Concussion

Pianos, exercise bikes and more: Inside the Faculty of Kinesiology & Physical Education research labs

Christopher.Sorensen — Thu, 08 Dec 2022 15:29:56 +0000

Pianos, exercise bikes and more: Inside the Faculty of Kinesiology & Physical Education research labs

Christopher.Sorensen Thu, 12/08/2022 - 10:29

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Julia Tom is a professional cellist and a doctoral student of the TEMPO lab, exploring fine motor skills and ways to enhance them (photo by Dewey Chang)

Jelena Damjanovic

Topic

Breaking Research

Athletic Centre

Concussion

Faculty of Kinesiology & Physical Education

Goldring Centre

Research & Innovation

Sport

A shiny black piano may not be the kind of instrument visitors would expect to find in a research lab at the University of Toronto's Faculty of Kinesiology and Physical Education (KPE) but that is exactly what they would discover – along with a transcranial direct current stimulation device and an exercise bike.

The faculty's Training and Enhancing Motor Performance Outcomes (TEMPO) lab is is where Joyce Chen, assistant professor of motor learning, and her team of graduate students study how factors such as aerobic exercise, non-invasive brain stimulation – and music – can enhance a person’s ability to learn motor skills, from putting the golf ball to using their upper limbs again after a stroke.

“My research aims to discover the limits of the brain’s plasticity, its ability to change as we learn,” says Chen. “Using fundamental and applied research approaches, we want to understand how far we can push motor performance in a musician or athlete, and find ways to enhance the brain's plasticity so that people with stroke can improve their capacity to move.”

Chen’s lab was one of many on display during a recent KPE lab tour organized by the faculty to showcase some of the new and renovated research spaces at the Warren Stevens Building (Athletic Centre) and the Goldring Centre for High Performance on the St. George campus, which house most of KPE’s research units, labs and centres.

A student in the Biomechanics of Orthopedics and Sport Medicine lab simulates a move that puts stress on the hips (photo by Dewey Chang)

Located in the lower levels of the Warren Stevens building is the Biomechanics of Orthopedics and Sport Medicine lab, run by Timothy Burkhart, an assistant professor of orthopaedic biomechanics at KPE, in conjunction with the orthopedic surgeons of the University of Toronto Orthopaedic Sports Medicine group. Here, athletes simulate game moves that put stress on the hips and knees. Motion-capture technology helps generate computer models that accurately estimate the forces on the hips and knees – a non-invasive way to retrieve data that used to require intramuscular probes. And a markerless motion-tracking system videotapes the athletes doing exactly what they would do in their natural environment, for example, playing a game of basketball on a court.

“The combination of the two techniques – capturing force and movement data in the lab and analyzing videotape of the players on court – produces an unprecedentedly granular level of analysis,” says Burkhart. “What we learn can help both athletes and the everyday healthy population that’s relatively active with injury prevention and rehabilitation.”

A study from Jacobs' lab looks at the performance enhancement effects of blood flow restriction of the limbs before commencing exercise aka ischemic pre-conditioning (photo by Ira Jacobs)

Just down the hall from Burkhart’s lab is the Human Physiology Lab where Ira Jacobs, professor of exercise physiology at KPE, and his team of graduate students are exploring therapeutic interventions, as well as training and physical activity recommendations for people across the human spectrum.

On one side of that spectrum are children with chronic disease. Jacobs and his team are studying the interaction between physical activity, nutrition, physiological function and disease severity in children with chronic disease with the overall goal of rapidly translating their research findings into patient care with new, disease-specific therapeutic interventions.

The lab’s high performance sport research program is designed to investigate the other end of the human condition.

“More specifically, we perform investigations on how the human body works at the limits of its capabilities and how we can push these limits using recovery strategies, nutritional supplementation, programming and testing,” says Jacobs, who is also interim director of the recently founded Tanenbaum Institute for Science in Sport (TISS). "These limits can be related to elite sport training and performance or to human performance in extreme conditions like altitude, heat and cold.”

Shared research space on the fourth floor of the Goldring Centre (photo by Dewey Chang)

Back at the Goldring Centre, Robert Bentley, assistant professor of cardiovascular physiology, is conducting research into how the heart and blood vessels function during exercise.

“I study the mechanisms of oxygen delivery during exercise and what that means not only for performance, but also for exercise tolerance,” he says. “My research spans the health spectrum, from basic science investigations in healthy populations to clinical investigations of patients with heart failure and pulmonary hypertension.”

One of the machines Bentley uses in his research is the stress echocardiography tilt-recline table ergometer, a specialized bicycle that allows study participants to exercise while the researchers manipulate them by tilting or reclining the bicycle as needed to obtain optimal images of the heart.

“This piece of equipment allows for cardiac imaging to be completed during exercise, which is pretty exceptional,” he says. “If you do not have this special bicycle, individuals often have to exercise on a treadmill or upright bicycle until some criteria is met and then quickly transition themselves onto a table upon which images of the heart can be obtained.”

Bentley’s Cardiovascular Exercise Physiology lab is housed on the fourth floor of the Goldring Centre, which has been significantly expanded in the recent renovation to provide individual labs and shared research space for a number of faculty.

