1. Head & Neck

2.  Cranium – protects brain.  Frontal  Parietal (2)  Occipital  Temporal (2)  Facial  Mandible  Maxille (2)  Zygomatic (2)  Nasal

4.  Cervical Vertebrae

5. MuscleLocationFunction SternocleidomastoidAnterior aspect of the neck Flex neck; rotate the head TrapeziusPosterior aspect of the neck Extends neck; adducts scapula

6.  Brain  Cerebrum – higher thought processes  Cerebellum – balance and coordinated movement  Brainstem – vital body functions

7.  Meninges- layers of tissue that surround brain and spinal cord. Has areas of space between each layer  DURA MATER- outer layer made up of arteries and veins  SUBDRUAL SPACE  ARACHNOID LAYER- spider web of veins  SUBARACHNOID SPACE- contains CSF  PIA MATER- inner layer lines brain and spinal cord  Cerebrospinal Fluid (CSF) - protects, cushions and nourishes the central nervous system.

9.  Intervertebral Disks  Cartilagenous discs that lie between the vertebrae.  Act as shock absorbers of the spine.

10.  Cranial nerves  12 pair that branch off of the brain  Spinal Nerves; nerve root pairs that branch off the spinal cord.  Brachial Plexus (C5-T1) – bundle of spinal nerves that innervate the shoulder and arm muscles

11.  Concussions  Characterized by immediate and transient post-traumatic impairment of neural function  Mechanism of Injury  Result of direct blow to the head from either a fixed or moving object.  Signs of Injury  Headache  Loss of consciousness  Tinnitus  Nausea  Irritability  Confusion  Disorientation  Dizziness  Amnesia  Concentration difficulty  Photophobia  Sleep disturbances  Vision disturbances  Balance disturbances

12.  Concussions  Assessment:  Neuropsychological Testing  If possible, preseason testing on a computerized system (ImPACT).  If a concussion occurs, retest injured athlete following recommended protocols.  Thorough evaluation of athlete: (Sport Concussion Assessment Tool (SCAT 2 – see additional resources) is a tool that can be used to evaluate a concussed athlete.  Physical Examination – evaluation of athletes physical symptoms as listed previously.

13.  Concussions  Assessment  Cognitive testing  Immediate memory testing  What month is it?  What time is it?, etc.  Concentration  Months of year backward  100-7, continue backward  Delayed Recall – have athlete remember words, repeat at later time

14.  Concussions  Assessment  Balance/Coordination testing  Balance Error Scoring System (BESS – see additional resources)  Romberg Test  Finger to Nose

15.  Treatment:  Careful removal from play  Thorough physical and neurological examination  Refer to physician for follow-up examination

16.  Return to Play Guidelines:  Depends on the level of play of the athlete involved. Currently, the NCAA, UHSAA, and a new Utah State law regarding youth sports (HB 204) will dictate a specific plan for concussion management and return to play guidelines. It will include some variation of the following :  Progression through Return-To-Play stages on a case by case basis with final clearance by an approved, licensed health care professional:

18.  Postconcussion Syndrome  Persistent symptoms following concussion - May begin immediately following injury and may last for weeks to months  Persistent headache  Impaired memory  Lack of concentration  Anxiety  Irritability  Fatigue  Depression  Continued visual disturbances  Treatment – No clear guidelines  Treat symptoms to greatest extent possible  Return athlete to play when all signs and symptoms have fully resolved

19.  Second Impact Syndrome  Rapid swelling of the brain from additional head trauma; life threatening  Second impact could be minor  Could be caused by blow to chest that accelerates head.  Signs and Symptoms  No initial loss of consciousness  Rapid worsening leading to:  LOC progressing to coma  Dilated pupils  Loss of eye movement  Respiratory failure  Treatment : Immediate transport to medical facility  Prevention  DO NOT LET THIS SITUATION OCCUR!  Careful decision making regarding return to play following initial head trauma