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Injuries to the Head and Brain

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Houses and Protects the Brain Parts of It!

Occipital* Frontal* Parietal* Temporal* Squamos (Ear) Mandible* Maxilla* Zygomatic* Nasal*

The Skull

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◦ Cushioned in a dense membrane called Cerebrospinal Fluid Produced by the Brain Clear and Colorless Circulates and Protects throughout

the Skull and Spinal Column Reabsorbed by the Circulatory

system Enough cerebrospinal fluid to fill a soft

drink can (about 350 cubic centimeters) is reabsorbed and replenished daily

Combats infection and cleansing the brain and spinal column

Skull or Membrane are broken – CSF leaks out – often through the nose and or ears

The Brain

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◦ Brain is protected by 3 layers Dura Mater – “Hard

Mother” Arachnoid – Spider Web

effect Pia Mater – “Soft

Mother”

The Meninges

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Regulates & Coordinates the bodies activities

Primary Organ of the Nervous System Responsible for:

Receiving sensory impulses Interpreting Sensations Forming perceptions:

THOUGHT SPEECH ACTION EMOTION MEMORY REASON JUDGEMENT

What Does the Brain Do?

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◦ Extends from the Central Nervous System (CNS) to EVERY part of body the information pathways

◦ Sensory impulses travel to and from the CNS The brain then generates an appropriate motor

response from the body Moving away from a source of perceived heat or responding to a question.

◦ Injuries that involve the brain must be taken seriously.

PERIPHERAL NERVOUS SYSTEM

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Part of the nervous system formed by all the motor or sensory nerves (43 pairs) connecting the central nervous system to the organism.

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◦ Brain contains specific blood vessels: Arteries = transport the blood and its nutrients to the brain Veins = blood vessels that transport blood containing waste

products away from the brain

◦ Is Blood Important to the brain? It’s Necessary

in order to provide ALL of the brain cells with: OXYGEN GLUCOSE

Interruption to ANY part of the brain may result in a “BRAIN INJURY”

Any type of brain injury can result in: Accumulation of Waste products

Carbon dioxide Lactic acid In turn - Causes Swelling

BLOOD SUPPLY

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Mouth Pieces

Dual composite construction. Shock absorbing jaw pads helps protect against concussions and create a channel for improved breathing. Front bumper absorbs and deflects impact ways from teeth. Quick-Release helmet tether.

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What happens when the Brain swells? Increased Pressure

within the skull Increased intracranial

pressure Due to excessive blood Excessive production

of Cerebrospinal fluid Swelling Reduces

BLOOD SUPPLY Leading to further

complications Brain damage DEATH

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Brain injuries occur as a result of a direct blow, or sudden snapping of the head forward, backward, or rotating to the side

May or may not result in loss of consciousness, disorientation or amnesia; motor coordination or balance deficits and cognitive deficits

May present as life-threatening injury or cervical injury (if unconscious)

Assessment of Head Injuries

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◦ Determine loss of consciousness and amnesia◦ Additional questions (response will depend on

level of consciousness) Do you know where you are and what happened? Can you remember who we played last week?

(retrograde amnesia) Can you remember walking off the field (antegrade

amnesia) Does your head hurt? Do you have pain in your neck? Can you move your hands and feet?

HISTORY

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◦ Is the athlete disoriented and unable to tell where he/she is, what time it is, what date it is and who the opponent is?

◦ Is there a blank or vacant stare? Can the athlete keep their eyes open?

◦ Is there slurred speech or incoherent speech?◦ Are there delayed verbal and motor responses?◦ Gross disturbances to coordination?

OBSERVATION

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◦ Inability to focus attention and is the athlete easily distracted?

◦ Memory deficit?◦ Does the athlete have normal cognitive function?◦ Normal emotional response?◦ How long was the athlete’s affect abnormal?◦ Is there any swelling or bleeding from the scalp?◦ Is there cerebrospinal fluid in the ear canal?

