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Rates of Head Injury in Children is Dropping, Death rates Stay the Same

posted by SK Brain Injury    |   November 7, 2011 11:28

The number of children hospitalized for head injuries has decreased in recent years, a new study finds.

However, the rate of death from such injuries has remained about the same, even though doctors are using aggressive treatments to try to save these kids, the study found.

Newborns and African American children were at particularly high risk of dying after a head injury, the researchers said. To prevent such injuries, future research should try to determine why this is, and whether other groups are also at increased risk.

"The more we expose these high risk groups, the more we expose the vulnerable age groups and race disparities," the better able we are to tackle and prevent these injuries, said study researcher Dr. Justin Lee, a surgical resident at Baystate Children's Hospital in Springfield, Mass.

The study was presented Oct. 17 at the American Academy of Pediatrics meeting in Boston.

Head injuries in kids

Lee and colleagues used a database to identify cases of U.S. children who were hospitalized for traumatic brain injuries (TBI) between 2005 and 2008.

Examples of injuries included severe concussions, and injuries that cause bleeding inside the brain, Lee said.

The researchers found 175,261 pediatric traumatic brain injuries. Over the study period, the number of yearly injuries decreased from 50,088 to 36,884. This decrease is likely due to increased awareness about head injuries, and the use of helmets while bicycling, Lee said.


However, the mortality rate remained at 3.5 percent for all three years.

The four main causes of injury were being hit by a car, being in a car that was in an accident, falling and biking accidents.

Some patients required aggressive operations, including removing part of their skull (a craniotomy), or placing a hollow bolt in their brain to monitor pressure in the skull, Lee said.

Newborns were 2.8 times more likely, and African American children were 1.4 times more likely, to die of their brain injury than other children.

It's possible lower access to health care may explain the increased risk of mortality in African American children, Lee said.


By the time children require aggressive treatments for head injuries, they are already at a high risk of dying, Lee said.

"It's not that the procedures weren’t good enough to rescue them," Lee said. "It’s the mere fact that they even required those procedures, put them at a high risk of death," he said.

The findings suggest the key to reducing deaths from head injuries may lie not in better treatments, but in preventing these injuries in kids who are likely to suffer from them.

"It's not necessarily what we do inside the hospital," Lee said. "It's what happens pre-hospital. That is what's really going to determine the morality."

The new study has not yet been published in a scientific journal.

Pass it on: The number of head injuries in children is decreasing, but the rate of deaths from these injuries has not changed.

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The Truth Behind Brain Injury

posted by SK Brain Injury    |   November 2, 2011 09:55

Brain injuries happen for many reason and affect everyone who has suffered one in different ways.

For Golden residents Garrett Appleton and Jennifer Maddock, injuries to their brains came at different points in their lives and have led to different challenges.

Appleton  is now a 23-year-old who works at Sobeys. When he was only four months old a type of bacterial meningitis changed what the idea of normal would be.

“When I grew up I felt (the way I was) was normal. What ‘normal people’ say is supposed to be normal, is not what normal is to me,” Appleton said.

One of the biggest issues for Appleton growing up was suffering very serious seizures.

“The difference for me was dropping down and having a seizure. That is the big difference. I do not have many seizures but when I do they are big,” Appleton said.

Maddock suffered her injury in a different way. She worked  at CIBC and is now on disability due to the effects of the meningitis which doctors have told her was a one in a million chance of contracting.

“To look at me I look fine. I look normal, but it is not the outside that is the problem. It is my brain which is different now,” Maddock said.

She developed a viral meningitis which caused encephalitis. This in turn caused her to have seizures. She explained that she has had some problems with her memory and that explaining things to people can cause her issues.

They both deal with questions in their everyday life because people do not completely understand the severity of the injury. The fact their injuries are hidden in their brains and they function fairly well in society causes some confusion for people who think they look fine on the outside.

“We are normal people but my brain does not work like it used to,” Maddock said.

Both Maddock and Appleton are members of the East Kootenay Brain Injury Association.