A stress echocardiography tilt-recline table ergometer allows study participants to exercise while researchers tilt or recline the bicycle as needed to obtain optimal images of the heart (photo by Dewey Chang)

The Kirkham lab, led by Amy Kirkham, assistant professor of clinical cardiovascular health, uses advanced imaging and lifestyle interventions to understand, treat and improve the health of women with cancer and cardiovascular disease.

Michael Hutchison, associate professor of sport concussion and director of the concussion program at the MacIntosh Sport Medicine Clinic, specializes in sport-related concussion research in various populations, from adolescents to professional athletes.

Daniel Moore, associate professor of muscle physiology, studies the influence of exercise and nutrition on skeletal muscle remodeling and protein metabolism, while Jenna Gillen, assistant professor of exercise physiology, conducts research into how exercise and nutrition can alter carbohydrate and fat metabolism in humans.

Dean Gretchen Kerr, Assistant Professors Robert Bentley and Jenna Gillen, and Professor Ira Jacobs were on hand to cut the ribbon at the official unveiling of new and renovated research space at KPE (picture by Dewey Chang)

“We have so many great spaces now available to do in person research, including an exercise training suite for exercise interventions or training studies and an expanded wet lab that lets us look, on a cellular and molecular level, at how exercise - on its own or in combination with nutrition - influences aspects of metabolic health and physiology,” says Gillen.

A new, more spacious metabolic kitchen is also now available for careful preparation of diets and nutrition interventions for study participants, while blood samples and muscle biopsies are collected for analysis in the procedures room.

“With over 20 research labs housed under KPE, our experts are able to do cutting-edge research in various areas related to physical activity, health and their interactions,” says Professor Tim Welsh. The interim associate dean of research at KPE, Welsh is also head of the Action and Attention lab and studies the cognitive and neural mechanisms behind goal-directed actions of people from average and special populations.

“This tour offered a snapshot of some of the important and far-reaching work that gets done.”

Study by �鶹��Ƶ, St. Michael's Hospital researchers reveals concussion-related injuries still present one year later

Christopher.Sorensen — Mon, 18 Nov 2019 14:45:26 +0000

Study by �鶹��Ƶ, St. Michael's Hospital researchers reveals concussion-related injuries still present one year later

Christopher.Sorensen Mon, 11/18/2019 - 09:45

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The study involved 146 athletes, both men and women, who competed for �鶹��Ƶ in various sports, including lacrosse (photo by Jimmy Wang)

Topic

Research & Innovation

St. Michael's Hospital

In the first longitudinal evaluation of its kind, researchers from the University of Toronto and St. Michael’s Hospital have discovered that one year after the event of a concussion and receiving medical clearance, signs of concussion-related injuries can still be observed in the brain.

The findings were published this fall in the journal Neurology.

“The objective of our study was to understand how the underlying brain physiology is changed after injury, and how long it takes to recover afterwards,” said �鶹��Ƶ alumnus Nathan Churchill, a researcher at St. Michael’s Hospital and the study’s lead author.

“Looking at brain activity, blood flow and structure, we saw that many of the things that were disturbed at the early stages of concussion were still present after being medically cleared to ‘return the play.’”

Using magnetic resonance imaging (MRI) technology, the concussed brains of 24 athletes from �鶹��Ƶ sports teams, assessed previously at the David L. MacIntosh Sport Medicine Clinic, were scanned at regular intervals: an average of four days after injury, after medical clearance to return to play (RTP) and one year after RTP. A control group of 122 athletes without concussions were also imaged to act as a reference cohort for the concussed athletes.

Of the 146 athletes included in this study, men and women were equally represented in both groups and competed in sports like water polo, lacrosse, hockey and football. All athletes also completed baseline assessments of symptoms and cognition.

By evaluating different aspects of brain physiology, including function, connectivity, blood flow and structure, researchers found that some components demonstrated different patterns of long-term recovery, while others showed non-significant concussion effects at the one-year marker after return to play.

“We found it interesting that even one year later, with no other intervening concussions or medical issues present, there were still lingering effects in the brains of previously injured athletes,” said Tom Schweizer, a senior corresponding author on the paper, associate professor with the division of neurosurgery at �鶹��Ƶ’s department of medicine and interim director of the Keenan Research Centre for Biomedical Science at St. Michael’s Hospital.

“Particularly, we observed persistent long-term effects like a reduction in cerebral blood flow and an increase in white matter mean diffusivity.”

The researchers suspect that reduced cerebral blood flow (CBF), which is needed to deliver oxygen and nutrients to brain tissues, may be linked to subtle long-term decreases in grey matter volume after concussions. Grey matter tissues play specialized roles in the brain and are involved in planning and decision-making skills, as well as temporal areas associated with language and memory.

(image courtesy of Nathan Churchill)

The increased presence of white matter mean diffusivity is also concerning because it demonstrates that concussed athletes may still be experiencing microscopic signs of swelling – possibly a sign of inflammation in the brain – suggesting that longer than a year may be required for it to return to normal function.

