Evidence of meeting #8 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 rowan's.
A video is available from Parliament.
MD/Ph.D. Candidate, University of Toronto, As an Individual
We are really encouraged by the creation of this subcommittee, as well as the discussions you've had thus far and the enthusiasm we've seen. Therefore, we're really hopeful for a near future in which we see a comprehensive concussion strategy that is implemented across the country.
Thank you for your time and attention. We greatly appreciate it.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you very much for your presentation, and thank you for the document. As Mr. Fisher has indicated, it's going to be very helpful for us to go through this and at a more leisurely time to actually have a look and invoice what you've brought forward to us.
We're going to start with some questions now.
We'll start with Madame Fortier, for seven minutes.
Liberal
Mona Fortier Liberal Ottawa—Vanier, ON
Thank you, Mr. Chair.
I'll speak in French. If you can understand me, that's fine. Otherwise, you can put on the headphones to listen to the interpretation.
What you've told us is truly fascinating and very clear. Since the start of our work, we've had the privilege of hearing from athletes, parents, coaches and representatives of associations. We now know that the federal government could take certain measures.
You spoke about prevention in terms of a culture change. I gather that, in your opinion, the culture change should take place at all levels. Based on your research, what culture change should be addressed at this time?
Ph.D. Candidate, University of Toronto, As an Individual
Thank you for the question. I'll respond in English.
We agree that a culture change is needed across the board. There are many ways and many areas in which to do that. For example, at the level of professional sports, we need to see a change in culture of the way sport is played, the way we look at what “sports” means, from athletes' perspectives, coaches' perspectives and the teams' perspectives, but also the perspectives of fans and how we consume sports, as well as the media.
That can also go towards the level of grassroots sports, because it's not just going to be at the professional level. Kids are watching how athletes are playing in the professional leagues, but they're also doing their own thing in their own leagues, and having some type of change in the culture at that level is very important as well.
We need to address it from all sorts of different perspectives.
MD/Ph.D. Candidate, University of Toronto, As an Individual
Yes. We recommend looking to the field of knowledge translation and behaviour change for this, because there are strategies that have research behind them in terms of what works for changing behaviour.
One of the things we would recommend is having, for example, champions for change, for knowledge translation. That would be people whom we hold in high regard, such as athletes—folks such as Eric Lindros, who was here previously, Cassie Campbell-Pascall, or Hayley Wickenheiser, who has spoken publicly about her concussions—and having them share their experience and really start normalizing the idea of talking about concussions. Because it's an invisible injury, it's difficult to talk about, but also in our experience, in playing hockey, you don't want to stop playing.
There are multiple reasons why folks don't want to stop and don't want to report. Reporting intention is a whole other question that we might get to today, but having a champion for change is something else that we do recommend, and also taking advantage of social media. In this day and age, there's a lot that can be done with communicating over social media and reaching grassroots levels of hockey and other sports, as well as all the way up to the elite level, so we need to take advantage of that.
We've seen bits and pieces of that with the conversations and discussions that have been had, but a lot more can be done in a more strategic and very consistent manner for the point of having change in our culture.
Ph.D. Candidate, University of Toronto, As an Individual
If you look at evidence-based change as well, there are theories in the literature in terms of how we can actually make this change. If we're thinking about intention or behaviour change, what are the other factors around that in terms of what we need to do? What are the norms and attitudes and all these types of factors that we need to look at before we expect change to actually happen?
In terms of having the champion, we know there are individuals out there, athletes, who are willing to speak about these types of things. For example, when we helped create a conference, the first one for women and girls and concussion in Toronto, the first one in Canada, Cassie Campbell-Pascall came and spoke. That was such a wonderful thing, because hers was a face that people recognized and they could actually say, “Okay, this is a really important issue, because I see this person that I recognize is also talking about it.”
Liberal
Mona Fortier Liberal Ottawa—Vanier, ON
I also greatly appreciate your second priority, which is the implementation of a pan-Canadian concussion strategy and the creation of a research centre.
