Head Blows Research Articles

Brain Punch: K-1 Fights Affect Brain Wave Activity in Professional Kickboxers

BackgroundKickboxing is a popular striking combat sport, and K-1 is a type of kickboxing. Direct head blows can cause significant long-term injury and affect brain wave activity.ObjectivesWe aim to compare the changes in brain wave activities of fighters during a K-1 kickboxing contest to those in a control group, who were striking a punching bag and were not hit by another K-1 athlete.MethodsA total of 100 professional Polish K-1 kickboxers were split evenly into experimental (n = 50, age 25.5 ± 4.63 years) and control (n = 50, age 26.6 ± 5.22 years) groups. We used quantitative electroencephalography (QEEG) to assess the spectrum of brain wave activity (delta, theta, alpha, sensorimotor rhythm (SMR), beta-1 and beta-2) before and after an intervention (experimental: K-1 contest, control: simulated contest), with eyes open and then closed. The number of direct blows to the head was also recorded for all bouts. Comparative and statistical analyses between selected variables were performed.ResultsK-1 fighters showed elevated baseline brain activity for the entire delta band (p < 0.001). There was significant variation in brain activity among the experimental group following the intervention and compared with the control group for all wave types (p < 0.001). No significant variation in activity was found in the control group. The number of direct head blows was positively correlated with brain activity, at delta and beta-2 wave frequencies.ConclusionsK-1 kickboxing is associated with detectable changes in brain wave activity. It is presently unclear what the long-term effects of these changes in brain wave activities are, and longitudinal studies are necessary to study the brain health of kickboxers.

Neurotrauma and Cerebrospinal Fluid in Homer's Poems

AbstractHomer's Iliad, from the 8th century BC, remains the oldest record of Greek medicine and a unique source of surgical history. The Odyssey, also authored by Homer, narrates several medically significant events. Among the 148 war traumas described in the Iliad, over a quarter occurred in the craniocervical region. Studies on the Odyssey report at least 11 craniocervical traumas, 9 of which prove fatal. Is there any indication of the presence of cerebrospinal fluid (CSF) in the cases described by Homer, considering its last mention was 800 years prior in the Egyptian surgical papyrus of Edwin Smith? A passage in the Iliad suggests that the “tears” Homer mentions in the eyes of Eumelos, resulting from trauma, might be due to CSF oculorrhea secondary to a skull base fracture. In Odyssey Book IX, when the Cyclops strikes the heads of two sailors, and fluid and cranial contents emerge, it can be inferred that the poet was aware of fluid in the head (CSF), as there is no mention of blood. It is proposed that 800 years after the writing of the Edwin Smith papyrus, Homer probably provides the second human observation of CSF associated with traumatic situations involving direct head blows.

Effectiveness of Protective Measures and Rules in Reducing the Incidence of Injuries in Combat Sports: A Scoping Review.

In recent years, much effort has been made to reduce the injury rate in combat sports. However, the question remains to what extent these measures are effective. Analysis of studies could provide evidence of the effectiveness of measures aimed at reducing the incidence of injuries. This scoping review aims (1) to map research articles dealing with the effectiveness of proper use of protective measures in reducing the incidence of injuries in combat sports; (2) to investigate to what extent the proper use of protective measures and compliance with sports rules help to reduce the incidence of injuries in combat sports; and (3) to identify gaps in the existing literature and suggest future research on this topic. The literature search was conducted on articles published between 2010 and 2023. The main inclusion criteria were studies investigating the effect of sports rules and protective equipment used during training or competition in combat sports on reducing the incidence of injuries. After meeting the criteria, only seven articles from boxing, karate, and taekwondo were included in this study. Results showed that mandatory head guards, along with modern thicker gloves, significantly reduced the rate of knockouts (KOs) and head injuries in boxing despite an increase in the number of head blows. However, the number of facial cuts increased significantly due to the removal of head guards as a piece of mandatory equipment. The use of mouth guards has significantly reduced the number of oral injuries. Changes in rules, such as shortening the duration of bouts, along with the introduction of greater competencies of referees in the supervision of bouts (the standing count, outclassed rule, and medical stops) have helped to reduce the rate of injuries in boxing. The application of a computerised scoring system also contributed to the rate of injuries reduction. The increase in the number of weight divisions had the same effect on U21 karate athletes. However, a higher incentive to attack the head area in taekwondo did not increase the incidence of injuries in youth athletes. It can be concluded that the proper use of protective measures (head and mouth guards) in combination with the rules established for health protection (higher competencies of referees and more weight divisions in competitions) effectively reduces the occurrence of injuries in combat sports. In all Olympic combat sports, the injury incidence should be regularly assessed using the Injury Incidence Rate (IIR) per 1000 min exposures (MEs). Nonetheless, further studies are needed to monitor how established rules (e.g., prohibited behaviour) affect the IIRs.

