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Impact study: Questionnaire aims to help local medical researcher shape new guidelines for when and how to safely get kids back on the field or rink after a concussion

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From his office window on the second floor of the MTS Iceplex, Jeff Leiter can look up from his research and watch kids play hockey on the rink below.

On a Friday afternoon in early April, the kids out there are young, their narrow legs pushing through drills as coaches carefully guide them along. At this age, they're just having fun. But if they stick with it, their games will soon get a little rougher and the risk of injury gets a little bigger, and from his office window, Leiter has the regular reminder: These are the young athletes his research is aiming to protect.

Last month, Leiter, a doctor of human anatomy and cell science, and the research director at Pan Am Clinic, teamed up with Football Manitoba to send a survey on concussion symptoms to over 6,200 players and 1,000 coaches. They hope at least 40 per cent of those surveys come back, enough to give them an inside track on how many kids did or didn't get concussions, and how the ones that did had their injury managed.

"We're excited to see what the results are," said Football Manitoba director Ron East, noting his group opted to work with Leiter to shore up gaps left by hearsay evidence. "We can't deny that concussions are part of the sport. What we can do is provide athletes with information and ensure we're mitigating as much as we can."

The survey questions are straightforward: Did you experience these symptoms? How long were you out? But the answers, Leiter says, could help shape new guidelines for when and how to safely get kids back to play.

Even with all the resources in professional leagues, that line is sometimes murky -- example: Crosby, Sidney.

"Parents get frustrated, players get frustrated, because they might go to two (experts) and get two different opinions," Leiter said. "But a lot of it right now is subjective. It's difficult to nail down quantitative reasons why someone could stay out."

The first phase of Leiter's research began last summer when Hockey Manitoba signed on to help spread a similar survey to over 7,000 players. Eight hundred responses came back, and of those 61 per cent had experienced concussion symptoms. Those numbers may be skewed -- parents of kids who did have symptoms may have been more likely to complete the survey -- but some of the results jumped off the page.

Among them: Over 100 hockey-playing kids in Manitoba missed more than 10 days of regular activity to concussion symptoms in the year before the survey was released.

"That's school, texting, spending time with friends," Leiter said. "When you're looking at concussions from a sport perspective, it's always 'OK, when can we get them back to play?' But they're missing two weeks of school or other activity. It's not to send alarm bells, but maybe we have to pay attention to what other activities are they missing, and ways we can more effectively manage that."

At 39, Leiter is no stranger to concussions. In six seasons of playing crash-bang minor pro in the Central Hockey League, "I had a few, I gave a few," he said, and watched a few of his friends forced out of the pro game by concussions. The experience left the former University of Manitoba forward with the battle scars of errant sticks and pucks, a piqued interest in concussion science -- and some first-hand experience of the sports culture that can sometimes allow these injuries to slip by.

For instance, there was that time in a game a concussion left Leiter unable to see out of one eye.

"Knowing probably enough that I shouldn't, I said, 'Well, I'll just switch wings, 'cause I can't see,'" he recalled. "Once you're in the environment, that's really hard. And that's what we tell parents now: Kids want to play. Watch their behaviour at home, off the ice. If they're just not themselves, maybe they haven't told you something."

Sports culture, after all, does lionize the warriors who stick it out. For instance, Duncan Keith playing out a Stanley Cup playoff game with the mangled remains of puck-shattered teeth. Every young player aches to be on the ice, the court or the field. And where broken legs provide an obvious reason to miss a game, concussion symptoms can be easier for players to ignore or hide.

"That's the culture we're trying to change here," East said. "It's more important that your health will be there. This isn't your career. This is a game you play for fun. You should play hard and play intense. But if you're hurt, you should sit out... and that message starts from the parents and the coaches."

Like Leiter, East, too, knows what it means to injure the brain: in 2001, while working as a physical education teacher, he suffered a vicious assault. Over a long rehabilitation, he had to learn how to walk again and talk.

"If there's anybody who understands the importance of this, it's me," he said. It's one of the biggest reasons he started spearheading new concussion-initiatives in provincial football, including top-line helmets and mouthguards for the provincial team.

This year, Football Manitoba teamed with a Montreal company called ShockBox that builds sensors to put inside helmets. When a player takes a hit, the sensors send data back to sideline trainers on how powerful the hit was and recommends if extra action should be taken to check the player out. Football Manitoba also pushes a baseline test for players to help detect the signs of concussion.

Now, East said, participating in Leiter's research is the "natural next step." Football Manitoba already distributes an information booklet on concussions, but the data that comes out could help clarify guidelines for how to respond.

"We wanted to be able to gauge what is the knowledge in the community?" East said. "What do athletes know, what do our trainers know?

"This will give us a starting point as to where to put more work in."


Last year, the Pan Am Clinic's research arm launched a study on youth athletes and concussions with a survey of young hockey players. While the second phase of the research continues this year with a similar survey of young football players, the initial hockey-player data helps give shape to the sports-concussion discussion in Manitoba.

Of the 821 survey respondents, 75 per cent of whom were male, 61 per cent experienced some concussion symptoms in the year leading up to the survey. That may reflect sampling bias -- players who did experience concussions may have been more likely to complete the survey -- but the answers illuminate how those who were injured moved through treatment and recovery.

Of those who did experience symptoms:

-- 34.5 per cent were diagnosed with a concussion, usually by a doctor (81 per cent) but often by a coach (30 per cent). Emergency-room visits accounted for the largest share of doctor diagnoses, with 58 per cent having their concussion confirmed in the ER.

-- Headaches were the most common symptom, with 80 per cent experiencing them. Fifty-eight per cent reported dizziness, 57 per cent reported a feeling of having their "bell rung," and 30 per cent had trouble concentrating.

-- 92 per cent of those diagnosed suffered the injury during a hockey game. All of them were wearing a helmet, and 93 per cent were wearing a mouthguard.

-- The most common concussion cause was a blow to the head (28 per cent), but only slightly: Player collisions accounted for 25 per cent of concussions.

-- 68 per cent -- 114 kids -- missed school or work as a result of the injury. One hundred-nine of them missed 10 or more consecutive days of regular activity.

-- 62 per cent experienced recurring symptoms during their recovery. Forty-three per cent didn't see a doctor for the recurring symptoms.

-- The majority of kids (88 per cent) returned to hockey within the year. Of those, 60 per cent had been cleared by a doctor to play.

-- Of all the survey respondents, just under half (45.4 per cent) were taught about concussions before or during the hockey season. When that education did come, it usually came from coaches or team managers (73 per cent). In a survey of parents, 38 per cent reported receiving information on concussions, again usually from coaches and team managers.

Republished from the Winnipeg Free Press print edition May 4, 2013 C7


Updated on Saturday, May 4, 2013 at 10:21 AM CDT: Adjust web headline

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