Head Blow Research Articles

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Another weekend night shift…In that place we call “The Pit”…The inner city E.R.…Where the tumult doesn't quit.Tonight the “Knife and Gun Club” meets…So named as you might tell.…It's when the locals hit the streets…And alleys turn to hell.I was still evaluating…If a head blow caused much harm…When the cops brought in another…With a bullet in his arm.“Here's another you can practice on…” I heard some old cop say.…“We're catchin’ ‘em like stripers…This one didn't get away.”His “fish” was only in his teens…They chained him to a cot.

ВЛИЯНИЕ ОБРАБАТЫВАЕМОЙ СРЕДЫ НА ЭФФЕКТИВНОСТЬ ПЕРЕДАЧИ ЭНЕРГИИ УДАРНОГО ИМПУЛЬСА ПРИ ВОЛНОВОМ ДЕФОРМАЦИОННОМ УПРОЧНЕНИИ

The investigations carried out are dedicated to the analysis of the material impact of the loading environment upon the effectiveness of a shock pulse at wave deformation strengthening. To carry out investigations in the specialized program there is developed a finite-element model of an impact system consisting of a head and a waveguide pressed statically to the environment of loading. The impact system effectiveness was estimated on the ratio of shock pulse energy imparted to a deformation source taking into account the material of the loading environment to the energy of a head blow to a waveguide. It is defined that the most significant impact upon a share of transient energy of the shock pulse is rendered by the head parameters the change of which in the range considered allows increasing the effectiveness of the impact system by 15.6 times. The next important factor affecting considerably the effectiveness of shock pulse energy transfer is a ratio of the lengths of a head and a waveguide the change of which in the value range investigated allows increasing a share of energy transferred by 2.8 times. The least impact upon the effectiveness of impact energy transfer in the center of deformation with the impact system is performed by the material of loading environment – 1…3% for the rational values of the parameter ratios of the impact system elements (n more than 80%). At the forced choice of less efficient impact systems (L1/d1=1 ; L1/L2=1…10; n less than 62%) the impact of the material of loading environment may make 6…10%.

Preventive potential of low intensity pulsed ultrasound for chronic traumatic encephalopathy after repetitive head collisions in contact sports

Chronic traumatic encephalopathy (CTE), a disease process well-recognized in boxers, American football players and military personnel, is a progressive neurodegenerative disease caused by repetitive blows to the head. Subjects with CTE can have a wide range of emotional, cognitive and physical symptoms. The cognitive group patients had a significantly higher probability of developing dementia in later years. Currently, there are no disease modifying regimen for CTE. Timely intervention of head blow could diminish the development of CTE. Low-intensity pulsed ultrasound (LIPUS) is a common adjunct used to promote bone healing for fresh fracture. Recent reports suggest that LIPUS can noninvasively modulate the cortical function and have neuroprotective effect in various animal models of traumatic brain injury, stroke, Alzheimer’s disease and major depressive disorder. The multifunctional mechanisms of LIPUS neuroprotective effect include several trophic factor stimulations, anti-inflammatory properties and reduction of brain edema. From the above evidence, LIPUS intervention could be a strategy for the prevention of the clinical CTE sequelae of repetitive head blows. We hypothesized that due to its neuroprotective effects, the non-invasive and easy-to-use method of LIPUS brain stimulation could have a preventive effect on players who have head blows during the match. The development of a time sensitive protocol, resembling the therapeutic algorithm for traumatic brain injury, would potentially prevent the development of subsequent CTE adverse outcome. Further long-term longitudinal studies of LIPUS stimulation are warranted to verify the prevention efficacy of this intervention for CTE.

