About concussions and memory loss

One of my friends, "Ling the Merciless" recently suffered a concussion. She fell down a steep slope and was thrown off her bike, landing on her face. She was immobile but eventually regained consciousness, was taken to SGH, observed and released with a one week MC.

Now she suffered a mild concussion and lost consciousness. Although it is not an exact science, with some 28 measures, the Cantu scale is often used, probably due to its realistic simplicity.

And it indicates my friend suffered a Grade II concussion.

Grade II concussions are not common even amongst collegial and high school American football players - a study of 17, 549 players revealed 88.9% suffered Grade 1 concussion and only 10.6% suffered Grade II concussion. Serious impact she took! If you perch on a bike at the top of the slope you will understand.

She experienced the "usual symptoms" - disorientation, confusion, loss of consciousness, partial loss of memory about events prior to (retrograde amnesia) and events after the impact (post-traumatic amnesia).

Maximal post-traumatic amnesia immediately after the injury is not unusual - hence, it was good that she as surrounded by friends who did answer her repeated questions about her whereabouts.

Though her memory may recover with time, a complete recovery often does not occur. There are apologetic psychiatric explanations about this but a mild head injury, though prominent for its transient functional loss, may be in all likelihood, accompanied by pathological damage - in one instance I read about microscopic shearing of nerve fibers in the brain. Ouch!

The treatment for concussion is rest - *Oh! Gasp! Really?* - tell that to my adventurous and active friend. 10 days to two weeks is a recommended rest period. Not that it means she get to mount her bike and tackle Bukit Timah immediately after that.

Some sports medicine researchers suggest a hasty return to sport may result in "second impact syndrome," which can be really serious? I haven't read enough but it appears to be linked to symptomatic patients (e.g. still suffering from headaches) returning to the fray, undetected or because an athlete's conscious choice.

Though supposedly uncommon and even disputed, it still makes for fascinating reading - there is some evidence that a period of change in brain function (e.g. in metabolic uptake of glucose) lasts between 24 hours to 10 days to allow for healing. During this period the patient may be vulnerable to injury.*So rest!* Somewhere else, I learnt that old fogies like me (>18 years old) are apparently less vulnerable since we don't have developing brains. Wait a minute!?

Anyway, the threshold for subsequent trauma may also be lowered, meaning any subsequent concussion may result in symptoms consistent with a more severe injury.

I've taken two hits myself in the past, mild ones. Grade I if you must, with no loss of consciousness.

In the first instance, I was in Secondary 4, and it was a PE lesson - we were playing rugby. I suffered a blow somehow but continued playing, and only experienced symptoms significantly, after the game was over. Walking back to class, I panicked at the thought of the 'O' levels the following week! I hadn't studied as yet! A classmate looked at me strangely and said it was still early in the year.

Then I could not find my schoolbag - it had been hidden earlier in the science block. I had a game going to evade prefects on guard in the mornings. I would slip past them into my classroom, after morning assembly but before classes began. It was test of how well we knew the school's nooks and crannies. Ironically, first thing I did was to mark attendance of the class since I was class monitor. It became too easy so I abandoned the game.

Luckily my buddy, the class chairman, knew about this duel and brought me to where my bag was hidden. So I got to change and study.

Second time, also during a rugby game, but this time in university grounds. Rather embarrassedly, I collided head first with the other prop - I was trying out playing with the forwards and was enjoying the heightened tacking immensely - up to that point. The little runt (opposition scrum half) we were after slipped out of our hands but even he as taken aback at the two of us groaning on the ground.

Interestingly I was brought back 5 years in time to the hazy events of the first concussion. Right there in the university field, my mind was flooded with the images of schoolboys and our rugby match that day, some six years ago. I silently struggled to overcome the same feeling of disorientation I felt then and now.

This was no namby-pamby deja vu. This was the stuff of time portals! Presumably the memory fragments associated with a hard blow to the head had surfaced with the right stimulant.