“It’s important to remember that the athletes in this study are in the ‘clear,’ as they’ve received full medical clearance to return to play and they’re not complaining of any effects,” said Schweizer. “So, it’s not as though they’re walking around with a bunch of symptoms and they’re not well. The brain is fantastic in terms of how it is able to fix itself and adopt a new normal,” .

This is one of the reasons that the researchers believe more investigation into the effects of concussion-related brain injuries is required.

Speaking about the impact of this study, Schweizer said: “Traditionally, a concussion has been defined as a mild injury to the brain. But we now know there are potential long-term effects from concussions, which is knowledge we didn’t have before. We’re starting to realize that with concussions, even if someone is asymptomatic, there can still be effects present in the brain that are long-lasting. This is important to know and treat seriously.”

As a followup to this novel research on concussions, Churchill and Schweizer are working on new studies that serve to examine the brain over a longer timespan.

The research was supported by the Canadian Institutes of Health Research and the Canadian Institute for Military and Veteran Health Research, among others.

�鶹��Ƶ researcher develops mobile rehab tool to help concussion patients manage their recovery

noreen.rasbach — Wed, 02 Oct 2019 04:00:00 +0000

�鶹��Ƶ researcher develops mobile rehab tool to help concussion patients manage their recovery

noreen.rasbach Wed, 10/02/2019 - 00:00

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(photo by SDI Productions/Getty Images)

Topic

Faculty of Kinesiology & Physical Education

Health

UTEST

Individuals suffering from a concussion who lack the resources, time or knowledge to handle their condition expertly will soon have access to a low-cost path to recovery.

Michael Hutchison, an assistant professor at the University of Toronto's Faculty of Kinesiology & Physical Education, has developed a mobile rehabilitation tool called RHEA, after the mother of Olympian gods and goddesses.

The mobile tool, developed with support from UTEST, a �鶹��Ƶ program that helps to commercialize research, draws on Hutchison’s clinical and research experience. He has found that starting graded aerobic exercise early following concussion can speed up recovery and improve functional outcomes – more than just resting.

“Despite such evidence, there still remains a lack of awareness and education regarding the initial medical management of concussion,” says Hutchison, who is director of the concussion program at the David L. MacIntosh Sport Medicine Clinic.

“The situation is further complicated by the fact that appointments with physicians and specialists occur approximately every one to two weeks, leaving patients at times to navigate and manage their symptoms without having the required knowledge or skills to do so.”

RHEA is an app designed to assist patients with their concussion recovery (images provided by Michael Hutchison)

He believes mobile health technologies or apps have the potential to help fill this void, as they are well-suited to serve as platforms for the self-management of various health conditions.

“They are ubiquitous, have great computational capabilities and are commonly carried on the person. RHEA will utilize these benefits through novel machine learning algorithms that will leverage user-reported feedback, as well as data acquired from the wearable technology, to provide users with recommended, personalized exercise programs over a three- to five-day period to assist with the rehabilitation process.”

What is unique about RHEA is that it is not a static system, another implication found in its name, which etymologists say means to ground and flow, much like what patients are required to do when navigating the road to recovery.

“Although RHEA’s starting point is grounded in well-established empirical evidence and clinical guidelines, moving forward RHEA will benefit from the environment of Big Data,” says Hutchison, “and as the community of people using the app grows, we will leverage that feedback to fine-tune the exercise prescriptions for a wide variety of people and profiles.”

Hutchison is looking forward to having the app available on both Apple and Android devices in the new year, following beta testing that is currently underway. Down the road, the plan is for RHEA to be tailored to health conditions beyond concussion, including post-traumatic stress disorder, depression and anxiety.

“The benefit of structured and individualized exercise is a very promising, low-risk and cost-effective intervention,” says Hutchison.

�鶹��Ƶ researcher calls for end to ‘bedroom jail’ with new pediatric concussion guideline

Christopher.Sorensen — Wed, 11 Sep 2019 17:11:08 +0000

�鶹��Ƶ researcher calls for end to ‘bedroom jail’ with new pediatric concussion guideline

Christopher.Sorensen Wed, 09/11/2019 - 13:11

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Nick Reed, an associate professor in �鶹��Ƶ's department of occupational science and occupational therapy, played a leading role in developing a publicly available guideline on how best to treat and manage concussions in youth (photo by Gabrielle Giroday)

Topic

Research & Innovation

Children and youth who experience concussions shouldn’t be limited to bed rest for weeks after they are injured, says a University of Toronto concussion researcher.

Dr. Nick Reed, who joined the Faculty of Medicine’s department of occupational science and occupational therapy in August as an associate professor, has played a leading role in developing a publicly available guideline on how best to treat and manage pediatric concussions.

The first-of-its kind guideline – known as the Living Guideline for Diagnosing and Managing Pediatric Concussion – was created in Ontario with the input of more than 40 researchers and clinicians from across North America. It contains 60 recommendations that health-care professionals and parents can use to help children and teens navigate their recovery following a concussion, including a call to end what Reed and other researchers refer to as “bedroom jail.”

