Dr. Charles Tator - Concussion Proofing

Welcome to the Canadian Concussion Center Webinar Series

Introduction and Overview

• Lesie Retan welcomes participants back to the Canadian Concussion Center's webinar series for the fall season, sponsored by the Laborers' International Union of North America (LIUNA).

• This marks the fourth year of webinars, which began in March 2021 during the pandemic, aimed at individuals with concussions, their caregivers, and healthcare providers.

• The sessions are scheduled every other Tuesday evening from 6:00 to 7:00 PM, focusing on various aspects of concussion management.

Acknowledgment of Indigenous Peoples

• Lesie acknowledges the indigenous peoples of Canada and emphasizes the importance of recognizing their ancestral lands as part of improving relationships and understanding.

Technical Information

• Participants experiencing technical difficulties can use the chat feature for assistance. Questions for speakers can be submitted via a Q&A box during the session.

• A poll is conducted to gather information about attendees, enhancing engagement and understanding of who is participating.

Introduction to Dr. Charles Tatter

Speaker Background

• Dr. Charles Tatter is introduced as an expert in neurosurgery and neuropathology with extensive experience in concussion research and prevention.

• He has held significant positions including chair of neurosurgery at University of Toronto and founder roles in organizations focused on brain injury prevention.

Importance of Concussion Prevention

• Dr. Tatter discusses "concussion proofing," emphasizing its significance over mere concussion prevention; it involves proactive measures to avoid future concussions after an initial injury.

Understanding Second Impact Syndrome

Risks Associated with Repeated Concussions

• Young individuals under 30 are particularly vulnerable to second impact syndrome—a condition that can lead to severe brain swelling or death if a second concussion occurs shortly after recovering from the first.

Causes and Avoidability

• Various activities can lead to concussions, even seemingly minor incidents like hitting one's head while playing sports; many causes are preventable through awareness and education.

Concussion Risks and Prevention Strategies for Older Adults

Understanding Concussion Vulnerability

• A recent paper highlights the susceptibility of teachers to concussions, particularly during recess where they may be struck by balls.

• For older adults, especially those over 65, recovery from a concussion is prolonged; head injuries are linked to significant memory loss and dementia.

• Women are at a higher risk for concussions due to generally smaller neck muscles, which can exacerbate the bobblehead effect during impacts.

Common Causes of Concussions

• Intimate partner violence is noted as a frequent cause of repetitive concussions in women; rear-end collisions also pose significant risks.

• Rushing to the bathroom at night increases fall risks leading to concussions; environmental hazards like loose mats or poor lighting contribute significantly.

Everyday Activities and Risks

• Climbing ladders or even simple tasks like putting on pants can lead to falls and potential concussions for older individuals.

• Hazards such as rough sidewalks and carrying multiple items while walking increase the likelihood of falls resulting in concussions.

Sports and Transportation Safety

• Contact sports, including hockey, present high concussion risks; non-contact leagues are recommended as safer alternatives.

• Concussions frequently occur in automobile collisions, particularly rear-end accidents. Seat belts and airbags offer protection but have design limitations that need addressing.

Protective Measures Against Concussions

• Bicyclists should wear helmets and avoid hazardous conditions like potholes or icy roads. Awareness of surroundings is crucial when cycling near parked cars.

• While helmets do not prevent concussions outright, they help mitigate severe brain injuries. The effectiveness of mouth guards in preventing concussions remains uncertain.

Concussion Awareness and Prevention in Sports

The Risks of Concussions in Contact Sports

• Concerns are raised about the normalization of concussions in sports like soccer, football, and hockey; they are preventable injuries.

• Fighting in hockey is criticized as dangerous, with references to two players who died from on-ice fights, highlighting the severity of head injuries.

• Boxing is identified as a high-risk sport for concussions, with recent fatalities including an 18-year-old female boxer who suffered from second impact syndrome after a previous knockout.

Legislative Efforts for Concussion Prevention

• Governments have made strides in concussion prevention through educational initiatives; Ontario was among the first to implement school programs addressing concussion hazards since 2015.

• The introduction of concussion laws across U.S. states began after a notable case involving Zachary Liat, emphasizing the need for awareness and reporting of concussions during games.

• The tragic death of Rowan Stringer, a high school rugby player due to second impact syndrome, led to significant legislative changes in Ontario regarding concussion management and prevention programs.

