Head Injuries In Sports<br />JOHN GONOUDE<br />
“Pain is weakness leaving the body.”<br />
the brain<br />Most complex organ of the human body<br />Foundation of the mind<br />All thoughts, perceptions, and behavi...
Neurons<br />Basic working unit of the brain<br />Responsible for the transmission of information<br />Nerve impulses<br /...
NEUROTRANSMITTERSThe brain’s chemical messengers.<br />Responsibilities<br />Generation of action potential<br />Tightenin...
neurotransmitters<br />Acetylcholine (ACh)<br />Normal attention, memory, and sleep<br />Glutamate and aspartate<br />Sign...
WHAT<br />IS A<br />CONCUSSION?<br />A concussion is a mild traumatic brain injury.<br />National Athletic Trainers’ Assoc...
Features of a Concussion<br />Vacant stare<br />Delayed verbal and motor responses<br />Disorientation<br />Confusion and ...
SYMPTOMS<br />Early Symptoms<br />Headache<br />Dizziness<br />Lack of awareness of surroundings<br />Nausea or vomiting<b...
During a concussion, the brain develops inabilities in regulating blood supply and making energy.<br />Nowinski, Head Game...
Neurotransmitters bind on to receptors and change the receptors<br />Susceptible to glutamate<br />Excitotoxic death<br />...
“IF PEOPLE SAY THERE IS NO CORRELATION BETWEEN WHAT HAPPENED TO THEM AND PLAYING; BULLS***, BULLS***.  AND PEOPLE CAN CALL...
POST-CONCUSSIONSYNDROME<br />Condition may take days, weeks, months, or even years to recover from<br />Symptoms include p...
DEPRESSION<br />Persistently sad or empty mood, low energy level, unusual fatigue, headaches, unresponsive chronic pain<br...
Neurology Now, “Head Games”<br />
The injured athlete is initially dazed by the impact and remains alert for another 15 seconds to a minute before collapsin...
Zachery Lystedt<br />Maple Valley, WA<br />Max Conradt<br />Waldport, OR<br />Covington Reporter<br />Goliath<br />
CHRONICTRAUMATICENCEPHALOPATHY<br />American Association of Neuropathologists<br />
Chronic Traumatic Encephalopathy is the progressive degeneration of brain tissue involving the build-up of tau protein.<br...
    Andre Waters         MIKE WEBSTER     1962-2006	            1952-2002<br />Nowinski, Head Games: Football’s Concussion...
“I don’t know how much sense that makes, because we’re dealing with the same organ.  No cardiologist ignores a ‘mild’ hear...
Return to Play Decisions<br />Multiple Grade 1 concussions<br />1 week<br />Grade 2 concussion<br />1 week<br />Multiple G...
SCAT2<br />Zurich Consensus<br />
ImPACT<br />Immediate Postconcussion Assessment and Cognitive Testing<br />ImPACT<br />
ImPACT<br />Attention span<br />Working memory<br />Sustained and selective attention time<br />Response variability<br />...
  Disqualification Guidelines<br />GAME, SEASON, or CAREER<br />National Athletic Trainers’ Association<br />
NEUROIMAGING<br />Computed Tomography (CT) Scan<br />Uses x-rays to create cross-sectional pictures of the brain to produc...
Injury Treatment<br />No evidence-based pharmacologic treatment options<br />Wake-ups<br />Rest<br />Avoid activities that...
It is estimated that between 1.6 to 3.8 million concussions occur every year in the United States.  In 2008, only 126,926 ...
What is being done?<br />
innovation in protection<br />Maher B-Protect Splint (Level III) Mouth Guard<br />Carefully designed to help prevent concu...
Xenith X1<br />Xenith<br />
THE EVOLUTION OF THE HELMET.<br />Popular Mechanics<br />
Popular Mechanics<br />
HELMET FITTING<br />
HEAD IMPACT TELEMETRY SYSTEM<br />(HITS)<br />Journal of Athletic Training<br />
Head Impact Telemetry System (HITS)<br />Evaluates regions of the head that are most susceptible to damage<br />Accounts f...
“We need to take a step back and start taking care of ourselves.”<br />										Chris Nowinski<br />
From 1945-1999, 491 head-related football fatalities occurred in high school, collegiate, professional, and recreational l...
TEN POINT PLAN TO SAVE FOOTBALL<br />Reevaluate how the game is practiced<br />Encourage mandatory brain trauma education<...
Acting Upon A Crisis.<br />Pennsylvania House Democratic Caucus<br />The Covington Reporter<br />The Register-Guard<br />
Starting From The TopThe Role of the National Football League<br />88 PLAN<br />National Football League<br />New York Tim...
Luck of the Draw Foundation<br />
Upper Merion Concussion Survey<br />63 out of 100 student athletes responded; 38 seniors, 15 juniors, 4 sophomores, and 6 ...
CONCLUSION<br />Concussions should be treated as a brain injury<br />Guidelines at all levels of play must be set in order...
