October 25, 2014 – The “Pan Am Concussion Clinic” in partnership with True North Foundation, the University of Manitoba’s Faculty of Medicine and the Winnipeg Regional Health Authority, opened at the MTS Iceplex in Winnipeg this month.
“The primary goal of this program is to elevate the standard of care for all children and adolescents with concussion and traumatic brain injuries,” said Dr. Michael Ellis, the neurosurgeon leading this clinic.
The 15-person team comprised of physicians and health care professionals including a neurologist, psychiatrist and physiotherapist with the highest degree of training in traumatic brain injury, will attend children and youth who suffer persistent concussion symptoms. They expect to see up to 30 new patients every week.
"The kids will not only get a good recovery plan, they'll get one tailored to their needs," said Health Minister Erin Selby.
"I remember when I was a kid and had a concussion; the treatment was stay awake for 12 hours and if you're still OK after that, you're right back at it. Well, we know now that it's a more serious thing,” Selby added.
“For parents of a child who has suffered a concussion in the past, the biggest concern is if their child is ready to go back to school or participate in sports. With access to some of the best doctors and research in Canada, our kids will get the care they need to safely get back to school and activities they love.”
The clinic will also conduct research as to how concussions are diagnosed and managed and offer information on the internet for athletes, parents, coaches, trainers and teachers including:
- When and where to seek care for concussion
- How to help children during their recovery
- How to support children as they resume regular activities, i.e. school and sports
Ryan Lucas, the lineman for Winnipeg Blue Bombers experienced two serious concussions and suffered from post-concussion syndrome. He suggests that young athletes should be aware of signals their bodies are sending them. They may not remember the time of impact that led to the concussion, but "if something does feel wrong... get it checked out and (do) not suffer in silence," he cautioned.
“In the past, it was a common thought that people with concussions would recover completely. Today we know this is not true,” said Dr. Wayne Hildahl, Chief Operating Officer at Pan Am Concussion Clinic.
Signs of Concussion
Concussion signs and symptoms may develop within a few minutes or hours of impact - and could even occur in the following days after an injury.
Signs and symptoms of concussion in younger children can be more subtle and therefore difficult to ascertain because of their limited communication skills. The chart below was resourced from the Canadian Paediatric Society.
Slowed reaction times
Facts and Statistics
A concussion is a brain injury defined as a complex, pathophysiological process affecting the brain, induced by biomechanical forces resulting in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.
A concussion may result from a direct or indirect impact to the head, neck or face, or somewhere else on the body, that transmits an impulsive force to the head.
Loss of consciousness is not a common feature of most concussions. The acute clinical symptoms of concussion represent a functional rather than a structural brain injury.
Concussion is a common injury among children and adolescents that participate in sports and recreational activities.
A Canadian study of head injuries involving five Hospital Emergency Departments in Edmonton, Alberta found that 53.4% of head injuries in children from 10 to 14 years of age and 42.9% of head injuries in adolescents from 15 to 19 years of age were sport-related. Concussions accounted for 9% to 12% of injuries in high school athletes.
According to Canadian Hospitals Injury Reporting and Prevention Program’s (CHIRPP) 1990 to 2009 report, there were 12,799 brain injuries related to six team sports.
Ice hockey accounted for the greatest number of brain injuries at 44.3%, followed by soccer at 19.0% and football at 12.9%. In ice hockey, rugby and basketball, striking another player was the most common injury mechanism.
Football, basketball and soccer also demonstrated high proportions of injuries due to contact with an object among younger players, i.e. a post.
In baseball, a common injury in the 5–9 year-old age group was being hit with a bat as a result of standing too close to the batter - 26.1% males and 28.3% females.
CHIRPP surveyed almost 13,000 injured children from the age of 5 to 19 between 1990 and 2009, and found that:
- hockey accounted for almost 50% of all traumatic brain injuries among Canadian children and teens.
- More than 80% of children and teens with brain injuries were male. The average age was 13.
About 175,000 children and youth in the United States are treated annually for sport-related head injuries.
Comprehensive Paediatric Concussion Guidelines
Paediatric emergency medicine researchers at the Children’s Hospital of Eastern Ontario (CHEO) and the Ontario Neurotrauma Foundation (ONF) launched the first comprehensive paediatric concussion guidelines for healthcare professionals, parents and/or caregivers, schools and/or community sports organizations.
“There have been recommendations and policies on concussion available in the past, but they tend to have focussed on sports-related injury and not on children and youth,” said Dr. Roger Zemek, project leader, scientist at CHEO and Assistant Professor of Paediatrics and Emergency Medicine at the University of Ottawa.
“This is so important because children get more concussions than adults do, with increased risk because their brains are still developing,” said Dr. Zemek.
The paediatric guidelines were initiated by ONF, managed by CHEO, and developed by an expert panel from Canada and the United States representing the full spectrum of paediatric health disciplines including emergency medicine, family practitioners, neurologists and rehabilitation professionals.
These new guidelines provide healthcare providers with evidence-based recommendations to standardize the diagnosis and management of concussion in children from five to 18 years of age, from the initial assessment through to the period of recovery - which could last months. It also fills a need to standardize the reintegration into school and social activities, both of which are crucial to children and adolescents during their formative years.
The guidelines include clear instructions and numerous tools:
üA pocket tool that can be used by a coach or parent at the sidelines of a game so as to recognize symptoms of concussion and offer advice when to remove children from play and when to seek medical attention.
üAlgorithms are provided for the emergency department physician to assist in the decision whether or not to obtain CT scans.
üExamples of written discharge handouts for patients and families
üFor family physicians and nurse practitioners, the guidelines provide recommendations for ongoing symptom management and decision tools to help navigate ‘return-to-learn’ and ‘return-to-play’.
üFor school boards, the guidelines provide an example of a policy statement regarding paediatric concussion.
“These guidelines are exceedingly clear and comprehensive,” said Rebekah Mannix, MD, MPH, Assistant Professor of Pediatrics, Boston Children's Hospital, and Harvard Medical School in Boston, Massachusetts.
“I think this will be an indispensable resource for caregivers in a wide range of care settings and also be accessible for the general public,” said Dr. Mannix.
The complete list of panel experts is credited in the guidelines, including the chair of the 2012 Zurich Concussion in Sport Conference, the co-founder and director of the Brain Injury Centre from Harvard University, the chair of the American Academy of Neurology Concussion Guidelines, the developer of commonly used post-concussion tools (ACE, PCSI), community and school based experts and organizational stakeholders - as well as the Ontario Neurotrauma Foundation, the project sponsor.
The guidelines are free and available at www.onf.org/documents/guidelines-for-pediatric-concussion and www.concussionsontario.org/guidelines-for-pediatric-concussion
Canadian Paediatric Society – Sports Related Concussions
Sports-related Concussions in Kids Need Action – from the Canadian Press
Ontario Neurotrauma Foundation – guidelines for paediatric concussions including:
- Recommendations for Health Care Professionals
Recommendations for Schools and/or Community Sports Organizations/Centres
Recommendations for Parents and/or Caregivers
Concussion Among Children and Youth in British Columbia – 2013 Report