A brief descriptive outline of the rules of mixed martial arts and concussion in mixed martial arts.

Mixed martial arts (MMA), a combat sport consisting of wrestling, boxing, and martial arts, is a popular activity associated with danger and violence. Of concern are the repetitive head impacts, both subconcussive and concussive, sustained by MMA athletes. The rules of MMA encourage head strikes, but there was no formal concussion protocol in the Ultimate Fighting Championship (UFC) until 2021. Because the UFC was established less than 30 years, the long-term consequences of these repetitive concussive head blows are lacking. In this review, we focus on current literature sought to summarize the current knowledge of repetitive head impacts and concussions in MMA. The objectives were to outline (a) the rules of MMA; (b) the postconcussion protocol for UFC athletes; (c) current behavioral and biochemical diagnostic measures; (d) epidemiology and prevalence of concussion in MMA; (e) long-term effects of subconcussive repetitive head impacts; (f) biomechanics of head impacts; and (g) considerations and research topics that warrant future research.

Chronic traumatic encephalopathy: an update review

Chronic traumatic encephalopathy is a progressive neurodegenerative disease occurring in retired sportspersons who have received several head blows with concussions during their games. The clinical symptoms start with mood disorders and with a progressive evolution into dementia and Parkinsonism. The disease is due to a progressive accumulation of hyperphosphorilated tau in neurons as neurofibrillary tangles, abnormal neurites and inclusions in astrocytes around small vessels. There is a tendency of the lesions to occur in clusters at the sulcal depths of the cerebral cortex. Chronic traumatic encephalopathy has to be differentiated from Alzheimer’s disease, in which head trauma can also increase the illness symptoms. Recently, new tracers in positron emission topography of the brain have been used for a better evaluation of chronic traumatic encephalopathy. There is actually no treatment that allows to cure or to slowdown the evolution of chronic traumatic encephalopathy. However, new treatment studies are recently conducted and in progress.

A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol.

The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.

Preventive potential of low intensity pulsed ultrasound for chronic traumatic encephalopathy after repetitive head collisions in contact sports

Chronic traumatic encephalopathy (CTE), a disease process well-recognized in boxers, American football players and military personnel, is a progressive neurodegenerative disease caused by repetitive blows to the head. Subjects with CTE can have a wide range of emotional, cognitive and physical symptoms. The cognitive group patients had a significantly higher probability of developing dementia in later years. Currently, there are no disease modifying regimen for CTE. Timely intervention of head blow could diminish the development of CTE. Low-intensity pulsed ultrasound (LIPUS) is a common adjunct used to promote bone healing for fresh fracture. Recent reports suggest that LIPUS can noninvasively modulate the cortical function and have neuroprotective effect in various animal models of traumatic brain injury, stroke, Alzheimer’s disease and major depressive disorder. The multifunctional mechanisms of LIPUS neuroprotective effect include several trophic factor stimulations, anti-inflammatory properties and reduction of brain edema. From the above evidence, LIPUS intervention could be a strategy for the prevention of the clinical CTE sequelae of repetitive head blows. We hypothesized that due to its neuroprotective effects, the non-invasive and easy-to-use method of LIPUS brain stimulation could have a preventive effect on players who have head blows during the match. The development of a time sensitive protocol, resembling the therapeutic algorithm for traumatic brain injury, would potentially prevent the development of subsequent CTE adverse outcome. Further long-term longitudinal studies of LIPUS stimulation are warranted to verify the prevention efficacy of this intervention for CTE.

Understanding white matter structural connectivity differences between cognitively impaired and nonimpaired active professional fighters.