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Head Injuries In Sports

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  • HEAD INJURIES IN SPORTS PERSONALLY DRIVEN DEDICATION TO UNDERSTANDING THE COMPLEXITY OF CONCUSSIONS GOAL TO MAKE SURE NO OTHER STUDENT ATHLETE TO COME THROUGH UPPER MERION WILL EVER HAVE TO DEAL WITH WHAT I HAD TO GO THROUGH
  • INTRODUCTORY VIDEO
  • CULTURE OF CONTACT SPORTS GLORIFICATION OF VIOLENT HITS GIVES PLAYERS AN OPENING TO PLAY BEYOND THE RULES AND GUIDELINES THAT THE SPORTS TRADIONALLY WERE INTENDED TO BE FOLLOWED BY HIGHER RATE OF INJURY CONCUSSIONS ARE AN INHERENT RISK OF CONTACT SPORTS COACHES PLAYING DOCTOR CLEAR DIFFERENCE BETWEEN BEING HURT AND INJURED MISCOMMUNICATION AND LACK OF RESPECT BETWEEN COACHING STAFF AND ATHLETIC TRAINERS “PAIN IS WEAKNESS LEAVING THE BODY.” QUOTE DISPLAYED IN THE FLORIDA GATORS LOCKER ROOM GREAT TOOL FOR MOTIVATION, BUT WHERE IS THE LOGIC BEHIND IT?
  • THE BRAIN VERY RARELY DO WE STOP TO THINK ABOUT WHAT MAKES US THINK THE BRAIN IS THE MOST COMPLEX ORGAN OF THE HUMAN BODY IT IS THE FOUNDATION OF THE MIND AND CONTROLS OUR BODILY FUNCTIONS THAT HELP US CONTINUE TO LIVE A HEALTHY, FUNCTIONAL LIFE ALL THOUGHTS, PERCEPTIONS, AND BEHAVIORS ARE A DIRECT RESULT OF COMBINATIONS OF SIGNALS AMONG NEURONS
  • NEURONS BASIC WORKING UNIT OF THE BRAIN RESPONSIBLE FOR THE TRANSMISSION OF INFORMATION SERVE AS A ROAD MAP OF INTERCONNECTED HIGHWAYS THAT ULTIMATELY SHAPE THE STRUCTURAL AND FUNCTIONAL PROPERTIES OF THE BRAIN DURING THE TRANSMISSION OF INFORMATION, NERVE IMPULSES (WHICH INVOLVE THE OPENING AND CLOSING OF ION CHANNELS) DIRECT SIGNALS THROUGHOUT THE BRAIN THESE SIGNALS TRAVEL THROUGH THE BRAIN AT AN ALARMINGLY QUICK RATE A PROCESS ENABLED BY ACTION POTENTIAL
  • NEUROTRANSMITTERS DURING THE TRANSMISSION OF INFORMATION THROUGHOUT NEURONS IN THE BRAIN, CHEMICAL MESSENGERS KNOWN AS NEUROTRANSMITTERS ARE RELEASED TO PERFORM SPECIFIC TASKS SUCH TASKS AND RESPONSIBILITIES INCLUDE… GENERATION OF ACTION POTENTIAL TIGHTENING OF MUSCLES BEGINNING OF ENZYME ACTIVITY RELEASE OF MORE NEUROTRANSMITTERS
  • NEUROTRANSMITTERS ACETYLCHOLINE (ACH) KEY NEUROTRANSMITTER THAT IS ESSENTIAL TO THE PROPER FUNCTIONING OF NORMAL ATTENTION, MEMORY, AND SLEEP GLUTAMATE AND ASPARTATE SIGNAL THE RELEASE OF A COMPOUND CALLED N-METHYL-D-ASPARTATE (NMDA) NMDA IS ASSOCIATED WITH THE PROCESS OF LEARNING, MEMORY, AND DEVELOPMENT OF NERVE CONTACTS PROMOTES BENEFICIAL CHANGES IN THE BRAIN, AND ARE DISRUPTED WHEN THE HEALTH OF THE BRAIN IS THREATENED
  • CONCUSSION WHAT IS A CONCUSSION? IT SEEMS LIKE A SIMPLE CONCEPT, BUT IS LARGELY A COMPLEX INJURY A CONCUSSION IS A MILD TRAUMATIC BRAIN INJURY A CONCUSSION IS OFTEN REFERRED TO AS BEING “DINGED” OR GETTING ONE’S “BELL RUNG” MINIMIZING THE SIGNIFICANCE OF THE THREAT OF A BRAIN INJURY IS A DANGEROUS PATH TO FOLLOW WHEN INFORMALLY DIAGNOSING A CONCUSSION IT IS CLINICALLY CONSIDERED AN ALTERATION IN BRAIN FUNCTIONING BRAUGHT ON MY TRAUMA TO THE BRAIN, THAT MAY OR MAY NOT INVOLVE A LOSS OF CONSCIOUSNESS REQUIRE CLOSE OBSERVATION AND ASSESSMENT IN ORDER TO DETERMINE PROPER RETURN TO PLAY GUIDELINES
