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Neal J, Hutchings PB, Phelps C, Williams D. Football and Dementia: Understanding the Link. Front Psychiatry 2022; 13:849876. [PMID: 35693952 PMCID: PMC9184440 DOI: 10.3389/fpsyt.2022.849876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Football, also known as soccer or association football, is popular but has a potential link with dementia developing in retired players. The FA and soccer regulators in the USA have imposed guidelines limiting players exposure to heading, despite controversy whether this dementia is caused by heading the ball, a form of mild repetitive head injury (RHI), over many years. Substantial data exist showing that many ex-North American Football players develop a specific neurodegenerative disease: chronic traumatic encephalopathy (CTE), the neuropathological disorder of boxers. In the United Kingdom evidence for the neuropathological basis of footballers' dementia has been slow to emerge. A 2017 study revealed that in six ex-soccer players four had CTE with Alzheimer's disease (AD) and two had AD. A 2019 study showed that ex-footballers were 3.5 times more likely to die from dementia or other neuro-degenerative diseases than matched controls. We argue that in childhood and adolescence the brain is vulnerable to heading, predicated on its disproportionate size and developmental immaturity. RHI in young individuals is associated with early neuroinflammation, a potential trigger for promoting neurodegeneration in later life. Evidence is available to support the guidelines limiting heading for players of all ages, while professional and non-players should be included in prospective studies to investigate the link between soccer and dementia.
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Affiliation(s)
- James Neal
- Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Paul B Hutchings
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
| | - Ceri Phelps
- Centre for Psychology and Counselling, Institute of Education and Humanities, University of Wales Trinity Saint David, Swansea, United Kingdom
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2
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Kieffer EE, Brolinson PG, Maerlender AE, Smith EP, Rowson S. In-Season Concussion Symptom Reporting in Male and Female Collegiate Rugby Athletes. Neurotrauma Rep 2021; 2:503-511. [PMID: 34901945 PMCID: PMC8655811 DOI: 10.1089/neur.2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Symptom inventories are generally only collected after a suspected concussion, but regular in-season monitoring may allude to clinical symptoms associated with repetitive subconcussive impacts and potential undiagnosed concussions. Despite sex-specific differences in symptom presentation and outcome of concussion, no return-to-play protocol takes sex into account. The objective of this study was to monitor a cohort of contact-sport athletes and compare the frequency and severity of in-season concussion-like symptom reporting between sexes. Graded symptom checklists from 144 female and 104 male athlete-seasons were administered weekly to quantify the effect of subconcussive impacts on frequency and severity of in-season symptom reporting. In-season, mean symptom severity score (SSS) (p = 0.026, mean difference of 1.8), mean number of symptoms (p = 0.044, mean difference of 0.9), max SSS (p < 0.001, mean difference of 19.2), and max number of symptoms (p < 0.001, mean difference of 6.8) were higher in the females. The females' survey results showed differences between elevated and concussed SSS (p < 0.005, mean difference of 28.1) and number of symptoms reported (p = 0.001, mean difference of 6.6). The males did not have a difference in SSS (p = 0.97, mean difference of 1.12) nor in number of symptoms (p = 0.35, mean difference of 1.96) from elevated to concussed athletes. Rugby players report concussion-like symptoms in the absence of a diagnosed concussion in-season. Female athletes reported elevated symptom frequencies with greater severities than the males, but both sexes reported considerable levels throughout the season.
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Affiliation(s)
- Emily E Kieffer
- School of Biomedical Engineering and Sciences and Virginia Tech, Blacksburg, Virginia, USA
| | | | - Arthur E Maerlender
- Center for Brain, Biology and Behavior, University of Nebraska at Lincoln, Lincoln, Nebraska, USA
| | - Eric P Smith
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Steven Rowson
- School of Biomedical Engineering and Sciences and Virginia Tech, Blacksburg, Virginia, USA
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3
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Kakavas G, Malliaropoulos N, Blach W, Bikos G, Migliorini F, Maffulli N. Ball heading and subclinical concussion in soccer as a risk factor for anterior cruciate ligament injury. J Orthop Surg Res 2021; 16:566. [PMID: 34538251 PMCID: PMC8451147 DOI: 10.1186/s13018-021-02711-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022] Open
Abstract
Soccer players have a high risk of anterior cruciate ligament (ACL) injury, a potentially career-ending event. ACL rupture has been linked with abnormal neuromuscular control in the lower limb. Additionally, heading the ball with the unprotected head during game play is increasingly recognized as a major source of exposure to concussive and sub-concussive repetitive head impacts. This article provides a hypothesis of potential connection of ACL injury with ball heading in soccer players. The study reviews literature sources regarding the impact of neurocognitive alterations after ball headings in ACL injuries. Poor baseline neurocognitive performance or impairments in neurocognitive performance via sleep deprivation, psychological stress, or concussion can increase the risk for subsequent musculoskeletal injury.