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Palpation◦ Neck and skull for point tenderness and deformity

Special Tests◦ Neurologic exam

Assess cerebral testing, cranial nerve testing, cerebellar testing, sensory and reflex testing

◦ Eye function Pupils equal round and reactive to light (PEARL)

Dilated or irregular pupils Ability of pupils to accommodate to light variance

Eye tracking - smooth or unstable (nystagmus, which may indicate cerebral involvement)

Blurred vision

PALPATIONS & SPECIAL TESTS

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– Balance Tests:• Romberg Test

– Assess static balance - determine individual’s ability to stand and remain motionless

– Tandem stance is ideal

– Coordination tests:• Finger to nose, heel-to-toe walking• Inability to perform tests may

indicate injury to the cerebellum

http://www.youtube.com/watch?v=MWeMuFoOIpU

Concussions in Football - National Athletic Training Month, March 2010

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COGNITIVE TESTS

• Used to establish impact of head trauma on cognitive function and to obtain objective measures to assess patient status and improvement• On or off-field assessment

– Serial 7’s, months in reverse order, counting backwards– Tests of recent memory (score of contest, 3 word recall)

• Neuropsychological Assessments– Standardized Assessment of Concussion (SAC) provides

immediate objective data concerning presence and severity of neurocognitive impairment

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TYPES OF CONCUSSIONS

– Define Concussion?• Agitation or a Shaking from being hit• Causes immediate symptoms:

– Headache» Major complaint

– Dizziness– Nausea-

» Caused by swelling of the brain» Release of neuro chemicals

– Symptoms of Disorientation» Confusion

– Confusion resulting from swelling at point of contact.» Observe Mood Changes

– Injury causes a temporary STOPPAGE in the blood supply to the brain.

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Biomechanical effect on the brain Disruption of function Series of changes in the nerve cells that

cause a disruption Wave propagates

◦ Discharge of chemical and electrical discharge across the cortex

◦ Shears the nerve cells (swell) Affects the anatomy of that cell

Brain Dysfunction

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Postconcussion Syndrome

• Follows a concussion (Mild)• Signs:– Persistent headache– Impaired memory– Lack of concentration– Anxiety / irritability– Giddiness / Fatigue / Depression – Visual disturbances

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SECOND IMPACT•Rapid swelling because previous concussion did not resolved.•Caused by relatively minor blow to the head/chest/back.• Increased symptoms w/in 15 seconds• The shock can lead to SERIOUS complications and may be FATAL.

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Cerebral Contusion

• Small hemorrhages or Intracerebral Bleeding within Cortex or Brainstem or Cerebellum

• Head strikes stationary immovable object• Signs:– LOC (loss of consciousness)– Become very alert/talkative– Neuro exam is normal– Headaches, dizziness and nausea PERSIST

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Epidural Hematoma (Cerebral)• Blow to the head – resulting in Skull Fracture• Causes tear in meningeal arteries.

– Bleeding occurs extremely fast • Signs:

– LOC– Lucid – Gradually symptoms worsen

• Severe head pains,• Dizziness / nausea• Dilation of one Pupil• Deteriorating consciousness• Neck rigidity• Depression of pulse/respiration • Convulsions • LIFE THREATHENING

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Subdural Hematoma

• Occur more frequently• Acceleration – deceleration forces– Tear vessels that bridge the dura mater and brain

• Involve venous bleeding– Symptoms appear more slowly (hours

• Signs:– LOC w/ one pupil dilated (same side as injury)– Headache, dizziness, nausea, sleepiness– LIFE THREATENING

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SUBDURAL HEMATOMA

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Any loss of Consciousness Loss Of Coordination

Persistent Low-Grade Headache Slurred or Incoherent Speech

Light-Headedness Irritability

Poor Concentration Anxiety

Retrograde Amnesia(no memory immediately

before the injury)

Anterograde Amnesia(No memory immediately

following the injury)

Sleepiness Depression

Ringing in the Ears (Tinnitus) Vacant Stare

Disorientation Nausea and/or Vomiting

Pupils Do Not React evenly to light or are Unresponsive

Not PERRL

NOT ALL ATHLETES REPORT CONCUSSIONS

Be Aware of the Following:

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HELMETS

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Student Enrichment Activities

• Get in groups of 4’s– Each group will take two (2) Assessment sheets– Put your names on one (1) of the sheets

• You will be given different Standardized tests– Verbal learning– Stroop Color Word – Digits backward / forward– Symbol identification

• Record your comments