  • CONCUSSION HOW DO YOU KNOW IF YOU, OR SOMEONE ELSE HAS SUFFERED A CONCUSSION? FEATURES OF A CONCUSSION INCLUDE… VACANT STARE DELAYED VERBAL AND MOTOR RESPONSES DISORIENTATION CONFUSION AND INABILITY TO FOCUS ATTENTION INCOORDINATION SLURRED AND INCOHERENT SPEECH EMOTIONS OUT OF PROPORTION MEMORY DEFICITS ANY PERIOD OF UNCONSCIOUSNESS
  • CONCUSSION SYMPTOMS EVOLVE OVER TIME AND MAY TAKE DAYS, WEEKS, OR MONTHS TO RECOVER FROM THE EARLY SYMPTOMS OF A CONCUSSION INCLUDE… HEADACHE DIZZINESS LACK OF AWARENESS OF SURROUNDINGS NAUSEA OR VOMITING THE LATE SYMPTOMS OF A CONCUSSION INCLUDE… LOW-GRADE HEADACHES LIGHTHEADEDNESS POOR ATTENTION AND CONCENTRATION MEMORY DYSFUNCTION EASY FATIGABILITY IRRITABILITY AND LOW FRUSTRATION TOLERANCE INTOLERANCE OF BRIGHT LIGHTS OR DIFFICULTY FOCUSING VISION INTOLERANCE OF LOUD NOISES ANXIETY OR DEPRESSED MOOD SLEEP DISTURBANCE
  • BIOLOGICAL BREAKDOWN DURING A CONCUSSION, THE BRAIN DEVELOPS INABILITIES IN REGULATING BLOOD SUPPLY AND MAKING ENERGY INJURY CAUSES THE BRAIN TO GO THROUGH A SERIES OF CHEMICAL AND METABOLIC CHANGES WHEN THE BRAIN GETS PUSHED OR PULLED VIOLENTLY, BRAIN CELLS FIRE LIKE A SMALL SEIZURE AND RELEASE NEUROTRANSMITTERS AT AN OVERWHELMINGLY LARGE RATE CAUSES POTASSIUM IONS TO RUSH OUT OF CELLS AND FLOOD THE BRAIN WHILE CALCIUM IONS RUSH BACK INSIDE THE CELLS REQUIRING GLUCOSE (ENERGY) THE FLOW OF CALCIUM INTERFERES WITH THE MACHINERY OF CELLS THAT MAKE ENERGY, AND THE BRAIN DEVELOPS AN INABILITY TO MAKE ENERGY AS CELLS “TURN OFF” WHEN BLOOD FLOW AND METABOLIC DEMAND IN THE BRAIN IS LOST AS A RESULT OF THE DISTRIBUTION OF IONS, THE BRAIN FIRES AND ASKS FOR FUEL THE BLOOD FLOW TO THE AREA OF DAMAGE ISN’T ENOUGH TO SUPPORT THE DEMAND FOR ENERGY, KNOWN AS CEREBRAL ISCHEMIA
  • BIOLOGICAL BREAKDOWN WHEN THE BRAIN IS INJURED, NEUROTRANSMITTERS ARE RELEASED BY NEURONS TO COMPENSATE FOR THE DAMAGE REGION THESE NEUROTRANSMITTERS ARE SUSCEPTIBLE TO A COMPOUND CALLED GLUTAMATE AN EXCITATORY NEUROTRANSMITTER THAT EXCITES CELLS SO MUCH THAT THEY DIE, WHICH IS KNOWN AS AN EXCITOTOXIC DEATH A CONCUSSION YIELDS THE PRODUCTION OF ENERGY AND LEADS TO BOTH CEREBRAL ISCHEMIA AND EXCITOTOXIC DEATH, SENDING THE BRAIN INTO A FRENZY OF CONTINUOUS PROBLEMS THAT KILLS CELLS DAMAGE TO THE BRAIN WILL ALWAYS BE PERMANENT HOWEVER, THE BRAIN CAN RETURN TO THE FUNCTIONING LEVEL PREVOUSLY HELD BEFORE INJURY BECAUSE THERE ARE ENOUGH SPARE PARTS OF THE BRAIN TO TAKE OVER THROUGH THE USAGE OF EXTRA NEURONS TO COMPENSATE, KNOWN AS PLASTICITY
  • THE RISKS OF REPETITIVE HEAD INJURIES CONTINUOUS BLOWS TO THE HEAD RUN THE RISK OF PROLONGED TEMPORARY OR PERMANENT DAMAGE SINCE 1997, THERE HAVE BEEN OVER 50 CASES OF SPORT-RELATED HEAD INJURIES IN THE UNITED STATES THAT HAVE RESULTED IN FATALITY OR SEVERE NEUROLOGICAL IMPAIRMENT THAT HAVE REQUIRED BRAIN SURGERIES THERE ARE HIGH SCHOOL ATHLETES THAT HAVE DIED, COLLEGE ATHLETES WHO HAVE BEEN HOSPITALIZED, CURRENT PROFESSIONAL PLAYERS WHO ARE STARING AT THE ENDS OF THEIR CAREERS, AND FORMER PLAYERS WHO CAN’T REMEMBER THE NAMES OF THEIR CHILDREN LIVING IN THE UNITED STATES WHY MUST IT TAKE A TRAGEDY TO LEAD TO A SOLUTION?
