Brain, Spinal Cord and Labyrinthine Concussion in Sports

In this paper, we discuss the 3 types of concussion that occur in sports; brain concussion, spinal concussion (spinal cord neurapraxia), and labyrinthine (inner ear) concussion. Brain concussion data was collected from professional ice hockey players (Tohoku Free Blades, Japan) during 9 consecutive seasons. Spinal cord concussion and Labyrinthine concussion data was collected from athletes who sustained the injury in various sports including ice hockey. Material and methods The average incidence of brain concussion in professional ice hockey players was 2.0 per season. All 13 cases of spinal cord concussion were cervical cord concussion. Seven cases showed evidence of spinal cord compression; six cases had no radiological abnormality observed. All cases of labyrinthine concussion were sustained through a traumatic blow to the lateral aspect of the head. Results In any sports injury, all three of these concussions can co-exist and requires the team doctor to be at the site in order to fully assess the injury.

P.134 Movement medicine: A systematic review on the effect of early aerobic exercise initiation on symptom recovery following concussion

Background: Mounting evidence supports aerobic exercise as a promising treatment option for individuals experiencing persistent post-concussion symptoms beyond four weeks. The purpose of this review was to determine whether initiating structured aerobic exercise within the early period (first two weeks) following concussion affects symptom recovery compared to standard care. Methods: A systematic literature search was performed using MEDLINE, Embase, PsycINFO and CENTRAL databases, combining keywords: (brain concussion, post-concussion syndrome, mild traumatic brain injury) AND (exercise, exercise therapy, physical activity, kinesiotherapy). Results were limited to Randomized Controlled Trials (RCTs). All selected articles underwent quality assessment. Results: The search generated 112 unique abstracts, of which 5 met inclusion criteria. Sample sizes ranged from 16 to 103 participants. Of the four studies that were able to analyze between-group differences, one showed significantly faster recovery in the early aerobic exercise group compared to control, while three showed no significant difference. Two studies demonstrated a trend toward faster initial symptom resolution in the early exercise group. Conclusions: Preliminary RCT evidence suggests that aerobic exercise initiated in the early postconcussion period does not exacerbate symptoms or prolong recovery time, and may potentially hasten recovery. Larger, more rigorous RCTs are required to define the optimal exercise parameters to facilitate symptom recovery.

Management of Traumatic Brain Injuries with Brain Concussion – A Review

A typical occurrence in emergency rooms is traumatic brain injury (TBI) resulting from head trauma which is normally responsible for far more than 1 million visits per year. The magnitude of TBIs varies from mild, intermittent symptoms to longer periods of altered states of consciousness. The precise mechanism of concussion is indefinite. In serious brain trauma, Axon tearing is expected, but there is no evidence for this concussion process. Most concussion patients improve rapidly and entirely. Concussion management is usually supportive and some cases may need hospital admissions and ICU care according to severity of injury and related symptoms.

Brain concussion in young athletes: major pain points

Numerous studies conducted in recent decades have generated vast amounts of knowledge on sport-related concussions. This review analyzes international data on pediatric and adolescent sport-related concussions. Drawing on the most recent research into the pathophysiology of brain concussions, the authors identify and discuss “pain points” associated with SRC, i.e. unsolved problems of diagnostic criteria, the use of modern neuroimaging modalities and promising biomarkers. Special attention is paid to the physiology of children and adolescents and predisposing factors important for developing adequate diagnostic and management strategies. The authors formulate problems that need to be solved in order to improve care for young athletes with brain concussions.

Characteristics of pediatric traumatic brain injury: study from Wongsonegoro Regional Public Hospital in Semarang

