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In Ontario, over 150,000 people are diagnosed annually with concussion in emergency departments and by primary care physicians. In 2016 there were 15,736 concussions diagnosed in the Champlain LHIN. It remains evident that both healthcare providers and patients feel ill-prepared to effectively navigate the healthcare system with respect to concussion care and management of persistent concussion symptoms.
The Ontario Neurotrauma Foundation,ONF has been working to provide clarity and evidence-informed direction with respect to post-concussion care for healthcare providers and patients by releasing the Standards of Post-Concussion Care and the 3rd Edition Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms for Adults over 18 Years of Age. Providers can use the resources to learn about up-to-date evidence-informed practices and recommendations. ONF’s goal is to streamline visits with healthcare providers and provide direction to patients and families to increase confidence about how, what and when care should be provided.
In October 2016, world leaders in the field of sport-related concussion (SRC), of which a large proportion are Canadian, met in Berlin to develop the latest statement on our current knowledge of the science of SRC. As a quick review, an SRC is a traumatic brain injury induced by biomechanical force transmitted to head causing functional disturbance. It does not require a direct blow to the head. Some of the new developments and highlights from the statement include:
– Assessment of mental status, cognitive functioning, sleep/wake disturbance, ocular function, vestibular function, gait, and balance is recommended
– Insufficient evidence for investigations such as EEG or MRI
– A new Sports Concussion Assessment Tool Version 5 (SCAT) was developed
– A brief period (24–48 hours) of cognitive and physical rest is appropriate for most patients
– Subsymptom threshold activities and submaximal exercise are encouraged (as long as symptoms are not exacerbated)
– Cervical spine rehab is recommended for neck pain/headaches
– Vestibular rehab is recommended for dizziness
– Return-to-play and return-to-school/work protocols can advance in parallel
– Children and adolescents should not return to sport until they have successfully returned to school
– Physiological dysfunction may be delayed relative to clinical recovery, suggesting that using a ‘buffer zone’ of a graduated return to activity/return to play progression before full return to contact risk may be appropriate
– Preinjury mental health problems and prior concussions appear to be risk factors for persistent symptoms.
– Greater acute and subacute symptoms are a consistent predictor of worse clinical outcome.
– The teenage years might be a particularly vulnerable time for having persistent symptoms—with greater risk for girls than boys.
– Strongest evidence exists for disallowing body checking in youth ice hockey
– Strong recommendations to mandate helmet use in skiing/snowboarding
– Mixed evidence for mouthguard but there may be an overall protective effect
The top 5 key messages from the 5th International Consensus Statement on Concussion in Sport
- McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5thinternational conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838-847.
- Shields, MD, CCFP, Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Taryn Taylor, MD, CCFP (SEM), Dip Sport Med
Education and Advocacy Traumatic brain injuries inflict complicated challenges for victims and caregivers and there is a need for political and social progress to improve quality of life.
Brain injuries can be caused by many factors including motor vehicle accidents, falls, sports injuries, physical abuse, and alcohol related incidents. Generally, the public doesn’t realize how widespread brain injuries are or the extensive and potentially devastating effects they can have on physical, cognitive, emotional, and behavioural levels. A traumatic blow to the head can lead to the disruption of brain functioning, resulting in confusion, forgetfulness, headaches with associated symptoms, and behavioural concerns, as well as a range of emotional issues including depression. Although some head injuries may not immediately appear to be serious, many have long-lasting and very detrimental effects.
Aquired Brain Injury (ABI) is an injury to the brain that occurs after birth. There are a variety of injuries that can cause ABI, and knowing what resources are available can be helpful in moving past the injury.
Living with an acquired brain injury
The brain controls everything we do—it’s the computer for our whole being! Imagine how you would feel if you sensed something was wrong with your own brain. A devastating feeling! Now, imagine you just suffered a brain injury. What would you do? Who could you talk to? The number and severity of problems resulting from a brain injury varies from person to person because each individual’s brain injury is different. A widely perceived myth is that a brain injury is simply a type of intellectual disability. People who acquire a brain injury usually retain their intellectual abilities but have difficulty controlling, coordinating and communicating their thoughts and actions.
Can the brain heal from an injury?
The healing brain has intense neuroplasticity. It is able to reshape and rebuild itself in ways we are only beginning to understand. While the initial intensity does gradually slow as healing progresses, it does not stop. With the right help, people with ABI can improve the way their brain functions, and they can often reclaim the portions of their lives that were affected by the injury. Years after brain injury, survivors are still passing incredible milestones.
Introducing Suzanne McKenna
Suzanne McKenna is a trusted and accomplished Acquired Brain Injury (ABI) System Navigator for the Champlain Community Care Access Centre (CCAC). She provides a single point of access for both individuals and caregivers living with an ABI. Suzanne also has first-hand experience as a caregiver for her 26-year old son who has lived for the last eight years with a traumatic brain injury. People living with acquired brain injuries can feel overwhelmed without the proper supports. Suzanne helps them and their caregivers to deal with difficult issues to improve their quality of life. Suzanne shares information about her role and offers hope for those with an ABI.
How can someone with a brain injury get help?
Please call the Champlain CCAC at 613-310-2222 to speak with Suzanne McKenna. You can also browse the ABI resource guide at www.champlainhealthline.ca. This guide brings together all of the ABI service providers, services and organizations available in the Champlain region into one user-friendly resource.
reposted from the Fall 2015 Health Matters magazine