Long-term traumatic brain injury due to repeated head impacts (RHI) has been shown to be a risk factor for neurodegenerative disorders, characterized by a loss in cognitive performance. Establishing the correlation between changes in the white matter (WM) structural connectivity measures and neuropsychological test scores might help to identify the neural correlates of the scores that are used in daily clinical setting to investigate deficits due to repeated head blows. Hence, in this study, we utilized high angular diffusion MRI (dMRI) of 69 cognitively impaired and 70 nonimpaired active professional fighters from the Professional Fighters Brain Health Study, and constructed structural connectomes to understand: (a) whether there is a difference in the topological WM organization between cognitively impaired and nonimpaired active professional fighters, and (b) whether graph-theoretical measures exhibit correlations with neuropsychological scores in these groups. A dMRI derived structural connectome was constructed for every participant using brain regions defined in AAL atlas as nodes, and the product of fiber number and average fractional anisotropy of the tracts connecting the nodes as edges. Our study identified a topological WM reorganization due to RHI in fighters prone to cognitive decline that was correlated with neuropsychological scores. Furthermore, graph-theoretical measures were correlated differentially with neuropsychological scores between groups. We also found differentiated WM connectivity involving regions of hippocampus, precuneus, and insula within our cohort of cognitively impaired fighters suggesting that there is a discernible WM topological reorganization in fighters prone to cognitive decline.

Chronic traumatic encephalopathy - confusion and controversies.

The term chronic traumatic encephalopathy (CTE) has recently entered public consciousness via media reports and even a Hollywood movie. However, in contrast to general impressions, the incidence of CTE is unknown, the clinical diagnostic criteria have not been agreed upon and the current neuropathological characterization of CTE is acknowledged as preliminary. Additionally, few studies have compared the pathologies of CTE with those of other neurodegenerative disorders or of age-matched controls. Consequently, disagreement continues about the neuropathological aspects that make CTE unique. Furthermore, CTE is widely considered to be a consequence of exposure to repeated head blows, but evidence suggests that a single moderate or severe traumatic brain injury can also induce progressive neuropathological changes. These unresolved aspects of CTE underlie disparate claims about its clinical and pathological features, leading to confusion among the public and health-care professionals alike.

Investigating possible retinal biomarkers of head trauma in Olympic boxers using optical coherence tomography

PurposeChanges to retina have been reported after a number of neurodegenerative conditions. The purpose of this study was to investigate retinal structures in Olympic boxers exposed to frequent head blows.MethodsRetinal imaging offers potential as a non-invasive biomarker of neuropathology. Macula and retinal nerve fiber layer (RNFL) thickness was measured using optical coherence tomography (OCT) in UK Olympic boxers attending two mandatory eye screening programs, 18 months apart. Data from the two eye screenings provide longitudinal data of retinal change over time. Sedentary healthy subjects (controls) without past or present history of concussion were also screened at the time of the second boxer screening to provide comparison of cross-sectional data.ResultsSixteen Olympic boxers aged 20–33 years and 20 sedentary healthy controls, aged 24–45 years, were recruited. Significant macula thickening was observed over time (18 months) in 75% of right and 50% of left eye sectors. For RNFL, left eye quadrants thickened. For right eye RNFL quadrants, thickening and thinning of this layer were observed. Cross-sectional results showed thinner macula sectors and RNFL quadrants in Olympic boxers compared to controls.ConclusionSignificant change to macula and RNFL densities, occurring over an 18 month interval is an unexpected finding in otherwise heathy elite sportsmen. In addition, macula and RNFL were thinner than healthy sedentary controls. OCT may prove clinically useful as a candidate retinal biomarker of neuropathological change after mild traumatic brain injury and/or repeat head blows.

Novel Method of Weighting Cumulative Helmet Impacts Improves Correlation with Brain White Matter Changes After One Football Season of Sub-Concussive Head Blows (P6.147)

Novel Method of Weighting Cumulative Helmet Impacts Improves Correlation with Brain White Matter Changes After One Football Season of Sub-Concussive Head Blows (P6.147)

Use of Head Guards in AIBA Boxing Tournaments-A Cross-Sectional Observational Study.

This study looks at the changes in injuries after the implementation of a new rule by the International Boxing Association (AIBA) to remove head guards from its competitions. A cross-sectional observational study performed prospectively. This brief report examines the removal of head guards in 2 different ways. The first was to examine the stoppages due to blows to the head by comparing World Series Boxing (WSB), without head guards, to other AIBA competitions with head guards. Secondly, we examined the last 3 world championships: 2009 and 2011 (with head guards) and 2013 (without head guards). World Series Boxing and AIBA world championship boxing. Boxers from WSB and AIBA world championships. The information was recorded by ringside medical physicians. Stoppages per 10 000 rounds; stoppages per 1000 hours. Both studies show that the number of stoppages due to head blows was significantly decreased without head guards. The studies also showed that there was a notable increase in cuts. Removing head guards may reduce the already small risk of acute brain injury in amateur boxing.