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Affiliation(s)
| | - Nikolaos Malliaropoulos
- Thessaloniki Sports Medicine Clinic, Thessaloniki, Greece.,Ports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK.,Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
| | - Wieslaw Blach
- Faculty of Physical Education and Sport Sciences, University School of Physical Education, Paderewskiego 35, 51-612, Wroclaw, Poland.,European Judo Union, Vienna, Austria
| | - Georgios Bikos
- Euromedica-Arogi Rehabilitation Clinic, Pylaia, Thessaloniki, Greece
| | - Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstrasse 31, 52064, Aachen, Germany.
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK.,London Sports Care, BMI London Independent Hospital, London, UK.,Department of Orthopaedics, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
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4
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Strauss SB, Fleysher R, Ifrah C, Hunter LE, Ye K, Lipton RB, Zimmerman ME, Kim M, Stewart WF, Lipton ML. Framing potential for adverse effects of repetitive subconcussive impacts in soccer in the context of athlete and non-athlete controls. Brain Imaging Behav 2021; 15:882-895. [PMID: 32712797 PMCID: PMC7861653 DOI: 10.1007/s11682-020-00297-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The benefits of athletic activity may be attenuated by sport-related head impacts, including soccer-related concussion and subconcussive events. The purpose of this study is to characterize the specific effects of soccer heading on white matter microstructure and cognitive function, independent of concussion, relative to non-athlete controls and relative to active athletes who are not involved in collision sports. 246 amateur soccer players, 72 non-contact/non-collision sports athletes and 110 healthy,non-athlete controls were included in the study, and underwent cognitive testing and 3T diffusion tensor imaging (DTI). Voxelwise linear regression, comparing soccer players and non-contact/non-collision sports athletes healthy,non-athlete controls, identified regions of abnormally low and high fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) in athlete participants. Generalized estimating equations were used to examine the effects of 2 week and 1 year heading exposure quartile on cognitive performance and on the volume of each high and each low DTI parameter. Athletes with no or lower exposure to repetitive heading exhibited greater expression of low RD, greater expression of high FA and better performance on tasks of attention, processing speed, verbal memory, and working memory compared to non-athletes. Soccer players with the highest exposure to repetitive head impacts, however, did not differ significantly from healthy, non-athletes on either micro-structural features or cognitive performance, findings not explained by concussion history or demographic factors. These results are consistent with the notion that beneficial effects of athletic conditioning or training on brain structure and function may be attenuated by exposure to repeated subconcussive head impacts.
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Affiliation(s)
- Sara B Strauss
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- NY Presbyterian, Weill Cornell Medical Center, New York, NY, 10065, USA
| | - Roman Fleysher
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Chloe Ifrah
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Liane E Hunter
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kenny Ye
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Richard B Lipton
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | - Mimi Kim
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | | | - Michael L Lipton
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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5
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The Impact of Sleep on the Relationship between Soccer Heading Exposure and Neuropsychological Function in College-Age Soccer Players. J Int Neuropsychol Soc 2020; 26:633-644. [PMID: 32098640 DOI: 10.1017/s1355617720000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Soccer is the most popular sport worldwide and is the only sport where athletes purposely use their head to deflect the ball during play, termed "heading" the ball. These repetitive head impacts (RHI) are associated with worse neuropsychological function; however, factors that can increase risk of injury following exposure to such head impacts have been largely unexamined. The present study provided a novel examination of the modifying role of sleep on the relationship between RHI exposure and neuropsychological function in college-age soccer players. METHODS Fifty varsity and intramural college soccer players completed questionnaires assessing recent and long-term heading exposure, a self-report measure of sleep function, and a battery of neuropsychological tests. RESULTS A high level of recent heading exposure was significantly associated with poorer processing speed, independent of concussion history. With reduced sleep duration, a high level of recent heading exposure was related to worse sustained attention. However, with greater hours of sleep duration, heading exposure was related to preserved neuropsychological outcome in sustained attention. CONCLUSIONS We replicated our earlier finding of an association between recent head impact exposure and worse processing speed in an independent sample. In addition, we found that sleep may serve as a risk or protective factor for soccer players following extensive exposure to head impacts. Ultimately, this study furthers the understanding of factors impacting neuropsychological function in soccer players and provides empirical support for sleep interventions to help ensure safer soccer play and recovery from injury.