“In the past, it was recommended that children and adolescents with a concussion should rest completely, with no sports, no school, no friends, no screens, no activity at all – essentially locked in the bedroom, until they no longer had symptoms related to their concussion. Once symptom-free, they could then gradually return to activities,” Reed says.

“We now know, and the guideline recommends, that complete rest for too long after a concussion does more harm than good.”

Reed adds that it’s important to take a balanced approach when it comes to concussion recovery.

“After resting for 24 to 48 hours after a concussion, it is important that children and teens gradually resume activities – even if they are experiencing post-concussion symptoms – like trying to read, going for a walk with friends or even getting back in the classroom with supports in place. These are all activities that can help recovery,” he says.

“That being said, if the activity a child or teen is doing significantly worsens their symptoms, it should be stopped. Injured youths should also stay clear of activities that pose a risk of a repeated concussion, like sports or rough play. And, they should continue to avoid those activities until the symptoms have fully resolved and they have medical clearance to resume.”

Reed and Dr. Roger Zemek, a senior scientist at the CHEO Research Institute, a physician in the division of pediatric emergency medicine at the Children’s Hospital of Eastern Ontario and an associate professor at the University of Ottawa, led development of the guideline.

Reed and Zemek started developing the guideline in 2017, when Reed was a senior clinician scientist at the Holland Bloorview Institute and co-director of the Holland Bloorview Concussion Centre. The Ontario Neurotrauma Foundation initiated and funded the creation of the guideline.

Reed says there has been a dramatic increase in the number of pediatric concussions reported to health-care providers, which could be due to greater awareness about the injuries.

“Now, more than ever, children and adolescents and their families are seeking care for concussion. They need help, they want help, and as the health-care professional community, we need to give them help,” he says.

“In order to provide that, we need to make sure we’re practicing in the most evidence-based way possible, using the great amount of research that’s been produced in the last 10 years to apply to clinical practice. So, to do that, we can use a clinical practice guideline like the guideline we’ve created.”

The creation of the guideline involved researchers from across in North America. They reviewed more than 300 articles, published from 2013 onwards, to distil the top advice.

The researchers met in Toronto for a two-day meeting in October 2018, where they crafted new recommendations that updated prior findings.

The guideline is unique because it will be continually updated to incorporate the latest research, says Reed. He adds that if new research shifts a recommendation or changes clinical practice, the guideline will be updated immediately.

“We want it to be living so that it is never out of date,” he says.

“The goal of this guideline is to make sure that health-care professionals have the best evidence to inform their care when supporting kids with concussion. And, we want to make sure that the newest evidence and research is included in their practices. So, we call this a living guideline because it lives on.”

Ontario launches concussion awareness campaign at �鶹��Ƶ event

Christopher.Sorensen — Tue, 11 Jun 2019 16:14:16 +0000

Ontario launches concussion awareness campaign at �鶹��Ƶ event

Christopher.Sorensen Tue, 06/11/2019 - 12:14

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Sandhya and Swapna Mylabathula, dressed to support the Raptors, pose with Gordon Stringer, Eric Lindros and Ministers Michael Tibollo and Lisa MacLeod (photo by Jelena Damjanovic)

Topic

Faculty of Kinesiology & Physical Education

Faculty of Medicine

Goldring Centre

Graduate Students

The Ontario government has a simple message for amateur athletes, children and youth: If you’re hit, stop and sit.

The message is part of a concussion awareness campaign unveiled Monday at the University of Toronto, where researchers have conducted significant research into the issue of concussions in sport and have helped influence policies aimed at their prevention.

The campaign is tied to Rowan’s Law, a piece of concussion-safety legislation that Ontario passed unanimously in 2018 and is named after Rowan Stringer, a 17-year-old rugby player from Ottawa who died after suffering a fatal concussion.

“The Ontario government is protecting amateur athletes by raising awareness about concussion safety,” said Michael Tibollo, the province’s minister of tourism, culture and sport.

“Concussions happen, unfortunately, but knowing what to do if a concussion happens – whether you’re an athlete, a student, a parent, a coach, an official or an educator – can save lives.”

Tibollo was at �鶹��Ƶ’s Goldring Centre for High Performance Sport for the official launch of the campaign. He was joined by Lisa MacLeod, the minister of children, community and social services who sponsored Rowan’s Law, Rowan’s father Gordon Stringer and hockey hall of famer Eric Lindros, who is a concussion awareness advocate.

Following the announcement, Tibollo toured the David L. MacIntosh Sport Medicine Clinic, housed on the fourth floor of the Goldring Centre overlooking Varsity Stadium. The clinic has been treating sport-related injuries, including concussions, for over 80 years and benefits from the expertise of staff and faculty, including Doug Richards, the clinic’s medical director and staff physician, as well as an assistant professor in �鶹��Ƶ’s Faculty of Kinesiology & Physical Education (KPE), Michael Hutchison, director of the clinic’s concussion program and a KPE assistant professor, and Lynda Mainwaring, an associate professor at KPE who studies the psychological impact of concussions.