As I struggled to bring myself back to the present time, I pondered about playing in the last game of that day-long inter-faculty tournament. In the end I decided to go ahead and strangely enough, and to my relief, I appeared to regain clarity as I played! Now I find how silly that was.

In both cases, the other players were unaware of my mild trauma. Apparently in the US, they are thus concerned about "bell ringers" who continue playing, unknowingly at the risk of long-term risks. If coaches and other staff are able to recognise mild symptoms (presuming they want to) the athlete's may be spared critical injury.

For some reason, players who suffer a concussion are three times more likely to do so again! Just makes you wonder, doesn't it?

For me at least, its probably good to know the memories of the playing fields of my old school are just a hard knock on the head away.

Reference:
Guskiewicz, KM. NL Weaver, DA Padua, WE Jr Garrett, 2000. Epidemiology of Concussion in Collegiate and High School Football Players. American Journal of Sports Medicine, 28: 643-650. The literature cited leads you to a large numbers of papers in this field.

First posted in Otterman speaks.

Drunk driver gets four months jail - reactions

Letters to the Forum page of The Straits Times on 4th March 2004, decry the light sentence meted out to the driver who killed togoparts and NTU cyclist Alvin Boey (press mistakenly called him Alvin Ho), R.I.P. See the ST report of the sentence.

One writer says, 'I am appalled at the light sentence - four months' jail for killing a cyclist while driving under the influence of alcohol.' "In another article on the same day, it was reported that a man was jailed for a year - three times longer than Koe - for oral sex."
The other writer says, "The message being sent out is that a cyclist, acting fully within his rights according to the Road Traffic Act, is expendable."
Read more....

First posted in Otterman speaks.

Driver who knocked down Alvin "Kroxy" Boey was drunk

"Soldier knocked down cyclist after drinking binge." By Chong Chee Kin. The Straits Times, 27 Feb 2004.

"SINGAPORE Armed Forces First Sergeant Koe Seng Wah had already had too many glasses of beer when he got behind the wheel of his car on Sept 13 last year.

It did not stop him from exceeding the speed limit though. Shortly after he left Tengah Air Base at about 4.15pm, he hit a 23-year-old cyclist, who died at the scene.

Yesterday, Koe, 31, was jailed four months for causing the death of the cyclist through his recklessness.

A district court heard that the breath analyser test he took about two hours after the accident showed he had 78 micrograms of alcohol in 100ml of his breath - more than twice the legal limit of 35 micrograms per 100ml.

The cyclist, Nanyang Technological University engineering undergraduate Alvin Boey, was on the road with a group of friends in Jalan Bahar, which has a speed limit of 60kmh, when the accident happened.

Koe, who was driving his car at about 70kmh, was on his way to pick up his wife and year-old son, when he spotted Mr Boey and his friends on the inside lane, travelling in the same direction.

Instead of slowing down or moving to the right lane, Koe continued driving on the inside lane at the same speed, and hit Mr Boey's bicycle.

The undergrad was flung onto the windscreen of Koe's car, landing so heavily that he cracked it before ending up on the road.

Investigations later revealed that Koe had finished work at the airbase at about noon and gone to the mess hall where he drank beer for about four hours until he left.

In his mitigation, he told the court he had a clean driving record before the accident. He also said he was remorseful and had swerved right after he hit Mr Boey to avoid running over him.

He could have been jailed for up to two years and fined."

Copyright @ 2004 Singapore Press Holdings. All rights reserved.

Who gets killed on the road?

See the updated post here

According to the traffic statistics in the Singapore Police Force's Annual Report 2000/1, motorcyclists and their pillion riders are the single largest road user group involved in accidents - accounting for 46% of road fatalities in 2000/1 and 52% of people slightly or seriously injured. The sheer numbers make them a specific target group for road safety measures by the police. Trends point to peak hour accidents and younger riders.

But if you look at fatalities amongst all accidents for 2000/1, the fatality rate for all accidents is 2.1% (407/19,308). This is contributed largely by the fatalities by motorbikes and their pillion riders at 1.9% (187/10,029). Motorcar drivers and passengers are relatively safe at 1% (47/4,584). Cyclists on the other hand have a 3.9% (27/689) fatality in reported accidents and for pedestrians, its 6.1% (113/1,852)!