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6
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Phelps A, Mez J, Stern RA, Alosco ML. Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework. Semin Neurol 2020; 40:439-449. [PMID: 32674182 DOI: 10.1055/s-0040-1713633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.
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Affiliation(s)
- Alyssa Phelps
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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7
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Pinar C, Trivino-Paredes J, Perreault ST, Christie BR. Hippocampal cognitive impairment in juvenile rats after repeated mild traumatic brain injury. Behav Brain Res 2020; 387:112585. [DOI: 10.1016/j.bbr.2020.112585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022]
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8
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Rodrigues AC, Lima MDM, de Souza LC, Furtado C, Marques CE, Gonçalves L, Lima MV, Lasmar RP, Caramelli P. No Evidence of Association Between Soccer Heading and Cognitive Performance in Professional Soccer Players: Cross-Sectional Results. Front Neurol 2019; 10:209. [PMID: 30915024 PMCID: PMC6422927 DOI: 10.3389/fneur.2019.00209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/18/2019] [Indexed: 12/29/2022] Open
Abstract
Although the scientific community has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during soccer heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The aim of this study is to investigate the effects of soccer heading on cognitive functioning in active professional soccer players. Male soccer players (n = 44), from two soccer teams that play in the Brazilian A Series Championship, and non-athletes (n = 47), comparable in age and education, were submitted to cognitive assessment, consisting of computerized and conventional neuropsychological testing (Neupsilin battery). In the computerized cognitive assessment, soccer players performed better than controls on reaction time measures in general motor coordination, executive functioning and memory tests, and on accuracy measures in executive functioning tests. There were no significant differences between groups on the Neupsilin battery. A comparison between two sub-groups of soccer players, based on the self-reported number of headings, did not show significant differences on tests performance. No significant correlations were found between an estimate of exposure to heading during professional soccer career and cognitive performance. Our data demonstrate no evidence of cognitive impairment in soccer players, compared to non-athletes, and no association between heading exposure and performance on neuropsychological tests. Longitudinal investigations, including neuroimaging assessment, will help to clarify whether soccer heading may be associated with brain injury and cognitive dysfunction.
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Affiliation(s)
- Ana Carolina Rodrigues
- Pró-Reitoria de Graduação, Reitoria da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Drummond Martins Lima
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Celso Furtado
- Departamento Médico do América Futebol Clube, Belo Horizonte, Brazil
| | | | - Lucas Gonçalves
- Departamento de Análise de Desempenho do Clube Atlético Mineiro, Belo Horizonte, Brazil
| | | | - Rodrigo Pace Lasmar
- Departamento Médico do Clube Atlético Mineiro, Belo Horizonte, Brazil.,Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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9
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Abstract
Background: Globally, soccer is the most popular team sport, unifying many fans all around the world. The epidemiological studies so far have confirmed that head playing and hitting the ball with head may cause minor head injuries, which exert their effects in a cumulative way. Methods: Literature search for this review was conducted and data about traumatic brain injury collected from various sources. Results: The consequences of head injury are evident as chronic changes in cognition, including disturbances in concentration and slowing of mental and physical agility. Conclusion: Various recommendations have been issued for the prevention of chronic negative cumulative effects of soccer ball head playing. In addition, the professional soccer players are also exposed to more intense craniocerebral trauma, such as concussions and contusions. These patients require treatment of skilled sports physicians, neurologists and neurosurgeons and some may need long to return to the sport scene again.
