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Brain work

How Concordians are impacting the field of sports-related head injuries
July 14, 2021
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By Richard Burnett, BA 88

brain-rugby-women-s-team

Kyla Demers, BSc (athletic therapy) 04, MSc (osteopathy and post-concussion syndrome) 19, has been playing rugby since she was 14 and had her first concussion when she was 25. The injury occurred in 2005, while she was playing for Town of Mount Royal R.F.C. in Montreal. 

“It was the last game of the season,” recalls Demers. “I was hit illegally by someone who did a very dangerous move. I didn’t have the ball. I was fully stretched out playing scrum half and was hit from behind. I didn’t see it coming. But we were still in that old way of doing things where you just shake it off.” 

There were no available substitute players, so Demers told a therapist who ran onto the field, “Ask me all the questions you want but I’m not coming off.” Demers finished the game and only realized afterwards that she had suffered a bad concussion. 

“I struggled for a couple of years,” she says. “So much so that I didn’t go anywhere near a field, nowhere near practice. I didn’t even go see any games.”

Demers has since fully recovered, but her initial reaction to her concussion is typical of many athletes who participate in a culture that celebrates toughness and encourages — and even rewards — them to play through pain. At the same time, concussions have become commonplace, and not just in rough-and-tumble sports like hockey, rugby, football, soccer and boxing. 

Thankfully, Concordia-led research and advances by Concordia graduates are giving neuroscientists, neurologists and sports therapists new insight on how to treat sports-related head trauma.

‘Strong clinical program in athletic therapy’

Kyla Demers Kyla Demers, BSc 04, MSc 19

The Lancet Neurology journal reported in 2013 that more than 50 million traumatic brain injuries (TBI) occur internationally each year. The concussion is a mild TBI — and the most common. According to estimates by the United States Centers for Disease Control and Prevention, 1.6 to 3.8 million sports- and recreation-related concussions occur each year in the U.S. The American Association of Neurological Surgeons reports that an athlete who has sustained a concussion is three to six times more likely to sustain another.

In Canada, more than one in four people (27 per cent) aged 15 and older regularly participated in sports in 2016, with hockey at the top of the list. 

The Public Health Agency recently reported that for “sports and recreation-related activities among children and adolescents five to 19 years of age, hockey consistently showed the highest proportion of TBI relative to all injuries. Rugby also emerges as a sport with a high percentage of TBI for both males and females aged 10 to 19 years.”

Research into concussions has taken on increasing importance at Concordia’s Department of Health, Kinesiology and Applied Physiology, where associate professor Geoff Dover serves as graduate program director. 

“Concordia has a very strong clinical program in athletic therapy and there has been a push over the last 20 years to increase research into concussions,” says Dover, a certified athletic therapist and athletic trainer whose 2020 study — “Athlete Fear Avoidance, Depression, and Anxiety are Associated with Acute Concussion Symptoms” — is currently under peer review for publication. 

Geoff Dover Geoff Dover

Dover was also a member of Kyla Demers’s thesis committee for her groundbreaking 2019 study “Prevalence of Cranial Bones and Upper Cervical Vertebrae Mobility Restrictions in Individuals Suffering from Post-Concussion Syndrome.” 

“Our study showed that people who suffer from post-concussion syndrome have more cranial and upper cervical mobility restrictions compared to a control group – which is the first study of this kind to indicate this relationship,” says Demers. “More research will be needed to determine how our results can be used in better assessing and treating people with post-concussion syndromes.” 

Survivor to role model

Other Concordia alumni conducting research on TBI include Enrico Quilico, BEd 12, who changed career paths after suffering a TBI in a 2006 motorcycle accident in Montreal. 

Quilico was cut off on Highway 20 by a driver and collided with a car head-first after skidding 20 metres. He broke several ribs, fractured his pelvis and lay in a coma for two weeks. Quilico would eventually recover to do life-saving rehabilitation at the Montreal Gingras-Lindsay Rehabilitation Institute.

“That marked a big turning point,” Quilico says. “I felt the most positive influential factor in my long-term recovery was cardiorespiratory endurance exercise.” In 2016, Quilico raised more than $10,000 for Brain Injury Canada by participating in the Lake Placid Ironman and in 2018 received the Changemaker Award from the Neurological Health Charities of Canada. 

