Athletic exposure to repetitive brain trauma and its effect on the development of chronic traumatic encephalopathy

Thesis (Ph.D.)--Boston UniversityChronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease marked by widespread accumulation of hyperphosphorylated tau (ptau). CTE is associated with a constellation of symptoms, including impairments in cognition, behavior, and mood. Although initially described in boxers as dementia pugilistrca, CTE has been diagnosed in athletes from a variety of backgrounds, as well as military veterans and other individuals exposed to traumatic brain injury (TBI). To date, the only shared risk factor for CTE is a history of single or multiple TBI. This work aimed to better elucidate the relationship between exposure to head impacts and the development and progression of CTE. Although the link between brain injury and CTE has been well described, the magnitude of this relationship has never been studied epidemiologically. The minimum prevalence of CTE was determined in a cohort at high risk of exposure to head impacts, specifically National Football League (NFL) athletes. All former NFL athletes who passed away in 2011 were identified; a subset of these athletes were studied and diagnosed with CTE to establish a minimum prevalence of CTE. The characteristics of those examined and diagnosed with CTE and those undiagnosed were explored. These analyses represent the first epidemiologic study of CTE; the high prevalence highlights the relationship between exposure to head impacts and the diagnosis of CTE. Next, the relationship between the nature of athletic exposure and CTE was quantified. An athletic history questionnaire was developed and integrated into a mathematical model, incorporating data from sensors placed in football players' helmets, to identify the theoretical frequency and magnitude of an athlete's head impact exposure. This model was adapted for use postmortem, and it was found that the duration of athletic exposure, total theoretical collisions experienced; and the sum of the 95th percentiles of the rotational acceleration endured, were all significantly associated with extent of CTE pathology. The relationships between the type of athletic exposure and the clinical presentation of disease and the specific neuroanatomic distribution of p-tau were also explored. These findings indicate the significant role of athletic exposure to head impacts on the diagnosis and progression of CTE, clinically and pathologically

A NOVEL MULTI-MODAL, WEARABLE SENSING SYSTEM TO AUTOMATICALLY QUANTIFY CHANGES IN EXTRAVASCULAR FLUID LEVELS

The buildup of static edematous fluids (swelling) in the tissue is indicative of a serious medical condition that can lead to long-term tissue damage, reduction in mobility and in some cases loss of limb. This swelling can be due to internal factors such as an immunoresponse to injuries or infections, or external factors such as a leakage of infused intravenous medication to the surrounding tissue (i.e., IV infiltration or extravasation). Detecting and tracking changes in a tissue’s extracellular fluid content is crucial in diagnosing the severity of the injury and/or infection, and thereby preventing irreversible tissue damage. However, current methods for quantifying fluid levels in the extravascular space are either (1) manual and subjective, relying heavily on the medical staff’s expertise, or (2) costly and timely, such as X-rays or magnetic resonance imaging (MRI). In this dissertation, I present non-invasive wearable technologies that utilize localized bioimpedance contextualized by the tissue’s kinematics to robustly quantify changes in the biological tissue’s extracellular fluid content. Towards this goal, several robust and miniaturized systems are designed and implemented by researching different integrated circuits, analog front ends, and novel physiology-driven calibration techniques that together increase the system’s accuracy and reduce its size and power consumption. Next, novel methods and algorithms are developed to allow for unobtrusive real-time detection of changes in extracellular fluid content. The systems, methods and algorithms were validated in human subjects studies, animal models and cadaver models for ankle edema tracking, and in human subjects studies and animal tissue for intravenous infiltration detection.Ph.D

Validação do equipamento Tanita TBF-310 na estimação da composição corporal tendo como referência um modelo molecular a quarto compartimentos em judocas