“For me it has been a place to go to help me. There are people out there in similar situations. They have been awesome in helping me with things such as paper work and things I would normally be able to do on my own. It frustrates me that I can’t anymore, but they help me deal with that. It is nice to know you have that support in your community and there are people who can share their situations,” Maddock said.

The East Kootenay Brain Injury Association is working hard to increase community education and awareness of Acquired Brain Injury(ABI). Throughout the year at various venues:  schools, service clubs, faith organizations, trade fairs, community organizations, public meetings, they speak and have displays.  They have been working with different groups in the region to provide programs that are effective in educating and making people aware of ABI.

The group promotes the use of helmets in sports all year long, not just summer.  Whether it be on a bicycle or a snow sport, the helmet is effective in the prevention of brain injury.

On the group’s website it states “It is important to recognize that brain injury also occurs through non-traumatic causes such as:  stroke, anoxia, substance abuse and heart attacks.  The effects are equally devastating for the individual and families.  If  you  have acquired a brain injury from a sporting activity, fall or any other cause,  know there is help and you do not have to do this alone.”


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Non-Pharmacological Treatment for Brain Injury

posted by SK Brain Injury    |   October 25, 2011 16:28

With a growing number of cases of traumatic brain injury among a host of other disorders such as neuropathic pain and cervical headaches, Integrative Medicine has found the only non pharmacological cure in the form of Scenar therapy.

In referring to the promise that the cure holds for troops coming back home from Iraq, Dr. Ron Stram says, “The good news is that Troops are coming home and Scenar Therapy can help. But are we ready to care for the growing number of those troops diagnosed with mild Traumatic Brain Injury (TBI)? More than ever, soldiers are facing TBI diagnosis and its associated disability of post traumatic stress disorder (PTSD). Our soldiers need alternate approaches for treatment to reduce dependency on opiods and their adverse side effects – and to allow optimal opportunity for reintegration into society.”

But what is Scenar? It’s a hand-held and portable device that sends a small current across one’s skin in order to measure the resistance that the skin has to the current that has been passed. As the intensity and frequency of the current is changed, this prevents nerves from getting accustomed to only one level of stimulation, and is effective from a therapeutic point-of-view.

With the success of this type of therapy and since patients responded positively to this kind of treatment when offered frequently, patients were also given training sessions on home self-treatment so that they could use these devices at home.

Scenar therapy is easy to learn for self-treatment, especially if it’s for focused areas of pain, and according to Dr. Ron Stram, takes only an half an hour session to educate the patient, making it a better choice of therapy as opposed to using opiods.

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Young Athletes at a Heightened Risk of Brain Injury

posted by SK Brain Injury    |   October 25, 2011 16:23

The number of traumatic brain injuries (TBIs) among young athletes has increased 60% over the last 10 years, federal health regulators warn.   

The U.S. Centers for Disease Control and Prevention (CDC) released a report earlier this month, indicating that youths 19 and under face increasing risk of TBIs with increased severity and prolonged recovery when compared to adults. The CDC estimates that minors account for 65% of all sports-related emergency department visits due to concussions and other TBIs.

In 2001, 153,375 young athletes were admitted to emergency rooms across the country for concussions and other sports-related head injuries. But by 2009, that number had climbed to 248,418, according to data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP). Fatal head injuries were not included in the report. Overall, about 298 youths per 100,000 suffered a head injury in 2009, up from 190 per 100,000 in 2001.

Bicycling and playground activities were the most common cause of TBIs. Other sports which were associated with a large portion of youth TBIs included football, basketball and soccer. Males ages 10 to 19 had the highest rate of injuries.

The CDC recommended that increasing awareness of TBI risks from sports and recreation, as well as employing proper techniques, protective equipment and quickly responding to injuries could reduce the number of TBIs among children as well as their severity and long-term health effects.

Traumatic brain injuries are one of the leading causes of death and permanent disability world wide, with 1.4 to 1.7 million people suffering a the head injuries each year. Such brain damage often result in a victim requiring extensive medical treatment and permanent around-the-clock care. Why the number of injuries has increased among minors was not known.

Athletes are not the only people with a high risk of TBIs.  Motorcycle and automobile accidents account for about 20% of all traumatic brain injuries.



