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PubMed2005

Rugby injuries.

OBJECTIVES: The purpose of this chapter is to review critically the existing studies on the epidemiology of pediatric rugby injuries and discuss suggestions for injury prevention and further research. DATA SOURCES: Data were sourced from the sports medicine and science literature mainly since 1990, and from a prospective injury surveillance project in rugby undertaken by the University of New South Wales (UNSW) in Sydney during 2002. Literature searches were performed using Medline and SportsDiscus. MAIN RESULTS: Reported injury rates were between 7 and 18 injuries per 1,000 hours played, with the rate of injuries resulting in loss of playing or training time measured at 6.5-10.6 per 1,000 hours played. Injury rates increased with age and level of qualification. Head injury and concussion accounted for 10-40% of all injuries. In the UNSW study, concussion accounted for 25% of injuries resulting in loss of playing or training time in the under 13 year age group. Upper and lower extremity injuries were equally apportioned, with musculoskeletal injuries being the main type of injury. Fractures were observed in the upper extremity and ankle, and joint/ligament injuries affected the shoulder, knee and ankle. The tackle was associated with around 50% of all injuries. The scrum produced fewer injuries, but is historically associated with spinal cord injury. CONCLUSIONS: Rugby is a contact sport with injury risks related to physical contact, primarily in the tackle. Most injuries affect the musculoskeletal system, with the exception of concussion. Spinal cord injury is rare, but catastrophic. Research is required to understand better injury risks and to reduce the incidence of shoulder, knee and ankle joint injuries, concussion and spinal injury.

Adolescent↗
PubMed2001

Heading and head injuries in soccer.

In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of concussive injury rates across the soccer spectrum, conduct prospective longitudinal studies on soccer players focusing on exposure, injury and cognition, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the issue of heading and head injuries in soccer.

Biomechanical Phenomena↗
PubMed2002

Neurologic considerations for adolescent athletes.

Sports-related head injuries in young athletes can have both acute and long-term complications. Concussions are the most common type of diffuse brain injury in young athletes. Research on concussions in young athletes is limited. Most current management guidelines are based on expert opinion and consensus. The role neuropsychological testing as an objective measure is increasingly being recognized in the management of concussions. This article reviews practical aspects of concussion management. The implications for sport participation by athletes with epilepsy, sport-related headaches, and burner syndrome are also reviewed.

Adolescent↗
PubMed1991

[Diagnosis of mild cranio-cerebral injury].

As many as 143 patients with concussion and 79 with contusion of the brain of the mild degree were examined. In concussion, the oral reflex never occurs. Meanwhile Marinesco-Radovici reflex is positive almost in 90%, appearing, however, not earlier than 6 hours after the injury and lasting up to 7-16 days. It should be mentioned that in 53.5%, the reflex is unilateral. The latter fact indicates that in concussion, over half the patients manifest the signs of cortical focal derangement together with general cerebral disseminated minisymptoms, seen throughout 1-2 weeks. In mild contusion of the brain in the acute stage, the oral reflex is detectable in 27% of cases. Marinesco-Radovici reflex appears only by days 2-4 after the contusion. The data obtained are helpful in defining the level, degree of the involvement of brain structures, and dynamics of their reverse development in patients with craniocerebral injury, thereby contributing to adequate differential diagnosis of concussion and contusion of the brain of the mild degree.

Brain Concussion↗
PubMed1990

The effect of M1 muscarinic blockade on behavior and physiological responses following traumatic brain injury in the rat.

