Subcommittee on Sports-Related Concussions in Canada Committee on Feb. 26th, 2019

[Robert Kitchen]

Great, thank you.

One thing we've talked a lot about is prevention and how to take this information, this data collection, which we need but don't have, to help us with prevention. It's great to see that often in sport.... For example, Dr. Schneider, in your comment about the volleyball practice, the reality is that we see a lot of it, and we see it as well in hockey. Many head injuries happen to goalies during warm-up and practice time, not during the actual game.

I have a question for both of you to answer quickly, if you could, because I want to let my colleague ask a question. You talked about volleyball. Will we be able to take that research data for hockey as well?

[Dr. Kathryn Schneider]

From a research standpoint, our research group has done a lot of work from a hockey standpoint looking at prevention—targeted prevention. We use an injury prevention model, first looking at how common concussions are in each sport and what the risk factors are. We partner with a lot of the stakeholders in the sport to say, “What do you think increases the risk? Let's measure it.” Then we can actually measure the risk factors and look to see what the biggest risk factors are and target prevention strategies so as to have the biggest health impact.

That's where a lot of the work around bodychecking research has come from. If we can decrease risk of concussion by 70%, that's a big public health saving.

Similarly, we've done work in soccer, volleyball and multiple different sports. Certainly this model would work well across sport, and the SHRED program will be doing that in the schools.

[Robert Kitchen]

Dr. Marshall, do you have any quick comment?

[Dr. Cameron Marshall]

She is the prevention expert. The University of Calgary has been one of the pioneers in this field. Where we might be able to help is purely in tracking—pre-intervention versus post-intervention—and being able to have measurable change with some of the interventions they might put in.

[Robert Kitchen]

Thank you.

I'm going to allow my colleague to ask one quick question.

[The Chair]

You have two minutes.

[Len Webber, Calgary Confederation, CPC]

Thank you.

Of course, MP Fisher asked most of my questions to you, Dr. Schneider, regarding this online course. Is there some type of certification, a certificate, that you get at the end upon completion of this course?

[Dr. Kathryn Schneider]

Yes.

[Len Webber]

Do you see this hopefully being a mandatory requirement for coaches in the future to take these types of courses in order to be more aware of concussions and how to deal with them?

[Dr. Kathryn Schneider]

That's a great question.

There is an option to have a certificate, but there's a nominal administrative fee. Everything else about the course is free, but there's a nominal fee for the certification of completion, and there is an evaluation component they have to complete so that we know that they've actually covered the material.

There are also other courses. The concussion awareness training tool gives you a certificate. It's of shorter duration, but then that can automatically go to specific organizations. It's meant for different professionals in different areas. The Coaching Association of Canada also has the “Making Head Way” program.

We cover all these different pieces within the MOOC, so that people are aware of them. I think depending on the needs of the individual there's a capacity to look at some of these different training modules in different environments.

[Len Webber]

Excellent.

How do you reach out to the community to let them know about this online course? What have you been doing?

[Dr. Kathryn Schneider]

We did one media release and it's gone, apparently, international. I've had lots of people contact me from overseas saying they've heard about it, so it's really spread like wildfire. We have the registration portal on our home page at the University of Calgary's faculty of kinesiology.

We haven't done a lot of hard marketing about it yet, but we're open to have whoever wants to participate join in.

[Len Webber]

I guess it's open internationally, too. If it's online, anybody can tap into it.

[Dr. Kathryn Schneider]

Yes, and we have international collaborators contributing, too.

[The Chair]

Thank you.

Now we're going to move over to the NDP and Ms. Hardcastle.

[Cheryl Hardcastle, Windsor—Tecumseh, NDP]

Thank you very much, Mr. Chair.

Hopefully I'll get to both of the doctors, but what I'd like to start off with, Dr. Schneider, is the issue of diagnosis of concussion. It's a sensitive issue. So many factors need to be considered and there has to be a lot more research done.

I don't know if you can explain to us where you think the most immediate challenges or hurdles are, breakthroughs that we need to get to, for understanding the issue of diagnosis.

[Dr. Kathryn Schneider]

I think that's a great question.

