This document provides information about head and neck injuries, specifically traumatic brain injuries (TBIs). It discusses brain anatomy, types of injuries including concussions, signs and symptoms, prevention strategies, and laws regarding sports injuries. Treatment for TBIs may include medications, surgery, and long-term therapy. Injuries can have damaging effects and affect the whole family. Local resources are available to support recovery. The story of William Dottery, who became paralyzed after a football injury, is shared as an example of recovering from injury through determination and by founding Dream Walkers, a non-profit organization.

1. What You Should Know
Attorney Malcolm Crosland
&
Mr. William Dottery

2.  Brain Anatomy
 Types of Head & Neck Injuries
 Signs & Symptoms
 Prevention & Preparedness
 SC Laws Regarding Sports Injuries
 What Parents, Coaches, and Student Athletes
Should Know
 Life After an Injury
◦ Damaging Effects
◦ Treatment
◦ Local Resources
◦ William’s Story

3. The base of the skull is rough,
with many bony protuberances.
These ridges can result in injury
to the temporal lobe of the brain
during rapid acceleration.
Bony ridges
Injury from contact
with skull

4. Parietal Lobe
Temporal Lobe
Frontal Lobe
Limbic Lobe
Occipital Lobe

5. The brain is a complex and delicate organ, and
one that is vulnerable to injury from a variety of
different traumas. These include:
 Frontal Lobe Injury
 Occipital Lobe Injury
 Temporal Lobe Injury
 Diffuse Axonal Injury

6. Types of Neck Injuries
Sprains and Strains: Sometimes called whiplash, a neck sprain
occurs when ligaments are torn or stretched by a sudden and
strong movement of the head.
Cervical Fractures: CFs are caused by high-energy trauma, such
as a car crash or high-impact sport injury (like a tackle).
Neck injuries may cause a variety of conditions, from minor
discomfort to paralysis or death due to cervical vertebrae
fracture and injury to the spinal cord.

7. Types of Brain Injuries
Closed – A closed injury does not break open your skull or
penetrate brain tissue, but can still cause bruising or swelling
of the brain.
Open – An open injury is any damage that penetrates the skull.
The damage may cause bleeding in the brain tissue, skull
fractures, or cause the bones to press into brain tissue.
Scalp Wound – Injuries to the skin that covers and protects your
skull may lead to bleeding or tissue damage.
Concussion – A concussion is caused by a bump, blow, or jolt
to the head that can change the way your brain normally works.

8. The frontal lobe of the brain can be
injured from direct impact on the
front of the head.
During impact, the brain tissue is
accelerated forward into the bony
skull. This can cause bruising of
the brain tissue and tearing of
blood vessels.
Frontal lobe injuries can cause
changes in personality, as well as
many different kinds of
disturbances in cognition and
memory.

9. Occipital lobe injuries
occur from blows to the
back of the head.
This can cause bruising
of the brain tissue and
tearing of blood vessels.
These injuries can result
in vision problems or
even blindness.

10. The temporal lobe of the brain is
vulnerable to injury from impacts
of the front of the head.
The temporal lobe lies upon the
bony ridges of the inside of the
skull, and rapid acceleration can
cause the brain tissue to smash
into the bone, causing tissue
damage or bleeding.

11. Brain injury does not require a
direct head impact. During
rapid acceleration of the head,
some parts of the brain can
move separately from other
parts. This type of motion
creates shear forces that can
destroy axons necessary for
brain functioning.
These shear forces can stretch
the nerve bundles of the brain.

12. The brain is a complex
network of interconnections.
Critical nerve tracts can be
sheared and stressed during
an acceleration-type of injury.
Diffuse axonal injury is a very serious
injury, as it directly impacts the major
pathways of the brain.

13. Traumatic Brain Injury
(TBI) occurs when a
sudden trauma
damages the brain
causing bleeding,
bruising, or tearing of
nerves.

14. • Auto, motorcycle or
bicycle crashes
• Falls
• Violence
– Gun shots
– Abuse
• Explosive blasts
– Military personnel

15. • Physical symptoms
– Unconsciousness
– Severe headache
– Repeated nausea and
vomiting
– Dizziness
– Seizures
– Weakness
– Numbness in arms and
legs
– Dilated pupils of the
eye
• Psychological
symptoms
– Slurred speech
– Confusion
– Agitation
– Memory or
concentration
problems
– Amnesia about events
prior to injury

16. Click to Play Video

17.  A concussion is a type of traumatic brain injury,
or TBI, caused by a bump, blow, or jolt to the
head that can change the way your brain
normally works.
 Concussions can also occur from a blow to the
body that causes the head to move rapidly back
and forth. Even a “ding,” “getting your bell rung,”
or what seems to be mild bump or blow to the
head can be serious.
 Concussions can occur in any sport or recreation
activity. So, all coaches, parents, and athletes
need to learn concussion signs and symptoms
and what to do if a concussion occurs.

