August 2018
Moving From Confusion To Clarity 
About Traumatic Brain Injuries

There is considerable confusion about what constitutes a concussion or traumatic brain injury (TBI). 

The consequence is that young athletes with TBIs are remaining in certain sports too long. Their brain injuries worsen. This inappropriate behaviour by parents and coaches puts these young athletes at risk. 
Case Study:
                               
Elizabeth is a 12 year old elite hockey player. She is considered world class in her age category. 

Elizabeth has played in the boy's league for the last 3 years. She is very fast and gets to the puck before the boys. That makes her a target. The boys like to hit her. There have been multiple hits.

Now, Elizabeth has developed persistent headaches with visual symptoms. Her parents asked the team at RCM to assess the situation.
 Factoids About TBI:
                               
A growing body of evidence suggests that concussion, or mild traumatic brain injury (mTBI), in young individuals is an often unrecognized or overlooked, under reported, and inadequately treated problem in pediatric and adolescent neuroscience.

Effects of TBI can include impaired thinking or memory, movement, sensation (e.g., vision or hearing), or emotional functioning (e.g., personality changes or depression).

TBI results in a set of clinical symptoms that may or may not involve loss of consciousness.

Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged.
Microbleeds With TBI: 
                               
Cerebral microbleeds are common in mild traumatic brain injury (TBI). They are associated with worse neuropsychological performance. They can be detected with a simple magnetic resonance imaging (MRI) sequence called susceptibility-weighted imaging (SWI). Many experts suggest that SWI should be added to any MRI evaluation of a mild TBI patient.

SWI is a two- to three-minute sequence that is easily added to a standard MRI protocol. It is particularly sensitive and can detect microbleeds at an "almost microscopic level." Experts also suggest that 3 tesla MRI machines be used for diagnosing TBI. 
Stopping Hockey Because Of A TBI:     
                               
A young athlete will often experience a loss of identity, when hockey must be stopped because of concussion.

Some hockey players underwent a biographical deconstruction when they experienced post-concussive mental illness, which was amplified by isolation, stigma from peers, and lack of a clear life trajectory.

These players recovered from their trauma with professional support from care providers. 
Conclusion:
                               
Concussion or TBI are cumulative injuries. 

Many hits over time will result in a TBI. It does not require that the a young athlete be "knocked" out or become unconscious to have sustained a TBI. 

It is important that parents and coaches recognize the problem early. If the injury is severe, then the young athlete's activities should be redirected into non-contact sports.
 
BTW- Elizabeth stopped playing hockey and became a figure skater. 
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1-800-620-7551 or 647-350-5500
 
 
 
It all starts with a conversation.   We are always pleased to help.
 

           



           Raymond Rupert MD. MBA.
           Founder/Medical Director
           Rupert Case Management Inc.
           505 Eglinton Avenue West, Suite 203
           Toronto, ON M5N 1B1
           
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