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Arciniega H, Baucom ZH, Tuz-Zahra F, Tripodis Y, John O, Carrington H, Kim N, Knyazhanskaya EE, Jung LB, Breedlove K, Wiegand TLT, Daneshvar DH, Rushmore RJ, Billah T, Pasternak O, Coleman MJ, Adler CH, Bernick C, Balcer LJ, Alosco ML, Koerte IK, Lin AP, Cummings JL, Reiman EM, Stern RA, Shenton ME, Bouix S. Brain morphometry in former American football players: Findings from the DIAGNOSE CTE research project. Brain 2024:awae098. [PMID: 38533783 DOI: 10.1093/brain/awae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/16/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Exposure to repetitive head impacts (RHIs) in contact sports is associated with neurodegenerative disorders including chronic traumatic encephalopathy (CTE) which currently can be diagnosed only at postmortem. American football players are at higher risk of developing CTE given their exposure to RHIs. One promising approach for diagnosing CTE in vivo is to explore known neuropathological abnormalities at postmortem in living individuals using structural magnetic resonance imaging (MRI). MRI brain morphometry was evaluated in 170 male former American football players ages 45-74 years (n = 114 professional; n = 56 college) and 54 same-age unexposed asymptomatic male controls (n = 58 age range 45-74). Cortical thickness and volume of regions of interest were selected based on established CTE pathology findings and were assessed using FreeSurfer. Group differences and interactions with age and exposure factors were evaluated using a generalized least squares model. A separate logistic regression and independent multinomial model were performed to predict each Traumatic Encephalopathy Syndrome (TES) diagnosis core clinical features and provisional level of certainty for CTE pathology using brain regions of interest. Former college and professional American football players (combined) showed significant cortical thickness and/or volume reductions compared to unexposed asymptomatic controls in the hippocampus amygdala entorhinal cortex parahippocampal gyrus insula temporal pole and superior frontal gyrus. Post-hoc analyses identified group-level differences between former professional players and unexposed asymptomatic controls in the hippocampus amygdala entorhinal cortex parahippocampal gyrus insula and superior frontal gyrus. Former college players showed significant volume reductions in the hippocampus amygdala and superior frontal gyrus compared to the unexposed asymptomatic controls. We did not observe age-by-group interactions for brain morphometric measures. Interactions between morphometry and exposure measures were limited to a single significant positive association between the age of first exposure to organized tackle football and right insular volume. We found no significant relationship between brain morphometric measures and the TES diagnosis core clinical features and provisional level of certainty for CTE pathology outcomes. These findings suggest that MRI morphometrics detects abnormalities in individuals with a history of RHI exposure that resemble the anatomic distribution of pathological findings from postmortem CTE studies. The lack of findings associating MRI measures with exposure metrics (except for one significant relationship) or TES diagnosis and core clinical features suggests that brain morphometry must be complemented by other types of measures to characterize individuals with RHIs.
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Affiliation(s)
- Hector Arciniega
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Concussion Center, NYU Langone Health, New York, NY 10016, USA
| | - Zachary H Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Omar John
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Concussion Center, NYU Langone Health, New York, NY 10016, USA
| | - Holly Carrington
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Nicholas Kim
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Evdokiya E Knyazhanskaya
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Leonard B Jung
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, 80336 Munich, Bavaria, Germany
| | - Katherine Breedlove
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tim L T Wiegand
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, 80336 Munich, Bavaria, Germany
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
| | - R Jarrett Rushmore
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Tashrif Billah
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona Scottsdale, AZ 85259, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10017, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY,10017, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, 80336 Munich, Bavaria, Germany
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, 82152 Munich, Bavaria, Germany
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute and Arizona Alzheimer's Consortium, Phoenix, AZ 85006, USA
- Department of Psychiatry, University of Arizona, Phoenix, AZ 85004, USA
- Department of Psychiatry, Arizona State University, Phoenix, AZ 85008, USA
- Neurogenomics Division, Translational Genomics Research Institute and Alzheimer's Consortium, Phoenix, AZ 85004, USA
| | - Robert A Stern
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Neurology, Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sylvain Bouix
- Department of Software Engineering and Information Technology, École de technologie supérieure, Université du Québec, Montréal, QC, H3C 1K3, Canada
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Krokhine SN, Ewers NP, Mangold KI, Boshra R, Lin CYA, Connolly JF. N2b Reflects the Cognitive Changes in Executive Functioning After Concussion: A Scoping Review. Front Hum Neurosci 2021; 14:601370. [PMID: 33424568 PMCID: PMC7793768 DOI: 10.3389/fnhum.2020.601370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: The N2b is an event-related potential (ERP) component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion. Methods: A scoping review was conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions. Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury (using terms such as concussion, mild head injury, and mild traumatic brain injury) found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged. Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency.