Dicyclomine (1 mg/kg or 10 mg/kg), scopolamine (1 mg/kg), or saline was administered intraperitoneally to rats 15 min prior to moderate fluid percussion brain injury. A variety of reflexes and responses were measured up to 60 min following injury, and body weight and several neurological measures were taken daily up to 10 days following injury. All 3 antimuscarinic treatments reduced the duration of transient behavioral suppression as assessed by these measures. It appears that blockade of the M1 muscarinic receptor can attenuate transient behavioral suppression associated with concussive brain injury. Thus, stimulation of M1 muscarinic receptors may mediate components of reversible traumatic unconsciousness following cerebral concussion. No differences were observed between saline and antimuscarinic treatments in the incidence or duration of apnea following injury. Scopolamine pretreatment significantly elevated heart rate prior to injury, but had no significant effect on the responses of heart rate and blood pressure to experimental concussion. Both doses of dicyclomine significantly reduced resting heart rate, but unlike scopolamine, significantly enhanced the cardiovascular response to fluid percussion injury. Antimuscarinic treatment significantly reduced body weight loss and certain motor deficits, including beam balance and beam walk performance, following concussive head injury. Scopolamine and both doses of dicyclomine appeared to be equally effective in reducing long-term deficits. Data from these experiments indicate that at least some of the long-term behavioral deficits following moderate levels of brain injury may involve the binding of acetylcholine to M1 muscarinic receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

EEG and postural correlates of mild traumatic brain injury in athletes.

Mild traumatic brain injury (MTBI), or concussion, is one of the least understood injuries facing the neuroscience and sports medicine community today. The notion of transient dysfunction and rapid symptom resolution is misleading since symptom resolution is not indicative of injury resolution. Our working hypothesis is that there are residual postural and EEG abnormalities in concussed individuals that could be reliably assessed using appropriate research methodology. This paper presents combined postural and electroencephalographic (EEG) findings suggesting the persistent functional deficits in athletes suffering from MTBI. Twelve concussed athletes and twelve normal controls participated in the study. There was a decrease in EEG power in all bandwidths studied in concussed subjects, especially in standing postures. This was accompanied by sustained postural instability especially under the no vision testing condition. Overall, this study demonstrated the presence of long-term functional abnormalities in individuals suffering from mild traumatic brain injury.

Adolescent↗
PubMed2004

An algorithm for estimating acceleration magnitude and impact location using multiple nonorthogonal single-axis accelerometers.

Accelerations of the head are the likely cause of concussion injury, but identifying the specific etiology of concussion has been difficult due to the lack of a valid animal or computer model. Contact sports, in which concussions are a rising health care concern, offer a unique research laboratory environment. However, measuring head acceleration in the field has many challenges including the need for large population sampling because of the relatively low incidence of concussions. We report a novel approach for calculating linear acceleration that can be incorporated into a head-mounted system for on-field use during contact sports. The advantages of this approach include the use of single-axis linear accelerometers, which reduce costs, and a nonorthogonal arrangement of the accelerometers, which simplifies the design criteria for a head-mounted and helmet compatible system. The purpose of this study was to describe the algorithm and evaluate its accuracy for measuring linear acceleration magnitude and impact location using computer simulation and experimental tests with various accelerometer configurations. A 10% error in magnitude and a 10 deg error in impact location were achieved using as few as six single-axis accelerometers mounted on a hemispherical headform.

Acceleration↗
PubMed2003

Snowblading injuries in Eastern Canada.

OBJECTIVES: To evaluate injury patterns of snowbladers and compare them with those of skiers and snowboarders. To determine possible effects of helmet use in these sports on injury to the head and neck. METHODS: This prospective case series observational study was conducted by collecting the injury reports from the ski patrol during the 1999-2000 season at Mont Tremblant ski resort, Quebec. All participants in downhill winter sports who presented themselves to the ski patrol with traumatic injury related to their sport were included. A concussion was defined as any loss of consciousness, amnesia, confusion, disorientation, vertigo, or headache that resulted from injury. The ski patroller reported helmet use on the accident report at the time of injury. RESULTS: Snowbladers present with a unique pattern of injury compared with skiers and snowboarders. The incidence of leg, knee, and ankle/foot injuries were 20.5%, 25.6%, and 10.3% respectively. Concussions represented 11% of all injuries. There was no increase in other injury, including neck injury, related to helmet use. CONCLUSIONS: Unique injury patterns in snowbladers warrant reconsideration of equipment design. Concussion is a common injury on the ski slope. Although the effects of helmet use on concussion rate are inconclusive based on this study, helmet use did not increase the rate of neck injury, even when adjusted for age.