Background: Traumatic brain injury is one of the leading causes of morbidity and mortality in the world, as well as disability in the pediatric group. This study aimed to describe the characteristics of pediatric traumatic brain injury patients, considering the lack of data in Indonesia. Methods: We conducted a descriptive-retrospective study at Wongsonegoro Regional Public Hospital Semarang. Data were extracted from medical records of patients admitted during the period of January 2017-December 2019 using a purposive sampling method. Results: Out of 296 patients, most of the patients were male (59.13%; 66.30%). Based on age group, the highest percentage was found in the (11-18-year-old) (40.87%) in operative patients and 5-10-year-old (37.57%) in non-operative patients. The most common cause of traumatic brain injury in operative patients was falling from motor vehicle (37.39%) while in non-operative patients was falling while playing (32.60%). The most common type of injury in operative patients was epidural hematoma (49.57%) and in non-operative patients was brain concussion (53.59%). Most of the patients had minor head injury (75.65%; 81.22%). Most of operative patients spent 3-5 days (64.35%) in the hospital while most of non-operative patients spent 1-3 days (72.37%). Of all the subjects, the majority of patients recovered and discharged. Conclusion: remains as the most common type of pediatric traumatic brain injury in this study. This study provides an overview of traumatic brain injury in children and shows the importance of enforcing driving rules and supervision by parents which play an important role in child safety. Keywords: pediatric, traumatic brain injury, Indonesia Abstrak Latar belakang: Cedera kepala merupakan salah satu penyebab utama morbiditas dan mortalitas di dunia, serta disabilitas pada kelompok pediatri. Penelitian ini bertujuan untuk mendeskripsikan karakteristik pasien pediatri dengan cedera kepala, mengingat minimnya data cedera kepala pada anak di Indonesia. Metode: Penelitian ini merupakan penelitian deskriptif-retrospektif di RSUD Wongsonegoro Semarang. Data diambil dari rekam medis pasien anak yang dirawat selama periode Januari 2017-Desember 2019 dengan menggunakan metode purposive sampling. Hasil: Dari 296 pasien, sebagian besar merupakan laki-laki (59,13%; 66,30%). Berdasarkan kelompok umur, persentase tertinggi pada kelompok operatif terdapat pada (40,87%) dan pada kelompok non operatif terdapat pada kelompok usia 5-10 tahun (37,57%). Penyebab tersering cedera kepala pada pasien operatif yakni jatuh dari kendaraan bermotor (37,39%) sementara pada pasien non operatif penyebab tersering berupa jatuh saat bermain (32,60%). Jenis cedera kepala tersering pada pasien operatif adalah Epidural Hematoma (49,57%) dan pada pasien non-operatif berupa commotio cerebri (53,59%). Kebanyakan pasien mengalami cedera kepala ringan (75,65%; 81,22%). Sebagian besar pasien operatif dirawat selama 3-5 hari (64,35%) sedangkan mayoritas pasien non operatif dirawat selama 1-3 hari (72.37%) Dari semua subjek, mayoritas pasien sembuh dan dipulangkan. Kesimpulan: Jatuh dari kendaraan bermotor merupakan jenis cedera kepala yang paling umum ditemukan dalam penelitian ini. Studi ini memberikan gambaran umum tentang cedera kepala pada anak dan menunjukkan pentingnya penegakan aturan dalam berkendara serta pengawasan oleh orang tua yang berperan penting dalam keselamatan anak. Kata kunci: anak, cedera kepala, Indonesia

Level of knowledge and misconceptions about brain concussion in Brazilian adults

Background: Brain concussion (BC) is seen as a public health priority due to its high incidence and morbidity rate, among thousands of people around the world. There are needs for fast identification, accurate diagnosis and correct management in order to reduce the short and long-term problems relating to BC. Proper knowledge of BC in the population and among clinicians is a critical factor in achieving this. Objectives: To evaluate the level of self-reported BC knowledge and gaps/misconceptions, and to identify variables correlated with this level. Methods: A cross-sectional descriptive survey was performed. A Brain Concussion Knowledge Questionnaire (BCKQ) that had been created to capture data was widely distributed. Total scores, domain partial scores and percentages of correct and incorrect answers were calculated to ascertain the level of knowledge relating to BC. Results: The sample was formed by 1,247 Brazilian adults (age: 41.7±11.8 years). Partial scores of the BCKQ revealed the existence of poor knowledge and misconceptions in all domains of the questionnaire, especially regarding questions about recovery from and management of BC. Moderate correlations between BCKQ scores and professions (p=0.312; P=0.00) or previous brain concussion knowledge (p=0.489; P=0.00) were observed. In a multiple linear regression model, age, profession and sports practice were predictors of BC knowledge. Conclusion: This first study to analyze the level of BC knowledge in a sample of Brazilian adults suggests that poor knowledge and misconceptions are present. Thus, meaningful and useful information was provided by this study for developing health education programs about BC for the population in order to improve fast diagnosis and correct BC management.