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Affiliation(s)
- Sophie N Krokhine
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada
| | - Nathalee P Ewers
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Kiersten I Mangold
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Rober Boshra
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A Lin
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada
| | - John F Connolly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
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Bosch S, Viviers PL, de Villiers R, Derman W. A "scattered" SCAT in a football goalkeeper: a case report. S Afr J Sports Med 2020; 32:v32i1a7737. [PMID: 36818975 PMCID: PMC9924585 DOI: 10.17159/2078-516x/2020/v32i1a7737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background In an acute field-side setting, it is often challenging to differentiate benign sports-related concussion (SRC) from potential, more sinister, intracranial pathology. Moreover, recovery in the ensuing days and weeks is often complex as the resolution of classical signs and symptoms does not always follow a standard pattern. Aim To highlight the value of a structured and repeated thorough clinical assessment approach toward SRC, particularly as atypical and unexpected sequences in patient recovery patterns may require further specialist referral and intervention. Findings A football goalkeeper sustained a concussion in which symptoms failed to resolve as expected. Deterioration in his clinical condition led to an eventual diagnosis of Chiari malformation (type I), which required surgical intervention. Implications Non-typical recovery patterns of concussion may be indicative of increased severity when considered retrospectively. However, clinicians should not discount the possibility of underlying conditions.
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Affiliation(s)
- S Bosch
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa,FIFA Medical Centre of Excellence, Stellenbosch University,
South Africa,Campus Health Service, Stellenbosch University,
South Africa,Catholic University of Leuven, Department of Physical Medicine and Rehabilitation, Leuven,
Belgium
| | - PL Viviers
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa,IOC Research Centre, Cape Town,
South Africa,FIFA Medical Centre of Excellence, Stellenbosch University,
South Africa,Campus Health Service, Stellenbosch University,
South Africa
| | - R de Villiers
- Winelands Radiology, Institute of Orthopaedics and Rheumatology, Stellenbosch,
South Africa
| | - W Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa,IOC Research Centre, Cape Town,
South Africa,FIFA Medical Centre of Excellence, Stellenbosch University,
South Africa
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Schultz V, Stern RA, Tripodis Y, Stamm J, Wrobel P, Lepage C, Weir I, Guenette JP, Chua A, Alosco ML, Baugh CM, Fritts NG, Martin BM, Chaisson CE, Coleman MJ, Lin AP, Pasternak O, Shenton ME, Koerte IK. Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players. J Neurotrauma 2017; 35:278-285. [PMID: 28990457 DOI: 10.1089/neu.2017.5145] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Thalamic atrophy has been associated with exposure to repetitive head impacts (RHI) in professional fighters. The aim of this study is to investigate whether or not age at first exposure (AFE) to RHI is associated with thalamic volume in symptomatic former National Football League (NFL) players at risk for chronic traumatic encephalopathy (CTE). Eighty-six symptomatic former NFL players (mean age = 54.9 ± 7.9 years) were included. T1-weighted data were acquired on a 3T magnetic resonance imager, and thalamic volumes were derived using FreeSurfer. Mood and behavior, psychomotor speed, and visual and verbal memory were assessed. The association between thalamic volume and AFE to playing football and to number of years playing was calculated. Decreased thalamic volume was associated with more years of play (left: p = 0.03; right: p = 0.03). Younger AFE was associated with decreased right thalamic volume (p = 0.014). This association remained significant after adjusting for total years of play. Decreased left thalamic volume was associated with worse visual memory (p = 0.014), whereas increased right thalamic volume was associated with fewer mood and behavior symptoms (p = 0.003). In our sample of symptomatic former NFL players at risk for CTE, total years of play and AFE were associated with decreased thalamic volume. The effect of AFE on right thalamic volume was almost twice as strong as the effect of total years of play. Our findings confirm previous reports of an association between thalamic volume and exposure to RHI. They suggest further that younger AFE may result in smaller thalamic volume later in life.
