Excerpt from “Concussion-ology: Redefining Sports Concussion Management for All Levels” by Harry Kerasidis, MD, published by Author House, September 2015.
Considering all the questions the movie Concussion and CTE are bringing to light, here’s a section from my book that helps put the most important organ in our body — the brain — into perspective.
Not all concussions are the same, and they affect individuals differently. This is largely due to the anatomy and functions of the brain, which when impaired, do not operate properly.
Therefore, from Chapter 3, “Brain Briefing: WARNING – Contents are Fragile,” I offer the following neurology lesson on the parts of the brain affected by concussion, based on the latest science on concussions.
Learning the fundamental principles of brain structure and function, will provide a better understanding of the sensitive relationship between the brain and its internal and external environments. We can alter the function of the brain either positively or negatively, and knowing the basics, we can be better prepared to prevent or detect neurological trauma.
- First, the brain is not a uniform mass of tissue. It’s made of several sections, responsible for various functions. The brain is also composed of billions of specialized cells, called neurons and glia.
- The brain floats within fluid inside the skull that has ridges and shelf-like areas, which is why it is vulnerable to jarring hits or whiplash-type action.
- The brain requires significant blood flow and oxygen to operate. The brain makes up about 2 percent of our body weight, but consumes 20 percent of the oxygen we breath and 20 percent of the energy we consume.
This enormous consumption of oxygen and energy fuels billions of chemical reactions in the brain every second. This is perhaps one of the most motivating reasons to provide the right kind of fuel, with a healthy diet and regular exercise.
Don’t let the word “anatomy” intimidate you. As you learn about the brain, you will discover more scientific terms about the brain, but I won’t overload this material with “unnecessary” neurological terms. Anatomy is not one of them, however. Simply put, anatomy is the understanding of the physical parts of the brain and their related functions. Since I believe “Concussion-ology” is becoming a new field in sports and science, you need to know a few basics to see how concussions can affect virtually every system in the brain and body.
The brain is organized into three main sections; the cerebrum, cerebellum and the brainstem, which are then divided into more specific areas. Trauma received in any of these areas tend to cause problems associated with that area’s functions. Any sudden movement with force can result in the brain sliding back and forth which can cause temporary and permanent cognitive damage. “Cognitive” refers to conscious mental activities such as thinking, reasoning, understanding, learning, memory, language, coordination, and emotion.
The most vulnerable areas of the brain are the frontal and temporal sides (lobes) due to their anatomy and proximity to the skull.
- Frontal: Responsible for executive functioning, forethought, planning, organizing, complex thinking, focus and concentration, emotional self-regulation.
- Temporal: Responsible for auditory processing, short-term memory, mood regulation.
Below is a general overview of some of the key areas of the brain, and associated behaviors which can be affected by concussions, and more severe brain trauma.
Cerebrum — the “forebrain” is the largest area of the brain, and is divided into left and right sections called hemispheres.
- Prefrontal Cortex (PFC) — The PFC is located in the front third of the brain, in the forehead above the eyes where most hits to the head are sustained in football. The PFC is particularly noteworthy because it’s role is to supervise the rest of your brain and body. It’s like your own personal CEO for life, serving to make decisions, pay attention, make judgments, plan, control impulses, know when to follow-through and empathize.
Conversely, damage to the PFC can result in poor decision-making, impulsivity, short attention span, lack of goal-setting and procrastination.
- Anterior Cingulate Gyrus (ACG) — Running lengthwise under the PFC, the ACG regulates our ability to shift attention when needed, adapt to change and be flexible in thought and reasoning. When this area of the brain is not working properly, people can get stuck on negative thoughts or actions, become overly worrisome, hold grudges and be oppositional or argumentative. Another word for these related behaviors is “compulsive.” For example, “compulsive gambling” is when a person can’t quit even when they realize it is compromising their livelihood.
- Limbic System (LS) — Near the center of the brain, the LS helps set your emotional tone, either positive and hopeful or negative and desperate. Problems with the LS have been linked to low motivation, poor self-esteem and feelings of guilt and helplessness which can lead to mood disorders.
- Temporal Lobes — Located on the left and right side, underneath the temples, and behind your eyes, the temporal lobes are involved in auditory processing, language, short-term memory, mood and temper stability. They also help interpret and name what things are. These lobes often experience trauma from jarring hits from contact and collision sports that can lead to problems with memory, mood and temper.
- Parietal Lobes — Located in the back, top part of the brain, the parietal lobes are involved with sensory processing, spatial relations and direction sense. Typically, Alzheimer’s Disease will impact this area, giving people with this condition a hard time with finding their way and getting lost. Other problems with parietal lobes can lead to inaccurate interpretations of body perception.
- Occipital Lobes — The occipital lobes, located in the back of the brain, are involved with vision and visual processing. Information taken through the eyes are sorted out in the occipital lobes and dispersed to the various regions of the brain for action.
Cerebellum — the “hindbrain” is located in the back area toward the base of the skull.
- Working in tandem with the PFC, the cerebellum is the “coordinator,” involved with voluntary physical (motor) movements, posture, balance, coordination as well as processing speed. This coordination is also linked to enable the PFC’s role of helping with judgment and impulse control. Trouble with the cerebellum leads to coordination problems, and ability to learn.
Brainstem — a portion of the brain that is continuous with the spinal cord at the base of the brain. The brainstem relays signals from the brain throughout the body via this section, controlling and regulating vital body functions including respiration, heart rate and blood pressure. The brainstem also contains the relay centers for control of information to and from various parts of the head including the coordination of eye movements, facial movement and sensation, hearing, balance, and control of the mouth and tongue.
The brain processes information by splitting a single behavior into component parts. For example, when we take a bite of food, there is sensory information (this is an apple), voluntary motor information (lift piece to mouth, chew), and involuntary motor information (salivate) for the brain to process. The different components are split, sent to the appropriate regions of the brain, then processed accordingly.
If there is trauma experienced in any of these processes, the brain’s ability to process the behavior can be affected.