Adolescent↗
PubMed1998

Second impact syndrome.

Diffuse cerebral swelling with delayed catastrophic deterioration, a known complication of brain trauma, has been postulated to occur after repeated concussive brain injury in sports--the "second impact syndrome" (SIS). Certain current concussion management guidelines are contingent upon this assumption. We established criteria for definite, probable, and possible SIS and analyzed all published cases. A total of 17 cases were identified in which the reports described the cases as being consistent with SIS. Of these, only five probable cases of SIS were found based on our diagnostic criteria. We also studied the accuracy of recalled episodes of minor concussion in football players by their teammates because the diagnosis of SIS is usually based on such accounts. We found overreporting of recalled episodes of concussion in teammates when compared with self reports and videotape analysis. Based on case reports, the claim that SIS is a risk factor for diffuse cerebral swelling is not established. Prevention strategies for sports-related cerebral swelling are difficult to implement in the absence of established risk factors.

Athletic Injuries↗
PubMed2001

Methodologic Issues in Neuropsychological Testing.

OBJECTIVE: To familiarize athletic trainers with methodologic issues regarding the development and implementation of neuropsychological tests used in programs for monitoring sport-related cerebral concussion. DATA SOURCES: Knowledge base and MEDLINE and PsychLit searches from 1980-2000 using the terms sports, athletes, concussion, and brain. DATA SYNTHESIS: Neuropsychological testing is a proven method for evaluating symptoms of concussion that results from a variety of different causes. These tests have been shown to be effective in evaluating symptoms of subtle cognitive dysfunction in a number of patient groups. Applying these tests in an athletic population has required some procedural modifications, including the use of brief test batteries, collection of preseason baseline data, and evaluation of subtle postconcussive changes in test scores over time. New methods are now being used for improved evaluation of the reliability and validity of neuropsychological tests in athletes. Proper scientific analysis of the psychometric properties of neuropsychological tests and the ultimate value of their use in the sport setting will require years of detailed study on large numbers of athletes with and without symptoms of concussion. CONCLUSIONS/RECOMMENDATIONS: Athletic trainers and related personnel need to be aware of the training and methodologic issues associated with neuropsychological testing. Knowledge of the scientific properties of these tests, their advantages, and current limitations will ultimately enhance the athletic trainer's ability to use information from neuropsychological testing in an effective manner.

Journal Article↗
PubMed1991

Traumatic brain injury in northern Sweden. Incidence and prevalence of long-standing impairments and disabilities.

Based on a retrospective survey of hospital admissions and autopsies the incidence of traumatic brain injury (TBI) for the age range 16-60 was found to be 24.9/10,000 in the Umeå district of Northern Sweden. In male youngsters aged 16-19 the incidence was remarkably high in comparison with reports from other parts of the western hemisphere. Self-reports on the prevalence of impairments and disabilities 1 1/2-3 years after the injury were obtained by a mailed questionnaire. Among the subjects with brain concussion 1/3 reported impairments and 1/10 disabilities, most commonly leisure-disability. By factor analysis impairments and disabilities could be logically grouped into three factors. Two of these factors clearly circumscribed combinations of impairments and disabilities, one of them being dominated by instrumental ADL, the other by basic self-care ADL. The third factor incorporated the classic post-concussion triad and memory. Taken together the findings indicate that many subjects with an early diagnosis of brain concussion, hospitalized for only one day, experienced losses in pre-injury functions and abilities. It is therefore suggested that not only radiologically and/or operatively confirmed TBIs but also subjects with brain concussion should be followed after discharge in order to minimize losses in social well-being.

