Head and Neck Injuries

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Head and Neck Injuries

• The Worst injuries in sport!

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Head and Neck Injuries

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

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Skull

• Jewel Box encases the brain

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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

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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

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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)

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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)

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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

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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!

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Concussions

• 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

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• 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.

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Some stats about concussions

• 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.

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Signs and Symptoms

• 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

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What Can Concussions Lead To

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

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Chronic Traumatic Encephalopothy

• 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.

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Second Impact Syndrome

• 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

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Post Concussive Syndrome

• 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

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Class Debate

• 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.

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The Silent Injury

• 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

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The Warrior Code

• 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.

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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!

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First Aid ContHow 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

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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)

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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!

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Reaction time tests

• Tests such as these can be used for baseline
  testing. The OHL uses similar tests.
• http//getyourwebsitehere.com/jswb/rttest01.html
• http//www.topendsports.com/testing/reaction-timer
  .htm
• http//www.exploratorium.edu/baseball/reactiontime
  .html

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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

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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
• lt7.5cm 7.5 - 15.9cm 15.9 - 20.4cm
  20.4 - 28cm gt28cm

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Videos

• http//www.youtube.com/watch?vD5haG28ZnfQ
• http//www.youtube.com/watch?v7U7jUbKQYdw
• http//www.youtube.com/watch?vr8TFHGKgpzA

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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)

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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!

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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

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Videos

• http//www.youtube.com/watch?vJHnL7wqtQLs
• http//www.youtube.com/watch?vyf0nTy4nSEo

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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 disagreetake 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!