ESS 150 Lecture Notes - Lecture 12: Motor Coordination, Ct Scan, Dura Mater
9 May 2018
School
Department
Course
Professor
Head Injuries: Concussion
Anatomy of the head
-
Skull is composed of 22 ones joined together by sutures
-
Sutures: immovable joints
-
The brain
-
Part of the CNS
1.
Cerebrum (cortex): voluntary muscle activity and sensory impulses
2.
Cerebellum: controls movement and coordination
3.
Pons: sleep, respiration, swallowing
4.
Medulla oblongata: heart rate, breathing, BP
Multiple layers of protection to the brain
-Skull
-Dura mater
-Subdural space
-Arachnoid mater
-Subarachnoid space
-Pia mater
Assessment of head injuries
-Brain injuries occur as a result of a direct blow, or sudden snapping of the head
forward, backward, or rotating to the side
-May or may not result in loss of consciousness, disorientation or amnesia motor
coordination or balance deficits and cognitive deficits
○Most concussions don't result in loss of consciousness
-May prevent as life-threatening injury or cervical injury (if unconscious)
Don't move unconscious individual but we don't know if spinal injuries
present
○
-Sudden movement can cause brain to bounce or twist in the head causing
damage
-Diagnosis requires CAT scan or MRI
-Can't see a concussion on X-ray (because it's a soft tissue)
The unconscious athlete
-Contact EMS
-Must be considered to have life-threatening condition
○Note body position and level of consciousness
○Check and establish airway, breathing, circulation
○Assume neck and spine injury
○Remove helmet only after neck and spine injury is ruled out (facemask
removal will be required for the event of CPR)
-Determine loss of consciousness and amnesia
-Additional questions (response will depend on level of consciousness)
○Do you know where you are and what happened?
○Can you remember who we played last week? 9retrograde amnesia)
○Can you remember walking off the field(antegrade amnesia)
○Does your head hurt?
○Do you have pain in your neck?
-Observation
○Is the athlete disoriented and unable to tell where he/she is, what time it
is, what date it is and who the opponent is?
○Is there a blank or vacant stare? Can the athlete keep their eyes open? Is
there slurred speech or incoherent speech?
Cerebral concussion (mild traumatic brain injury)
-Characterized by immediate and transient post-traumatic impairment of neural
function with no focal lesions found on neuroimaging
-Cause
○Result of direct blow from fall or object
○Acceleration/ deceleration forces producing shaking or the brain
○Collision causing a jolt to torso
-Sign
○Altered level of consciousness and post-traumatic amnesia are 2 factors
that must be considered
○Different among athletes
-Signs and symptoms
Observed by coach/trainer Reported by athlete
Appear dazzled or stunned Headache or pressure in the head
Confusion about instruction Nausea or vomiting
Unsure about game, score, opponent Balance problems
Clumsy movements Sensitive to light or noise
Loses consciousness Double or blurry vision
Mood, behavior or personality change Confusion or foggy
Can't recall events before impact Not "feeling right"
Eye function
-Abnormal eye function is related to head injuries
PEARL
○Pupils must be equal, accommodate, round, react to light
-
-Dilated pupils
-Eye tracking
-blurred vision
Special tests
-Palpation:
○Neck and skull for point tenderness and deformity
-Neurologic exam:
○Performed by a trained health professional
○Cognitive, cranial nerve, coordination and motor function
-Cognitive tests
○Used to establish impact of head trauma on cognitive function
○On or off-field assessment
§Serial 7's
□ Count backwards from 100 by 7
□ Name months in reverse order
□ Test of recent memory (score of contest, breakfast, 3 word
recall)
Neuropsychological assessments
-Standardized assessment of concussion (SAC)
○Provides immediate objective data concerning immediate and delayed
memory recall, orientation and concentration
-Computer-based testing (ImPACT, ANAM)
-Baseline preseason data used to compare in post- trauma
Special tests
-balance tests:
○Romberg test
§Assess static balance
Danger signs (consider it am medical emergency)
1 pupil larger than the other Convulsion or seizures
Repeated vomiting or nausea Loss of consciousness (even brief)
Weakness, numbness decrease in coordination Headache that get worse
Increasing confusion
Cause
-Most concussion don't involve loss of conscious
-Blow to head by an object
-Moving head hits a fixed object
-Opposite side of the head
Care
-Return to play decision is a difficult one that takes a great deal of consideration
-If any loss of consciousness occurs the athletic trainer must remove the athlete
from competition
-All post-concussive symptoms should be resolved prior to returning to play
-Gradual return to play should be employed
-Recurrent concussions can produce cumulative traumatic injury to the brain
(even death)
Lecture 12
Wednesday, May 9, 2018
9:00 AM
Head Injuries: Concussion
Anatomy of the head
-Skull is composed of 22 ones joined together by sutures
-Sutures: immovable joints
-
The brain
-Part of the CNS
1. Cerebrum (cortex): voluntary muscle activity and sensory impulses
2. Cerebellum: controls movement and coordination
3. Pons: sleep, respiration, swallowing
4. Medulla oblongata: heart rate, breathing, BP
Multiple layers of protection to the brain
-
Skull
-
Dura mater
-
Subdural space
-
Arachnoid mater
-
Subarachnoid space
-
Pia mater
Assessment of head injuries
-
Brain injuries occur as a result of a direct blow, or sudden snapping of the head
forward, backward, or rotating to the side
-
May or may not result in loss of consciousness, disorientation or amnesia motor
coordination or balance deficits and cognitive deficits
○
Most concussions don't result in loss of consciousness
-
May prevent as life-threatening injury or cervical injury (if unconscious)
Don't move unconscious individual but we don't know if spinal injuries
present
○
-
Sudden movement can cause brain to bounce or twist in the head causing
damage
-
Diagnosis requires CAT scan or MRI
-
Can't see a concussion on X-ray (because it's a soft tissue)
The unconscious athlete
-
Contact EMS
-
Must be considered to have life-threatening condition
○
Note body position and level of consciousness
○
Check and establish airway, breathing, circulation
○
Assume neck and spine injury
○
Remove helmet only after neck and spine injury is ruled out (facemask
removal will be required for the event of CPR)
-
Determine loss of consciousness and amnesia
-
Additional questions (response will depend on level of consciousness)
○
Do you know where you are and what happened?