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Affiliation(s)
- Gorazd Bunc
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
| | - Janez Ravnik
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
| | - Tomaz Velnar
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
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10
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Stewart WF, Kim N, Ifrah C, Sliwinski M, Zimmerman ME, Kim M, Lipton RB, Lipton ML. Heading Frequency Is More Strongly Related to Cognitive Performance Than Unintentional Head Impacts in Amateur Soccer Players. Front Neurol 2018; 9:240. [PMID: 29740384 PMCID: PMC5928847 DOI: 10.3389/fneur.2018.00240] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Compared to heading, unintentional head impacts (e.g., elbow to head, head to head, head to goalpost) in soccer are more strongly related to risk of moderate to very severe Central Nervous System (CNS) symptoms. But, most head impacts associated with CNS symptoms that occur in soccer are mild and are more strongly related to heading. We tested for a differential relation of heading and unintentional head impacts with neuropsychological (NP) test performance. Method Active adult amateur soccer players were recruited in New York City and the surrounding areas for this repeated measures longitudinal study of individuals who were enrolled if they had 5+ years of soccer play and were active playing soccer 6+ months/year. All participants completed a baseline validated questionnaire (“HeadCount-2w”), reporting 2-week recall of soccer activity, heading and unintentional head impacts. In addition, participants also completed NP tests of verbal learning, verbal memory, psychomotor speed, attention, and working memory. Most participants also completed one or more identical follow-up protocols (i.e., HeadCount-2w and NP tests) at 3- to 6-month intervals over a 2-year period. Repeated measures General Estimating Equations (GEE) linear models were used to determine if variation in NP tests at each visit was related to variation in either heading or unintentional head impacts in the 2-week period before testing. Results 308 players (78% male) completed 741 HeadCount-2w. Mean (median) heading/2-weeks was 50 (17) for men and 26 (7) for women. Heading was significantly associated with poorer performance on psychomotor speed (p < 0.001) and attention (p = 0.02) tasks and was borderline significant with poorer performance on the working memory (p = 0.06) task. Unintentional head impacts were not significantly associated with any NP test. Results did not differ after excluding 22 HeadCount-2w with reported concussive or borderline concussive symptoms. Conclusion Poorer NP test performance was consistently related to frequent heading during soccer practice and competition in the 2 weeks before testing. In contrast, unintentional head impacts incurred during soccer were not related to cognitive performance.
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Affiliation(s)
| | - Namhee Kim
- The Gruss Magnetic Resonance Research Center, Bronx, NY, United States.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Chloe Ifrah
- The Gruss Magnetic Resonance Research Center, Bronx, NY, United States.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Martin Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
| | - Molly E Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Fordham University, Bronx, NY, United States
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Richard B Lipton
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Bronx, NY, United States.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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11
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Recent and Long-Term Soccer Heading Exposure Is Differentially Associated With Neuropsychological Function in Amateur Players. J Int Neuropsychol Soc 2018; 24:147-155. [PMID: 28829004 PMCID: PMC6554717 DOI: 10.1017/s1355617717000790] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The present study examined the relative contribution of recent or long-term heading to neuropsychological function in amateur adult soccer players. PARTICIPANTS AND METHODS Soccer players completed a baseline questionnaire (HeadCount-12m) to ascertain heading during the prior 12 months (long-term heading, LTH) and an online questionnaire (HeadCount-2w) every 3 months to ascertain heading during the prior 2 weeks (recent heading, RH). Cogstate, a battery of six neuropsychological tests, was administered to assess neuropsychological function. Generalized estimating equations were used to test if LTH or RH was associated with neuropsychological function while accounting for the role of recognized concussion. RESULTS A total of 311 soccer players completed 630 HeadCount-2w. Participants had an average age of 26 years. Participants headed the ball a median of 611 times/year (mean=1,384.03) and 9.50 times/2 weeks (mean=34.17). High levels of RH were significantly associated with reduced performance on a task of psychomotor speed (p=.02), while high levels of LTH were significantly associated with poorer performance on tasks of verbal learning (p=.03) and verbal memory (p=.04). Significantly better attention (p=.02) was detectable at moderately high levels of RH, but not at the highest level of RH. One hundred and seven (34.4%) participants reported a lifetime history of concussion, but this was not related to neuropsychological function and did not modify the association of RH or LTH with neuropsychological function. CONCLUSION High levels of both RH and LTH were associated with poorer neuropsychological function, but on different domains. The clinical manifestations following repetitive exposure to heading could change with chronicity of exposure. (JINS, 2018, 24, 147-155).