18.  Any one or more of the following visual clues
can indicate a possible concussion:
◦ Loss of consciousness or responsiveness
◦ Lying motionless on ground
◦ Slow to get up or unsteady on feet
◦ Balance problems or falling over
◦ Incoordination Grabbing
◦ Clutching of head
◦ Dazed, blank or vacant look
◦ Confused / Not aware of plays or events

19.  Presence of any one or more of the following
signs & symptoms may suggest a concussion or
other head or neck injury:
• Loss of consciousness
• Headache, neck pain
• Decreased range of motion
• Seizure or convulsion
• Dizziness
• Balance problems
• Confusion
• Nausea or vomiting
• Feeling slowed down,
foggy
• Drowsiness, fatigue, or low
energy
• “Pressure in head”
• Exaggerated emotions,
sadness
• Blurred vision
• Irritability
• Sensitivity to light or noise
• Amnesia, difficulty
recalling basic facts or
current events
• Nervous or anxious
• Bruising
• Trouble sleeping
• Pain or tingling in
head/neck/shoulders

20.  Any athlete with a suspected concussion should
be IMMEDIATELY REMOVED FROM PLAY, and
should not be returned to activity until they are
assessed medically.
 Athletes with a suspected head or neck injury
should not be left alone and should not drive a
motor vehicle.
 It is recommended that, in all cases of suspected
sports injury, the player is referred to a medical
professional for diagnosis and guidance as well
as return to play decisions, even if the symptoms
resolve.

21.  Ensure athletes follow their coach’s rules for
safety and the rules of the sport.
 Encourage athletes to practice good
sportsmanship at all times.
 Make sure all athletes wear the right protective
equipment for their activity.
◦ Protective equipment should fit properly and be well
maintained.
 Wear a helmet! A helmet can reduce the risk of a
serious brain injury or skull fracture.
◦ NOTE: There is no “concussion-proof” helmet. Even with
a helmet, it is important for athletes to avoid hits to the
head.

22.  Check with your league, school, or district
about sports injury policies.
 Create an emergency action plan to ensure
that concussions and other injuries are
identified early and managed correctly.
 Educate athletes and other parents or
coaches about concussions and head/neck
injuries.
 Consistently monitor the health of your
athletes.
 Always insist: Safety First!

24.  A report of any head or spinal injury or
broken limb suffered by a student enrolled
in the public schools of South Carolina shall
be filed by the coach with the principal of
the school.
 The report shall be made a part of the
student's school record.

26. Nationally recognized guidelines, policies, best practices, and
procedures regarding the identification and management of
suspected concussions in student athletes, as well as return-to-
play decisions, are posted on the SC DHEC website, SCDHEC.gov.
These guidelines are based on scientific and medical data
developed by several sports medicine community organizations:
 Brain Injury Association of South Carolina
 South Carolina Medical Association
 South Carolina Athletic Trainer's Association
 National Federation of High Schools
 Centers for Disease Control and Prevention
 American Academy of Pediatrics
These guidelines apply to ALL South Carolina High School
League-sanctioned events. Local school districts shall develop
guidelines and procedures based on these models.

27.  Each year, prior to participation in athletics, each school
district is required to provide an information sheet on
concussions to all coaches, volunteers, student athletes,
and their parents or legal guardians.
 This sheet informs of the nature and risk of concussion and
brain injury, including the risks associated with continuing
to play after a concussion or brain injury.
 The parent or legal guardian's receipt of this
information sheet must be documented in writing or by
electronic means before the student athlete is permitted
to participate in an athletic competition or practice.

28.  Always inform coaches and trainers of any
previous head or neck injuries or other
medical issues prior to your child’s
participation in any sport or athletic activity.
 You can request baseline testing and
routine monitoring of your child’s health
throughout the season.

29.  If a coach, athletic trainer, official, or
physician suspects that a student athlete
has sustained a concussion or brain injury
in a practice or in an athletic competition,
the student athlete shall be removed from
practice or competition immediately.

30.  The athletic trainer, physician, physician
assistant, or nurse practitioner who evaluates
the student athlete during practice or an
athletic competition and authorizes the student
athlete to return to play is not liable for civil
damages resulting from an act or omission in
rendering this decision, other than acts or
omissions constituting gross negligence or
willful, wanton misconduct.
 This immunity applies to an athletic trainer,
physician, physician assistant, or nurse
practitioner serving as a volunteer.

31.  DHEC posts continuing education
opportunities in concussion evaluation
and management on its website, so
coaches and trainers can stay up-to-date
on current best practices and
information about identifying and
managing concussions and brain injuries
in student athletes.

32.  A student athlete who has been removed
from play may return to play ONLY IF an
on-site athletic trainer, physician, physician
assistant, or nurse practitioner properly
evaluates the athlete and determines in
his/her best professional judgment that the
student athlete does not have any signs or
symptoms of a concussion or brain injury.

33.  A student athlete who has been removed
from play and, after a proper evaluation,
is suspected of having a concussion or
brain injury may not return to play until
the student athlete has received written
medical clearance by a physician.

