1. 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

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

5. 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

8. 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

9. Contrecoup Injury

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

11. 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.

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

13. 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

14. 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

16. 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

17. Read Intracranial concussion segment of “In Your Face”

18. 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

19. 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??

20. 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??

21. 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 game, place, score, etc
Memory- Silly sentence, remember 3-5 facts
2. Observation~ determine level of consciousness, speech, balance, gait

22. 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 game, place, score, etc
Memory(short term)- Silly sentence, remember 3-5 facts
Concentration- alphabet backwards, repeat numbers backwards, 100-7

23. 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

24. Sideline Cognitive Evaluation

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

26. Article about CTE and Dr. Omalu