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 25. CT imaging of the spine in pediatric trauma patients: prevalence of fractures and mechanisms of injury

BACKGROUND CONTEXT Computed tomography (CT) scans have become ubiquitous in the assessment of the trauma patient because of its diagnostic acuity in assessing head and axial skeletal pathology. Consensus recommendations exist for limiting the ionizing radiation dose as it pertains to CT head imaging in the pediatric population. However, little published data exist assessing the diagnostic yield of current practices in the pediatric population. As pressure mounts to diagnose emergent pathologies in the emergency department, children are at risk for a relatively high cumulative burden as sequela of medical imaging such as an increased lifetime attributable risk of cancer. PURPOSE To evaluate the diagnostic yield of CT scans of the spine in pediatric trauma patients STUDY DESIGN/SETTING Retrospective, Level I trauma center. PATIENT SAMPLE Patients 18 and under, undergoing CT scans in the ER 1/2013-12/2015. OUTCOME MEASURES Presence of fracture. METHODS Medical records of pediatric trauma patients who arrived at the emergency department and underwent spinal CT were reviewed. We reviewed the CT scans as well as the radiology reports for fractures. Medical records were reviewed for mechanism of injury and management for these patients as well as demographics. Factors associated with pediatric patients with fractures were then compared to those without fractures. RESULTS A total of 831 patients underwent CT scans in to the ER. Average age was 13.86 years (0.24-18.99) with 43% (355) females and 57% (476) males. The racial demographics were as follows: 70% Caucasian, 20% African American, 1.4% Asian, with the remainder listed as other or not available. The most common mechanism of injury (MOI) was motor vehicle accident (MVA) (26%) followed by sports injury (18%), then fall from height (15%) bicycle/motor bike (14%). Other mechanisms of injury were pedestrian struck (9.5%), assault (5%), syncope (3%), direct head blow (3%), neck pain (2%), fall from standing (1%), seizure (1%), strangulation/hanging ( CONCLUSIONS It is important to consider the long-term implications when deciding to expose a pediatric patient to radiation. In this study we found the overall axial fracture rate to be low (6.1%). The fractures were distributed throughout the mobile spine and sacrum. Of the fractures that were detected 54% were transverse process and compression fractures. Pediatric trauma CT scanning best practices focusing on MOI most likely resulting in spine fractures (MVA, bike/motor bike, sport injuries) should be investigated. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Factors influencing self-rated health in traffic-related mild traumatic brain injury

To report self-rated health and factors influencing health after traffic-related mild traumatic brain injury. Population-based, cross-sectional study of traffic-related mild traumatic brain injury occurring between 1 December 1997 and 31 November 1999 in Saskatchewan, Canada. Subjects were 929 adults making a personal injury claim after a traffic collision. Inclusion criteria were a head blow with certain or possible loss of consciousness or post-traumatic amnesia, or a possible head blow with certain loss of consciousness/post-traumatic amnesia. Excluded were those with loss of consciousness > 30 min and those hospitalized longer than 2 days. Data were self-reported through insurance application forms completed within 6 weeks of the injury. Multivariable multinomial logistic regression was applied to identify factors associated with self-reported general health. In contrast to the 74.5% of subjects reporting excellent or very good health prior to injury, 70.8% reported having poor/fair health after the injury. Post-crash depressive symptoms, sleep problems, greater neck/low back pain and low expectations for recovery were associated with poorer post-injury health. Those with traffic-related mild traumatic brain injury reported a decline in self-perceived general health. We identified potentially modifiable factors associated with poor post-injury health and suggested that these factors should be considered during early clinical intervention.

Delayed-onset temporary auditory threshold shift following head blow in guinea pigs

This study attempts to investigate the development of sensorineural hearing loss following a head blow without skull fracture in association with physiological and histopathologic changes in an experimental animal model. With the head in a freely movable position, albino guinea pigs were given a single blow to the occipital region by a head blow device. At 1, 7, and 14 days after the blow, the animals’ auditory brainstem response (ABR) and cochlear microphonics (CM) were examined, and both the temporal bone and brain stem were observed by light and electron microscopy. The ABR threshold was unchanged at day 1, was significantly increased at day 7, and was fully recovered at day 14. The I–V and I–II interpeak latencies were significantly prolonged at days 1 and 7, and wave I latency was significantly prolonged at day 7 only. These latencies were recovered to normal limits at day 14. On the other hand, no significant change in CM versus the control group was observed at any point in the measurements. Histopathologically, no abnormal finding was seen at the light microscopic level. However, at the electron microscopic level, there were some injuries to the eighth nerve. At day 1, the lamellar structure of the myelin sheath was irregular, and the periaxonal space was expanded; at day 7, the myelin sheath was disintegrated. At day 14, however, these changes were partially reversed. These results suggest that sensorineural hearing loss following a head blow in this model is attributed to dysfunction of the eighth nerve rather than to cochlear impairment.

