Head and Neck Injuries

The Worst injuries in sport!

Head and Neck Injuries

   Potentially severe and life threatening Very Preventable (choice of activity, equipment, techniques) Initial Management can make all the difference!

Skull

 Jewel Box – encases the brain

Meninges and Cerebral Spinal Fluid

   The lining outside of the Central Nervous System, encases and surrounds the brain Three Layers of Meninges (Dura mater, Arachnoid mater, Pia mater) Veins are mostly subdural and arteries are mostly epidural

Mechanisms of Injury

 Injuries to the head and or neck can occur by mechanical overload of the brain or brain stem. This would include any load or trauma to the head or neck!

 The Skull along with the CSF and Meninges protect the brain from mechanical overload. This is why we do not get permanent damage after landing from a jump, or banging our head into a cabinet

Protecting ourselves from injury

 Our entire body absorbs the energy from the ground to the point where the head should move as little as possible. When landing properly, we should cushion our landing by bending as many joints as we can so that the energy is dispersed as much as possible! (motorcycle landing)

Trauma

 Blunt trauma is the acceleration or deceleration of the head that exceeds the ability of the meninges to absorb the energy    Direct loading (blow to skull) such as a direct shoulder or elbow to the head Indirect loading (through the neck) such as whiplash caused by a car accident. This hurts twice acceleration and deceleration!

Sharp trauma (direct laceration of neural tissue by angular acceleration or deceleration of the brain, or bullets, knives or broken bones). Injury to brain tissue (axons)

Other Injuries

   Scalp injuries – not as severe but often result in lots of bleeding Fractures to the skull Vascular injuries – are very dangerous because the slow bleeding against the brain will cause increased pressure and can lead to brain damage, coma or death

Concussions

• Concussions – Shaking of the brain caused by direct and or indirect trauma to the brain.

• shaking of the brain which causes elastic deformation of the brain, brain contusion, or diffuse axonal injury (this could be very severe depending on the acceleration and how many axons are severed)  Temporary neurological deficit caused by mechanical trauma or over load to the nervous system….can range from a few minutes or hours to days weeks or months!

  Concussion, or mild traumatic brain injury(mTBI) is defined as a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces resulting in the rapid onset of short-lived impairment of neurological function that resolves spontaneously This means that there is physiological changes in the brain after some kind of trauma to the head. These changes will increase initially and begin to subdue in a general period of 7-10 days for adults or in about 14 days for children

  When a concussion occurs there is increased blood flow to the brain. This causes an increased intercranial swelling and pressure increases inside the skull. Most of the damage in a concussion is superficial and functional in nature so many current imaging techniques do not accurately detect them.

   Approximately 1.6-3.8 million people in the united states alone will suffer from some kind of traumatic brain injury. Approximately 20% of that will occur during sport It has been reported that as high as 20% of concussions can lead to post concussive syndrome which include persistent symptoms three months pos injury.

       Headache, nausia, dizziness, “feel like your in a fog” slow, sluggish Physical signs –loss of consciousness Behavioural changes – irritability Cognitive impairment – slow reaction time Sleep disturbance Change of mental state (ability to concentrate, incoherent speech, short and long term memory, delayed responses) Visual or sensory disturbance (seeing dots, vacant stare) Motor disturbance (trouble walking, slurred or speech

   Chronic traumatic encephalopathy (CTE) Second impact syndrome (SIS) Post concusive syndrome (PCS)

    Is a progressive degenerative disease (gets worse as you age) Occurs from sustaining repetitive head injuries or concussions Often show symptoms of dementia, memory loss, aggression, confusion and depression Can be very debilitating and can lead to premature death.

  Any impact to the head prior to full healing of a first traumatic event – can result post concussive syndrome and/or in permanent, lifelong brain damage. Critical 7-10 days of full rest and recovery

   PCS is defined as a constellation of physical, cognitive and emotional symptoms that persist in a small percentage of patients who suffer from a concussion Impairments in memory, attention, dizziness, headaches, alteration of mental status, irritability.

Is a result of functional rather then structural damage

  To play or not to play You are coaching a high school soccer team. It is a close game in the semifinals of the playoffs. One of your better players goes up to head the ball and incidentally collides heads with an opposing player who was also trying to head the ball. As he lands you can tell he was shaken up a bit. He wobbles slightly while standing back up. He approaches the sidelines and tells you that he is fine and requests not to take him off. What do you do? In your groups you have 8 minutes to decide what your points will be for the debate. You then have 2 minutes to make your statements. You will then be given 2 minutes to plan a rebuttal and one minute to state your rebuttal.

