PEARL
pupil equal and reactive to light
Cranial nerves
12 nerve pairs that begin in areas of the brain. They are designated by number and name
Cognitive testing
study the effects of head trauma on cognitive function (mental processes that allow us to carry out common tasks)
Alert
awake and responds immediately and appropriately
confused
impaired memory, disorientation and confusion
Lethargic
drwosy yet easily arouswed, oriented to persono, place and time
Stuporous
asleep most of the time, difficult to arouse, responds inappropriately
Semicomatose
no response to verbal stimuli, some response to painful stimuli
comatose
no response
epistaxis
bloody nose
anterograde amnesia
length of time from injury until conscious memory returns
retrograde amnesia
loss of memory of events that occurred before the injury
immediate recall
can recite 4-5 words or numbers right after you say them
Tinnitus
ringing in the ears
Rhomberg’s test
balance testing for intracranial damage
Diplopia
double vision
Acronym for cranial nerves…
On Old Olympus Towering Tops, A Finn And Greek Viewed Some Hops
Olfactory
Smell (I)
Optic
vision (II)
Oculomotor
eye movement, constriction of pupil (III)
Trochlear
eye movement (IV)
Trigeminal
head and face sensation (V)
Abducens
lateral movement of the eye (VI)
Facial
taste, facial movements (VII)
Acoustic
hearing and equilibrium (VIII)
Glossopharyngeal
swallowing (IX)
Vagus
speech (X)
Spinal Accessory
movement of neck and spine (XI)
Hypoglossal
movement of the tongue (XII)
Skull Fracture
Blunt trauma to head.
S/S- blood and/or CSF in ear or nose, severe headache, nausea, skin indentation
T/X- 911
Concussion
Direct or indirect trauma to head
S/S- confusion, headache, dizziness, trouble concentrating, abnormal pupil response
T/X- take out of play, determine LOC, watch for symptoms to worsen
Intracranial Hemorrhage
Blow to head (may be a slow bleed)
S/S- show signs of mild headache but then has sever head pains, dizziness, nausea, unequal pupils.
TX- referral to the ER
Epidural Bleeding (FAST)
blow to the head
S/S- extremely fast bleeding, arterial. (in 10-20 min the athlete will go grom fine to having major symptoms
TX- ER, surgery
Subdural Bleeding
Veins are torn that bridge the dura mater to the brain (Contrecoup)
S/S- bleeding is slow, s/s may not appear for hours
TX- 911 after s/s appear
Countercoup
occurs at site opposite of impact
Intracerebral bleeding
Force trauma to being (bleeding within the brain)
S/S- deterioration of neurological function
TX- 911, ER
Post Concussive Syndrome
Happens after head injury
s/s- impaired memory, lack of concentration, anxiety, depression
TX- may not return to play until symptoms are gone and have been cleared by a health care provider
Second impact Syndrome
Second head injury before S/S of initial injury go away ( caused 50 deaths over the last decade)
S/S- appear stunned, within short time athlete may collapse, dilated pupils, loss of eye movement, respiratory failure.
TX- prevention
Chronic Traumatic Encephalopathy (CTE)
Repetitive blows to the head (progressive degenerative brain disease
S/S- depression, mood changes, impulse control problems (eventually causes dementia)
TX- no cure
Cerebellum (SMALL)
Motor function, balance, posture
Cerebrum (LARGEST)
Voluntary movements
Sensory
Motor functions
Consciousness depends on excitation of the cerebral cortex
Cerebrospinal fluid
between arachnoid and pia mater (subarachnoid space)
-Suspends brain
-Cushions it from shock
Meninges (4 LAYERS)
Dura Mater- Dense, inelastic, outermost matter
Arachnoid membrane- thin, delicate membrane, attached to the spinal cord by small tissue strands
Subarachnoid space- in between the arachnoid and the pia mater. Helps contain the spinal fluid
Pia Mater- innermost layer
Cranium consists of large FLAT bones…
Frontal, Occipital, 2 Sphenoid, 2 Parietal, 2 Temporal
Brainstem
Medulla- heart, lungs motor
Pons and midbrain- reflexes
Hops (Questions)
Note length of time unconscious for
Alert-comatose
Headache- Location, type
Memory- immediate recall, recent memory
QUESTIONS-
Do you know where you are
What happened
Does your head hurt
Do you have pain in your neck
can you move your hands and feet
hOps
obvious deformity
slurred or incoherent speech
gross disturbance in coordination
length of time athletes affects abnormal
swelling or bleeding from scalp
discoloration
disorientation
delayed verbal and motor responses
hoPs
-skull deformity
-open wounds
-palpate both neck and skull
hopS
BALANCE TESTS-
Rhomberg (stand with eyes closed, single leg and tandem stance)
BESS (balance error scoring system)
COORDINATION TESTS-
finger to nose
heel-to-toe walk
heel to knee test
CONGITIVE TESTS-
count backwards from 100 by 7
spelling a word backwards
3 word recall
name the months in reverse order
Special Tests (neurological exam)
Cerebral testing- cognitive function
Cranial nerve testing- rule out isolated injury
Cerebellar testing- coordination and motor function
Sensory testing- dermatomes
Reflex testing
CAM Log
Cognitive Activity Monitoring Log
What is the first step in any concussion management plan
the institution of both physical and cognitive rest
What does cognitive rest possibly include?
no school attendance, no home/school work, no reading, no video games, no texting, no computer time, and no television
mTBI
mild traumatic brain injury
RTL
return to learn
when should you stop the cognitive activity when returning from a brain injury
after mild symptoms develop and before severe symptoms develop
Idaho concussion law is under house bill NO.
577
what are the stages of the symptoms monitoring tool or RTL plan
NO activity
Gradual reintroduction of cognitive activity
Homework at home before schoolwork at school
School re-entry
Gradual reintegration into school
Resumption of full cognitive workload
Home care OK TO
ice pack for head and neck, eat light diet, go to sleep, rest, tylenol
Home care NO NEED TO
check eyes with flashlight, wake up every hour, test reflexes, stay in bed
Home care DO NOT
drink alcohol, eat spicy foods, drive
Gradual RTP Protocol
Step 1- light aerobic exercise
Step 2- Sport specific exercise
Step 3- noncontact training drills and resistance training.
Neurocognitive test=
PASS- non contact training drills and resistance training
FAIL- retake in 48 hours
Step 4- full contact practice
Each step of RTP is….
a full 24-hour period. if symptoms return athlete drops back one level
External occipital protuberance
bump of knowledge
Where is CSF
between arachnoid and pia mater
What does CSF do
suspends brain, and cushions it from shock
Meninge layers