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Former NHL Player and Neurosugeon Talk About Concussion

posted by SK Brain Injury    |   October 21, 2011 16:12

Head injuries in sports need to stop.

That was something Charles Tator, a leading expert on concussions, and former NHL tough guy George Laraque could both agree on.

The two were at the John George Althouse Auditorium, on Western Road, speaking about the dangers of head injuries during Thursday’s (Oct. 20) conference Violence in Sports: Promotion in the Media.

Tator, a Toronto-based neurosurgeon, opened the discussion by giving people the realities of concussions.

“What treatment do we have for concussions?” Tator asked the audience. “We have no treatment for concussions, zero. We have no pill, we have no medication, we have no remedy and we have no exercise.”

Prevention, Tator added, is the only cure for concussions.

Sports cause 10 to 15 per cent of all brain and spinal injuries in Canada.

“The trauma does not have to be to the head,” Tator said. “If the blow is to the body for example and the head has a whiplash type effect, that could jiggle the brain sufficiently to cause a concussion.”

The easiest way, he said, a sport like hockey can bring down the number of concussions is by changing equipment like large solid elbow pads.

Laraque wore those bulky elbow gaurds in a lot of games during his 13-year career playing professional hockey. In over 130 fights while in the NHL, Laraque wasn’t wearing his gloves a lot of the time.

Laraque, now the Deputy Leader of the Green Party, said fighting wasn’t the issue when it comes to concussions in hockey.

“The real problem is the hits to the head,” he said. “When you fight on the ice you’re on skates and when you’re on skates you’re out of balance. So when you hit somebody in a fight, it’s not as big of a blow as you would think. When you skate 40 km/h and then you hit somebody with a flying elbow, this often causes concussions.”

In all of Laraque’s fights he didn’t receive a single serious head injury. He also doesn’t remember a single boo from the crowd after any of his fights.

He said he never worried about getting hurt while fighting and was always more concerned with the anxiety leading up to a fight.

“The fact that you’re fighting in front of an audience with a lot of people watching you and if you lose too many fights in a row, you can actually lose your job,” Laraque said. “You can be at home eating a happy dinner with your family and then you’re just thinking about the next fight you’re going to have and you can’t focus.”

Ron Wicks, another speaker at the conference, echoed Laraque’s cries for getting rid of hits from behind.

Wicks, a retired NHL referee of 26-years, started officiating before goalie masks became popular.

He had one simple rule to give to hockey players and referee’s to help bring down the number concussions in the sport- play smarter and get control of the game.

“Players need to respect each other more,” he said. “The whole integrity of the game hockey is in the referee’s hands.”

The University of Western (UWO) auditorium was filled with about 400 people, among them 250 delegates from the Thames Valley School Board (TVDSB).

“(Hockey players) are entertaining us,” said Peter Jaffe, a professor at UWO and TVDSB trustee. “But they’re also high school students, they’re also my students, they’re teenagers risking their lives in various ways looking for success.”


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Study of Brain Injury Treatment Effectiveness

posted by SK Brain Injury    |   October 21, 2011 16:08

Techniques being used to treat psychological lapses from traumatic brain injuries, the signature wounds suffered by troops in Iraq and Afghanistan, appear to be helpful, but lack rigorous scientific support, a government-appointed panel reported Tuesday after completing the most comprehensive analysis of the evidence to date.

The report, completed by the Institute of Medicine at the request of the Defense Department, concluded that some specific methods — the use of special daily diaries, for instance, to improve memory — were backed by more evidence than others. But it concluded that the evidence base over all was too thin to support any guidelines for which therapies to provide to whom.

Since 2009, the Pentagon has provided more than 71,000 hours of so-called cognitive rehabilitation, and its insurer, Tricare, has covered an additional 54,000 hours in private clinics for active duty, National Guard and retired service members, according to Cynthia O. Smith, a Department of Defense spokeswoman.

Such rehabilitation methods have come under intense scrutiny from family members of veterans who suffered traumatic brain injuries, including those caused by nonpenetrating blasts, as well as wounds from bombs, bullets or blows to the head. Some 20 percent of service members wounded in Iraq and Afghanistan have suffered blows to the face, neck or head, and the number of brain injuries has nearly tripled in the past decade, to more than 30,000 from 11,000.

