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Traumatic brain injury, concussion, and subconcussion are different clinical conditions associated with head injury. These conditions share a common origin, mechanical forces directly or indirectly transmitted to the head. In sports, modalities with high exposure to head traumas require further investigation, especially those in which strikes directly to the head are allowed and a determinant of success, such as combat sports. The causes and effects of brain injuries in combat sports such as Mixed Martial Arts, boxing, Muay Thai, and kickboxing are complex and require a comprehensive investigation of many factors. The objective of this dissertation was to explore the main causes that justify combat sports as the main sport sample when it comes to head injury and the effects of chronic exposure to head trauma in this population. Original studies were developed to assess the head injury risk in competition and in training, the level of knowledge of athletes and coaches, and the consequences of chronic exposure to head traumas in the balance function, brain activity, and spinal cord excitability. The risk of a fight ending due to head strikes in competition is directly related to the weight category, and the risk seems to be exacerbated in female athletes. Combat sports athletes are exposed to numerous strikes to the head in simulated fights on a weekly basis in training, when healthcare professionals are absent. During this time that makes up the bulk of exposures, therefore, athletes and coaches are the ones managing potential cases of concussion. However, coaches are not familiar with assessment tools and don’t often seek out concussion knowledge. Alarmingly, coaches, often prior athletes themselves, are the main source of concussion knowledge for their athletes. High exposure to head trauma both in competition and training in addition to iv poor knowledge and behavior are liable to cause consequences in the nervous system. Athletes chronically exposed to head trauma presented subtle deficits in static balance in the most basic human stance, which is the double-leg over a firm surface. Moreover, while the literature consistently shows impairments in brain function, our study expanded the association between head trauma and nervous system deficits to the least studied component of the nervous system, the spinal cord. While athletic training promotes neuroplastic benefits in spinal cord excitability, these were hindered in a sample of athletes chronically exposed to head traumas. The studies in this dissertation demonstrated that athletes in combat sports are chronically exposed to intentional and repetitive head traumas, and that this exposure is likely associated with long-term functional detriments in balance and spinal cord excitability. / Graduate

Unintentional injuries present a major threat to the health and welfare of humans. Over 120,000 deaths and over 30,000,000 non-fatal injuries are estimated annually in the United States. The leading causes of nonfatal injuries vary with age, but falls, motor vehicle collisions (occupants), and being struck by or against are among the top 4 leading causes of unintentional injury for all ages. The loading mechanism that cause forces to be transmitted to the body during these events can cause a wide assortment of injury types with a range of severities. Understanding the biomechanical response to loading in these environments can facilitate efforts in injury mitigation. Biomechanical responses can be quantified by performing controlled laboratory experiments with human volunteers and surrogates, such as anthropomorphic test devices (ATDs) and post mortem human surrogates (PMHSs). The overall objective of this dissertation is to quantify the biomechanical response to loading regimes present in motor vehicle collisions, falls, and when being struck by or against an object using human volunteers and surrogates. Specifically, the research will achieve the following: quantify the dynamic responses of human volunteers, Hybrid III ATD, and PMHSs in low-speed frontal sled tests; quantify the neck response of human volunteers and PMHSs in low-speed frontal sled tests; quantify the kinetic and kinematic responses of PMHSs and the Hybrid III ATD in high-speed frontal sled tests; characterize thoracic loading as a result of same level falls using a Hybrid III ATD; and quantify the ability of children to swing sword-like toys and the human kinematic response that could be anticipated as a result of forceful impact using a Hybrid III 6-year old head and neck. / Ph. D.

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L’exposition aux impacts commotionnels et sous-commotionnels est une préoccupation majeure dans les sports de contact en raison de leurs effets néfastes sur la santé cérébrale. Des changements physiopathologiques et neurocognitifs ont été constatés après une seule saison de football chez des athlètes exposés à des coups sous-commotionnels. Vu l'absence d'outils sur les lignes de côtés permettant d'identifier les coups sous-commotionnels potentiellement dangereux, il est crucial de mettre au point des mesures objectives pour évaluer les perturbations neuropsychologiques aiguës associées aux chocs à la tête dans les sports de contact. Cette étude a pour but de documenter l'association entre l'exposition aux impacts à la tête pendant un match de football universitaire et les changements à court terme de l’excitabilité du cortex moteur primaire (M1) à l'aide de la stimulation magnétique transcrânienne (SMT). À cette fin, vingt-neuf athlètes masculins de niveau universitaire ont porté des protège-dents instrumentés (iMG) pendant un match de football afin de mesurer l'exposition aux impacts à la tête. Les mesures SMT ont été effectuées 24 heures avant et 1 à 2 heures après le match. De plus, vingt athlètes de football assigné au groupe contrôle ont participé à une séance d'entraînement physique sans contact et ont effectué les mêmes mesures de SMT. Les résultats suggèrent que, par rapport au groupe contrôle, le groupe d'athlètes ayant joué un match de football présentait une désinhibition intracorticale significative (p=0,028) sur l'inhibition intracorticale à intervalle court (SICI 3-ms) après le match. Par ailleurs, les joueurs de football exposés à un plus grand nombre de coups de 40g+ et à des forces cumulées plus importantes dues à des chocs de 40g+ présentaient une désinhibition intracorticale plus importante après le match. Compte tenu les effets délétères d'une diminution de l'inhibition sur le contrôle moteur et l'équilibre, suivre de manière systématique l'exposition aux impacts à la tête des athlètes tout au long de la saison pourrait s'avérer avantageux pour la gestion clinique des risques de blessure. Ces changements observés renforcent la conviction qu’il est nécessaire d’investiguer davantage les effets à long terme de l’exposition aux impacts sous-commotionnels. / Repetitive head impacts and sport-related concussions are significant concerns in contact sports due to their adverse effects on brain health. Pathophysiological and neurocognitive changes have been found after a single season of football in athletes exposed to subconcussive hits. Considering the lack of sideline tools to identify potentially dangerous subconcussive hits, coming up with objective measures to evaluate acute neurologic impairments associated with head impacts in contact sports is crucial from a clinical standpoint. The current project aimed to investigate the association between head impact exposure (HIE) during a varsity football game and short-term changes in cortical excitability of the primary motor cortex (M1) using transcranial magnetic stimulation (TMS). To this end, we conducted a study, in which twenty-nine university-level male athletes wore instrumented mouthguards (iMGs) during a football game to measure HIE. TMS measurements were conducted 24 hours before and 1-2 hours after the game. Additionally, twenty control football athletes submitted to a non-contact physical training session and underwent identical TMS assessments. Results suggest that relative to controls, the group of athletes who had played a full contact football game exhibited a significant intracortical disinhibition (p=.028) on short-interval intracortical inhibition (SICI 3-ms) within hours following the game. Moreover, football players exposed to more 40g+ hits and greater cumulative forces from 40g+ head impacts exhibited greater post-game SICI disinhibition. Given the deleterious effects of decreased inhibition on motor control and balance, systematically tracking head impact forces throughout the course of contact sport season could reveal essential for sideline clinical management of head injury risk. These observed changes add to the concern that more research into the lasting consequences of HIE is needed.