1. Brain Function and Head Injuries

2. Bony Anatomy

3. Bony Anatomy

4. Bony Anatomy The Cephalic Region has 28 bones:
The “skull” is called the cranium
Its bones (flat bones) are “sutured” together forming Synarthrodial (fibrous – immovable – joints)
The mandible is the only moveable bone
Temporomandibular joint (TMJ)
Combination hinge and gliding (Synovial) joint supported by 3 main ligaments (Temporomandibular, Stylomandibular & Sphenomandibular)
Masseter – muscle prime mover for chewing (3 other muscles also help) & talking (along w/tongue)
Mastication = chewing

5. Brain Anatomy
Frontal lobe

6. Brain Facts The brain: Weighs about 3 lbs:
75% of the weight is water
85% by weight is cerebrum
Fattest organ in the body
Doesn’t feel pain – there are no pain receptors in the brain
Requires 20% of body’s oxygen
Requires 15-20% of the blood supply – there are 100,000 miles of blood vessels in the brain
Has billions of cells (neurons)- (brain cells do not reproduce)

7. More Brain Facts Transmits information through neurons
100 billion – 1 trillion neurons
1,000 to 10,000 synapses for each neuron
Process information at speeds of up to 268 mph.
Neurons do not reproduce – but new connections can be created.
Information is sent electrically or chemically (neurotransmitters)
Axon transmits info across synapse
Dendrite receives information

8. Even More Brain Facts
Neuroplasticity capacity of neurons and neural networks in the brain to change their connections and behavior in response to new information, sensory stimulation, development, damage, or dysfunction.
Neurotransmitters – chemical agents that assist information transfer such as:
Endorphins: Associated with emotions and pain perception.
Dopamine: Associated with thought and pleasurable feelings.

9. 3 Main Brain Areas
Cerebrum: 2 hemispheres - The right hemisphere of the brain controls the left side of the body (and vice versa)
Frontal Lobe: reasoning & problem solving, voluntary muscle movement, emotions & eye movement
Parietal Lobe: Sensation, perception, movement
Occipital Lobe: Vision
Temporal Lobe: Hearing, memory & speech
Cerebellum: equilibrium, coordination, posture, muscle actions & some reflexes
Brain Stem: controls automatic functions (i.e. breathing)

11. Cerebrospinal Fluid It is a clear, colorless fluid
It’s primary functions are:
Protect the brain from impacts – keeps tissue buoyant absorbing shock
Bathe the brain in chemicals for proper functioning (delivering nutrients/removing waste products)
Help maintain regular pressure between cranium and spinal column
In severe head injury cases may drain from nose or ear.

12. The Scalp Contains a large # of blood vessels muscles and hair.
Lacerations of the scalp bleed profusely
A blow to the head may cause bleeding under the skin – a hematoma – or visible lump
Can significantly reduce the force of impact to the cranium.

13. Preventing Head Injuries
Use of proper safety equipment including helmets, face masks and mouth pieces.
Adhering to safety rules.
Teaching and using proper technique.
Using safety videos to demonstrate dangers of the sport.
Using common sense.

14. Head Injury Mechanisms
The most common cause is direct impact.
The most susceptible area is the temporal region (thinnest bone).
Contrecoup injuries are also possible.
Whiplash like event with head hitting ground/surface
Rotation of the head (after initial impact) can also cause injury.
Nerve receptors overload can cause unconsciousness.

15. Skull Fractures Types of fractures include:
Depressed – pushes part of skull toward the brain.
Bleeding under skin or from laceration
Linear – fracture straight across the skull
No displacement but blood vessels under the skull are torn.
Compound – part of the skull sticking out through the scalp – profuse bleeding.
Penetrating – object goes through scalp, skull & often the brain.