Impact of Public Policy on Concussion Management

• Since 2017, public health measures have been implemented across Canada to educate students about concussions and ensure proper management protocols are followed.

• Despite progress, Ontario remains the only province with specific concussion legislation; there is hope for broader adoption across other provinces.

Rowan's Law: A Case Study

• Rowan's Law Day serves as an annual reminder of the importance of concussion awareness following Rowan Stringer's death from preventable brain injury due to unreported concussions.

• The law encompasses regulations that now apply not just to elementary schools but also university students within Ontario’s educational framework. This expansion aims to enhance safety measures across all levels of education.

Advocacy and Future Directions

• Minister Neil Lumsden's commitment to safe sports includes personal involvement in research related to chronic traumatic encephalopathy (CTE), showcasing governmental support for ongoing studies into brain injuries in sports.

• Young athletes are urged to report any head injuries immediately; this proactive approach could significantly reduce risks associated with undiagnosed concussions—an issue highlighted by Rowan Stringer's experience.

Concussion Awareness and Prevention Strategies

Importance of Concussion Awareness Week

• The week from September 22 to 28 is designated as Concussion Awareness Week in Canada, initiated by the Coaching Association of Canada about five years ago.

• Ontario celebrates Rowan's Law Day during this week, emphasizing the importance of concussion awareness across all Canadian provinces.

Role of Parachute Canada

• Parachute Canada, a national injury prevention agency, supervises and organizes activities for Concussion Awareness Week.

• Improved awareness and recognition are linked to better prevention strategies; resources on concussion prevention are available on their website.

Sponsorship and Support

• Layuna has sponsored the event series for four years, with additional support from Mcclesich Orlando personal injury lawyers for this specific evening.

• Dr. Tatter invites questions regarding concussion prevention, laws, or any related topics.

Neck Strengthening as a Risk Mitigation Strategy

Importance of Neck Muscle Strengthening

• Neck muscle strengthening is highlighted as an essential injury prevention measure against concussions.

• Isometric neck muscle exercises are recommended over traditional range-of-motion exercises to avoid joint damage while strengthening muscles.

How to Perform Isometric Exercises

• To perform isometric neck strengthening:

• Place your hand on one side of your head and push against it for five seconds.

• Repeat this process with hands at the front, back, and other side of the head.

• Aim for ten minutes each morning and evening; adjust duration based on comfort levels.

Understanding Second Impact Syndrome

Risk Factors for Second Impact Syndrome

• Youth is identified as a non-modifiable risk factor; repetitive hits within short intervals increase vulnerability to second impact syndrome.

Case Study: Rowan Stringer

• The case of Rowan Stringer illustrates how multiple concussions can lead to severe outcomes; she suffered three concussions within a week during school rugby games.

Rarity but Preventability of Second Impact Syndrome

• While second impact syndrome is rare (only two or three cases per year in Canada), it remains preventable through proper awareness and management practices.

Understanding Concussions and Their Long-Term Effects

The Impact of Repetitive Trauma on the Brain

• The brain swells after repetitive trauma, a phenomenon not observed in older brains, which may reduce the risk of second impact syndrome.

MIPS Bike Helmets and Concussion Prevention

• MIPS helmets are designed to reduce concussion risk but lack evidence proving they are superior to traditional helmets. While helmets can prevent severe brain injuries, they do not effectively prevent concussions.

NFL's Exploration of Helmet Safety

• The NFL is experimenting with the Guardian helmet, which has a soft covering aimed at reducing injury risk. However, current evidence does not confirm its effectiveness during games.

Smelling Salts and Concussion Symptoms

• Smelling salts stimulate the brain and may mask symptoms of concussions but are not considered a treatment or preventative measure for concussions.

Link Between Concussions and Dementia Risk

• There is ongoing research into how multiple concussions may increase dementia risk. The Canadian Concussion Center aims to understand prevention methods for complications like CTE (Chronic Traumatic Encephalopathy).

Chronic Traumatic Encephalopathy (CTE)

• CTE was previously known as "punch drunk syndrome" and is linked to repeated head trauma leading to balance issues. Research continues on its connection to memory loss and Alzheimer's disease.

Research Progress on CTE and Memory Loss

• Despite advancements in recognizing CTE post-mortem, there remains no reliable method for diagnosing it during life. Trauma has been added as a recognized risk factor for various types of dementia.