 Concussion is often referred to as the silent injury because there is often no or little visible trauma although there could be high amounts of brain and nerve damage

  The mentality that you must sacrifice your body for the better of the team – you must play through any injuries and are expected to compete at your top level. Can lead to early return to play which can put the athlete at a greater chance of injuring themselves and possibly sustaining life long damage.

First Response

   Suspect catastrophe Stabilize the head and neck ***Never exercise after a concussion because it will lead to increased blood pressure and thus increase bleeding!

    

First Aid Cont…How do you determine concussion

If LOC then you know it is severe no need for the following, but if no LOC then… Ask them questions like: person, place, time, situation Short term memory test: Give them a phrase or license plate number to remember and then go on to… Concentration tasks (count down from 100 by 2 or 5) Be sure to seek medical attention regardless after any hit to the head

Grades of Concussion

 There are different grades or degrees of severity but it is important to note that concussions are not black and white they are more of a GREY MATTER! These are no longer used very often    Grade 1 (mild) –No LOC, symptoms last less than 15min Grade 2 (moderate) – No LOC, symptoms last longer than 15min Grade 3 (severe) – LOC, symptoms last greater than 15 min (often days or weeks)

Return to play

    Must be determined by a health care professional Usually no exercise for 24 hours after symptoms disappear No risk of contact for twice the time of the symptoms plus 24 hours LOC is automatic 3 weeks but if symptoms persist could be longer still!

Reaction time tests

    Tests such as these can be used for baseline testing. The OHL uses similar tests. http://getyourwebsitehere.com/jswb/rttest 01.html

http://www.topendsports.com/testing/reac tion-timer.htm

http://www.exploratorium.edu/baseball/re actiontime.html

Ruler Drop Test

           

Objective

The objective of this test is to monitor the athlete's reaction time.

Required Resources

To undertake this test you will require: Metre ruler Assistant

How to conduct the test

The ruler is held by the assistant between the outstretched index finger and thumb of the athlete's dominant hand, so that the top of the athlete's thumb is level with the zero centimetre line on the ruler The assistant instructs the athlete to catch the ruler as soon as possible after it has been released The assistant releases the ruler and the athlete catches the ruler between their index finger and thumb as quick as possible The assistant is to record distance between the bottom of the ruler and the top of the athlete's thumb where the ruler has been caught. The test is repeated 2 more times and the average value used in the

Cont…

      Calculations are based on the normative data table The algorithm to calculate the reaction speed is d = vt + ½at² where d = distance in metres v = initial velocity = 0 a = acceleration due to gravity = 9.81m/s² t = time in seconds        We need to manipulate d = vt + ½at² to give us an algorithm for t As v = 0 then vt = 0 therefore the algorithm is t = Sqrt(2d/a) Example d = 9cm t = sqrt(2 × 0.09 ÷ 9.81) t = sqrt(0.01835) t = 0.135 seconds   Excellent Above Average Average Below Average Poor <7.5cm 7.5 - 15.9cm 15.9 - 20.4cm 20.4 - 28cm >28cm

Videos

   http://www.youtube.com/watch?v=D5haG 28ZnfQ http://www.youtube.com/watch?v=7U7jU bKQYdw http://www.youtube.com/watch?v=r8TFH GKgpzA

Hockey Issues

     Direct hits to the head Blindside hits (indirect trauma) Equipment is different today vs. 20 years ago Players’ size today vs. 20 years ago (players are faster and stronger) Recent rule changes and concussions (2 line pass and others)

DEBATE!

  There has been a motion to ban all combat sports ( boxing, MMA and fighting in hockey) because of their effects on increased incidence of concussion. Agree or disagree.

Perspective of …educator, parent, government, average joe, etc!

Boxing and other contact sports

   Various medical associations have recommended a ban on full contact fighting sports The Goal of boxing is to leave the opponent with brain damage The magnitude of victory is judged by the degree of brain injury that a boxer inflict on his opponent

Videos

  http://www.youtube.com/watch?v=JHnL7 wqtQLs http://www.youtube.com/watch?v=yf0nTy 4nSEo

Combat sports debate

 Boxing and MMA are barbaric Sports that should be banned! The ultimate goal is delivering a concussion or injury to the opponent, we need to get rid of it! Agree or disagree……take one of the following points of view and argue this…..Debate will be tomorrow!

     Parent perspective Government Educators Ave. Joe Educated student  **Be sure to have plenty of references to support your arguments!...you have to back up your point of view will facts/stats!