LibGuides: Concussion: Contact Sports and Brain Injuries: Journal Articles

Spotlight On: Football

Alzheimer's Dementia due to Suspected CTE from Subconcussive Head Impact (PEER REVIEWED ARTICLE) Chronic traumatic encephalopathy (CTE) has been receiving increasing attention due to press coverage of professional football players. The devastating sequelae of CTE compel us to aim for early diagnosis and treatment. However, by current standards, CTE is challenging to diagnose. Clear clinical diagnostic criteria for CTE have not been established. Only recently, pathological diagnostic criteria have been recognized, but postmortem diagnosis is too late. Reliable biomarkers are not available. By imaging criteria, cavum septum pellucidum has been the only consistent identifiable MRI finding. Because of the imprecise nature of diagnosis based on clinical suspicion, physicians must become cognizant of the broad spectrum of presentations of CTE. With this awareness, appropriate workup can be initiated. CTE can present with early symptoms of emotional changes or late symptoms with memory decline and dementia. Here we present an unusual case of a patient with Alzheimer's disease secondary to suspected CTE that stems from subconcussive head impacts presenting with severe memory and MRI changes. Clinicians should be aware of this presentation and consider CTE in their differential diagnoses while undergoing workup of memory disorders.
Believers Versus Deniers: The Radicalization of Sports Concussion and Chronic Traumatic Encephalopathy (CTE) Science (PEER REVIEWED ARTICLE) Unprecedented media coverage of concussion in sport has led to increased fears regarding the potential negative effects of participation in contact sports including North American football and ice hockey. Initial responses of professional sports leagues to implementation of acute concussion management practices and reports of a neurodegenerative condition known as chronic traumatic encephalopathy (CTE) developing in retired players caused an atmosphere of distrust whereby the leagues were accused of maintaining cover-ups analogous to what had been seen in association with studies of tobacco and smoking. This article reviews the important role that psychology has played in the study of sports concussion and in the establishment of methods currently used to diagnose and track concussion symptoms. Results of existing studies have shown that the neurobiological effects of concussion are rather short-lived with development of persisting symptoms in some individuals associated more with psychosocial factors than underlying physiological effects. With regard to CTE, the status of the science remains preliminary with little definitive information known about its epidemiology or cause. In the midst of the ongoing controversy, a polarized climate has developed in association with concussion and CTE, divided by believers in the dangers of long-term consequences and deniers who question the status of the existing science. The conclusion is that it is important for psychology to extend its scope of study to provide increased understanding of the social factors underlying the current polarized climate while continuing to provide the public with an accurate and reliable account of the existing science. Public Significance Statement Continued media reporting of the sports concussion and its potential long-term effects has been accompanied by public concerns about the safety of contact sports and potential development of chronic traumatic encephalopathy (CTE). Controversies have emerged about the status of the science, creating polarization on the topic. Psychology has provided significant contributions to our scientific knowledge on sports concussion and has the potential to provide a key to understanding the factors underlying division on these topics.
Chronic Traumatic Encephalopathy (CTE) and Former National Football League Player Suicides (PEER REVIEWED ARTICLE) Our understanding of Chronic Traumatic Encephalopathy (CTE) has rapidly advanced, since 2002, when Dr. Bennet I. Omalu first discovered CTE in the brain of deceased former National Football League (NFL) player Mike Webster. Although it is clear that there is a link between the neurological diseases and exposure to repeated mild traumatic brain injuries, the explicit link between the long-term consequences that are associated with CTE and the suicide death of several former NFL players is much less clear. The purpose of this paper is to examine if the psychological and cognitive consequences that are associated with CTE are factors in the suicide death of several former NFL players. Method: The literature used in this paper was acquired using the words NFL concussions, NFL player CTE research, CTE symptoms in NFL players, and NFL player suicide death in the EBSCOhost and Internet Explorer search engines.
FOOTBALL FALLOUT: The Legalities of CTE (PEER REVIEWED ARTICLE) The DSM-5 identifies the following criteria for NCD: (A) Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor or social cognition) based on: (1) mild decline in cognitive function; (2) modest impairment in cognitive performance (preferably with neuropsychiatric testing); (B) Cognitive deficits do not interfere with capacity for independence in everyday activities. CTE was a central figure in the complaint, which alleged that the NFL makes money by promoting a product of brutality . . . and inculcating in players at every level of the game the false and lifethreatening ideas that (a) brutal, ferocious and debilitating collisions are a required and desired outcome in the game of football; and (b) playing despite repetitive head impacts is a laudable and desirable goal. [...]CTE could be brought up as a mitigating factor in a number of contexts, including capital litigation. (Michael McCann, Could Kellen Winslow Jr. 's Attorneys Use FootballInduced Brain Injury as Defense for Alleged Crimes?, Sports Illustrated (June 16, 2018), https://www.si.com/ nfl/2018/06/16/kellen-winslow-rape-sexual-assault-charges-ctedefense.) If convicted on the charges, the 34-year-old Winslow could be sentenced to life in prison.
Is Youth Football Safe? An Analysis of Youth Football Head Impact Data. (PEER REVIEWED ARTICLE) Recent NFL rule changes recognize the dangers of playing through concussions, and the league is working to eliminate unnecessary head collisions. Studies that suggest professional players face greater chances of brain disease than the general population are still preliminary. The risks involved in playing football are part of what makes the sport great; athletes who choose to play should bear some responsibility for their own health.
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BACKGROUND: The issue of whether sports-related head trauma at the youth level can result in long-term sequelae that may negatively impact the participant has been widely debated.