Previous Brain Injuries Affecting Recovery from New Concussions

• Evidence suggests that prior brain injuries can hinder recovery from new concussions. Even if an individual appears fully recovered from an initial concussion, subsequent injuries may be more severe due to retained effects from earlier trauma.

Concussion Recovery and Treatment Insights

Understanding Concussion Recovery

• A concussion can be recovered from, but the susceptibility to future concussions remains lifelong.

Hyperbaric Oxygen Therapy for Concussions

• There is no strong evidence supporting hyperbaric oxygen therapy for concussion treatment; it may not harm the brain but could affect hearing or balance.

Mental vs. Physical Activities Post-Concussion

• Individuals with prolonged post-concussion symptoms should engage in both mental and physical activities; there’s no evidence that mental exercises worsen long-term well-being.

• Evidence supports that aerobic physical activity aids recovery from concussions, while weightlifting does not contribute positively to brain health.

Recommendations for Physical Activity

• It is recommended to gradually work up to 30 minutes of daily aerobic exercise, as consistent physical activity significantly benefits concussion recovery.

Long-Term Effects of Concussions

• Generally, individuals do not experience worsening symptoms years after a concussion unless they have had multiple concussions; younger people tend to recover better.

Rowan's Law and Private Schools

• Private schools in Ontario are likely adhering to Rowan's Law principles despite not being mandated by the Ministry of Education.

Causes of Concussions Beyond Impact

• A concussion can occur without direct impact; violent head movement alone can cause sufficient acceleration leading to a concussion.

• Examples include blast injuries or motor vehicle accidents where the head moves violently without striking an object.

Engineering Insights on Concussions

• Engineers have contributed significantly to understanding how movement causes concussions, emphasizing that even rear-end collisions can lead to concussive injuries without direct contact.

Concussion Management and Recovery Guidelines

Understanding Concussions in Sports

• The speaker discusses the mechanics of concussions, emphasizing that unlike rear-end collisions, certain protective measures can prevent head injuries during impacts. However, if a head injury occurs, it can lead to severe consequences.

• A question arises regarding the safe return to rugby after a concussion. The speaker advises against returning within a week, suggesting that recovery typically requires at least 7 to 10 days for teenagers.

• The speaker notes that while some teenagers may recover quickly from their first concussion, repeated concussions tend to prolong recovery times. Therefore, thorough checks are essential before resuming sports activities.

Testing and Protocols for Return

• To ensure complete recovery before athletes return to play, the speaker mentions using provocative tests like the rapid turning test which can reveal symptoms not present during normal activity.

• The NFL's efforts in studying concussions are highlighted as significant; they have implemented research symposiums and invited experts to address concussion management effectively.

Evolving Guidelines in Rugby

• Newer guidelines in rugby now recommend a two-week period without returning to play post-concussion, indicating an increased awareness of concussion risks within the sport.

Medications for Concussion Symptoms

• In response to a question about medications for concussions, the speaker explains that specific drugs can alleviate symptoms such as headaches but often require trial and error for effectiveness.

• Neurologists specializing in headaches are frequently consulted for difficult cases involving concussed patients who experience migraines or other complex symptoms related to multiple concussions.

Preventive Measures and Individual Variability

• Amitriptyline is mentioned as a preferred medication because it helps with both headache prevention and sleep improvement—critical factors following a concussion.

• When asked about second impact syndrome in adult boxers, the speaker indicates that while younger individuals are more susceptible, individual variability plays a significant role in determining risk levels across different ages.

Understanding Concussions and Individual Variability in Boxers

The Impact of Head Hits on Boxers

• Some boxers can endure more hits to the head than the average person, which is essential for their continued participation in the sport.

• Individual variation exists; some boxers may withstand multiple hits without concussing, while others may be susceptible after just one or two impacts.

Concussion Effects on Blood Pressure

• There is limited evidence suggesting that concussions routinely raise blood pressure; however, they do cause various autonomic effects.

• The autonomic nervous system controls involuntary functions such as heartbeat and blood vessel constriction, which can be affected by a concussion.

Closing Remarks and Future Sessions

• The session concluded with gratitude expressed towards Dr. Tatter for his presentation and responses to questions.

• A reminder was given about the next session scheduled for September 30th, featuring Dr. Carmemella Tarteia discussing "Concussion: An Invisible Injury."