What exactly is a concussion?
A concussion, or mild traumatic brain injury (mTBI), often happens when the brain is exposed to excessive forces. This can happen from a direct blow to the head, face, neck, or chest, as well as an indirect blow elsewhere of the body causing a jarring to occur in the head. This may or may not involve a brief loss of consciousness. Concussions are often short-lived and can often go unnoticed, as they can affect you very differently from someone else. This often makes them difficult to detect and to ultimately treat. Symptoms may be immediate, or take minutes to hours to develop. Normally, imaging studies (i.e. MRI) do not show anything to concretely diagnose a concussion such as a hemorrhage making concussion further difficult to diagnose. However, guidelines for diagnosing concussion early on are available, and when applied by trained professionals, can improve your ability to access care quickly and regain your normal life ultimately returning you to school, play, work and life in a safer manner.
Concussions present very differently between people, and also very differently in children than adults, or in athletes. It is important to recognize that concussions are not bias to race, gender, age or socio-economic status and they can happen to anyone, but are common in:
car or work accidents
'We know that about 80% of people who have a concussion will recover completely within 4-6 weeks. However, about 15-20% of people may go on to have persistent symptoms, and a recent Canadian study found that 30% of children and youth age 5-<18 years are still symptomatic 30 days after their concussion.'
(Taken from https://www.osla.on.ca)
What are the signs and symptoms of concussion?
Often patients who are experiencing a concussion, or post-concussion symptoms describe changes in physical, emotional and cognitive abilities, including:
trauma with or without loss of consciousness prior to symptoms up to 4 weeks after
3 or more of the following:
vision sensitivity/changes to vision
ringing in the ears/tinnitus
trouble sleeping/increased sleeping
difficulty following directions
difficulty remembering information
difficulty word finding
difficulty with social skills
disinterest in/withdrawal from social activities/pursuits
executive functions difficulty (organizing, deducting, planning, sequencing)
feeling 'slowed down' or having 'brain fog' or being 'dazed'
So how is Concussion Care NorthWest (CCNW) different and how can it help me, or my family?
Well, the first part in answering this question is that we are the only concussion management program in NorthWestern Ontario that offers our unique approach, which is rooted in current research, education and rapid communication. Our approach provides you with an individualized, unique, 1-on-1 and face-to-face experience with an interdisciplinary team that provides you with a single point of access to trained:
Certified Sports Medicine Physician
Our approach is two-tiered, and geared towards screening those at risk of having a concussion, as well as those who are now injured and needing care. CCNW provides services for:
Pre-Concussion screening for individuals, and teams/groups, based on current, research-based guidelines of physical and cognitive abilities. This allows rapid communication between you and your current health providers and/or team, guided by your PT and SLP from the program.
Post-Concussion care for those who have experienced a concussion early on, or who have been struggling for some time following a concussion. Post-concussion care typically involves detailed assessment by a Certified Sports Medicine Physician to determine the appropriate path for your care. Following this, involvement of your current health care providers, or our interdisciplinary team (Sports Medicine Physician, Physiotherapist and Speech-Language Pathologist) at CCNW is rapidly organized in order to start helping you to recover and achieve your return to school, play, work and life goals.
Often a required component of recovery from concussion involves specific physical and cognitive re-training including vestibular assessment and treatment. Our therapists are trained extensively in vestibular rehabilitation, as well Infrared Video Frenzel assessment, Capnography evaluation and cognitive communication which may be utilized along your recovery.
CCNW is founded on evidence-based guidelines, a diverse interdisciplinary health care team, and rapid response following injury. But overall, it is founded based on YOU as the patient and your plan of care becomes as unique as your life or goals are. We are proud to be your “missing link” to concussion screening and recovery after concussion and our goal is to help you successfully return to school, play, work and most importantly life. Contact us today to inquire about our services and to book your consultation. Wishing you all the best in your goals!
-- Work Hard, Play Smart and Live Safe! --
What is normal to expect when I’m treated?
Assessment and treatment following a concussion often involves addressing any depression, anxiety or irritability, as well as improving the quality of your sleep and managing any post-injury headache. It is important to have these things addressed early on, rather than waiting to see if they go away on their own.
