Watch your head: brain neurophysiology and contact sports

In the world of contact sports there is rising concern about the long-term effects of sport participation on athletes’ brains. Apart from concussions, the repetitive subconcussive head impacts (RSHI) in sports have been suggested to be detrimental for brain health. RSHI in football are thought to be linked with the onset of neurodegenerative diseases, like Chronic Traumatic Encephalopathy and Alzheimer’s disease. However, to understand how and why the athletes’ brains might suffer in the long-term, we should first understand the acute brain changes caused by the potential risk factors for brain damage (concussive and sub-concussive impacts). The experimental studies of this PhD thesis aim to investigate the acute effects of heading, the main source of RSHI in football, on the brain functions of athletes, by using a mixture of sensitive neuroscientific modalities. Secondary data is used in this thesis for method development and to examine the broader problem posed by sport-related head impact. Chapter 1 expands on the aims of the thesis. Chapter 2 presents the current state of the literature on RSHI. Chapter 3 includes a scoping review of the literature on biofluid markers use to assess the effects of RSHI highlighting the high heterogeneity of the existing studies and providing guidelines for future studies. Chapter 4 includes an investigation of the injury characteristics and prognosis of sport-related traumatic brain injury (TBI). It highlights the seriousness of sport-related TBI and specifically sport-related mTBI, whose remaining effects can potentially be worsened by the burden of RSHI during play. Chapter 5 investigated the effects of RSHI on balance in various ways, providing no evidence of an effect, while chapter 6 provides evidence for associative memory changes caused by heading. The following chapters (7 & 8) attempted to further examine the alterations in cognitive functioning post heading and present the first EEG evidence that the cognitive functions of attention, memory and learning are acutely affected by RSHI. After showing that RSHI affect mainly association learning and attention processes and not affect response inhibition, motor control and motor learning, chapter 9 aimed to examine the replicability of RSHI effects on motor cortex inhibition, providing evidence of no effect. The outcome of this thesis is that RSHI have detrimental effects to athletes’ cognition, mainly in the functions of learning and attention, while motor control appears to remain intact

Longer Neurophysiological vs. Clinical Recovery Following Sport Concussion

Objectives: The objective of this study was to assess if injury-related alterations in the Sport Concussion Assessment Tool-5 (SCAT5) are matched by changes in transcranial magnetic stimulation-derived intracortical inhibition. We hypothesised that neurophysiological measures would take longer to return to normal than recovery assessed by the SCAT5 following sport related concussion (SRC). Methods: Thirteen male contact sport athletes (20.5 ± 4.5 years), who reported a concussion were recruited from local Rugby and American football clubs. Participants were tested at 4 timepoints throughout the concussion recovery period: within 24 h of concussion (day 0), and at 7, 9, and 11 days after concussion. All participants completed the SCAT5 and underwent TMS to assess cortical silent period duration (CSp), a measure of intracortical inhibition. Results: After concussion CSp significantly declined from day 0 (122 ± 28 ms) to day 11 (106 ± 15 ms) [F(3, 33) = 7.80, p < 0.001]. SCAT5 measures of symptom number and severity were significantly decreased [symptom number: χ2(3) = 30.44, p < 0.01; symptom severity: χ2(3) = 25.75, p < 0.001] between the day 0 timepoint and each of the other timepoints. SCAT5 balance errors (mBESS) decreased significantly [F(3, 33) = 19.55, p < 0.001] between the day 0 timepoint and each of the other timepoints. CSp and SCAT5 recovery patterns were different. SCAT5 domains recovered faster showing no further significant changes after day 7, whilst CSp was still decreasing between days 7 and 9. Due to the small sample size we also used a Bayesian linear model to investigate the recovery of CSp and mBESS. The posterior distribution of our Bayesian model provided evidence that CSp decreased at day 7 and it continued to decrease at day 9, unlike mBESS which decreased at day 7 and then reached a plateau. Conclusion: There are clinically important discrepancies between clinical and neurophysiological measures of concussion recovery. This finding has important implications for return to play (RTP) protocols and the prevention of complications after sport concussion

The use of biofluid markers to evaluate the consequences of sport-related subconcussive head impact exposure : a scoping review

This review was supported by the University of Stirling (no grant number applies). L.W. also received support as part of Framework 7 programme of the European Union (CENTER-TBI, Grant number: 602150–2). S.M. received research support from the Italian Ministry of Health (GR-2013–02354960).Background Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. Objective This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. Methods PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. Results Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers—such as NfL—appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. Conclusion Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers’ utility.Publisher PDFPeer reviewe

Repeated Sub-Concussive Impacts and the Negative Effects of Contact Sports on Cognition and Brain Integrity

Sports are yielding a wealth of benefits for cardiovascular fitness, for psychological resilience, and for cognition. The amount of practice, and the type of practiced sports, are of importance to obtain these benefits and avoid any side effects. This is especially important in the context of contact sports. Contact sports are not only known to be a major source of injuries of the musculoskeletal apparatus, they are also significantly related to concussion and sub-concussion. Sub-concussive head impacts accumulate throughout the active sports career, and thus can cause measurable deficits and changes to brain health. Emerging research in the area of cumulative sub-concussions in contact sports has revealed several associated markers of brain injury. For example, recent studies discovered that repeated headers in soccer not only cause measurable signs of cognitive impairment but are also related to a prolonged cortical silent period in transcranial magnetic stimulation measurements. Other cognitive and neuroimaging biomarkers are also pointing to adverse effects of heading. A range of fluid biomarkers completes the picture of cumulating effects of sub-concussive impacts. Those accumulating effects can cause significant cognitive impairment later in life of active contact sportswomen and men. The aim of this review is to highlight the current scientific evidence on the effects of repeated sub-concussive head impacts on contact sports athletes’ brains, identify the areas in need of further investigation, highlight the potential of advanced neuroscientific methods, and comment on the steps governing bodies have made to address this issue. We conclude that there are indeed neural and biofluid markers that can help better understand the effects of repeated sub-concussive head impacts and that some aspects of contact sports should be redefined, especially in situations where sub-concussive impacts and concussions can be minimize