An traumatic brain injury related to exercise is a serious accident that can cause significant morbidity or mortality. Traumatic brain injury (TBI) in exercise is usually the result of physical contact with other people or stationary objects, these sports may include boxing, soccer, field/ice hockey, lacrosse, martial arts, rugby, soccer, wrestling, racing cars , cycling, horse riding, roller blading, skateboarding, skiing, or snowboarding.
A study completed identifying the severity and frequency of traumatic brain injuries that occur in high school sports:
"Of the 23,566 reported injuries in 10 sports over the 3 year study period, 1219 (5.5%) were MTBI.From MTBI, football accounted for 773 (63.4%) cases, wrestling, 128 (10.5%), women football, 76 (6.2%), soccer boys, 69 (5.7%), women's basketball, 63 (5.2%), boy basketball, 51 (4, 2%), softball, 25 (2.1%), baseball, 15 (1.2%), field hockey, 13 (1.1%), and volleyball, 6 (0.5%). 100 player-season is 3.66 for football, 1.58 for wrestling, 1.14 for women's soccer, 1.04 for girls basketball, 0.92 for boys' soccer, 0.75 for basketball boys, 0.46 for softball, 0.46 for field hockey, 0.23 for baseball, and 0.14 for volleyball.The median time lost from participation for all MTBI was 3 days There were 6 cases of subdural hematoma and Intracranial injury reported in football Based on this data, an estimated 62,816 MTBI cases occur each year among athletes of the university who participated in this sport, with football accounting for about 63% of cases. "
The most common TBIs in exercise are cerebral contusions, concussion syndrome second impact, dementia pugilistica, and hematoma.
Video Sports-related traumatic brain injury
Concussion
Epidemiology
A concussion is defined as a stunning, destructive, or destructive effect of a hard blow; especially: a brain-shaking injury that causes cerebral function disruption. Concussions are also sometimes referred to as mTBI (Mild Traumatic Brain Injury). A concussion is a head injury that causes temporary hoses in normal operation of brain function. A concussion has many symptoms that can be displayed physically, psychologically or emotionally. Symptoms of concussion are sometimes difficult to determine because they come in a subtle way. A symposium was held in 2008 in Zurich, Switzerland where the definition of concussion developed. A concussion is now defined as "a complex pathophysiological process that affects the brain, caused by traumatic biomechanical forces."
There are five main features in relation to the definition:
- Concussions can be caused by a direct blow to the head, face, or neck or any other place in the body with an "implosive" force that is transmitted to the head.
- A concussion usually results in a rapid onset of short-term neurologic damage that recovers spontaneously.
- Concussions can cause neuro-pathological changes, but acute clinical symptoms largely reflect functional disorders rather than structural injuries.
- A concussion produces a series of clinical symptoms that may or may not involve loss of consciousness. The resolution of clinical and cognitive symptoms usually follows a sequential sequence; However, it is important to note that in a small percentage of cases, post concussive symptoms may be prolonged.
- No abnormalities in the study of standard neuroimaging structures are seen in concussions.
(see concussion for more information)
Signs and symptoms in sports
Signs and symptoms of concussion can be difficult to determine because they may not be present strongly and because they may not be present for several hours after the incident occurred. There are 4 categories that concussion symptoms can be classified in: physical, cognitive, emotional and sleep disorders. The most common symptoms are headache as well as a feeling of "fog like". Other more subtle symptoms that may accompany headaches are changes in emotion, irritability, slow and drowsy reaction time. The accompanying symptoms may include sensitivity to light, and noise, fatigue, dizziness, nausea and vomiting. The loss of consciousness is a characteristic of an identifiable concussion but it is not a symptom necessary to diagnose it. Loss of consciousness occurs only in 10% of concussions, so it can not be a sign of a concussion that can be relied upon. Other concussion characteristics are retrograde amnesia (memory loss just before injury) and post traumatic amnesia (time-recall interruption between injury or consciousness return and the point at which new memory is stored and retrieved).
Diagnosis in sports
There are many diagnostic tools and tests in sports. While tests and scales can vary greatly from sport to sport, in the end, they effectively get the same information regardless. The first initial assessment to be done with every athlete found unconscious after head or neck trauma is "ABC" (respiratory, respiratory, and circulatory). There are various early side evaluations that can be done after possible concussions such as Maddocks questions, Standard Disorder Check (SAC), Balance Error Scoring System (BESS), or Sport Concussion Assessment Tool 2 (SCAT2). "The Maddocks questions are a series of short questions to evaluate the short-term and long-term orientations and memories associated with current sports and games.The question is for side use only and is included in SCAT2." The BESS test is a test based on an athlete's posture. There are 3 positions tested by athletes and a combined score of their error for 6 rounds of testing determines their score. SCAT2 uses BESS and SAC tests. SAC and SCAT-2 evaluations also contain symptom checklists that can define cognitive and motor deficits rapidly, although many symptoms may appear several hours after the initial injury. 85% of certified athletic trainers use symptom lists as part of a concussion assessment according to a recent survey.
