1. SPORTS MEDICINE Head Injuries

2. Daily Objectives  Content Objectives  Learn the anatomy of the cranium and brain.  Gain an understanding of the dangers involved with head injuries.  Language Objectives  Copy notes off of power point.  Complete reading assignment.

3. Pace Lap  Why are head injuries so dangerous?  4 minutes

4. Head Injury Facts  Any injury to the scalp, cranium, or brain.  Can occur in any sport.  Caused by the application of a sudden force.

5. Assignment  Please read page 531 and 532 label the cranium diagram and answer the following question.  What two anatomical groups can we divide the head into? 1. Face 1. Eyes 2. Ears 3. Nose 4. Jaw 5. Mouth 2. Cranium 1. Brain 2. Spinal Cord

6. Anatomy of the Skull Oblong, egg shaped collection of bones that is designed to protect the brain.

7. The Skull (Cranium)  Frontal Bone  Anterior bone that makes up the forehead. Very Strong  Temporal Bone  Bone that makes up the sides of the skull along the temples. Much weaker and more susceptible to fracture.

8. The Skull (Cranium)  Occipital Bone  The most posterior bone of the skull.  Foramen Magnum: A big hole in the occipital bone that allows the spinal cord to pass through. http://faculty.washington.edu/chudler/skull.htm l

9. The Skull (Cranium)  Parietal Bone  The largest of the bones of the skull.  Protects the largest part of the brain.

10. Reading Assignment  Read pages 561- 562 and answer the following questions. 1. What are the three parts of the brain? 2. Define the three parts of the brain. 3. What are the three meninges? 4. Define the three meninges.

11. The Brain  Three Parts  Brainstem  Cerebellum  Cerebrum http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

12. Brainstem  Brainstem  Lowest part of the brain that merges with the spinal cord.  Functions controlled in the brainstem include:  Breathing  Heart Rate  Blood Pressure  Arousal (Awake and Alert)  Digestion http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

13. Cerebellum  Cerebellum  Part of the brain that controls muscular coordination and complex movements.  Also known as: Athletic Brain Little Brain http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

14. Cerebrum  Cerebrum  The largest and most highly evolved part of the brain.  Divided into a right and left hemisphere.  Divided into four different lobes. Frontal Lobe Temporal Lobe Parietal Lobe Occipital Lobe http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

15. Lobes of the Cerebrum  Frontal Lobe  Speech  Higher Intellectual Functioning  Temporal Lobe  Hearing  Memory  Speech Perception

16. Lobes of the Cerebrum  Parietal Lobe  Somatic Sensory  Occipital Lobe  Auditory  Vision  Visual Perception

17. Meninges  Protective membranes that surround the brain and spinal cord.  Dura Mater  The outermost membrane that lies just beneath the skull and covers the brain and spinal cord.  Arachnoid  The membrane that lies beneath the dura mater. It is web like and covers the entire brain and spinal cord.  Subarachnoid space: Space between the arachnoid and the pia mater.  Pia Mater  The innermost membrane that directly covers the spinal cord and brain.

18. The Meninges

19. Pace Lap  What are the four lobes of the brain?  4 minutes

20. Background Info  ½ of the trauma related deaths in the US are due to head injuries.  The mortality rate after a sever head injury is approximately 35%.  Three categories of Head Injuries 1. Scalp Injuries 2. Skull Fractures 3. Brain Injuries

21. Scalp Injuries  Contusions and Lacerations are most common.  Key Question  Does a scalp injury indicate an injury to the skull or brain?  No, they may or may not involve skull and brain injuries.  You can have an observable scalp injury and no brain injury  You may not have an observable scalp injury, but have a severe brain and skull injury.

22. Signs and Symptoms of a Scalp Injury  Profuse bleeding.  Swelling  Tenderness  Hematoma (Goose Egg)

23. Treatment and Rehabilitation for Scalp Injuries  Locate and control bleeding with direct pressure.  The neurologist or physician should decide when the athlete should return to play.  Apply ice if there is no bleeding.  Refer to the nearest emergency facility when necessary.

24. Reading Assignment  Read the section titled “Skull Fractures” on page 564 and answer the following questions.  What are some causes of a skull fracture?  What are some signs and symptoms of a skull fracture?  What is the best treatment for a skull fracture?  Who may decide when the athlete can return to play?

25. Skull Fracture  Not common in athletics  Can be a simple fracture.  Can be a compound/depressed fracture  These are more dangerous because the skull fragments can lacerate brain tissue.  Causes  Direct blow to an unprotected head.

26. Skull Fractures SSigns and Symptoms BBleeding or Cerebrospinal fluid (CSF) that drains from the ear or nose. OObvious deformity. PPoint tender upon palpation. TTreatment and Rehabilitation IImmobilization and EMS. TTreat for shock. CControl Bleeding RReturn to play dictated by physician. AAdded protection when returning to play.

27. Pace Lap  Is the inside of the skull smooth or rough?  How does this answer effect the brain?  4 minutes

28. Reading Assignment  Read page 564-565 regarding brain injuries and answer the following questions: 1. What is the difference between a cerebral concussion and a cerebral contusion? 2. What is a contrecoup injury? 3. What determines the severity of the brain injury? 4. True or False: A brain injury is a result of a single blow to the head.

