Head and Neck InjuriesHead and Neck Injuries

The Worst injuries in sport!The Worst injuries in sport!

Head and Neck InjuriesHead and Neck Injuries

Potentially severe and life Potentially severe and life threateningthreatening

Very Preventable (choice of activity, Very Preventable (choice of activity, equipment, techniques)equipment, techniques)

Initial Management can make all the Initial Management can make all the difference!difference!

SkullSkull

Jewel Box – Jewel Box – encases the brainencases the brain

Meninges and Cerebral Spinal Meninges and Cerebral Spinal FluidFluid

The lining outside of the Central The lining outside of the Central Nervous System, encases and Nervous System, encases and surrounds the brainsurrounds the brain

Three Layers of Meninges (Dura Three Layers of Meninges (Dura mater, Arachnoid mater, Pia mater)mater, Arachnoid mater, Pia mater)

Veins are mostly subdural and Veins are mostly subdural and arteries are mostly epiduralarteries are mostly epidural

Mechanisms of InjuryMechanisms of Injury

Injuries to the head and or neck can Injuries to the head and or neck can occur by mechanical overload of the occur by mechanical overload of the brain or brain stem. This would include brain or brain stem. This would include any load or trauma to the head or neck!any load or trauma to the head or neck! The Skull along with the CSF and Meninges The Skull along with the CSF and Meninges

protect the brain from mechanical protect the brain from mechanical overload. This is why we do not get overload. This is why we do not get permanent damage after landing from a permanent damage after landing from a jump, or banging our head into a cabinetjump, or banging our head into a cabinet

Protecting ourselves from injuryProtecting ourselves from injury

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

TraumaTrauma

Blunt trauma is the acceleration or Blunt trauma is the acceleration or deceleration of the head that exceeds the deceleration of the head that exceeds the ability of the meninges to absorb the energyability of the meninges to absorb the energy Direct loading (blow to skull) such as a direct Direct loading (blow to skull) such as a direct

shoulder or elbow to the headshoulder or elbow to the head Indirect loading (through the neck) such as Indirect loading (through the neck) such as

whiplash caused by a car accident. This hurts whiplash caused by a car accident. This hurts twice acceleration and deceleration!twice acceleration and deceleration!

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

Other InjuriesOther Injuries

Scalp injuries – not as severe but often Scalp injuries – not as severe but often result in lots of bleedingresult in lots of bleeding

Fractures to the skullFractures to the skull Vascular injuries – are very dangerous Vascular injuries – are very dangerous

because the slow bleeding against the because the slow bleeding against the brain will cause increased pressure and brain will cause increased pressure and can lead to brain damage, coma or deathcan lead to brain damage, coma or death

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

Concussions cont…Concussions cont…

““shaking of the brain” which causes elastic shaking of the brain” which causes elastic deformation of the brain, brain contusion, deformation of the brain, brain contusion, or diffuse axonal injury (this could be very or diffuse axonal injury (this could be very severe depending on the acceleration and severe depending on the acceleration and how many axons are severed)how many axons are severed)

Temporary neurological deficit caused by Temporary neurological deficit caused by mechanical trauma or over load to the mechanical trauma or over load to the nervous system….can range from a few nervous system….can range from a few minutes or hours to days weeks or minutes or hours to days weeks or months!months!

Signs of Concussions Signs of Concussions

Change of mental state (ability to Change of mental state (ability to concentrate, incoherent speach, short and concentrate, incoherent speach, short and long term memory, delayed responses)long term memory, delayed responses)

HeadacheHeadache NauseaNausea Visual or sensory disturbance (seeing dots, Visual or sensory disturbance (seeing dots,

vacant stare)vacant stare) Motor disturbance (trouble walking, Motor disturbance (trouble walking,

slurred or speech)slurred or speech) LOCLOC

First ResponseFirst Response

Suspect catastropheSuspect catastrophe Stabilize the head and neckStabilize the head and neck ***Never exercise after a concussion ***Never exercise after a concussion

because it will lead to increased because it will lead to increased blood pressure and thus increase blood pressure and thus increase bleeding!bleeding!

First Aid Cont…How do you First Aid Cont…How do you determine concussion determine concussion

If LOC then you know it is severe no need If LOC then you know it is severe no need for the following, but if no LOC then…for the following, but if no LOC then…

Ask them questions like: person, place, Ask them questions like: person, place, time, situationtime, situation

Short term memory test: Give them a Short term memory test: Give them a phrase or license plate number to phrase or license plate number to remember and then go on to…remember and then go on to…

Concentration tasks (count down from 100 Concentration tasks (count down from 100 by 2 or 5)by 2 or 5)

Be sure to seek medical attention Be sure to seek medical attention regardless after any hit to the headregardless after any hit to the head

Grades of ConcussionGrades of Concussion

There are different grades or degrees There are different grades or degrees of severity but it is important to note of severity but it is important to note that concussions are not black and that concussions are not black and white they are more of a GREY white they are more of a GREY MATTER!MATTER! Grade 1 (mild) –No LOC, symptoms last Grade 1 (mild) –No LOC, symptoms last

less than 15minless than 15min Grade 2 (moderate) – No LOC, symptoms Grade 2 (moderate) – No LOC, symptoms

last longer than 15minlast longer than 15min Grade 3 (severe) – LOC, symptoms last Grade 3 (severe) – LOC, symptoms last

greater than 15 min (often days or weeks)greater than 15 min (often days or weeks)

Return to playReturn to play

Must be determined by a health care Must be determined by a health care professionalprofessional

Usually no exercise for 24 hours after Usually no exercise for 24 hours after symptoms disappear symptoms disappear

No risk of contact for twice the time of No risk of contact for twice the time of the symptoms plus 24 hoursthe symptoms plus 24 hours

LOC is automatic 3 weeks but if LOC is automatic 3 weeks but if symptoms persist could be longer still!symptoms persist could be longer still!