About 1.7 million American civilians each year suffer traumatic brain injury, many from car accidents.

“I think the panel had a slight bias toward wanting these therapies to work, but at the same time it did not overstate the evidence,” said Dr. Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange, N.J., who was not on the committee.

Dr. Grafman said that applying cognitive rehabilitation techniques, which focus on improving memory, attention and decision making, “is almost a no-lose proposition. It’s like going to school; you should get better at what you practice and you shouldn’t get worse.”

How much better is still an open question.

The expert panel reviewed 90 studies published from 1991 to 2011, involving thousands of patients. Some of their injuries were mild, causing subtle memory deficits; others were severe and disabling. The therapies aimed to improve overall functioning, or to achieve more specific goals, like remembering appointments and chores or organizing and planning tasks.

The panel rated two types of treatment, one focused on memory and the other on social skills, as having a “modest” evidence base. It rated other techniques — for sharpening organizational skills, sustaining focus or improving overall functioning — lower still, with only a hint of evidence to back them up.

Dr. Ira Shoulson, a professor of neurology at Georgetown University Medical Center and chairman of the expert panel, said that evaluating traumatic brain injury treatment was inherently difficult because the severity of injuries varies so widely, techniques are often tailored to individuals, and veterans in particular come in with compound problems, including chronic pain, post-traumatic stress and depression.

The people providing the therapy — nurses, social workers, doctors, psychologists and, ultimately, family members — also vary from case to case. And the approach for each individual often has several components, leaving scientists to ask which made a difference.

“That’s a lot of moving targets,” Dr. Shoulson said. He and fellow panel members called for larger, better-designed trials that use agreed-upon tools to measure effects — something the field is only just beginning to develop.

Therapies for brain injuries are not well studied “because the whole field is Balkanized,” said Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College in New York. “Because there’s no infrastructure, no organized plan of attack for what happens after a brain injury, at all stages, you’re simply not going to find many” large, well-designed studies, he said.

As a rule, therapists do not begin intensive cognitive rehabilitation until months after an injury, to give brain tissue a chance to heal. But the underlying molecular processes are not well understood, Dr. Grafman said.


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High School Football Player Died from a Brain Injury

posted by SK Brain Injury    |   October 18, 2011 17:00

Authorities say a 16-year-old high school football player who died after collapsing during a game suffered bleeding on his brain, apparently from a helmet-to-helmet collision.

Cortland County Coroner Kevin Sharp says Ridge Barden died from a massive subdural hematoma, a traumatic brain injury.

The lineman for John C. Birdlebough High School in the Oswego County village of Phoenix was hurt during Friday night's game at Homer High School, south of Syracuse. Authorities say he was able to sit up after the play but complained of a headache and collapsed when he tried to stand.

Sharp says there's no evidence of any pre-existing injury or condition that contributed to Barden's death.

He says the fatal injury was consistent with the helmet-to-helmet hit reported between Barden and another player.


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Brain Injury Related ER Visits on the Rise

posted by SK Brain Injury    |   October 18, 2011 16:57

The Centers for Disease Control and Prevention reported that emergency room visits for sports and recreation-related brain injuries, including concussions, among young people have jumped 60% during the last decade.

Researchers think the primary reason is that more adults made the determination that youngsters needed to be seen by a doctor.

Researchers call the injuries traumatic brain injuries, or TBIs. From 2001 to 2009, the number rose from 153,375 to 248,418 nationwide.

There was no breakdown by state.

Injuries among males most often occurred playing football or bicycling. Females suffered injuries most often while playing soccer or basketball or while bicycling.

Bicycling, football, playground activities, basketball and soccer were the primary sports involved.

Kevin Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin, said the CDC's numbers did not surprise him.

"There's more awareness these days that it can be a significant injury, and there are simply more concussions now because kids are getting involved with contact sports at an earlier age," he said.

According to the CDC report, most of the visits to hospital emergency rooms were by males (71%). A total of 70.5% of the visits were among young people ages 10 to 19. Children up to 9 years old tended to be injured while playing on the playground or while bicycling.

