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.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you very much for being here. I appreciate your presentation. It's truly fabulous, as you go through it step by step.
You talked about whiplash and the whiplash effect. When I went to school—and that's a few years ago; we won't say how many—we studied coup-contrecoup injuries, and the strength of the cervical spine.
I'm interested to hear whether you've looked at that in your research. We've heard from other organizations suggesting strengthening of the cervical spine in our young athletes, as a preventative measure to try to minimize injury.
Do you have any comments?
Ph.D. Candidate, University of Toronto, As an Individual
You mentioned a preventative measure, but my first comment is going to be about management and some of the research I'm doing right now.
I mentioned that we're doing some exercises to help people get back to their normal functioning, and one of the areas we focus on is the strengthening of the neck and neck exercises, because even if it's not part of the concussion injury itself, you often see that co-occurring with the injury of concussion, where somebody has issues around their neck, the neck muscles and something going on there. That's certainly an area that we want to look at.
In terms of prevention, this is still an area that's equivocal in the literature, but it seems that strengthening the neck to prevent concussions would be a good area to look at.
MD/Ph.D. Candidate, University of Toronto, As an Individual
With the stance of no harm done, in most cases, for neck strengthening.... While, again, it's very equivocal, some research is positing that perhaps women and girls have less musculature in the neck, and so potentially that might be an approach for that avenue.
Ph.D. Candidate, University of Toronto, As an Individual
Of course, at the same time, certain individuals, certain women and girls may not have.... One woman could have better neck musculature than a male, so it's important to look at gender and sex and all those factors as well.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
You did mention gender research a bit, and I think it's important to see that and to talk about that. Is that something that would be recommended to the sport organizations, or particular sports? Do you see that, or do you see it in certain sports versus others?
Ph.D. Candidate, University of Toronto, As an Individual
At this point, in terms of management, I don't know that we have enough information to say that this is the way we're going to manage for females versus males, but there are particular considerations that can be applied to everybody and that might be particularly useful for one or the other.
MD/Ph.D. Candidate, University of Toronto, As an Individual
That includes mental health-related management strategies too.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
You had a nice little visual display for us earlier, and I appreciate your pointing that out. I recall my days in school, and I'll go back to the coup-contrecoup injury. Some theorists would say it's a coup-contrecoup-coup injury because of the whiplash effect. Some of the research has talked about that aspect of it.
Can you tell us what you envision happening to the brain in that scenario?
MD/Ph.D. Candidate, University of Toronto, As an Individual
The key thing is that the brain is not tethered within the cerebrospinal fluid, so it does bump around and get damaged. This conversation reminds me of the conversation we were having recently about helmets. There's a conversation about whether helmets help prevent concussions and so on. It's incredibly equivocal. They are not recommended right now as a prevention strategy that has very compelling evidence to say that helmets do prevent concussions. That's because of the physics of collisions.
There are three ways in which that could happen through helmets, theoretically. One is by absorbing energy, through a viscoelastic deformation. Currently, we don't have materials for which there is compelling evidence to say they can absorb enough energy to prevent a concussion. Two is by dissipating energy over more space, which is a great thing that helmets do, transferring a potentially focal injury into a more diffuse injury, preventing fractures but not preventing concussions in more diffuse injuries such as those. Three is by dissipating energy over time. Just making that impact last longer on a helmet could theoretically be very helpful because with that you would reduce the peak force and peak acceleration. At this point, we don't have compelling evidence or knowledge of materials in the padding of the helmet that would dissipate the energy over enough time to have that effect.
Ph.D. Candidate, University of Toronto, As an Individual
There is some literature to suggest that full face protection could potentially reduce the severity of injury, but that literature is limited, so we definitely need more in that area. Also, we don't know what that threshold might actually look like—how many Gs of force we need to actually have a concussion happen and whether that changes per person.
Also, just to comment on the pathophysiology of the brain, I think we need to have a lot more research done to really understand what's going on. We still don't fully understand what's going on when we get a concussion. We know there could be shearing in terms of the axons in the brain. The white matter and grey matter are different densities, so they're moving at different rates. We also know that there are biochemical changes in the brain that can result in cell death and inflamation, as well as uncontrolled discharge in the brain that can result in seizure-like symptoms.
All these things are going on—we know this—and all these things could lead to the symptoms we've talked about. There is some amazing research being done in terms of imaging to look at what's happening.
MD/Ph.D. Candidate, University of Toronto, As an Individual
That's another reason to have a national centre of excellence in concussion research.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
In your concluding statements, you talked about a national concussion awareness week. Tell us what you mean by that. What does it entail? Is it purely that we put that out there and then everybody forgets about it? What do you envision with that?
Ph.D. Candidate, University of Toronto, As an Individual
Putting it out there is the first step, and that alone will show Canadians that the federal government cares about this issue and recognizes it as an issue of concern.
MD/Ph.D. Candidate, University of Toronto, As an Individual
And that it is taking it seriously....
Ph.D. Candidate, University of Toronto, As an Individual
This could also mean doing coordinated activities around educating Canadians about concussions. There are already a lot of organizations that do some of this type of work. We're involved in a lot of this type of work ourselves as well. Making sure there's a coordinated effort at this particular time will actually get the attention of Canadians so that we have people focusing on it.
Yes, it would be just for that week, potentially, but then it would reoccur and keep coming back, and people would start thinking that this is an actual injury, something they need to be concerned about, or connect that to things they've experienced themselves or things their friends or family have experienced, and that will start to be a national conversation.
MD/Ph.D. Candidate, University of Toronto, As an Individual
It's an opportunity for those who maybe don't think about it on a day-to-day basis to pay attention to it and spend some time thinking about what it means to them. I kind of think of it in the same way as Earth Day, which just happened. We do lots of activities around Earth Day. It's one day dedicated to a certain concept. The national concussion awareness week could be parallel to that.
Conservative
The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen
Thank you very much.
Mr. Fisher.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Thank you very much.
What an improvement tonight in chairing, an absolutely incredible job.
Conservative
Conservative
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Unfortunately he asked a lot of the questions I wanted to ask.
Thank you so much. I'll have a chance to go through the pages that you have there. On one of your early slides, I don't know if it was a typo or something we had not heard about yet, but it says “sequelae”. I don't think this committee has heard that word. I think it might be on your second slide.
Ph.D. Candidate, University of Toronto, As an Individual
It's here, under “Management”.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Maybe everyone else in the committee knows this, but can you tell me what “psychological sequelae of concussion” means?
MD/Ph.D. Candidate, University of Toronto, As an Individual
Those are the psychological or mental health consequences that occur after a concussive impact. We were just getting fancy there.
