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Calculating the risk of brain injury
At the end of January, the New York Times
reported the death of a sixth former
National Football League (NFL) player
who died under the age of 50 suffering
from brain damage normally associated
with boxers.
The report casts a shadow over American
football which has already been confronted
with growing medical evidence that its
players face significant risk of developing
brain damage.
Determining who is at risk of this brain
damage is part of the problem.
Dr. John Stiller, the chief physician of the
Maryland State Athletic Commission, may
soon be able to help solve this dilemma
with a study of boxers that could have
far-reaching implications for all contact
sports.
The Maryland commission and Stiller
have devised a test to determine whether
boxers are developing symptoms that
could be an indicator of more-serious
brain disorders as they age.
“We are talking about how to limit the
number of people who end up with
chronic traumatic brain injury and who
end up disabled,” said Stiller, the chief
neurologist at St. Elizabeth’s Hospital in
the District.
The results of this study would be useful
not only in boxing but in football and all
other contact sports in which incidences of
concussion are high. Players are uncertain
of the risks they take when they return to
the field after blows to the head.
“We are hopeful this study will have a
significant impact on all athletes,” said
Patrick Pannella, executive director of the
Maryland State Athletic Commission.
“Football is a physical game. Boxing is
a physical game. I would say it could
have a lot of value for football players,
anyone who is subjecting themselves to
concussions and other injuries. Getting hit
in the head is a part of the game.”
Stiller is looking to define ways to discover
brain injuries and reduce the incidence of
occurrence.
“The big stumbling block [Stiller] had was
that boxers and trainers and managers
normally don’t want to participate in tests
that would prevent a boxer from fighting,”
Pannella said.
“He and I came up with the idea that we
would conduct this study at boxing weigh-
ins. There is down time, particularly at the
club level, at boxing weigh-ins, where the
fighters are waiting for the next test or
the paperwork to be done or the medical
examination, so this was the perfect time
to do it.
“Then we had to convince the boxers it
was OK,” he added. “So this is a voluntary
study where boxers do not have to
participate. When they do participate,
they become anonymous. They are given
a number, and the doctors who conduct
the study cannot give any information to
the commission.”
All fighters licensed in Maryland must
pass a neurological exam, so anyone
who already had developed a problem
that comes up in such tests would not be
licensed. The study, though, is designed
to discover visible indicators that show
up before any symptoms do in standard
neurological testing.
This study, which began in 2003 and so
far has included nearly 250 fighters, is
an effort to chronicle a boxer’s symptoms
throughout his career, looking for changes
from test to test.
Stiller hopes to complete a paper on the
preliminary findings soon. He also hopes
to expand the study to convince other
commissions to take part as well.
“It is a simple protocol and takes about
10 to 15 minutes in private,” Stiller said.
“We gather some basic information, such
as how much a fighter spars. Some of our
data already shows that sparring is very
important. We ask for an estimate on how
often they spar, how many ground and to
what degree to get a cumulative sparring
index. Those with a high amount tend to
do worse.”
Other tests include a smell identification
test, a symbol digit modality test and a
balance test.
“If we can go back and see if their smell
was changing or some combination, we
may be able to find a window to tell
people, ‘Stop now and your chances of
developing this [brain damage] will be
small compared to if you keep going,’ “
Stiller said. “By the time you know you
have it, it is too late.”
The NFL and other contact sports may
find this study unlocks the mysteries of
brain injuries.
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