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Mike Hennessy, Lawyer
Caruso Club
Friday, Jul. 28, 2017
Shedding some light on the darkness of post-concussion symptoms
2017-06-30
by Randy Pascal

Not a day goes by where the topic of concussions is not raised somewhere in the province of Ontario, more often than not within the realm of the world of amateur sports. Truth be told, in an environment as complex as the scope of attempting to understand the proper treatment of brain injuries, it really is no small wonder that parents and athletes alike are often unsure of where exactly to turn for answers.

Thankfully, a media release issued earlier this month by the Ontario Neurotrauma Foundation (ONF) has helped the shed some light on the issue. Perhaps even more comforting, from a local perspective, is the fact that a pair of Sudburians were very much involved with the creation of the new “Standards of Post-Concussion Care.”

Carol Di Salle serves as the North Eastern Ontario Acquired Brain Injury Resource Clinician at Health Sciences North while family physician Tara Baldisera is currently the Medical Director of the Sudbury Sport and Exercise – Concussion Clinic, with both women also active members of the ONF Concussion Advisory Subcommittee that penned the most recent report.

“The creation of the standards was in response to the proliferation of clinics, all across the province, offering concussion care,” Di Salle said recently. “What we were observing was that there was a lot of variation in the quality and types of services that were being offered throughout various agencies.”

“That resulted in a lot of confusion for patients and families, knowing where to find care, and to find care that they could rely on and that was evidence based.” The questions, however, were hardly limited to those who were most affected by the concussion symptoms themselves.

“It was also very difficult for health care providers, family physicians, the primary care providers who were wanting to refer patients on to more specialized care when their patients were experiencing more persistent symptoms, not really knowing where to refer them and who was providing good care,” Di Salle continued.

In a world where research and knowledge reigns supreme, it only stands to reason that a wide net would be cast before moving forward with any kind of official statement. “Prior to the development of the standards, there was a concussion summit that ONF held with experts, health care providers from a variety of disciplines, researchers, and people that were representing the public and private health care systems,” explained Di Salle.

“We really had a wide variety of expertise in the room, and certainly there were differences of opinions that we had to reach consensus on. We feel very confident and happy with the results, based on having broad stakeholder engagement,” noted Di Salle. “While it’s true that everybody might not have been on exactly the same page, we have reached consensus on these fifteen criteria that have been informed by people coming at it from all different directions, including people with lived experience of concussion and persistent post-concussion symptoms.”

Part of the challenge facing the group stemmed from the speed at which new information in this domain is arriving. Di Salle, Baldisera and the group acknowledged that they are dealing with something of a moving target when it comes to incorporating the very latest research in releasing any kind of standards that might well change over time.

“We do recognize that concussion knowledge is continually evolving, and likely more rapidly than in some other areas,” admitted Di Salle. “Part of what has been built in to these standards is a suggestion that concussion clinics, or networks of providers who are working together to provide concussion care, will collect common data about the type of care they are providing, and how patients are responding to that care. Putting these standards in place will help inform that research.”

In fact, Di Salle noted that the “consensus statement on concussion in sport”, issued in April in response to the 5th International Conference on Concussion in Sport (Berlin, October 2016) summarized nicely what has changed recently.

So what exactly to make of all of this information if you are the parent of a young athlete whose concussion symptoms appear to be dragging along far longer than initially anticipated?

Di Salle and company offer some very pragmatic advice. “We wanted to ensure that we are helping people understand that if someone is experiencing consistent post-concussion symptoms, they should be receiving inter-disciplinary care, with a physician involved,” she said. “It’s good to drive patients and the public to that site (www.concussionsontario.org), to understand what they should expect and who should be providing the care.”

“We have all of the different disciplines listed on the site, and what is within their scope of practice. We will be pushing primary care providers and family physicians to understand the limits of what they can offer, and what else is available in every community.”

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