The dangers of concussions long after the injury

[Rowan Stringer, a high-school student from Ottawa, is seen here in a Facebook photo. Stringer died on May 13, 2013 after her parents took her off life support following a rugby injury]

The effects of concussions can be severe and permanent, sometimes fatal. Consider the case of Rowan Stringer, an Ottawa girl who was just 17 when she died in 2013 because of multiple concussions she suffered from playing rugby.

With a bill called Rowan’s Law, Ontario politicians are to create an advisory committee that will look at the dangers of head injuries. A coroner’s jury into Rowan’s death made 49 recommendations, including having guidelines for when to remove an athlete from playing higher-risk sports if a concussion is suspected and to ensure players don’t return to the sport until they’re medically cleared to do so.

While Ontario is looking to adopt the first concussion legislation in Canada to protect young athletes from the dangers of head injuries, a Vancouver expert in the field says there’s enough medical evidence to put policies into place immediately. 

The facts around Derek Lyon’s case certainly seem ample enough. When he was playing for the Ontario Hockey League, Lyons suffered four concussions. His sports career ended a decade ago, but in 2014 while at work, he sustained another concussion so severe that he lost consciousness.

A couple of weeks following that fifth concussion, Lyons was arrested for impaired driving after he tapped his front bumper against the back of a woman’s new car at a gas station. As they could detect no hint of alcohol, police officers assumed he was on drugs. He had slurred speech and a spacey stare, was slow and unsteady on his feet, and couldn’t follow simple instructions.

Lyons was recently acquitted, an Ontario judge concluding his symptoms could have been related to post-concussion syndrome, not illicit substances.

“We know enough about concussions and how insidious and dangerous they are that I don’t think further investigation is appropriate at this time; I think we  really do need to act,” says registered psychologist Cirelle Rosenblatt, founder and director of Advance Concussion Clinic, a multidisciplinary centre offering education, prevention, baseline testing, and rehabilitation. “In the last four to five years we’ve really achieved traction in agreeing more education is needed, but in my opinion we’re beyond that. The education charges us with a real call to action and we must act in managing the injury better than we have.

“What’s charged Ontario to a new level of action has been the recognition of the avoid ability perhaps of Rowan Stringer’s death,” she says. “Those tragedies do not need to happen in every region for us to act.”

Concussions can lead to sleep problems, balance and visual issues, thinking and cognitive troubles, and emotional changes.

Once you have a concussion and until it is fully resolved, Rosenblatt notes, you have a 400 percent chance of suffering a second concussion. However, Part of the challenge now is properly dealing with concussions is that many of them are not recognized: say, someone playing sports didn’t think they were hit that hard or didn’t feel any immediate signs like a headache, dizziness, or being off balance and continued to play but maybe noticed those symptoms later that night. Later symptoms are a red flag.

“When a person begins to suspect a sustained concussion they really need a  concussion management plan so they know where to go to get checked out so they know they’re okay before going back to play,” Rosenblatt says.  

Although some experts put a number on how many concussions are “too many”, Rosenblatt says there’s no real tipping point in terms of potential for serious or lasting damage; the effects vary greatly from person to person. Factors that can complicate recovery include history of headaches, learning disabilities, developmental delays, psychiatric disorders such as anxiety or depression, and past concussions, she notes.

“Anybody who’s engaged in play… really do need a plan,” she says. “The things need to be covered in a concussion management plan are to be aware that someone has set themselves up to engage in a sport or activity with a reasonable risk of mild traumatic brain injury… Then we can learn to recognize the signs of concussion and know where you’re going to go to get the information you need to make that critical decision about putting that athlete back at the risk for re-injury, because that’s where things become really complicated and potentially permanent.”

Baseline testing can help athletes measure the extent of an injury, she notes that concussion awareness is vital not just for dedicated athletes but for anyone who plays high-risk sports. For young athletes, neck strengthening can help lessen the effects of a hard hit. Then there’s the need for a commitment to safe and careful play.

“With the movie Concussion out there’s more awareness around injuries, but sometimes that inspires extreme that don’t necessarily help support healthy play and the value of organized team sports that play out in a young athlete’s life,” Rosenblatt says. “The fact that there is a risk of concussion and traumatic brain injury is something we need to recognize, not something we need to avoid. It’s about getting education and planning in place so can deal with these injuries.”