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12
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Nel K, Govender S, Rapetsoa M, Nel C. Cumulative mild head injury (CMHI) among college rugby players: A replication and extension study. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2017.1399571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kathryn Nel
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | | | - Mokgadi Rapetsoa
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | - Christopher Nel
- Department of Human Movement Science, University of Zululand, Kwadlangezwa, South Africa
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13
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Affiliation(s)
- Alexander A. Tarnutzer
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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14
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Stewart WF, Kim N, Ifrah CS, Lipton RB, Bachrach TA, Zimmerman ME, Kim M, Lipton ML. Symptoms from repeated intentional and unintentional head impact in soccer players. Neurology 2017; 88:901-908. [PMID: 28148633 DOI: 10.1212/wnl.0000000000003657] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the rate and differential contribution of heading vs unintentional head impacts (e.g., head to head, goal post) to CNS symptoms in adult amateur soccer players. METHODS Amateur soccer players completed baseline and serial on-line 2-week recall questionnaires (HeadCount) and reported (1) soccer practice and games, (2) heading and unintentional soccer head trauma, and (3) frequency and severity (mild to very severe) of CNS symptoms. For analysis, CNS symptoms were affirmed if one or more moderate, severe, or very severe episodes were reported in a 2-week period. Repeated measures logistic regression was used to assess if 2-week heading exposure (i.e., 4 quartiles) or unintentional head impacts (i.e., 0, 1, 2+) were associated with CNS symptoms. RESULTS A total of 222 soccer players (79% male) completed 470 HeadCount questionnaires. Mean (median) heading/2 weeks was 44 (18) for men and 27 (9.5) for women. One or more unintentional head impacts were reported by 37% of men and 43% of women. Heading-related symptoms were reported in 20% (93 out of 470) of the HeadCounts. Heading in the highest quartile was significantly associated with CNS symptoms (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.57-6.37) when controlling for unintentional exposure. Those with 2+ unintentional exposures were at increased risk for CNS symptoms (OR 6.09, 95% CI 3.33-11.17) as were those with a single exposure (OR 2.98, 95% CI 1.69-5.26) when controlling for heading. CONCLUSIONS Intentional (i.e., heading) and unintentional head impacts are each independently associated with moderate to very severe CNS symptoms.
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Affiliation(s)
- Walter F Stewart
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Namhee Kim
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Chloe S Ifrah
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Richard B Lipton
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Tamar A Bachrach
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Molly E Zimmerman
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Mimi Kim
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY
| | - Michael L Lipton
- From Sutter Health Research (W.F.S.), Walnut Creek, CA; The Gruss Magnetic Resonance Research Center (N.K., C.S.I., T.A.B., M.L.L.), the Departments of Radiology (N.K., C.S.I., T.A.B., M.L.L.), Neurology (R.B.L., M.E.Z.), Epidemiology and Population Health (R.B.L., M.K.), and Psychiatry and Behavioral Sciences (M.L.L.), and The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine and Montefiore Medical Center; and Fordham University (M.E.Z.), Bronx, NY.
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15
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Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA, Sproule DW, Tyson AM, Duma SM. Biomechanical Perspectives on Concussion in Sport. Sports Med Arthrosc Rev 2016; 24:100-7. [PMID: 27482775 PMCID: PMC4975525 DOI: 10.1097/jsa.0000000000000121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussions can occur in any sport. Often, clinical and biomechanical research efforts are disconnected. This review paper analyzes current concussion issues in sports from a biomechanical perspective and is geared toward Sports Med professionals. Overarching themes of this review include the biomechanics of the brain during head impact, role of protective equipment, potential population-based differences in concussion tolerance, potential intervention strategies to reduce the incidence of injury, and common biomechanical misconceptions.
