Introdução: Acidentes com ciclistas podem ser bastante sérios especialmente pela possibilidade de trauma cranioencefálico grave. Métodos: O objetivo desse trabalho foi estimar a prevalência do uso de capacetes por ciclistas nos finais de semana e feriados na cidade de Porto Alegre. Durante os finais de semana e feriados da primavera de 2007, foi realizado um estudo transversal. 969 ciclistas foram incluídos na amostra. Este estudo foi aprovado pelo Comitê de Ética do Grupo de Pesquisa e Pós-Graduação do Hospital de Clínicas de Porto Alegre. Resultados: A prevalência do uso de capacetes pelos ciclistas foi de 5,6% (IC 95% 4,5 a 7,5). Os ciclistas mais jovens (idade ≤ 20 anos) tiveram uma prevalência menor do uso do capacete, quando comparados à observada entre os demais ciclistas (idade > 20 anos), (P< 0,001; 2,1% vs. 7,8%, respectivamente). Discussão: Embora esse estudo tenha sido realizado em fins de semana e feriados, quando se espera que a prevalência do uso do capacete seja maior, nós encontramos somente 5,6% dos ciclistas utilizando esse equipamento de proteção. Medidas educativas e iniciativas que reduzam o preço de tais equipamentos poderiam trazer benefícios consideráveis para a saúde dessa população. / Introduction: Accidents involving cyclists can be very serious, especially due to the possibility of severe traumatic brain injury. Methods: The objective of this work was estimate the prevalence of helmet use among cyclists in weekends and holidays in the city of Porto Alegre. During the spring of 2007 we conducted a cross-sectional study involving 969 cyclists. The survey was carried out during weekends and holidays on 20 randomly distributed observation sites around the city. The Ethics Committee of the Research and Pos-Graduation Group of Hospital de Clínicas de Porto Alegre approved this study. Results: The observed prevalence of helmet use was 5.6% (IC 95% 4.5 a 7.5). Younger cyclists (age ≤ 20 years) had a lower prevalence of helmet use than that observed among older cyclists (age > 20 years), (P< 0.001; 2.1% vs. 7.8%, respectively). Discussion: Although this study was carried out on weekends and holidays, when the prevalence of helmet use was expected to be higher, we found only 5.6% of cyclist using this protective device. Educational measures and incentives to reduce the price of such equipment could bring considerable benefits to the safety and health of cyclists in this population.

Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.

Introduction: Despite the unique act of actively using the head as part of the game in soccer, insufficient attention is paid to its potential harmful effects. There is an increased concern regarding head trauma in soccer and its impact both in the short- and long-term. Only a few studies have examined the ability of head protection to mitigate head trauma, and opinions differ regarding its effectiveness. Objective: The purpose of this project was to investigate the injury mechanisms behind concussions in soccer and its short- and long-term effect. Furthermore, the project aimed to evaluate the ability of head protection to protect against head impacts in soccer. Methods: Two finite element models of THUMS version 4.02 pedestrians were used to simulate head collisions between two players, with the aim of mimic an aerial duel in soccer. Different impact angles and impact points were simulated, after which worst case scenarios were selected for further evaluation with head protection. The kinematics of the head and the strains of the brain tissue were used to evaluate the head's response to impacts and to evaluate the effectiveness of head protection. Results: The study showed that the maximum strain of the brain tissue as well as the kinematics of the head were sensitive to the point of impact, while the angle of impact did not show any significant influence. Head protection showed a good ability to reduce the kinematics of the head and the strain of the brain tissue. A thicker head protector had an increased ability to reduce the max values and a low friction head protector had the capacity to further reduce the max values in certain types of impacts. Conclusion: Head protection showed promising ability to reduce head kinematics and the maximum strain of the brain tissue. / Introduktion: Trots den unika handlingen av att aktivt använda huvudet som en del av spelet i fotboll, ägnas otillräcklig uppmärksamhet åt dess potentiella skadliga effekter. Det finns en ökad oro kring huvudtrauman inom fotboll och dess påverkan både på kort och lång sikt. Endast ett fåtal studier har undersökt huvudskydds förmåga att mildra huvudtrauman och olika åsikter råder angående dess effektivitet. Syfte: Syftet med detta projekt var att undersöka skademekanismerna bakom hjärnskakningar inom fotboll samt dess kort- och långsiktiga påverkan. Vidare ämnade projektet till att utvärdera ett huvudskydds förmåga att skydda vid huvudislag inom fotboll.  Metoder: Två finita element modeller av THUMS version 4.02 fotgängarmodell användes för att simulera huvudkollisioner mellan två spelare, i syfte att imitera en luftduell i fotboll. Olika islagsvinklar och islagspunkter simulerades varpå värsta scenarier valdes för vidare utvärdering med huvudskydd. Huvudets kinematik samt töjningar av hjärnvävnaden användes för utvärdering av huvudets respons på islag samt för att undersöka huvudskydds effektivitet.  Resultat: Studien visade att den maximala töjningen av hjärnvävnaden samt kinematiken av huvudet var känslig för islagspunkt medan islagsvinkeln inte visade på någon signifikant inverkan. Huvudskydd visade på god förmåga att reducera huvudets kinematik och töjningen av hjärnvävnaden. Ett tjockare huvudskydd hade en ökad förmåga att reducera maxvärdenaoch ett huvudskydd med låg friktion hade kapaciteten att reducera maxvärdena ytterligare vid vissa typer av islag.. Slutsats: Huvudskydd visade på lovande förmåga att reducera huvudets kinematik och den maximala töjningen av hjärnvävnaden.

