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• In your opinion what is the most
  difficult injury to overcome in
  sports today? Why?

• We will analyze the causes of concussions
  and the trauma that can be caused from a
  concussion using notes and discussion
• Vocabulary: encephalon, concussion,
  retrograde, anterograde
     Central Nervous System
Central Nervous System (CNS)
• Brain (encephalon) and spinal cord compose
  the CNS.
• CNS is protected by meninges, cranium, and
• CNS consists of gray and white matter and
  weighs 3 to 3.5 lbs (adult).
• Brain has three basic components – cerebrum,
  cerebellum, and brain stem.
• Neural impulses travel to and from the CNS via
  12 pairs of cranial nerves and 31 pairs of spinal
Head Injuries in Sports
 Even minor head trauma can result in serious

 • Brain tissue is unable to repair itself.
 • Any tissue loss results in some level of
   permanent disability.
 • Severe injuries can result in death.
 • Significant advances in understanding of
   head injuries
  ▫ Coaches can learn to recognize head injuries
    and render first aid when necessary.
Head Injuries
• Can occur in any sport at any level
• Research over who is most susceptible to
  head injuries is ongoing
 ▫ Guskiewicz: 3 year study of head/ brain
   injuries in high school and college football
    Approximately 300,000 traumatic head or brain
    Players with a head or brain injury had a 3x
     higher risk of a second head injury
Head Injuries
• Cheerleading highest risk of head injury in
  female sports
 ▫ Most injuries resulting in catastrophic injury
• Injury rates dramatically increasing in soccer
  and basketball
  Mechanisms of Head Injury
Direct mechanism of injury involves a blow to the
 head that causes injury at impact site (coup
 injury) or on the opposite side of the skull from
 impact (contracoup injury).
 ▫ Contrecoup: associated injury occurs when the
   head is moving and stops abruptly
 ▫ Example: when a tackle is made; brain is moving
   in the skull then compressed on the side of the
   head opposite the impact
Mechanism of Injury
• Indirect injury to the head results from
  damaging forces traveling from other parts of
  the body.
  ▫ blows to the jaw or face
  ▫ Rapid and violent movement of the cervical
    spine (whiplash)

Treat every head injury as if there is a neck
 injury and vice versa.

A concussion is “a clinical syndrome
 characterized by immediate and transient
 impairment of neurologic function secondary
 to mechanical forces.”
 ▫ Symptoms include unconsciousness,
   disorientation, headache, amnesia
   (anterograde or retrograde), dizziness, and
• There is some level of structural damage
• Brain cells not destroyed remain extremely
  vulnerable to another trauma

 Concussion Classification

• Variety of systems used
• Based on duration of unconsciousness and the
  pressence or absence of post-traumatic amnesia
 ▫ Retrograde: unable to recall events prior to the
 ▫ Anterograde: unable to recall events after the
  Concussions Classification
Cantu classification

• Grade 1 (mild) involves no amnesia but are
  difficult to identify.
• Grade 2 (moderate) involves loss of
  consciousness for less than 1 minute and/or
  PTA lasting longer than 30 minutes.
• Grade 3 (severe) involves loss of
  consciousness for more than a minute and
  PTA lasting more than 24 hours.
Grade 1 Concussion
• Most common
• Most difficult to identify
• Major distinction between Grade 1 and 2
  (Cantu) is loss of consciousness and/or PTA
  lasting longer than 30 minutes
  Grade 2 and 3

• Usually have loss of consciousness
• Slow response to simple questions
• Distinction is amount of PTA
      Second Impact Syndrome
Second Impact Syndrome (SIS) can be a serious

 ▫ Results when an athlete with a head injury
   receives another head injury before the
   symptoms of the initial injury have resolved.
 ▫ Involves rapid, catastrophic brain swelling.
 ▫ SIS can result in death.

Any athlete sustaining a head injury, no matter
 how minor, should be referred to a physician
 before being cleared to return to participation.

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