Head & Neck Concussion injuries

Anatomy of the head & neck - bones Cranium – protects brain. Frontal Parietal (2) Occipital Temporal (2) Facial Mandible Maxille (2) Zygomatic (2) Nasal

Anatomy of the head & neck - bones

Anatomy of the head & neck - bones Cervical Vertebrae

Anatomy of the head & neck - Muscles Location Function Sternocleidomastoid Anterior aspect of the neck Flex neck; rotate the head Trapezius Posterior aspect of the neck Extends neck; adducts scapula

Anatomy of the head & neck – Soft Tissues Brain Cerebrum – higher thought processes Cerebellum – balance and coordinated movement Brainstem – vital body functions

Anatomy of the head & neck – soft tissues 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.

Anatomy of the head & neck – soft tissues

Anatomy of the head & neck – soft tissues Intervertebral Disks Cartilagenous discs that lie between the vertebrae. Act as shock absorbers of the spine.

Anatomy of the head & neck - Nerves 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

Common Injuries – Head/Neck 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

Common Injuries – Head/Neck 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.

Common Injuries – Head/Neck 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

Common Injuries – Head/Neck Concussions Assessment Balance/Coordination testing Balance Error Scoring System (BESS – see additional resources) Romberg Test Finger to Nose

Common Injuries – Head/Neck Treatment: Careful removal from play Thorough physical and neurological examination Refer to physician for follow-up examination

Common Injuries – Head/Neck Return to Play Guidelines: Depends on the level of play of the athlete involved. 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:

Common Injuries – Head/Neck

Common Injuries – Head/Neck 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

Common Injuries – Head/Neck 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