Subcommittee on Sports-Related Concussions in Canada Committee on April 1st, 2019

[The Vice-Chair (Mr. Robert Kitchen (Souris—Moose Mountain, CPC)), Conservative, Robert Gordon Kitchen]

Thank you, everybody, for coming.

I'll call the meeting to order. We are here in the meeting of the subcommittee for sports concussions. Pursuant to the motion adopted by the Standing Committee on Health on Thursday, October 4, 2018, the subcommittee is resuming its study of sports-related concussions in Canada. I appreciate everyone coming today.

We have two panel witnesses with us tonight. First, we'd like to welcome Sandhya Mylabathula and Swapna Mylabathula. Thank you very much for being here.

Both are Ph.D. candidates at the University of Toronto. Both seem to know this place, as they played an active part in Bill C-566, which was tabled in the 41st legislature.

They have a PowerPoint presentation, and I will give them the floor.

[Sandhya Mylabathula, Ph.D. Candidate, University of Toronto, As an Individual]

Thank you very much.

Good evening, everyone, and thanks so much for having us here today.

Good evening, everyone.

Thank you for your attention this evening.

We're really excited and very honoured to be here to speak with you and share our perspectives.

My name is Sandhya.

[Swapna Mylabathula, MD/Ph.D. Candidate, University of Toronto, As an Individual]

My name is Swapna. Don't worry, you're not seeing double. It's not an April Fool's joke. We are twins.

We'll begin with a brief introduction of ourselves just for some context. As was mentioned, we are a Ph.D. candidate and an MD/Ph.D. candidate at the University of Toronto. We've been involved in the field of concussions for just under a decade now. We have an interdisciplinary background in concussions. We are currently conducting our doctoral research, but we started out by working on proposed legislation at the federal level, starting in 2010. We've also consulted on Ontario policies, including Policy/Program Memorandum No. 158, which is currently being implemented in schools across Ontario.

We're long-time advocates for concussion issues, stemming from our passion for hockey. We are also very involved in science communication and education outreach on the topic for all ages.

[Sandhya Mylabathula]

What is a concussion? We know you've already heard this many times, so we're just going to do a brief recap.

This is an injury that involves a temporary functional disturbance of the brain caused by a traumatic force, which can lead to a pathophysiological process that can, in turn, manifest in debilitating physiological and psychological symptoms. It can have social consequences as well. These symptoms, as well as the injury experienced, can vary from person to person. We also know that the effects of a concussion are not always observable to an onlooker, so it's very much an invisible injury, too.

We know that our brains are quite fragile. We have a 3-D printed model of a brain just to show that. We know that the consistency of the brain, even more so than in this model, is actually quite like that of Jell-O. That just emphasizes the need to protect it.

We have an example of the mechanism of injury. Here, you're seeing a direct blow to the head. Another way to get a concussion is a blow to the body, which then results in a whiplash effect to the brain and the head.

[Swapna Mylabathula]

Concussions are a growing problem in Canada. This image from the Canadian Institute for Health Information shows that it's been reported to have grown most in children and youth in recent years. This represents a lot of sport concussions. This is just the tip of the iceberg. It truly is a public health problem.

It's important to note, however, that while many concussions happen in sport—and we are in the subcommittee for sport concussions—concussions do occur in other contexts, such as transportation, the workplace, the home and in other recreational activities, as well as in all ages and populations.

[Sandhya Mylabathula]

Our recommendations cover five key areas where our government can play an important and crucial role. These are listed on the slide here.

These recommendations are based on current research, including some of our own, as well as feedback from and discussions with a wide variety of stakeholders from across the country and beyond, and also some of our own policy work with Bill C-566, which was introduced in the 41st legislature.

The first area we're going to talk about today is prevention. Prevention is key to reducing things such as the financial burden that you would see with an injury such as this, as well as the adverse effects on the quality of life.

Our first recommendation here is to ask the government to encourage policy that's going to ensure that sport organizations and schools are contributing to a culture shift towards reducing the risk of concussion.

[Swapna Mylabathula]

The second recommendation on concussion prevention for you to consider is supporting the development and implementation of concussion prevention strategies. This includes things like rule changes—such as bodychecking policies—as well as changes to our built environment and promoting awareness.

Our last prevention-related recommendation is about supporting and promoting research on strategies for concussion prevention.

We have six recommendations for concussion management for you to consider, the first of which is the promotion of post-concussion psychological screening to help identify potential mental health concerns that may occur—

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

I have a point of order, sorry. This is brilliant. Can we have this? Have we been given this?