OBJECTIVE: To investigate head impacts in the Summit Youth Football League equipped with helmets using the Riddell InSite impact monitoring system. The monitoring system allowed for analysis of the number of impacts and severity of impacts by player.

METHODS: Data were obtained for all 20 members of the youth football team. Impacts were recorded as "low," "medium," and "high" intensity.

RESULTS: All 20 players participated in all practices and games throughout the season. No player suffered a concussion throughout the entire season. There were 817 recorded impacts throughout the season. This was an average of 41 impacts per player over the course of the season and fewer than 4 impacts per player per week. Only one impact registered as "high."

He Helped Ex-Players Get Benefits. His Family Is Still Waiting The article reports that the family of Mike Webster, former football player of the Pittsburgh Steelers team and the first National Football League (NFL) player who died from chronic traumatic encephalopathy (CTE), continue to struggle financially, 15 years after his death while he helped disabled players to receive benefits. It mentions that NFL insisted on a settlement provision that could prevent players who died before 2006 from receiving compensation...
Aaron Hernandez Had CTE. How Much More Damage Can The NFL Take? Still, for anyone who appreciates the artistry of football, this latest CTE finding is chilling. In a statement, Boston University's CTE Center said that neuropathologist Dr. Ann McKee found a "severe deposition" of tau, a protein that kills brain cells, in the frontal lobes of Hernandez's brain. The Hernandez family is suing the NFL and the New England Patriots; Jose Baez, who represented Aaron Hernandez at a separate double murder trial -- Hernandez was found not guilty in April -- said Hernandez played pro football because the NFL led him to think the game was safe. "Those representations turned out to be false," Baez said.
CTE Discoverer: We Shouldn't Be Surprised That Aaron Hernandez Had CTE.
Fears of C.T.E., and Then a Gunshot The article discusses how former National Football League (NFL) player Jason Hairston's suspicion of having chronic traumatic encephalopathy (CTE) has led him to suicide. Topics discussed include the success of the KUIU hunting gear and apparel business of Hairston and his wife Kirstyn, Hairston's history of concussions and symptoms of CTE, and the confirmation of his CTE through autopsy...
Two Numbers: Degenerative Brain Disease Nearly Universal Among NFL Players; Post-mortem analyses showed 96 percent had chronic traumatic encephalopathy There's no denying that football is a dangerous sport. Regardless of whether the game is played on a professional or amateur level, it is high risk, particularly for traumatic head injury and concussions. In many circumstances--if not most--frequent blows to the head have effects that may last a lifetime, a condition now known as chronic traumatic encephalopathy (CTE). The degenerative brain disease causes a spectrum of neurological and psychiatric symptoms, including memory loss, depression, anxiety, aggression and dementia.

Other Contact Sports

The NHL Lacks Serious Commitment to Reducing Head Injuries
An Olympic hockey hero was accused of a violent crime. Was head trauma to blame? A member of the famed 1980 Miracle on Ice hockey team was found incompetent to stand trial on charges of beating a neighbor in an alleged attack that his sister...
The National Hockey League is skating around the brain-injury problem
The Symptoms - A personal narrative is presented which explores the author's experience of suffering concussions from playing ice hockey.

Concussion rears its ugly head-again: it took Dale Sr. to wake us up to head and neck safety, will Dale Jr. lead us to greater awareness of brain injury?

Does Soccer Have a Brain-Trauma Problem?
Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players (PEER REVIEWED ARTICLE) In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer's disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer's disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.
Chronic traumatic encephalopathy is a common co-morbidity, but less frequent primary dementia in former soccer and rugby players (PEER REVIEWED ARTICLE) Chronic traumatic encephalopathy (CTE) is reported at high prevalence in selected autopsy case series of former contact sports athletes. Nevertheless, the contribution of CTE pathology to clinical presentation and its interaction with co-morbid neurodegenerative pathologies remain unclear. To address these issues, we performed comprehensive neuropathology assessments on the brains of former athletes with dementia and considered these findings together with detailed clinical histories to derive an integrated clinicopathological diagnosis for each case. Consecutive, autopsy-acquired brains from former soccer and rugby players with dementia were assessed for neurodegenerative pathologies using established and preliminary consensus protocols. Thereafter, next of kin interviews were conducted to obtain detailed accounts of the patient's clinical presentation and course of disease to inform a final, integrated clinicopathological diagnosis. Neuropathologic change consistent with CTE (CTE-NC) was confirmed in five of seven former soccer and three of four former rugby players' brains, invariably in combination with mixed, often multiple neurodegenerative pathologies. However, in just three cases was the integrated dementia diagnosis consistent with CTE, the remainder having alternate diagnoses, with the most frequent integrated diagnosis Alzheimer's disease (AD) (four cases; one as mixed AD and vascular dementia). This consecutive autopsy series identifies neuropathologic change consistent with preliminary diagnostic criteria for CTE (CTE-NC) in a high proportion of former soccer and rugby players dying with dementia. However, in the majority, CTE-NC appears as a co-morbidity rather than the primary, dementia causing pathology. As such, we suggest that while CTE-NC might be common in former athletes with dementia, in many cases its clinical significance remains uncertain.

Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy. (PEER REVIEWED ARTICLE) 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.
Ashley Massaro wanted to donate her brain to CTE research. Here's what we know about head trauma in pro wrestling
Dozens of wrestlers sue WWE over CTE, effects of traumatic brain injuries
Boxing: medical care in and out of the ring.

Spotlight On: Cheerleading

Catastrophic High School and Collegiate Cheerleading Injuries in the United States: An Examination of the 2006-2007 Basket Toss Rule Change (PEER REVIEWED ARTICLE) Cheerleading is a specialized athletic activity that can lead to catastrophic injuries. Cheerleading rules are in place to maximize safety of participants. The purpose of this study was to describe catastrophic cheerleading injuries among high school and collegiate-level participants in the United States and to explore whether the 2006-2007 basket toss rule change was effective at reducing the number of catastrophic injuries.
Concussions in Cheerleaders Reported from a Countywide Concussion Injury Surveillance System. (PEER REVIEWED ARTICLE) The purpose of this study was to advocate for the acceptance of cheerleading as a sport so that its athletes are eligible for the same resources available to other sports, such as concussion education programs and injury surveillance systems. The subjects of this study were cheerleaders from Miami Dade County public high schools who sustained a sports related concussion (SRC) from August 2015 to June 2019, identified from the Miami Concussion Model Concussion Injury Surveillance System. The database is compiled from reports submitted by certified athletic trainers after a suspected concussion, from post-injury ImPACT tests, and from patients who present to the University of Miami Sports Concussion Clinic for evaluation. A total of 29 cheerleaders were identified. The 2018-19 academic year accounted for 45% of reported concussions, representing a large increase in number compared to previous years. This was observed after increased emphasis was placed on certified athletic trainers to report SRC in cheerleaders. On average cheerleaders with SRC were withheld from sport for 26.2 days, and 38% had prolonged recovery of >28 days. Cheerleaders perform complex athletic maneuvers that put them at risk of injury, particularly SRC. If considered a sport, cheerleading would be afforded the same benefits as other sports, including resources for better facilities, mandatory concussion education, ATC availability, baseline neurocognitive testing, and inclusion in injury surveillance systems. Increased knowledge of the long-term sequelae of concussions and repetitive head injuries has led to the development of concussion education programs and injury surveillance systems to protect athletes from these types of injuries. Although competitive cheerleading has been recognized as a sport, cheerleading as a whole has not, putting its athletes at risk as its participants are not included in these safety programs.
Pediatric Cheerleading Injuries Treated in Emergency Departments in the United States (PEER REVIEWED ARTICLE) This study investigates the epidemiology of cheerleading injuries to children in the United States. Data were analyzed from the National Electronic Injury Surveillance System for children 5 through 18 years of age treated in US emergency departments for cheerleading injuries from 1990 through 2012. An estimated 497 095 children ages 5 to 18 years were treated in US emergency departments for a cheerleading injury during the 23-year study period, averaging 21 613 injured children per year. From 1990 to 2012, the annual cheerleading injury rate increased significantly by 189.1%; and from 2001 to 2012, the annual rate of cheerleading-related concussion/closed head injury increased significantly by 290.9%. Falls were the most common mechanism of injury (29.4%) and were more likely to lead to hospitalization (relative risk = 2.47; 95% confidence interval = 1.67-3.68) compared with other injury mechanisms. The rising number and rate of pediatric cheerleading injuries underscore the need for increased efforts to prevent these injuries.
Underreporting of Concussions and Concussion-Like Symptoms in Female High School Athletes. (PEER REVIEWED ARTICLE) Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.
The Most Dangerous Sport for Women? Try Cheerleading
Andrus Anderson Files Lawsuit Against University of California Citing Lack of Concussion Protocol for Campus Cheerleaders.
Concussion Recovery Is Slower in Girls, Mounting Evidence Suggests. The article reports that according to a new study, concussion recovering typically takes female athletes more than twice as long as males. The study that analyzed medical records of hundreds of teenagers active in sports, found that female children and adolescents are more susceptible to head injuries. The study was conducted by sports medicine physician John Neidecker and his colleagues.

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Concussion: Contact Sports and Brain Injuries: Journal Articles

Articles - Purpose of Page

Spotlight On: Football

Other Contact Sports

Spotlight On: Cheerleading

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