Researchers have found that young athletes who had a traumatic brain injury experience longer recovery times and are at greater risk of serious outcomes compared with adults.

"TBI symptoms may appear mild, but the injury can lead to significant lifelong impairment affecting an individual's memory, behavior, learning and/or emotions," the CDC reported.

"In reality, brain injuries are still underreported and unrecognized," Walter said.

Recently, the Wisconsin Assembly Education Committee heard testimony in favor of a bill that would require young athletes who might have suffered a concussion or head injury to leave the game or activity immediately.

That athlete could not return until he or she is evaluated by a health care provider trained in the evaluation and management of concussions or head injuries and has written permission to return to play.

The bill would cover any organized athletic activity for young people between the ages of 11 and 19.

The bill has bipartisan support.


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NHL Great, Rick Martin, Diagnosed with Degenerative Disease

posted by SK Brain Injury    |   October 10, 2011 21:05

Boston University researchers have found a degenerative disease linked to head trauma in the brain tissue of the late NHL great Rick Martin, the first 50-goal scorer for the Buffalo Sabres and a member of their famed French Connection line.

Martin, who died in March of hypertensive heart disease at age 59, becomes the third former NHL player found by researchers to have had chronic traumatic encephalopathy (CTE) — a disease that causes cognitive decline, behavioural abnormalities and ultimately dementia.

After his death, Martin's family donated his brain to the Centre for the Study of Traumatic Encephalopathy, a collaboration between Boston University Medical School and the Sports Legacy Institute.

All three former NHL players who agreed to have their brains studied post-mortem at the centre — Martin, Bob Probert and Reggie Fleming — have now been shown to have had CTE, but Martin is the first who did not play an enforcer role and regularly participate in on-ice fights, the centre says.

Neurosurgeon Robert Cantu, who co-founded the institute and is co-director of the CTE centre, told CBC News the findings in Martin's case are alarming because he only suffered perhaps one concussion in his career, unrelated to fighting.

"What I can tell you bothers me: The first two cases in the National Hockey League, Reggie Fleming and Bob Probert [were] renowned fighters, 400 recognized fights during their ice hockey career, God knows how many in bars," Cantu told CBC's Stephanie Jenzer in an documentary airing Wednesday on The National, in which CBC News was granted rare access to the brain centre's lab.

"And so the amount of brain trauma they took from fighting was horrendous. And it could be thought logically that their CTE is related to their fighting. And indeed it possibly is.

"But when we look at this most recent case of Mr. Martin, that's a problem because he wasn't a fighter, he'd only had perhaps one concussion. And so we've got to be concerned that the jostling of the brain just from the skills of the sport of playing in the National Hockey League led to him having chronic traumatic encephalopathy when he died."

Star's head struck ice

Born in Verdun, Que., Martin was an NHL star in the 1970s with 384 goals and 317 assists for 701 points in 685 games, all but a handful with the Sabres.

During his time in Buffalo, Martin combined with fellow French Canadians Gilbert Perreault and René Robert to give Buffalo the top line in the league for a time, and they helped lead the Sabres to the 1975 Stanley Cup final in just the franchise's fifth year of existence.  

Martin was remembered as much for his goal-scoring abilities as a frightening incident in 1978, when he was hooked from behind and his helmet-less head struck the ice. He was knocked unconscious and went into convulsions on the ice before being carried off on a stretcher.

Martin was back the next season with a helmet, as were many other players on his team.

Over the years, Martin adopted Buffalo as his home, and died there in March when his heart failed while he was driving.

Chris Nowinski, a co-founder and president of the Sports Legacy Institute, tracked down Martin's widow after his death, not long after the brain lab made the results of former NHLer Bob Probert's CTE case public.

"Mrs. Martin said Rick would have wanted people to learn from him," Nowinski, the only Harvard graduate to wrestle at the WWE, is widely credited with putting the concussion issue on the map, told CBC News. "If other hockey players could be safer by studying his brain then he would have been all for it."

The centre's researchers said Martin's disease was relatively mild and suggested he was resilient to the disorder and less susceptible to its severity than some of the other athletes whose brains they've studied.