A limited test study since its release of the Zurich Concussion statement has not been possible to verify as a successful testing method. The SAC, however, has considerable evidence of its reliability, with researchers finding tests that have a re-test reliability of 53%. Many major professional sports organizations such as NFL, NHL, MLB and NBA have taken a stronger view on game concussions through extensive research to develop safer equipment and playing conditions for players. In doing so they have developed their own sideline testing and protocol concussions themselves. The NFL has adopted a standard test evaluation form based on SCAT2 that has been implemented into all head and neck trauma incidents. In 2011 NFL changed their concussion protocol and built on their previous SCAT2 standard test. "New implementations include focused screening neurologic screening to exclude the cervical spine and intracranial hemorrhage, orientation assessment, immediate and delayed memory, concentration, and balance evaluation."
Similarly in 2011, the NHL adopted a new league concussion protocol that would remove players from the bench, who may have head or neck trauma, and take them back to an undisclosed quiet room. Players will be held there for at least 15 minutes while completing tests similar to those to the NFL testing protocol. In 2007 Major League Baseball also adopted a concussion program for referees and players. In 2011 the policy was revised and 4 new features were added to the program. The first is that all referees and players must perform baseline testing during spring training or after signing of players. Secondly, SCAT2 has been adopted as the official sideline test for all MLB teams. Thirdly, a list of 7 day defects has been set for players with concussions; players in the list for 14 days will be moved to the disabled list for 15 days. Finally, the league medical director must clear all the players who experience a concussion before they can return to play. Of the four major professional sports in the US, the NBA is the only league that has not yet implemented a concussion policy. Each team and its medical staff proceeded in a different way from their policies.
Prognosis (short/long-term effects)
Short-term effects
Short-term effects are mostly associated with Post-concussion Syndrome, which has no clear definition. A person suffering from a single fainting incident usually has a strong recovery rate. The most common post-concussion symptoms are persistent headaches that usually disappear within 1-2 weeks. Other common short-term effects include dizziness, vomiting, nausea, light and sound sensitivity, irritability, cognitive impairment and memory impairment. 20-90% of affected persons develop one symptom within one month after the incident, after 3 months 40% of affected persons showed at least 3 symptoms.
Long-term effects
Accepting several concussive incidents has long been known to cause cumulative effects on the brain. Also note that any successive concussions make it easier to get another concussion in the future. Receiving multiple concussions can cause long-term memory loss, psychiatric disorders, brain damage and other neurological disorders. There are no clear guidelines for an athlete's retirement, but it has been suggested that an athlete who maintains 3 concussive incidents in one season or has post-concussion symptoms for more than 3 months should consider a long period of exercise. Especially with sports, when multiple concussions are accepted the possibility of a doctor will advise the concerned player to avoid returning to the sport where contact is possible.
second impact syndrome
The second-induced syndrome (SIS) occurs when an athlete sustains a second odd incident before the symptoms of a previous concrete event have healed completely. No need for severe concussions to cause SIS, even a mild concussion can cause it. This condition is often fatal, and if death does not occur severe disability is possible. SIS is most often developed in young athletes, who are considered very vulnerable.
Prevention in sports
Helm
Throughout the development of contact sports there has been continuous innovation in protective equipment, especially in terms of limiting head and neck trauma. The earliest use of football helmets is known to be documented in an Navy-1893 game. Early helmets are usually only made of leather padding. Throughout the early 1900s the helmet was developed to incorporate metals and plastics to further protect the players. In 1939 helmets became mandatory for college players, and a year later the NFL adopted the same policy. The increased development and standardization of helmets along with changes in rules that will protect players will ultimately reduce head and neck trauma. In 2012 testing is being done on new helmet types that combat the associated rotation acceleration closer to concussion than the typical impact. This helmet is called Multidirectional Impact Protection System (MIPS). This new generation helmet is proven to reduce the rotation acceleration by 55% compared to traditional football helmets. As the NHL NFL took steps to protect players with a helmet mandate in 1979. In 2009 about 60% of NHL players currently wear a half protector for upper face protection.