Activities of Daily Living↗
PubMed1988

Head and spine injuries in the young athlete.

Recent studies have shown a decrease in the mortality rates from head and neck injuries, especially in American football. This has resulted because of rule changes and their enforcement, equipment modifications, improved coaching and training techniques, and educational programs for coaches, trainers, and team physicians on the early recognition of head and neck injuries. However, morbidity data is not as complete, particularly as it applies to concussion, the most frequent type of head injury in contact sports. Questions on this condition that still need to be answered before a sound medical disposition can be made are the possible cumulative damage from repeated concussions, and whether one concussion renders a player more susceptible to a second. Presently, decisions on when to allow a football player to return to a game or participate in future contests are arbitrary and based primarily on the experience of the team physician. Data on the incidence, mechanisms, and prognosis of transient spinal cord signs and symptoms, such as spinal cord concussion and the central core symptoms, is also incomplete. What is the long-term prognosis for players who suffer frequent "burners"? Certainly, further studies are essential before these questions can be answered. Thus, the pioneer work of Richard Schneider needs to be continued.

Adolescent↗
PubMed1980

Football head and neck injuries--an update.

In the last 5 years there has been a dramatic decrease in the deaths directly related to football participation. The incidence of serious spinal cord injuries, however, appears to be increasing. The number of quadriplegic athletes varies from an estimated 1 per 7,000 to 1 per 58,000 participants per year in different areas of the country. The majority of catastrophic head and neck injuries occurs while tackling or blocking, and defensive players are much more liable to sustain these injuries than offensive players. In addition to permanent and irreversible spinal cord damage, football players may suffer spinal concussions as well as spinal contusions. The latter may be manifested by severe burning paresthesias and dysesthesias in the extremities as the only symptoms. Furthermore, fracture-dislocations with ligamentous tears may be present in this syndrome, with no complaint of cervical pain. Adequate preconditioning and strengthening of the head and neck musculature prior to football participation are essential for the prevention of catastrophic head and neck injury. Furthermore, proper blocking and tackling techniques must be taught, and such punishing maneuvers as spearing, goring, and butt-blocking and tackling must be eliminated. Arbitrarily, most physicians discourage further football participation if an athlete has suffered three cerebral concussions. Strong consideration must be given, however, not only to the number and severity of the concussion, but also to any CAT scan evidence of cerebral edema, contusion, or hemorrhage. With this incredibly sensitive diagnostic tool, one concussion, which is associated with radiographic evidence of structural brain damage, may be enough to strongly discourage or forbid further football participation.

Adolescent↗
PubMedDate not supplied

Chiropractic diagnosis and treatment of closed head trauma.

OBJECTIVE: The objective of this article is to review the current literature relating to the chiropractic diagnosis and treatment of closed head trauma. It outlines the clinical exam, offers a diagnostic protocol and describes current chiropractic management and treatment of acute and chronic closed head trauma. Particular importance is placed on the need to differentiate between mild, moderate and severe head injury. Treatment protocols are elucidated for cerebral concussion and a rationale proposed for the management and treatment of posttraumatic concussion syndrome. DATA SOURCES: Information was obtained from English language chiropractic, medical and scientific journals as well as chiropractic and medical textbooks. The CHIROLARS data retrieval system was used (year 0-1992) as was the MEDLINE data base (1988-1992). Head trauma, head injury, headache, concussion, vertigo, posttraumatic syndrome and whiplash injury were the indexing terms used. CONCLUSION: The doctor of chiropractic is often the first practitioner a patient will see following a motor vehicle accident, sports injury or other acute trauma. The chiropractor is also the practitioner a patient seeks for help after suffering for months with chronic posttraumatic concussion syndrome. It is important that we have a protocol for effectively managing both acute and chronic closed head injury.

Chiropractic↗
PubMed1991

Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury.

