Newswise — Can the number of concussions in a football player influence the likelihood of developing chronic traumatic encephalopathy (CTE)? In an extensive study involving 631 deceased football players, the most comprehensive CTE investigation to date, researchers discovered that the mere quantity of diagnosed concussions did not correlate with the risk of CTE. Rather, the chances of football players developing CTE were linked to both the frequency and intensity of the head impacts they experienced.
Today, a team of researchers from Mass General Brigham, Harvard Medical School, and Boston University (BU) published a study in Nature Communications. This study introduced a groundbreaking tool called a positional exposure matrix (PEM), which amalgamated data from 34 distinct studies to estimate the quantity and intensity of head impacts experienced by football players throughout their careers.
"According to Dr. Jesse Mez, the senior author of the study and Associate Professor at the BU Chobanian and Avedisian School of Medicine, as well as the Co-Director of Clinical Research at the BU CTE Center, these findings provide additional evidence that repetitive non-concussive head injuries play a significant role in the development of CTE pathology, contrary to what is commonly suggested in medical and general literature regarding the importance of symptomatic concussions."
The new data could provide football with a playbook to prevent CTE in current and future players, according to researchers.
"According to Dr. Dan Daneshvar, the lead author of the study, Assistant Professor at Harvard Medical School, and Physician at Spaulding Rehabilitation (affiliated with Mass General Brigham), this study indicates the potential to mitigate the risk of CTE by implementing modifications to the practice and gameplay of football. By reducing both the frequency and intensity of head impacts during training sessions and matches, we could decrease the likelihood of athletes developing CTE."
Using the innovative PEM tool, the researchers made estimations regarding the cumulative count of head impacts and the cumulative linear and rotational accelerations linked to those impacts, taking into account the positions and levels at which the athletes participated throughout their football careers. The study demonstrated that the cumulative exposure to repetitive head impacts (RHIs) exhibited a correlation with the CTE status, severity, and pathological burden observed in the football players. Furthermore, the study revealed that models utilizing the intensity of impacts were more effective in predicting CTE status and severity compared to models that solely considered the duration of play or the number of head hits.
The PEM proves to be an invaluable tool for researchers aiming to enhance their investigations into the risks associated with football play. Its utilization in future studies opens up opportunities to explore additional potential consequences of repetitive head impact (RHI) exposure beyond CTE. This enables researchers to gain a more comprehensive understanding of the particular types of RHI that are most likely to contribute to these issues.
Daneshvar noted, "While this study focused on football players, it offers valuable insights into the impact characteristics that play a significant role in CTE pathology beyond the realm of football. This is because the brain does not discriminate when it comes to the impacts it receives. The discovery that estimated lifetime force was associated with CTE in football players is likely applicable to other contact sports, military exposure, or incidents of domestic violence."
One limitation of the study is that it relied on a convenience sample of brain donors who were football players, and these individuals generally had higher exposure to repetitive head impact (RHI) compared to the broader population of football players. However, it is worth noting that a significant number of donors had lower levels of exposure. As a result, while the findings may not directly represent the entire population of football players, they can still be reasonably extrapolated to apply to the majority of football players.
The study received support in the form of grants and funding from various sources including the National Institutes of Health, Department of Veterans Affairs, Department of Defense, the Alzheimer's Association, the Nick and Lynn Buoniconti Foundation, the Concussion Legacy Foundation, the Adlinger Foundation, and World Wrestling Entertainment Inc. These organizations played a crucial role in providing financial assistance for the study to be conducted.
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