Different proactive and reactive action control in fencers’ and boxers’ brain

Practicing sport at top level requires excellent physical and cognitive skills. The goal of the present study was to investigate whether specific sport practice may affect the preparation–perception–action stages of processing during a visuo-motor task requiring perceptual discrimination and fast response. We recruited 39 participants (two groups of professional fencers and boxers, and a control group; N=13 for each group) and measured behavioral performance and event-related potentials (ERPs) while performing a go/no-go task. Results revealed that athletes were faster than controls, while fencers were more accurate than boxers. ERP analysis revealed that motor preparation, indexed by the Bereitschaftspotential (BP), was increased in athletes than controls, whereas the top-down attentional control, reflected by the prefrontal negativity (pN) component, was enhanced only in fencers when compared to controls. Most of the post-stimulus ERPs i.e. the N1, the N2, the P3, and the pP2, were enhanced in fencers. Combat sports require fast action execution, but the preparatory brain activity might differ according to the specific practice required by each discipline. Boxers might afford to commit more errors (as reflected by high commission error (CE) rate and by a small pN amplitude), while fencers have to be as much fast and accurate as possible (thanks to an enhanced pN amplitude). Although the possible influence of repetitive head blows on cerebral activity cannot be excluded in boxers, our results suggest that cognitive benefits of high-level sport practice might also be transferred to the daily (i.e., no sport-related) activities.

MRI Evidence of Neuropathic Changes in Former College Football Players.

To examine effects of participating in collegiate football on neural health several years after retirement. We hypothesized that relative cortical thinning and loss of white matter integrity would be observed in former players. Former NCAA Division I football players were compared with demographically similar track-and-field athletes with regard to cortical thickness and white matter integrity. Participants participated in MRI scans at the Center for Imaging Research at the University of Cincinnati. Eleven former football players and 10 demographically similar track-and-field athletes. Normalized cortical thickness was compared between groups using 2-tailed Student t test. As a secondary analysis, Spearman correlation coefficient was calculated between cortical thickness and number of concussions. Fractional anisotropy for regions-of-interest placed in frontal white matter tracts and internal capsule were compared between groups using 2-tailed Student t test. Football players showed significantly lower cortical thickness within portions of both the frontal and temporal cortex. Affected frontal regions included left frontal pole and right superior frontal gyrus. Affected temporal regions included portions of the superior temporal gyrus, left inferior temporal gyrus, and right middle and superior temporal gyri. Cortical thickness inversely correlated with number of reported concussions over most of these regions. In addition, fractional anisotropy was lower in the right internal capsule of former football players, relative to controls. These findings suggest that at least some consequences of high-level collegiate football play persist even after the cessation of regular head blows. Longer-term studies are warranted to examine potential cognitive and functional implications of sustained cortical atrophy.

Are There Subconcussive Neuropsychological Effects in Youth Sports? An Exploratory Study of High- and Low-Contact Sports

This exploratory study was designed to examine the neuropsychological effects of sports-related head trauma—specifically, repetitive subconcussive impacts or head blows that do not result in a diagnosable concussion. The researchers compared the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test scores of 2 groups of nonconcussed youth athletes (n = 282), grouped according to the frequency of concussions in their respective sports, with the assumption that more subconcussive impacts occur in sports in which there are more reported concussions. The results indicated that high-contact-sport (football) athletes had significantly poorer performance in processing speed and reaction time compared with athletes in low-contact sports (wrestling, soccer, baseball, judo, and basketball). This study into the effects of repetitive subconcussive head trauma tentatively raises concern that participation in high-contact sports, even without evidence of a diagnosable concussion, could result in lowered neuropsychological functioning among high school athletes. Limitations of this exploratory research effort are discussed.

Recognizing and managing concussion in school sport.

Every country around the world enjoys some sort of sport. The Olympics sees countries from all over the globe participate in elite sport, in both winter and summer competitions. Australia is widely known for cricket and rugby; America is known for baseball and gridiron football (among others). These sports are played at an elite level as well as beginners from early ages as young as 4 years in the backyard. Yet, it is also these sports that can deliver a ball at the speed of 100 km/h (football), 105 km/h (baseball), 112 km/h (rugby), 150 km/h (cricket), and 211 km/h (soccer). This is the same force that a car collision can produce. That force eventually finds a target, and in some cases, unfortunately, it is a head. Damage to the brain is not only from the impact of the ball hitting its target but rather also the shearing forces of acceleration-deceleration injury that can cause extensive injuries. There has been much discussion of late regarding concussion in sport and the accumulative effects of head blows resulting in varying degrees of memory loss and dementia later in life. The media have been saturated with heightened awareness of chronic traumatic encephalopathy. This, however, is still being researched. It is true that each concussion compounds the one before, but rather than focus on the injury, managers/coaches and sporting codes should be focusing on the identification and proper management of a suspected concussion and the return-to-play protocols. This is especially important in our schools where growing brains need nurturing. Neuroscience nurses are at the forefront of educating school children, teachers, and coaches through partnering with local schools. This article will focus on concussion recognition and management in school sport.