  • POST-CONCUSSION SYNDROME THE MOST COMMON RESULT OF A MILD TRAUMATIC BRAIN INJURY CONDITION MAY TAKE DAYS, WEEKS, MONTHS, OR EVEN YEARS TO RECOVER FROM SYMPTOMS INCLUDE PROLONGED CASES OF PHYSICAL, COGNITIVE, EMOTIONAL, AND BEHAVIORAL ISSUES INVOLVES PERIODS OF PERSISTENT LOW-GRADE HEADACHES, DIFFICULTY CONCENTRATING, DEPRESSED MOOD, AND IRRITABILITY MOST CASES OF POST-CONCUSSION SYNDROME WILL ALWAYS RESOLVE AS THE SEVERITY OF SYMPTOMS GENERALLY LESSEN OVER TIME
  • DEPRESSION MANY RESEARCH STUDIES HAVE FOUND A CONNECTION BETWEEN MILD TRAUMATIC BRAIN INJURIES AND THE DEVELOPMENT OF A PERIOD OF DEPRESSION DEPRESSION INVOLVES THE BODY, MOOD, AND THOUGHT PROCESS, AND AFFECTS THE WAY A PERSON EATS AND SLEEPS, FEELS ABOUT THEMSELVES, AND THE WAY THAT THEY THINK CHEMICAL CHANGES IN THE BRAIN MAY CAUSE SYPTOMS THAT INCLUDE… PERSISTENTLY SAD OR EMPTY MOOD LOW ENERGY LEVEL UNUSUAL FATIGUE HEADACHES UNRESPONSIVE CHRONIC PAIN
  • SECOND IMPACT SYNDROME (SIS) ONE OF THE MOST TRAGIC RESULTS OF REPETITIVE HEAD INJURIES IN SPORTS THAT IS ALMOST ALWAYS FOUND IN TEENAGERS THAT RETURND TO PLAY BEFORE SYMPTOMS OF A PREVIOUS CONCUSSION HAD RESOLVED COMPILATION OF TWO BRAIN INJURIES WITHIN A SHORT PERIOD OF TIME REFERRED TO AS THE “SWELLING OF THE BRAIN”
  • SECOND IMPACT SYNDROME (SIS) RARE CONDITION THAT MAY TAKE THE LIVES OF AT LEAST 3-5 TEENAGE ATHLETES PER YEAR IN THE UNITED STATES WHEN IT DOES OCCUR, THAT ATHLETE IS… DAZED BY THE IMPACT REMAINS ALERT FOR ANOTHER 15 SECONDS TO A MINUTE COLLAPSES TO THE GROUND FALLING INTO A SEMI-CONSCIOUS STATE RAPIDLY DILATING PUIPLS MAY EVEN STOP BREATHING
  • STORY OF ZACHERY LYSTEDT STORY OF MAX CONDRADT
  • CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE) PROGRESSIVE DEGENERATIVE DISEASE OF THE BRAIN THAT IS FOUND IN ATHLETES WITH HISTORIES OF MULTIPLE HEAD INJURIES CAN ONLY BE DIAGNOSED AFTER DEATH
  • CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE) PROGRESSIVE DEGENERATION OF BRAIN TISSUE INVOLVING THE BUILD-UP OF TAU PROTEIN CHANGES IN THE BRAIN CAN BEGIN MONTHS, YEARS, OR DECADES AFTER LAST CONCUSSION OR END OF ATHLETIC ACTIVITY BRAIN DEGENERATION ASSOCIATED WITH… MEMORY LOSS, CONFUSION, IMPAIRED JUDGEMENT, PARANOIA, IMPULSE CONTROL PROBLEMS, AGGRESSION, DEPRESSION, AND PROGRESSIVE DEMENTIA CTE IS RESPONSIBLE FOR INDIVIDUALS DEVELOPING THE ONSET OF ALZHEIMER’S DISEASE IN THEIR 30’S AND 40’S CASE OF 18 YEAR OLD MALE DISPLAYING DISTRIBUTION OF TAU PROTEIN AFTER DYING FROM FOOTBALL HEAD-RELATED INJURY
  • STORY OF ANDRE WATERS STORY OF MIKE WEBSTER
  • PROPER MANAGEMENT CULTURE OF CONTACT SPORTS HAS SIGNIFICANTLY DOWNPLAYED THE SEVERITY OF MILD TRAUMATIC BRAIN INJURIES FOR WHATEVER REASON, A CONCUSSION HAS COMMONLY BEEN VIEWED AS A LESS SIGNIFICANT INJURY WHEN COMPARED TO OTHER INJURIES SUCH AS MUSCLE PULLS, BROKEN FINGERS, ETC.
