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. 2023 Mar 17:7:e39061.
doi: 10.2196/39061.

Public Awareness of the Fencing Response as an Indicator of Traumatic Brain Injury: Quantitative Study of Twitter and Wikipedia Data

Kyle L Roe  1 , Katherine R Giordano  1   2 , Gary A Ezzell  1 , Jonathan Lifshitz  1   2
Affiliations

Public Awareness of the Fencing Response as an Indicator of Traumatic Brain Injury: Quantitative Study of Twitter and Wikipedia Data

Kyle L Roe et al. JMIR Form Res. .

Abstract

Background: Traumatic brain injury (TBI) is a disruption in normal brain function caused by an impact of external forces on the head. TBI affects millions of individuals per year, many potentially experiencing chronic symptoms and long-term disability, creating a public health crisis and an economic burden on society. The public discourse around sport-related TBIs has increased in recent decades; however, recognition of a possible TBI remains a challenge. The fencing response is an immediate posturing of the limbs, which can occur in individuals who sustain a TBI and can be used as an overt indicator of TBI. Typically, an individual demonstrating the fencing response exhibits extension in 1 arm and flexion in the contralateral arm immediately upon impact to the head; variations of forearm posturing among each limb have been observed. The tonic posturing is retained for several seconds, sufficient for observation and recognition of a TBI. Since the publication of the original peer-reviewed article on the fencing response, there have been efforts to raise awareness of the fencing response as a visible sign of TBI through publicly available web-based platforms, such as Twitter and Wikipedia.

Objective: We aimed to quantify trends that demonstrate levels of public discussion and awareness of the fencing response over time using data from Twitter and Wikipedia.

Methods: Raw Twitter data from January 1, 2010, to December 31, 2019, were accessed using the RStudio package academictwitteR and queried for the text "fencing response." Data for page views of the Fencing Response Wikipedia article from January 1, 2010, to December 31, 2019, were accessed using the RStudio packages wikipediatrend and pageviews. Data were clustered by weekday, month, half-year (to represent the American football season vs off-season), and year to identify trends over time. Seasonal regression analysis was used to analyze the relationship between the number of fencing response tweets and page views and month of the year.

Results: Twitter mentions of the fencing response and Wikipedia page views increased overall from 2010 to 2019, with hundreds of tweets and hundreds of thousands of Wikipedia page views per year. Twitter mentions peaked during the American football season, especially on and following game days. Wikipedia page views did not demonstrate a clear weekday or seasonal pattern, but instead had multiple peaks across various months and years, with January having more page views than May.

Conclusions: Here, we demonstrated increased awareness of the fencing response over time using public data from Twitter and Wikipedia. Effective scientific communication through free public platforms can help spread awareness of clinical indicators of TBI, such as the fencing response. Greater awareness of the fencing response as a "red-flag" sign of TBI among coaches, athletic trainers, and sports organizations can help with medical care and return-to-play decisions.

Keywords: athlete; brain; concussion; fencing response; health communication; health information; injury pattern; posture; public education; science communication; social media; sport; trauma; traumatic brain injury.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trends in Twitter mentions of the fencing response. (A) The annual number of tweets that mention the fencing response increased overall from 2010 to 2019. (B) The highest number of tweets occurred on Sunday, followed by Monday. (C) The total number of tweets varied by month, with most occurring between September and January. (D) The years were divided into two 6-month periods roughly representing the American football season (September-February) and its offseason (March-August). There were more than 3 times as many tweets that mentioned the fencing response during the months of September-February compared to March-August.
Figure 2
Figure 2
Tweets per month by year, 2010-2019. This is a topographical map of months by year, with the total number of tweets represented by elevation. In addition to the seasonal peak of tweets that mention the fencing response between September and February, there was an increase in the number of tweets over the years 2010-2019, with notable peaks in January 2013 and December 2017.
Figure 3
Figure 3
Tweets per day of the week by month. This topographical map shows that tweets that mention the fencing response were most common on Sunday and Monday during the months of September-February, which corresponds to the American football season.
Figure 4
Figure 4
Trends in page views of the “Fencing Response” Wikipedia article. (A) The annual number of page views increased overall from 2010 to 2019. (B) Page views by day of the week varied with no clear pattern (eg, weekend vs weekday). (C) Monthly page views varied with January representing the peak month. (D) Dividing the years in half revealed only slight seasonal variation, with more page views occurring in September-February.
Figure 5
Figure 5
Page views of the “Fencing Response” Wikipedia article per month by year, 2010-2019. Article page views increased overall from 2010 to 2019. The topographical map does not appear to demonstrate a clear seasonal pattern; rather, it identifies multiple peaks across various months and years.
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