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Brain gain: Experts making great strides in diagnosis, treatment of concussions

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Dr. Neil Craton makes a point at the concussion forum at the University of Winnipeg.

BORIS MINKEVICH / WINNIPEG FREE PRESS Enlarge Image

Dr. Neil Craton makes a point at the concussion forum at the University of Winnipeg. Photo Store

Compared to five or 10 years ago, the depth of concussion knowledge and awareness is finally getting somewhere.

But it also follows that old idiom, "Be careful what you wish for."

The more that's learned about concussions -- what causes them, what actually happens to the brain during and after one, how to diagnose it correctly and how to treat it all once you do -- the more researchers and medical experts and in-the-field sports practitioners are realizing they need to find out.

The Canadian Sports Concussion Project held its second annual symposium in Toronto earlier this year, a gathering of pre-eminent minds and authorities from a wide range of fields, including neurologists, authors medical imaging experts and even a retired CFL player, to name but a few. In all, 28 15-minute presentations were made in one day to share information and research, representing a mind-numbing amount of findings and experiences being passed around but barely scratching the surface.

Earlier this month in Archives of Physical Medicine and Rehabilitation, a review was published updating the mild traumatic brain injury prognosis review from the World Health Organization Task Force in 2004.

This exhaustive effort -- concerning strictly the "Self-Reported Prognosis in Adults," after a concussion -- went through 77,9145 trials and studies and picked out just 299 that were relevant and eligible.

That's a lot of ink that didn't make the cut, illustrating much of the work being done doesn't fit a one-road map.

And in Winnipeg, there's plenty going on.

Earlier this month, it was announced that Pan Am Clinic neurosurgeon Dr. Mike Ellis will head up a new research and treatment centre here for children and adolescents.

And Thursday night at the University of Winnipeg, Kinesiology associate dean Dr. Glen Bergeron moderated a forum about current practices and research that was attended by local coaches, physiotherapists athletic therapists and athletic therapy students.

The evening, which began with the thought- and emotion-provoking documentary Head Games, included a panel discussion with another wide field of authorities such as University of Regina exercise physiologist and concussion researcher Dr. Patrick Neary, Winnipeg's Legacy Sports Medicine director and Blue Bombers team physician Dr. Neil Craton, Winnipeg native and former German hockey star Kerry Goulet, author and founder of stopconcussions.com, Nicole Beauchesne of the Concussion Care Community Clinic and Sport Manitoba president and CEO Jeff Hnatiuk to give input on behalf of the amateur sporting community.

Once again, the topics and vigorous conversation had nary a wasted minute and could have lasted six hours instead of the scheduled three.

Really, you say? What could possibly be the sex appeal of hearing about being hit in the head, seeing stars and returning to your sport or your life as quickly as possible?

The extent of concussions, for one. It's not an injury restricted to boxers or football or hockey players, as was generally thought some years ago.

And it's fascinating to find that those on the front lines -- practising physicians like Dr. Craton and active researchers like Dr. Neary -- absolutely crave more information, more tools, more guideposts to help them discover better treatments.

Both men mentioned Thursday that current neuropsychological tests administered after concussions are no longer good enough on their own.

"They helped to give us some indication of what the brain was doing after concussion... and that has helped to push us a long way but I also think it's very limited as well," Dr. Neary said. "You can't have just a neuropsychological test in your toolbox."

Both men also said there is some level of anticipation for something that researchers are now eagerly pursuing -- a "gold standard" sort of test or blood marker to indicate the concussion or brain damage, such as the blood test that exists to confirm heart damage or attack.

Until that breakthrough arrives, methods and assessments are evolving but are not yet specific enough for the liking of many.

"We have serious problems ahead of us in the diagnostic construct of concussion," Dr. Craton said Thursday. "The problem is with the lack of specificity of concussion symptoms."

He mentioned the 22 symptoms associated with post-concussion syndrome but pointed out that things like sadness, irritability, headache, fatigue are things that well people have "all the time."

"I think what we're seeing is that symptoms get clumped together," Dr. Craton said. "There are some that sound very much like the brain -- I'm having trouble concentrating, I'm having trouble following stories -- so those are typical attentiveness issues like I can't pay attention at school.

"Then there are things that sound like it's a mechanical thing -- my neck is sore, if I (touch) here it's stiff to move. And then there are things that sound like inner-ear -- I really feel dizzy, I have this ringing in my ear, I get wobbly when I stand up.

"So we're talking about this idea of sub-categorizing the notion of concussion. I'd be happy to get the 'concussion' term out of the literature and say you have a brain injury, you have a neck injury or you have an inner-ear injury and look at it from that perspective and so getting better ways of sub-categorizing these patients that we see."

While those concerns about assessments and gold standards are very real and show a sort honourable impatience in those wanting to provide better care, the ever-changing landscape does reveal important strides.

Those injured are growing less resistant to reporting symptoms, despite all the social and emotional consequences that may have deterred their honesty in the past.

"We're light years better than we were," Dr. Craton said. "In the CFL, for example, there are big concussion posters on the wall. They have to get a concussion talk before the season. They have to get a baseline test. The players, as part of their negotiations for the current collective bargaining agreement, they're asking for people in the stands and a neurologist on the sidelines.

"The league's going to try to get the refs involved, make the refs accountable because they're seeing stuff going on. The (reluctant) athlete is much less common. We used to have guys that we'd have to hide their helmets. We don't do that any more.

"We're light-years ahead, especially in the area of professional sports."

tim.campbell@freepress.mb.ca

Republished from the Winnipeg Free Press print edition March 29, 2014 C4

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