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Affiliation(s)
- Steven Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
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16
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Rodrigues AC, Lasmar RP, Caramelli P. Effects of Soccer Heading on Brain Structure and Function. Front Neurol 2016; 7:38. [PMID: 27047444 PMCID: PMC4800441 DOI: 10.3389/fneur.2016.00038] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/07/2016] [Indexed: 12/14/2022] Open
Abstract
Soccer is the most popular sport in the world, with more than 265 million players worldwide, including professional and amateur ones. Soccer is unique in comparison to other sports, as it is the only sport in which participants purposely use their head to hit the ball. Heading is considered as an offensive or defensive move whereby the player's unprotected head is used to deliberately impact the ball and direct it during play. A soccer player can be subjected to an average of 6-12 incidents of heading the ball per competitive game, where the ball reaches high velocities. Moreover, in practice sessions, heading training, which involves heading the ball repeatedly at low velocities, is common. Although the scientific community, as well as the media, has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The purpose of this study is to review the existing literature regarding the effects of soccer heading on brain structure and function. Only in the last years, some investigations have addressed the impact of heading on brain structure, by using neuroimaging techniques. Similarly, there have been some recent studies investigating biochemical markers of brain injury in soccer players. There is evidence of association between heading and abnormal brain structure, but the data are still preliminary. Also, some studies have suggested that subconcussive head impacts, as heading, could cause cognitive impairment, whereas others have not corroborated this finding. Questions persist as to whether or not heading is deleterious to cognitive functioning. Further studies, especially with longitudinal designs, are needed to clarify the clinical significance of heading as a cause of brain injury and to identify risk factors. Such investigations might contribute to the establishment of safety guidelines that could help to minimize the risk of possible adverse effects of soccer on brain structure and function.
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Affiliation(s)
- Ana Carolina Rodrigues
- Pró-Reitoria de Graduação, Reitoria da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo Pace Lasmar
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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17
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Andre JB. Arterial Spin Labeling Magnetic Resonance Perfusion for Traumatic Brain Injury: Technical Challenges and Potentials. Top Magn Reson Imaging 2015; 24:275-287. [PMID: 26502309 DOI: 10.1097/rmr.0000000000000065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.
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Affiliation(s)
- Jalal B Andre
- Harborview Medical Center, University of Washington, Seattle, WA
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18
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Abstract
Traumatic brain injury (TBI) is a major cause of death and disability, and therefore an important health and socioeconomic problem for our society. Individuals surviving from a moderate to severe TBI frequently suffer from long-lasting cognitive deficits. Such deficits include different aspects of cognition such as memory, attention, executive functions, and awareness of their deficits. This chapter presents a review of the main neuropsychological and neuroimaging studies of patients with TBI. These studies found that patients evolve differently according to the severity of the injury, the mechanism causing the injury, and the lesion location. Further research is necessary to develop rehabilitation methods that enhance brain plasticity and recovery after TBI. In this chapter, we summarize current knowledge and controversies, focusing on cognitive sequelae after TBI. Recommendations from the Common Data Elements are provided, with an emphasis on diagnosis, outcome measures, and studies organization to make data more comparable across studies. Final considerations on neuroimaging advances, rehabilitation approaches, and genetics are described in the final section of the chapter.
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Affiliation(s)
- Irene Cristofori
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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19
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Maher ME, Hutchison M, Cusimano M, Comper P, Schweizer TA. Concussions and heading in soccer: a review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. Brain Inj 2014; 28:271-85. [PMID: 24475745 DOI: 10.3109/02699052.2013.865269] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Soccer is currently the most popular and fastest-growing sport worldwide. Similar to many sports, soccer carries an inherent risk of injury, including concussion. Soccer is also unique in the use of 'heading'. The present paper provides a comprehensive review of the research examining the incidence, mechanisms, biomarkers of injury and neurocognitive outcomes of concussions and heading in soccer. METHODS Seven databases were searched for articles from 1806 to 24 May 2013. Articles obtained by the electronic search were reviewed for relevance, with 229 selected for review. Ultimately, 49 articles met criteria for inclusion in the present review. RESULTS Female soccer players have a higher incidence of concussions than males. The most frequent injury mechanism is player-to-player contact for both genders. Few studies examined the effects of concussion in soccer players; however, neurocognitive outcomes were similar to those reported in the larger sport concussion literature, while the effect of heading is less clear. CONCLUSION Despite variation in research designs and study characteristics, the outcomes of concussions in soccer align with the greater concussion literature. This review makes recommendations for future research to increase standardization of research for improved understanding of concussions in soccer as well as the effects of heading.