Patients with post-concussional symptoms (PCS) about 6 months after a mild head injury (MHI) were examined for tolerance of light and sound in comparison with concussed patients without PCS and non-concussed healthy controls. MHI patients with PCS were individually matched with subjects from the two control groups for the time elapsed from the injury, and for age and sex. Using a computerized rating technique, we assessed both the maximal and submaximal levels of lowered tolerance for light and sound over a wide range of stimuli. We found that the MHI patients with PCS 6 months after the trauma (n = 11) tolerated significantly less well stimuli of intensities of 71 dB and 500 lx than MHI patients without PCS (n = 11) and non-concussed controls (n = 11). There were no significant differences in tolerance for light and sound between MHI patients without PCS and the non-injured controls. Decreased tolerance for light and sound may contribute to the persistence of symptoms up to 6 months after a mild head injury. The psychophysical method provides an objective measure for the evaluation of the late persistent post-concussional syndrome.

Acoustic Stimulation↗
PubMed1978

[Cytology, lactate dehydrogenase, and creatine kinase in CSF in mild head injuries (author's transl)].

Cytology, lactate dehydrogenase, and creatine kinase in cerebrospinal fluid were investigated 6-72h after mild head injuries in 59 patients aged 16-49 years. Significant differences were not found in creatine kinase. Lactate dehydrogenase, however, was significantly more elevated in mild cerebral contusions compared with concussions 24h after head injury. Monocytoid reaction in cerebrospinal fluid was significantly more distinct in mild contusions compared with concussions 24h after impact. Large phagocytes were rarely found in concussions and were not traceable 48h after impact. Large phagocytes, however, were found in 50-55% of the mild contusions 48-72h after head injury. Siderophages were found only in contusions (16.5-35%), 48-72h after impact). The optimal time for lumbar punction is 24h after head injury.

Adolescent↗
PubMed1977

Serum activities of hydroxybutyrate dehydrogenase (HBD) and the isoenzymes of lactate dehydrogenase (LD) as an index of traumatic brain injury.

The lactate dehydrogenase (LD), the hydroxybutyrate dehydrogenase (HBD), and the LD isoenzyme activities in serum were followed in the posttraumatic period in 113 patients with cranio-cerebral injury, 70 of whom had verified brain contusion--laceration. In patients with brain contusion the HBD activity, known to be exerted mainly by the anodal LD isoenzyme fractions dominating in brain tissue, was significantly raised in 91% of the blood samples taken within four hours, and in 92% of the samples taken between 12 and 24 hours after trauma, while it was within normal limits in all the samples taken within four hours in patients with brain concussion, and increased in only 17% of the concussion patients 12-24 hours after trauma. The LD1 and the LD1+2 activities were of less diagnostic importance in blood samples taken during the first 24 hours. However, after 24 hours the LD1 activity was as informative as the HBD activity. The LD1 activity was normal in all concussion patients from the third day after trauma, while 78% of the contusion patients still showed raised LD1 activity then. The determination of HBD activity in serum in the immediate post-traumatic period is recommended as an appropriate method for screening parenchymatous brain injury. A complete LD isoenzyme separation may later add some further information in doubtful cases.

Adolescent↗
PubMed2000

Head and neck injuries in young athletes.

Careful study of the pathophysiology and epidemiology of sports-related spine injuries brings to light many common features. The incidence increases as the sport becomes increasingly violent and aggressive. Poor conditioning and lack of knowledge of the proper techniques of the sport put the athlete at significant risk for head and spine injury. Improper helmet fit and the use of the head as an offensive weapon also are common features of injury. Although recognition of these features has resulted in a dramatic reduction in catastrophic neurological injury, the athlete remains at risk for less severe head and spine injury, and concussion remains at epidemic proportions at high school, university, and professional levels. It is hoped that careful recognition of the signs of concussion and knowledge of return-to-play criteria will prevent catastrophic complications from minor head injuries, although the long-term effects of multiple concussions on cognition may be problematic.

Adolescent↗