At this committee, we met with a witness who was studying the brains of athletes. I asked him a question about his study—it concerned football or rugby. He told me that he was studying only the brains of male athletes and that, given his area of research at the time, it wasn't possible for him to study the brains of female athletes.
You addressed the gender issue. Can you elaborate on the challenges involved in obtaining data on women? Why is it important to strengthen this aspect of the research?
Ph.D. Candidate, University of Toronto, As an Individual
Yes, it's a challenge across a lot of health research fields not to have representation of females in the research. Females may respond differently to the injury or may have different pre-existing factors. We need to know whether there is a difference and, if so, what we need to do about that. The way we manage the injury might be different; we don't know, and we won't know until we look at those things and those factors.
MD/Ph.D. Candidate, University of Toronto, As an Individual
That's one of the reasons we need more research. We don't know for certain what's going on in terms of gender and sex considerations. We do know more than we did, say, a decade ago. It's very encouraging and it's even more motivating to do more research in that area.
Ph.D. Candidate, University of Toronto, As an Individual
At this time, for example, we know that some of the research is suggesting that maybe females do have a different experience in terms of symptoms and so on. There is research to say that we should be looking at this further, for sure. There is some research to say that females might experience more symptoms and so on, but there are other considerations that we need to take. For example, females do report more symptoms at baseline, before an injury at all. So maybe it's not that they are experiencing more symptoms after the injury; it's just the way that females are experiencing life.
MD/Ph.D. Candidate, University of Toronto, As an Individual
In addition to that, there are potentially different mechanisms of the injury. Some research has shown that males tend to have more player-to-player contact as their mechanism of injury than females do. That's because there is a lot less intentional contact in, say, women's hockey or other sports. The mechanism for how we make change and how we do those prevention strategies is something that we also need to look at.
Liberal
Mona Fortier Liberal Ottawa—Vanier, ON
This past weekend, I attended a volleyball tournament involving teams composed of 17- and 18-year-old women. Three women on the teams couldn't play because they had just suffered concussions. This happens all the time. I spoke with their parents. They're also concerned that not enough research is being done to find solutions to this issue.
I don't have much time, but I just wanted to ask another question.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
We would need a really quick answer.
Liberal
Mona Fortier Liberal Ottawa—Vanier, ON
You spoke about what the federal government could do, but the provinces and territories could also do something. When you answer other questions, you could tell us how the federal government, as part of this study, could work with the provinces, territories and even the municipalities to address this issue.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you. We need to move on.
We'll go to Ms. Hardcastle, please.
NDP
Cheryl Hardcastle NDP Windsor—Tecumseh, ON
Thank you, Chair.
Thank you very much. This is really intriguing. I like seeing how you laid out that our national strategy has to address not just prevention and not just looking at this as a public health issue; there's also the issue of diagnosis. The issue of research comes in, because if you don't have enough research, you can't diagnose. It's not just about prevention; it's also about treatment, innovative forms of treatment, and being cutting edge on those innovative forms of treatment.
I read the word cloud you had at the beginning. If you listened to some of the testimony, you will know that there is a gap in availability of treatment when it comes to some of the more complex emotional trauma symptoms and the physical symptoms. I'd like to hear a little bit more from you about how you think that works in a national strategy, when we're still dealing with issues like the one you mentioned, that of harmonizing how we track concussions and exchanging information.
MD/Ph.D. Candidate, University of Toronto, As an Individual
One of the first steps is to create and implement a national surveillance system. I think there are multiple ways one could do that. In the States, for example, the NCAA has the largest collegiate database of injury information. A corollary of that is the High School RIO system, or reporting information online, which is relatively newer and is doing quite well in terms of being sustained since 2005, actually, so more than a decade ago. That is very consistent in that it's a national sample. It's something that, perhaps, we can take some information from in terms of how we might have that implemented here in Canada.
One thing that may be different here in Canada is that the individual who actually inputs the data in both of those is the athletic therapist, and that's not quite as prevalent here, especially in elementary and secondary schools in Ontario and beyond. We'd have to figure out how that would be implemented and who would be doing the inputting. But systems like that do exist, and we can take advantage of the experiences that have been had elsewhere and apply them here in Canada.
