Evidence of meeting #9 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 sport.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Randy Ambrosie  Commissioner, Canadian Football League
Robert McCormack  Medical Director, Canadian Olympic Committee
Kevin Gordon  Sports Medicine Committee, Canadian Soccer Association

6:45 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

One of the challenges you have when you address the issue of baseline testing is that you have to realize that the bulk of our players are youth players, and that means their baselines change at least once a year and possibly twice a year. You're going to have to put them in a testing paradigm that goes over and over to get a baseline, and that is a huge number. It will add substantially to the cost of sport, and yet many of the practitioners out there don't rely on baseline testing because it just isn't available and people have learned to work without it.

That being said, when we wrote our guidelines—because our guidelines were to be inclusive across Canada Soccer—we did include the following line, and I think it's fair to point out, because we're dealing with two things:

Professional and National players typically have access to an enhanced level of medical care, which means that their concussion and their return to play can be managed in a more closely monitored way.

That's a euphemistic way of saying that there really is a baseline that we have to get to everyone, and some of our very high-risk players need to be monitored more closely. It has come up for us that many of our national team players come to us from professional clubs, and those professional clubs have baseline testing as part of their paradigm, and therefore, when we take the players for our use, we have to adhere to their paradigms as well. From a youth perspective, really, I'm not sure that it's necessary—and I understand where Parachute Canada was coming from—so we don't have anything in our paradigm about doing baseline testing on youth and recreational players.

6:45 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Was Canada Soccer involved directly with developing the soccer component of the guidelines? Were you involved in developing the soccer component of the—

6:45 p.m.

Sports Medicine Committee, Canadian Soccer Association

6:45 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Okay, so is there a bit of a gap in understanding? Is this just a matter of interpretation, or is it a matter of not enough knowledge, and not just enough resources? Is the issue miscommunication, or is the issue—

6:45 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

No, I don't think it's miscommunication. I think most practitioners in the field are not relying on testing at this stage. There are further issues. We can get into this. One of the issues is what you do when you fail your baseline test.

6:50 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Yes.

6:50 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

That means if we're rolling that out, the test has to be cheap and globally available. I've already heard, as Dr. McCormack has pointed out, that you need expert people to do the interpretation of those tests. You can't afford to have any significant proportion of the population failing the test, because if you fail the test, then what are you going to do with them? Do you not let them play sport?

6:50 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Yes, exactly.

6:50 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

That's the fundamental issue.

6:50 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Thanks.

6:50 p.m.

Liberal

The Chair Liberal Peter Fonseca

We'll have to move over now to the Liberals.

I understand that Mr. Bossio and Mr. Saini will be splitting some time. Mr. Saini, you have a question, and then Mr. Bossio will have the rest of the time.

April 3rd, 2019 / 6:50 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

You go first.

6:50 p.m.

Liberal

Raj Saini Liberal Kitchener Centre, ON

Thank you to both of you for coming here.

Just to frame the question a bit, I'm a pharmacist by profession, so when I was sitting here listening to you, a couple of things crossed my mind. One was that I have never been trained, as a pharmacist, outside of the basic—really basic—things, to diagnose a concussion, or something of that nature. I'm saying that because I think there might be a lot of medical professionals without that training. Yes, at the doctor level, but not at the pharmacy and nursing levels, where sometimes you see more patients than doctors do.

The main point I want to make is that soccer is a worldwide sport. There are countries that have more entrenched leagues and soccer players compared to Canada. Has there been any attempt to go to Europe or other countries to look at best practices? I don't think this is a Canadian phenomenon. I think this would be an international phenomenon with sport. With other sports, hockey generally is in Europe and North America, and football is obviously in North America, but has there been any attempt to go to other countries to learn from best practices, especially in those societies where soccer is more ingrained than in Canada?

6:50 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

Yes, there has. Specifically, I would talk about our concern about the health and safety of players. From a head injury perspective, I think there are two components. It's frequently the issues of concussion and repetitive head trauma. I think everyone's worried about both. I don't know which one we worry about more, but from a repetitive head trauma perspective, the Football Association in the U.K. is now 18 months into something they call the FIELD study. It's headed by Dr. Stewart.

We have been in touch with the FA. We're going to follow that study with interest. It will talk about the long-term follow-up on the health benefits and harms of playing soccer.

6:50 p.m.

Liberal

Raj Saini Liberal Kitchener Centre, ON

I have a quick note on that. In many cases, a parent might go to a soccer game and something happens. They don't deem the injury important enough, or maybe it's mild. They don't think they need to see a doctor, but they may go to see either a pharmacist or another health practitioner. Has there been some attempt at education outreach, to make things a little clearer to other medical professionals as to what signs specifically to look for, outside of just the normal things?

6:50 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

We said at the very start of this that education is foremost. I would agree with you that one in four patients with a reported concussion does not seek medical care. That group is quite interesting. Obviously, we don't know a lot about them. They would be picked up by a more global sense of concussion. I think we are educating the next generation of parents and individuals. This is an injury outside of sport that is going to affect one in 200 Canadians next year.

6:50 p.m.

Liberal

Raj Saini Liberal Kitchener Centre, ON

Thank you very much.

I'm going to give my time to Mr. Bossio.

6:50 p.m.

Liberal

The Chair Liberal Peter Fonseca

You have about three and a half minutes.

6:50 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

A lot of it is about how we measure the data. How do we derive the data in the first place? That seems to be a great challenge, especially in amateur recreational soccer. I can understand why it's almost an impossible task.

Other than trying to educate parents and parent coaches.... I, myself, have coached basketball and other sports and really had no understanding of concussions and what kind of protocol to put in place.

I know that basketball, hockey and soccer all have great organizations in place to try to disseminate and push that education out into the amateur level. What do you think it's going to take to get it out there? What different tools need to be made available so that parents...? I know we have all kinds of web tools and webinars and everything now. Are webinars being utilized in this specific area, though, to illustrate what to look for and the telltale signs?

6:55 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

That's a complex question. I think the fundamental answer is yes, but I would say that.... I'm a pediatric neurologist. I started this when my own kid was concussed 20 years ago, and I was looking over my shoulder for the emergency doctor because my formal training as a neurologist who looks after children did not involve concussions. Now 20 years later, I'm here in front of you, and I know that most of the kids on my kids' teams are just as good at recognizing concussions. In fact, I'm thrown back to a national championship where I didn't recognize the concussion, but the kids told me exactly when it happened on the field. I missed it. The kids are getting better at this.

I think one of the things that came from Rowan's inquest is really the issue that this is a community injury. We are all responsible: pharmacists, parents and coaches. I think one of the problems we have is the field is moving so quickly right now that some of us who had our coaching certification a few years ago are out of date. It's time to recertify. Things are changing so very rapidly in this field that I'm amazed. As I said, it's truly amazing keeping up with the field.

I have to say one thing. One month ago, the first of the trials for exercise became published, showing that exercise is actually a valid treatment for concussion. We'd been waiting for that. Now the first of the trials is out. Life is changing. I'm sitting back and changing what I'm doing clinically again.

6:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

That's a great point. Where did that clinical data come from to show that it was...? Are we seeing more and more clinical studies being done to get a better understanding of concussion all the time?

6:55 p.m.

Sports Medicine Committee, Canadian Soccer Association

6:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Are those just Canadian, or are we looking at American and European—

6:55 p.m.

Sports Medicine Committee, Canadian Soccer Association

Dr. Kevin Gordon

Canadians are four times more likely to be the primary authors of the articles. We own this condition. I would recommend anyone to google “concussion” under Google trends. Canada is number one in this area.

6:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Fantastic.