The new provincial awareness campaign includes a video featuring a young athlete who keeps taking hits to the head during soccer games and eventually collapses on the field. It’s followed by the message: “Don’t risk everything.”

The ad has been playing in cinemas across Ontario and aired during Monday night’s NBA Finals game between the Toronto Raptors and the Golden State Warriors, which drew a record TV audience.

“I am so proud to lend my voice to raising awareness about concussion safety,” Lindros, who experienced the effects of concussion first hand, said in a statement.

“Rowan’s Law is using the slogan ‘Hit-stop-sit’ to encourage kids to stop and sit it out when they get hit in a game. No one should play through a potential concussion.”

The Rowan’s Law awareness campaign encourages coaches, parents and players to move away from a culture that glorifies “warriors” who jump back in the game too soon after a concussion, urging them instead to recognize the serious nature of concussions and the time that is required to treat them.

Sandhya Mylabathula, a PhD candidate in the exercise science program at KPE, and her twin sister Swapna, who is pursuing a PhD degree in the Faculty of Medicine, were consulted on an Ontario policy on concussions that was implemented in public schools and was a precursor to Rowan’s Law.

“There is so much that we can do for mandatory prevention, diagnosis and awareness and seeing some of our recommendations show up in Rowan’s Law is both exciting and timely,” said Sandhya.

“I think it’s great that we have an awareness campaign that’s going to be reaching so many people in all sorts of ways – through video, print and social media. Concussions affect everyone and any awareness helps,” added Swapna.

Other �鶹��Ƶ researchers who have made significant contributions to concussion research and policy include Michael Cusimano, a professor in the department of surgery who has been raising awareness about the severity and prevalence of concussions in sport for more than a decade, and Charles Tator, a professor of neurosurgery and director of the Canadian Concussion Centre.

Professor Ira Jacobs, dean at KPE, said he was keen for the faculty to host this event because it exemplifies what all universities should aspire to do.

“That is to expose students to cutting-edge knowledge generated by scientists, but also to teach them to be leaders – to actually apply that knowledge, so that society can make informed choices about policy,” he said.

“What you have done collectively to inform society and to make real change is something deserving of our gratitude.”

Twin sisters go from lab to legislature in their fight against concussions

geoff.vendeville — Fri, 12 Apr 2019 04:00:00 +0000

Twin sisters go from lab to legislature in their fight against concussions

geoff.vendeville Fri, 04/12/2019 - 00:00

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“They have achieved status and credibility in the concussion field, especially as related to policy,” says concussion expert Dr. Charles Tator about �鶹��Ƶ students Sandhya and Swapna Mylabathula (photo by Geoffrey Vendeville)

Geoffrey Vendeville

Topic

Our Community

Concussion

Faculty of Kinesiology & Physical Education

Faculty of Medicine

Graduate Students

Health

Research & Innovation

The reason for identical twins Sandhya and Swapna Mylabathula’s visit to Parliament was no joke – even if they were carrying a life-size brain made of Jell-O on April Fools' Day.

They were invited to speak to a subcommittee on sports-related concussions, part of a roster of witnesses including top sports scientists and hockey legends like Eric Lindros and Ken Dryden.

“Concussions are a growing problem in Canada,” Swapna told MPs while she held up a graphic showing an increase in concussions among youth. “This represents a lot of sport concussions. This is just the tip of the iceberg. It truly is a public health problem.”

The sisters have been studying concussions since their undergraduate years in biology and nutritional sciences. For just about as long, they have also pushed for better policy on concussions, which affect one in 10 Ontario students. In Canada, about 46,000 concussions were diagnosed among youth up to age 19 by hospital emergency departments in 2016-2017.

Concussions are caused by a hit to the head or body that makes the brain move inside the skull. They can lead to symptoms ranging in severity – dizziness, headaches, seizures – and can be fatal.

At the subcommittee meeting, a few legislators shared their personal concussion stories – about being body-checked in hockey when they were young or knocked off their bikes on the way to work.

Sandhya and Swapna found an enthusiastic audience for their recommendations: incentives encouraging a culture shift within sport to reduce risks of concussions, a national research centre on concussions and a national concussion awareness week.

Minister of Science and Sport Kirsty Duncan and Swapna and Sandhya Mylabathula on their visit to Parliament in April (photo courtesy of Sandhya Mylabathula)

Neither of the sisters has had a concussion, but they have seen plenty as long-time hockey and Toronto Maple Leafs fans. In a TedX talk, they explain that their interest in the subject started around the time Paul Kariya – a gold medallist in hockey with Team Canada in 2002 – cut his career short due to repeated concussions.

Then there were even fewer resources in place for concussion sufferers, no strategy and little awareness, the sisters recalled in an interview with �鶹��Ƶ News. They explained their reason for getting involved in advocacy, often finishing each other’s sentences.

Sandhya: “We saw this gap and thought: Someone’s got to do something.”

Swapna: “We can try.”

Sandhya: “Why not?”

