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
But that's why. That change—almost more than doubling—can potentially be attributed to a heightened awareness. We're reporting more now. We're seeing a lot more reporting—
Liberal
MD/Ph.D. Candidate, University of Toronto, As an Individual
This is very encouraging, but we do know there's a lot still falling through the cracks, so there's more work to be done.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
How much of that falling through the cracks is a male athlete—as opposed to a female athlete—not wanting to report because he doesn't want to be benched?
MD/Ph.D. Candidate, University of Toronto, As an Individual
We don't know about male versus female.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
They did say they report more honestly in baseline.
MD/Ph.D. Candidate, University of Toronto, As an Individual
Typically that is the case.
Ph.D. Candidate, University of Toronto, As an Individual
You're right.
In this picture, there are people who don't want to report, so we don't see those concussions coming up in the stats. We can kind of guess at that, and typically male athletes are going to be the ones who are not reporting as much.
At the same time, there are other factors too, as you were mentioning. If we're looking at the equipment and at the way people play the sport—there's something called the gladiator effect—if you're putting on so much equipment and it's getting harder and tougher and thicker or whatever, people—
Liberal
MD/Ph.D. Candidate, University of Toronto, As an Individual
They feel invincible.
Ph.D. Candidate, University of Toronto, As an Individual
Exactly. People will feel invincible and feel they can do anything on the ice. However, you're also forgetting that the person's head is their head, and there's a brain inside that you need to protect. Sure, they're wearing all this equipment, but you can still give them a concussion. You kind of lose that sense of the responsibility to take care of your body and other people's bodies.
That's another factor that can play into it right now, but there are lots of factors, for sure.
MD/Ph.D. Candidate, University of Toronto, As an Individual
There are other reasons that people don't report their concussions. For example, say you're talking about a student athlete—and this has been shown in some of the literature—they don't want to make their coach or their parents upset; they don't want to lose the opportunity for a scholarship.
Liberal
MD/Ph.D. Candidate, University of Toronto, As an Individual
Exactly.
You don't want to lose any playing time—and I'm guilty of this for a shoulder injury—because you're doing something you enjoy. Or maybe it's the playoffs and you don't want to lose the opportunity for that and let your team down.
Knowing all of these reasons is really helpful and important, because then we can start addressing them. If, for example, a student athlete is worried that their coach is going to be upset, then we can address that with education, perhaps where both of them are sitting at the same table, making sure there's a common understanding and expectation for the reporting of concussions.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you very much. I gave you a little extra time.
We're now going to go into five-minute questions, and we're going to start with Mr. Richards.
Conservative
Blake Richards Conservative Banff—Airdrie, AB
Thank you.
Mr. Chair, I think the order worked out quite well, because Mr. Fisher asked some of the questions I was going to ask. There are also some things that lead into what I want to ask about, so it works out quite well.
The first thing I want to ask about is with regard to medical treatment and the protocols around that, and what has changed in the last number of years. Some of the members here have probably been through a number of meetings on this—I'm just subbing in today—so I may be behind in terms of my knowledge compared to some of the others on the committee.
In terms of medical treatment, I'll give you some of my history.
I played hockey as a young guy. I had concussions. I'm not sure exactly how many. Back then, it was kind of, “How many fingers am I holding up?” If you knew that—and maybe he'd give you a whiff of a smelling salt or something—you were back at it. The only time I can ever remember a teammate being sent for any kind of medical treatment—I think he'd been hurt in the first or second period—was when, after the game, he couldn't remember who won the game, what the score was or what town we were in. He was sent to be looked at, but they didn't know what to do with him. I'm pretty sure he played a game, maybe not the next day, but probably the next week.
I think back to my son. He's 23 now. He would have been probably 12 years old, so it was a little over 10 years ago. This wasn't a hockey injury, but we were at a hockey camp. We'd gone a few days early. It was on a lake. He was wakeboarding and got a concussion, and they said, “Well, you know, just be careful for the first couple of days of the hockey camp, but you should be good.” That was about all the medical treatment there was.
I'll be honest. Given the experience I had previously had with that, when I had a concussion a few years ago in a car accident, I just thought, what's the point? I'm not going to bother going to the hospital. I'll just get on the bike every once in a while and see how it feels—until it feels good—because they're not going to do anything anyway.
I'm assuming that's changed.
Can you tell me a little about what that looks like now when someone goes to the hospital, goes to see a doctor about a concussion? What kind of protocols do they go through now?
Ph.D. Candidate, University of Toronto, As an Individual
That's a great question. In the sport context for health care practitioners there's something called the SCAT5 right now, which is the sport concussion assessment tool. There are a bunch of questions and things they can go through with the athletes to get that first impression of whether they have a concussion or not and whether they suspect an injury, and then go on from there.
If they're not a health care practitioner, there's a tool called the concussion recognition tool, which is a similar thing. Somebody who's not a health care practitioner can use that to try to see if there's a suspected injury, and then go on from there.
In terms of the actual management of the injury, you'll probably recognize the idea of rest, complete cognitive and physical rest, which used to be the cornerstone of what was done. But we're moving away from that now, because we know that having complete rest, particularly for prolonged periods of time, can be quite problematic. You're increasing isolation and frustration and so on, and there are all those mental health issues that could be cropping up. There's also deconditioning, particularly in athletes who are used to doing a lot of exercise and movement and physical activity for quite some period of time.