○
Can you remember who we played last week? 9retrograde amnesia)
○
Can you remember walking off the field(antegrade amnesia)
○
Does your head hurt?
○
Do you have pain in your neck?
-
Observation
○Is the athlete disoriented and unable to tell where he/she is, what time it
is, what date it is and who the opponent is?
○Is there a blank or vacant stare? Can the athlete keep their eyes open? Is
there slurred speech or incoherent speech?
Cerebral concussion (mild traumatic brain injury)
-Characterized by immediate and transient post-traumatic impairment of neural
function with no focal lesions found on neuroimaging
-Cause
○Result of direct blow from fall or object
○Acceleration/ deceleration forces producing shaking or the brain
○Collision causing a jolt to torso
-Sign
○Altered level of consciousness and post-traumatic amnesia are 2 factors
that must be considered
○Different among athletes
-Signs and symptoms
Observed by coach/trainer Reported by athlete
Appear dazzled or stunned Headache or pressure in the head
Confusion about instruction Nausea or vomiting
Unsure about game, score, opponent Balance problems
Clumsy movements Sensitive to light or noise
Loses consciousness Double or blurry vision
Mood, behavior or personality change Confusion or foggy
Can't recall events before impact Not "feeling right"
Eye function
-Abnormal eye function is related to head injuries
PEARL
○Pupils must be equal, accommodate, round, react to light
-
-Dilated pupils
-Eye tracking
-blurred vision
Special tests
-Palpation:
○Neck and skull for point tenderness and deformity
-Neurologic exam:
○Performed by a trained health professional
○Cognitive, cranial nerve, coordination and motor function
-Cognitive tests
○Used to establish impact of head trauma on cognitive function
○On or off-field assessment
§Serial 7's
□ Count backwards from 100 by 7
□ Name months in reverse order
□ Test of recent memory (score of contest, breakfast, 3 word
recall)
Neuropsychological assessments
-Standardized assessment of concussion (SAC)
○Provides immediate objective data concerning immediate and delayed
memory recall, orientation and concentration
-Computer-based testing (ImPACT, ANAM)
-Baseline preseason data used to compare in post- trauma
Special tests
-balance tests:
○Romberg test
§Assess static balance
Danger signs (consider it am medical emergency)
1 pupil larger than the other Convulsion or seizures
Repeated vomiting or nausea Loss of consciousness (even brief)
Weakness, numbness decrease in coordination Headache that get worse
Increasing confusion
Cause
-Most concussion don't involve loss of conscious
-Blow to head by an object
-Moving head hits a fixed object
-Opposite side of the head
Care
-Return to play decision is a difficult one that takes a great deal of consideration
-If any loss of consciousness occurs the athletic trainer must remove the athlete
from competition
-All post-concussive symptoms should be resolved prior to returning to play
-Gradual return to play should be employed
-Recurrent concussions can produce cumulative traumatic injury to the brain
(even death)
Lecture 12
Wednesday, May 9, 2018 9:00 AM
Document Summary
Skull is composed of 22 ones joined together by sutures. Part of the cns: cerebrum (cortex): voluntary muscle activity and sensory impulses, cerebellum: controls movement and coordination, pons: sleep, respiration, swallowing, medulla oblongata: heart rate, breathing, bp. Brain injuries occur as a result of a direct blow, or sudden snapping of the head forward, backward, or rotating to the side. May or may not result in loss of consciousness, disorientation or amnesia motor coordination or balance deficits and cognitive deficits. Most concussions don"t result in loss of consciousness. May prevent as life-threatening injury or cervical injury (if unconscious) Don"t move unconscious individual but we don"t know if spinal injuries present. Sudden movement can cause brain to bounce or twist in the head causing damage. Can"t see a concussion on x-ray (because it"s a soft tissue) Must be considered to have life-threatening condition. Note body position and level of consciousness.