Secondly, trained professionals with extensive knowledge and experience managing concussion will provide you with specific activities to improve your balance, reduce your dizziness/vertigo, reduce any cognitive changes, fatigue and/or sensitivity to noise, as well as provide you with a very strategic plan of care. Treatment normally involves a “team” approach between a medical doctor as well as physiotherapists (PTs) and speech-language pathologists (S-LPs) to assess and treat physical and cognitive communication abilities and other professionals who are trained in concussion care to .
Why would I see a Speech-Language Pathologist if I play a sport?
Playing sports is a very dynamic and fast paced experience. Your brain is constantly taking in visual and auditory information and having to process it immediately. As soon as one piece of information is processed, another has already started. Combine this with having to understand rules, team plays/systems, routines, and other dynamics that each individual sport entails, cognitive communication is at the essence of every single aspect of sports. If you cannot process, understand or communicate in an effective and safe manner, many if not most sports can put you at increased risk of suffering a concussion.
A speech-language pathologist (S-LP) can help you by assessing your symptoms relating to your communication (e.g. listening, understanding, following conversations, speaking, thinking of what to say, reading, writing) and cognition (thinking and slowed thinking, or processing information).
They provide direct therapy to help manage these symptoms and develop strategies to help you cope.
S-LPs can and do help to address the functional impact of concussion such as the Return to School and Return to Learn process, Return to Work, Return to Play and also with Social Communication (e.g. turn taking, unfiltered comments, changes in personality including irritability, short fuse etc, as well as things like being able to think on your feet, and responding quickly in conversation).
S-LPs can and often do work as part of a multi-disciplinary concussion management team.
What are Cognitive Communication Disorders?
‘Cognitive Communication Disorders’ is a term used to describe a set of communication features that result from underlying deficits in cognition. Communication difficulties can include issues with hearing, listening, understanding, speaking, reading, writing, conversational interaction and social communication. These disorders may occur as a result of underlying deficits with cognition, that is: attention, orientation, memory, organization, information processing, reasoning, problem solving, executive functions, or self-regulation (ASHA 2005; Ylvisaker & Johnson Greene, 2004; Turkstra et al., 2002; Kennedy et al., 2008). Acquired Cognitive Communication Disorders are distinct from other neurological communication disorders. Etiologies from which Cognitive Communication Disorders may arise include concussion and brain injury. (taken from: http://www.caslpo.com)
Do you use IMPACT or other computer based testing?
No. CCNW has developed a service delivery model that does not use IMPACT or other computerized based assessment and concussion management programs. We have strategically developed an interdisciplinary model built on the foundation of research and evidence based approaches, in combination with a team approach relying heavily on communication, rapport, personal relationships and the extremely important face-to-face experience while providing extensive knowledge and experience of neurorehabilitation and concussion management. We believe this approach will allow our team to truly know YOU and YOUR unique and individual abilities, assisting us in developing an individualized concussion care program for your specific needs.
"We therefore question the rationale of using ImPACT for clinical management of sport-related concussion and specifically for determining the time of return to play"
(Taken from: Computerized Tests For Concussions May Be Unreliable, February 2, 2012, Nancy Shute;
"We conclude that the empirical evidence does not support the use of ImPACT testing (a popular computer-based concussion test) for determining the time of post-concussion return to play"
Mayers et al. Journal of Clinical and Experimental Neuropsychology, 2012
"We found variable test-retest reliability for ImPACT metrics....Our current data support a multifaceted approach to concussion assessment using clinical examinations, symptom reports, cognitive testing, and balance assessment"
J Athl Train. 2013 Jul-Aug; 48(4): 506–511. ImPact Test-Retest Reliability: Reliably Unreliable?
"Computer-based concussion evaluations did not provide stable measures of cognitive functioning. Inconsistent performance on concussion assessments may lead clinicians to inaccurate determinations of cognitive function"
Boglio et al., 2007
Why should my child and/or his/her teammates complete pre-concussion screening before his/her season?
