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Toronto study shows concussion effects are long-lasting and highlights importance of prevention

[Freeskier praised this week a new technique used at Vancouver General Hospital with her survival and recovery after a traumatic brain injury last year at Whistler, B.C. Photo: GrindTV]

New research from St. Michael’s Hospital in Toronto shows that concussions may have more long-lasting effects on young athletes than once believed, which experts say highlights the importance of prevention and proper treatment for even minor brain injuries.

The study, published this week in the Journal of Neurotrauma, found that university athletes with at least one past concussion still showed changes in the brain’s size, blood flow and connections months and even years later. It’s another indication that the previous belief that minor concussions don’t have long-term effects for young people who recover quickly is false, Nathan Churchill, lead author of the study, tells Yahoo Canada News.

“Historically we tend to think of concussion as sort of a short-term brain change,” Churchill says.

But studies like this and others indicate that there can be changes in the brain as a result of concussions that were quickly resolved, or perhaps never diagnosed at all.

These studies highlight the importance of addressing concussion prevention, recognition and treatment from the earliest ages, Dr. Pierre Frémont, chair of the Canadian Concussion Collaborative (CCC), tells Yahoo Canada News.

“That’s another recent study that indicates the functional change and the consequences of brain trauma,” Frémont says, “and that emphasizes the importance of doing better as soon as possible.”

There has been a shift in the public conversation about concussion because of serious effects experienced by amateur and pro athletes. Hockey player Sidney Crosby missed months of play because of post-concussion symptoms, for example. Chronic traumatic encephalopathy (CTE), a degenerative disease associated with repeated brain trauma, has been diagnosed post-mortem in at least 33 former NFL players.

And this week former pro skier Jamie Crane-Mauzy praised a new technique used at Vancouver General Hospital with her survival and recovery after a traumatic brain injury last year at Whistler, B.C., though she doesn’t expect to ski competitively again.

“In the last few years there’s been a whole pile of studies coming out, looking at mainly retired athletes, showing that there are a lot of long-term consequences associated with brain trauma,” Churchill says. “This has exposed how little we know how about how the brain recovers from concussion, especially in the long term.”

The St. Michael’s Hospital study, done with the University of Toronto, looked at some of those younger athletes. They looked at male and female varsity athletes, in both contact and non-contact sports, between the ages of 18 and 23 who had a concussion at some point in the past. MRIs of the brains of those athletes were compared with those of non-athletes who didn’t have a history of concussions.

“What we found is that there are consistent differences in the brains of concussed athletes months, even years, after the injury,” Churchill says.

Many of the athletes studied had only one or two past diagnosed concussions, but the MRIs found differences in the frontal lobes of their brains compared to the non-athletes.

The damage to the frontal lobe is particularly important to study further because it’s an area of the brain that is still actively developing into a person’s early 20s, Churchill says. And while it’s important to remember that a concussion in young people may not be debilitating, it could still have long-term effects that were previously unexpected, he says.

“I think people should be very curious about what comes next with the research,” Churchill says.

Preventing concussions

It will take decades to uncover some of the long-term effects of concussion in children and young adults. In the meantime it’s important to both prevent those concussions in the first place and improve the management of those that occur, Frémont says.

Research has standardized childhood practices like wearing a helmet when bicycling or skiing, and has changed how sports are managed into the teens and young adulthood.

One Canadian study showed lower concussion incidence in youth hockey players in Quebec versus Western Canada, where body checking is allowed at earlier levels of play.

“They clearly demonstrated that there was less concussions when body checking was forbidden in Quebec,” Frémont says. “That changed the way hockey is played across North America altogether.”

Another way to do this is to give coaches the tools to recognize concussion symptoms and ensure that children experiencing them receive quick treatment, Frémont says. It’s good that this training is happening for team staff in major leagues and at the college levels, but it should also be provided to the volunteers and parents running sport extracurriculars for the youngest children.

“If a concussion goes unrecognized on the field of play when daddy is the coach of the soccer game on Saturday morning, no expert can do anything about it because nobody will seek expert medical care,” Frémont says.

The CCC works with a variety of Canadian associations to implement concussion-detection protocols at all levels of sport, and will soon release a road-map document expanding on the protocol components.

It’s important to do this work now, from the youngest ages, in order to ensure that Canadian children grow up active and benefitting from sports without experiencing long-term harm from play. The focus on helping professional athletes is important, Frémont says, but changing the culture of sports from Little League up will help prevent the issues many professionals are now experiencing.

“Let’s not forget to do better for the kids that are now playing, because we want them to remain a young generation that is still active,” Frémont says.