Diffusion tensor imaging (DTI) is a specialist MRI modality that can identify microstructural changes or abnormalities in the brain. It can also be used to show fibre tract pathways. Both of these features were used in this thesis. Firstly, standard imaging analysis techniques were used to study the effects of mild, repetitive closed head injury on a group of professional boxers. Such data is extremely rare, so the findings of regions of brain abnormalities in the boxers are important, adding to the body of knowledge about more severe traumatic brain injury. The author developed a novel multivariate analysis technique which was used on the same data. This new technique proved to be more sensitive than the standard univariate methods commonly used. An important part of diagnosing and monitoring brain damage involves the use of biomarkers. A novel investigation of whether diffusion parameters obtained from DTI data could serve as bio-markers of cognitive impairment in Parkinson's disease was conducted. This also involved developing a multivariate approach, which displayed increased sensitivity compared with any of the component parameters used singly, and suggested these diffusion measures could be robust bio-markers of cognitive impairment. Fibre tract connectivity between regions of the brain is also a potentially valuable measure for diagnosis and monitoring brain integrity. The feasibility of this was investigated in a multi-modal MRI study. Functional MRI (fMRI) identifies regions of activation associated with a particular task. DTI can then find the pathway of the fibre bundles connecting these regions. The feasibility of using regional connectivity to interrogate brain integrity was investigated using a single healthy volunteer. Fibre pathways between regions activated and deactivated by a working memory paradigm were determined. Though the results are only preliminary, they suggest that this line of research should be continued.

Background: The hippocampus and corpus callosum have been shown to be vulnerable in head injury. Various neuroimaging modalities and quantitative measurement techniques have been employed to investigate pathological changes in these structures. Cognitive and behavioural deficiencies have also been well documented in head injury. Aims: The aim of this research project was to investigate structural changes in the hippocampus and corpus callosum. Two different quantitative methods were used to measure physical changes and neuropsychological assessment was performed to determine cognitive and behavioural deficit. It was also intended to investigate the relationship between structural change and neuropsychology at 1 and 6 months post injury. Method: Forty-seven patients with head injury (ranging from mild to severe) had undergone a battery of neuropsychological tests and an MRI scan at 1 and 6 months post injury. T1-weighted MRI scans were obtained and analysis of hippocampus and corpus callosum was performed using region-of-interest techniques and voxel-based morphometry which also included comparison to 18 healthy volunteers. The patients completed neuropsychological assessment at 1 and 6 months post injury and data obtained was analysed with respect to each assessment and with structural data to determine cognitive decline and correlation with neuroanatomy. Results: Voxel-based morphometry illustrated reduced whole scan signal differences between patients and controls and changes in patients between 1 and 6 months post injury. Reduced grey matter concentration was also found using voxel-based morphometry and segmented images between patients and controls. A number of neuropsychological aspects were related to injury severity and correlations with neuroanatomy were present. Voxel-based morphometry provided a greater number of associations than region-of-interest analysis. No longitudinal changes were found in the hippocampus or corpus callosum using region-of-interest methodology or voxel-based morphometry. Conclusions: Decreased grey matter concentration identified with voxel-based morphometry illustrated that structural deficit was present in the head injured patients and does not change between 1 and 6 months. Voxel-based morphometry appears more sensitive for detecting structural changes after head injury than region- of-interest methods. Although the majority of patients had suffered mild head injury, cognitive and neurobehavioural deficits were evidenced by a substantial number of patients reporting increased anxiety and depression levels. Also, the findings of relationships between reduced grey matter concentration and cognitive test scores are indicative of the effects of diffuse brain damage in the patient group.