  • PROPER MANAGEMENT RETURN TO PLAY DECISIONS MULTIPLE GRADE 1 CONCUSSIONS, 1 WEEK GRADE 2 CONCUSSION, 1 WEEK MULTIPLE GRADE 2 CONCUSSIONS, 2 WEEKS GRADE 3 WITH BRIEF LOSS OF CONSCIOUSNESS, 2 WEEKS MULTIPLE GRADE 3 CONCUSSIONS, 1 MONTH OR LONGER (BASED ON CLINICAL DECISION OF EVALUATING DECISION)
  • STANDARDIZED CONCUSSION ASSESSMENT TOOL EVALUATIVE TOOL USED IN CHARTING SYMPTOM SEVERITY AND IN DETERMINING EFFECTIVE RETURN TO PLAY GUIDELINES FOR THE INJURED ATHLETE TEST IS GIVEN ON A REGULAR DECIDED BASIS TO MONITOR THE HEALING OF THE BRAIN DURING A CONCUSSION
  • IMMEDIATE POSTCONCUSSION ASSESSMENT AND COGNITIVE TESTING (IMPACT) DEVELOPED BY THE UNIVERSITY OF PITTSBURGH A COMPUTERIZED BASELINE TESTING PROGRAM USED TO DETERMINE THE NORMAL BRAIN FUNCTIONING LEVELS OF A HEALTHY ATHLETE TO BE USED TO COMPARE TO AN ADDITIONAL TEST WHEN AN ATHLETE SUFFERS A CONCUSSION
  • IMMEDIATE POSTCONCUSSION ASSESMENT AND COGNITIVE TESTING (IMPACT) TEST MEASURES… ATTENTION SPAN WORKING MEMORY SUSTAINED AND SELECTIVE ATTENTION TIME RESPONSE VARIABILITY NON-VERBAL PROBLEM SOLVING REACTION TIME
  • DISQUALIFICATION FROM GAME OR PRACTICE BASED ON SIDELINE EVALUATION, SYMPTOMS EXPERIENCED, SEVERITY OF APPARENT SYMPTOMS, AND INJURY HISTORY DISQUALIFICATION FROM SEASON AMERICAN ACADEMY OF NEUROLOGY RECOMMENDS SEASON TERMINATION AFTER A THIRD CONCUSSION IN THE SAME SEASON DECISION IS DIFFICULT TO MAKE DEPENDING ON SEVERITY AND POSSIBILE RISK FRO RECURRENT INJURY DISQUALIFICATION OF CAREER DEPENDENT ON THE SEVERITY AND OCCURRENCE OF REPETITIVE CONCUSSIONS ONE STUDY HAD SHOWN THAT RECURRENT, IN-SEASON CONCUSSIONS OCCURRED WITHIN 10 DAYS OF THE INITIAL INJURY 92% OF THE TIME
  • NEUROIMAGING COMPUTED TOMOGRAPHY (CT) SCAN USES X-RAYS TO CREATE CROSS-SECTIONAL PICTURES OF THE BRAIN TO PRODUCE A THREE-DIMENSIONAL IMAGE MAGNETIC RESONANCE IMAGING (MRI) RADIOLOGY TECHNIQUE USING MAGNETISM, RADIO WAVES, AND A COMPUTER TO PRODUCE IMAGES OF BODY STRUCTURES NOT ALWAYS EFFECTIVE IN DIAGNOSING OR DETERMINING THE OCCURRENCE OF A CONCUSSION UNLESS THE BRAIN IS BLEEDING HOWEVER, NEW RESEARCH PRESENTED BY DR. ROBERT CANTU AT A SEMINAR AT DUQUESNE UNIVERSITY HAD SHOWN THAT THERE IS PROGRESS IN DEVELOPING SUCH TECHNOLOGY
  • INJURY TREATMENT NO EVIDENCE-BASED PHARMACOLOGIC TREATMENT OPTIONS BLOOD-THINNING MEDICINE IS NOT RECOMMENDED BECAUSE THE BRAIN HAS ALREADY DEVELOPED A DEFICIENCY IN ITS BLOOD FLOW, MAKING IT MORE DIFFICULT FOR BLOOD TO EFFECTIVELY REACH THE AREA OF DAMAGE WAKE-UPS PARENTS AND GUARDIANS ARE ADVISED IN MORE SEVERE CASES TO WAKE UP THE INJURED ATHLETE EVERY THREE OR FOUR HOURS DURING THE NIGHT TO MAKE SURE THE CONCUSSED ATHLETE DOES NOT SLIP INTO A COMA METHOD RAISES DEBATE OVER DISTURBING SLEEP PATTERNS WHICH COULD POTENTIALLY INCREASE SYMPTOMS REST AVOID ACTIVITIES THAT CREATE COGNITIVE OR PHYSICAL STRESS
  • IT IS ESTIMATED THAT BETWEEN 1.6 TO 3.8 MILLION CONCUSSIONS OCCUR EVERY YEAR IN THE UNITED STATES. IN 2008, ONLY 126,926 SPORTS-RELATED CONCUSSIONS WERE TREATED IN UNITED STATES HOSPITAL EMERGENCY ROOMS. 47,807 (37.6%) OF THOSE CONCUSSIONS OCCURRED IN CHILDREN UNDER THE AGE OF 14.
