2. Introduction The term “head injury” can be used to describe damage to the scalp, cranium, or brain. Any injury to the head or spine is a serious matter due to possible brain hemorrhage. The head can be divided into two anatomical groups: the face and the cranium. Face – eyes, ears, nose, jaw, and mouth. Cranium – brain and spinal cord attachments.

3. Head and Spinal Injuries Sports that carry a higher risk of head/neck injuries: Gymnastics Ice Hockey BasketballFootballDiving Extreme Sports https://www.youtube.com/watch?v=UKZ6yQA1SLw

4. Anatomy of the Head The “Head” is comprised of the cranium and the face. The head contains several of the special sensory organs such as the eyes, ears, nose, and mouth (sight, sound, smell, and taste. Cranium = The cranium is a collection of bones fused together to protect the brain. 8 Bones Face = The anterior portion of the head. Comprised of the Eyes, Ears, Nose, Jaw, and Mouth. 14 Facial Bones

5. Anatomy of the Cranium Occipital Parietal (2) Frontal Temporal (2) SphenoidEthmoid Housed within the cranium are the brain and the primary neural tissues of the Central Nervous System (CNS) that send vital nerve impulses to and from the brain. CNS = the body system composed of the brain and the spinal cord.

6. Anatomy of the Cranium

7. Anatomy of the Face Mandible Maxilla (2) Zygomatic (2) Nasal Bones (2) Lacrimal Bones(2) Vomer Palatine (2) Inferior Nasal Conchae (2)

8. Joints of the Cranium Except for the mandible, the bones of the cranium articulate with one another via immovable joints, called sutures. The temporomandibular joints (TMJ), which are freely movable, join the mandible with the temporal bones. https://www.youtube.com/watch?v=0CfZkIVNw7M

9. The Nervous System The main components: Brain, cranial nerves, spinal cord, spinal nerves, and peripheral nerves. Main function is to coordinate and regulate the body’s many responses to internal and/or external environmental changes. The basic structural unit of the nervous system is the nerve cell, or neuron (neurons differ from common cells in their design and specific function). Two types of neurons – sensory (afferent) and motor (efferent). Example: If a person touches a hot surface, the sensory neurons will detect heat, and the motor neurons will cause the body to remove the hand away from the heat source.

10. Nervous System Divisions Central Nervous System (CNS) Peripheral Nervous System (PNS)

11. Central Nervous System CNS : consists of the brain and the spinal cord. The Brain: located within the cranium and performs numerous functions, primarily controlling and coordinating the body’s activities. Parts of the Brain include: Cerebrum – controls willful actions; interprets sensory messages gained from sound, sight, smell, touch, and taste; and governs thought and speech. Cerebellum – responsible for muscle coordination. Midbrain – conducts impulses throughout the brain and certain visual and auditory reflexes. Pons – responsible for some reflexive actions, such as chewing and salivation. Medulla oblongata – controls involuntary actions such as respiration, heartbeat, blood pressure, swallowing, and coughing.

12. Central Nervous System The Spinal Cord: Attached to the medulla oblongata of the brain and continues down to the first or second lumbar vertebrae. Protected by the vertebrae, cerebrospinal fluid, and meninges. Serves as a pathway for messages. Two Main Functions: Conduct impulses through nerves Connect body parts to the brain If the spinal cord is damaged in an accident, the sections below the injury will be cut off from the circuit of information to and from your brain. This means, all nerves, and all body parts linked to these areas of the spinal cord will also be disconnected from the brain and will stop functioning.

13. The Spinal Cord

14. Peripheral Nervous System Outside the CNS Responsible for gathering information and carrying the response signals to and from the CNS. Composed of the nerves located outside the brain and the spinal cord. Two Divisions: Somatic – Controls skeletal muscles for voluntary movement. Autonomic – Involuntary functions of the body (“fight or flight”) and maintains homeostasis.

15. Head & Spinal Injuries Any injury to the head or spine is very serious. A head trauma: Can cause brain hemorrhage (bleeding in the brain). Can fracture the skull. Can send a fragment of the skull into the brain. A spinal cord injury: Can be life threatening and can cause paralysis. The spinal cord serves as the communication pathway between the brain and the rest of the body.

16. Concussion Facts Most common head injury in athletics. Fewer than 10 percent result in loss of consciousness (LOC). In football alone there are over 250,000 concussions each year. Once a concussion has occurred a player is 4 to 6 times more likely to sustain a second concussion.

17. What is a Concussion? Cerebral Concussions : Temporary alteration in brain function without structural damage. Cerebral Concussions: Temporary alteration in brain function without structural damage. Injury to the brain, accompanied by loss of neural function. Frequently caused by blows to the head or sudden jerks of the head and neck. Different degrees of concussions present with different symptoms. Second-impact syndrome : a second concussion before the S&S of the first concussion have been resolved; a life-threatening emergency. Second-impact syndrome: a second concussion before the S&S of the first concussion have been resolved; a life-threatening emergency. https://www.youtube.com/watch?v=Sno_0J d8GuA

18. Mechanism of Injury of Concussions Coup – results when a relatively stationary skull is hit by an object traveling at high velocity. Example – being struck in the head with a baseball Results in trauma on the side of the head that was struck. Countrecoup – when the skull is moving at relatively high velocity and is suddenly stopped. Example – falling and striking the head on the floor. Causes the brain to strike the skull on the side opposite of the impact

19. Mechanism of Injury of Concussions

20. S&S of Concussions LOCDisorientationHeadacheDizzinessNausea/Vomiting Poor concentration Posttraumatic amnesia Retrograde – no memory of events that occurred before the injury Anterograde – no memory of being injured or immediately following the injury Loss of coordination Slurred or incoherent speech IrritabilityAnxietyDepression Tinnitus – ringing in the ears Vacant stare Pupils not reacting evenly to light or unresponsive Athlete may experience one or more S&S and have a concussion!

