JHU boxing study takes its best shot at beating head injuries to the punch BRAIN STORM


A photo caption on the front of yesterday's Today section misidentified the Johns Hopkins researchers developing a device to measure the impact of blows to the head. They are, from left, Nicholas Jones, Walter Stewart and Wolfger Schneider.

The Sun regrets the error.

Imagine your brain, a delicate blob of floating gray matter fragilely moored to the skull.

Now, imagine your brain after a ferocious left hook.

Not a pretty picture.

But one worth examining. While the Journal of the American Medical Association wages a continuing crusade against the sweet science -- a June editorial called for a ban on amateur boxing -- Johns Hopkins researchers have jumped in the ring for a closer look.

"Sports like this will never be banned, I suspect," says Nicholas Jones, associate professor in civil engineering at Johns Hopkins University. "Our view is if we can learn as much about the mechanics of the process [of boxing] as possible, then we can make it as safe as it possibly can be."

Dr. Jones is part of a three-man team led by Dr. Walter "Buzz" Stewart, an epidemiologist at the Johns Hopkins School of Hygiene and Public Health, applying advanced technology to the primitive pastime. The team, which includes Wolfger Schneider of the Applied Physics Laboratory, has developed a lightweight "accelerometer" to gauge the magnitude and the direction of head movement caused by head blows.

"In a sport like this," Dr. Jones says, "the skull is not crushed by a blow. . . . It is the motion of the head relative to the rest of the body that produces the injury."

The accelerometer, a miniature censor attached to a pugilist's headgear, will help the research team learn at what threshold head motion causes persistent brain damage by measuring how fast and in what direction the head is moving. This information is "an important piece missing in a lot of head injury research," Dr. Stewart says.

His theory -- that different head speeds and motions can be correlated to specific injuries in various brain regions -- is an "intuitive idea" that has never been established in humans, he says. In addition, head injury research has focused primarily on people who have been knocked out, but not on those who receive constant, low-level exposure to blows, Dr. Stewart says.

Prolonged exposure to punishing blows can take its toll. In professional boxing, where safety precautions are limited, numerous boxers, most notably Muhammad Ali, are afflicted with a Parkinsons disease-like syndrome. Sometimes called the punch-drunk syndrome, the condition causes impaired mobility and slurred speech.

Dr. Stewart intends for the device to shed new light on a Hopkins study -- now in its seventh year -- of central nervous system function in 484 amateur boxers around the country. (Participants, some as young as 13, include members of one Baltimore boxing club.) Study findings reported in the March issue of the American Journal of Epidemiology show that fighters who had boxed during or before 1986 exhibited persistent impairment in certain nervous system functions. Those who boxed between 1988 and 1989, after amateur boxing safety standards had been upgraded, did not show any effects.

The lack of injury found in the second group of boxers is attributable to two possible factors, Dr. Stewart says. Either brain damage does not show up for a number of years, or the new safety measures reduced the risk of injury. A more conclusive answer may come from current data collected on the same boxers, Dr. Stewart says.

In its first two years, the multimillion-dollar boxing study was funded in part by USA Boxing Inc. -- the sport's U.S. Olympic Committee affiliate -- and the National Institutes of Health. For the past five years, it has been funded exclusively by NIH, Dr. Stewart says.

Once the accelerometer is fine-tuned, Dr. Stewart and colleagues will embark on the "ideal study," in which central nervous system function will be measured before and after a bout. The information gathered from these screenings, together with accelerometer readings from the bout itself, will deliver more specific answers about when or whether the brain recovers from certain kinds of blows, what regions of the brain are affected and what "directions of head movement are the most problematic," Dr. Stewart says.

In addition to refining the amateur boxer study, the accelerometer could lead to the design of safer helmets and a monitoring system that would allow officials to pull injured boxers from bouts.

"Our interest here is to understand extreme conditions we should watch for more quickly," Dr. Stewart says. His ultimate goal is for each amateur boxer to have a monitoring device built into his or her helmet that would measure exposure to the force of a foe's blows. Exposure levels would be recorded and monitored so as not to exceed a certain limit. If an exposure was determined to be too high, the boxer in question would be required to stay out of the ring for a mandated period of time.

Design challenges

The device has posed formidable design challenges and is now being rebuilt after an earlier model was scratched. Weight is one among many factors to consider: "You can't put a steel block on the side of the helmet," Dr. Jones says. "And certainly, it can't be connected with wires."

As used for safety monitoring, the accelerometer would contain a storage chip for recording information that could be retrieved at a later point. If the data were to be analyzed instantly, the censor would be equipped with a radio unit to transmit signals to ringside.

Scoring techniques may also be revolutionized by the accelerometer, Dr. Stewart says. But not before "an equivalent for body blows" is also developed.

The device has relevance as well for football, which "should be subjected to the same safety considerations," Dr. Stewart says.

In a wider arena, the study can potentially help to solve what he calls "an enormous public health problem." There are a small percentage of people who suffer from persistent problems from head injury, Dr. Stewart says. The accelerometer may assist in identifying the exact source of continuing symptoms, which can be complex, difficult to pinpoint and easily dismissed, he says.

So far, the accelerometer has been tested only on a Styrofoam head in the laboratory. The Hopkins team plans to place a prototype on a human head soon at the Sugar Ray Leonard gym in Hyattsville.

Neither Dr. Jones nor Dr. Stewart is a boxing fan. In fact, Dr. Stewart was initially skeptical that the boxing study was even necessary. Early in the study, however, he attended an amateur tournament where, "I saw a kid get knocked out." That, he says, was the crowning blow.

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