head injuries Flashcards
what does the research support in instances of head injuries? a change in protective equipment or a change in rules?
change in rules is more supported
- change in equipment may allow people to feel more invincible
- equipment can reduce impact forces but studies aren’t inclusive in demonstrating prevention
- athletes change their playing behaviours if they believe their equipment prevents all injuries
what are 4 examples of how helmets offer multiple layers of protection?
1) round, hard outer layer: deforms to chock and then rebounds forces (deflect)
2) layer of polymer: columns move in multiple directions to reduce force (absorbs)
3) face mask: spreads forces over larger area (dissipates)
4) soft layer of memory foam: for comfort and peoper fit (absorbs)
______ Canadians sustain brain injuries each year
165,000
50% of brain injuries in Canada are due to what?
falls or MVAs
30% of brain injuries are experiences by who?
children and youth while participating in sport or activities
there are currently over _____ people living with the effects of an acquired brain injury
1 million
are concussions more common in males or females?
more in males according to stats Canada in 2010
where are the peak times people get concussions?
peaks at teenagers/young adults and then again with middle aged groups
who has the highest risk of concussions? (which sport)
cheerleaders
-also very common in basket ball
concussion -def
“mild traumatic brain injury (mTBI)
- complex pathophysiological process brought on by traumatic biomechanical forces which affect the brain
- head injury that temporarily affects brain function
concussions - MOI
- direct blow to the head - head hit by moving object or moving head hits fixed object
- direct blow to the body - acceleration/deceleration force indirectly act on the brain
what is a coup vs countercoop injury
coup: impact at direct site
countercoop: shifting going back - impact on opposite side
concussion - S&S
- shearing forces disrupt axonal connections - not visivle lesions, can’t x-ray, MRI, CAT scan, etc.
- functional brain disturbance rather than a structural injury - fMRI and EEG may show slight alternations in brain activity patterns
variety of symptoms:
- disorientation or amnesia
- motor, coordination, balance deficits
- cognitive deficits
- loss of consciousness (may or may not occur)
what are the most common S&S of concussions?
- dizziness
- headache (#1 reported symptom)
- blurred vision
- nausea
may also have:
- altered LOC
- amnesia (retrograde: events prior; anterograde: loss after)
FOP concussion assessment: unconscious
1) assess scene safety
2) stabilize head and C-spine
3) assess UABC’s (primary survey) - if unconscious, call 911 and request AED
- open airway and look for obstruction and assess breathing
- assess pulse and scan for bleeding
- treat for shock
4) assess DEFG (secondary survey)
- vital signs
- full body scan
- SAMPLE history
- monitor vitals and treat shock
FOP concussion assessment: conscious
1) scene safety and ask permission to help
2) assess UABC’s (primary)
- R/O spinal and MSC injury
- treat shock
3) assess DEFG (secondary)
- vital signs
- SAMPLE and injury history
- focused scan of head and face - structural injury must be ruled out (numbness and tingling, muscle guarding, crepitus, deformity, pain), CAUTION be aware that some S&S may develop later
- removal from FOP - graded and controlled - look for balance and or gait disturbances, confusion, vacant look
- complete a sideline concussion assessment (SCAT5) remove them to somewhere quiet and private
- if noone on scene has training, send to hospital
what are red flags that are indications of severe head injury?
- neck pain or tenderness
- weakness, N/T or burning sensation in the arms and or legs
- increasingly restless, agitated, or combative
- high risk MOI - high velocity impact or vertical falls
- immediate or prolonged UNC or deteriorating LOC; GCS under 8
- evidence of a skull fracture or penetrating skull trauma - CSF and blood from ears, nose or mouth, raccoon eues, battle sign, deformity
- focal neurological signs - i.e problems with hearing, vision, or eye movements, paralysis, weakness in extremities, unequal pupil size, drooping eyelid, difficulty swallowing
- seizure(s) or convulsive movements
- persistent vomiting
- progressive worsening headache or intense pressure
- worsening of any S&S over time
- any difficulty encountered during assessment
what is the SCAT5?
a tool to help health care professionals assess for the possible presence of concussions immediately after an injury
- should not be used as a stand alone method for diagnosis
- baseline testing not necessary
SCAT5: symptom evaluation
- many S&S in isolation are not indicative of a concussion
- MOI and one symptoms indicates a possible concussion
SCAT5: cognitive screening
- orientation (time and place)
- memory (5 or 10 word recall)
- concentration (digits or months of the year repeated backwards
SCAT5: neurological screen and balance exam
- finger to nose, finger to finger, etc
- standing on single foot, tandem, semi tandem, etc.
SCAT5: delayed recall
-go back to see if they recall words from beginning
concussion: management
1) NO return to current game or practice
2) DO NOT leave athlete or individual alone
- regular monitoring for deterioration or post concussion symptoms is essential esp overnight and for next 24-48 hours
- no meds without medical supervision
- no sleeping tablets
- no aspirin or NSAIDs or stronger pain meds
- we want to monitor if symptoms are getting worse
- no alcohol
- no driving
3) a medical evaluation is a necessity, may involve neuropsychological testing to estimate recovery of cognitive function
what is the gradual RTP protocol for concussions?
1) symptom limited activity
2) light aerobic exercise
3) sport specific exercise
4) non contact training drills
5) full contact
6) return to sport
there should be at least 24 hours (asymptomatic) between each step in the progression
- if any symptoms worsen, go back to last step
- if symptoms persist for more than 10-14 days, refer to concussion specialist
what is the gradual return to school protocol for concussions?
1) daily activities at home that do not give the child symptoms
2) school activities
3) return to school part time
4) return to school full time
SCAT5 for ages 5-12
- may present with different symptoms, may require parents input to complete
- neuropsychological testing and timing requires adjustments at school and at home (due to development and or maturation of cognition)
- recovery time may be longer than adults
- cognitive rest is highlighted
- limited scholastic and other cognitive stressors (texting, computer, video games, reading)
- recommend to return to learning prior to RTP - but in some situations it could be computer screens that are irritating
- REQUIRES a more conservative approach for RTP
post-concussion syndrome
- poorly understood condition
- persistent S&S following a concussion - headaches, vision and balances problems, irritability, inability to concentrate
- S&S begin immediately or within days of injury
- may last weeks, months, or years
- occurs with both mild or severe concussions
post concussion syndrome: management
- no clear cut treatment - customized to each individual
- may experience increase anxiety regarding slow or no progression
- important to focus on what the athletes CAN do and not on what they can’t
what is a useful early strategy for the management of post concussion syndrome?
decreasing stimulation
- use of sunglasses
- limited use of monitors or screens or screen modifications and light settings
- earplugs, limited exposure to noisy environments
- sporting environments may be too stimulating however complete avoidance of these environments is not recommended due to the importance of peer support and maintaining routine - meet with teammates or staff in quiet
second impact syndrome (SIS)
rapid swelling and herniation of the brain after a 2nd head injury occurs before the symptoms of a previous head injury have resolved
-disrupted cerebrovascular auto-regulation leads to swelling, which significantly increases intracranial pressure and compromises the brain stem
what is the cause of second impact syndrome?
- caused by premature RTP
- 2nd impact may only be a minor blow to the head or body
- adolescents and child more susceptible
