I Anatomy A) Bones of the Skull Maxilla- Top of mouth Mandible- Jaw Zygomatic- Cheek bone Tempomandibular Joint-TMJ- mandible to temple Nasal –top of nose

B) The brain- Encephalon Central Nervous System- brain and Spinal Cord 4 parts- Cerebrum~ thinking Cerebellum~ movement Pons~ Medulla Oblongata~ involuntary

C) Meninges Three membranes that surround and suspends the brain and spinal chord. Used for shock absorption, cushioning and to dispense force Dura Mater Arachnoid Mater- silk like threads Sub-arachnoid space~ where spinal fluid is found (CSF- cerebral spinal fluid) 3) Pia Mater

II Injuries Concussions- jarring or shaking of the head. Can have immediate or delayed impairment of neurological function ~ not always LOC Symptoms: headache, memory loss, nausea, tinnitus, pupil changes, confusion, dizziness, loss of coordination, photophobia, sleep problems, anxiety, irritability

Contrecoup Injury

Grades of Concussions Grade 1- No LOC “bell rung” Confusion/dizziness watch for Deterioration TX- watch and test after 15 minutes

Grade II no LOC Confusion/dizziness Poor gait Tinnitus Headache Nauseous Memory loss Pupil response (see grade 3) TX- stop playing, Doctor, can’t return until post test completed.

Grade III LOC- any Retrograde amnesia Pupils irregular (dilated, uneven, constricted, not responding to pen light, photophobia) TX-911

II. Injuries cont. Subdural 3) Hematoma Blood/lymph in a localized area- usually no room If happens in skull there is no room so blood puts pressure in brain- neurological disfunction Named by where blood is located: Epidural Subdural

II. Injuries cont 1) Epidural Hematoma- 1st LOC then headache, vomitting, dilated pupils, etc TX-immediate surgery 2) Subdural Hematoma- Signs might not show up for days/weeks- slow bleed from vein  fatal

II Injuries cont 2) Face injuries from article- “In Your Face” Directions: 1) underline def, symptoms and TX as we read 2) Answer question on back of packet Read NFL stories

Read Intracranial concussion segment of “In Your Face”

II Injuries cont Trainers’ Nightmare Second Impact Syndrome- two head injuries that separate would be mild, but together…. Fatal A second concussion happens before the symptoms/recovery from 1st concussion is gone – person collapses and dies quickly

2nd Impact cont. Difficult to detect 1) fear of not playing How?? 2) unaware of dangers 3) thinking symptoms are minor 4) others can’t see symptoms ***** 100% preventable How??

2nd Impact cont In most reported cases athlete denied symptoms from 1st concussion When received 2nd head injury  collapsed within minutes TX- how to prevent??

III. Assessment of Concussions A) Primary Survey! B) Secondary Survey (HOPS) History- Have you ever had a concussionHow is your headache? Tinnitus? Nausea? Etc Amnesia- Ask question @ game, place, score, etc Memory- Silly sentence, remember 3-5 facts 2. Observation~ determine level of consciousness, speech, balance, gait

III. Assessment cont. 3. Palpations~ pulse, BP, PT in neck region 4. Special Tests (repeat some of History) a) Pen Light-pupil response: size, response, nystagmus, ask about Diplopia b) Ask questions How is your headache? Tinnitus? Nausea? Etc Amnesia (retrograde)- Ask question @ game, place, score, etc Memory(short term)- Silly sentence, remember 3-5 facts Concentration- alphabet backwards, repeat numbers backwards, 100-7

4. Spec tests cont. Romberg test Stork Stand test Heel toe test Stress tests(exertion tests): sit ups, carioca, sprints 5. Neurological (in this class we do not do)- strength, sensation, Bilateral

Sideline Cognitive Evaluation http://static1.1.sqspcdn.com/static/f/707372/11252161/1300281153863/side+line+card+7-10.pdf?token=TTpizV8xpjROFRrlgXAKoUsDhHQ%3D http://kingdevicktest.com/concussion/demonstration-videos/

Complete Sideline Evaluation from NFL (found in packet) on “an Injured player”

Article about CTE and Dr. Omalu http://www.nytimes.com/2007/01/18/sports/football/18waters.html