Orginal Guard
Many sports including soccer, ice hockey, lacrosse, field hockey, and boxing implements mandatory keeper policies during the 1960s and 70s. These policies were introduced to reduce the likelihood of an orofacial injury player and a concussion. Several studies conducted in various professional sports and colleges have not validated the claim that mouth guards reduce concussions; although a study conducted by NHL showed that the severity of symptoms had decreased significantly with the use of oral protective measures.
Maps Sports-related traumatic brain injury
Cerebral Contents
Epidemiology
Cerebral contusions are bruises to the brain caused by a direct blow to the head that causes the brain to soar into the inside of the skull and bruised brain tissue. The power of the blow leads to tears or structures and blood vessels that block the receptor's ability to send feedback to the brain. By tearing or twisting the structure, the brain begins to swell and bleed. Because the brain cavity has no room to develop due to swelling, bruising begins to form. Due to the nature of the injury, most of the contusive damage is found deeper in the brain.
In sports, most cerebral contusions are caused when the brain suddenly accelerates, slows down, or attacks an immovable object. When the blow occurs, the brain tissue can be damaged, sometimes resulting in the need for hospitalization and surgery. The contractionary tissue resection is required in the operation to wait for the severity of the incident. The highest rates of contusions occur in men between the ages of 15 and 24, somewhat due to their aggressive nature. If a person drinks a one-time contusions, they are more likely to keep repeating.
(see brain flake for more information)
Signs and symptoms in sports
In the heat of a game, it may be difficult to see or feel the symptoms associated with cerebral contusions. If any of these signs are seen or as an athlete, you feel them, escape from competition immediately. Cerebral contusions and other injuries can occur in any sport, not just in traditional "collision" sports. According to the USCPSC, four of the top five sports that cause brain injury are thought to have limited brain contact: basketball, biking, baseball and playground activities. The most popular sport that causes the contusions of cerebral is American football because of the drastic acceleration/deceleration of the brain.
Direct signs of cerebral contusions
- Headache
- Nausea
- Unclear speech
- Restless
- Pupil dilation
- Memory loss
- Personality shift
- Seizures
Post-match symptoms
- Loss of consciousness
- Severe headache
- Coma (due to loss of consciousness)
If these symptoms are felt or noticed, it is necessary to visit a hospital where further machine testing is performed. In boxing, rapid deceleration of the brain after an impact causes the symptoms to develop much faster or at a more traumatic level. Doctors who talked to the boxers and brain functions throughout the fight and could stop the game following the shocking news.
Diagnosis in sports
Contusions are identified by two forms of diagnosis: brain acceleration and direct trauma. Direct traumatic injury is much more severe than accelerated injury (in many cases) and requires far more intensive diagnosis and testing. The full extent of the injury may not be known until testing done at the hospital is complete.
In football, experienced medical trainers to diagnose symptoms related to traumatic brain injury. However, they can not determine what kind of injury or the extent to which the injury originated. Medical football coaches can be clear or unclear of players based on symptoms of brain injury. If a coach feels that certain symptoms are similar to a cerebral contusions, they will remove players from the game and take them to the hospital. After admission to the hospital, CT scan will be ordered. CT scan is the fastest method to diagnose cerebral contusions because it can be done immediately and has a fairly precise finding. The best method, as suggested by medical doctors, is MRI because they present more sensitive and accurate findings. MRI, however, should be scheduled and can not be completed immediately after the injury. MRI also takes a long time to do where the injury suffered players can get worse within that time period.
Case Study Example
History : The person may be unaware when examined by a medic in the field. Common symptoms are prolonged consciousness (coma), but these players report headaches, dizziness, nausea, vomiting, and limb weakness (paresis) and make inappropriate responses to questions.
Physical examination : The level of individual awareness is disrupted. Neurological examination can not reveal signs of localization. Individuals without serious injuries other than cerebral contusions will not have a cracked skull or signs of opening or penetrating the skull.
Test : The x-ray skull checks the fracture. CT or MRI detect bleeding in the skull. The Glasgow Coma scale classifies the severity of brain injury, with a score of 15 as normal and lower scores indicate greater neurological injury to the brain.
After testing is complete, the doctor will make an estimate of the extent of injury and possible recovery time. If congestional bleeding and swelling are small, short hospital stay (up to a week) is required with close observation. If the bleeding is severe, the player may be treated as a patient with severe head injury (with surgery as the primary choice). This process requires the patient to be included in the intitusve care unit by closely monitoring the blood level and brain activity.