'No question' Martin would have developed dementia

Martin only had stage 2 disease at 59 years old, and by that age most cases in the centre's brain bank have advanced to stage 3 or 4.

But Nowinski said had Martin lived longer, the disease would have progressed.

"Who knows how quickly and who knows how badly, but he would have eventually developed dementia had he lived long enough," Nowinski said. "No question."

 Dr. Ann McKee, the brain centre's co-director who diagnosed the two previous former NHLers Probert and Fleming with CTE after their deaths, said it is unlikely that Martin's disease was triggered by just the 1978 on-ice incident.

"I'm going to imagine that there were many other more trivial blows to the head," she told CBC News chief correspondent Peter Mansbridge in an interview.

"He didn’t play with a helmet for most of his years. So any blow to the head may have been a contributing factor."

Ex-players hope brain study gives answers

There is growing concern about players suffering head trauma and struggling with physical and mental health issues later, especially amid this summer's tragic off-season for the NHL, which saw the deaths of three NHL enforcers: Derek Boogaard, Rick Rypien and Wade Belak.

Cantu and his team have examined Boogaard's brain but the results are not yet public.

Keith Primeau and Ryan VandenBussche, two former players forced out of the game because of traumatic brain injury, have agreed to have their brains donated to the centre for study after their deaths.

Both skilled and physical on the ice, Primeau never shied from aggressive play, even as the concussion tally mounted.

Six years on from his last concussion, Primeau still only counts the number of days he doesn't suffer from the effects of the brain injury — dizziness, headaches and torment that can come with depression — in days and weeks.

 "I have periods where I feel much better and I enjoy them while they last, but I have the ability to regress and show symptoms again," Primeau said at a hockey tournament, where he was coaching one of his kids.

"You become very emotionally volatile. People around you take the brunt of it, so that is sad. So it is almost a domino effect of emotions, and nothing you can really do or are capable of stemming it other than ride it out."

Looking back on his career, Primeau said it was one of his four documented concussions — he believes he suffered "north of 10" in his career — which should have been the wakeup call. On May 2000, a devastating hit at centre ice sent him to the hospital. But 48 hours later, Primeau was back for another game.

"For me, probably, I would reflect that as being the beginning of the demise," he said. "I grew up with the mentality that you get out there at all costs. You play through injury and you play through pain, and I was no different."

VandenBussche told CBC News he first brought up the idea of donating his brain to the centre with Probert, his former roommate.

"I remember chatting to him that I was going to donate my brain and we both agreed that's what we were going to do," he said. "Why wouldn't you?"

A fellow tough guy of the league who famously ended the career of Nick Kypreos with a knockout punch, VandenBussche said he tried to conceal several of the more than a dozen concussions he suffered during his playing days, first to avoid being considered concussion-prone, then later just to stay in the NHL.

"I hid every one of them that I possibly could hide," he said.

Concussions and other injuries ended his career in 2007. His body battered, today he's almost constantly in pain. But VandenBussche never imagined that a few years later, his friend would be dead and his brain might be used to help solve the concussion riddle.

"I believe I don't know the facts," he said. "I wanna be able to see it. I mean I hear a lot of stuff but whether or not you believe it, you have to go figure it out yourself. I am sure it has got some sort of correlation to that. There is no doubt about it if you take repeated blows to the head, there is going to be some sort of effects later on down the road. So I just don't know to what degree."



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Brain Injuries - General Information

posted by SK Brain Injury    |   October 10, 2011 21:03

In the course of everyday life, most of us have suffered the pain of a solid bump on the head. Whether from a fall, a door or a low-hanging branch, that sharp shock is familiar. We can usually sit for a minute or put on some ice, and carry on. But from March 2003 to March 2004, more than 16,000 people were admitted to hospital in Canada with a head injury. Most of those injuries came from falls. The tally doesn't include people who were treated and released at doctors' offices or emergency departments

As well, an estimated 2,000 children a year suffer head injuries in tobogganing accidents. Health Canada has recommended that all children use a helmet when sledding. But no province has passed legislation requiring the use of a helmet while sliding down a snow-covered hill — although most have some kind of bicycle helmet law in place.

