Bath
A LOOK AT CONCUSSION
Shaken brain
By Which Tyler
August 2 2018
Let’s take a look at concussion, AKA mild Traumatic Brain Injury (mTBI). The brain is made of soft tissue, which is cushioned by spinal fluid and encased in the protective shell of the skull. When you sustain a concussion, the impact can shake your brain, literally causing it to move around, impacting the inside of your skull. The trauma is suffered by the brain itself, and can be suffered without direct trauma to the head.
As concussion is an injury sustained inside the skull, padding the outside of the skull (eg a scrum cap) provides no protection from concussion – no more so than padding the back of a cricket bat makes the front any less solid. It is worth noting that you can lose consciousness without suffering concussion, and can suffer concussion without losing consciousness; it is also worth noting that the victim is often the least reliable person to say if a loss of consciousness occurred. Loss of consciousness itself is considered to mean concussion until proven otherwise, but is far from the only sign to look out for.
The principal concern with concussion isn’t so much for the concussion itself, but for potential complications; such as Post-Concussion Syndrome, Second-Impact Syndrome, Chronic Traumatic Encephalopathy or Traumatic Brain Injury (that isn’t mild).
The most immediately concerning is Second-Impact Syndrome – a second concussion suffered before the first has completely recovered. This is the reason that any sportsperson MUST be removed from the field immediately and until Return To Play Protocols have been completed if there is even a suspicion of concussion.
#Concussion #HeadInjury #mTBI #HeadKnock #RecogniseAndRemove
You can find out more here:
www.sportsinjuryclinic.net/sport-injuries/head-injuries/concussion
www.physio-pedia.com/Concussion
www.englandrugby.com/my-rugby/players/player-health/concussion-headcase
www.nhs.uk/Conditions/Concussion/Pages/Introduction.aspx
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Discussion started by Comeonmylovers.co.uk (IP Logged), 02/08/2018 14:22
02/08/2018 14:22
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Edited 1 time(s). Last edit at 2018:08:15:11:39:52 by P G Tips.
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Edited 1 time(s). Last edit at 2018:08:15:11:39:52 by P G Tips.
As we learn more about the subject I'm beginning to think that other sports also need to make provision for this type of injury. Rugby (both codes), American football and Boxing are the obvious examples of sports where concussion can occur.
However, there seems to be growing evidence that Football has issues to consider as highlighted by Jeff Astle's dementia How often do heads get a bump in cricket from either the ball or the ground is that an issue?
Now we are aware medical tracking of players head injuries and the occurrence of 'dementia related' illnesses needs to occur straight away as there is about a 40 year gap between the two. Its all a bit scary isn't it.
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
However, there seems to be growing evidence that Football has issues to consider as highlighted by Jeff Astle's dementia How often do heads get a bump in cricket from either the ball or the ground is that an issue?
Now we are aware medical tracking of players head injuries and the occurrence of 'dementia related' illnesses needs to occur straight away as there is about a 40 year gap between the two. Its all a bit scary isn't it.
There is also a thing called "diffuse axonal injury" which seems to be associated with stretching of the neurons caused by the brain being rapidly rotated within the skull cavity. A direct blow to the head is not necessary for this to happen, a glancing blow is sufficient.
Edit - it turns out things have changed since I worked in this area and DAI is now much more broadly defined
[en.m.wikipedia.org]
... IMHO, of course.
Now in Honolulu
Edited 3 time(s). Last edit at 2018:08:03:00:33:32 by joethefanatic.
Edit - it turns out things have changed since I worked in this area and DAI is now much more broadly defined
[en.m.wikipedia.org]
... IMHO, of course.
Now in Honolulu
Edited 3 time(s). Last edit at 2018:08:03:00:33:32 by joethefanatic.
Football is currently looking at concussion, about where rugby was 5-8 years ago
The evidence is there, but most heads are still in the sand, but some are shouting that they need to take it more seriously.
As for DAI, it's often lumped in with concussion these days under the mTBI tag. I absolutely agree that more information needs to be given to sportsmen that you don't need head contact to suffer mTBI
For me the bit that's going missing is that the vast majority of mTBI that I see in practice (which by definition creates selection bias) go hand in hand with undiagnosed whiplash, which then isn't treated as physicians and physics get hung up on the obvious, and easily testable mTBI
A man who cannot change his mind, cannot change anything
RAEBURN SHIELD
The evidence is there, but most heads are still in the sand, but some are shouting that they need to take it more seriously.