If your child plays a high impact sport that places them at a greater risk of concussion we want to know as much as possible about their physical (movement, strength, balance, proprioception etc.) and cognitive (memory, executive functioning, thinking, reading, writing etc.) abilities when they are healthy and typically functioning. Research has shown that even without a confirmed concussion ‘event’, changes to brain function can occur throughout a high-impact sport season; therefore, it is important to complete a pre-concussion screening on an annual basis. In the event of a concussion occurring in season, this will allow our concussion care team a better understanding of their specific, unique and individualized pre-concussion abilities allowing us to develop a truly individualized treatment and return to school, play, work and life program.
'Remember, very few children will go on to play sports at an elite level but all children will require the use of their brains for the rest of their lives!' (Chad Clower, CCNW, 2017)
Ontario Neurotrauma Foundation, June 2014: Guidelines for Diagnosing and Managing Pediatric Concussions recommends 'baseline neuro-cognitive testing if the child/adolescent plays high-risk sports…to provide baseline information on children/adolescents who play high-risk sports in case they sustain a concussion [and] to assist with return-to-play decisions’.
Management of Sports-Related Concussion in Children and Adolescents states ‘under new recommendations, pre- and post- neuropsychological testing is considered the cornerstone of concussion management, return-to-play decision making, and diagnosis and management of the athlete who has experienced concussion’
Duff, July 2009
The pre- and post-testing allows comparison between the individual’s performance pre-injury and after a concussion. The goal is to individualize the decision-making process for return to play.’
Duff, July 2009
Is pre-concussion screening only for student athletes?
Absolutely not! Pre-concussion screening can be completed for all people and ages (4+). The information collected in the pre-concussion screening will be filed and stored at our clinic. In the event that you suffer a concussion in any setting or event (slip, fall, athletic competition, motor vehicle accident, assault etc), you will have your information readily available to allow your concussion care management team direct comparative data for analysis. We believe this is a very cost effective way to have comparative data to analyze in the event that you do suffer a concussion. This will allow our team to provide you with an individualized treatment plan and the best possibility for success. Just as your finger print is unique, so too are your individualized physical and cognitive abilities.
What sports put my child at risk of concussion?
There are obviously the well identified sports that we can quickly name ‘off-the-top-of-our-heads’ but there are many not-so-obvious sports that put your child at risk. The following is a list of sports/activities that put your child at greater risk of suffering a concussion:
Downhill mountain biking/competitive cycling
Racing - car, motorcycle
(*please contact us for any additions to this list)
What if my child has all ready suffered a suspected concussion (without medical confirmation) or confirmed concussion; is a concussion screening even useful?
Yes, especially if the concussion was not medically confirmed. No, we won’t be able to know exactly how your child presented prior to their first possible event but it will provide the much needed insight into their current abilities in the event that a future concussion occurs. Second-impact-syndrome (SIS) has been clinically researched and validated showing that a secondary concussion before the initial concussion has healed can result in life altering brain damage and even death. Furthermore, research has proven that multiple concussions can cause chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease occurring from a severe concussion or multiple concussions resulting in physical and cognitive decline.
'In my opinion, taking professional football players as a cohort, I think over 90% of American football players suffer from [CTE]. Over 90% of players who play to the professional level have some degree of this disease. I have not examined any brain of a retired football player that came back negative.' Dr. Bennet Omalu, neuropathologist
‘…as many as 15% of concussed athletes experience post concussion symptoms that do not resolve within a week, thus interfering with academic and sports-related performance’
Bernstein, 1999: Macleod, 2010
‘Reductions in cognitive performance have been reported in the following areas: verbal and visual memory (immediate and delayed recall), speed of information processing, impulse control, orientation, attention, and executive functions; with the most common persistent deficits occurring in verbal memory, speed of processing (i.e. reaction time) and attention.
Bruce & Echemendia 2009; Covassin, Stearne, & Elbin, 2008; Macciocchi, Barth, ALves, Rimel & Jane, 1996; McCrea, Iverson, Echemendia, Makdissi, & Raftery, 2013; Shatz, Padrini, Lovell, Collins, & Powell, 2006; Webbe & Barth, 2003
Can a concussion management program really help me?