Enrico Quilico Enrico Quilico, BEd12

As a public speaker, Quilico has been advocating for brain injury awareness since 2008, and as a PhD candidate in the Rehabilitation Sciences Institute at the University of Toronto, is currently researching an adapted exercise program for people living with TBI. His research is rooted in a community-based physical activity program with the YMCAs of Quebec that he developed for adults with moderate to severe TBI. 

“The PhD is very important to me, conducting some very cutting-edge research about the benefits of physical activity for people with brain injuries,” says Quilico, who since January 2021 has also been teaching Quantitative Research Methods for Practitioners in the Department of Applied Human Sciences at Concordia. 

“I feel that by doing my work, and living my life to the fullest, I am offering hope to those suffering from TBI. There are a lot of stages that you go through in the long journey to recovery — some of them are very dark. Despite the odds, others can also have a positive outcome.”

Prevention and education

The work of TBI researchers like Quilico is helping to change the game, especially in the vulnerable world of youth sports. The Conversation, which publishes analyses by academics and researchers, reported in May 2020 that one in 10 Canadians aged 13 to 18 seek medical attention each year for a sports-related concussion: “Forty per cent of these youth have experienced a previous concussion, and 20 per cent will have a variety of persistent symptoms for longer than one month.” 

Many believe professional contact sports should lead by example, but progress has been slow. In 2013 the National Football League (NFL) paid $765 million USD to settle a lawsuit brought by more than 4,500 players and their families who charged the league knew about the dangers of repeated play-related head blows that have been shown to likely cause chronic traumatic encephalopathy (CTE), the term used to describe brain degeneration, a condition associated with parkinsonism and dementia. 

This past June, the league announced that it would no longer settle concussion lawsuits on the basis of a pernicious formula that assigned a lower level of cognitive function to Black players. Two former players have filed a civil-rights lawsuit over the racist practice. 

Majid Fotuhi Majid Fotuhi, BSc 87

One of the foremost authorities in the field of concussions, Majid Fotuhi, BSc 87, a Harvard- and Johns Hopkins-trained neurologist and neuroscientist, is medical director of the NeuroGrow Brain Fitness Center in Northern Virginia. Fotuhi often gives speeches about concussions and CTE.

“I’m not very popular with football coaches,” he says. “Once, in Texas, I was giving a lecture to a group of physicians where I said I think encouraging nine-year-olds to bump and hit each other violently on the football field is child abuse. 

“Youth should be playing tag or flag football. Kids should not be bumping their head intentionally at a time when their brain is still developing. Some physicians in attendance — who sat on the board of a football team in the area — were offended.”

Fotuhi — who says he “fell in love with the brain” when he took a physiological psychology course taught by Peter Shizgal in 1985 at Concordia — was saddened when he met Muhammad Ali in 2013. Ali developed severe Parkinson’s disease due to an estimated 29,000 blows to his head during his boxing career.

“I had watched Ali fight when I was a kid,” Fotuhi recalls. “So to see him in person was quite a memorable experience. But he had difficulty articulating a few words and had difficulty walking. He was confused and I felt so bad for him.

“We cherish the fact that he was such a good athlete, but I think we should have stopped him from fighting. As a neurologist whose job is to take care of people’s brains, if it were up to me, I would ban boxing and martial arts. They are barbaric.” 

Diagnosis and treatment

There is no definitive test that can say whether one has had a concussion or not, but experts in the field rely on two common tools to evaluate concussions: the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Sport Concussion Assessment Tool (SCAT). The ImPACT test is a baseline concussion assessment developed by neuroscientists at the University of Pittsburgh Medical Center in 2002.

There are two types of ImPACT tests: pediatric ImPACT for ages five to nine, and adult ImPACT for age 10 and older. Hundreds of thousands of athletes across North America take the ImPACT test each year — especially when school sports begin in the fall — to create a cognitive baseline that helps provide a guideline for how quickly concussed athletes can return to play. The test is used by the Canadian Football League, Major League Soccer, U.S. Lacrosse, the U.K.-based Football Association, NASCAR and Formula One. It is also offered to students at Concordia’s PERFORM Centre.