As for DAI, it's often lumped in with concussion these days under the mTBI tag. I absolutely agree that more information needs to be given to sportsmen that you don't need head contact to suffer mTBI
For me the bit that's going missing is that the vast majority of mTBI that I see in practice (which by definition creates selection bias) go hand in hand with undiagnosed whiplash, which then isn't treated as physicians and physics get hung up on the obvious, and easily testable mTBI
RAEBURN SHIELD
OK so if diagnosis and recording are an issue why not enforce all players to wear scrum caps!
Hold it WT i haven't finished...
....to wear scrum caps with an accelerometer integral so that impact intensity and direction can be recorded. That way you could asses the head impact without having to see it on video and it could be in real time if need be. That would cover the knee to the head in the scrum that wouldn't be seen with today's systems.
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
Hold it WT i haven't finished...
....to wear scrum caps with an accelerometer integral so that impact intensity and direction can be recorded. That way you could asses the head impact without having to see it on video and it could be in real time if need be. That would cover the knee to the head in the scrum that wouldn't be seen with today's systems.
I don’t think you need a cap - seem to remember that the Sarries players all wore a teeny chip behind their ear last year (or the one before)?
Edit: found the article
[www.independent.co.uk]
[24/25 adoptee: Francois van Wyk]
Edited 1 time(s). Last edit at 2018:08:03:14:41:58 by BathMatt53.
Edit: found the article
[www.independent.co.uk]
[24/25 adoptee: Francois van Wyk]
Edited 1 time(s). Last edit at 2018:08:03:14:41:58 by BathMatt53.
Quote:BathMatt53
I don’t think you need a cap - seem to remember that the Sarries players all wore a teeny chip behind their ear last year (or the one before)?
Oh I see so it's behind the ears...that would make it on the shoulder then!
as BathMatt said - they experimented with that a couple of years ago, Sarries were one team in one sport who helped them with data gathering - as far as I'm aware the research has not been published yet. I can pretty much guarantee you that it won't be simple; and that it won't provide you with a diagnosis of concussion/mTBI any more than BMI provides you with a diagnosis of diabetes. It will be about ranges of forces leading to likelihoods of concussion in differing directions.
And no, behind the ear =/= shoulder - it means the mastoid process.
There is also some evidence that neck strengthening exercises, and that proprioceptive training exercises can reduce rates of concussion. There is also talk about saliva and blood testing for concussion - ultimately the best evidence currently is going through the existing psych and motor testings in an fMRI scanner - not exactly practical pitch-side
A man who cannot change his mind, cannot change anything
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:03:19:03:10 by Which Tyler.
And no, behind the ear =/= shoulder - it means the mastoid process.
There is also some evidence that neck strengthening exercises, and that proprioceptive training exercises can reduce rates of concussion. There is also talk about saliva and blood testing for concussion - ultimately the best evidence currently is going through the existing psych and motor testings in an fMRI scanner - not exactly practical pitch-side
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:03:19:03:10 by Which Tyler.
Quote:Which Tyler
And no, behind the ear =/= shoulder - it means the mastoid process.
That was a joke WT i.e. Saracens having a chip on their shoulder. Well it made me laugh!
Ah, Sorry - a quick glance between patients towards the end of a long shift - managed to miss that completely
A man who cannot change his mind, cannot change anything
RAEBURN SHIELD
RAEBURN SHIELD
[www.bbc.co.uk]
Heading a football should be restricted in the professional game and banned for those under the age of 18, according to one of the world's leading experts on brain injuries.
[24/25 adoptee: Francois van Wyk]
Heading a football should be restricted in the professional game and banned for those under the age of 18, according to one of the world's leading experts on brain injuries.
[24/25 adoptee: Francois van Wyk]
I have an awful lot of respect for the man - the trouble with his solution is very similar to arguments over banning tackling inage-grade rugby - you need to learn the niceties of the skill before being exposed to the full-on nature of adult sport - otherwise you're creating a much larger problem by having people with no engrained skills in the area, suddenly trying to learn them.
Wither eliminate the element from the game; or introduce it young enough that the impacts are much reduced and there' smuch more scope for both thraining and care-taking.
Graded exposure trumps all-or-nothing in pretty much every aspect of life.
A man who cannot change his mind, cannot change anything
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:08:12:42:36 by Which Tyler.