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Affiliation(s)
- Vivian Schultz
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Robert A Stern
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,4 Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Yorghos Tripodis
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Julie Stamm
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,6 Department of Kinesiology, University of Wisconsin , Madison, Madison, Wisconsin
| | - Pawel Wrobel
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Christian Lepage
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,7 Department of Psychology, University of Ottawa , Ottawa, Ontario, Canada
| | - Isabelle Weir
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Jeffrey P Guenette
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alicia Chua
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael L Alosco
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Christine M Baugh
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,9 Interfaculty Initiative in Health Policy, Harvard University , Boston, Massachusetts
| | - Nathan G Fritts
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Brett M Martin
- 10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine E Chaisson
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Michael J Coleman
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alexander P Lin
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,11 Center for Clinical Spectroscopy , Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ofer Pasternak
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Martha E Shenton
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,12 VA Boston Healthcare System, Brockton Division, Brockton, Massachusetts.,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Inga K Koerte
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany .,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
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5
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Blumenfeld RS, Winsell JC, Hicks JW, Small SL. The Epidemiology of Sports-Related Head Injury and Concussion in Water Polo. Front Neurol 2016; 7:98. [PMID: 27445965 PMCID: PMC4919321 DOI: 10.3389/fneur.2016.00098] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose Water polo is a sport with a high degree of physicality and aggressive play. Unlike most contact sports, epidemiological data on the incidence or prevalence of head trauma in water polo have not been gathered, reported, or made publicly available. The purpose of this study was to begin a systematic characterization of the risks of head impact and concussion in men and women who play water polo at various levels. Design We sent an electronic survey to the 44,000+ members of USA Water Polo, asking questions about concussions, head impacts, and symptoms commonly associated with prior concussion. From over 1500 complete responses, we report summary information on the prevalence of concussions and major head impacts in water polo. Results We found that 36% of respondents report sustaining a concussion while playing water polo, with an average of two concussions reported. The prevalence and number of concussions reported varied across positions, levels, and gender. Most strikingly, we found that goalies are at significantly higher risk for concussion, report a significantly more concussions, and appear to experience a qualitatively different type of head impact compared to other positions. Additionally, we found that competition level, gender, and field position are robust predictors of concussion risk. Conclusion Our findings demonstrate that concussions are not uncommon in water polo players. We conclude that there is need for systematic concussion reporting in water polo and suggest that understanding the risk factors of concussion in water polo will require fully considering differences in the head impact exposure between different field positions, competition levels, sexes, and differences in exposure between competition and practice.
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Affiliation(s)
- Robert S Blumenfeld
- Department of Psychology and Sociology, California State Polytechnic University, Pomona, CA, USA; Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Jessica C Winsell
- Department of Neurology, University of California Irvine , Irvine, CA , USA
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California Irvine , Irvine, CA , USA
| | - Steven L Small
- Brain Circuits Laboratory, Biological Sciences III, University of California Irvine , Irvine, CA , USA
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