SCAT — the current fifth edition is more commonly referred to as SCAT-5 — was developed by the Concussion in Sport Group (CISG) as a standardized sideline concussion-screening tool for medical professionals to assess athletes aged 13 and older (Child SCAT-5 is used for ages five to 12). SCAT-5 is supported by the International Ice Hockey Federation, FIFA and the International Olympic Committee.

Over at the NeuroGrow Brain Fitness Center, Fotuhi has treated more than 5,000 patients with various degrees of post-concussion syndrome. His 12-week Concussion Recovery Program consists of targeted brain training, treating migraine, sleep and anxiety issues with lifestyle modifications such as guided physical exercise, breathing exercises, meditation and different forms of biofeedback. According to his publication in the Journal of Rehabilitation in 2010, more than 80 per cent of his patients demonstrated improvement. Fotuhi has two general recommendations for patients with TBI symptoms.

“First, athletes need to accept and respect that the brain is an organ that has been damaged and must be fully repaired,” he says. “Just like they would not rush back to playing a game with half-treated torn ligaments, they should not return to playing a game with half-recovered concussion symptoms. If they do, they are more likely to experience more concussions.

“Second, they need to find a neurologist with experience in treating concussions with a multidisciplinary team of experts, because different symptoms — such as headaches, dizziness, anxiety, anger management, sleep problems and balance issues — need different treatments.” Kyla Demers — who suffered a second concussion in 2012 — manages a multidisciplinary team at Vertex Commotion, the clinic she founded in 2018.

Demers and her colleagues establish an individually tailored concussion rehabilitation program for each patient to treat different symptoms. Their six-part program includes the Vestibular / Ocular Motor Screening (VOMS) Assessment, a manual assessment, and NeuroTrackerX, a cognitive training program that improves the efficiency of the brain, developed by Concordia graduate Jocelyn Faubert, BA 84, MA 87, PhD 91, an experimental psychology expert and professor at Université de Montréal.

brain-isa-galiana Centre right, with ball: Isabel Galiana, BSc 98, CEO of Saccade Analytics, with her 1996 Concordia Stingers volleyball teammates

Another groundbreaking tool helping deliver better care for concussions is NeuroFlex, created by McGill University professor emerita Mimi Galiana. Galiana co-founded Montreal-based Saccade Analytics in 2016 with her daughter, Isabel Galiana, BSc 98, who serves as CEO of the company.

In March 2021, World Rugby announced that Saccade Analytics’ eye-tracking technology will be trialled to assist with the detection of concussions in the sport. Other clients also include the Montreal Canadiens, whose superstar netminder Carey Price suffered a concussion in an April 2021 game against the Edmonton Oilers, following a bump by Oilers forward Alex Chiasson.

A former professional volleyball player who also played for the Concordia Stingers, Galiana says NeuroFlex enables clinicians and therapists to objectively assess and manage concussions and vestibular disorders by leveraging eye-tracking in virtual reality. NeuroFlex is currently used commercially across Canada and Australia for both diagnostic support and rehabilitation, but Saccade Analytics remains committed to its research and development roots.

“We are currently doing a clinical trial with the Montreal Neurological Institute-Hospital that compares our results to functional MRI on concussed individuals,” Galiana says. “Functional MRIs are kind of the gold standard for concussion diagnosis, and our goal is to see just how close we can get to be able to say that we can diagnose a concussion.”

As Concordians continue to advance treatment and research in the field of concussions and TBI, athletes can also protect themselves and help prevent concussions with proper training. 

“The key is anticipation,” says Demers, who was part of the medical team at the Vancouver Olympic Games and at two Canada Games. “You have to make sure that your brain is always sharp. Because if your brain is slow before a game, then your reaction time will be slow. 

“You also have to get a good night’s rest. Eat well. You have to have healthy life hygiene so that you’re always 100 per cent. And invest in your core: good posture, good stabilizers in your neck. You need to be fit and you need to be strong. And just because you’re wearing a helmet, it doesn’t mean you’re safe.”

 

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