Head and spinal cord trauma involving youth recreational activities.

Participation in recreational activities is a gift that we in our highly technological society, should treasure. However, this participation is not without its risks. Injury is the leading cause of death among Americans through the age of 44 (Centers for Disease Control, 1990). Recreational and sport-related activities are among the major causes of those injuries. Specifically "40% of all head injuries in children and adolescents exclusive of those related to motor vehicles" (Baker, et al., 1994) can be attributed to participation in recreational pursuits. Fun, fitness and recreation should not correlate with injury, morbidity and mortality.

This article will serve as a summary of what current research on head and spinal cord injures sustained while participating in recreation has to offer practitioners in the field in terms of awareness and possible preventative strategies.

The brain and spinal cord are "largely incapable of regeneration" (Cantu, 1990). Contrary to what many youthful participants believe, there is also no magic piece of technology, surgery or pill to "fix" damage sustained to these structures, therefore, the damage is permanent. In light of the importance of these vital organs in terms of a lifestyle that is physically active. the following research needs to be considered.

In terms of traditional activity, The National Center for Catastrophic Sports Injury Research reports that football, gymnastics, ice hockey, and wrestling pose the greatest danger for head and spinal cord injury. In addition, baseball players between the ages of five and 14 have the highest death rate of any recreation-related activity (Cantu, 1995). Bicycling is the leading cause of recreational injury among children (Baker,et. al., 1993), with head injury being the leading cause of death and permanent injury/disability. Li (1995) reports that "... head injury accounts for less than 60% of bicycle-related deaths and about one-third of emergency room treated bicycling injuries." Cantu (1995) offers a list of recreational sports posing the greatest threat for spinal cord and head injury (Table 1).

Table 1. Recreational Sports Posing the Greatest Threat for Spinal
Cord
and Head Injury
1. Auto racing
2. Boxing
3. Cycling
4. Diving
5. Equestrian sports
6. Football
7. Gymnastics
8. Hang Gliding
9. Ice Hockey
10. Lacrosse
11. Martial Arts
12. Motorcycling
13. Parachute
14. Rugby
15. Skating/rollerblading
16. Skiing
17. Soccer (goalie)
18. Track (pole vaulting)
19. Trampolining
20. Wrestling

Cantu recommends that "avoidance" of some of these activities is perhaps the best preventative measure to be taken. In respect to any given individual, parent or program avoidance may or may not be a realistic option. The Consumer Product Safety Commission (as reported by Baker et. al., 1994) also offers the statistics in Table 2.

[TABULAR DATA 2 OMITTED]

A popular recreational activity, "in-line" skating is reported to be one of the fastest growing sports in the U.S. In a study conducted by Malanga and Stuart (1995), the authors cite research findings of 34,000 injuries attributed to in-line skating in 1992 and 83,000 emergency room visits in 1994.

The authors also provide data generated through the National Electronic Surveillance System in which it is "estimated that 30,863 persons were treated for in-line skating injuries during a one-year period." Obviously, all of these injuries and emergency visits did not result in head or spinal cord trauma. However, the numbers do show significant cause for concern. In their study of 32 in-line skating patients the authors report 78% of all injuries were to the upper extremity of the body (Malanga and Stuart, 1995). A comparative study conducted by Schieber, Branche-Dorsey and Ryan (1994) reported 3.3 roller skating and 1.2 skateboarding injuries for every in-line skating injury. Here, too, the "upper extremities" suffered the largest proportion of trauma representing 54% of the total.

Another recreational activity associated with head and spinal cord injury involves horses. Last year, the actor Christopher Reeve suffered an equestrian related injury while jumping his horse in a competition. Thrown off the animal. Reeve is now a quadrapalegic. The American Horse Council estimates that, in the U.S., more than 1.2 million horse owners are younger than 20 years of age. In a review of the literature, Nelson and Bixby-Hammet (1992) also concur with the previous research findings that head injuries (72% to 78%) were associated with the majority of deaths and hospitalizations (55% to 100%).