Anticipatory modulation of neck muscle reflex responses induced by mechanical perturbations of the human forehead

The aim of this study was to test whether anticipation of upcoming head blow stimuli, which elicit reflex responses in the neck muscle, makes the reflex responses greater or not. In nine healthy subjects the reflex responses were elicited in the sternocleidomastoid (SCM) muscle in the eyes-open (EO) and eyes-closed (EC) conditions, which corresponded to the predictable and unpredictable conditions, respectively. The subjects were instructed not to resist the perturbations after the impact. The results demonstrated that the reflex response of the SCM muscle was significantly smaller in the predictable EO condition than in the unpredictable EC condition ( P < 0.05), although no significant differences were observed in either the background EMG activities or the head accelerations. Further, this effect of anticipation was observed only in the later reflex EMG component, which most probably mediated the stretch reflex pathway. In contrast, no significant difference was observed in the early component, which was presumed to be the vestibular-collic reflex. The reduced stretch reflex response was suggested to be functionally relevant to the task requirement, i.e., to let the neck extension movement occur, and not to resist after the impact of the head blow. It was concluded that the anticipation has an effect on reducing the stretch reflex responses in the neck muscle, but does not have any effect on the presumed vestibular-collic reflex under the present experimental paradigm. It is suggested that the gain of the stretch reflex pathway is modulated by anticipatory information of upcoming mechanical event.

Incidence study of head blows and concussions in competition taekwondo.

To examine the incidence of head blows and concussions in competition taekwondo. Incidence cohort design. Taekwondo tournament in 2001, in South Korea. A total of 2328 competitors (female, 676; male, 1652; age, 11-19 years) from 424 schools participated in the tournament. All recipients of head blows were interviewed immediately after the match. All matches were recorded on videotape. Head blow and concussion rates were calculated. Also, factors associated with head blows and concussions were analyzed. The incidence of head blows and concussions was 226 and 50 per 1000 athlete exposures, respectively. Only 17% of competitors reported that they had had a concussion in the last 12 months. A multinomial logistic model showed that head blows and concussions were associated with young age and a lack of blocking skills. The incidence of head blows and concussions is high in competition taekwondo. Promoting blocking skills to prevent head blows could decrease concussions in taekwondo.

Effect of age on the contraction of pulmonary venous sphincters in rats.

Pulmonary veins of rats have regular focal ringlike muscular constrictions (sphincters) that deepen with stimuli, such as head injury, sufficient to cause pulmonary edema. The depth of the individual constrictions on the veins can be determined by casting the pulmonary circulation, fracturing the cast veins at their narrowed points, and measuring the constriction using a scanning electron microscope. A recent study in rats given a blow to the head showed that the venous constriction was attenuated by alpha-adrenergic antagonism, but interaction between the antagonist, the animal body weight, and sex was found. Older, heavier male animals constricted more. To clarify these factors and assess the change in pulmonary venous sphincter contraction with age, 20 female Sprague-Dawley rats aged 5, 10, 15, 20, and 30 wk had their lung vasculature cast with methyl methacrylate. Of the 4 animals in each age group 3 were given a blow to the head to constrict the veins while the plastic was solidifying. The lungs were digested and the casts of the blood vessels were fractured, exposing the constricted portions of the veins. The depths of these focal constrictions were measured. In animals that received the head blow the constrictions were 2.9 +/- 0.3% (5 wk), 4.1 +/- 0.3% (10 wk), 5.8 +/- 0.4% (15 wk), 6.8 +/- 0.4% (20 wk), and 7.1 +/- 0.5% (30 wk) (p < 0.0001). To separate age from weight, a multivariate regression that accounted for venous contraction was carried out. Although head blow, age, and weight were each individually important, the combined model showed age was insignificant (p = 0.9) when weight (p = 0.02) was present.(ABSTRACT TRUNCATED AT 250 WORDS)