Ph.D. Candidate, University of Toronto, As an Individual
Also, in terms of looking at prevention but at the same time at management, we purposefully made our suggestions comprehensive and across the board, because it's important to do things like tracking, looking at prevention and doing all those things. People are still going to get concussions, and we obviously have people who have concussions already. It's important for us to learn how we can best manage this injury and treat them, and make sure their injury experience is as good as possible. It's actually a very exciting area to be in as a researcher at this point, because we're looking at, as you mentioned, the cutting edge of what we can do with individuals.
In one of the projects I'm involved in right now, we are looking at different types of exercises we can use to help people get back to normal or better than their previous functioning, which is a really exciting place to be. This is an area where we're looking at exercise, for example, rather than rest for prolonged periods of time, different types of management that are specific to the symptoms people are experiencing, which can be different, particularly after three months, four months and so on.
This is an area that's very important for us to continue to put focus on, because we are not ever going to see the end of concussions completely. It's an accidental injury, as well. We must, of course, do as much as we can to reduce the risk, but we can't completely prevent every single situation of a concussion, so we need to know how to best manage the injury.
MD/Ph.D. Candidate, University of Toronto, As an Individual
To go back to the question of conversations and communication among the federal, provincial, territorial, municipal and other levels, we do think there needs to be communication among all levels. That's because some of the things that are going to be done are going to be under the jurisdiction of education or health, and that can be quite different across the country. But it's important to have a consistent and standard way of doing things. Without consistency, we see a lot of gaps in how things are done, and that does lead to a lot of issues in terms of implementation, so having that consistency is important.
Having that as potentially the role of the federal government can be very important, but also ensuring that there is communication among organizations, such as sports organizations and universities that might be doing some of the data analysis in order to give you the answers in terms of what should be done next, how the evaluation is going and whether the policy is doing what it's intended to do.
NDP
Cheryl Hardcastle NDP Windsor—Tecumseh, ON
Thank you.
Yes, I think that's a given. That's part of our role here, to make sure it is orchestrated at all levels. This leads me to the real question of.... I know you're familiar with Parachute. How can we enhance that, make it mandatory? Or maybe you think I'm misguided to be....
I'm trying to use something we already know, like Parachute, that tries to take all of the cutting-edge information and have one place that we can move out from. It's ultimately voluntary. If you are a member of an organization that requires you to do that.... It's not the same thing as what you're asking. You're saying that you expect that the federal government, in our strategy, would be pointing at certain things and making them mandatory.
I would like to hear you stress that a bit more, because we hear this in very serious areas of policy development. Even international human rights issues can be voluntary. Can you articulate that a bit more and maybe explain where you think we can springboard off Parachute?
MD/Ph.D. Candidate, University of Toronto, As an Individual
To go back to your point of when policy items are voluntary versus mandatory, there is some research that has shown that the voluntary components of certain policies and legislation in the United States, compared with the mandatory elements, are not implemented quite as much. That's because there is the choice. When you have the choice, you have different competing priorities for the person on the front line implementing this. Things do fall through the cracks. When it's mandatory, that's when you know something is going to be implemented.
Ph.D. Candidate, University of Toronto, As an Individual
In terms of trying to facilitate making things mandatory, tying an organization's funding to having met certain requirements is one way to do that. These things are not necessarily going to take up too much of the organization's time and effort, but they are going to have a big payoff in the end for the athletes, as well as the coaches, the team, the staff, and everyone involved in this.
This is something that needs to be everybody's responsibility. This is part of the culture shift as well.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
That's great. Thank you very much. I appreciate your comments.
Being a subcommittee, we have a little more leeway than others, so I'm trying to allow people a little extra time when we do.
I would like to recognize that in the back of the room we have some students from the University of Ottawa and Carleton University. They are future scientists, and I appreciate their coming to learn more about this. Thank you for being here.
With that, I am going to take the opportunity as chair to take over the Conservative questioning. The clerk will cut me off at seven minutes to make sure I don't overextend where I am.