17. Concussions
Temporary impairment ( a type of TBI – traumatic brain injury) of brain function caused by impact or rotation.
Symptoms include:
Confused, dazed or unconscious
Nausea, dizziness, loss of balance, headache
Vomiting, difficulty speaking, disorientation
Tinnitus – ringing in the ears
Amnesia – loss of memory
Battle Sign – discoloration behind the ear

18. Concussions (cont’d) Severe symptoms – Can lead to paralysis or death
Unconsciousness
Also include:
Rapid eye movement (fluttering eyes)
Unequally dilated pupils (pupil on injury side will be enlarged if head injury is serious.
Coma (although the athlete will be able to hear)
Increased blood pressure, decreased pulse rate, shock
Can lead to paralysis or death

19. Concussions
ATC must check for other injuries that may be caused during the impact – especially a neck or spine injury.
In the cases of moderate or severe concussions the athlete should be back boarded (head & neck immobilized)
The athlete should be monitored for 24 hours as some symptoms maybe delayed
Must rule out intracranial hematoma (severe bleeding within the brain) a potentially fatal condition.
An athlete who has had a concussion is 4 times more likely to suffer another one.

20. Recent concussion statistics

21. Comparison of Cantu Concussion Guidelines (1986 & 2001)
Grade 1 (mild)
  1986 Cantu
No loss of consciousness (LOC)
Posttraumatic amnesia (PTA) lasting less than 30 minutes
2001 Cantu (Evidence Based)
No LOC
PTA lasting less than 30 minutes OR
Post concussion signs or symptoms lasting less than 30 minutes

22. Comparison of Cantu Concussion Guidelines (1986 & 2001)
2nd Degree (moderate)
1986 Cantu
LOC lasting less than 5 minutes OR
PTA lasting longer than 30 minutes but less than 24 hours
2001 Cantu (Evidence Based)
LOC lasting less than 1 minute
AND PTA lasting longer than 30 minutes but less than 24 hours OR
Post concussion signs or symptoms lasting longer than 30 minutes but less than 24 hours

23. Comparison of Cantu Concussion Guidelines (1986 & 2001)
3rd Degree (severe)
1986 Cantu
LOC lasting longer than 5 minutes OR
PTA for more than 24 hours
2001 Cantu (Evidence Based)
LOC lasting longer than 1 minute OR
PTA for more than 24 hours OR
Post concussion signs or symptoms lasting longer than 7 days

24. ImPACT Testing and Return to Activity
Baseline test
done prior to participation
results good for 2 calendar years.
Incident occurs – initial evaluation of concussion
Athlete’s parents are notified
Athlete is sent to physician or ER
Recovery –
Student’s next school day completes symptom check list
Low score - student takes ImPACT test.
High score – student must wait additional 24 hours
Failed ImPACT test
student must wait 3 days before retaking (each failure)
Academic accommodations and/or referral to concussion specialist for severe persistence of symptoms.

25. ImPACT Testing and Return to Activity
Recovery (cont’d)
Athlete must
pass ImPACT test
Be symptom free for 24 hours after attending normal school day (w/o accommodations) and watching practice
5 day return to play progression
Walking, stationary bike, jog/run, non-contact activities
Length of workouts increased over progression
Any re-occurrence of symptoms stops the progression
6th day – athlete returns to play

26. Related conditions Post concussion syndrome – Second-impact syndrome –
a persistence of symptoms
Usually does not last more than 1-2 weeks
Can become a long term problem with repeated concussions
Second-impact syndrome –
When an athlete receives more than one concussion in a short period of time.

27. Related conditions CTE – (Chronic Traumatic Encephalopathy)
Degenerative condition of the brain in athletes with repetitive brain trauma from both concussions and sub concussive events
Build up of Tau protein in the brain causes dysfunction
First identified in boxing as “punch drunk” syndrome in the 1920’s
Symptoms are not present for years or decades afterwards

28. CTE cont’d The symptoms of CTE include: Memory loss Confusion
Impaired judgment
Impulse control problems
Aggression
Depression
Anxiety
suicidality, parkinsonism & progressive dementia.

29. CTE cont’d Not known: Why some end up with CTE and others don’t
How many impacts does it take to trigger CTE changes
No current way to diagnose CTE (including through CAT scan or MRI)

30. Concussion interview & video