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

We don't have it now.

[The Vice-Chair (Mr. Robert Kitchen), Conservative, Robert Gordon Kitchen]

We have the PDF.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

That's fine. We can get it even after the meeting. I don't want to interrupt this, but this is really important, and we should have this.

[The Vice-Chair (Mr. Robert Kitchen), Conservative, Robert Gordon Kitchen]

We would ask you, then, if you wouldn't mind, to share these slides with us after the fact.

[Swapna Mylabathula]

Sure. We have a copy with us today.

[The Vice-Chair (Mr. Robert Kitchen), Conservative, Robert Gordon Kitchen]

Okay, we do have it. Okay, great. Thank you.

Sorry for interrupting.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

We'll all get one, right?

[Swapna Mylabathula]

We will send one to you. We appreciate that this will be useful to you.

The second point here, the second recommendation, is to really promote educational initiatives that explicitly include mental health.

The third is to ensure concussion care for all Canadians who need it.

[Sandhya Mylabathula]

Next, we're recommending that the government encourage sport organizations to mandate that all athletes, as well as coaches, referees and other team staff, complete concussion management education. We also believe that it's imperative to have support for concussion management research, as knowledge in this area can help us better understand how to improve outcomes and how to reduce the recovery times, as well as improve the injury experience itself.

Finally, for management, we're recommending that the government encourage the establishment as well as the enforcement of mandatory concussion recognition and management training, particularly for professional accreditation programs.

[Swapna Mylabathula]

There have been a lot of emerging themes in the field of concussion in recent years. We have four recommendations based on those emerging themes for you to consider, the first of which is to support prospective and well-designed research studies on concussion and gender and sex considerations, as women and girls are often an overlooked population in research.

The second is to support and promote research on the most appropriate strategies for improving reporting intention, as well as programs that help support that behaviour change.

[Sandhya Mylabathula]

We also ask the government to mandate sex and gender research training for all government-funded researchers in order to facilitate this type of research, and also to support areas of research in these emerging topics—for example, sub-concussive impacts and multiple impacts to the head—because knowledge in these areas can help us to better understand how these factors might influence management needs, what role they may play in long-term effects and how these can affect Canadians.

The next area we're going to discuss with you is policy research.

Our first recommendation, of course, is to ask the government to encourage and to fund and support research on concussion policies themselves. It's also important to disseminate very consistent messaging through policies themselves and also to facilitate these conversations at and among the federal, provincial and territorial, and municipal levels of government.

Furthermore, we'd like to have the government support policy at the provincial and territorial levels of elementary, secondary and post-secondary educational institutions that will help to provide strategies for return to play, return to activity and return to learning, particularly including academic accommodations.

[Swapna Mylabathula]

Our next recommendation about policy research is to address any regional inequities that may exist among rural, suburban and urban areas in terms of access to resources in order to be able to even implement concussion policy.

The next recommendation is to ensure regular evaluation of concussion policy wherever it may exist.

Our final policy-related recommendation is to promote, develop and implement a national surveillance system for tracking concussions across the country to help with evaluation but also to help perhaps identify any subset of the population that might need extra help.

[Sandhya Mylabathula]

The final area of recommendations that we're going to discuss with you today is education.

First, we recommend that our government support national education efforts, as well as the harmonization of information between school and non-school sport activities, with a particular focus on developing and promoting a national code of conduct.

[Swapna Mylabathula]

We also recommend, for education, the support for research, development and implementation of effective, multimodal, stakeholder-specific and interactive education to improve knowledge outcomes for all of these stakeholders. We also recommend the support and promotion of education for clinical trainees and practising clinicians alike that is competency-based, adequate and consistent, as there is a current knowledge gap among clinicians.

Our final recommendation—in which all of the five domains that we've just discussed actually fit—is for the federal government to move ahead with the three key priorities that have also been identified in the proposed Bill C-566, as we've previously mentioned.

[Sandhya Mylabathula]

The first of these is a national concussion awareness week. This would help us improve education and awareness in the general population across the country.

[Swapna Mylabathula]

The second is a pan-Canadian concussion strategy, including a national centre of excellence for concussion research.

[Sandhya Mylabathula]

The final one is a governmental concussion board. This would be useful for evaluation and accountability, but also for continuity.

Canada has a unique position where we actually have this amazing opportunity to become leaders in the concussion policy landscape, but also to be proactive in terms of reducing the risk of concussions through prevention and promoting the well-being of our citizens, and we call upon our government to do so.