HJNO Nov/Dec 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2023 21 Dianne Hartley, Editor Thank you, Dr. Stern, for taking the time to discuss CTE and con- cussions. I am looking at a release from the NFL that says concussions were down this preseason due to the Guardian Cap. This is coming off of research saying concussions were actually up 22% last season. Are the eggshell-looking caps some players were wearing in preseason the answer to pre- venting the brain damage happening to tackle football players’ brains? Robert Stern, PhD I’m looking right now at the three papers that have been published examining the use of the Guardian Cap. The first one came out in the Journal ofAth- letic Training six years ago, in 2017, and it compared a bunch of new helmets. It was not on the field but in a laboratory where they were doing helmet testing to see what kind of protection different helmets give. It’s a lab used to examining G-force and the amount of force that happens when a helmeted pretend head is struck in certain directions. This is a study that looked at Guardian Caps. They retested all the same helmets, with and without Guardian Caps, and found that the Guardian Cap “failed to significantly improve the helmet’s ability to mitigate impact forces at most locations.” The next one came out October 2021 in Annals of Biomedical Engineering . That study, again, was a laboratory test using helmets with and without the Guardian Cap on. What they found was that it did seem to decrease the head impact severity by 9%, but the effects varied by impact condition and helmet model, with the add-ons wors- ening helmet performance in some con- ditions. There was a second study in that paper that looked at neck injuries, and the differences were less than 4% when exam- ined. That was another laboratory study that didn’t really show much improvement. There is a study that hasn’t been pub- lished yet. It’s called a reprint, and it’s sub- mitted without peer review, so people can look at the findings. This was done in NCAADivision I football players. They wore instrumented mouth guards to measure the impacts with regular helmets and Guard- ian Cap helmets, and they then looked at pre- and post-linear acceleration, annular acceleration, and total amount of impacts, etc. What they found was that Guardian Caps were not effective in reducing the magnitude of head impacts experienced by NCAA Division I American football play- ers. The title of that paper is “Preliminary Examination of Guardian Cap Head Impact Data Using Instrumented Mouth Guards.” Editor Well, the NFL is miraculous. Stern They always are. The NFL has not pub- lished the data yet for what they’re reporting now, but you have to remember that the use of Guardian Caps was not mandatory. It was not mandatory for all clubs, and it wasn’t during games. There was a lot of variability in who decided to wear them and who didn’t. Imagine if you’re someone who said, “Okay, I’ll wear it,”then you’re probably going to be more careful anyway because you’re part of this experiment. So, you’re wearing it — and it looks bad — and everyone is aware that you’re wearing it. Plus, these are practices. I would guess that it has a lot to do with how hard people are hitting and allowing themselves to be hit when they’re wearing a Guardian Cap. Players are avoiding the hits that result in a symptomatic concus- sion. And you have to remember that con- cussions are kind of subjective; a big part of the diagnosis of concussion is what the person says they’re feeling. Then, a small part of the diagnosis is usually a physical examination or a neurological examination This is the fourth installment in the Journal’s CTE series, which focuses on concussive and subconcussive repetitive head impacts and their effects on former and current tackle football players playing at all levels. During our investigation for this series, we reached out to Division I NCAA football schools in our area with medical schools and research centers to inquire about CTE research initiatives. Spokespersons from the University of Arkansas for Medical Sciences (UAMS), Louisiana State University School of Medicine, and Texas A&M School of Medicine all said CTE is not being researched at their institutions. This is in spite of the nation’s largest football player brain bank, located at Boston University, revealing that the SEC leads the nation in confirmed CTE cases. Boston University consistently stands out as the primary hub for CTE research and has played a central role in addressing the NFL’s concussion and CTE crisis from its early stages. We recommend watching PBS Frontline’s “League of Denial: The NFL’s Concussion Crisis,” which is available on YouTube. This documentary provides insights into how vehemently the NFL denied CTE, which eerily mirrors the current NCAA, college, and high school positioning of this preventable neurodegenerative disease. In this documentary, you will encounter Robert A. Stern, PhD, the director of clinical research at BU’s Chronic Traumatic Encephalopathy Center and subject of this interview. Early in our investigation, we asked Stern why BU is so deeply involved in CTE research when many other universities are not. He explained that BU eliminated their football program in 1997. We leave it to you to draw your own conclusions from this. Here is Stern.