  • WHAT IS BEING DONE? IN JUST ABOUT EVERY GAME, POSSIBLY ON EVERY DOWN, SOMEWHERE, A CONCUSSION IS BEING SUFFERED AT ALL LEVELS OF PLAY, MOST NOTABLY IN FOOTBALL TACKLING TECHNIQUES HAVE FALLEN APART, ATHLETES ARE BECOMING FASTER AND STRONGER, AND PLAYERS DEVELOP SENSES OF INVINCIBILITY WHILE COVERED IN ADVANCED EQUIPMENT
  • INNOVATION IN PROTECTION MAHER B-PORTECT SPLINT (LEVEL III) MOUTH GUARD CAREFULLY DESIGNED TO HELP PREVENT CONCUSSIONS DESIGNED FOR OPTIMUM FIT, COMFORT, COMMUNICATION,AND STABILITY
  • XENITH X1 FOOTBALL HELMET LATEST INNOVATION IN THE HELMET INDUSTRY AIR CHAMBERS IN THE HELMET DISPERSE THE ENERGY OF EACH IMPACT ACROSS A GIVEN REGION OF THE HELMET RATHER THAN FOCUSING THE ENTIRE HIT IN ONE POINT, ALLOWING FOR SOFTER COLLISIONS THAT THE ATHLETE FEELS WITH LESS POWER BEHIND THE HITS
  • EVOLUTION OF THE HELMET REVOLUTIONIZED THE WAY THE GAME WAS PLAYED TACKLING TECHNIQUES DISAPPEARED SAVED LIVES, BUT ALSO HURT LIVES, SERVING AS A DOUBLE EDGED SWORD
  • EVOLUTION OF THE HELMET
  • CLASS ACTIVITY: HELMET FITTING
  • HEAD IMPACT TELEMETRY SYSTEM (HITS) METHOD OF MEASURING AND DETECTING VIOLENT HITS STRONG ENOUGH TO INFLICT DAMAGE STORES INFORMATION REGARDING ACCELERATION AND MOVEMENT OF HEAD WHILE MEASURING LINEAR AND ANGULAR FORCES TO THE HEAD
  • HEAD IMPACT TELEMETRY SYSTEM (HITS) EVALUATES REGIONS OF THE HEAD THAT ARE MOST SUSCEPTIBLE TO DAMAGE ACCOUNTS FOR LINEAR &amp; ROTATIONAL ACCELERATION, JERK, FORCE, IMPULSE, AND DIRECTION HAS ONLY BEEN USED AS A TOOL FOR RESEARCH, BUT MAY HAVE A FUTURE IN DIAGNOSTICS
  • STORY OF CHRISTOPHER NOWINSKI OCTOBER INTERVIEW IN OAKS, PA
  • FROM 1945-1999, 491 HEAD-RELATED FOOTBALL FATALITIES OCCURRED IN HIGH SCHOOL, COLLEGIATE, PROFESSIONAL, AND RECREATIONAL LEVELS WHY DO WE NOT HEAR THIS STORIES? AGAIN, IT GOES BACK TO THE CULTURE OF THE GAME
  • SPORTS LEGACY INSTITUTE’S TEN POINT PLAN TO SAVE FOOTBALL 1. REEVALUATE HOW THE GAME IS PRACTICED 2. ENCOURAGE MANDATORY BRAIN TRAUMA EDUCATION 3. REEVALUATE PROTECTIVE EQUIPMENT 4. DEVELOP BETTER METHODS OF DIAGNOSIS 5. DEVELOP BETTER METHODS OF MANAGAMENT 6. CONSIDER MINIMUM MEDICAL RESOURCES 7. REEVALUATE TECHNIQUES OF TACKLING AND BLOCKING 8. REEVALUATE THE RULES 9. REEVALUATE RULE ENFORCEMENT AND ROLE OF REFEREES 10. RECONSIDER THE CULTURE OF THE GAME
  • ACTING UPON A CRISIS ZACKERY LYSTEDT BRAIN PROJECT ZACK’S LAW (WASHINGTON) MAX’S LAW (OREGON) PA CONCUSSION MANAGEMENT BILL
  • NATIONAL FOOTBALL LEAGUE NFL PUTTING MONEY TOWARDS CONCUSSION RESEARCH AND STRICTER ENFORCEMENT OF RULES RECOGNIZING THE ISSUE 88 PLAN NFL WILL GIVE UP TO $88,000 A YEAR TO FORMER PLAYERS WHO NEED NURSING-HOME CARE DUE TO BRAIN INJURIES COMPENSATES FOR THOSE ENDURING SEVERE INJURIES MENTALLY AND PHYSICALLY
  • LUCK OF THE DRAW FOUNDATION SPEAKING TO PLAYERS, PARENTS, COACHES, AND TRAINERS FUNDRAISER TOURNAMENT EVENTS RELATIONSHIP WITH CHRISTOPHER NOWINSKI MEETING WITH STATE REPRESENTATIVE TIM BRIGGS HEADSTRONG.WEEBLY.COM
  • UPPER MERION CONCUSSION SURVEY 63 OUT OF 100 STUDENT ATHLETES RESPONDED; 38 SENIORS, 15 JUNIORS, 4 SOPHOMORES, AND 6 FRESHMEN 78 TOTAL CONCUSSIONS WERE REPORTED BY 39 OUT OF 63 (61.9%) STUDENT ATHLETES ONLY 37 OUT OF THE 78 (44.8%) CONCUSSIONS WERE REPORTED TO HAVE BEEN DIAGNOSED BY AN ATHLETIC TRAINER 25 OUT OF 63 (39.7%) STUDENT ATHLETES SAID THEY WOULD NOT TELL A COACH OR ATHLETIC TRAINER IF THEY HAD A CONCUSSION 9 OUT OF 39 (23.1%) STUDENT ATHLETES REPORTED THAT THEY HAVE HAD THREE OR MORE CONCUSSIONS DURING THEIR ATHLETIC CAREERS
  • CONCLUSION CONCUSSIONS SHOULD BE TREATED AS A BRAIN INJURY GUIDELINES AT ALL LEVELS OF PLAY MUST BE SET IN ORDER TO BEST PROTECT OUR ATHLETES ATHLETES, PARENTS, AND COACHES MUST BE EDUCATED ON THE SIGNS SYMPTOMS, AND RISKS OF MILD TRAUMATIC BRAIN INJURIES NO CHILD’S LIFE SHOULD BE PUT AT RISK TO PERFORM ON THE PLAYING FIELD
  • Head Injuries In Sports

    1. 1. Head Injuries In Sports<br />JOHN GONOUDE<br />
    2. 2.