Their visit to Parliament this spring wasn’t their first experience in policy-making. Years ago, they worked with their member of Parliament, Kirsty Duncan, now the minister of science and sport, on a bill to develop a pan-Canadian strategy on concussions. Sandhya and Swapna gathered thousands of signatures in support of the proposal, from their own Etobicoke riding to Prince Edward Island and British Columbia. Although the bill hasn’t become law, some of its elements are still being discussed in committee today.

The twins were also consulted on an Ontario policy on concussions that was implemented in public schools and was a precursor to Rowan’s Law, concussion-safety legislation passed in 2016. Its namesake, Rowan Stringer, was just 17 when she died on Mother's Day, after suffering what proved to be a fatal concussion in a rugby game.

Dr. Charles Tator, a professor of neurosurgery in the Faculty of Medicine and director of the Canadian Concussion Centre, is Swapna’s supervisor as she works toward her MD-PhD at �鶹��Ƶ, but he knows both sisters through their advocacy. In her research, Swapna is evaluating Ontario’s policy on concussions in public schools before Rowan’s Law. Sandhya is a PhD candidate in the Faculty of Kinesiology & Physical Education and a fellow in public health policy with the Canadian Institutes of Health Research. She's researched concussion risk factors, policy, education and sex and gender considerations, among other things.

“They have achieved status and credibility in the concussion field, especially as related to policy,” Tator told �鶹��Ƶ News.

The total number of concussions in Canada across all ages is as large as 200,000, according to some estimates. And about a quarter of people experience symptoms beyond one month, Tator says. “Some are unlucky enough to have symptoms be lifelong,” he added, “so this is an important condition. It’s a big health-care problem.”

“These sisters certainly have my admiration and my support,” he said. “I think it’s great they’ve taken up the cause and I hope they continue.”

Risk of suicide twice as high among those who sustained concussion: �鶹��Ƶ-led study

noreen.rasbach — Mon, 19 Nov 2018 15:25:08 +0000

Risk of suicide twice as high among those who sustained concussion: �鶹��Ƶ-led study

noreen.rasbach Mon, 11/19/2018 - 10:25

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“It is important to note that the vast majority of people who have a concussion do not experience a suicide-related outcome, and I do hope that is reassuring to people,” says Dr. Michael Fralick (photo by Ben Hershey via Unsplash)

Topic

Research & Innovation

A new study by researchers at the University of Toronto and other universities is highlighting the association between concussions and the risk of suicide. The study, published in JAMA Neurology, found that the risk of suicide is twice as high for people who had at least one concussion compared to those who had not.

Dr. Michael Fralick, a general internist and trainee in the department of medicine’s Eliot Phillipson Clinician Scientist Training Program, led the research team that conducted a systematic review and meta-analysis of several other studies that explored the association between suicide and concussion. They found there was a heightened risk of both suicide and suicidal ideation following a concussion or other forms of mild traumatic brain injury (TBI).

Growing up playing contact sports like hockey, soccer and rugby, Fralick saw many of his friends sustain concussions. He also observed mounting reports of athletes who died by suicide following concussions and brain injury. Skeptical at first of the association between concussion and suicide, Fralick and his team decided to study the topic.

The research team – including researchers from University of Saskatchewan, University of California, San Diego, Harvard University and Ohio State University – reviewed data from 17 studies for more than 700,000 people diagnosed with concussion or mild TBI. Most of the studies included did not differentiate between the number of concussions an individual sustained and their respective rate of suicide risk.

“There were a few studies that included the number of concussions, and they suggested that multiple concussions were associated with an even higher rate of suicide-related outcomes,” says Fralick (pictured left).

Fralick emphasizes that although people who have experienced a concussion are at a heightened risk of suicide and suicidal ideation, the reported rate of death by suicide was extremely low at less than one per cent.

“It is important to note that the vast majority of people who have a concussion do not experience a suicide-related outcome, and I do hope that is reassuring to people,” he says.

The study contributes to a body of research that explores the outcomes and side-effects of concussions and TBIs. Noting that concussions are both common and frequently preventable, Fralick says more research is needed to address the risk of suicide following concussions and to identify strategies to reduce this risk.

“The burden of preventing concussions needs to be shared with policy-makers and professional organizations,” says Fralick. “It is encouraging to see athletic organizations have raised the age for some contact sports and implemented concussion policies to ensure athletes are removed from play if they have a suspected concussion.”

Individuals who have sustained a concussion and are experiencing anxiety and depression are urged to seek medical attention.

For those who play contact sports, Fralick adds: “Wearing a helmet and using a mouthguard can help reduce the risk of concussion. If someone has a concussion, it’s really important to rest, stay hydrated, and avoid alcohol.”

This Mother's Day, know the symptoms of concussion

noreen.rasbach — Thu, 10 May 2018 14:42:37 +0000

This Mother's Day, know the symptoms of concussion noreen.rasbach Thu, 05/10/2018 - 10:42

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The changes in the brain from a concussion do not appear on conventional imaging tests such as CT scans or MRIs, nor are there any other tests to diagnose a concussion (photo by Shutterstock)

Topic

Research & Innovation

The Conversation

Subheadline

The Conversation with �鶹��Ƶ's Carmela Tartaglia, a cognitive neurologist and concussion researcher

A bump on the head. And then another. That’s all there was to it. Yet, Mother’s Day 2013 would change one mother’s life. Her daughter Rowan Stringer, a high school rugby player with her whole life ahead of her, died after sustaining multiple concussions in the span of a few days.

