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Biomechanics of Brain Injury in Boxing

Adam Bartsch, PhD; Jay Alberts, PhD; and Edward Benzel, MD

Boxing Biomechanics Study

Researchers from the Center for Spine Health’s Spine Research Laboratory are joining with colleagues from Cleveland Clinic’s Concussion Center and Lou Ruvo Center for Brain Health on an investigation we call the Boxing Biomechanics Study. We are using all three modalities — imaging, behavioral assessment and evaluation of impact dynamics — to begin to pinpoint the dose of head impact that produces brain changes linked to neurodegenerative disease. Our aim is to assess and refine this three-pronged data-gathering approach in a small group of boxers and mixed martial arts fighters to build toward prospective longitudinal studies in large numbers of athletes tracked over years or decades.

We began the Boxing Biomechanics Study earlier this year and expect to report final results in 2014. We are enrolling 10 boxers or mixed martial artists in Las Vegas who are evaluated over one to two days as follows:

• They undergo a baseline brain MRI and a baseline assessment of motor and cognitive functions via the Cleveland Clinic Concussion (C3) App for the iPad

• They take part in a sparring session wearing the Cleveland Clinic Intelligent Mouthguard to capture head impact data. The Intelligent Mouthguard, developed by Spine Research Laboratory and Concussion Center researchers, is equipped with sensors to measure linear and rotational head movement in real time. These data are compared with neurological and motor test results from after the sparring session to drive a computer-based brain model that helps diagnose and pinpoint brain injuries.

• Right after the session, they undergo a post-sparring C3 App assessment and brain MRI. We are analyzing and correlating data from all three modalities in this initial group of 10 fighters in the hope that this approach will prove to be a comprehensive, “one stop” data collection strategy for assessing and quantifying the dose of head impact causing neurodegenerative changes. After we refine our data collection and technologies based on these findings, our next steps will be to expand the study population closer to 100 fighters and ultimately to 1,000 or more. Likewise, we hope to extend follow-up assessments to years and even decades if we can follow fighters who turn professional — a prospect facilitated by the Lou Ruvo Center’s presence in Las Vegas. This presence, paired with Cleveland Clinic’s deep concussion expertise, uniquely positions us to comprehensively pursue new insights into how impact-related brain injury occurs, how it relates to clinical deficits, and which types of impacts do and do not cause concussion or other forms of traumatic brain injury.

Next Studies Take Flight with FAA Grant

One of our follow-on studies to the Boxing Biomechanics Study is now getting underway. This investigation, funded by a three-year grant from the Federal Aviation Administration (FAA), aims to determine the level of head impact that causes a human to lose consciousness. The FAA is also looking to identify the types and degrees of functional deficits present right after a person loses consciousness and how long it takes to recover from those deficits following various degrees of impact. For the FAA, the findings have implications for safety procedures in the event of a pilot’s loss of consciousness and for determining if recovery could be swift enough to permit timely exit from an aircraft. Because boxers and mixed martial artists represent essentially the only population of humans in whom it is feasible to study the threshold of consciousness loss, our work on the Boxing Biomechanics Study has optimally prepared Cleveland Clinic for performing this type of research. The study for the FAA is being conducted in fighters during professional fights, as loss of consciousness is rare during sparring sessions. We are spending the first 12 months of the study modifying the Intelligent Mouthguard for use in professional fights, which requires placement of the device’s battery in the mouthpiece rather than the headgear, and coordinating use of the Intelligent Mouthguard with the C3 App for the new research questions at hand. The next 12 months will involve collecting data with the modified mouthguard and C3 App from a series of professional fights. The final 12 months will involve data analysis and additional data collection from fights as needed.

A Coordinated Concussion Research Vision

As our studies of the biomechanics of impact-induced brain injury evolve, we are grateful for the comprehensive resources Cleveland Clinic brings to bear to help curb the concussion crisis. Our studies marrying the physics and acute clinical effects of brain injury are complemented by other Cleveland Clinic investigations utilizing pathbreaking radiology methods, novel blood biomarkers, genomic testing and pioneering pathology methods to better understand concussion and its prevention and treatment. They are part of an unparalleled and well-coordinated institutional vision to protect the brains of athletes, warriors and others from damaging impacts. We look forward to sharing our results and helping to advance this vision.

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