Este estudo foca uma análise comparativa de diferentes painéis internos de capôs de veículos, com o objetivo de minimizar as lesões ao pedestre em caso de um atropelamento. As lesões na cabeça do pedestre são medidas através de um modelo em elementos finitos de uma cabeça padrão de acordo com o comitê europeu de melhorias da segurança de veículos. Os valores de desaceleração obtidos nas análises são comparados com valores toleráveis de acordo com o critério HIC (Head Injury Criteria), criado pela NHTSA (National Highway Traffic Safety Administration). Baseando-se nos resultados obtidos demonstra-se a influência dos tipos de estruturas internas de capô e recomenda-se a melhor estrutura para aplicações na indústria automobilística. / This study focus on comparative analysis of different vehicle hood inner panels, with the objective to minimize the injuries to the pedestrian in case of a running over accident. The method to measure the injuries in the head of the pedestrian will be made through a finite element model of a standard head in accordance with the European committee of improvements of the security of vehicles. The values of decelerations obtained in the analysis are compared with human tolerance levels according to HIC criteria (Head Injury Criteria), created by NHTSA (National Highway Traffic Safety Administration). Based on the finite element analysis results, this study demonstrate the influence of different hood inner panels and recommends the best structure to be applied by automobile industry.

Previous research has shown that cognitive deficits arising from neurological impairment can impact on driving performance. The diverse nature of cognitive, perceptual and behavioural impairments experienced by drivers with neurological impairment and the resulting impact on driving ability has been the subject of extensive research involving the use of psychometric off-road measures, road safety statistics, actual on-road driving assessments and self-report. This research has shown that some drivers can compensate for limitations in their driving skills but this is dependent upon realistic self-appraisal of driving abilities. Few studies have investigated the role of self-awareness of driving abilities on on-road driving performance in persons with neurological impairment. Aims: To investigate the relationship between self-awareness of driving related abilities in neurologically impaired drivers and on-road driving performance. Participants: Retrospective data were collated on 79 participants who were referred for Occupational Therapy driving assessment, comprising 24 with Closed Head Injury (CHI) (mean age 24.67 + 5.57 yrs), 30 with Cerebrovascular Accident (CVA) (mean age 61.00 + 9.08 yrs) and 25 with 'Other' diagnosis (mean age 50.64 + 21.14 yrs). All participants held a current driver's licence or learner's permit Results: Five predictor variables were significantly associated with the on-road driving assessment outcome including three demographic variables:- diagnosis (2(2)= 7.69, p = 0.021), time since injury/illness onset (2(2)= 6.40, p = 0.041), and mileage (2(2)= 5.84, p = 0.05); and two self-awareness variables:- reaction time (2(2)= 8.04, p = 0.018), and impulse control (2(2)= 13.47, p = 0.001). Logistic regression yielded a final best model containing two predictor variables (2(4) = 20.81, p = 0.000), including diagnosis (p = 0.02) and self-awareness of impulse control (p = 0.01). Discussion and Conclusion: Participants who over-estimated their driving abilities were more likely to fail a driving assessment or require driving rehabilitation than participants who under-estimated or accurately predicted their performance and participants with a diagnosis of CVA were more likely to fail or require driving rehabilitation than those with a CHI or 'Other' diagnosis.

Diffusion tensor imaging (DTI) is a specialist MRI modality that can identify microstructural changes or abnormalities in the brain. It can also be used to show fibre tract pathways. Both of these features were used in this thesis. Firstly, standard imaging analysis techniques were used to study the effects of mild, repetitive closed head injury on a group of professional boxers. Such data is extremely rare, so the findings of regions of brain abnormalities in the boxers are important, adding to the body of knowledge about more severe traumatic brain injury. The author developed a novel multivariate analysis technique which was used on the same data. This new technique proved to be more sensitive than the standard univariate methods commonly used. An important part of diagnosing and monitoring brain damage involves the use of biomarkers. A novel investigation of whether diffusion parameters obtained from DTI data could serve as bio-markers of cognitive impairment in Parkinson's disease was conducted. This also involved developing a multivariate approach, which displayed increased sensitivity compared with any of the component parameters used singly, and suggested these diffusion measures could be robust bio-markers of cognitive impairment. Fibre tract connectivity between regions of the brain is also a potentially valuable measure for diagnosis and monitoring brain integrity. The feasibility of this was investigated in a multi-modal MRI study. Functional MRI (fMRI) identifies regions of activation associated with a particular task. DTI can then find the pathway of the fibre bundles connecting these regions. The feasibility of using regional connectivity to interrogate brain integrity was investigated using a single healthy volunteer. Fibre pathways between regions activated and deactivated by a working memory paradigm were determined. Though the results are only preliminary, they suggest that this line of research should be continued.

