Concussions
Information, Statistics, Issues and Next Steps
International Concussion
Summit – Presenters
Dr. Scott Delaney Assistant Professor of Sports Medicine, McGill University, and
Montreal Alouettes team Physician
Dr. Blaine Hoshizaki Neurotrauma Impact Research Laboratory, University of
Ottawa
Dr. Charles Tator Chair of Neurosurgery, at the University of Toronto
Dr. Michael Hutchison Director, Concussion Program, University of Toronto
Chris Nowinski Sports Legacy Institute (SLI)
Dr James Carson Assistant Professor, Department of Family and Community
Medicine and the Department of Surgery at the University of Toronto
OBIA, OPHEA, Brock University, Sunnybrook Health Sciences Centre
Simple facts of Concussions
Immediate and temporary alteration of mental functioning
due to trauma
Not necessarily caused by direct impact to the head, but due
to whiplash effect on the brain
Want to avoid the term mTBI - as Concussion issues are not
so mild
Exact mechanism is still unknown
Continuous concussions cause brain degeneration
Canadian Statistics
25% of Hockey, 50% of Football players with average age 18yrs
concussed each year.
20% School aged children concussed in 12mth period, 6/10 suffer
a ABI
1/2 of all trauma deaths due to TBI, 30% pediatric injuries - ABI
500 000 people in Ontario living with a brain injury
Brain injury #1 cause of death and disability <45yrs
Incidence of Brain Injury 15x more prevalent than Breast Cancer
Costs $19.8 Billion/year
Global Stats
85% direct trauma to the head
<5-7% include LOC
15-20% Pre/Post Amnesia
TBI – kills >5mill a year, 9% of global mortality
Sport injuries statistically small, yet on the rise and the focus
has been one of acceptance.
Movement of the Brain
Mechanism of Injury
Tends to vary for females and males (female – ice, boards,
balls. Male – elbows, fists, shoulders
15msec impact can cause 100-190 G’s of force. Longer the
impact, more effect on brain (puck vs soccer ball)
What we are dealing with.
Falls create the biggest
Linear impact
Punches lead to the
biggest angular
impacts
Issues and Recovery
Blue – Professional Athletes
Red – College Athletes
Green – High School Students
Recovery rates amongst teens is much greater than those more physically developed
First Concussion
Adult 7-14 days
Child up to 1 month
Issues and Recovery
Showing longer healing rates in
females than males.
Some evidence to indicate
susceptibility and effects have a
genetic link
5-15% symptoms >6mths.
C a novel experience and don’t
have skills to deal with it.
Rest is a foreign concept, hard to
get students to rest.
Delay of treatment can greatly
effect recovery times.
Issues we are facing
Hiding concussions – Individuals and Staff
WWE Trainers reported 5%, Survey shows 50%
CT/MRI DO NOT show any indicators of concussions
Continued impacts are causing degenerative brain conditions
– CTE Chronic traumatic encephalopathy
Frontal and Medial Temporal lobe inhibition (path of
destruction for CTE – reasoning and memory)
Doctor’s not up to scratch with current and evolving
information.
Issues in the school
Heavy focus on R2P, need more focus on R2L
NO universal R2P, R2L protocol
Need “Point Person” in each school
Resentment and lack of success implementing strategies in IEP’s
for recovery (ABI brain has changed, LD is a brain that has always been
that way)
ABI/TBI symptoms can overlap with existing LD conditions
Baseline testing flawed – easy to misinterpret
Concerns that no Dr. signature required on C3 forms
Doctors charging up to $80 for a concussion assessment.
What can be implemented in the
class for sufferers?
ID ABI/TBI in the classroom (BC/NFLD only provinces)
Avoid the labeling of behaviour
Treat as ABI, not LD even if they present the same
Target organization/planning problems.
Focus on initiation for “lazy” aspect
Structure and Routine
Monitor learning on their capabilities NOW, not from before
Allow opportunities for success
Provide alternatives for frustration.
Time to talk
Recommended R2L Procedures
Recommended R2P Procedures
RDSB Schools
Community
Total
Cases
Concussions
-
-
2
2
-
-
-
0
0
-
-
-
-
0
0
-
2
-
-
4
8
8
1
1
1
-
-
1
4
4
-
-
-
4
-
1
3
8
8
2
2
7
2
1
2
7
23
14
Hockey
Flag Football
Basketball
Football Wrestling Hallway
1
-
-
1
-
n/a
n/a
-
n/a
Sudbury Sec
-
-
-
Lively
1
1
LoEllen
-
Lockerby
Lasalle
School
Confederation
Chelmsford
Espanola
Manitoulin
Where do we go now?
Continual implementation of “Prevention” and removing
“accidents”
Comprehensive and consistent message to all stakeholders
Point Person + Time to manage
Academic Support needs a bigger focus during recovery
Procedure to monitor progression and development of ILP
Annual concussion education for staff and students
WILLINGNESS TO CHANGE