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Concussion/Mild Traumatic Brain Injury Strategy

Overview  and Update (May 2011)

Much has been made of concussions in the National Hockey League in recent months, with the Sidney  Crosby out of play after sustaining two concussions, and the ugly attack on Max Pacioretty. For years now, professional sports and the military are the public arenas where concussion, also called Mild Traumatic Brain Injury (mTBI), have garnered the attention. 

But concussion/mTBI occurs in any arena, including from motor vehicle crashes, falls, assaults, and recreational injuries.  It occurs in homes, in the workplace, on the street, and in schools, from children and youth to adults to the elderly.  

In Ontario, prevention efforts aimed at decreasing the incidence of brain injury are continuing through the work of numerous organizations.  Despite this, concussion/mTBI occurs at high rates in all age groups.  The incidence rate may be as high as 600/100,000 population (Cassidy et al). Some have it as even higher. Ten to fifteen percent of people who sustain mTBI do not recover as expected.  From a population-based perspective, the number of Ontarians who do not recover well from mTBI on an annual basis is estimated to be 11,000 individuals.  Persistent symptoms can affect the individual’s health, ability to work, psychosocial functioning and family functioning.  

Prevention efforts must continue so that the incidence of concussion can be reduced but until such a time, a systematic approach is needed regarding appropriate diagnosis, prognosis, secondary prevention and management across the continuum of care, for all age groups, with the involvement of numerous sectors.  

The Concussion/Mild Traumatic Brain Injury Strategy aims to do just that.  An informal collaboration of close to 40 organizations led by the Ontario Neurotrauma Foundation is working to improve and standardize evidence-informed practice, working together to improve cooperation between sectors, and most importantly aiming to improve outcomes of individuals who sustain mTBI. The Strategy includes organizational leaders and experts from multiple sectors, including medical and rehabilitation fields, health associations, consumer organizations, sports, workplace, education, research, insurance, law, government, as well as many others.    

The Strategy includes a focus on Recognition and Awareness, Diagnosis and Early Education of Patients and Families, Access to Care and Timely Intervention, Management of Persistent Symptoms, and Psychosocial and Reintegration. A Coordinating Committee which includes the Co-Chairs of the five Working Groups addressing these priority areas acts as an oversight, communication and coordinative body to align the actions and reduce overlap.   

Some First Stage Projects include:  

Update of the Review of Prognosis after mTBI  

This review was previously conducted for the World Health Organization. The update will incorporate all research since 2002 with the previous findings to provide a complete and current picture of prognosis and risk factors for recovery.  This information will aid in better understanding recovery or (slowed recovery) from mTBI, guide the development of decision- tools for prognosis, and guide interventions.  

Environmental Scan of Curricula in Medical, Nursing and Paramedic Programs to ascertain how concussion/mTBI is being taught and to what degree. This information will assist the strategy if we wish to go forward to approach these schools for a more comprehensive approach to education of concussion/mTBI.  

Gathering information on existing concussion cards and other tools used to identify mTBI.   

This information to develop site specific (coaches, paramedics, schools, workplace, etc.) to improve recognition of concussion in general, and specifically to increase identification that a concussion may have occurred so that an individual with a potential mTBI can get medical attention.

Examine the issues around navigating the system with or without third party funding Depending how or where a person sustains their injury they may have a different pathway of care, oversight of their injury and access to treatment.  The Strategy will examine what the issues and potential differences are between individuals who receive Insurance or WSIB coverage versus those who travel through the mainstream system.  The goal is to ensure equity of care and treatment for people who sustain concussion/mTBI in different circumstances.  

Share the Guidelines for MTBI and Persistent Symptoms 

These Guidelines were generated with the support of the Ontario Neurotrauma Foundation, through an evidence-informed and clinical expertise process, and have been reviewed by external experts.   A mobilization plan is being developed to share these with the field at large, seek input and endorsement and then work with stakeholders to make use of them to improve patient outcomes.   

Further actions include but are not limited to:  

Develop Performance Indicators and Measurement Systems 

Finalize the Strategy Business Plan and share with partners and stakeholders 

Examine legislation regarding “return to play”’ after sports concussion 

Improve existing educational information and standardize protocols provided to patients and families upon diagnosis of concussion/mTBI in emergency departments and physicians’ offices.    

Work with physicians and other medical and rehabilitation specialists through relevant associations to make use of the Guidelines for mTBI and Persistent Symptoms.  

Generate guidelines and articulate principles for return to  work following a mTBI that was not sustained in the workplace.  

It is early days yet, but collaboration, consistency and communication will hopefully pay off.  The Business Plan is near completion; articulating the aims, key activities and rationale for the Strategy.  This will be used to maintain engagement of existing partners, encourage new partners to join in and to make the case for investment in the longer term for approaches that will have impact and benefit across the province of Ontario.  

For more information on the Concussion/Mild Traumatic Brain Injury Strategy, please contact:  

Corinne Kagan 

Senior Program Director, ABI 

Ontario Neurotrauma Foundation 

corinne@onf.org 

(416) 422-2228, ext. 204