34.  Damaging Effects of TBIs
 Treatment
 Family Stressors, Coping, & Support
 Local Resources
 William Dottery’s Story
 Road To Recovery
 Plans for the Future
 Dream Walkers

35.  Depending on what part of the brain has been
injured, a TBI can have a significant effect on
vision, hearing, speech, and motor functions,
as well as psychological and emotional
effects.

36. The prefrontal cortex is
involved with intellect,
complex learning, and
personality.
Injuries to the front lobe
can cause mental and
personality changes.

37. Emotions are an extremely
complex brain function. The
emotional core of the brain is the
limbic system. This is where
senses and awareness are first
processed in the brain.
Mood and personality are
mediated through the prefrontal
cortex. This part of the brain is
the center of higher cognitive and
emotional functions.
Prefrontal cortex
Limbic system

38. Click to Play Video

39.  Medications:
◦ Diuretics to reduce the
amount of fluid in
tissue
◦ Anti-seizure
medication
◦ Coma-inducing
medication to
decrease oxygen
needs to the brain
 Surgery
◦ Remove blood clots
◦ Repair broken skull
bones
◦ Remove skull bone to
allow the brain to
swell

40.  Therapy
◦ Patients with moderate to severe traumatic brain
injury will need to have intense rehabilitation
◦ Therapy begins in the hospital
◦ Types of therapy include:
 Physical therapy: walking, strength, regaining balance
 Occupational therapy: self care activities, career
assistance
 Speech therapy: talking, reading, comprehension
◦ Therapy may continue for months or years

41.  Head/neck injuries affect not only the patient,
but the total family system
 Family provides most of the care for the
injured, often without adequate professional
support and intervention
 Family caregivers often experience:
◦ Anxiety
◦ Shock
◦ Disbelief
◦ Denial
◦ Frustration

42.  Challenges that caregivers often encounter:
 Monitoring medications
 Managing challenging behaviors
 Adjusting to different emotions
 Grief or sense of loss
 Caregiver Resources:
 Support groups through Brain Injury Association
 Supportive counseling
 Family therapy
 Respite care

43.  A brain injury often
erases memory of
events that occurred
just before injury.
 It may be difficult to
remember new
information and learn
new tasks
 Some problems may
get better over time,
and some may be
permanent.
 Coping strategies:
 Slow down
 Stop and think
 Break it down, step by
step
 Ask questions
 Do not assume
 Pay attention to details
 Take frequent breaks
 Carry a calendar

44.  MUSC Sports Medicine – 843-792-1414
 SC Sports Medicine & Orthopaedic Center – 843-572-2663
 Lowcountry Orthopaedics & Sports Medicine – 843-797-
5050
 Trident Sports Medicine & Rehabilitation - 843-847-4873
 Healthsouth Rehabilitation Hospital - 843-820-7777
 Roper Rehabilitation Hospital – 843-724-2843
 Robison Family Chiropractic - 843-795-2575
 Steinberg Law Firm – 843-720-2800
 Trident Head Injury Support Group – 843-881-1214
 Charleston Area Spinal Cord Injury Support Group – 843-
863-1165
 disAbility Resource Center – 843-225-5080
 Charleston Urology Associates - 843-884-8045

45.  William R. Dottery III.
 Born in Charleston, raised in Awendaw and
McClellanville.
 Graduated from Lincoln High School in 1996.
 Played football, basketball, and baseball all 4
years in high school
 Received 13 scholarship offers to attend
several Colleges and Universities
 Chose to attend Johnson C. Smith University
with a full scholarship offer to play football.

46.  Scouted by NFL after freshman year at JCSU
 End of sophomore year:
◦ “My last play on the football field, I came up to
make a tackle from the free safety position on the
running back, and as I was going down his knee
was coming up, hitting the side of my helmet.
Everything went numb as I laid on the ground.”
 William suffered a career-ending football
accident, leaving him paralyzed with a spinal
cord injury fracture to the C4 and C5
vertebrae.

47. Even though my progress in physical therapy rehabilitation
is very slow, I've always motivated myself to walk again.

49.  Although I suffered several tragedies, I am blessed
with a 9 year old son that also plays football now and
a loving and caring father to help me.
 I was always a role model to the younger kids in my
community. Even though I had NFL dreams, I lacked
a back up plan.
 When you are an athlete, you need to know what to
do after sports because no back-up plan could
potentially lead to failure.
 I decided that since I was already a role model in the
community, I wasn't going to let my injury stop me
from helping myself and others in my position
through a seemingly life ending situation.
 My friends and family often dream of me walking, I
have dreamed it. So, the time now!

50. • Dream Walkers is a 501-c3 non-profit
organization serving the entire tri-county
area of Charleston, SC.
• Our mission is to bring injury awareness
to children and young adults that play contact sports, and to have a
support system for any situation – from minor or temporary injuries to full
paralysis – for athletes and their families.
• Our goal is to help find a solution - whether it be financially, mentally,
socially, or physically. Dream Walkers is an informational data base where
you can find treatments for different types of injuries.
• Dream Walkers also embraces Veterans and anyone else who has
suffered a serious injury and is experiencing paralysis, head trauma, etc.