Epidemiology and risk stratification of minor head injuries in school-going children

Introduction: Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore. Methods: This is a retrospective study of children 7–16 years old who presented to the Emergency Department (ED) of KK Women’s and Children’s Hospital in Singapore with minor head injury between June 2017 and August 2018. Data including demographics, clinical presentation, ED and hospital management were collected using a standardised electronic template. Multivariable logistic regression analysis was performed to identify early predictors for brain concussion. Concussion symptoms were defined as persistent symptoms after admission, need for inpatient intervention, or physician concerns necessitating neuroimaging. Results: Among 1,233 children (mean age, 6.6 years; 72.6% boys) analysed, the commonest mechanism was falls (64.6%). Headache and vomiting were the most common presenting symptoms. A total of 395 (32.0%) patients required admission, and 277 (22.5%) had symptoms of concussion. Older age (13–16 years old) (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.12–2.08), children involved in road traffic accidents (aOR 2.12, CI 1.17–3.85) and a presenting complaint of headache (aOR 2.64, CI 1.99–3.50) were significantly associated with symptoms of concussion. Conclusion: This study provides a detailed description of the pattern of head injuries among school-going children in Singapore. High risk patients may require closer monitoring to detect post-concussion syndrome early. Keywords: Brain injuries, child, concussions, school, sport

Epidemiology and risk stratification of minor head injuries in school-going children

Introduction: Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore. Methods: This is a retrospective study of children 7–16 years old who presented to the Emergency Department (ED) of KK Women’s and Children’s Hospital in Singapore with minor head injury between June 2017 and August 2018. Data including demographics, clinical presentation, ED and hospital management were collected using a standardised electronic template. Multivariable logistic regression analysis was performed to identify early predictors for brain concussion. Concussion symptoms were defined as persistent symptoms after admission, need for inpatient intervention, or physician concerns necessitating neuroimaging. Results: Among 1,233 children (mean age, 6.6 years; 72.6% boys) analysed, the commonest mechanism was falls (64.6%). Headache and vomiting were the most common presenting symptoms. A total of 395 (32.0%) patients required admission, and 277 (22.5%) had symptoms of concussion. Older age (13–16 years old) (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.12–2.08), children involved in road traffic accidents (aOR 2.12, CI 1.17–3.85) and a presenting complaint of headache (aOR 2.64, CI 1.99–3.50) were significantly associated with symptoms of concussion. Conclusion: This study provides a detailed description of the pattern of head injuries among school-going children in Singapore. High risk patients may require closer monitoring to detect post-concussion syndrome early. Keywords: Brain injuries, child, concussions, school, sport

Handball concussion case series in a Brazilian Team

ObjectiveTo analyze the history of self-reported head impacts, prevalence of post-concussion symptoms and performance in motor coordination tests in amateur handball athletes.BackgroundHandball is a contact sport where athletes can suffer collisions through different mechanisms and there are few published data about brain concussion in handball, mainly in Brazilian athletes.Design/MethodsAmateur male athletes aged between 18 and 35 years, with 4–6 hours of training per week and an average of 12.5 games in the last 6 months were evaluated regarding to the head impact history during handball games and practices. The athletes were also evaluated regarding of the most common kind of impact mechanism, loss of consciousness (LOC), reported cervical injury (pain and decreased range of motion), symptoms prevalence and their severity using the Post Concussion Symptom Scale (PCSS), time to execution of single-task tandem gait (TG) and performance in the Finger-to-Nose test (>4 seconds to perform five successive finger to nose repetitions was considered abnormal).ResultsSix athletes reported direct impacts on the head while playing handball. Falls, elbow to the head, trunk to the head and hit by the ball were the most reported mechanisms of head impact in handball athletes. Two athletes reported LOC and all of them denied cervical injury after trauma. Regarding the PCSS score, three athletes had a score between 6-21 and five athletes had a 22–84 score. The most reported symptoms were sleeping more than usual, drowsiness, fatigue, changes in behavior (nervousness, feeling more emotional and irritability), trouble falling asleep and dizziness. However, athletes shown a normal performance in the single task TG (14.6–17.2 seconds) compared to normative data and three athletes shown altered performance on the Finger-to-Nose test.ConclusionsAmateur handball athletes had significant scores of PCSS mainly related to sleep, emotional and possibly to the vestibular function.