21. Classification of Concussions Categorized by severity. Guidelines for concussion severity have been created by several organizations, therefore differ. Concussion GradeCANTU Grading System Grade 1 (Mild) No LOC Either PTA (Posttraumatic amnesia) or postconcussion symptoms that clear in less than 30 minutes Grade 2 (Moderate) LOC lasting less than 1 minute and PTA or Postconcussion signs or symptoms lasting longer than 30 minutes but less than 24 hours Grade 3 (Severe) LOC lasting more than 1 minute or PTA lasting longer than 24 hours or Postconcussion signs or symptoms lasting longer than 7 days

22. Treatment of Concussions When an athlete shows any S&S of a concussion: The player should not be allowed to RTP (return to play) in the current game or practice. The player should not be left alone; regular monitoring for deterioration is important. The player should be medially evaluated following the injury. RTP must follow a medically supervised, stepwise process.

23. Postconcussion Syndrome Condition that can develop following a mild or severe concussion. S&S: Persistent headache Impaired memory Inability to concentrate Anxiety and irritability FatigueDepression Visual Disturbances

24. Second Impact Syndrome Rapid swelling of the brain after a 2 nd head injury occurs before the symptoms of the previous head injury have resolved. The second impact may be minor, or may even not involve impact to the head – A blow to the chest or back may create enough force to move the athlete’s head suddenly. Rapid deterioration of condition – LOC, dilated pupils, loss of eye movement, respiratory failure. 50% mortality rate. PREVENTION!! Do NOT allow an athlete who is symptomatic to RTP!

25. Prevention Maintaining flexibility and strength of the neck musculature. Properly fitted protective gear - shoulder pads, helmets, face masks. Following safety rules of the game – no helmet to helmet contact or leading with the head in football.

26. Concussion Evaluation History Mechanism – How did it happen? Chief Complaint Previous History Recovery time for previous concussions Headache Neck or Cervical Pain Location and Type of pain Pain level (Scale of 1-10) Mental Confusion Weakness in Limbs Abnormal Drowsiness or Sleepiness Loss of Appetite Difficulty Concentrating Tinnitus = ringing in the ears Diplopia = double vision

27. Concussion Evaluation History Continued Numbness, Tingling, or Loss of Sensation Dizziness or Lightheadedness Photophobia = sensitivity to light Nausea or Vomiting

28. Concussion Evaluation Cognitive Questions Orientation Questions Where are you? What school/stadium/field? What month is it? What team are you playing? What is the score? Post Traumatic Amnesia Ask athlete to repeat and remember 3 words. Retrograde Amnesia Do you remember the injury? Concentration Say the days of the week backwards. Word List Memory Ask athlete to recall the 3 words from earlier.

29. Concussion Evaluation Observation Level or Loss of Consciousness Poor Balance or Unsteadiness Gross Incoordination Seizures, Convulsions, Vomiting Slurred Speech Asphasia = inability to speak Respiration Rate Unusual Behavior or Heightened Emotions Swelling, Deformity, Discoloration, Bleeding Fluid discharge Otorrhea or Rhinorrhea Battle Sign (Mastoid Ecchymosis) Raccoon eyes Pupils – Size (Anisocoria – Unequal) Reaction to Light (PEARL) Tracking (Nystagmus – inability to track smoothly)Vitals

31. Palpation Mastoid Process Temporal Bones Occipital Bones Sphenoid Bones Parietal Bones Frontal Bones Front Sinus Zygomatic Bones MaxillaOrbit Nasal Bone MandibleTMJ C2 – C7 Vertebrae

32. Special Tests 1.Balance & Coordination 2.Cognitive Thinking 3.Neurological

33. Concussion Evaluation Coordination Index finger to nose Index finger to index finger Rhomberg test Tandem walking

34. Rhomberg Test Patient Position: Instruct the athlete to stand with feet shoulder width apart. Examiner Position: The examiner should stand lateral to the patient ready to support them if needed. Procedure: The athlete shuts their eyes and abducts their arms to 90 degrees with the elbows extended. Then tilts the head backward and lifts one foot off the ground while attempting to maintain balance. Positive Sign: Gross unsteadiness

35. Tandem Walking Patient Position: Standing with feet straddling a straight line. Examiner Position: Beside the patient ready to provide support. Exam Procedure: The patient walks heel to toe along the straight line for approximately 10 yards. Then the patient returns to their starting position by walking backwards. Positive Sign: Unable to maintain a steady balance.

36. Retired NFL Players: Nearly 9 in 10 suffer aches and pains daily. 91% connect nearly all their pains to football. 9 in 10 are happy they played football, but fewer than half recommend their children play. 9 in 10 report suffering concussions. Nearly 6 in 10 report 3 or more concussions. 2 in 3 experience continuing symptoms from concussions.

37. https://www.youtube.com/watch?v=F4foY1EtmKo http://espn.go.com/video/clip?id=8574507 http://espn.go.com/video/clip?id=5453050 https://www.youtube.com/watch?v=wb6Bm 5skuBA

38. Project - Concussion PSA Create a concussion PSA to raise awareness of the importance of reporting a head injury!