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Affiliation(s)
- Monica E Maher
- Institute of Medical Sciences, University of Toronto , Toronto, Ontario , Canada
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20
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Shuttleworth-Edwards AB, Radloff SE, Whitefield-Alexander VJ, Smith IP, Horsman M. Practice effects reveal visuomotor vulnerability in school and university rugby players. Arch Clin Neuropsychol 2013; 29:86-99. [PMID: 23917347 DOI: 10.1093/arclin/act061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article reports on three pre- versus post-season prospective studies in which male university and high school contact sport players predominantly of Rugby Union (hereafter rugby) were compared with age, education, and IQ equivalent non-contact sport controls on the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) test. All analyses revealed a relative absence of practice effects on the Visual Motor Speed (VMS) composite for contact sport groups compared with controls. The VMS data for rugby players from each study were pooled and subjected to additional analysis (Rugby, n = 145; Controls, n = 106). Controls revealed significant improvement over the season (p < .001), whereas no learning effect was in evidence for rugby players whose performance remained the same (interaction effect, p = .028). It is apparent that practice effects have diagnostic potential in this context, implicating vulnerability on speeded visuomotor processing in association with participation in rugby. Pointers for further research and concussion management in the individual case are explored.
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21
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Han DH, Park HW, Kee BS, Na C, Na DHE, Zaichkowsky L. Performance enhancement with low stress and anxiety modulated by cognitive flexibility. Psychiatry Investig 2011; 8:221-6. [PMID: 21994509 PMCID: PMC3182387 DOI: 10.4306/pi.2011.8.3.221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/10/2011] [Accepted: 03/14/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare cognitive flexibility abilities, stress, and anxiety between starters and non-starter athletes. METHODS A total of 30 male professional-soccer and 40 professional-baseball athletes were recruited. Wisconsin Card Sorting Test (WCST) and Trail Making Test A & B (TMT A & B) were administered to assess cognitive flexibility during competition. The Korean version of the STAI form Y (STAI-KY) and Visual analogue scale for anxiety and stress were used to assess the anxiety and stress. RESULTS The starter group had better cognitive function (fewer perseverative errors and rapid TMTB times) (Z=3.32, p<0.01; Z=2.20, p=0.03, respectively) and lower stress and anxiety (F=4.34, p=0.01; F=6.61, p<0.01, respectively) during competition than the non-starter group. CONCLUSION The better cognitive performances were negatively correlated with stress and anxiety. Current results suggested that cognitive flexibility would enhance human performance by modulation of the anxiety and stress during competition.
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Affiliation(s)
- Doug Hyun Han
- Department of Psychiatry, Chung Ang University Medical School, Seoul, Korea
| | - Hyung Woo Park
- Department of Psychiatry, Chung Ang University Medical School, Seoul, Korea
| | - Baik Seok Kee
- Department of Psychiatry, Chung Ang University Medical School, Seoul, Korea
| | - Churl Na
- Department of Psychiatry, Chung Ang University Medical School, Seoul, Korea
| | - Do-Hyun E. Na
- Department of Sports Marketing, DanKook University, Seoul, Korea
| | - Leonard Zaichkowsky
- Education, Graduate Medical Science & Psychiatry, Boston University, Boston, MA, USA
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Abstract
Sport-related concussion is a common injury in children and adolescents. Athletes seldom report concussive symptoms, which makes the diagnosis a challenge. The management of sport-related concussion has changed significantly over the last several years. The previously used grading systems and return-to-play guidelines have been abandoned in favor of more individualized assessment and management. Neuropsychological testing is being used more frequently to assist in management. After recovery, it is recommended that an athlete's return-to-play progress in a gradual, stepwise fashion while being monitored by a health care provider. Proper assessment and management of a sport-related concussion is crucial, because repeat concussions can result in decreased neurocognitive functioning, increased symptomatology, and, at times, catastrophic outcomes.
