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.
Sports Medicine Committee, Canadian Soccer Association
It's very hard to do that. Our registration is done at the provincial level, so it would have to be somewhere further away from Canada Soccer.
Liberal
Sports Medicine Committee, Canadian Soccer Association
Or on a global Canadian level....
Liberal
Neil Ellis Liberal Bay of Quinte, ON
Okay.
In your view, could medical assessment letters and medical clearance letters that are part of the Parachute concussion guideline be used as a means of maintaining a registry of concussions?
Sports Medicine Committee, Canadian Soccer Association
We've certainly seen in a number of sports, with insurance, the under-reporting by way of insurance. I would suspect that this would be inadequate.
Liberal
The Chair Liberal Peter Fonseca
We'll move over to the Conservatives now for seven minutes.
Dr. Kitchen.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Doctors, thank you both for being here today. I much appreciate it. Your testimony is very helpful.
Dr. McCormack, I've read the recent Canadian Olympic and Paralympic Sport Institute Network...and the paper you published. Included within that, as you indicated, you talked a lot about the issue of pretesting of athletes. I'm interested to follow up on that a bit as to whether you feel that all medical professionals should have that information prior to a season starting.
Medical Director, Canadian Olympic Committee
It's a challenge. It's fairly difficult to interpret the results of this neuropsychological testing. Really, I don't think there is a broad enough base of practitioners who have that knowledge at the moment. So really, again, the reason we focused on the high performance athletes is we're often under pressures of time and we want to make sure that we give the best care to the athletes who are representing us internationally, our national treasures. Maybe in a perfect world we'd have baseline neuropsychological testing in all sports, but right now in Canada, there is simply not the capacity for that.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Right. With that said, I'm assuming you're okay with there actually being a pretesting of a number of psychomotor skills, health obviously, orthopaedic and neurologic, having that baseline to start off with, though. Am I correct?
Medical Director, Canadian Olympic Committee
A baseline is always helpful and I think can be very valuable. If you have a baseline, it's much easier to interpret injury.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Would you say that would be of value not just at your level but also when we take that down from the Olympic and Paralympic level to the junior hockey level, to some of the more.... What's the word I'm looking for?
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
In soccer, for example, I mean basically in the high-level performance, whether they be tiered teams, whether they're 12 years old, going all the way up to 18 and 20.
Medical Director, Canadian Olympic Committee
The reason that Parachute Canada has not recommended baseline testing is that, done in isolation without appropriate interpretation, it is not helpful and can actually cause challenges. You need to have the whole system in place, and that was simply one part of it. The question is how we deliver that expertise across the entire sports community and grassroots level. Where do you draw the line? I think it does come back to the resources, and not only financial resources but expertise that's available to be able to interpret those tests and administer them.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
In a utopian world would it be of value, though, if costs were not an issue?
Medical Director, Canadian Olympic Committee
My perspective is that, yes, it would be of value. That's one of the reasons it's done in virtually all professional sports and we've taken it on for the high-risk, high performance athletes.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
That's great. Thank you.
Dr. Gordon, I have my coaching levels in soccer and l also have them in a number of other sports. I can say I don't believe I ever had a concussion playing soccer, although I did break my nose at the age of 18 from an elbow while I was going to head a ball. There may have been one then, but in those days we didn't talk about it that way. I played rugby, so there are other ways.
In soccer, obviously, putting player health and safety first is extremely important. I'm a big believer in education, continuous education, and not only from a professional point of view, but also disseminating that down to our coaches, down to our managers, down to our trainers, who are there on the field, even our soccer moms who are going there every day to watch their children play. Can you tell us some of the steps that the Canada Soccer has taken to expand that? I know in hockey we've put in requirements for trainers to be on the bench, etc. Can you explain some of that for us?
Sports Medicine Committee, Canadian Soccer Association
Okay. I think we're going to come back to the fact that every sport in Canada is moving to a compliance—in Ontario with Rowan's law—so we all are pushing a form of education of one sort or other. I think everyone needs to be educated about this as an injury. If I could get everyone in this country to look at the concussion recognition tool before sending their kid out on a field, I think the world would be a much safer place. So I would agree with you wholeheartedly.
The other thing I think we have to do is look out for one another. Once we've been educated, we need to recognize it. Athletes need to recognize it in other athletes. Coaches need to recognize it. One of the problems is the relative scarcity of this injury in the younger age groups. A coach may spend years before he has a kid with a concussion to assess. Now if they get up into the 14- to 15-year-olds, that's a little less often, but when they're younger the coaches just don't have the experience with it. They may have a lifetime experience in some of these sports, with maybe having seen one or two children with concussion, and it becomes quite challenging for them. We can educate, but we all need to be educated.
Liberal
NDP
Cheryl Hardcastle NDP Windsor—Tecumseh, ON
Thank you very much, doctors.
Dr. Gordon, can you tell us a little bit more about what evidence you've gathered and how responsive you've been able to be with rules so that you can reduce injury, for instance, the zero tolerance that rugby has done for the head hits, and the volley ball? What are your steps, and what was your evidence?
Sports Medicine Committee, Canadian Soccer Association
The evidence in soccer, as I pointed out to you earlier, is very much in its infancy. In getting ready for this committee, I was stressed to find primary preventative evidence within our field, but I think we have to go back 20 years to when we started to realize there were a lot of head injuries from soccer goalposts tipping over. I'm seeing some head nodding here. This was in the era of the unanchored goalposts. Now it's a simple fact that all soccer goalposts are generally anchored, and everyone is aware that there's a tip-over risk. Those weren't just concussions; those were some pretty significant brain injuries.
The other thing I was talking about is that it was our own Rudy Gittens of Canada Soccer's precursor to our current sport medicine committee, who did work with one of the biomechanics firms here in the city and recognized that if you overinflate a soccer ball, there is far more striking force to an individual doing a header. That information has been largely transmitted across the world to make sure that balls are not overinflated. There was a huge trend at one stage to get a livelier ball by overinflating it—and again, I'm seeing some heads nodding, because everyone liked those lively balls—but they hurt when they hit you, and there was more force involved and they were dangerous. So that has been adopted across the sport.
There are two studies that are really quite interesting that we need to talk about. One is a Norwegian study that looked at just taking rules that are currently in play and enforcing them in aerial contests a lot more rigorously. They were able to show a significant reduction in injuries. A German league put that into place and found that also. Those points came up in the last Berlin conference and it was suggested that more vigorous endorsement might produce effects. We're not quite to the point of saying yes, it does, but we're getting to the point where we need to start talking about things of this nature. We have not as yet adopted it.
NDP
Cheryl Hardcastle NDP Windsor—Tecumseh, ON
Thank you.
I have time to hear more from both of you about baseline testing recommendations. The COC has recommendations but different organizations take a different approach.
Are we ready to decisively recommend that we need baseline testing or is that also part and parcel of the research that we need to be doing, in terms of concussion in sport?