Sphincters in Pulmonary Veins: An Anatomic Study in Rats

To better understand blood flow and edema formation in the lung, anatomic evidence for venous sphincters was sought by a scanning electron microscopic investigation of vascular casts in the rat. In the first study, indentations in the casts of veins and arteries were compared. Casts of the pulmonary veins had narrow (1 to 3 microns) circumferential constrictions about every 30 microns in length (range 20 to 50 microns) and before and after accepting tributaries. Most arteries had no constriction. Infrequently, arterial narrowing occurred over long distances (greater than 30 microns). To determine if these indentations could be altered by a neural stimulus, a second study tried to cast the pulmonary microcirculation after the rats were given a blow to the head, but was unsuccessful. In a third study, the pulmonary vasculature of anesthetized rats was cleared and cast. As the resin began to harden and the animals' circulation ceased, half the animals were given a sharp blow on the head. The casts of the veins in the animals that received the blow had deeper bands than the control animals (p less than 0.001). Pulmonary veins have annular constrictions (sphincters) that are strategically located to influence blood flow. They deepen in response to the neural discharge of a head blow and should be considered in the study of neurogenic pulmonary edema.

Pathogenesis of Hearing Loss in Head Trauma

A common type of head trauma in man was simulated in guinea pigs by delivering them a head blow with the pendulum device.The effects of the direction and intensity of the head blow and the effects of the lapse of time after the head blow on the development of hearing loss were studied.The electrical responses from the inferior collicurus and from the round window to acoustic stimuli were measured. The elevation in threshold of the evoked responses from the inferior colliculus in the presence of normal cochlear potentials in the animals suggests that the site of lesions is central to the cochlea. Biomechanics of the development of damages in the central auditory pathway secondary to a head blow was discussed further.

Effects of head blow on the development of hearing loss.

The effects of the direction and intensity of the head blow and the effects of the lapse of time after a head blow on the development of hearing loss were studied in guinea pigs. The electrical responses from the right inferior colliculus (ER) and from the left round window (CP) to acoustic stimuli were measured. The elevation in threshold of the ER in the presence of normal CP in guinea pigs after a head blow suggests that the site of the lesion is central to the cochlea.

Electrophysiological responses from the cochlea and inferior colliculus in guinea pigs after head injury

Electrical responses from the inferior colliculus (ER) and round window (CP) to acoustical stimuli were compared in control and experimental guinea pigs which had received a single blow to the freely movable head. After the blow to the head, all of the animals showed signs of commotio cerebri, and some of them died. The experimental animals were divided into two groups so that the physiologic responses to sound could be evaluated one day (early group) and seven days (intermediate group) following the head blow. The animals of the early group had elevated ER thresholds over the entire frequency range tested with an average threshold of 37.8 db. The animals of the intermediate group also had elevated ER thresholds which averaged 23.9 db. Input-output intensity function of ER for the experimental animals showed a recruitment-like phenomenon. The CP thresholds in the injured animals did not differ significantly from those in the control group. Damage to the VIIIth nerve and higher central pathways is very likely a more frequent cause of the otoneurologic manifestations following head injury than end organ damage.

