Brain Injuries That Occur In Sports

Over the past decade, the scientific information on traumatic brain injury has increased considerably. A number of models, theories and hypotheses of traumatic brain injury have been elaborated.

Despite dramatic advances in this field of medicine, traumatic brain injury, including the mild 2 Slobounov and Sebastianelli traumatic brain injury (MTBI), commonly known as a concussion, is still one of the most puzzling neurological disorders and least understood injuries facing the sport medicine world today.

Definitions of concussion are almost always qualified by the statement that loss of consciousness can occur in the absence of any gross damage or injury visible by light microscopy to the brain.

According to a recent NIH Consensus Statement, mild traumatic brain injury is an evolving dynamic process that involves multiple interrelated components exerting primary and secondary effects at the level of individual nerve cells (neuron), the level of connected networks of such neurons (neural networks), and the level of human thoughts or cognition.

The need for multidisciplinary research on mild brain injury arises from recent evidence identifying long-lasting residual disabilities that are often overlooked using current research methods. The notion of transient and rapid symptoms resolution is misleading since symptoms resolution is not indicative of injury resolution.

There are no two traumatic brain injuries alike in mechanism, symptomology, or symptoms resolution. Most grading scales are based on loss of consciousness (LOC), and post-traumatic amnesia, both of which occur infrequently in MTBI. There is still no agreement upon diagnosis and there is no known treatment for this injury besides the passage of time. LOC for instance, occurs in only 8% of concussion cases.

Overall, recent research has shown the many shortcomings of current MTBI assessments rating scales, neuropsychological assessments and brain imaging techniques.

Humans are able to compensate for mild neuronal loss because of redundancies in the brain structures that allow reallocation of resources such that undamaged pathways and neurons are used to perform cognitive and motor tasks.

Three to four weeks after conception, one of the two cell layers of the gelatin-like human embryo, now about one-tenth of an inch long, starts to thicken and build up along the middle. As this flat neural plate grows, parallel ridges, similar to the creases in a paper airplane, rise across its surface.

Within a few days, the ridges fold in toward each other and fuse to form the hollow neural tube. The top of the tube thickens into three bulges that form the hindbrain, midbrain and forebrain. The first signs of the eyes and then the hemispheres of the brain appear later.

How does all this happen? Although many of the mechanisms of human brain development remain secrets, neuroscientists are beginning to uncover some of these complex steps through studies of the roundworm, fruit fly, frog, zebrafish, mouse, rat, chicken, cat and monkey.

Knowing how the brain is put together is essential for understanding its ability to reorganize in response to external influences or to injury. These studies also shed light on brain functions, such as learning and memory.

Brain diseases, such as schizophrenia and mental retardation, are thought to result from a failure to construct proper connections during development. Neuroscientists are beginning to discover some general principles to understand the processes of development, many of which overlap in time.

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Typical human brain
human brain
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Typical human brain

The human brain has the same general structure as the brains of other mammals, but has a more developed cerebral cortex than any other. Large animals such as whales and elephants have larger brains in absolute terms, but when measured using the encephalization quotient, which compensates for body size, the human brain is almost twice as large as the brain of the bottlenose dolphin, and three times as large as the brain of a chimpanzee. Much of the expansion comes from the cerebral cortex, especially the frontal lobes, which are associated with executive functions such as self-control, planning, reasoning, and abstract thought. The portion of the cerebral cortex devoted to vision, the visual cortex, is also greatly enlarged in humans.

The human cerebral cortex is a thick layer of neural tissue that covers most of the brain. This layer is folded in a way that increases the amount of surface that can fit into the volume available. The pattern of folds is similar across individuals, although there are many small variations. The cortex is divided into four “lobes”, called the frontal lobe, parietal lobe, temporal lobe, and occipital lobe. (Some classification systems also include a limbic lobe and treat the insular cortex as a lobe.) Within each lobe are numerous cortical areas, each associated with a particular function, including vision, motor control, and language. The left and right sides of the cortex are broadly similar in shape, and most cortical areas are replicated on both sides. Some areas, though, show strong lateralization, particularly areas that are involved in language. In most people, the left hemisphere is “dominant” for language, with the right hemisphere playing only a minor role. There are other functions, such as spatiotemporal reasoning, for which the right hemisphere is usually dominant.

Despite being protected by the thick bones of the skull, suspended in cerebrospinal fluid, and isolated from the bloodstream by the blood–brain barrier, the human brain is susceptible to damage and disease. The most common forms of physical damage are closed head injuries such as a blow to the head, a stroke, or poisoning by a variety of chemicals that can act as neurotoxins. Infection of the brain, though serious, is rare due to the biological barriers that protect it. The human brain is also susceptible to degenerative disorders, such as Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease. A number of psychiatric conditions, such as schizophrenia and depression, are thought to be associated with brain dysfunctions, although the nature of such brain anomalies is not well understood.

Scientifically, the techniques that are used to study the human brain differ in important ways from those that are used to study the brains of other mammals. On the one hand, invasive techniques such as inserting electrodes into the brain, or disabling parts of the brain in order to examine the effect on behavior, are used with non-human species, but for ethical reasons, are generally not performed with humans. On the other hand, humans are the only subjects who can respond to complex verbal instructions. Thus, it is often possible to use non-invasive techniques such as functional neuroimaging or EEG recording more productively with humans than with non-humans. Furthermore, some of the most important topics, such as language, can hardly be studied at all except in humans. In many cases, human and non-human studies form essential complements to each other. Individual brain cells (except where tissue samples are taken for biopsy for suspected brain tumors) can only be studied in non-humans; complex cognitive tasks can only be studied in humans. Combining the two sources of information to yield a complete functional understanding of the human brain is an ongoing challenge for neuroscience.
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