Cleveland Clinic recommends changes in light of brain injuries

The Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. AP Photo/Isaac Brekken

LAS VEGAS -- Dr. Charles Bernick of the Cleveland Clinic Lou Ruvo Center for Brain Health is scheduled to appear before the Nevada State Athletic Commission on Nov. 30 to present recommendations that could impact the current methods used to license combat sport athletes.

Since 2011, Bernick has led a brain study dedicated to researching the long-term effects of trauma on boxers and mixed martial artists. The study has enrolled 600 athletes, both active and retired, and has published results in the British Journal of Sports Medicine.

Bernick's three recommendations include the following: The introduction of a Fight Exposure Score (FES), which uses several factors beyond simply an athlete's age and number of fights to determine that individual's risk. Plans for a pilot program that involves the use of iPad software that tests an athlete's balance and cognitive processing, which would be used to collect data at weigh-ins. And finally, a mandatory educational program on the effects of concussions for the sports' trainers and cornermen.

If these sound like somewhat modest recommendations, that's probably because they are. In terms of the study revealing any concrete medical findings on when a fighter is at greater risk for a condition like chronic traumatic encephalopathy (CTE), and should possibly be denied a license, Bernick says the Cleveland Clinic has only "scratched the surface." Even in its published results, the study cited increased blows are linked to smaller brain structure, but medical conclusions on the effects of those are still to come.

Still, even in its relatively young age, the study can hopefully encourage some improvement by athletic commissions related to fighter safety and, perhaps more importantly, provide information to the sports' athletes.

"What we're presenting is really just practical tools," Bernick said. "Something like education for the cornermen, it's hard to argue against that.

"There are certain things that can come out of this study that can drive policy and can be shared with the athletes that let them determine decisions for their own health. The research is not there yet in terms of a standardized test [to receive a license], if I can put it that way -- but even now, using the information you can get from neurological tests, you can advise people if they should stop fighting and we have done that."

Bernick has made it very clear throughout the course of the study that its purpose is not to dissuade athletes from competing in combat sports. If it were, it's unlikely the study would be receiving such financial support from the largest fight promoters in the country. The study is partially funded by donations given by the UFC, Bellator MMA, Top Rank, Golden Boy and Haymon Boxing.

The purpose of the study is to collect data on these athletes' brains that includes cognitive processing skills and MRI imagery. Eventually, that data might be able to identify when an athlete is at a greater risk for degenerative brain conditions. Currently, licensing bodies are, in some ways, flying blind. The NSAC has little to determine the matter of licensing beyond age, recent results, medical records and observing potential licensees in the gym. Those methods could overlook a younger athlete who, under the surface, might be more susceptible to brain damage.

"We don't know yet if it's worse to get five concussions, where you're knocked out and have symptoms after, or if you get one concussion but there are so many sub-concussive blows that add up before it -- nobody knows that," Bernick said. "We're working on an intelligent mouthpiece that can record the severity of blows and the way the head moves. A blow that consists of rotational force might not be the same as an offensive lineman kind of blow, that linear motion.

"There are some people who can take a punch and that just might come down to anatomically -- the neck muscles and the way the brain sits in the skull. We haven't done it yet, but there's interest in studying the woodpecker phenomenon. Why don't woodpeckers get brain damage? Probably because there is no space between the brain and skull. When you get a concussion, there's movement and you're stretching those brain fibers. That's a reasonable thing to look into and nobody has done it yet.

"Does the age you start fighting at make a difference? Something else we presented but didn't publish is if you count punches, the lower weight classes throw so much more and there was actually a slight tendency for lighter-weight fighters to show more damage, even if there was a lower knockout rate."

It's a complicated topic and studying it requires hundreds of professional athletes to participate. Currently, the study has generated 600 participants, but has a retention rate of only 40 percent. Despite the obvious benefit of monitoring their health, it can be difficult to convince athletes to make multiple, unnecessary clinical visits -- which last several hours.

While single, one-time MRI scans are useful within the study, Bernick says, it's really the comparison of these scans and test results over time that produce the greatest findings.

A high number of athletes use the study as a way to obtain a free MRI scan and blood work, which is necessary for licensing. Some do, however, participate for the sole purpose of overseeing their health. The study is confidential, but UFC female strawweight Jessica Aguilar recently allowed ESPN.com to shadow her second visit to the Cleveland Clinic. Aguilar was introduced to the study in 2012 and has encouraged other fighters to participate.

She understands that concrete findings aren't yet available when it comes to determining risk, but still sees value in the information. She also considers herself a pioneer for female MMA and sees this as another step towards helping those who come after her.

"I'm not qualified to read results but I do ask a lot of questions," Aguilar said. "For me, seeing what has happened to some boxers with Parkinson's disease, it makes me want to track my own brain. I know how much impact we take. I love this sport and I haven't prepared myself to walk away from it, but if something were to come up on my scans, that conversation would have to come up. That's why I do this study. I'm hopefully preventing that in the long-run -- for myself and future generations. "