Neuropsychological impairment as a consequence of football (soccer) play and football heading: A preliminary analysis and report on school students (13–16 years)

Footballers run the risk of incurring mild head injury from a variety of sources, including the intentional use of the head to play the ball, known as heading. This paper presents a preliminary exploratory analysis of data collected to examine whether cumulative incidence of mild head injury, or cumulative heading frequency, are related to neuropsychological functioning in male adolescent footballers. In a quasi-experimental cross-sectional design, neuropsychological test scores of school team footballers were compared with those of similarly aged rugby players and noncontact sport players. Cumulative mild head injury incidence was estimated using self-reports, and cumulative heading was estimated using a combination of observation and self-reports. No participants had sustained a head injury within 3 months of testing. There was no relationship between head injury and neuropsychological performance, and there were no decrements in either the footballers or the rugby players in comparison with the noncontact sport players. Within the footballers, cumulative heading did not predict any of the neuropsychological test scores. These findings indicate the absence of neuropsychological impairment arising due to cumulative mild head injury incidence, or cumulative heading. Although these null findings may be reassuring to players, parents, and football organizers, we stress that they are preliminary. Further data is being collected from the same populations to provide more reliable effect estimates.     

Neuropsychological impairment as a consequence of football (soccer) play and football heading: a preliminary analysis and report on school students (13-16 years).

Footballers run the risk of incurring mild head injury from a variety of sources, including the intentional use of the head to play the ball, known as heading. This paper presents a preliminary exploratory analysis of data collected to examine whether cumulative incidence of mild head injury, or cumulative heading frequency, are related to neuropsychological functioning in male adolescent footballers. In a quasi-experimental cross-sectional design, neuropsychological test scores of school team footballers were compared with those of similarly aged rugby players and noncontact sport players. Cumulative mild head injury incidence was estimated using self-reports, and cumulative heading was estimated using a combination of observation and self-reports. No participants had sustained a head injury within 3 months of testing. There was no relationship between head injury and neuropsychological performance, and there were no decrements in either the footballers or the rugby players in comparison with the noncontact sport players. Within the footballers, cumulative heading did not predict any of the neuropsychological test scores. These findings indicate the absence of neuropsychological impairment arising due to cumulative mild head injury incidence, or cumulative heading. Although these null findings may be reassuring to players, parents, and football organizers, we stress that they are preliminary. Further data is being collected from the same populations to provide more reliable effect estimates.     

The accuracy of footballers' frequency estimates of their own football heading

A number of studies have suggested that football heading is associated with neuropsychological impairment. However, analyses indicating such a relationship have employed footballers' subjective estimations rather than objective measures of their heading frequency. This is despite frequency estimation research suggesting that such subjective estimations would be inaccurate. In two studies examining the relationship between footballers' heading frequency estimates and their observed heading frequency, footballers' estimates were found to be inaccurate, but positively related to their actual heading frequency. However, there were differences in estimate accuracy between studies. Possible reasons for these differences are discussed and recommendations are made for studies examining the relationship between heading frequency and neuropsychological impairment. Copyright © 2005 John Wiley & Sons, Ltd.     

Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

The relationship of neuropsychological impairment to conduct disorder in adolescence: A conceptual review

This review is an attempt to expand the understanding of the neuropsychological mechanisms that may influence the expression of violent or aggressive behavior in adolescents. Although a relative large literature of adult studies examining the relation of neuropsychological impairment and aggression exists, the research literature investigating this relationship in adolescents is much smaller. With a few exceptions, the delinquent literature suffers from methodological problems, including biased sampling methods, small numbers of subjects, failing to objectively diagnose conduct disorder, incorrect use of specific statistical procedures, and lacking of appropriate control groups. In general, a mixed pattern of neuropsychological deficits are displayed across studies, depending on the sampling method, methodological design, statistics employed, control groups, and assessment tools that were utilized. Verbal deficits have been frequently displayed across the literature, while evidence for executive dysfunction varies, depending on the specific construct being evaluated (e.g., attention, cognitive flexibility, concept formation, planning abilities) and the specific population. Relatively inconsistent findings have been observed for visuospatial, sensory, and motor deficits. This article provides a critical review of this literature and discusses the varying impact that any neurological insult will have, depending on premorbid personality and cognitive functioning, location of the lesion, age at which the injury occurred, child's pre- and postinjury environment, and ability of the brain to adapt to acquired deficits as the result of the insult. On the basis of this review and neuropsychological theory, four subgroups within this population are proposed (i.e., adolescents with subcortical injuries, dominant hemisphere temporal-parietal injuries, nondominant hemisphere temporal-parietal injuries, and injuries to the prefrontal regions), which may better explain the neuropsychological and behavioral outcomes exhibited by this heterogeneous population. Recommendations for future research are offered.     