Second-impact syndrome, the cause of Rowan’s death, is rare. However, persisting symptoms after concussion – also known as post-concussion syndrome – are more common and can have devastating effects on people’s lives.

Rowan’s parents envisioned a world where this happens to no other family. They petitioned for more education on concussions, for better surveillance and for improved return-to-learn and return-to-play practices.

On March 7, concussion safety legislation known as Rowan’s Law was passed by the Ontario legislature, compelling sport organizations across the province to take concussions seriously.

As a cognitive neurologist and concussion researcher with the Canadian Concussion Centre at Toronto Western Hospital who sees people with brain diseases, I believe Rowan’s Law is a necessary, important step that will help protect the young athletes of Ontario.

However, all its recommendations highlight the need for better understanding, detection and management of concussions. We must admit there is a lot we do not know.

This law should also have more widespread ramifications. People of all ages can suffer concussions. Many do happen in the context of sport. But many are the consequence of motor vehicle accidents, trauma, domestic violence and falls.

Symptoms of a brain injury

Until recently, concussions were considered trivial incidents, not worthy of medical attention. We now know that the symptoms that accompany concussions are the result of a brain injury.

The changes in the brain from a concussion do not appear on conventional imaging tests such as CT scans or MRIs; nor are there any other tests to diagnose a concussion.

But we know that these changes can cause symptoms such as headache, dizziness and unsteadiness, as well as changes in mood, concentration and memory.

Concussions: 10 things you may not know

Although most people recover from a concussion, 10 to 15 per cent can develop persistent symptoms lasting months or years.

This can have profound effects on school, work and relationships. These consequences from head injury can make return to one’s life difficult, and in some cases impossible, as not everyone recovers.

I am always amazed that most people realize that memory, attention, language, movement and such activities are functions of the brain but don’t understand it is also responsible for mood, love, judgment and the like.

The idea that someone who has been concussed is in the best position to know whether they should continue to play or not reflects our poor understanding of brain function. A concussion that causes headache or poor memory is also likely to impair other aspects of behaviour.

The long-term effects of multiple concussions and the long-term risk of developing a neurodegenerative disease in the form of chronic traumatic encephalopathy (CTE), is now being recognized by the medical community.

Mandatory concussion education

Rowan’s Law imposes requirements on sports organizations. These are all geared towards recognizing a concussion and avoiding repeat concussion while an individual is still recovering.

Rowan’s Law, Concussion Legislation requires:

Medical clearance of a concussed athlete before they return to play.
Mandatory concussion education for young athletes, parents and coaches.
The immediate removal of a young athlete from play if a concussion is suspected.
Strict adherence to return-to-learn and return-to-play protocols for youth athletes with concussions.

Thanks to the Stringers’ tireless advocacy, it will not be up to the athletes to decide whether to pull themselves out, or put themselves back, into a game after a concussion.

The law mandates that coaches and others responsible for young athletes are educated about concussion and take action when they suspect one has occurred.

You only have one brain

Currently, we have no methods to detect concussions. There is no marker of persistent concussion symptoms and so we have no way to predict the length of recovery. And we do not know what predisposes someone to persistent concussion symptoms.

We also have no treatments that are specific for concussion and so we borrow ideas from other areas without much evidence.

We still do not even know what happens to the brain to cause a concussion and all its symptoms. Answering this last question is essential to move us toward treatments.

Although Rowan’s Law focuses on young athletes, people of all ages can suffer concussions. These can occur as a result of motor vehicle accidents, trauma, falls, domestic abuse and many other types of incident. Many concussions happen outside the context of sport.

Protecting one’s brain from concussion, appropriate treatment of concussion and importantly, prevention of further concussions, should be on everyone’s agenda.

You only have one brain, it defines who you are – when it changes you change. Multiple concussions can permanently change the brain and result in grave consequences for you, those around you and, most of all, your loved ones.

Carmela Tartaglia is a clinician-scientist at the University Health Network and an associate professor at the University of Toronto

This article was originally published on The Conversation. Read the original article.

Starting aerobic exercise soon after concussion improves recovery time, �鶹��Ƶ study finds

noreen.rasbach — Thu, 19 Apr 2018 16:19:00 +0000

Starting aerobic exercise soon after concussion improves recovery time, �鶹��Ƶ study finds noreen.rasbach Thu, 04/19/2018 - 12:19

Cutline

Exercising on stationary bikes at �鶹��Ƶ's David L. MacIntosh Sport Medicine Clinic, located in the Goldring Centre for High Performance Sport (photo courtesy of the Faculty of Kinesiology & Physical Education)

Jelena Damjanovic

Topic

Our Community

Concussion

Faculty of Kinesiology & Physical Education

Global

Research & Innovation

A new study from the University of Toronto’s Faculty of Kinesiology & Physical Education has found that starting aerobic exercise sooner rather than later after a diagnosed concussion contributes to a faster recovery and return to sport, school and work.

