ICE CREAM BUCK­ETS AND BELL RINGINGS

Australian Mountain Bike - - Speakers Corner - WORDS: ANNA BECK PHO­TOS: MIKE BLEWITT

Have you had a big crash and kept on rid­ing? We see it plenty of times in the World Cup down­hill rac­ing, and in the World Cup XCO – plus in freeride videos. What makes moun­tain bik­ers so spe­cial when other sports treat head in­juries with more cau­tion? When was the last time you crashed and hit your head? Did you get straight back up? Did you seek med­i­cal at­ten­tion? Back in the day, foot­ball play­ers would be knocked out cold, get slapped in the face and sprayed with wa­ter un­til they roused, then be back play­ing in a few min­utes, lolling all over the field. Now, foot­ball codes all have strin­gent head-in­jury pro­to­cols af­ter a spate of NFL play­ers in the USA were di­ag­nosed with Chronic Trau­matic En­cephalopa­thy (CTE) af­ter a long ca­reer of head-knocks. CTE has been linked to in­creased rates of de­men­tia, cog­ni­tive im­pair­ment, and per­son­al­ity changes. While con­cus­sion can be di­ag­nosed from a sin­gle trau­matic event, these longer last­ing changes often take a much longer time to ap­pear. Per­haps we should un­pack what a head in­jury is.

WHAT IS A HEAD IN­JURY?

The Mon­roe-Kel­lie Doc­trine is, as a univer­sity lec­turer once ex­plained, the law re­lat­ing to the phys­i­o­log­i­cal phe­nom­e­non of the brain and skull; es­sen­tially that the brain is a big squishy thing with a com­plex vas­cu­la­ture, bathed in spinal fluid, which is stuck in­side a hard box (your skull). A rapid ac­cel­er­a­tion/de­cel­er­a­tion or di­rect blow can cause the ra­tio of these con­stituents to in­crease (such as in the case of a cere­bral bleed), caus­ing in­tracra­nial pres­sure to in­crease and re­sult­ing in much bad­ness, in­clud­ing her­ni­a­tion, changes in con­scious state and in the worst case, death. A di­rect blow isn’t nec­es­sary to cre­ate trauma, a sud­den ac­cel­er­a­tion/de­cel­er­a­tion can cre­ate the shred­ding forces that cre­ate neu­ron dam­age. Head in­juries are clas­si­fied us­ing a scale called the Glas­gow Coma Scale (GCS), and sorted into mi­nor, moder­ate and se­vere de­pend­ing on the best re­sponse to ver­bal, mo­tor and eye as­sess­ments. But GCS has lim­i­ta­tions; some­one can present fully ori­en­tated, with­out a loss of con­scious­ness, and still have a con­cus­sion. In fact, CT scans can come back clear and the pa­tient can still be con­cussed. Most of us will know the ob­vi­ous signs of a moder­ate to se­vere head in­jury; changes in con­scious state, nau­sea and vom­it­ing, se­vere headache, in­abil­ity to talk, mem­ory loss, ob­vi­ous head trauma, dizzi­ness, seizure and in­abil­ity to walk in a straight line. What is less ob­vi­ous are the more sub­tle, oc­cult signs of con­cus­sion post-trauma; blurred vi­sion, pho­to­sen­si­tiv­ity, emo­tion­al­ity, dif­fi­culty con­cen­trat­ing, fa­tigue, ir­ri­tabil­ity, mem­ory dif­fi­cul­ties, de­crease in bal­ance, gen­eral headache, ag­gres­sion, in­som­nia, and changes in re­ac­tion time. The thing is, the brain has had a big knock and re­quires rest to re­pair neu­rons and get back to nor­mal func­tion. That doesn’t mean hop­ping back on your bike and rid­ing, it means com­plete lack of stim­u­la­tion and rest­ing un­til symp­tom free. But we have HEL­METS guys, it’s go­ing to be OK!

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