The following case history cited by Nelson and Bixby-Hammet, although specific to an equestrian accident is one that could possibly apply to ANY head and spinal cord injury accident in that preventative steps could have (should have) been taken: "A 13-year old girl was practicing (horse jumping) in preparation for a competition. She fell forward onto the ground. As the horse (which had also fallen nearby) was righting himself, he stepped upon the rider's head. She was found to be unconscious and never demonstrated any recovery of neurological function. Her skull had been fractured at the base, and she died five days following the injury. Autopsy revealed extensive bruising and hemorrhage deep within the brain."

In reviewing the previous research findings, a number of preventative strategies seem apparent, regardless of the nature of the activity. As a template for virtually any preventative methodology to be structured or employed, Rosenstock's Health Belief Model (Rosenstock, 1974) is easily applied in a variety of recreational settings. In seeking to encourage people to take preventative action for their well being, educators know that disseminating "safety" information alone is not adequate. Attitudes, beliefs, and cognition all need to be considered before any program or teaching strategies are employed.

The Health Belief Model (HBM) provides, through its three basic components, a paradigm for the recreational practitioner to adopt. An individual must believe the following for a behavior to be adopted or changed: 1.) he/she is personally at risk or susceptible to a danger ("It can happen to me!") 2.) the consequences of the danger are severe 3.) an action he/she may take will work--or be effective in preventing the danger of disease--the benefits of the action taken outweigh any of the costs or barriers needed to be overcome (time, money, effort, etc.).

By applying the three components of the HBM to any recreational pursuit (in the context of the "safety" part of the class or program) the practitioner has a simple but effective strategy to help individuals protect themselves from needless injury. Two common recommendations gleaned from the current literature reviewed concerning activity and head/spinal cord injury, (and which should be put to use with the HBM), were the following statements: 1.) Proper protective clothing and HELMETS should be worn at all times by participants. 2.) The concept of "thinking first" of the possible consequences and risks associated with a particular activity - and what precautions might be taken to reduce possible dangers and injury. It is obvious that regardless of the specific activity, if the practitioner can motivate the participant to take measures that prevent injury, the quality (as well as costs) of the experience will be enhanced. By addressing injury prevention through the HBM paradgim the recreation practitioner moves a step further than simply "providing education."

References

Baker, B.P., Fowler, C., Li, Guohua., Warner, M., Dannenberg, A.L., (1994). Head Injuries Incurred by Children and Young Adults During Informal Recreation. American Journal of Public Health, Vol. 84, No. 4, 649.

Cantu, C. R.(1995). Head and Spinal Cord Injuries in Youth Sports. Clinics in Sports Medicine, Vol.14, No.3, pg. 517-531

Centers for Disease Control, Division of Injury Control. Childhood Injuries in the U.S. AJDC 1990,144: 627-46.

Consumer Products Safety Commission. The National Electronic Injury Surveillance System. NEISS Data Highlights 1991.

Cummings, K.M., M.H. Becker, and M.C. Maile (1980). Bringing the Models Together: An empirical approach to combining variables used to explain health outcomes. Journal of Behavioral Medicine,3: 123-145.

Guohua, L., Baker, S.B., Fowler, C., Di Scala, C. (1995). Factors Related to the Presence of Head Injury in Bicycle-Related Pediatric Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care, Vol. 38, No. 6. pg. 871-75.

Malanga, G.A., Stuart, M.J., (1995). In-Line Skating Injuries. Mayo Clinic Proc; 70: 75254.

Rosenstock, I., (1974). Historical Origins of the Health Belief Model. In "The Health Belief Model and Personal Health Behavior," edited by M. Becker. Thoroughfare, N.J.: Slack.

Willis J. McAleese, Ph.D. is an associate professor of Health Education in the Department of Health and Nutrition Science at Idaho State University in Pocatello. He also serves as director of the Idaho State University "Think First Program"-Prevention of Head and Spinal Cord Injury Ed Scantling, Ph.D. is an associate professor of Physical Education in the Department of Health, Physical Education, Recreation, and Leisure Studies at the University of Nebraska at Kearney.