Prognosis (short/long-term effect)
The effects of cerebral contusions depend on the cause of the injury and which part of the brain is most affected. Results vary from minor injuries requiring short recovery times to severe injuries that can lead to death. Short-term effects of cerebral contusions can range from mild headaches to feeling dizzy for several days. Most of the short-term effects match the mild head injury while the long-term effects can be much more serious. Most long-term injuries require surgery, rehabilitation, and close monitoring. In small cases, cerebral contusions can cause death (about 15 per 100,000 people). If cerebral contusions lead to coma, recovery can be very long and extensive rehabilitation. If coma length, the chances of death or permanent neurological damage are very likely.
Prevention in sports
Rules exist in every sport to help prevent cerebral contusions and traumatic brain injury. However, individual athletes are the best prevention against their own injury. In the game, athletes pay attention when they have bruising symptoms and have to get out of the game. It may be difficult for medical personnel or coaches to notice when a player has a traumatic brain injury, so it is the best interest of the player to be removed from the game. In hockey, traumatic brain injury accounts for 10% -15% of all head injuries. With a high percent of traumatic injuries, extensive design improvements have been made to helmets. These improvements reduce the risk of cerebral contusions by providing more cushioning around the skull and chin straps that keep the helmet comfortable. In baseball, a big improvement on the helmet was made to protect the batters of collisions that can be owned by a baseball while hitting their heads. Helmets, before these big improvements, are designed to withstand a speed of 70 mph from a pitch or foul ball. Due to Rawlings' new corporate design, the helmet can withstand a speed of 100 mph and has further bearings around the softer parts on the side of the skull.
Dementia_Pugilistica_.28Punch-Drunk_Syndrome.29 "> Dementia Pugilistica
Epidemiology
A syndrome that affects boxers is caused by cumulative brain injury and is characterized by cognitive process disorders (such as thinking and remembering), Parkinsonism, disorder and frequent speech slurred, and slow slowly coordinated movements especially from the foot. Dementia Pugilistica, better known as "Punch Drunk Syndrome", is a degenerative brain disorder resulting from head trauma. Dementia Pugilistica (DP) is usually associated with boxing sport; although DP symptoms may appear soon after a traumatic brain injury, they are usually described after termination of exposure to chronic brain injury.
Signs and symptoms in sports
Some of the subjective symptoms experienced after Knockout are headache, tinnitus, forgetfulness, hearing loss, dizziness, nausea and gait disturbances. About ten percent of the active boxers reportedly continue to suffer from forgetfulness, headaches and other symptoms. Symptoms can be progressive and can develop until the end of a boxer's career or may be years into retirement. Some early symptoms of "drunk blow syndrome" are seen in the extremities; such as shaking hands or feet, or instability in equilibrium. Signs of chronic brain damage can also affect irritability, paranoia and cause violent outbursts.
Diagnosis in Sports
Dementia pugilistica difficult to diagnose until the final stage of life boxer. The symptoms are not visible until the boxer is retired. Damage is done in four major brain sites: the area of ​​the septum, the cerebellum, the substance of the nigra, and the neurons. Septa is finally separated and torn apart when the ventricles are enlarged. "The main motor route in the cerebellum and substance of the nigra is affected, as well as the foramen magnum." Finally, neurons in the boxer's brain have a "peculiar tendency for many neurons, especially in the deep gray matter of the temporal, to develop abnormal neurofibrils called Alzheimer's tangles." The most successful way to diagnose DP is through magnetic resonance imaging techniques, more commonly known as MRI The imaging technique of reversed segmentation reversal ratio is based on the ratio of white matter that is pressed images and images are pressed gray matter. "The (SIRRIM) technique enhances the gray matter differentiation of white and sensitive material to detect intracellular space abnormalities, including changes over cellular death. "
Prognosis (short/long-term effect)
Several studies have concluded that there is evidence of neurological damage to pyramidal, extrapyramidal and cerebellum systems with associated psychosis, memory loss or dementia, personality changes and social instability. After the fight, boxers showed increased levels of brain chemicals of light protein neurofilaments and total tau then they did after three months without boxing.
Prevention in sports
Protective measures have been taken mainly in amateur boxing, such as the use of headgear, more padded gloves (weighing 10 ounces in amateur boxing and 8 ounces in professional boxing), shorter and fewer rounds, the addition of the 'lose' rule ( in which point difference becomes greater than 20), and an option for the boxer to disrupt the fight itself.