I am missing estimates for number of road users by user group. Considering the relatively small number of cyclists on the road, the 27 fatalities are high. But I can understand Traffic Police being more concerned, for now, about the 10,000+ injury-resulting accidents involving motorbikes.

First posted on Otterman speaks

Thoughts about cycling in Singapore

I was part of a URA Subject Group to provide feedback to URA/NParks about the Parks & Waterbodies and Rustic Coast Draft Concept Plan. This was fed into the Master Plan 2003 subsequently. I spoke up for cyclists/skaters where relevant. No one was against sensible suggestions in this objective group but they were active citizenry, not government.

Suggestions ultimately have to be implemented and if attention is drawn to it, it gets some priority, especially by multi-tasking departments.

I have been mulling over some ideas, and here they are off the top of my head:

• Leisure cyclists do not have a coherent voice, but I see now gradual changes in SACA; SMURFS and Togoparts are a very good development.


• There are not enough events for regular folk. We have a few mass cycling but none on ride safety for HDB town riders. Groups like BOAC bikers contribute a lot and are very important. We need more to pop up. I know there are a few out there, I met them during some public rides.


• Thanks to the internet and sites like togoparts, there is already a lot of basic information about bike shops etc. All this helps.


• We must harness our voices with others who share common desires, e.g. Other park connector users: joggers, walkers, nature lovers, students. Mountain bikers should see how they can integrate their desires with naturalists. Park Watch groups have been formed to take a social role in their parks. We can contribute in some, e.g. in East Coast Park this has begun.


• By not having a significant profile and reach amongst citizenry and their leaders, not enough people are speaking up at opportune moments ≠ squeaky wheel gets the grease.


• Park connectors make up some 40km. Another 120km by 2015- not promised but it will be "a challenge" to realise this. We have to ensure the public enjoys the rewards of a park connector ≠ fresh air, less dust, a place of serenity, more plant and animal life nature, impression of space in a small country, connectivity between neighbourhoods. NParks has been on their own so fasr. E.g. there are RC leaders who believe park connectors should be provided with the connectivity despite the expense. I had balked at the cost of an underpass inane discussion, but he said it was a matter of priority, which merely depends on outlook.


• The current state of park connectors has issues - they are blocked at a whim in some parts, they are not connected when they could be - we need to examine these and begin to take action in a small way.


• There are mature plans overseas which have considered some of these ideas (urbanised cities have the same space issues) and I am looking for such information for ideas when I can.


• I am not the idealist or visionary to think of inserting cycling lanes on Singapore roads. But how about cycling lanes in the very wide and frequently used roads for cycling such as Changi Coastal Road or Thomson Road, that is not too demanding? Are there not accidents at Changi Coastal Road?


• Use such a proposal to find out who can and will do things, or who won't. Personal networking is very important. To get hints about timing to pitch, people to avoid and others to hunt down!


• The cyclistπs image is bad in places like pavements in Punggol; mountain biking in some parts - exclusive or inconsiderate. Embrace a code of conduct. E.g. On pavements, park connectors, anywhere, the cyclists should give way to the pedestrian - and this also means not alarming them by loud warnings from behind. Race management must be done effectively yet politely so we do not antagonise others. Bikers should be more considerate when they go offroad. I see some sensible suggestions on Togoparts recently about riding safely.


• We need bike clinics about traffic riding. That SMURFS group did a great job for introductory mountain biking. We need one for riding with traffic, as opposed to mountain biking, road riding and urban cycling. These are terms I use to differentiate the classes of cycling because they require different approaches and techniques; there may be proper names for these. For traffic riding, I still profit from my compulsory motorbike lessons for Class 2B and Highway Code taken some 16 years ago! You need to adapt those for bicycling. Even so-called experienced riders can profit from this from my observations.


