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March 6, 2012, former Ontario
Education Minister, Laurel Broten, received the support
of all parties by introducing Bill 39, Education
Amendment Act (Concussions), 2012 to the
Ontario
legislature. The Act received first reading and was in
committee stage when parliament was prorogued and all
bills that had not reached second reading automatically
died on the table.
As
of March 19, 2013, when this article was written, we
were still awaiting the reintroduction of Bill 39 and
suggest that it must be given top priority. Everyone is
anxious to continue with the reviewing of the terms of
the legislation so that it can be passed through the
legislature quickly.
We now have very reliable proof that tens of
thousands of students attending elementary and secondary
schools in
Ontario
may be walking around with mild
traumatic brain injuries that place them at risk for
life-altering consequences from multiple concussions.
The most revealing evidence was included in a
special publication of the Ontario School Boards’
Insurance Exchange on concussions. The OSBIE provides
insurance coverage for almost all school boards in
Ontario
. Each school is required to maintain
incident reports to record the details of accidents and
injuries that are experienced by students.
During 2011, a total of 634 incident reports were labeled
as concussions or possible concussions. Of this, only
60%, or approximately 400 were sport-related. With
approximately 1 million students enrolled in Grades 7
through 12 alone, the fact that only 400 sport-related
injuries were labeled as concussions or possible
concussions is great cause for concern.
Experts from the medical field tend to agree that the
annual rate of concussions for sports like hockey,
football and soccer typically range from 15 to 20%. With
over 900 secondary schools in Ontario, many of which
offer competitive hockey, football and soccer programs
for both boys and girls, to see only 400 sport-related
incident reports labeled concussions or possible
concussions is a clear indication that this type of
injury is being grossly under reported or unidentified.
Consider still that aside from injuries
attributed to playing for school teams, students may
also receive concussions during physical education
classes, intramural sports and in pick-up games in the
school yard or at home, to say nothing about the number
of students who receive concussions while playing on a
minor sport team.
Representatives from St. Michael’s College, an
all-boy Grade 7 to 12 private school in
Toronto
, made a presentation about their
concussion management program during the OuCH! Outcomes
Following Concussion in Hockey 2012 Conference, which
was held at St. Michael’s Hospital on September 8,
2012. It was pointed out that during the previous year
they recorded 80 concussions out of the approximately
1000 boys who were enrolled in the school.
St. Michael’s College has such an effective program
that very few concussions go undetected, but other than
that, they are representative of most public and
independent high schools throughout
Ontario
. If we projected their rate of
concussions across the province, it means that we could
expect up to 80,000 sport-related concussions out of the
1 million students we have enrolled in Grades 7 to 12
alone. And yet we had less than 400 recorded incidents
during 2011.
Dr. Michael Czarnota, Ph. D., is the primary
consulting neuropsychologist for most of the Major
Junior leagues in
Canada
, including the OHL, the QMJHL, and the
WHL. He is also involved in the same capacity with the
CHL, the NOJHL, the EPHL and has worked with the
Women’s Hockey Association and Hockey
Canada
. Dr. Czarnota is concerned that if we do
not become more successful in identifying concussions
when they first occur, there is great danger that
student-athletes may suffer serious consequences from
multiple concussions because of their increased
vulnerability once the brain is in an injured state.
“To better understand what takes place in the brain
when you receive a concussion, just think of what
happens when you have a scab on your skin that forms
from a small cut. If you leave the scab alone and allow
it to heal, there shouldn’t be any remaining sign of
the original injury. However, if you pick at the scab it
may become larger or infected. Moreover, it will take
longer for the wound to heal and there is a good chance
that there will be a permanent scar left on the skin.
The same thing happens to the brain with concussions. If
you follow a rehabilitation program that includes
physical and cognitive rest, there is a good chance that
the injury will heal and you won’t have any long term
symptoms. However, if you continue to play sports and
end up subjecting the brain to excessive stimulation
while the first concussion is healing, you may prolong
the recovery period and you may also receive additional
concussions which could end up leaving you with
permanent long-term symptoms. The key is identifying the
injury in the first place. ”
I am afraid that many school boards may be waiting
for the legislation to be passed before they develop or
revise their own formal concussion management programs
in order to be in compliance with the new regulations
that are expected. In the meantime, tens of thousands of
students may be slipping through the cracks while
classroom teachers, phys. ed. Instructors, school
coaches and even parents are unaware that they are
placing so many students in grave danger. If they
don’t know their students are injured, then teachers
cannot be expected to make the necessary accommodations
in the classroom which will help with the recovery
process and allow the student to cope with the academic
program.
Instead of waiting for pending
legislation, it is suggested that School Boards should
at least take time to review and evaluate the
effectiveness of their existing concussion management
programs in light of the report from OSBIE. We’ve
already heard enough from the experts about the nature
of traumatic brain injuries to be able to develop formal
preparation, identification and rehabilitation protocols
that will ensure the safety and well-being of our
student-athletes. We just need the will to take the
knowledge we already have and make the necessary
enhancements once we identify the weaknesses of our
current practices. This review, evaluation and revision
of existing concussion management programs is something
that should not be delayed. Multiple
concussions have unpredictable cumulative effects on
cognitive, emotional and psychological functions and may
leave a person with a life-time of memory and vision
impairment, headaches, dizziness, and even cause serious
mental health problems later on in life.
While we are waiting, I would like to invite members
of school boards and minor sport organizations to
contact me by email at robertkirwan@concussionmanagementpartners.com,
by phone at (705) 969-7215 or download our 287 page Program
Development Guide and begin doing something positive
and concrete to develop your own student-athlete
concussion management program that will easily meet any
requirements that may be forthcoming from the Ontario
legislature. We can’t afford to wait any longer.
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