The study, published in the journal PLOS ONE, supports the view that aerobic exercise is safe and potentially protective in symptomatic individuals.

“We knew aerobic exercise had a positive influence in other conditions that affect the brain (such as depression, stroke and cognitive impairment) and in cases of persistent symptoms following concussion. However, only a couple of studies previously examined aerobic exercise in the acute period, and none as early as we did,” said Dr. David Lawrence, staff physician at the David L. MacIntosh Sport Medicine Clinic at �鶹��Ƶ and principal author of the study.

So, how soon after a concussion is it safe to start doing aerobic exercise? Lawrence says the study, which followed the recovery of 253 people between the ages of 15 and 20, has shown that some individuals benefit from starting low-impact, aerobic activity as early as 24 hours after injury.

For each successive day of delaying the start of aerobic exercise, individuals had a less favourable recovery trajectory, according to the study. Initiating aerobic exercise at three and seven days following injury was associated with a reduced probability of 36.5 per cent and 73.2 per cent respectively of a faster full return to sport, and a reduced probability of 45.9 per cent and 83.1 per cent respectively of a faster full return to school and work.

“Historically, concussion management was based on a simple recipe of rest until your symptoms go away. However, what we have realized is that in many people symptoms take time to resolve and prolonged periods of rest may have a negative impact because rest was interpreted as no activity in sport, school, work, screen and social activities," said Michael Hutchison, director of the concussion program at the MacIntosh clinic and co-author of the study.

“We still believe that a brief reduction in activity from normal levels is beneficial," he said. "However, we recommend maintaining activity levels that do not exacerbate symptoms in the acute period.”

Read the research in the journal PLOS ONE

Lawrence suggests initally doing low-impact aerobic exercise with minimal head movement, such as stationary cycling, elliptical and walking. Jogging and swimming are not recommended at this stage as they involve greater head movement.

“Exercise recommendations should be individualized based on the clinical assessment, but we feel the intensity of aerobic exercise should begin with low-intensity (you should be able to have a conversation with someone as you exercise) and should not worsen the symptoms,” says Lawrence.

The results of this study did not observe a different recovery pattern between men and women. However, a history of concussion, higher symptom burden and loss of consciousness were associated with a prolonged recovery.

The scientists recommend any exercise plans prescribed by physicians following an injury such as a concussion should include recommendations about when to start exercise post-injury, in addition to the customary recommendations about the frequency, intensity and type of exercise.

The study’s co-authors include Doug Richards, an assistant professor in the Faculty of Kinesiology & Physical Education, and Paul Comper from the Toronto Rehabilitation Institute, University Health Network.

�鶹��Ƶ's Dr. Charles Tator on his fight for concussion prevention

rasbachn — Thu, 24 Aug 2017 17:22:12 +0000

�鶹��Ƶ's Dr. Charles Tator on his fight for concussion prevention

rasbachn Thu, 08/24/2017 - 13:22

Cutline

Dr. Charles Tator: "It became clear to me that the only uniformly effective treatment for major injuries is prevention" (photo by Keith Beaty/Getty Images)

Topic

“When I was a boy I was obsessed with sports.”

So begins Dr. Charles Tator’s first-person account for CBC Sports on his love of playing hockey growing up (“I was not a star but I had a great time”), his work as a brain and spine surgeon specializing in trauma (“I learned first-hand that the sports I loved could put a player in a wheelchair for life”) – and his advocacy of concussion prevention (a different kind of “team sport” that he says has to involve athletes, their families, coaches, teachers, referees and leagues).

Dr. Tator, a professor of neurosurgery at University of Toronto's Faculty of Medicine and director of the Canadian Concussion Centre, writes about working, through the injury-prevention organization Parachute Canada, on the federal government’s new push to harmonize concussion guidelines for all the country’s sports so that the messaging to athletes and their families will be “more uniform and more effective.”

He also speaks about his thrill of being inducted this year in Canada’s Sports Hall of Fame for his role in injury prevention. “It was my greatest sports achievement because in electing me, Canada’s Sports Hall became a member of my sports injury prevention team.“

Concussion

Pianos, exercise bikes and more: Inside the Faculty of Kinesiology & Physical Education research labs

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�鶹��Ƶ researcher develops mobile rehab tool to help concussion patients manage their recovery

�鶹��Ƶ researcher calls for end to ‘bedroom jail’ with new pediatric concussion guideline

Ontario launches concussion awareness campaign at �鶹��Ƶ event

Twin sisters go from lab to legislature in their fight against concussions

Risk of suicide twice as high among those who sustained concussion: �鶹��Ƶ-led study

This Mother's Day, know the symptoms of concussion

Symptoms of a brain injury

Mandatory concussion education

You only have one brain

Starting aerobic exercise soon after concussion improves recovery time, �鶹��Ƶ study finds

Read the research in the journal PLOS ONE

�鶹��Ƶ's Dr. Charles Tator on his fight for concussion prevention

Read Tator’s essay on CBC Sports