• If we don't care about others, should they care about us? It is easy to dismiss the needs of an unpopular group. How many are even thankful for mass rides organised for them like Leisure Cycling and Runway Cycling! A code of conduct might serve to build up an awareness of what is "not cool" to do. The inconsiderate cyclist is bringing disrepute to every other cyclist and closing the minds of the necessary people. Not everyone is objective enough to see past an unpleasant incident.


• Cycling must have a more mainstream image than it has now. I seem to feel (but am not sure) this happening. Alvin was apparently working to get cycling recognised in NTU. We need more like him. I have friends in SACA who are trying with schools.


• NTU's Round Island Cycling is the sort of event that we need to see more of. It was a hospitable environment in which beginners at long distance can safely tackle a round island ride. What you might expect from a national organiser level, but they did it. Kudos to the NTU students. I went up to them and thanked them and also emailed them my thanks again later. I wonder how many did. Some of friends did make the effort but our culture for acknowledgement is poor, although it can significantly motivate.


• If any of us have a strategy or set of ideas which are coherent and practical get input from friends and send it the papers, SACA and the relevant government department. Then follow up on it. Individual action is also helpful.


• Share thoughts with the cycling community, who must come to be socially conscious enough to understand such approaches. We must be able to talk about it to friends and colleagues. If it is non-confrontational, embracing of other communities (naturalists, joggers, walkers, etc) needs, sensible, practical and not too demanding, it has a good chance of even recruiting advocates.


• It means compromise: you cannot sprint on a park connector filled with people. How many riders grumble abut how slow cycling is on East Coast park? There are good bits with the bad.


• In Togoparts I see some young ones who appear to understand this already. It's a good sign. They are getting familiar with the methods. They'd better, this is their fight too.


• Some nature conservation results were 15-years in the making. I feel the environment is now more hospitable to such a social process. What took a decade may now take half the time. Of course good timing helps. Will cyclists stand up and make a difference for themselves? There will always be drunk drivers.

Ride safe all.

Sivasothi

First posted in Otterman speaks.

Safe Riding and Park Connectors

I registered at togoparts the Singapore cycling community's webpage, to post my condolences to Alvin (a.k.a. Kroxy) Ho's friends and family. It's been a sombre day.

It seems Alvin was hit from behind, nothing much you do about that. But it prompted a review of unsafe riding many had witnessed. As some talked generally about cycle lanes and classes to teach safer riding, I added:

"I feel cyclists would profit from the sort of basic training - theory and practical - that motorcyclists go through, at the very least. I ride on roads regularly and find I have to apply a lot of strategies to survive the ride. The lack of skills my friends potray shock me. Some are skilled offroad but traffic-riding is another story. Of the bunch, only one or two are road-worthy. Same impression at mass ride events."

I profited a lot from the philosphy of safe riding imparted to trainees when I took my motorbike Class 2B ages ago. I wish cyclists had something like that to turn to.

I am doubtful we will ever have the bliss of cycle lanes. My best hope is the Park Connector network. Another 120km by 2015. It's "a challenge" not a promise. We have to see that it happens somehow, all of us.

First posted in Otterman speaks.

NTU undergrad cyclist killed by suspected drunk driver

A friend of mine saw the news footage last night. Blood was splattered near a bus stop at Jalan Bahar.

"He was the last man in the group because it was his duty to ensure the safety of the other 20 or so participants." - Straits Times, 15 Sep 2003

Poor chap. Biking advocate. Only son. Friendly and humble chap from condolences at togoparts. Gone just like that.

A cyclist or pedestrian is easy prey for an errant driver. While pleased that most of my cycling kakis are now well lit on roads and wear helmets these days, we would still need a miracle to survive a rear hit by an errant driver. Drunk drivers should lose their right to drive forever, even after a long spell in jail.

Ride safe everyone. Hope you are at peace now, Alvin Boey.

See The Straits Times> report and Togoparts Forum.

First posted in Otterman speaks (post date refreshed to 2005 after correction to surname; press had mistakenly called him Alvin Ho; his cousin corrected the error in Togoparts).