    3. 3. “Pain is weakness leaving the body.”<br />
    4. 4. the brain<br />Most complex organ of the human body<br />Foundation of the mind<br />All thoughts, perceptions, and behaviors are a direct result of combinations of signals among neurons<br />Society for Neuroscience<br />
    5. 5. Neurons<br />Basic working unit of the brain<br />Responsible for the transmission of information<br />Nerve impulses<br />Action potential<br />Society for Neuroscience<br />
    6. 6. NEUROTRANSMITTERSThe brain’s chemical messengers.<br />Responsibilities<br />Generation of action potential<br />Tightening of muscles<br />Beginning of enzyme activity<br />Releasing more neurotransmitters<br />Nowinski, Head Games: Football’s Concussion Crisis<br />Society for Neuroscience<br />
    7. 7. neurotransmitters<br />Acetylcholine (ACh)<br />Normal attention, memory, and sleep<br />Glutamate and aspartate<br />Signal the release of N-methyl-D-aspartate (NMDA)<br />Learning, memory, and the development of nerve contacts<br />Society for Neuroscience<br />
    8. 8. WHAT<br />IS A<br />CONCUSSION?<br />A concussion is a mild traumatic brain injury.<br />National Athletic Trainers’ Association<br />
    9. 9. Features of a Concussion<br />Vacant stare<br />Delayed verbal and motor responses<br />Disorientation<br />Confusion and inability to focus attention<br />Incoordination<br />Slurred and incoherent speech<br />Emotions out of proportion<br />Memory deficits<br />Any period of unconsciousness<br />American Academy of Neurology<br />
    10. 10. SYMPTOMS<br />Early Symptoms<br />Headache<br />Dizziness<br />Lack of awareness of surroundings<br />Nausea or vomiting<br />Late Symptoms<br />Low-grade headaches<br />Lightheadedness<br />Poor attention and concentration<br />Memory dysfunction<br />Easy fatigability<br />Irritability and low frustration tolerance<br />Intolerance of bright lights or difficulty focusing vision<br />Intolerance of loud noises<br />Anxiety or depressed mood<br />Sleep disturbance<br />American Academy of Neurology<br />
    11. 11. During a concussion, the brain develops inabilities in regulating blood supply and making energy.<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    12. 12. Neurotransmitters bind on to receptors and change the receptors<br />Susceptible to glutamate<br />Excitotoxic death<br />(PLASTICITY)<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    13. 13. “IF PEOPLE SAY THERE IS NO CORRELATION BETWEEN WHAT HAPPENED TO THEM AND PLAYING; BULLS***, BULLS***. AND PEOPLE CAN CALL ME ANYTHING THEY WANT. THEY CAN CALL ME A MALCONTENT, A BABY; WHATEVER THE F*** YOU WANT TO CALL ME. BUT NOBODY IS GOING TO SHUT ME UP FROM TALKING ABOUT WHAT I KNOW.”<br /> HARRY CARSON<br />ESPN, Outside the Lines<br />
    14. 14. POST-CONCUSSIONSYNDROME<br />Condition may take days, weeks, months, or even years to recover from<br />Symptoms include prolonged cases of physical, cognitive, emotional, and behavioral issues<br />University of Buffalo, Current Treatment Options in Neurology<br />
    15. 15. DEPRESSION<br />Persistently sad or empty mood, low energy level, unusual fatigue, headaches, unresponsive chronic pain<br />MedicineNet<br />Nowinski, Head Games; Football’s Concussion Crisis<br />
    16. 16. Neurology Now, “Head Games”<br />
    17. 17. The injured athlete is initially dazed by the impact and remains alert for another 15 seconds to a minute before collapsing to the ground in a semi-conscious state. They display rapidly dilating pupils and may even stop breathing.<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    18. 18. Zachery Lystedt<br />Maple Valley, WA<br />Max Conradt<br />Waldport, OR<br />Covington Reporter<br />Goliath<br />
    19. 19. CHRONICTRAUMATICENCEPHALOPATHY<br />American Association of Neuropathologists<br />
    20. 20. Chronic Traumatic Encephalopathy is the progressive degeneration of brain tissue involving the build-up of tau protein.<br />American Association of Neuropathologists<br />
    21. 21. Andre Waters MIKE WEBSTER 1962-2006 1952-2002<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    22. 22. “I don’t know how much sense that makes, because we’re dealing with the same organ. No cardiologist ignores a ‘mild’ heart attack. He doesn’t say to his patient, ‘don’t worry about exercise or your diet unless the heart attack is severe.’ He still treats him as if he has had a heart attack. Yet we don’t treat a concussion in the same way as we do a brain injury. For some reason we tell people, ‘you’re fine,’ when we know they aren’t.”<br /> Dr. Heechin Chae<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    23. 23. Return to Play Decisions<br />Multiple Grade 1 concussions<br />1 week<br />Grade 2 concussion<br />1 week<br />Multiple Grade 2 concussions<br />2 weeks<br />Grade 3 with brief loss of consciousness<br />2 weeks<br />Multiple Grade 3 concussions<br />1 month or longer (based on clinical decision of evaluating physician)<br />National Athletic Trainers’ Association<br />
