Encased in a tough bony skull and suspended in shock-absorbing fluid, the brain is protected by several layers of defence. Responsible for everything from our thoughts and memories to planning and movement, the brain, with its delicately wired connections, warrants such care.
However, injuries can still happen. On the ice, on the sports field, during an intense match— or just from a clumsy fall or a bump on the fridge door. These common mishaps can have lasting effects on brain health, especially when injuries go unnoticed or untreated.
June is Brain Injury Awareness Month in Canada. To learn more and spread awareness about brain injury, we spoke to Dr. Shelina Babul, one of Canada’s foremost concussion experts.
As the creator of the Concussion Awareness Training Tool (CATT), Dr. Babul has made concussion education more accessible to youth, educators, parents, coaches, and health-care professionals across Canada and beyond.
What is a concussion?
Concussions are caused by a direct blow to the head or other body parts, resulting in a rotational movement of the brain within the skull. They can occur with or without loss of consciousness, and symptoms can be subtle, including headaches, confusion, nausea or dizziness, and may not appear for hours or days.
What do you think are the most common misconceptions about brain injuries and concussions?
Even though we’ve made significant progress in recognizing that concussions are brain injuries, many people still don’t take it seriously and think that it’s not a big deal. What they don’t realize is that if you fail to identify the signs of a concussion, neglect diagnosis, or don’t receive proper treatment, it can seriously impact your quality of life.
Your brain is your information highway for daily functioning (i.e., walking, talking, eating, seeing, speaking), and you need to protect it from roadblocks – if you suspect that you may have a concussion, it’s important to reach out quickly. Immediate recognition is key to recovery!
Who is most at risk for concussion, and in what contexts are you seeing the highest rates? Are there trends that have surprised you?
Individuals most at risk for concussion are youth and young adults, especially those involved in contact or high-collision sports like hockey, football, rugby and soccer. However, it is important to note that concussions can also occur in daily life and are NOT just a sport-related injury. Outdoor recreational activities (e.g., cycling, e-scooters, etc.), motor vehicle collisions, individuals involved in intimate partner violence, or simply tripping on the sidewalk can result in a concussion.
Research also demonstrates that females may be more vulnerable to concussions and have a higher frequency of concussion diagnoses, more reported symptoms, and potentially slower recovery times than males.
We’ve certainly seen an upward trend over the past decade, but that’s not necessarily a result of more concussions happening – rather, heightened awareness around concussions, especially in the younger age group, have led to more frequent diagnoses.
How do symptoms and recovery trajectories differ between individuals?
Concussions, I like to state, are a “conundrum of uncertainty.” What I mean by this is that no two concussions are alike, and everybody recovers differently.
We don’t know why this is the case, but based on current research and evidence, the number and severity of symptoms initially tend to be indicators of recovery (i.e., more symptoms and more severe in nature will likely result in a longer recovery period). Furthermore, we do know that age, gender/sex, concussion history, predisposing conditions, psychosocial factors and circumstances around the injury can all play a role in recovery.
Immediate recognition, accurate diagnoses, optimal management and appropriate follow-up can all play a role in the recovery of an individual who has sustained a concussion.
The Concussion Awareness Training Tool (CATT) has reached thousands across various sectors. What kind of impact have you seen from CATT in real-world settings?
We’re very fortunate to have seen such a global uptake of the CATT since its debut. We often hear ‘I never knew….and now I know what to do!’ and ‘thank you for giving us such a comprehensive resource where I know I’m getting accurate information and quickly.’
In addition to concussion education in sports and schools, I am also working to address brain injury in vulnerable and often overlooked populations — particularly survivors of intimate partner violence (IPV).
Can you tell us more about Project SOAR and ongoing initiatives to support survivors of Intimate Partner Violence (IPV)?
The SOAR initiative (Supporting Survivors of Abuse and Brain Injury through Research), founded by Dr. Paul van Donkelaar and Karen Mason at UBC Okanagan, is focused on survivors who have experienced concussions or more severe brain injuries, such as hypoxic injury from strangulation.
Survivors of IPV face unique challenges when it comes to concussions because it is an invisible injury and more often than not, goes undiagnosed. Typical assessments look for visible injuries such broken bones and bruises, while subtle symptoms of concussion may be overlooked.
Currently, in collaboration with SOAR, we’re using the CATT for Women’s Support Workers to help raise awareness and provide education tailored to this group. There’s also promising research underway looking at blood biomarkers to help detect brain injuries related to intimate partner violence. In addition, SOAR offers workshops that focus on training and support, all through a trauma-informed approach. Finally, on the medical side, we’re implementing education and training to develop clear clinical pathways for assessing and treating individuals affected by IPV.
Looking ahead, where do concussion research and education need to go next?
We’ve come a long way but certainly have a long way to go to understand the intricacies of this unique organ – the brain. Currently, there is no diagnostic tool as diagnosis is based on clinical history, symptoms at the time of assessment, balance and cognitive testing, as well as a few other measures (such as blood pressure and heart rate).
Can we develop a diagnostic tool to identify a concussion? Can a simple blood test become available to diagnose an individual with a concussion? I think we will get there, as we’re definitely going in the right direction. We also need to educate so many more individuals on the seriousness of a concussion and the potential life-changing impact it can have if it isn’t recognized immediately. We also need to change the mindset that concussions are not only a sport-related injury but rather can happen to anyone, anywhere, anytime.
