gaps in knowledge and future directions.
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Affiliation(s)
- Steven D'Ascanio
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States.
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Schultz V, Stern RA, Tripodis Y, Stamm J, Wrobel P, Lepage C, Weir I, Guenette JP, Chua A, Alosco ML, Baugh CM, Fritts NG, Martin BM, Chaisson CE, Coleman MJ, Lin AP, Pasternak O, Shenton ME, Koerte IK. Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players. J Neurotrauma 2017; 35:278-285. [PMID: 28990457 DOI: 10.1089/neu.2017.5145] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Thalamic atrophy has been associated with exposure to repetitive head impacts (RHI) in professional fighters. The aim of this study is to investigate whether or not age at first exposure (AFE) to RHI is associated with thalamic volume in symptomatic former National Football League (NFL) players at risk for chronic traumatic encephalopathy (CTE). Eighty-six symptomatic former NFL players (mean age = 54.9 ± 7.9 years) were included. T1-weighted data were acquired on a 3T magnetic resonance imager, and thalamic volumes were derived using FreeSurfer. Mood and behavior, psychomotor speed, and visual and verbal memory were assessed. The association between thalamic volume and AFE to playing football and to number of years playing was calculated. Decreased thalamic volume was associated with more years of play (left: p = 0.03; right: p = 0.03). Younger AFE was associated with decreased right thalamic volume (p = 0.014). This association remained significant after adjusting for total years of play. Decreased left thalamic volume was associated with worse visual memory (p = 0.014), whereas increased right thalamic volume was associated with fewer mood and behavior symptoms (p = 0.003). In our sample of symptomatic former NFL players at risk for CTE, total years of play and AFE were associated with decreased thalamic volume. The effect of AFE on right thalamic volume was almost twice as strong as the effect of total years of play. Our findings confirm previous reports of an association between thalamic volume and exposure to RHI. They suggest further that younger AFE may result in smaller thalamic volume later in life.
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Affiliation(s)
- Vivian Schultz
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Robert A Stern
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,4 Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Yorghos Tripodis
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Julie Stamm
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,6 Department of Kinesiology, University of Wisconsin , Madison, Madison, Wisconsin
| | - Pawel Wrobel
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Christian Lepage
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,7 Department of Psychology, University of Ottawa , Ottawa, Ontario, Canada
| | - Isabelle Weir
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Jeffrey P Guenette
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alicia Chua
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael L Alosco
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Christine M Baugh
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,9 Interfaculty Initiative in Health Policy, Harvard University , Boston, Massachusetts
| | - Nathan G Fritts
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Brett M Martin
- 10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine E Chaisson
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Michael J Coleman
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alexander P Lin
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,11 Center for Clinical Spectroscopy , Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ofer Pasternak
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Martha E Shenton
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,12 VA Boston Healthcare System, Brockton Division, Brockton, Massachusetts.,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Inga K Koerte
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany .,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
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Fife GP, O'sullivan DM, Lee SY. Rotational and linear head accelerations from taekwondo kicks and punches. J Sports Sci 2017; 36:1461-1464. [PMID: 29099672 DOI: 10.1080/02640414.2017.1398406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose was to compare rotational and linear head accelerations as a result of taekwondo kicks and punches. Taekwondo athletes executed five repetitions of the turning kick, spinning hook kick, hook punch, straight punch, and jab punch to a Hybrid III Crash Test Dummy head-neck complex. A tri-axial accelerometer and an angular rate sensor were mounted inside the Hybrid III head to measure resultant linear (RLA) and rotational accelerations. The Hybrid III was fixed to a height-adjustable frame and fitted with protective taekwondo headgear. Dummy head height was positioned to each participant's standing height. Acceleration data were processed in accordance with SAE J211-1.There was no significant multivariate difference in RLA but the effect was not clear. Univariate follow-up analysis showed a significant difference in RLA but the effect was also not clear. There was no difference in rotational acceleration. The highest RLA and rotational acceleration were produced, in order, by the turning kick, hook kick, hook punch, straight punch, and jab. These data are clinically important as they provide a better understanding of the biomechanical injury measures and support for improved headgear testing methodology.