Hematoma
Epidemiology
Hematoma is a collection of local blood gathered outside the blood vessels in an area that is not included. In particular, hematoma is tissue damage due to acceleration or deceleration of the infinite movement, where the result is shaving of brain tissue. Two types of hematoma that occur in the brain are: subdural and extradural hematoma, which is classified as traumatic brain injury (TBI). When a direct blow to the head occurs, there are bruises to the brain and damage the internal tissues and blood vessels. In addition, brain rumbling of the skull causes a hematoma. Injuries generally occur during contact sports such as boxing, soccer, basketball, motorcycling, scuba diving, mountain climbing, gantole, skydiving, and horseback riding. Council of scientific affairs. After a brain injury serves or a skull fracture one of two hematomas can occur. The extradural hematoma is TBI in which blood is collected between the interior of the skull and dura, the thick outer layer of the brain. Subdural hematomas are when localized blood clusters occur beneath the dura-material surface. Blood collects in the outermost layer of the brain and creates intracranial pressure.
Signs and symptoms in sports
Generally, symptoms for hematoma are confused speech, difficulty with balance or walking, headache, lethargy or confusion, nausea or vomiting, numbness, seizures, slurred speech, impaired vision, and weakness. For example, an athlete experiencing subdural hematoma will lose consciousness with little or no clarity. Pupils are often dilated or not alike. In addition, hemiparesis, seizure activity, and vomiting, can be seen. Epidural hematomas usually cause headaches followed by a brief loss of consciousness and variable clarity. This can last for several hours while brain function deteriorates. If an untreated hematoma epidural causes an increase in blood pressure, shortness of breath, malfunctioning of the brain and can lead to death.
Diagnosis in sports
Subdural and epidural hematoma is a serious condition and should be immediately diagnosed and treated by a doctor. The hematoma may not fully demonstrate the initial problem after head injury, but may be revealed after a comprehensive medical evaluation and diagnostic test. Diagnostic tests may include: blood test, x-ray, computed tomography scan (CT/CAT scan), electroencephalogram (EEG), and magnetic resonance imaging (MRI). The two most important diagnostic tests are CT scan and MRI. A CT scan shows evidence of blood within the skull, fracture, and signs of compression in the brain from a hematoma. MRI is a more comprehensive evaluation of injuries to brain tissue. However, MRI can not occur if the injured victim is confused. Small hematoma may not require surgery if there is no pressure on the brain and minimal symptoms. Small hematomas can be closely monitored to ensure the hematoma is not enlarged and resolved properly. Hematomas larger than 1 cm at the thickest point result in severe headaches and impaired brain function requiring immediate surgery by a neurosurgeon. Surgery reduces the pressure inside the brain and stops the bleeding.
Prognosis (short/long-term effect)
The most crucial aspect of recovery in patients with severe hematomas is rapid diagnosis and appropriate treatment. After the clot has been removed, intracranial pressure is monitored for several days. Conditions that are also monitored after surgery are seizures, accumulation of blood clots, and infections. If complications do occur, sometimes the hematoma needs to be dried again. Additional complications after surgical or nonsurgical treatment may include temporary or permanent weakness, numbness, speech impairment, memory loss, dizziness, headache, anxiety, difficulty concentrating, seizures, and/or brain herniation. The most helpful predictor of treatment outcomes is the glasgow coma scale (GCS). This is a standard pupillary response assessment of the patient's neurologic status. GCS helps assess the different types of head injuries and predicts how a patient will recover after a hematoma. Factors such as increased intracranial pressure, increased patient age, and abnormal GCS outcomes lead to poor prognosis. The death rate after hematoma can reach 80% and many survivors do not get the same pre-injury function. Subdural and epidural hematomas are serious injuries and recovery varies greatly depending on the severity of the hematoma. The severity depends on the type and location of the injury, the size of the blood collection, and how quickly the treatment is obtained. Therefore, it is difficult to determine when an athlete can return to the sport after he or she is injured. Multidisciplinary people such as sports medicine doctors, neurologists/neurosurgeons, athletic trainers, trainers, and families need input. If an athlete is approved to return, he is required to finish asymptomatic at rest and with exertion. The athlete should also clean the CT scan indicating the hematoma has been completely resolved. Lastly, athletes need to be slowly brought back to the sport with close monitoring to ensure symptoms do not recur.
Prevention in sports
Preemptive measures include using safety equipment to reduce the risk of head injury. Examples of equipment are hard hats, bicycle or motorcycle helmets, and seat belts. To reduce the risk of hematoma, factors to avoid are taking anticoagulant drugs (blood thinners, such as aspirin), long-term alcohol abuse, recurrent falls, and recurrent head injuries.
See also
- Concussion in sports
- Sports injuries
- Monitor impact
References
Source of the article : Wikipedia
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