UVic study aims to get a heads-up on concussions in sports

Take away high-level hockey and lacrosse from 11-year-old Simon Pollock and you would no longer have Simon Pollock, says his dad, Quentin.

“The kind of kid he is, if there was ever somebody genetically designed to be a jock, it’s him,” said Quentin Pollock. “And it’s not from me. I never even looked at TSN until he came along.

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“To prevent him from being active in sport would be like preventing a person born to run from running or telling a born musician they couldn’t play.”

At the same time, like any other concerned and watchful parent, he has seen and read media reports about the dangers of concussions. So Pollock was delighted and grateful when Simon became a subject in a University of Victoria study gathering data on athletes and concussions.

The Vancouver Island Concussion Project is looking for volunteers for two studies:

• A local study called the Neurotracker Study is looking for volunteers of all ages, especially those who play competitive sports.

• A national study, called Improving the diagnosis and treatment of youth with mild traumatic brain injury, is looking for kids five to 17 who have been diagnosed with a concussion in the previous month.

Sports concussions, injuries to the brain usually through blows to the head, have made headlines in recent years.

Last year, the National Football League earmarked $1 billion to take care of thousands of lawsuits. Former players sued, contending they suffered head injuries and, as a result, were more likely to be affected by dementia or neurological diseases such as Parkinson’s.

The National Hockey League is also nervous, after high-profile deaths in 2011. Derek Boogaard died of an overdose, while Vancouver Canuck Rick Rypien committed suicide.

Both players were fighters who sustained repeated blows to the head, and both suffered from depression.

Amateur and kids’ sports are also looking seriously at concussions. Two years ago, Hockey Canada voted to ban body checking for players 12 and younger, citing concussions as an important factor.

In 2003, the U.S. Centers for Disease Control called sports-related concussions a public health problem. It singled out youth as still suffering too many “often preventable injuries.”

A recent study in Alberta indicated the majority — 53.4 per cent — of concussions in kids 10 to 14 were sports-related. For those 15 to 19, sports accounted for 42.9 per cent of concussions.

Last year, two Ontario doctors, in a paper published in Neurosurgeon, cited the Alberta study and called for wide-ranging rule and game changes to reduce concussions. The paper called it an “ethical responsibility” for all levels of society.

Faced with these kinds of statistics, tragedies and cries for action, it’s a wonder any parents allow their children to participate in minor sports.

But UVic neuroscientist Brian Christie, a leader in the Vancouver Island Concussion Project, points out that all kinds of data exist to demonstrate the benefits of sports and activity. That’s an issue where the science really is settled.

“We have great evidence to show kids who exercise, get cardiovascular activities, will do a lot better socially, emotionally and academically,” said Christie.

Concussions do remain a risk, however. And the science in that area is still evolving.

Christie said many misconceptions exist about concussions. For example, helmets can protect against cuts to the head or even skull fractures. But no helmet can protect against a concussion.

Also, a concussion is not a bruise or a bleed in the brain. It’s also not usually the blow to the head that is responsible.

Most concussions occur because the head is snapped back or stopped quickly. A soccer player heads a ball kicked up long and high. A hockey player travelling at more than 40 km/h crashes into the boards.

The physics are simple: The skull, a hard case, stops or jolts suddenly. Inside, a soft spongy item, the brain, bumps against the hard case.

Unless the bump was especially severe and causes bleeding, leading to a stroke-like incident requiring hospitalization, there is no bruising or bleeding.

Nothing shows up on a CT scan afterwards. And until recently, most tests were subjective. Questions were asked: “Do you have a headache?” or “Do you know where you are?”

But Christie said science is starting to reveal that what’s affected most acutely in a concussion is the brain’s ability to co-ordinate the complex interplay of nerve signals between the brain’s various regions.

These brain regions govern everything from body movement to making a decision.

One concussion test, the King-Devick Test, is quickly gaining prominence. Used in the UVic study, it takes advantage of the complex interplay between brain regions that govern sight.

Some studies suggest as much as 50 per cent of brain pathways are tied to vision.

So the King-Devick Test simply asks subjects to read numbers, arranged in various patterns, while the tester times them.

Once a baseline score is established, the King-Devick test is simple enough to be administered on the bench or sidelines to assess the severity of a player’s injury.

Christie’s research at UVic also uses the interplay of brain pathways involved in vision to assess players before and after a concussion in another way.

Subjects are placed in front of television screens showing moving, yellow balls. Some balls flash red and then go back to yellow. Subjects are then asked to identify the balls that flashed red and their performance is scored.

The beauty of both these tests is that they offer hard numerical scores for researchers and doctors. These scores are especially useful with children. It’s hard to get an accurate response from a child to a question such as “Do you have a headache?” because they don’t have much experience with headaches.

“Kids can even say they have a headache because they think you want them to have a concussion,” said Christie.

Ultimately, entering their kids in the UVic study can provide parents with an extra piece of information when it comes to deciding things like “should Johnny play tonight?”

Christie emphasized the UVic study will not answer that question directly. It is not a medical service and should not be regarded as such. But the test scores can be passed along to a family doctor, or used by parents in making decisions on things like “a return to play.”

And this decision is important, since studies are revealing that concussions can have all sorts of serious effects, socially, athletically and scholastically.

But Christie said it’s also important to recognize that most people, including kids, will recover from a concussion within days.

And while sports are rightfully being implicated, the UVic study has seen people who have sustained concussions doing everything from yoga to tying their shoelaces. So you can’t bubble wrap your kids to keep them safe.

“It doesn’t matter if you are a cross-country runner, or on a bike, a swimmer, a rower or rugby player, you can get a concussion,” said Christie.

rwatts@timescolonist.com

To join the Vancouver Island Concussion Project at the University of Victoria, contact the project co-ordinator Kristina Kowalski at 250-472-5997, or 250-634-4471 or via email at brainlab@uvic.ca.

 

Concussion facts:

A concussion is defined as a mild traumatic brain injury, but no single medical definition has been widely accepted.
The World Health Organization cites a trauma resulting in mild physiological disruption of brain function made evident by one or more of the following:
• unconsciousness for up to, but not exceeding, 30 minutes
• loss of memory for up to 24 hours of events just before or after receiving the trauma
• change of mental state, feeling dazed, disoriented or confused
• focal neurological deficits, such as having difficulty moving a specific part of the body, such as the left arm or the right leg.
Eighty to 90 per cent of concussions can be regarded as mild traumas. But it’s difficult to quantify because many concussions go unreported.
Many concussions involve blows to the head, face or neck. But they can also be caused by a blow to the body where the force is transferred to the head.
Some physical symptoms listed by the Canadian Paediatric Society include headache, nausea, vomiting, dizziness, poor co-ordination and problems with vision.
Behavioural changes can include irritability, depression and anxiety.
Cognitive impairment can show up as slowed reaction times, difficulty concentrating or remembering, confusion or feeling dazed or in a fog.
Symptoms usually subside after one to two weeks, and up to three months.
Up to 20 per cent of people with concussions will report symptoms beyond three months.
 
Source: Concussions Ontario sponsored by the Ontario Neurotrauma Foundation.

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