1. DO NOW Read the article about Seattle high school football player Write down some thoughts and/or questions

2. Student Football Players Dead Tyrell Cameron http://abcnews.go.com/Sports/louisiana-high-school-football- player-dies-suffering-injury/story?id=33555847 DeAntre Turman https://www.youtube.com/watch?v=MP6Zf_JCHlg Charles Youvella https://www.youtube.com/watch?v=1PH7jDQ3lS4

3. Traumatic Brain Injury (TBI) Disruption of normal brain function – Due to physical forces Blow to the head (blunt impact) – A fall – A motor vehicle accident (MVA) – A bicycle crash – A sports injury – An explosion Faul, (2010) Injury Prev.

4. TBI Statistics 5.3 million Americans currently live with long- term disability 1,700,000? Total 1,365,000 Emergency Room Visits 275,000 Hospitalizations 52,000 Deaths 85,000 Disabilities

5. What do you see? Normal CT image Traumatic Brain Injury CT image

6. Mild TBI – aka Concussion Estimated 300,000 adult, sports-related concussions annually During post-concussive recovery – Higher incidence for re-injury – Time to recover is increased after a second TBI – Increased deficits with subsequent injuries Motor function Verbal and visual memory Increased reaction time Increased neurodegeneration (brain cell death) Sub-concussive events may be cumulative – High profile cases of NFL athletes Possible links to chronic traumatic encephalopathy (CTE) cdc.gov, Concussion Fact Sheet, TIME, AP

7. Chronic traumatic encephalopathy A progressive degenerative disease, which can only be definitively diagnosed post-mortem in individuals with a history of multiple concussions and other forms of head injury The only known diagnosis for CTE occurs by studying the brain tissue after death. CTE has been most commonly found in professional athletes participating in American football, who have experienced repetitive brain trauma Symptoms include dementia, memory loss, aggression, confusion and depression, which generally appear years or many decades after the trauma

8. Former National American Football (NFL) players that have been diagnosed post-mortem with CTE:

9. What a concussion really feels like https://www.youtube.com/watch?v=_dcs9RS7Hi0

10. Independent Practice Using your notes, complete the classwork

11. The strange case of Phineous Gage

12. Do Now: Reading – Phineas Gage: Neuroscience’s Most Famous Patient

13. Phineous Gage Railroad foreman Well-respected, hard-working 1848: tamping iron accident He never lost consciousness, and had no obvious neurological symptoms But he was “no longer Gage”

14. Phineas Gage “the powder exploded, carrying an iron instrument through his head an inch and a fourth in circumference, and three feet and eight inches in length, which he was using at the time. The iron entered on the side of his face, shattering the upper jaw, and passing back of the left eye, and out at the top of the head. The most singular circumstances connected with this melancholy affair is, that he was alive at two o’clock this afternoon, and in full possession of his reason, and free from pain.” – from Free Soil Union, September 1948

15. “The equilibrium or balance between his intellectual faculties and animal propensities, seems to have been destroyed.” (Former R.R. Employer)

17. Brain Anatomy - Phineas Gage Personality changed – Gage became crude, uncaring, impulsive, irrational, anti-social Ventromedial region of the frontal lobes on both sides - causing a defect in rational decision making and the processing of emotion

18. Phineous Gage Gage’s Doctor described Gage’s post-accident personality as: “Fitful, irreverent, indulging at times in the greatest profanity which was not previously his custom, manifesting but little deference for his fellows, impatient of restraint and advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned … a child in his intellectual capacity and manifestations, he has the animal passions of a strong man.”

20. “He was no longer Gage…” Several different angles of where the rod passed through his skull

21. Phineous gage

22. Some symptoms associated with frontal lobe damage Working memory deficits Temporal memory / Source memory Perseveration Loss of spontaneous behavior Apathy Planning deficits/impaired goal-directed behavior Disinhibition/impulsive behavior Impaired attention Depression Elevated mood

23. Mood/Affect/Emotion Symptoms Depression Mood elevation Apathy

24. Frontal Lobotomies 1935: chimps who were neurotic before surgery became more relaxed after it 1930s: Egaz Moniz begins frontal lobotomies in humans (and eventually wins Nobel Prize) 1950s: psychosurgery in vogue; 40,000 frontal lobotomies in North America The story of Agnes (Kolb & Whishaw) – no outward signs of emotion – no facial expression – no feelings toward other people (but still liked her dog) – felt empty, zombie-like – Other patients lose prosody = emotional component of speech orbitofrontal cortex – Patients with damage can remember info but don’t have emotions associated with it

25. Frontal Lobe Lobotomy: Early Critisicms Hoffman (1949) – "these patients are not only no longer distressed by their mental conflicts but also seem to have little capacity for any emotional experiences - pleasurable or otherwise. They are described by the nurses and the doctors, over and over, as dull, apathetic, listless, without drive or initiative, flat, lethargic, placid and unconcerned, childlike, docile, needing pushing, passive, lacking in spontaneity, without aim or purpose, preoccupied and dependent."

26. Frontal Lobe Frontal Lobe Damage May have normal IQ on standard tests Poor control: reasoning, planning & emotions – Disinhibition: poor control of emotions Poor mental flexibility – Perseveration: e.g. trouble stopping action once initiated, e.g. dialing 999. Frontal lobe modulates functions of other regions