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Affiliation(s)
- Gabriel P Fife
- a Department of Health & Human Performance , Texas State University , San Marcos , TX , USA
| | - David M O'sullivan
- b Department of Sports Science , Pusan National University , Busan , Republic of Korea
| | - Sae Yong Lee
- c Department of Physical Education , Yonsei University , Seoul , Republic of Korea.,d Yonsei Institute of Sports Science and Exercise Medicine , Yonsei University , Seoul , Republic of Korea
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48
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Oliver JM, Jones MT, Anzalone AJ, Kirk KM, Gable DA, Repshas JT, Johnson TA, Höglund K, Blennow K, Zetterberg H. A Season of American Football Is Not Associated with Changes in Plasma Tau. J Neurotrauma 2017; 34:3295-3300. [PMID: 28614998 DOI: 10.1089/neu.2017.5064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
American football athletes are routinely exposed to sub-concussive impacts over the course of the season. This study sought to examine the effect of a season of American football on plasma tau, a potential marker of axonal damage. Nineteen National Collegiate Athletic Association (NCAA) football athletes underwent serial blood sampling over the course of the 2014-2015 season at those times in which the number and magnitude of head impacts likely changed. Non-contact sport controls (NCAA men's swim athletes; n = 19) provided a single plasma sample for comparison. No significant differences were observed between control swim athletes and football athletes following a period of non-contact (p = 0.569) or a period of contact (p = 0.076). Football athletes categorized as starters (n = 11) had higher tau concentrations than non-starters (n = 8) following a period of non-contact (p = 0.039) and contact (p = 0.036), but not higher than swimmers (p = 1.000 and p = 1.000, respectively). No difference was noted over the course of the season in football athletes, irrespective of starter status. Despite routine head impacts common to the sport of American football, no changes were observed over the course of the season in football athletes, irrespective of starter status. Further, no difference was observed between football athletes and non-contact control swim athletes following a period of non-contact or contact. These data suggest that plasma tau is not sensitive enough to detect damage associated with repetitive sub-concussive impacts sustained by collegiate-level football athletes.
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Affiliation(s)
- Jonathan M Oliver
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Margaret T Jones
- 2 Division of Health and Human Performance, George Mason University , Manassas, Virginia
| | - Anthony J Anzalone
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - K Michele Kirk
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas.,3 Department of Sport Medicine, Texas Christian University , Fort Worth, Texas.,4 Department of Sport Medicine, John Peter Smith Hospital , Fort Worth, Texas
| | - David A Gable
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas.,3 Department of Sport Medicine, Texas Christian University , Fort Worth, Texas
| | - Justin T Repshas
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Torie A Johnson
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Kina Höglund
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden
| | - Kaj Blennow
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden
| | - Henrik Zetterberg
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden .,6 Department of Molecular Neuroscience, UCL Institute of Neurology , Queen Square, London, United Kingdom
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49
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Perrine K, Helcer J, Tsiouris AJ, Pisapia DJ, Stieg P. The Current Status of Research on Chronic Traumatic Encephalopathy. World Neurosurg 2017; 102:533-544. [PMID: 28254594 DOI: 10.1016/j.wneu.2017.02.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) evolved from the term dementia pugilistica describing the dementia found in many boxers to its current use in describing the dementia and depression sometimes found in athletes subjected to multiple concussions or subconcussive blows to the head. Concurrently, the neuropathology evolved to specify a unique type of tauopathy found in perivascular spaces at the depth of sulci and other features not typically seen in neurodegenerative tauopathies. Four stages of CTE have been proposed, with 4 corresponding clinical syndromes of traumatic encephalopathy syndrome. However, it remains unclear whether this is a syndrome unique to repetitive head trauma, especially in contact sports, because the epidemiology has been difficult to establish. In particular, research to date has had a denominator problem in not establishing the total number of potential cases at risk for developing CTE. The current review examines the evidence to date for these syndromes and contributing or complicating factors affecting the neuropathology, neuroimaging, and clinical presentations associated with them.
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Affiliation(s)
- Kenneth Perrine
- Department of Neurological Surgery, Weill Cornell Medical College, New York, USA.
| | - Jacqueline Helcer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - David J Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Philip Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, New York, USA
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50
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Cheever K, Kawata K, Tierney R, Galgon A. Cervical Injury Assessments for Concussion Evaluation: A Review. J Athl Train 2016; 51:1037-1044. [PMID: 27835042 PMCID: PMC5264559 DOI: 10.4085/1062-6050-51.12.15] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A concussion is a complex pathophysiologic process that is induced by biomechanical forces and affects the brain. Cervical injuries and concussion can share similar mechanisms and nearly identical symptoms or causes. Therefore, symptoms or causes alone may be insufficient to differentiate between patients with a concussion and patients with cervical injuries. OBJECTIVE To demonstrate the homogeneous causes and symptoms observed in patients with a concussion and patients with cervical injury and to provide information on clinical tests that can differentiate cervical injury from pathologic conditions of vestibular or central origin. SUMMARY Given that concussion and cervical injury share similar causes and symptoms, this information alone may be insufficient to diagnose a concussion. Clinical assessments, such as the cervical joint-reposition error test, smooth-pursuit neck-torsion test, head-neck differentiation test, cervical flexion-rotation test, and physical examination of the cervical spine, can be performed after a head and neck pathomechanical event to identify the presence of cervical injury. Differentiating between a concussion and cervical injury is clinically vital for timely and appropriate evidence-based treatment. CONCLUSIONS Specific clinical tests should be used after a head and neck pathomechanical event to differentiate between symptoms due to a concussion and cervical injury. Continued research on the clinical utility of the 5 identified cervicogenic tests is also recommended.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington
| | - Ryan Tierney
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
| | - Anne Galgon
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
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