A avaliação da composição corporal, especialmente ao nível das componentes moleculares,é relevante para a população atlética pela sua relação com o desempenho desportivo. Sabe-se que o modelo molecular a quatro compartimentos (4C) é o método de referência na avaliação da massa gorda (MG). No entanto, a sua implementação em contexto real é impraticável. Deste modo, treinadores e atletas procuram informar-se sobre a composição corporal usando os métodos mais acessíveis, onde a bioimpedância elétrica (BIA) se engloba, e mais ainda em desportos onde o peso é seletivo para a competição, como é o caso dos desportos de combate. A literatura mostra que existem diversas equações e equipamentos que utilizam a BIA mas poucos estudos foram conduzidos para determinar a sua validade na população atlética. O objectivo deste estudo é determinar a validade da BIA (Tanita, modelo TBF-310) na determinação da MG e massa isenta de gordura (MIG) em judocas de elite. Um total de 29 atletas, do sexo masculino, foram avaliados num período de estabilidade do peso entre Setembro e Outubro pelo método de referência (4C) e método alternativo (Tanita). Realizaram-se comparações de médias, coeficiente de correlação de concordância, regressões lineares e análises de concordância entre métodos. Para valores absolutos, a MG obtida pela Tanita sobrestimou os valores obtidos pelo método de referência (4 compartimentos) embora não existam diferenças entre os métodos na diferença da MIG. A Tanita apresentou um poder explicativo de 21% e 72% na estimação de valores absolutos de MG e MIG obtidos, respectivamente, pelo método de referência. Os limites de concordância foram elevados e variaram entre -6,7kg a 7,0 kg para a MG e de -8,9kg a 7,5kg para a MIG. Em suma, o modelo usado neste estudo (Tanita TBF-310) não é uma alternativa válida na determinação da composição corporal em judocas de elite.Body composition assessment at the molecular level is relevant for the athletic population and its association with high performance is also recognized. It’s known that the four compartment molecular model (4C) is the reference method for fat mass (FM) estimation. However, its implementation in the real context is not feasible. Coaches and athletes need practical body composition methods for body composition assessment and the bioelectrical impedance analysis method (BIA) is usually seen as an useful alternative. Several BIA equations and devices are available but few studies were conducted to test its validity in an athletic population. The aim of this study is to test the validity of BIA (Tanita, TBF-310) in the determination of fat mass (FM) and fat-free mass (FFM) in judo elite athletes. A total of 29 male athletes were evaluated in a period of weight stability between September and October using the reference method (4C) and the alternative method (Tanita). FM from Tanita overestimated the reference method although no difference was found for FFM. Tanita explained 21% and 72% respectively in the estimation of absolute values of FM and FFM from the reference method. Limits of agreement were large varying from -6,7kg to 7,0kg for FM and from -8,9kg to 7,5kg FFM. The TBF-310 Tanita is not a valid alternative method for estimating body composition in this top-level population of judo athletes

Creatine Supplementation for Health and Clinical Diseases

Creatine plays a critical role in cellular metabolism, primarily by binding with phosphate to form phosphocreatine (PCr) as well as shuttling high-energy phosphate compounds in and out of the mitochondria for metabolism. Increasing the dietary availability of creatine increases the tissue and cellular availability of PCr, and thereby enhances the ability to maintain high-energy states during intense exercise. For this reason, creatine monohydrate has been extensively studied as an ergogenic aid for exercise, training, and sport. Limitations in the ability to synthesize creatine and transport and/or store dietary creatine can impair metabolism and is a contributor to several disease states. Additionally, creatine provides an important source of energy during metabolically stressed states, particularly when oxygen availability is limited. Thus, researchers have assessed the role of creatine supplementation on health throughout the lifespan, as well as whether creatine availability may improve disease management and/or therapeutic outcomes. This book provides a comprehensive overview of scientific and medical evidence related to creatine's role in metabolism, health throughout the lifespan, and our current understanding of how creatine can promote brain, heart, vascular and immune health; reduce the severity of musculoskeletal and brain injury; and may provide therapeutic benefits in glucose management and diabetes, cancer therapy, inflammatory bowel disease, and post-viral fatigue

Exercise Evaluation and Prescription

This is a reprint of articles from the Special Issue published online in the open access journal Journal of Functional Morphology and Kinesiology (ISSN 2411-5142) available at https://www.mdpi.com/journal/jfmk/special_issues/Exercise_Evaluatio

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients

Proceedings of the 11th International Conference on Kinanthropology

The 11th International Conference on Kinantropology was held on the Nov 29 – Dec 1, 2017 in Brno and was organized by the Faculty of Sports Studies, Masaryk University and the Faculty of Kinesiology, University of Zagreb. This year was divided into several themes: sports medicine, sport and social science, sport training, healthy lifestyle and healthy ageing, sports management, analysis of human movement. Part of the conference was also a symposium Atletika and Ortoreha that gathered specialists in physiotherapy

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require