Η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου μετά από ελαφρές κρανιοεγκεφαλικές κακώσεις στις ανεπτυγμένες χώρες κυμαίνεται από 40% έως 80% κατά τις πρώτες εβδομάδες μετά τον τραυματισμό. Ωστόσο, σχεδόν το 50% των ασθενών αναφέρουν συμπτώματα έως και 3 μήνες μετά και το 10-15% από αυτούς για περισσότερο από ένα χρόνο. Οι ελαφρές κρανιοεγκεφαλικές κακώσεις και το μεταδιασεισικό σύνδρομο αποτελούν σοβαρό πρόβλημα δημόσιας υγείας, μιας και το ποσοστό επαγγελματικής ανικανότητας που οφείλεται σε αυτά εκτιμάται από 12% για 2 μήνες έως και 20% για 1 χρόνο, με τον αντίστοιχο οικονομικό και κοινωνικό αντίκτυπο. Σκοπός της παρούσας μελέτης είναι να προσδιοριστούν τα χαρακτηριστικά και να εκτιμηθεί η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου σε έναν ενήλικο ελληνικό πληθυσμό, ταυτόχρονα με την καταγραφή των δημογραφικών στοιχείων και των παραμέτρων που αφορούν αποκλειστικά στις ελαφρές κρανιοεγκεφαλικές κακώσεις στην ίδια πληθυσμιακή ομάδα. Υλικό-Μέθοδοι: Η προοπτική αυτή μελέτη πραγματοποιήθηκε στο Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών, στη Δυτική Ελλάδα. Η συλλογή των ασθενών με ελαφρά κρανιοεγκεφαλική κάκωση ξεκίνησε τον Μάιο του 2006 και ολοκληρώθηκε τον Μάιο του 2008. Πεντακόσιοι τριάντα εννέα ασθενείς με ελαφρές κρανιοεγκεφαλικές κεφαλής συμπεριλήφθηκαν με τυχαία διαλογή στην μελέτη. Συνολικά, 223 ασθενείς (223/539: 41,5%) (άνδρες 63% και γυναίκες 37%) πληρούσαν τα κριτήρια του "Colorado Medical Society Guidelines" για τον καθορισμό της διάσεισης, με μέση ηλικία τα 30 έτη (εύρος: 18.5-57.5). Η παρακολούθηση των ασθενών συνεχίστηκε μέσω τηλεφωνικών συνεντεύξεων στους 1, 3 και 6 μήνες μετα-τραυματικά, οπότε ρωτήθηκαν εάν εμφάνισαν οποιοδήποτε από τα κοινά μεταδιασεισικά συμπτώματα (ICD-10 κριτήρια). Αποτελέσματα: Το ποσοστό του μεταδιασεισικού συνδρόμου στο τέλος του πρώτου, του τρίτου και του έκτου μήνα μετά τον τραυματισμό υπολογίστηκε σε 10,3%, 6%, και 0,9%, αντίστοιχα, δηλαδή 4-8 φορές μικρότερο σε σχέση με τις άλλες μελέτες. Το μεταδιασεισικό σύνδρομο βρέθηκε να είναι συχνότερο μεταξύ των γυναικών (17%) και μεταξύ των ατόμων με αιμορραγική διάθεση (26%), σε σύγκριση με τους άνδρες και τους ασθενείς χωρίς διαταραχές πήξεως, αντίστοιχα. Επιπλέον, το μεταδιασεισικό σύνδρομο παρατηρήθηκε σε υψηλότερα ποσοστά σε ανθρώπους που υπέστησαν επίθεση ή κακοποίηση, σε σύγκριση με άλλου είδους ατυχήματα καθώς και σε ασθενείς με μετατραυματική ανοσμία. . Συμπεράσματα: Τα αποτελέσματά μας βρίσκονται σε αντίθεση με προηγούμενες μελέτες άλλων ανεπτυγμένων χωρών, όπου η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου ήταν αξιοσημείωτα υψηλή. Οι πολιτιστικές διαφορές όσον αφορά στα προσδοκώμενα συμπτώματα μετά την κάκωση, οι διαφορές στο νομικό πλαίσιο και το ασφαλιστικό καθεστώς μεταξύ των χωρών και η έλλειψη αξίωσης αποζημίωσης, θα μπορούσαν να εξηγήσουν το χαμηλό ποσοστό των χρόνιων συμπτωμάτων στους Έλληνες. Από όσο είμαστε σε θέση να γνωρίζουμε, αυτή είναι η πρώτη προοπτική μελέτη για τον καθορισμό της επίπτωσης του μεταδιασεισικού συνδρόμου σε Έλληνες ενήλικες και η πρώτη που καταγράφει δημογραφικά στοιχεία και παραμέτρους που να αφορούν αποκλειστικά στις ελαφρές κρανιοεγκεφαλικές κακώσεις. Τα συμπεράσματα αυτά , εάν επιβεβαιωθούν από μεγαλύτερες σειρές, θα μπορούσαν να εγείρουν ερωτήματα , όπως π.χ. ποιοι ασθενείς πάσχουν πραγματικά και εάν θα μπορούσε να αποφευχθεί η απουσία τους από την εργασία, μιας και το κόστος της χαμένης παραγωγικότητας λόγω του μεταδιασεισικού συνδρόμου στις ανεπτυγμένες χώρες φαίνεται να είναι ιδιαίτερα υψηλό. / The prevalence of postconcussion syndrome following mild traumatic brain injury in developed countries varies from 40% to 80% during the first weeks after injury. However, as many as 50% of patients report symptoms for up to 3 months and 10-15% of them for more than a year. Mild head injuries and postconcussion syndrome represent a very serious public health issue, as estimates of occupational disability range from 12% at 