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Affiliation(s)
- William P Meehan
- Children's Hospital Boston, Division of Emergency Medicine, Boston, MA 02115, USA.
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23
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Rutherford A, Stephens R, Fernie G, Potter D. Do UK university football club players suffer neuropsychological impairment as a consequence of their football (soccer) play? J Clin Exp Neuropsychol 2008; 31:664-81. [PMID: 19048428 DOI: 10.1080/13803390802484755] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Male players from football and rugby clubs and sportsmen from a variety of noncontact sports clubs at a UK university were compared on biographical and neuropsychological test measures. A data analysis paradigm was developed and employed to control the inflation of Type 1 error rate due to multiple hypotheses testing. Rugby players sustained most head injuries in their chosen sport, but neuropsychological tests of attention, memory, and executive function provided no evidence of performance impairment attributable to the number of head injuries sustained or the football, rugby, or noncontact sport groups. Footballers' heading frequency was related to the number of football head injuries sustained, but no relationship was detected between footballers' heading frequency and their neuropsychological test performance. Following discussion of pertinent methodological limitations it is concluded that there was no evidence in this dataset of neuropsychological impairment consistent with either mild head injury incidence or football heading frequency. However, a need for further research examining the long-term neuropsychological consequences of such head injuries was identified.
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Affiliation(s)
- Andrew Rutherford
- School of Psychology, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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24
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Balance control during gait in athletes and non-athletes following concussion. Med Eng Phys 2008; 30:959-67. [PMID: 18243036 DOI: 10.1016/j.medengphy.2007.12.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 11/14/2007] [Accepted: 12/14/2007] [Indexed: 11/24/2022]
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25
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Thornton AE, Cox DN, Whitfield K, Fouladi RT. Cumulative concussion exposure in rugby players: Neurocognitive and symptomatic outcomes. J Clin Exp Neuropsychol 2008; 30:398-409. [DOI: 10.1080/13803390701443662] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - David N. Cox
- a Simon Fraser University , Burnaby, British Columbia, Canada
| | - Kevin Whitfield
- a Simon Fraser University , Burnaby, British Columbia, Canada
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26
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Shuttleworth-Edwards AB, Smith I, Radloff SE. Neurocognitive vulnerability amongst university rugby players versus noncontact sport controls. J Clin Exp Neuropsychol 2008; 30:870-84. [PMID: 18608657 DOI: 10.1080/13803390701846914] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
University rugby players were compared with IQ-equivalent noncontact sports controls on memory and attentional tasks at the pre- and postseason intervals. Results revealed significant lowering for rugby players relative to controls at the postseason interval for attentional tasks with a speeded visuomotor component (ImPACT Visual Motor Speed; Trail Making Test, TMT, A and B). There was a practice effect for controls only between the pre- and postseason intervals for attentional tasks that commonly reveal improvements after a long retest interval (TMT A and B; Digits Backwards). Medium to large effect sizes implicate clinically relevant cognitive vulnerability for university-level rugby players in association with years of exposure to repetitive concussive injury.
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27
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Wicks P, Ganesalingham J, Collin C, Prevett M, Leigh NP, Al-Chalabi A. Three soccer playing friends with simultaneous amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2007; 8:177-9. [PMID: 17538780 DOI: 10.1080/17482960701195220] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disease of largely unknown cause, predominantly affecting upper and lower motor neurons. A recent study in Italy suggested an increased incidence of ALS among professional Italian soccer players. We report a cluster of three amateur league soccer players who were friends from the same part of southern England, and developed ALS simultaneously. This might suggest that keen amateur soccer players are also at risk.
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Affiliation(s)
- Paul Wicks
- MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, Department of Psychology, London, UK
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28
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Affiliation(s)
- Allan H Ropper
- Department of Neurology, Caritas St. Elizabeth's Medical Center, and Tufts University School of Medicine, Boston, MA 02135, USA
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