The Evolution of Horn-Like Organs

Hornlike organs evolved independently in a number of mammalian families. Though these organs assumed great diversity they did evolve into several general functional types. A short review of the structure and development of hornlike organs is given. Some views on horn function and evolution are critically discussed. The evolution of hornlike organs is visualised as follows: In primitive large mammals the head blow became effective as a fighting form due to increased mass and inertia of the heads. Some forms grasped this potential. Combats were carried out from the broadside while opponents delivered head blows on each others body. Skull protuberances now became adaptive. Concurrently, defensive mechanisms evolve, decreasing the effectiveness of these protuberances. Foremost among them is a thick, heavy hide or specialised dermal shield. These adaptive syndromes gave no impetus towards larger and more complex horns. This impetus arose with the appearance of a new method of defense - catching the opponent's blows with the horned head. This leads to the evolution of heavy skulls and horns capable of catching and holding the opponent's head. The target area of attack remained the body. Frontal engagements resulted from the opponents' attempts to control each others horned head. It is shown that bovids and suids followed similar evolutionary roads in their mode of combat. The tusks of the suidae fulfill the same function and were subject to similar selection as the horns of short horned bovids. Thus Sus and Oreaisinos, and Bos and Phacochoerus are entirely similar in their mode of combat, hornlike organs and defense mechanisms. The primitive frontal engagement gave rise to two different modes of combat, ramming and wrestling. The wrestlers evolved complex horns, whose function is to bind opponents together, thus allowing them to develop full strength wrestling and pushing matches. The rammers evolved a heavy skull and heavy horns. A trend towards cephalisation of display organs can be detected in ruminants and suids. Display organs are interpreted as attention guiding adaptations. It is shown that the distribution of display organs correlates with the display. A broadside body display is found in ruminants with a diffuse distribution of display organs. If display organs are cephalised, the broadside display disappears. This is found in the North American wild sheep. Display centers about one heavy, very large horns of males. Next it is verified that the rams horns are display organs. It is shown, the horn display is the prerogative of the dominant; sheep can differentiate horn size classes; large horned males enjoy reproductive advantage; horn size carries a priori dominance status. Hence horns evolved to function as weapons inflicting damage; as defense organs shielding their owner; as binding organs allowing opponents a secure lock in battle; as display organs having an a priori intimidating effect on certain conspecifics. Some species of ruminants possess hornlike organs which change progressively in size with the age of their owner. It is postulated that, as in North American wild sheep, horn size parallels dominance order. Conspecifics learn to associate horn size and agonistic potential of opponents. Hence horn size signals to conspecifics predictable social relationships. In large cervids from temperate and cold climates this system must save stored energy during the rut, which males need for the severe winter. Graded horn sizes allow wild sheep to live in an open society in which strange individuals may meet and fit into the dominance hierarchy with a minimum of combat. Graded horn sizes hence serve as rank indicators. It is next made plausible that territories in ruminants function in conjunction with displaying males as rank indicators. Outside the territories males mix freely. Hence graded horn sizes and territoriality may enable open societies, by acting as communication mechanisms and creating a predictable, social environment. A hypothesis is presented explaining the selective forces for the evolution of display. It predicts that, antagonistic selection forces shape display and display-organs, that a potential exists for rapid spread in a population of differences in behaviour and morphology, that intimidation mechanisms evolved for all sensory pathways, that external appearance af animals changes more repidly than their primary adaptations.

Hearing impairment due to head blow. Differential diagnosis of retrocochlear impairment

Recent advances in audiology have made it possible to determine locus of pathologic lesions in the auditory pathways. However, attention should be paid to examine hearing of head blow patients.Because two or more areas from the middle ear up to the auditory cortex are frequently involved.We have examined 90 cases of head blow with special attention in finding retrocochlear lesions, by combining several audiometric procedures.The following auditory tests were performed in all cases, in addition to routine examinations of otoscopic finding, X-ray photography pure tone audiometry, vestibular tests and EEG.1) Speech AudiometryDiscrimination scores were made by a speech audiometry with and without filters which cut off frequencies higher than 1700 cps or lower than 1200cps.2) Bekesy AudiometryFrequencies of 1000cps and 4000cps were used in this test. Tone decay was examined after an exposure of 80dB for a minute.3) Directional Hearing TestA device was made to measure threshold of the interaural time difference which produced a shift of the tone image, by placing two microphones apart from 0 to 1.2 msec (0 to 42cm). A value over 0.06msec (2cm) was considered to be pathological.Speech audiometry frequently helped us in diagnosis of retrocochlear deafness in cases of poor discrimination scores with an excellent pure tone threshold. Bocca and Calearo devised an apparatus to avoid patients being accustomed in conventional speech audiometry. In our series of examinations, we employed 1200cps low pass filter and 1700cps. high pass filter to obtain discrimination scores Control experiment in normal person showed 50 to 70% in each test at 80dB above threshold, whereas in patients of suspected retrocochlear deafness poor scores were obtained. The sum of scores tested with filters did not exceed that without filters.Many authors have reported that the recruitment phenomenon is present in head blow patients.A narrow amplitude in Bekesy audiogram is often observed in patients with positive recruitment.Tone decay is suggestive of retrocochlear lesion.An effective test for demonstrating retrocochlear lesion is to measure threshold of the interaural time difference. Matzker states that a lesion, higher than the crossing-over of the auditory system in the brain stem, showed a high value in the directional hearing test.By combining Bekesy audiometry, filtered speech audiometry, and a directional hearing test, it is possible to determine retrocochlear lesions in the auditory system.