King-devick Test As A Measure Of Brain Dysfunction From Subconcussive Head Blows Among Football Players

King-devick Test As A Measure Of Brain Dysfunction From Subconcussive Head Blows Among Football Players

Sport w szkole i wstrząśnienie mózgu — co należy wiedzieć

Every country around the world enjoys some sort of sport. The Olympics sees countries from all over the globe participate in elite sport, in both winter and summer competitions. Australia is widely known for cricket and rugby, America for baseball and gridiron football (amongst others). These sports are played at an elite level as well as beginners from early ages as young as 4yrs in the backyard. Yet it is also these sports that can deliver a ball at the speed of 112km/h (rugby), 105km/h (baseball), 150km/h (cricket) and 211km/h (soccer). This is the same force that a car collision can produce. That force eventually finds a target and in some cases unfortunately, it is a head. Damage to the brain is not only from the impact of the ball hitting its target, rather, the shearing forces of acceleration-deceleration injury that can cause extensive injuries. There has been much discussion of late regarding concussion in sport and the accumulative effects of head blows resulting in varying degrees of memory loss and dementia later in life. The media has been saturated with heightened awareness of chronic traumatic encephalopathy (CTE). This however, is still being researched. It is true that each concussion compounds the one before, but rather than focus on the injury, managers/coaches and sporting codes should be focusing on the identification and proper management of a suspected concussion and the return-to-play protocols. This is especially important in our schools where growing brains need nurturing. This paper will focus on concussion recognition and management in school sport. (JNNN 2014;3(1):31–38)

Cavum Septi Pellucidi as a Marker of the Neuropsychiatric Diseases: A Pointer or Mislead? A Cadaveric–Clinical Observation

Cavum Septi pellucid (CSP), a cavity between the laminae of the septum pellucidum, for a longer period has been reported as an anomaly of the brain midline, associated with neuropsychiatric diseases, mostly schizophrenia, but also posttraumatic stress disorder, De la Tourette disease, and persons who survived a repeated a serious head trauma, boxers on the first place. Our investigation has been performed on 479 unfixed frozen brains, of the autopsied individuals of both genders, and MRI scans of 250 examinees, out of which 110 had neuropsychiatric illness. In our sample, the prevalence of CSP was 22.96% among the autopsied individuals and 9.2% in examinees who underwent MRI scan. The cause of the death among schizophrenia suffering persons was suicide (18 out of 25 patients). Obviously, CSP is more frequently associated with neuropsychiatric diseases, but a dilemma still exists, did we make a bias in brain suitability for the examination or we did the same mistake in observing clinical cases. A large CSP, though, is an almost certain sign for an underlying neuropsychiatric impairment, especially schizophrenia. The CSP among alcoholics and persons with the priory sustained head blows is probably of the same cause and represents an aftermath of the diffuse axonal injuries, i.e. brain trauma.

New Guidelines for Management of Concussion in Sport: Special Concern for Youth

The incidence of sports related concussion appears to be increasing, raising alarm over long-term consequences of these head injuries on cognitive function in youth. The American Academy of Neurology (AAN) has recently revised its position statement on concussion in sports, reflecting the burgeoning scientific evidence on its epidemiology, neurophysiology and prognosis. The AAN, along with other scientific organizations addressing concussion policy, has abandoned the use of algorithms for assigning a grade to concussions and instead stresses an individualized approach to concussion management. Recent evidence suggests that children and adolescents may be more susceptible to concussions from head blows, and may take longer to recover, than adults. Young women in certain sports also appear to be more susceptible to concussion than young men. The AAN recommends a more conservative approach to management of sports concussion in children and adolescents. Under no circumstances should a young athlete be allowed to participate in sport while still symptomatic. The use of standardized assessment tools is recommended to aid the healthcare provider in assessing the young athlete's recovery.