Reaction time testsReaction time tests

Tests such as these can be used for Tests such as these can be used for baseline testing.baseline testing.

http://getyourwebsitehere.com/jswb/http://getyourwebsitehere.com/jswb/rttest01.htmlrttest01.html

http://www.topendsports.com/http://www.topendsports.com/testing/reaction-timer.htmtesting/reaction-timer.htm

http://www.exploratorium.edu/http://www.exploratorium.edu/baseball/reactiontime.htmlbaseball/reactiontime.html

Ruler Drop TestRuler Drop Test ObjectiveObjective The objective of this test is to monitor the athlete's reaction time.The objective of this test is to monitor the athlete's reaction time. Required ResourcesRequired Resources To undertake this test you will require:To undertake this test you will require: Metre ruler Metre ruler Assistant Assistant How to conduct the testHow to conduct the test The ruler is held by the assistant between the outstretched index 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 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 the athlete's thumb is level with the zero centimetre line on the ruler ruler

The assistant instructs the athlete to catch the ruler as soon as The assistant instructs the athlete to catch the ruler as soon as possible after it has been released possible after it has been released

The assistant releases the ruler and the athlete catches the ruler The assistant releases the ruler and the athlete catches the ruler between their index finger and thumb as quick as possible between their index finger and thumb as quick as possible

The assistant is to record distance between the bottom of the ruler 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. 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 The test is repeated 2 more times and the average value used in the

Cont…Cont… Calculations are based on the normative data table Calculations are based on the normative data table The algorithm to calculate the reaction speed is The algorithm to calculate the reaction speed is d = vt + ½at²d = vt + ½at²

wherewhere d = distance in metres d = distance in metres v = initial velocity = 0 v = initial velocity = 0 a = acceleration due to gravity = 9.81m/s² a = acceleration due to gravity = 9.81m/s² t = time in seconds t = time in seconds

We need to manipulate We need to manipulate d = vt + ½at²d = vt + ½at² to give us an algorithm for to give us an algorithm for tt As As vv = 0 then = 0 then vtvt = 0 therefore the algorithm is = 0 therefore the algorithm is t = Sqrt(2d/a)t = Sqrt(2d/a) ExampleExample d = 9cm d = 9cm t = sqrt(2 × 0.09 ÷ 9.81) t = sqrt(2 × 0.09 ÷ 9.81) t = sqrt(0.01835) t = sqrt(0.01835) t = 0.135 seconds t = 0.135 seconds

Excellent Above Average Average Below Average Excellent Above Average Average Below Average PoorPoor

<7.5cm 7.5 - 15.9cm 15.9 - 20.4cm 20.4 - 28cm <7.5cm 7.5 - 15.9cm 15.9 - 20.4cm 20.4 - 28cm >28cm>28cm

VideosVideos

http://www.youtube.com/watch?v=Dhttp://www.youtube.com/watch?v=D5haG28ZnfQ5haG28ZnfQ

http://www.youtube.com/watch?http://www.youtube.com/watch?v=7U7jUbKQYdwv=7U7jUbKQYdw

http://www.youtube.com/watch?http://www.youtube.com/watch?v=r8TFHGKgpzAv=r8TFHGKgpzA

Hockey IssuesHockey Issues

Direct hits to the headDirect hits to the head Blindside hits (indirect trauma)Blindside hits (indirect trauma) Equipment is different today vs. 20 Equipment is different today vs. 20

years agoyears ago Players’ size today vs. 20 years ago Players’ size today vs. 20 years ago

(players are faster and stronger)(players are faster and stronger) Recent rule changes and concussions Recent rule changes and concussions

(2 line pass and others)(2 line pass and others)

Boxing and other contact sportsBoxing and other contact sports

Various medical associations have Various medical associations have recommended a ban on full contact recommended a ban on full contact fighting sportsfighting sports

The Goal of boxing is to leave the The Goal of boxing is to leave the opponent with brain damageopponent with brain damage

The magnitude of victory is judged The magnitude of victory is judged by the degree of brain injury that a by the degree of brain injury that a boxer inflict on his opponentboxer inflict on his opponent

VideosVideos

http://www.youtube.com/watch?http://www.youtube.com/watch?v=JHnL7wqtQLsv=JHnL7wqtQLs

http://www.youtube.com/watch?http://www.youtube.com/watch?v=yf0nTy4nSEov=yf0nTy4nSEo

Combat sports debateCombat sports debate Boxing and MMA are barbaric Sports that Boxing and MMA are barbaric Sports that

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

Parent perspectiveParent perspective GovernmentGovernment EducatorsEducators Ave. JoeAve. Joe Educated studentEducated student

**Be sure to have plenty of references to support your **Be sure to have plenty of references to support your arguments!...you have to back up your point of view arguments!...you have to back up your point of view will facts/stats!will facts/stats!