Introducing exercise earlier seems to be a really good idea, and there's a lot of work that's being done on that. Some of my own research right now is in trying to get people to do exercise earlier in their recovery period. There's even some literature saying that the earlier you do this type of exercise, which is aerobic, the better your outcomes might actually be, and your recovery time might be reduced as well.
There are different types of management, therapies and so on that are being used for persistent symptoms, for example. You might have persistent symptoms in the vestibular or ocular realm of things, with balance and vision and this type of thing. There are particular therapies that are being developed for those symptoms, because you would see these symptom clusters crop up as a particular thing for individuals, but that can be different from individual to individual.
MD/Ph.D. Candidate, University of Toronto, As an Individual
Generally, what's been developed over the years, as you probably recognized, by the international sport and concussion group is the graduated return to activity. It's return to play, because it's in the context of sport, but that is the typical idea now for a graduated return to whatever it is that you were doing. In schools, you'll see the return to play and return to learn as well.
You touched on the concept or idea that sometimes clinicians may not know what to do, and that is a bit of an issue in some areas. One of the things we mentioned was the gap in knowledge for clinicians and clinical trainees alike, and that is not just a Canadian issue. There's research coming out of Singapore, Croatia and the States also saying that clinical trainees and practising clinicians may not have as much knowledge about concussions because they're not necessarily trained about it. I think U of T, the medical school that I'm going to, is perhaps one of the luckier ones, where we have Dr. Charles Tator, who is giving us some knowledge on concussion. But that's not the case across the board.
We really do need to see consistent, adequate and competency-based education for clinicians. There is research in Boston, where there is a primary care hospital. They saw a change in terms of the concussion care that was given after an in-person and online.... It was a combination, a multimodal education program, and there was an improvement in concussion care. So it's possible even in practising clinicians, whether or not they had that emphasis on concussion in their clinical training. However, in terms of continuing medical education, we do need to stay away from unregulated certification, just to make sure it is adequate, competency-based and consistent across the board. But it's possible.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you very much. I hate to interrupt when there's such important information being put on the table.
Mr. Fergus.
Liberal
Greg Fergus Liberal Hull—Aylmer, QC
Thank you very much, Mr. Chair.
Thank you very much for testifying before the committee.
I am not a regular member of this committee, but I'm a person who has suffered from a concussion. I want to tell you this little story because I think it's people like me who are the problem. I had my concussion falling off a bike while riding to work. I used to think a lot of these professional athletes were exaggerating—“Gee, they got hit. That's just a problem”—until I fell off my bike. It wasn't a huge thing. I wasn't being pounded against the wall. I just fell off my bike and hit my chin on the ground. I couldn't read for a week. I just couldn't focus. It was tough. It was terrible.
I realized, aside from a lot of humility, that it's people like me who are the problem, people who don't recognize that this is a serious concern.
Mr. Fisher and Mr. Richards also pointed out that, quite often, coaches or even athletes themselves might not recognize it, or might take steps to always try to downplay the severity of what's happening. And we know now this is a brain injury.
You recommended that we work with the provinces and try to work with schools. It seems that we even have to go a bit further and get to the general population, to have them appreciate that not all injuries are things you can see. There are things that obviously you can't see but that have grave physical and mental affects.
How do we break through that ice? What's your recommendation to try to get that general knowledge out there?
MD/Ph.D. Candidate, University of Toronto, As an Individual
We'll start by saying that it's also people like you who are part of the solution—look at where you are now, on the subcommittee—so thank you.
To get to the general public, going through schools and sports organizations is a little more clear because there's an organization and there are standards and structure in how to communicate with them. A national concussion awareness week is one of the ways in which we want to get through to the public in general and have that conversation so that it's something that is brought up in the lives of people who maybe don't think about it on a day-to-day basis.
Liberal
Greg Fergus Liberal Hull—Aylmer, QC
Would you be able to point to other physical conditions for which we've been able to go from a policy recommendation to an actual culture change on the ground in schools and among families? Are there any other examples or best practices that we can turn to?
MD/Ph.D. Candidate, University of Toronto, As an Individual
Smoking is one that comes to mind, for sure. It's not an injury, but it is related to public health. Wearing a seat belt is another one that comes to mind. There was policy on bike helmets, as well, on the east coast, if I'm correct. I'm not an expert in that area. I think there are policies, strategies and conversations that have been had in Canada previously that we can look to for motivation and hope, to see that change can be made and is possible.
Ph.D. Candidate, University of Toronto, As an Individual
I think you make a really fantastic point, because we need to reach the general population. This is something we're really interested in, as well, because it's not just elite athletes who are going to be suffering concussions. It's going to be elite athletes you see suffering concussions in the media, but of course everybody else can suffer the same injury. Some of the work we've been doing in terms of science outreach and outreach in general that reaches more of the general population can be through one place where there's some sort of structure in terms of an organization that does outreach as one of its goals in communication, but that's going toward the general public.
For example, the Royal Canadian Institute for Science and Let's Talk Science are two organizations that we've worked with, as well as Parachute Canada, but these are geared towards the general public rather than to elite athletes or specifically to schools. Let's Talk Science is for schools, as well. These are some of the ways that we can use to make sure there is a channel to get to the general public.
Again, a national concussion awareness week—making it a national conversation, making sure there's attention on this issue and making sure that Canadians know that the government sees this as an issue of concern that we need to be talking about—can be a way to do that as well.