A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing

Forensic investigation into head trauma in combat sports, blunt force homicides, and traditional martial arts

BACKGROUND

The analysis of circumstantial elements in post-mortem examinations is crucial for identifying perpetrators in unarmed close-range homicides. This study explores the forensic analysis of head trauma fatalities related to combat sports, blunt force trauma homicides, and traditional martial arts (TMA), aiming to bridge the gap between historical martial arts documentation and modern forensic pathology.

MATERIALS AND METHODS

Following PRISMA guidelines, we conducted a systematic literature review and interdisciplinary analysis combining traditional forensic methods with the study of TMA manuscripts and consultations with martial arts experts.

RESULTS

The research uncovered a high incidence of head injuries in combat sports and identified distinct injury patterns in blunt-force trauma homicides. In martial arts, lethal techniques targeting the cranial region were pinpointed. An algorithm was developed to differentiate between injuries from various sources effectively.

CONCLUSION

This study offers a framework to distinguish injuries from combat sports, homicides, and martial arts, improving diagnostic accuracy in forensic pathology. It advocates for a detailed protocol that considers the technical aspects of TMA and their forensic implications, enhancing the evaluation of head trauma cases in forensic investigations.

Accuracy of Instrumented Mouthguards During Direct Jaw Impacts Seen in Boxing

PURPOSE

Measuring head kinematics data is important to understand and develop methods and standards to mitigate head injuries in contact sports. Instrumented mouthguards (iMGs) have been developed to address coupling issues with previous sensors. Although validated with anthropomorphic test devices (ATDs), there is limited post-mortem human subjects (PMHS) data which provides more accurate soft tissue responses. This study evaluated two iMGs (Prevent Biometrics (PRE) and Diversified Technical Systems (DTS) in response to direct jaw impacts.

METHODS

Three unembalmed male cadaver heads were properly fitted with two different boil-and-bite iMGs and impacted with hook (4 m/s) and uppercut (3 m/s) punches. A reference sensor (REF) was rigidly attached to the base of the skull, impact kinematics were transformed to the head center of gravity and linear and angular kinematic data were compared to the iMGs including Peak Linear Acceleration, Peak Angular Acceleration, Peak Angular Velocity, Head Injury Criterion (HIC), HIC duration, and Brain Injury Criterion.

RESULTS

Compared to the REF sensor, the PRE iMG underpredicted most of the kinematic data with slopes of the validation regression line between 0.72 and 1.04 and the DTS overpredicted all the kinematic data with slopes of the regression line between 1.4 and 8.7.

CONCLUSION

While the PRE iMG was closer to the REF sensor compared to the DTS iMG, the results did not support the previous findings reported with use of ATDs. Hence, our study highlights the benefits of using PMHS for validating the accuracy of iMGs since they closely mimic the human body compared to any ATD's mandible.

Sleepiness in retired male boxers: daytime sleepiness and its relationship with impulsiveness and depression symptomatology in retired professional male boxers

BACKGROUND

Boxing exposes fighters to head impacts and potential traumatic brain injury (TBI). Though research has explored the neuropsychiatric consequences of contact sports, there is limited research into Excessive Daytime Sleepiness (EDS) and its relationship to other outcomes, such as impulsiveness and depression. Therefore, this study aimed to describe EDS in retired boxers using the Epworth Sleepiness Scale (ESS) and to examine how boxing and sleepiness relate to impulsiveness and depression symptomatology.

METHODS

86 male retired professional boxers from the Professional Fighters Brain Health Study (PFBHS) met the inclusion criteria. Adjusted multivariable models analyzed relationships between professional boxing bouts, EDS (ESS), impulsiveness (Barratt Impulsiveness Scale Version 11 (BIS-11)), and/or depression (Patient Health Questionnaire-9 (PHQ-9)). A causal mediation analysis was performed to assess whether boxing bouts and ESS scores predicted BIS-11 and PHQ-9 scores.

RESULTS

Mean age was ∼51 years, fighters averaged ∼36 professional bouts, and ESS mean(SD) was 7.5(5.3). ESS scores were significantly associated with raw BIS-11 (Beta = 1.26, 95%CI = 0.77-1.75, p < 0.001) and ordinal PHQ-9 (OR = 1.20, 95%CI = 1.11-1.31, p < 0.001) scores in adjusted models, and the significant relationship between boxing bouts and BIS-11/PHQ-9 was mediated by ESS.

CONCLUSIONS

EDS in retired male professional boxers may be strongly associated with other neuropsychiatric sequelae of TBI (impulsiveness and depression).Sleepiness; sleep; boxing; contact sports; impulsiveness; impulsivity; depression; Epworth sleepiness scale box.

Boxing behavior recognition based on artificial intelligence convolutional neural network with sports psychology assistant

The purpose of this study is to deeply understand the psychological state of boxers before the competition, and explore an efficient boxing action classification and recognition model supported by artificial intelligence (AI) technology through these psychological characteristics. Firstly, this study systematically measures the key psychological dimensions of boxers, such as anxiety level, self-confidence, team identity, and opponent attitude, through psychological scale survey to obtain detailed psychological data. Then, based on these data, this study innovatively constructs a boxing action classification and recognition model based on BERT fusion 3D-ResNet, which not only comprehensively considers psychological information, but also carefully considers action characteristics to improve the classification accuracy of boxing actions. The performance evaluation shows that the model proposed in this study is significantly superior to the traditional model in terms of loss value, accuracy and F1 value, and the accuracy reaches 96.86%. Therefore, through the comprehensive application of psychology and deep learning, this study successfully constructs a boxing action classification and recognition model that can fully understand the psychological state of boxers, which provides strong support for the psychological training and action classification of boxers.

The spectrum of acute and chronic consequences of neurotrauma in professional and amateur boxing - A call to action is advocated to better understand and prevent this phenomenon

Introduction

Despite changes in regulations, boxing-related injuries and fatalities are still occurring. The numbers available in the literature regarding mortality and long-term consequences may not accurately represent the actual situation. Indeed, the real extent of this phenomenon remains poorly known.

Research question

Delineating the spectrum of acute and chronic consequences of boxing-related traumatic brain injuries (TBI).

Material and methods

Narrative review of the literature concerning acute and chronic boxing-related TBI. Keywords such as mortality, boxing, subdural hematoma were used to search in PubMed and Google scholar. An updated analysis of the Velazquez fatalities collection in boxing was undertaken.

Results

The Velazquez collection includes 2076 fatalities from 1720 to the present with a death rate of 10 athletes per year. More than half of the deaths (N = 1354, 65.2%) occurred after a knock-out, and nearly 75% happened during professional bouts. In Australia, from 1832 to 2020, 163 fatalities were recorded (75% professional). In Japan, from 1952 to 2016, 38 deaths were recorded with a mean age of 23.9 years. Up to 40% of retired professional boxers in the United States were diagnosed with symptoms of chronic brain injury. Clinical dementia is far more prevalent among professional boxers than in amateurs with an incidence of 20%.

Discussion and conclusions

A concerted effort to raise awareness and shed light on boxing-related neuro-trauma is required. Similar considerations can be made for other combat sports or contact sports. A call to action to address this knowledge gap, decrease and prevent this phenomenon is advocated.