Yes! Post-concussion syndrome can linger for weeks, months and even years if untreated resulting in physical and cognitive symptoms such as: headaches, light sensitivity, mood changes/depression, sleep changes, dizziness and cognitive decline (memory, word finding, executive functioning). It can and often impacts your ability to be successful at school, work, athletics, social relationships and overall day-to-day functioning. If you have gone ‘un-managed’ and it has been weeks, months or even years from your suspected or confirmed concussion and you are living with any signs and symptoms of concussion, it is important to seek assistance from health care providers with extensive knowledge and experience providing concussion care management. An individualized concussion care management program can not only have you feeling better reducing symptoms such as headaches, nausea and dizziness, it can also get you back to daily activities such as work, school, sports and leisure hobbies in a safe way ultimately improving your quality of life!
What if I do not know or understand enough about concussion to protect my child, do you provide education and training?
Yes! We offer workshops to children/players, parents, coaches, teachers, support staff, teams and associations that provide education and information regarding concussion, ultimately building capacity and awareness to the signs and symptoms of concussion. We truly believe that concussion management is a holistic process where all parties involved have a very important and equal role. We want you as the person or caregiver (student, athlete, teacher, coach, parent, friend etc) to understand how to identify the signs and symptoms of concussion and who to contact in the event of a suspected concussion but ultimately allow the health care professionals with extensive knowledge and experience to manage the concussion program.
If I suspect that my child or family member has suffered a concussion, what should I do?
Contact your family Physician or health care provider immediately. If your family Physician or health care provider is unavailable, assist your child or family member by accompanying them to the local Emergency Department. Often people suffering with a concussion may need your assistance to physically ambulate, as well as speak to provide historical or demographic/personal information. It is extremely important not to attempt to manage their symptoms by yourself by not contacting a medical professional. Lastly, it is important to seek professional health care from a trained concussion management program to ensure a safe return to school, play, work and life.
I have heard of Rowans/Stringers Law but what does it really mean?
It is legislation that was put into law (yes law) in Ontario basically stating that we need a very strategic protocol in managing concussion in youth and all sports. CCNW is pursuing and hoping to achieve exactly this! ‘Rowan's Law, which is largely based on international concussion guidelines established in Switzerland, will provide education on sport-related concussions to athletes, coaches and parents. It also aims to outline a framework for when to remove an athlete from playing higher-risk sports if a concussion is suspected, ensure athletes don't return to play until they're medically cleared to do so, and ensure appropriate return-to-learn and return-to-play strategies.
Other recommendations announced by the jury Wednesday after the 12-day coroner's inquest include:
• Requiring students and their parents to take a mandatory concussion awareness and management session before students are allowed to take part in higher risk youth sports, such as rugby and football. The session would include signs and symptoms of concussion, as well as how and when to return to play following injuries.
• Developing a way to track student concussion injuries to ensure proper treatment and clearer data.
• Adopting a zero-tolerance policy for head hits and high tackles in any level of rugby, with progressive penalties for repeat offenders including expulsion for repeat offenders.
• Determining an optimum, safe length of time between games and practices involving contact to lessen the risk of concussion and other injuries, particularly for athletes competing in more than one league.
• Creating an annual awareness and learning opportunity at all Ontario school boards, such as "Brain Day," to provide students consistent, up-to-date and accurate information.’ (Taken from: cbc.ca)
How do I contact you?
This is the only easy part about concussion and concussion management. You can contact us directly to book your pre-concussion screening and/or post-concussion assessment at:
Pre-Concussion Baseline Assessment
1 807 630 6884
1 807 344 5242
Also, you can have your Family Physician fax a referral to:
Pre-Concussion Baseline Assessment
1 807 285 9038
ATTENTION: CONCUSSION BASELINE ASSESSMENT REFERRAL
1 807 344 5242
ATTENTION: POST-CONCUSSION ASSESSMENT REFERRAL
Click on the icon below for the Physician's Referral form