Wither eliminate the element from the game; or introduce it young enough that the impacts are much reduced and there' smuch more scope for both thraining and care-taking.
Graded exposure trumps all-or-nothing in pretty much every aspect of life.
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:08:12:42:36 by Which Tyler.
Quote:Which Tyler
as BathMatt said - they experimented with that a couple of years ago, Sarries were one team in one sport who helped them with data gathering - as far as I'm aware the research has not been published yet. I can pretty much guarantee you that it won't be simple; and that it won't provide you with a diagnosis of concussion/mTBI any more than BMI provides you with a diagnosis of diabetes. It will be about ranges of forces leading to likelihoods of concussion in differing directions.
Whilst that is a really detailed piece of research yet to be published, I would cat doubt on its relevance.
What is needed is a historical accurate record of incidences of mTBI's, at the moment it's only the ones caught on camera or because it leaves a player on the floor.
No record of the impacts that don't lead to injury, or the invisible ones at ruck time. No comparison of data from year to year etc.
What is needed is an accelerometer chip that simply records the impact. Then look in detail at the mechanisms.
It's done for metres run etc. why not for life threatening injury? This IMV is a real threat to the game and we don't seem to know eve basic stats.
That’s what it was SW:
Encased in protective plastic, the device measures impact forces throughout the skull using a gyroscope and an accelerometer, which between them can sense the rotation, tilt, movement and speed applied to them.
[24/25 adoptee: Francois van Wyk]
Encased in protective plastic, the device measures impact forces throughout the skull using a gyroscope and an accelerometer, which between them can sense the rotation, tilt, movement and speed applied to them.
[24/25 adoptee: Francois van Wyk]
I get that Matt, it is how it is being used, or not used. What I'm advocating is the device being worn by ALL players then the results collated to give a background picture of the issue.
What did American Football do to establish they had a problem?
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
What did American Football do to establish they had a problem?
Itnwas a trial to test the validity, and gather initial data.
If it looks promising, I'm sure it will be extended further.
It isn't being widely used yet because we don't know if it's valid yet - and won't until the research has been gathered.
You also still seem to be massively oversimplifying the complexity of mTBI, and it's relationship to skull impact. It's not that simple, and even very precise measurements will still only lead to better knowledge of risk factors.
Personally, I'm interested to read that research when it comes out, but don't think it's a particularly promising line - I'm more interested in things like the saliva test which is theorised to show actual changes in brain metabolism; rather than the existence of an unreliable risk factor.
A man who cannot change his mind, cannot change anything
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:09:07:19:24 by Which Tyler.
If it looks promising, I'm sure it will be extended further.
It isn't being widely used yet because we don't know if it's valid yet - and won't until the research has been gathered.
You also still seem to be massively oversimplifying the complexity of mTBI, and it's relationship to skull impact. It's not that simple, and even very precise measurements will still only lead to better knowledge of risk factors.
Personally, I'm interested to read that research when it comes out, but don't think it's a particularly promising line - I'm more interested in things like the saliva test which is theorised to show actual changes in brain metabolism; rather than the existence of an unreliable risk factor.
RAEBURN SHIELD
Edited 1 time(s). Last edit at 2018:08:09:07:19:24 by Which Tyler.
I realise that WT, my question is quantifying the problem, how do you know if measures are effective if you don't have a baseline?
Does every player who is impacted respond in the same way? It just seems to me from your knowledge we are analysing in detail a few incidents rather than understanding the size of the problem.
It all seems a bit random and reactive to me.
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
Does every player who is impacted respond in the same way? It just seems to me from your knowledge we are analysing in detail a few incidents rather than understanding the size of the problem.
It all seems a bit random and reactive to me.
Quote:shipwrecked
What did American Football do to establish they had a problem?
Seems as a result of autopsies on dead NFL players, problem is that it is only recently that the collisions have become more intense, due to rugby union players bulking up.
I have to say I enjoyed the era of rugby where contact avoidance was the norm as opposed to seeking contact to pull in defences.
[m.sport24.co.za]
Anything that the researchers can do to help prevent things like this has to be a good thing - very sad.
[24/25 adoptee: Francois van Wyk]
Anything that the researchers can do to help prevent things like this has to be a good thing - very sad.
[24/25 adoptee: Francois van Wyk]
This thread has been idle for a while but this article on headgear reducing impacts in rugby seems to differ from previous ones.