    24. 24. SCAT2<br />Zurich Consensus<br />
    25. 25. ImPACT<br />Immediate Postconcussion Assessment and Cognitive Testing<br />ImPACT<br />
    26. 26. ImPACT<br />Attention span<br />Working memory<br />Sustained and selective attention time<br />Response variability<br />Non-verbal problem solving<br />Reaction time<br />ImPACT<br />
    27. 27. Disqualification Guidelines<br />GAME, SEASON, or CAREER<br />National Athletic Trainers’ Association<br />
    28. 28. NEUROIMAGING<br />Computed Tomography (CT) Scan<br />Uses x-rays to create cross-sectional pictures of the brain to produce a three-dimensional image<br />Magnetic Resonance Imaging (MRI)<br />Radiology technique using magnetism, radio waves, and a computer to produce images of body structures<br />MedicineNet<br />National Athletic Trainers’ Association<br />
    29. 29. Injury Treatment<br />No evidence-based pharmacologic treatment options<br />Wake-ups<br />Rest<br />Avoid activities that create cognitive or physical stress<br />National Athletic Trainers’ Association<br />Nowinski, Head Games: Football’s Concussion Crisis<br />
    30. 30. It is estimated that between 1.6 to 3.8 million concussions occur every year in the United States. In 2008, only 126,926 sports-related concussions were treated in United States hospital emergency rooms. 47,807 (37.6%) of those concussions occurred in children under the age of 14.<br />American Association of Neurological Surgeons<br />Centers for Disease Control and Prevention<br />
    31. 31. What is being done?<br />
    32. 32. innovation in protection<br />Maher B-Protect Splint (Level III) Mouth Guard<br />Carefully designed to help prevent concussions<br />Designed for optimum fit, comfort, communication, and stability<br />Mahercor Laboratories<br />
    33. 33. Xenith X1<br />Xenith<br />
    34. 34. THE EVOLUTION OF THE HELMET.<br />Popular Mechanics<br />
    35. 35. Popular Mechanics<br />
    36. 36. HELMET FITTING<br />
    37. 37. HEAD IMPACT TELEMETRY SYSTEM<br />(HITS)<br />Journal of Athletic Training<br />
    38. 38. Head Impact Telemetry System (HITS)<br />Evaluates regions of the head that are most susceptible to damage<br />Accounts for linear & rotational acceleration, jerk, force, impulse, and direction<br />Has only been used as a tool for research, but may have a future in diagnostics<br />Journal of Athletic Training<br />
    39. 39. “We need to take a step back and start taking care of ourselves.”<br /> Chris Nowinski<br />
    40. 40. From 1945-1999, 491 head-related football fatalities occurred in high school, collegiate, professional, and recreational levels.<br />Journal of Athletic Training<br />
    41. 41. TEN POINT PLAN TO SAVE FOOTBALL<br />Reevaluate how the game is practiced<br />Encourage mandatory brain trauma education<br />Reevaluate protective equipment<br />Develop better methods of diagnosis<br />Develop better methods of management<br />Consider minimum medical resources<br />Reevaluate techniques of tackling and blocking<br />Reevaluate the rules<br />Reevaluate rule enforcement and role of referees<br />Reconsider the culture of the game<br />Sports Legacy Institute<br />
    42. 42. Acting Upon A Crisis.<br />Pennsylvania House Democratic Caucus<br />The Covington Reporter<br />The Register-Guard<br />
    43. 43. Starting From The TopThe Role of the National Football League<br />88 PLAN<br />National Football League<br />New York Times<br />
    44. 44. Luck of the Draw Foundation<br />
    45. 45. Upper Merion Concussion Survey<br />63 out of 100 student athletes responded; 38 seniors, 15 juniors, 4 sophomores, and 6 freshmen.<br />78 total concussions were reported by 39 out of 63 (61.9%) student athletes.<br />Only 37 out of the 78 (44.8%) concussions were reported to have been diagnosed by an athletic trainer.<br />25 out of 63 (39.7%) student athletes said they would not tell a coach or athletic trainer if they had a concussion.<br />9 out of 39 (23.1%) student athletes reported that they have had three or more concussions during their athletic careers.<br />Luck of the Draw Foundation<br />
    46. 46. CONCLUSION<br />Concussions should be treated as a brain injury<br />Guidelines at all levels of play must be set in order to best protect our athletes<br />Athletes, parents, and coaches must be educated on the signs, symptoms, and risks of mild traumatic brain injuries<br />No child’s life should be put at risk to perform on the playing field<br />

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