Concussions have reached epidemic proportions in Canada, warned speakers at a recent panel discussion held at McGill University called Heads Up: On the Concussion Issue. Every year, 160,000 Canadians sustain a traumatic brain injury (TBI), from accident victims to athletes at all levels, a rate of 600 per 100,000 population.
“Compare that to other well-known neurological disorders,” said Alain Ptito, director of psychology at the McGill University Health Centre. The rate of new diagnoses of Parkinson’s disease each year is 20 out of 100,000 people, and the number is three in 100,000 for multiple sclerosis. “Yet, research funding for TBIs lags behind,” said Dr. Ptito.
“TBI is a disease that has not had enough attention or research. It’s a major cause of disability and death,” said Guy Rouleau, event organizer and director of the Montreal Neurological Institute and Hospital, also known as The Neuro.
Dr. Rouleau lamented that TBI cases are among the most frustrating cases that he treats. “There are very few objective tests to evaluate the injury. We can’t predict recovery rates, complications, or potential long-term consequences of repeated concussions. We don’t know why some people are more susceptible than others.”
Head injuries in sports came in for particular attention at the event. Keynote speaker J. Scott Delaney found, in an anonymous survey, that 45 percent of CFL players reported having sustained one or more concussions. Dr. Delaney, a team physician for McGill football, McGill men’s and women’s soccer, as well as Montreal’s pro football and soccer teams, conducted a similar anonymous study of Canadian university athletes shortly after joining McGill. In the study, published in 2002, he found that 70 percent of football players and two-thirds of soccer players show common concussion symptoms.
Dr. Delaney said he believes that, if the study were repeated today, the results would be similar. “I think the main difference today would be that athletes have greater awareness; they recognize symptoms of a concussion. In the early 2000s, only about 20 percent of the athletes recognized those symptoms.”
He attributes this to educational campaigns, and, especially, the media coverage of high-profile cases highlighting the dangers of concussions. Those include a possible elevated life-time risk of developing degenerative neurological diseases, such as ALS (amyotrophic lateral sclerosis) and CTE (chronic traumatic encephalopathy). CTE has been in the news in recent years, reportedly linked to the suicides of retired pro athletes.
The panel discussion doubled as a fundraiser for The Neuro’s research initiatives, conducted with partners the Université de Montréal and the Toronto Rehabilitation Institute, which are striving to fill gaps in science’s understanding of traumatic brain injuries.
In one project, The Neuro tests varsity athletes before the season begins, using functional MRI (fMRI). If they sustain a concussion during the season, the testing is repeated. Concussed individuals usually show less activation in several regions of the brain, painting a picture of the concussion’s neurological impact.
Dr. Delaney said that, despite the growing awareness of concussion, many varsity athletes still try to hide symptoms in order to keep playing. “The university season is very short. … So, varsity athletes often want to hide injuries, not just concussions, because they have a very short window in which to showcase their abilities,” he said.
“We need to continue educating athletes about the risks. Education makes the biggest difference in their behavior,” said Dr. Delaney.
One promising initiative at McGill is a pilot project, launched this academic year, in which athletes and coaches sign a “concussion contract.”
“We give them information about concussions, and a series of guidelines. By signing the contract, they agree to abide by these guidelines, which state that they must come to see us if they have symptoms, and they understand that they will be kept out of games until they are medically cleared,” said Dr. Delaney.
The contract ensures that coaches refer a symptomatic individual to the medical team and “underlines the point that academics has to be more important than sport. A student has to be back at full school participation before they can return to varsity athletics.” With this kind of contract, “there is never any argument or confusion about what to do when someone shows symptoms. Before the season begins, everyone knows what is supposed to happen.”
The Heads Up event also heard from some high-profile concussion victims – retired professional athletes – who were on the same page as the academics, calling for increased research funding and urging sports leagues to keep up with the latest scientific knowledge.
Hockey Hall of Famer and former Montreal Canadiens goaltender Ken Dryden has suffered two concussions. Although neither occurred during his playing days, he sounded the alarm that head injuries pose “the greatest risk to sports in the future.”
Despite far greater awareness of the issue by athletes and concussion protocols by teams, “I worry about sports now in a way I never did before,” Mr. Dryden said, adding that the evolution of sports training and performance means that “the impossible becomes possible, and the extreme becomes the norm. Compared to 20 years ago, many of our mainstream sports have become extreme sports.”
Hall of Famer and former New York Rangers goaltender Mike Richter spoke emotionally about the trauma of the two concussions which ended his NHL career. In an interview following the event, he concurred with Mr. Dryden. “Compared to even 10 years ago, athletes today are bigger, stronger, faster, and collisions are more violent,” Mr. Richter said. “But the human brain has not gotten any bigger and stronger.”
Mr. Richter, who retired 13 years ago, remains optimistic that rule changes, better equipment and greater awareness will attenuate the worst of the problem. He was impressed by the Pittsburgh Penguins’ handling of Sydney Crosby, who has sometimes missed months of playing time with concussion symptoms. “If you can take the best player in the world out of the lineup for that long, you can certainly do it for Jimmy the Peewee hockey player.”