Modeling the Ecological Validity of Neurocognitive Assessment in Adults with Acquired Brain Injury

Neuropsychologists are increasingly asked to make judgments regarding treatment options and rehabilitation strategies in addition to evaluating the degree and scope of neuropsychological impairment following acquired brain injuries. The capacity to make informed clinical decisions relies upon research investigating the relationships between neuropsychological and psychosocial status (i.e., ecological validity). Unfortunately, much of this research employs exploratory analyses, an approach that can lead to theoretical ambiguity and ad-hoc interpretations. The current availability and accessibility of analytical tools, like structural equation modeling (SEM), however, permits the testing of specific hypotheses regarding ecological validity and promotes a-priori theory development. In the current study, a theory-driven model of the ecological validity of a neurocognitive assessment was tested against data obtained from individuals with acquired brain injury using SEM. The results provide confirmatory evidence for the ecological validity of neurocognitive constructs and empirical support for a theory-driven analytical approach to ecological validity research.     

Alcohol,head injury,and neuropsychological function

Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.     

Ethics,Brain Injuries,and Sports: Prohibition,Reform, and Prudence

Abstract

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on (a) the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative brain disease known as chronic traumatic encephalopathy (CTE); and (b) John Stuart Mill’s rejection of consensual domination (ie voluntary enslavement). We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that (i) certain autonomy-based arguments undermine paternalist arguments for reform; (ii) the nature of the goods people pursue in their lives might justify their foregoing (degrees of) future autonomy; (iii) Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; (iv) the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded.     

The neuropsychological profile in unipolar depression

There is a wealth of empirical data pertaining to the issue of neuropsychological impairment in depression. However, a coherent and comprehensive framework for understanding the disorder remains elusive. This review will briefly consider some of the important issues on which recent research has focused. It would be premature to derive firm conclusions in an area characterized by considerable confusion, so the aim of this review is to highlight the key areas that must be addressed. Three distinct questions are considered. The first concerns the neuropsychological specificity of the deficits associated with depression; whether they represent selective deficits or a more general profile of impairment. The second question is to determine how cognitive deficits might relate to clinical and demographic factors, including symptom severity, hospitalization, medication and ageing. Finally, a comprehensive theory of depression must also relate impairments to neuropathology, and evidence is now available from imaging studies that have attempted to elucidate neural substrates of neuropsychological deficits.     

Turning it Upside Down: Areas of Preserved Cognitive Function in Schizophrenia

Patients with schizophrenia demonstrate marked impairments on most clinical neuropsychological tests. These findings suggest that patients suffer from a generalized form of cognitive impairment, with little evidence of spared performance documented in several large meta-analytic reviews of the clinical literature. In contrast, we review evidence for relative sparing of aspects of attention, procedural memory, and emotional processing observed in studies that have employed experimental approaches adapted from the cognitive and affective neuroscience literature. These islands of preserved performance suggest that the cognitive deficits in schizophrenia are not as general as they appear to be when assayed with clinical neuropsychological methods. The apparent contradiction in findings across methods may offer important clues about the nature of cognitive impairment in schizophrenia. The documentation of preserved cognitive function in schizophrenia may serve to sharpen hypotheses about the biological mechanisms that are implicated in the illness.     

Walk the Talk: Financial Fairness in European Club Football

UEFA’s Financial Fair Play (FFP) regulations represent the most restrictive regulatory intervention European club football has ever seen. Put simply, it demands from clubs to operate on the basis of their own football-related incomes. While the policy has attracted considerable attention from the economic and social sciences, very few contributions systematically investigate it from a philosophical-ethical perspective. The present paper fills this research gap by posing questions on FFP in relation to fair play as a normative concept. We draw on sport economic assessments concerning potential outcomes of FFP and argue that the policy should go beyond the mere pragmatic goal of promoting financial sustainability and truly aim for creating a level playing field, otherwise it should not be labeled ‘fair play’.     

Neuropsychological Findings in Congenital and Acquired Childhood Hydrocephalus

Hydrocephalus is an increase in cerebrospinal fluid volume that can be caused by a variety of etiologies. The most common connatal and acquired causes of hydrocephalus are spina bifida, aqueduct stenosis, and preterm low birthweight infants with ventricular hemorrhage. In general, the literature suggests mild neuropsychological deficits associated with hydrocephalus, which are predominant in visuospatial and motor functions, and other nonlanguage skills. Although the precise nature of the neuropsychological deficits in hydrocephalus are not completely known, several factors such as etiology, raised intracranial pressure, ventricular size, and changes in gray and white matter tissue composition as well as shunt treatment complications have been shown to influence cognition. In fact, the presence of complications and other brain abnormalities in addition to hydrocephalus such as infections, trauma, intraventricular hemorrhage, low birthweight, and asphyxia are important determinants of the ultimate cognitive status, placing the child at a high risk of cognitive impairment.     