Unfortunately, I don't think there's a really simple answer to it, which makes it a challenging area. It's very much a clinical diagnosis based on a trauma, followed by the onset of symptoms and clinical findings. Typically there are no findings on any type of neuroimaging.

In a lot of the research work that we're doing, because there are so many different areas that can be affected from a concussion, we want to look at them all together, so we have people with expertise in multiple different areas all working together. We just finished a five-year cohort study with just over 3,000 youth ice hockey players, where we looked at a bunch of different tests in different areas, looking at cognition, balance, dizziness, neck involvement, some of the mood and other factors, and how those associate with one another. We're actually in the process of analyzing some of that data right now.

We'll build on the SHRED concussions more, where there are also biomarkers, neuroimaging, robotics. There's going to be even greater depth so that we can help better understand what we're actually seeing following concussion to better measure it, which can then help inform that diagnosis piece.

The literature has really evolved over the last few years and is continuing to do so, but because there are so many different components, different areas of the body that can be affected from a concussion, it's certainly an ongoing process that we need to further evaluate.

[Cheryl Hardcastle]

We don't have any set, effective methods right now. Are we still trying to achieve that?

[Dr. Kathryn Schneider]

There's no one test, but there's—

[Cheryl Hardcastle]

What is your impression on that, Dr. Marshall?

Sorry to cut you off. I'm just trying to get an idea of where we should be going or how we should be approaching this view in this study, knowing what we know about diagnosis. What do we know? This is your chance to say it on the record so that nothing is assumed.

[Dr. Cameron Marshall]

As Dr. Schneider said, it is very much a clinical diagnosis. We don't have any objective testing for concussion that can do this definitively. There's no gold standard.

Take surgery for knee injuries, for example. That would be the gold standard. You can actually go in and see that a ligament is torn. You can confirm that as a diagnosis. There's no way right now to confirm that a concussion has happened, so we don't have a gold standard. It's very much a clinical diagnosis. The injury occurred and there was some sort of mechanism of injury, followed shortly thereafter by the onset of symptoms.

There are tests out there. As Dr. Schneider said, any one test used in isolation is not helpful. However, combining them into a battery of tests, if you will, can add some insight into the picture. However, there are some challenges with that still.

[Cheryl Hardcastle]

I will give each of you a chance to respond to this. It's with regard to the evidence that you are gathering, the data that you are gathering, and what you're noticing now. I think what we're noticing, as we're doing this study, is that there are some really exemplary and vanguard leaders in this area. Do you know that each other exists and is collecting this data? How do you think we could help with that?

I will give you an example. We heard in earlier testimony from Eric Lindros that there should be a brain bank or some kind of knowledge bank—one place. Tell me what your impression is.

[Dr. Kathryn Schneider]

I think there's an opportunity for it. From a Canadian standpoint, we have a lot of people who do a lot of leading-edge work and who all work together across the country very collaboratively. It's very unique internationally. At the last consensus, people would come up to the mike and say, “I'm not from Canada, but I have a cousin there”. There was a really strong Canadian presence, and pan-Canadian, which was extremely exciting. I think it speaks to the large number of people who are doing a lot of leading work in this area.

Then we have a very collaborative network called the Canadian Traumatic Brain Injury Research Consortium, or CTRC, where everyone does a lot of work together. From a research standpoint, we recently published some different guidelines around concussion in terms of what we should be collecting so that we can then all pool together that information. I think there are a lot of efforts to work together collaboratively. Ultimately, I think the more we can all work together in a team, getting all the different perspectives.... That's how we'll be able to answer some of these questions in the best way.

[Cheryl Hardcastle]

Dr. Marshall, do you see an opportunity for a government role in that?

[Dr. Cameron Marshall]

I don't know if there's necessarily a government role, other than potentially some funding towards some initiatives like that. The way we see our role in that is purely this. We try to take the evidence that the researchers do, put that into practice and at the same time we collect that information to see how well it actually works in the real world. Then with that data, we partner with universities like the University of Calgary—we're not partnered with them, but we can talk later.

We've done a bunch of research with U of T, McMaster, the University of Ottawa and Carleton. Just in using the data we have, it's such a wealth of knowledge. It's not really replicable anywhere. That's where I see our role, at least—trying to collaborate with the universities while we're on the front lines collecting data from the rural and urban areas.