29. Brain Injuries  Usually result from movement of the brain within the skull.  Remember  The inside of the skull is not smooth.  Two Types of Brain Injuries  Concussion  Contusions  BOTH are very serious injuries

30. Mechanisms Brain Injuries 1. Direct Blow or Repetitive Direct Blows 1. Coupe Injury: When a moving object strikes the stationary head, and the injury is at the site of impact. 2. Contrecoupe Injury: When a moving head strikes a stationary object, and brain rebounds off of the opposite side of the skull and causes an injury at the opposite side of impact. 2. Sudden Acceleration or Deceleration of head  Impact occurs away from the head, but the energy is transferred. 3. Combination of both

31. Coupe vs. Countrecoupe Injury Coupe Injury

32. Reading Assignment

33. Background Information  The brain can move in all directions and impact the inside of the skull.  Helmet to helmet football hits can occur in excess of 20 miles per hour.  Changes in brain velocity can reach up to 20 miles per hour during the game of football.

34. Signs and Symptoms CognitivePathologicalBehavioral DisorientationHeadacheIrritability Loss of Focus and difficulty concentrating Loss of consciousnessAbrupt changes in mood. Immediate Memory DeficitsNausea/VomitingChanges in personality Delayed Memory DeficitsVision difficulties (Poor Depth Perception) Loss of Vision Fatigue DizzinessSleep Disturbances Ringing in EarsUncharacteristic Behaviors (TEE) Neck Pain

35. Concussion Grading Criteria Grade ClassificationSymptoms Grade I (Mild)No Loss of Consciousness Transient Confusion Post Traumatic Amnesia and post concussion signs and symptoms that last less than 15 minutes. Grade II (Moderate)No Loss of Consciousness Transient Confusion Post Traumatic Amnesia and post concussion signs and symptoms that last more than 15 minutes Grade III (Severe)Any Loss of Consciousness Brief (seconds) Prolonged (minutes) American Academy of Neurology

36. Returning The Athlete To Play GradeCriteria for Return to Play Grade I Must be symptom free within 15 minutes of the initial injury. Must be able to physically exert themselves without symptoms returning. Must be cleared by a licensed physician Grade II May return to play when they are symptoms free for 1 week. Athlete must be able to physically exert themselves without symptoms returning. Must be cleared by a physician. Grade III Brief LOC Same as Grade II Prolonged LOC May return to play when they are symptom free for 2 weeks. Must be able to physically exert themselves without symptoms returning. Must be cleared by a licensed physician

37. The Problem 1. Concussions are a “invisible” injury. 2. Proper diagnosis depends on the athlete to report “ALL” symptoms. 3. Athletes are not sure what they are feeling when the have a concussion.

38. Reading Assignment  Read the last page of the handout that was given to you on Friday. 1. What conclusion can you make about the reporting rates of concussions?

39. Reporting Rates High School Athletic Trainers 4% - 8% of players reported having a concussion. High School Athletes 15% – 70% reported having a concussion. The Bottom Line Athletes do not report symptoms. Why? ▫ They Do Not Want To Leave The Game ▫ Afraid of Letting Down Coaches and Teammates. ▫ They are not sure what they are feeling. ▫ “Are you hurt or are you injured”?

40. Dangers of a Second Impact  Second Impact Syndrome  Occurs when an athlete sustains a direct or indirect force to the head before recovering from the last concussion.  Dangers  Increase in severity of symptoms.  Increase in the amount of time that symptoms hang around. Post Concussion Syndrome  DEATH Occurs in 50% of the cases

41. Pace Lap  What is second impact syndrome?  4 minutes

42. Second Impact Syndrome  Second Impact Syndrome  Occurs when an athlete sustains a direct or indirect force to the head before recovering from the last concussion.  Dangers  Increase in severity of symptoms.  Increase in the amount of time that symptoms hang around. Post Concussion Syndrome  DEATH Occurs in 50% of the cases

43. Reading Assignment  Please read page 574 and 575 and answer the following questions: 1. What are five signs and symptoms of a brain contusion? 2. Which are objective and which are subjective? 3. What is aphasia? 4. What can cause a hemorrhage? 5. List and define the three types of hematomas that can occur within the skull?

44. Brain Contusions  AKA: Bruising of the Brain  Cause  When the brain collides with any part of the skull.  Effects  Decreased nerve function.  Depending on the portion of the brain that is bruised.  Signs and Symptoms  Numbness  Weakness  Loss of Memory  Aphasia: Loss of speech or comprehension.  General Misbehavior

45. Brain Hemorrhage  Hemorrhage = Bleeding  LIFE THREATENING CONDITION  Causes  Direct or indirect blow to the head.  Contact between the brain and inside of the skull can damage or lacerated blood vessels.  The hemorrhaging can cause a hematoma.  A pooling of blood within the tissues.

46. Intracranial Hematomas  Subdural Hematoma  Hematoma that develops between the brain and the dura mater.  Epidural Hematoma  Hematoma that develops between the skull and the dura mater.  Intracranial Hematoma  Hematoma that develops within the brain.

47. Subdural Hematoma  The most frequent cause of death due to trauma in athletics.  Tearing of the cerebral vessels between the brain and dura mater.  Usually occurs as a result of a twisting motion of the hemispheres.  Bleeding may occur rapidly or slowly.  Symptoms may be present immediately or may not appear for hours or days after.

48. Epidural Hematoma  Injury to the arteries between the skull and the dura mater.  Usually associated with a skull fracture.  Bleeding occurs between the skull and the dura mater.  Hematoma occurs rapidly and signs and symptoms develop rapidly.

49. Intracranial Hematoma  Occurs when blood vessels within the brain are disrupted.  Associated with cerebral contusions.

50. Signs and Symptoms of Hemorrhages  Hematoma places pressure on the hemispheres of the cerebrum and causes a decreased Neurological Function.  Altered levels of consciousness.  Slowed pupil reactions  Loss of movement  Loss of speech.  Etc……  Constant Re-evaluation is important.