While helmets for hockey and lacrosse are regulated, others are not. A private member's bill introduced in the House of Commons would require all recreational snow sport helmets not approved by the Canadian Standards Association to be prohibited under the Hazardous Products Act.

When does a knock to the bean become a cause for concern and medical attention? Here are a few answers to common questions about head injuries.

What are the common causes of head injury?

Car accidents are a major cause of serious head injury. Other causes are falls, sports and assaults. You don't have to be hit on the top of the head — a blow to the jaw or side of the head can also cause a brain injury. People who have had previous head injuries are believed to suffer more serious repercussions when they have another. Another injury to the head before a person has fully recovered can lead to brain swelling.

What types of head injuries are there?

The four main types of head injuries are:

  • Concussion: a mild brain injury that is usually temporary.
  • Contusion: a bruise on the brain.
  • Fracture: broken skull bones.
  • Hematoma: a blood clot caused by a blow to the brain.

The head and brain can be injured whether or not the skull is actually damaged. A hard knock or jolt, even with no external sign of injury, is enough to cause a brain injury.

What are the symptoms?

Symptoms can range from none to mild pain at the site of the injury, bleeding or lack of consciousness. Indications that the injury needs medical attention include:

  • Loss of consciousness.
  • Continued headaches, and headaches that get worse.
  • Nausea and vomiting, particularly in adults.
  • Seizures.
  • Confusion.
  • Loss of memory of events surrounding injury.
  • Drowsiness or lack of responsiveness.
  • Blood or clear liquid from the ears, nose or mouth.
  • Unusually large pupils, or pupils of different sizes.
  • In infants, an inability to stop crying.

How should it be treated?

Many mild concussions don't require more than rest and monitoring. Someone else should watch for signs of more serious injury, though. Sometimes the symptoms of a serious concussion, a contusion or hematoma may not show up for days.

Monitor when the patient does not appear to have any signs of serious injury. Make sure the person with the injury is not confused or having trouble walking. Watch for symptoms listed above.

Call the doctor if the patient later experiences dizziness, repeated vomiting, difficulty concentrating, or changes in personality.

Call an ambulance if the patient has lost consciousness, or is having seizures, paralysis, or problems walking or talking. If it is a small child, call the doctor if you think the child is not behaving as usual.

If the person has a skull fracture, put a bandage on the wound but do not try to clean it out or disturb it in any way. If the injury is serious, call an ambulance and do not try to move the patient.

Someone with a serious head injury is likely to be admitted to the hospital for treatment and observation. Symptoms can take days to show themselves. Surgery may be required to relieve pressure on the brain, if there is swelling or bleeding.

When can normal activity resume?

This will depend on the seriousness of the injury. Be sure to wait until all symptoms are gone. After a mild concussion, some people can resume normal activity almost immediately. Ask a doctor how long to wait after symptoms are gone.

Can they be prevented?

Most injuries can be prevented by sitting quietly at home — but people don't want to live their lives that way. But a few simple steps can drastically reduce the risk:

  • Don't drink and drive.
  • Wear a helmet when biking, inline skating or snowboarding.
  • Wear a seatbelt in the car and make sure children are in safety seats.
  • Slip-proof your home, especially the bathroom.
  • Play sports responsibly, using the proper equipment.

Children and helmets

One of the challenges parents face in protecting their children from head injuries is persuading them to wear a helmet, even when an adult isn't watching over them.

Ellie Wannamaker, a member of the Canadian Physiotherapy Association who treats children with head injuries at Bloorview Kids Rehab in Toronto, has some tips.

  • Convince them that wearing a helmet is "cool" by pointing to people like cyclist Lance Armstrong or other popular athletes.
  • Have children participate in the selection of the helmet, If they like Spiderman and he's on the helmet, they're more likely to wear it.
  • Get the whole family to wear helmets. If parents don't wear them, children are less likely to stick with them through their teens and into adulthood.

Wannamaker says a general guideline is that children should wear a helmet whenever they are going faster than they can run — using roller skates, inline skates, bikes, skateboards, scooters, skis, snowboards, toboggans, etc.



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