2 months to 20% at 1 year, with severe concomitant social and financial impact. The objective of this study is to determine the characteristics and estimate the prevalence of postconcussion syndrome in an adult Greek population and to reveal demographics and injury characteristics concerning exclusively mild head injuries in the same cohort. Material-Methods: This prospective study was undertaken in the University Hospital of Patras in Western Greece. Recruitment of patients with mild traumatic brain injury began on May 2006 and finished on May 2008. Five hundred and thirty nine patients (539) with mild head injury were randomly recruited. Overall, 223 patients (223/539: 41,5%) (male 63% and female 37%) met the inclusion criteria of the ΄΄Colorado Medical Society Guidelines΄΄ for concussion, with median age 30 years (range: 18.5-57.5). The patients had a follow-up through telephone interviews at 1, 3 and 6 months post-injury and were asked about having any of the common postconcussion symptoms (ICD-10 criteria). Results: The rate of postconcussion syndrome at the end of the first, third and sixth month post-injury, was estimated at 10.3%, 6%, and 0.9%, respectively, which was 4-8 time less than other studies. Postconcussion syndrome was found to be more frequent among women (17%) and among individuals with bleeding diathesis (26%), compared with men and patients without clotting disorders, respectively. In addition, postconcussion syndrome affected in higher rates people who sustained assaults in comparison with other types of accident and was also more frequent among patients with posttraumatic anosmia. Conclusions: Our results are in contrast with previous studies in other developed countries, where the prevalence of the postconcussion syndrome was remarkably higher. The cultural differences regarding symptom expectation and the lack of compensation might explain the low rate of chronic symptoms in Greeks. To our knowledge, this is the first prospective study to estimate the prevalence of postconcussion syndrome among Greek adults and also the first trial in recording demographics and injury characteristics concerning exclusively mild head injuries in the same cohort. If further studies confirm our results in the future, reasonable queries could emerge, such as which patients really do suffer and whether their absence from work could have been avoided, as the cost of the lost productive work time after mild head injuries is extremely high.

Objective: The long-term cognitive effects of mild traumatic brain injury (MTBI) and sport-related concussion (SRC) are not always clear. Higher-level longer-term cognitive difficulties can indicate enduring neurological damage, as part of a post-concussion syndrome (PCS). This study aimed to investigate whether cognitive performance and self-reported PCS symptoms of athletes (rugby players) relate to SRC and whether gender moderates these effects. Method: Eighty-six participants completed a questionnaire detailing SRC history (frequency and severity) and rated long-term symptoms using the Sport Concussion Assessment Tool 3 (SCAT3) symptom evaluation scales, before completing the CogState Brief Battery and STOP-IT (stop-signal response inhibition task). Results: No significant relationships between SRC dosage (frequency/severity), self-reported PCS symptoms, and cognitive test performance were identified. A greater proportion of males reported SRC compared to females, but no effect of gender was found on any of the cognitive outcome measures or self-reports of PCS symptoms. Conclusions: The results show that SRC has no observable long-term effects on cognitive test performance or PCS symptom self-reports. The analysis may have lacked power to detect effects. Analysis of individual performance over time against baseline scores may be more relevant for accurate diagnosis than relying on normative test scores. Recommendations for future research were made.