If this is the case then surely as these are already available they should be made mandatory. Very frustrating that the research is contradictory in this critical area of player safety!
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
If this is the case then surely as these are already available they should be made mandatory. Very frustrating that the research is contradictory in this critical area of player safety!
Looks rather dubious of you read the method. Only read the first bit and that rather briefly. it looks to me like they've dropped a head gear from a heigh that would be just sufficient to cause a concussion and found that wrapping an accelerometer in padding causes the acceleration to drop below that limit.
Would be interestingly to know who has driven and funded this research.
Would be interestingly to know who has driven and funded this research.
Its published by the BMJ though Dan, I agree its a basic test though but there is an argument that "it can't do any harm and might do some good".
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
There's plenty published in the bmj.
Others would say the heightened sense of false confidence can do a lot of harm... Not 100% convinced myself, but there is research I believe that supports that idea. They are certainly no substitute for technique.
Others would say the heightened sense of false confidence can do a lot of harm... Not 100% convinced myself, but there is research I believe that supports that idea. They are certainly no substitute for technique.
Quote:Methods Seven different branded headguards were fitted onto a rigid headform and drop-tested in three different positions. An accelerometer measured the linear acceleration the headform experienced on impact with the ground. Each test involved dropping the headform from a height that generated 103.8 g on average when bare, which is the closest acceleration to the upper limit of the concussion threshold of 100 g. A mean peak acceleration for each drop position was calculated and compared with the bare baseline measurement.
Results Each headguard demonstrated a significant decrease in the mean peak acceleration from the baseline value (all p≤0.01). Overall the Canterbury Ventilator was the most effective headguard, decreasing the impact force on average by 47%. The least effective was the XBlades Elite headguard, averaging a force reduction of 27%. In five of the seven headguards, the right side of the headwear was the most effective at reducing impact force.
Conclusion Overall, the results indicate that it would be beneficial to wear a headguard during rugby in order to reduce the impact forces involved in head collisions. There was also a clear difference in performance between the tested brands, establishing the Canterbury headguard as the most effective. However, only one model of headguard from each brand was tested, so further research evaluating all other models should be considered.
That conclusion seems... non-linear to me.
They do accept that this test doesn't say anything about angular impacts. But if you look at what they've done it really doesn't simulate a rugby collision very well at all. It's about head contact with the ground.
I am prepared to concede that it is not the most technical pieces of research but would love to know what comprehensive research is being carried out. You know with measurements of forces and medical examination before and after law changes. it all seems a bit based on pub chat to me without proper data.
Tyler Offiah
Opinion is based on assumptions, whereas fact is based on observation or research.
I agree. My point is that their conclusion is a little '1, 2, skip a few, 99, 100'.
Quote:hastaQuote:Methods Seven different branded headguards were fitted onto a rigid headform and drop-tested in three different positions. An accelerometer measured the linear acceleration the headform experienced on impact with the ground. Each test involved dropping the headform from a height that generated 103.8 g on average when bare, which is the closest acceleration to the upper limit of the concussion threshold of 100 g. A mean peak acceleration for each drop position was calculated and compared with the bare baseline measurement.
Results Each headguard demonstrated a significant decrease in the mean peak acceleration from the baseline value (all p≤0.01). Overall the Canterbury Ventilator was the most effective headguard, decreasing the impact force on average by 47%. The least effective was the XBlades Elite headguard, averaging a force reduction of 27%. In five of the seven headguards, the right side of the headwear was the most effective at reducing impact force.
Conclusion Overall, the results indicate that it would be beneficial to wear a headguard during rugby in order to reduce the impact forces involved in head collisions. There was also a clear difference in performance between the tested brands, establishing the Canterbury headguard as the most effective. However, only one model of headguard from each brand was tested, so further research evaluating all other models should be considered.
That conclusion seems... non-linear to me.
I would have thought that "deceleration" would be what was experienced by the headform and 100 times the force of gravity seems awfully high as a concussion threshold. Plus brain damage is often related to the "contra coup" where the brain bounces off the inside of the skull on the side of the head opposite the impact site so linear acceleration and deceleration may not be the best way of assessing the protective qualities of the head guards.
Where's Which Tyler when you need him?
... IMHO, of course.
Now in Honolulu
Have read somewhere that the brain has more protection in front to back to front collisions than side to side collisions, something to do with the shape of the skull or something similar.
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