Evidence of meeting #6 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was concussion.
A video is available from Parliament.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
The public care for brain injuries is very limited. I'm talking mostly in rehabilitation. All the resources are taken by the moderate and severe brain injuries. There is very little left for mild traumatic brain injuries or concussion, so that is a barrier to accessing care. That is something that should be addressed, improving that access to care when you evolve with persistent symptoms.
Windsor—Tecumseh, NDP
Going back to your organization, it's collaborative. Tell me what your experience has shown where we need, as a government, to facilitate more the evidence gathering or the data sharing so that you have effective regulations even down the road.
We've had various testimony already. One group, Parachute, for example, did the guideline for concussion.
That information, that evidence, is evolving all the time. Then you have these silos. Then you have which stakeholders should be included. When you set regulations, I know that everyone is most comfortable when they are evidence based.
Where do you think we could be facilitating that data gathering, data sharing and evidence sharing? Where are there opportunities?
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
What was initiated with the Canadian concussion protocol harmonization project, which was led by Parachute with funding from the Public Health Agency of Canada, was the start of creating a centralized, validated and hopefully continuously updated hub of information. Hopefully there will be more federal funding to keep that going and keep that updated.
What we used to have before that was the international consensus, which is updated every four years. The next one will be in Paris in 2020. Then we need Parachute to have the resources to work with the experts and contextualize the new updated recommendation at that point and maintain that central hub.
The next challenge you have is transfer of that information and contextualization to a broad spectrum of contexts that go from the very resourceful elite sports to the non-resourceful grassroots sports. They still can do well if they are supported to do the best they can with the resources they have.
The next challenge is knowledge transfer and implementation while keeping support for the harmonization project which I think made big progress towards avoiding the problem of googling “concussion” and getting 2,000 results and you didn't know what was good or bad.
Windsor—Tecumseh, NDP
It's interesting you say that, because if you go online to sports at the Government of Canada, it's a very different mandate for concussions in sport from what there is under health when it's sport and concussion. I think it's maybe “sport and concussion”, and then the other one is “concussion in sport”. There are these nuances of language.
I think it's been pointed out that ultimately it doesn't matter where the concussion came from, but we're starting with sport. We have what I'll call this social infrastructure. These stakeholders are here and have been working in elite sport. Can we leverage that? What do you think we could be leveraging?
President Elect, Canadian Academy of Sport and Exercise Medicine
I agree with everything Pierre said.
I think we have the knowledge. I think we have the evidence. I think we have to keep that coming so that it keeps getting updated and renewed.
Then the challenge is really getting that down to more recreational levels without missing anybody. When you think of who is doing recreational sports, if you're in rural Saskatchewan, it might be your community association. If we just consider the national sporting organizations, we're going to miss a lot of sports. We have to think of schools, community groups and recreation centres and how we are going to bring that knowledge we have down to a grassroots level.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
We're going to be moving over to the Liberals now with Madame Fortier for seven minutes, and that will conclude our first round with the members.
Mona Fortier Ottawa—Vanier, Lib.
Thank you, Mr. Chair.
I'm sorry that I missed the witnesses' opening remarks. I hope that my questions won't force them to repeat themselves, since that's not my intention.
Here in the subcommittee, we're trying to determine what we can do and suggest, as members of Parliament and legislators, to ensure that the government can support all the initiatives under way and work with the provinces. I gather that the issue is complex, and that both the federal and provincial governments must play a role.
I know that you've already proposed some ideas. Since we're in the final round of discussions, I'd like you to say what you think that we, as legislators, should do. You specifically talked about the need to increase funding, and I want to hear what you haven't had the chance to tell us yet.
Mr. Frémont, you may begin.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
I'll start by repeating a point that I've already mentioned. We must continue to support the positive steps that have already been taken by asking the Department of Health and the Department of Sport and Persons with Disabilities to work together to develop a national strategy on concussions. The project needs to continue. The strategy must be constantly updated and it must have a decades-long impact if we want to successfully resolve the concussion issue.
The first step was obvious because the way forward was clear. We needed to work with national sports associations. The second step is to successfully carry out the same thing, but at the base of the pyramid, at all stages of sport development. I've already referred to this challenge. It involves an ongoing transfer of the application of knowledge for which new methods must be explored. I've already mentioned one method that we're currently applying, which is open online courses. This is an example of a very good strategy that suits this type of activity.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
The first course was provided four times in French at the Université Laval.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
The French course showed very conclusively that the concept is feasible. We're in the process of developing the English version of the course together with the University of Calgary. We've already received 4,000 registrations in two weeks.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
These are examples of new strategies.
A final issue has been clearly identified through the work of the groups in which I've participated. The issue is the need for better data collection and for a monitoring system that uses new sources. We've traditionally relied on data from the health care system. This data includes hospital visits, hospitalizations and, to a lesser extent, clinic visits. However, we must try to obtain data where the concussions occur, meaning in the sports environments. This additional challenge requires evaluative research. However, research involves funding.
President Elect, Canadian Academy of Sport and Exercise Medicine
I completely agree with Pierre.
The only thing that I would emphasize is that I think we need help in some ways getting the attention of some of these sporting organizations. I don't think they think about it, and it's not because they don't think it's important; it's just that they've always done it this way, and it's the way it's done. It get's a bit into sporting culture and bringing that evidence down to them. I think sometimes you knock at the door and the answer is, “No, we don't need that.” A little bit of a nudge in that direction might be helpful.
Ottawa—Vanier, Lib.
Thank you. I understand.
Do I have any time left, Mr. Chair?
Ottawa—Vanier, Lib.
I just want to know whether there are any best practices or different measures in other parts of the world that Canada may not have taken into account and that it should adopt or study more closely.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
I don't want to be biased, but I would say that Canada is recognized as a world leader in the area of concussions.
Chair of the Sport and Exercise Medicine Committee, College of Family Physicians of Canada
A significant percentage of international experts come from Canada, and advances often begin in Canada. That said, some major sports federations occasionally make good moves. For example, the conservative rugby community agreed to disregard its traditional culture and change an absolutely fundamental rule. A player can now be withdrawn for assessment purposes.
These good examples will ensure that we agree to examine how we play certain sports in order to avoid making mistakes and to identify whether concussions have occurred. Great things are being done, and there are great examples to follow, even though we're a leader in this area.
Ottawa—Vanier, Lib.
That's good to hear. Thank you.
Do you have anything to add, Ms. Hobden?
President Elect, Canadian Academy of Sport and Exercise Medicine
I would echo that. The Canadian equestrian federation is actually being held up as an example in the international federation for its concussion protocol. That goes greatly against the culture of the sport where you get back up on your horse again. It has accepted that you come out, you sit out and you need clearance to go back in. I think we are leaders, yes.