In recent years, concussion awareness and research has drastically increased, making the reality of the significance of brain injuries and concussions a topic of casual conversation.
A concussion – also known as a mild traumatic brain injury – is the result of your brain shaking inside your skull, due to some sort of physical impact to your head or body. Whether it’s getting a blow to the head in a rugby scrum, or whiplash from a car accident, you’re at risk of getting a concussion.
They can vary between mild to extreme, but unlike common colds – where people generally show the same symptoms – everybody reacts differently to concussions.
Because of this, Karen Decker, a physiotherapist and director of varsity student trainers at the University of King’s College, introduced a concussion policy in September 2016 for King’s varsity athletics.
“Everyone needs a concussion policy, so everyone is on the same board and everyone understands what our protocol is going to be,” Decker said.
She added that the making of the policy, though still in the drafting stages, has been rushed since she was given the responsibility by Neil Hooper, the King’s athletic director, and Trish Miles, the athletic coordinator.
According to the policy, King’s and partner ACCEL Physiotherapy and Sports Performance Centre are collaborating with Complete Concussion Management (CCM) to provide education, assessment and rehabilitation of suspected concussions in UKC varsity athletes.
However, possibly the most significant part of this policy is the “Return-to-Play” pProcess”. The policy states that if there is a suggested concussion, the athlete will be guided through a ten- stage protocol, developed by CCM. This involves absolute rest, then return to school, then graduated return to practice and play.
There are two major improvements with this policy. First, the ten-stage protocol used to only have seven stages.
“Over the years, when I used to do sport physio[therapy] and they said, ‘you have to return-to-learn first,’ I said, ‘this guy’s got to get onto the field. What are you talking about?’,” Decker said. “But [getting the student-athlete back to class] is very important.”
“If you look at our protocol, the first four steps are, basically, return-to-learn. It used to be a seven-step protocol until we realized return-to-learn is most important and the best way to start,” she added. “We do the cognitive part before we throw you back into the physical part.”
The second improvement to the policy is that a student athlete can’t begin practicing or playing after a concussion until they are cleared by a trained professional.
“The usual protocol is evaluated by a physician,” Decker said. “The unfortunate thing is not every physician is trained in the latest protocols… So Neil [Hooper] and Trish [Miles] agreed for me to say ‘a trained professional’, whether it’s me or somebody at our clinic.
Decker feels that this will ensure that students will be seeing a physician who has training and background in concussion injury.
This clearance is key for those injured because it stops athletes, people who consistently will themselves to fight through pain for their sport, from further damage to their health.
“The concern with concussions is if you go back and you’re symptomatic, you can get a second concussion and it can be fatal,” Decker said.
At a King’s varsity athletics event last semester, Decker spoke about the concussion policy and used the example of Rowan Stringer, a 17-year-old high school rugby player from Ontario. She died of a brain injury due to a concussion during a rugby match.
All that said, it’s ironic that an institution such as a university – a place of learning, where people literally need their brains to function properly – doesn’t always accommodate concussions.
At King’s and Dalhousie, accommodations are made by individual professors, and while they’re usually accommodating, there are times they’re not.
Bridget Irwin – a fourth-year student, who was interviewed in the first part of this series – was concussed during a rugby match in September 2015 and still had symptoms going into exam season, so she asked for a prorate – the ability to waive the final exam – and was denied by one of her professors, Daniel Stevens.
“His logic seemed a little odd to me,” Irwin said in a message. “He told me that, because I had achieved high marks thus far in the course, there was no reason he thought I wouldn’t be able to do just as well on the final exam.”
“When [Jennifer Hall] interviewed me, I explained to her that this is why I thought he may have misunderstood what concussions are and how they affect people…When I had a concussion, no matter how high my marks were on previous assignments and exams and no matter how hard I studied, I was not able to focus as well or for as long as I normally can,” she continued.
Irwin added that writing a final exam was “mentally exhausting” and she believes that toll may have contributed to her prolonged concussion symptoms.
When asked about the specifics of the decision to deny the prorate, Stevens couldn’t remember. However, he did say that he granted Irwin hand-in extensions. He also added that, last semester, he taught a Dalhousie hockey player who had a concussion and was extremely accommodating to them.
“We can confidently say [after testing] ‘we feel someone has a concussion,’” Decker said. “Now, we’ve been overruled before… but once you do the tests, and you can highly suspect a concussion, then we’re pretty confident, again, that this is what the protocol has to be. You need to rest the brain.”
Decker added that they give templates, provided by CCM, to professors and schools to help them understand that the brain needs to heal – which could mean still going to class, but needing more time on tests, for example.
“[The cognitive rehab] is four steps, not four days,” Decker said.
She used an example of a women’s rugby player who was recently at the ACCEL clinic, still getting cognitive treatment for a concussion she received in the fall.
“She still can’t go to school fully yet, and so she’s not doing any exercise yet,” Decker said. “That fourth step has taken about three months to get there.”