Central executive system impairment in traumatic brain injury

The aim of the present study was to identify cognitive functions affected by traumatic brain injury (TBI) and to verify the mechanism underlying cognitive impairment. More precisely, cognitive deficits following TBI can be considered as a consequence of (a) a speed processing deficit, that is a general slowing of perceptual, motor and cognitive subroutines; (b) an impairment of the Central Executive System of working memory (CES).Thirty-seven patients were submitted to a neuropsychological battery, aimed to evaluate different cognitive functions.Results showed severe deficits in speed processing, divided attention,working memory, executive functions and long term memory.Regression analyses, performed to test the two hypotheses, showed that the working memory deficit hypothesis is able to explain divided attention, executive functions and long term memory deficits more than speed processing hypothesis.     

Cognitive Event-Related Potentials in Neuropsychological Assessment

Neuropsychology is a behavioral approach to studying the brain, and an integration of neuropsychology with on-line processing measures of brain function is important for advancing the understanding of brain–behavior relationships. Cognitive event-related potentials (ERPs) are on-line processing measures that are of interest to neuropsychologists because they are linked to familiar neuropsychological test paradigms and because they have reached a degree of standardization sufficient to make them applicable in individual assessment. A selective review of cognitive ERPs is given, focusing on studies of attention in the oddball paradigm and arguing that an adequate assessment of attention is basic in understanding higher order cognitive functions. General principles for using ERP data to supplement and clarify neuropsychological analysis are discussed, and available evidence on dementia and traumatic head injury is reviewed. It is concluded that ERPs are a useful supplement to neuropsychological assessment. Although diagnostic use of ERPs must be guarded because of limited standardization and validation, information-processing analysis with ERPs may aid significantly in interpretation of behavioral data.     

Two Kinds of Brain Injury in Sport

Abstract

After years of skepticism and denials regarding the significance of concussions in sport, the issue is now front and center. This is fitting, given that the impact of concussions in sport is profound. Thus, it is with trepidation that one ventures to direct some attention onto brain injuries other than concussions incurred through sport. Given a closer look, however, it may be that considering various kinds of brain injuries, with different causes, will help us better understand the range and seriousness of brain injuries in sport. My focus is on emotional trauma in sport. I argue that severe emotional pathology is evidence of underlying brain injury. Any attempt to minimize the significance of emotional disturbance that results from emotional trauma as ‘merely’ psychological in nature is thus misguided.     

Chronic Pain and Neuropsychological Functioning

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.     

Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents

Previous studies suggest that neuropsychological impairment following mild to moderate pediatric head injury may become persistent and interrupt the normal course of intellectual development. In this study 45 subjects were assessed with a standardized neuropsychological test battery 25 years after sustaining mild to moderate head injury as children. Although the group scores in the normal range, significant relations between head injury severity and current neuropsychological function were found. The most important predictor of poor outcome was length of PTA at injury, EEG pathology, and loss of consciousness at injury. No significant influence of pre- and post-injury risk factors on current neuropsychological function was evident. The findings support the view that complicated mild and moderate paediatric head injury may heighten the risk of developing subtle neuropsychological problems later in life.     

Restoring More than Smiles in Broken Homes: Dental and Oral Biomarkers of Brain Injury in Domestic Violence

ABSTRACT

While much of the focus on brain injury has centered on athletes and military veterans, victims of domestic violence (DV) comprise an under-represented cohort. Epidemiological studies show that a majority of domestic violence cases have a history of trauma to the head or neck resulting in both TBI and oral maxillofacial damage. However, distinctive oral injuries that are sustained simultaneously with brain trauma as a result of DV have yet to be fully elucidated. If a correlation can be made between specific oral injuries and TBI, then dentition may serve as a reliable biomarker for TBI. Specific dental biomarkers of injury would improve identification, diagnosis, and prognosis of TBI regardless of patient declamation. Dentists have the opportunity and obligation to add significantly to the body of knowledge regarding the frequency, presentation, profile, and characteristics of head and neck injuries of TBI in victims of DV. In so doing, the effort will fill the knowledge gaps and clarify misinformation in the lay, clinical, and scientific communities regarding the impact of TBI in DV events. The dental field can become a leader in branding the procedures, protocols, and clinical practices in the recognition and intervention against TBI in the DV population.     

Sensitivity and specificity of reliable digit span in malingered pain-related disability

The reliable digit span (RDS) performance of chronic pain patients with unambiguous spinal injuries and no evidence of exaggeration or response bias (n = 53) was compared to that of chronic pain patients meeting criteria for definite malingered neurocognitive dysfunction (n = 35), and a group of nonmalingering moderate-severe traumatic brain injury (TBI) patients (n = 69). The results demonstrated that scores of 7 or lower were associated with high specificity (> .90) and sensitivity (up to .60) even when moderate to severe TBI are included. Multiple studies have demonstrated that RDS scores of 7 or lower rarely occur in TBI and pain patients who are not intentionally performing poorly on cognitive testing. This study supports the use of the RDS in detecting response bias in neuropsychological patients complaining of pain as well as in the assessment of pain-related cognitive impairment in patients whose primary complaint is pain.