From mountain biking and kiteboarding to climbing and rugby, many of the sports enjoyed by locals in the Sea to Sky Corridor come with a risk of brain injury.
With June being Brain Injury Awareness Month, The Squamish Chief caught up with Dr. Shelina Babul, director of the BC Injury Research and Prevention Unit at BC Children's Hospital, to find out more about this dirty little secret of our outdoor recreation lifestyle.
What follows is a version of that conversation edited for length and clarity.
Q: You have won an award for your work trying to prevent brain injuries. What are one or two, perhaps less obvious things you think parents could do to help their kids prevent injuries?
A: We want to change the trajectory from "It won't happen to me,” that then shifts to "If only I knew." To do that, we want everybody to know prevention efforts that they can take to prevent a concussion or a mild, moderate or severe brain injury. We want people to recognize that your brain is the only organ that you can't transplant. It's your information highway that processes information at speeds of 400 kilometres (250 miles) per hour. So, you really want to do everything you can to not jeopardize your quality of life. So, for parents, acknowledge and recognize that your child can be seriously injured if they don't wear protective equipment. It's a no-brainer, to use a pun. If you hit your head on cement without a helmet, what's going to protect you? There's no such thing as a concussion-proof helmet, but by wearing a helmet, you're mitigating the severity of that impact, because the helmet will absorb that energy and transfer it. So, it may protect you from, say, a moderate injury, a brain injury, and you may get a milder concussion.
Q: What sports are you seeing kids hurt by?
A: You've got your typical high-impact sports like hockey, rugby, soccer, and football, but being on the West Coast, we see skiing, snowboarding, and mountain biking injuries. And now we've got these micro-mobility devices, like e-scooters. We're trying to ensure that people wear helmets on those as well, because some go up to crazy fast speeds. So, again, wear the equipment to protect yourself.
Recognizing symptoms
Q: Most of us are aware of the symptoms to watch for when there is a bump on the head, nausea, vomiting, for example, but what are some lesser-known symptoms to watch for?
A: Headache is the most common symptom. There's nausea, vomiting, dizziness, sensitivity to light, sensitivity to noise, loss of appetite, sleeping too much, sleeping too little, confusion, difficulty concentrating or remembering. And you don't have to have all of these. You can just have one to be diagnosed with a concussion. One really important point I'd like to make is that symptoms can appear immediately or up to several days later. A lot of times, you'll see a significant head-to-head collision, in soccer, for instance, and the individual is pulled off the field. The coach or the athletic trainer asks them a few questions, and they seem to answer them normally, so it is assumed there are no issues. They're put back in. And that's not necessarily the right thing to do.
You want to closely monitor yourself or your child for up to two days after a hit to the head to see if signs and symptoms appear.
The brain weighs only 1.4 kg (three pounds), and it's encased in a skull that's the thickness of three pennies. That's not a lot that's protecting the brain. This is quality of life we are talking about. Your brain allows you to walk, to talk, to eat, to see, to listen, and you don't want to do anything that injures the brain so that there are lingering symptoms in any of these areas.
Q: What is happening in the brain between the injury and the few days later when symptoms start to appear?
A: Typically, it's like a functional change that happens to the brain. So your brain has billions of neurons, and when there's a rotational acceleration-deceleration, that bouncing around of the brain inside the skull, you get a shearing and a tearing of those neurons. I like to give the example of an earthquake. When I'm driving on Highway 99 to head to Children's Hospital, I can proceed normally in non-rush hour times. If there's an earthquake and there are fractures in the road, the car can't proceed on the road until the road is fixed. And that's kind of what's happening to your brain, where you're seeing fractures, shearing, tearing of those neurons that need immediate rest so that they can heal and repair—so that your information highway can process normally. The symptoms that you see are really a backlog of information being transmitted because the information can't get through. That results in the symptoms you see. Obviously, this is the simplest explanation for a layperson, but I think that puts some kind of context to it.
New research
Q: Many of us were taught that after a hit to the head, we should go lie down in a dark room, and if we are caring for someone with a head injury, wake them up every two hours. What should we do?
A: The science around concussions has changed quite a bit over the last 10 years.
Previously, you were told to wake up every two hours. We know not to do that, because you want the brain to sleep after the initial incident. You want to let the brain rest.
You also don't want to put them in a dark room, because that gives rise to mental health concerns. And we now know that that's changed. We know that exercise, aerobic, limited exercise, and keeping within your symptom threshold actually help in your recovery. So, what we want individuals to do is to take initial physical and cognitive rest for 48 hours. That doesn't mean don't do anything; that means continue with your activities of daily living, as long as they're not bringing on new symptoms or making your symptoms worse, and don't do anything that could result in another impact on your head, and then follow a graduated return to activity protocol.
[For more information on brain injury prevention and recovery, visit the online Concussion Awareness Training Tool (CATT).]
Q: Some people with brain injury have mentioned that there's a social cost. For example, it can be socially isolating for long periods because people recovering may not want to go into a restaurant with friends, as it makes their symptoms worse. We think of physical ramifications, but not the social. Can you speak to that aspect?
A: Concussions don't just affect the individual; they affect everyone around that person. We need to recognize that mental health is a huge component of an individual who is diagnosed with a concussion.
About 70 to 80% of people who sustain a concussion will recover with no problem, within four weeks. But you've got about 25 to 30% who will have persisting symptoms, and those individuals can't understand why they can't function.
The restaurant example you just gave me, the noise creates headaches as do the LED lights in a lot of places. We recommend that physicians have a two-week follow-up with their patient, just to make sure that they are recovering uneventfully and that they're not going downward. It's important for individuals to have social outlets and social supports.
We want parents and caregivers to have constant dialogue with their kids who are having persistent symptoms. They can't hang out with their peers, can't go to school, and can't play the sports that they love to play. So, we want to ensure that they get the right help before it's too late.
Q: What advances or innovations in the research around brain injury are you excited about?
A: Concussions are—I call it a conundrum of uncertainty, because there's a lot of grey area.
But there have been advances in medical imaging to really see what's happening.
And blood biomarkers—there's some testing being done to see if we can develop a blood test to diagnose a concussion. Right now, there's no diagnostic tool to say this person has a concussion. It's purely based on an assessment of clinical symptoms, previous history, doing a bit of cognitive testing, balance testing, those kinds of things. I'm hopeful that in another 10 years, maybe we will have a definitive diagnostic tool where someone can go to the emergency department, have a blood test to say, yes, you've got a concussion.
We're making strides, but we do have a long way to go.
Balancing risk with outdoor lifestyle
Q: One of the dirty little secrets of the Sea to Sky is all the injuries, including head injuries, that come from our love of recreation. But we don't want to put ourselves or our kids in a rubber room. So where's the balance?
A: We know the benefits of participating in sport and recreational activity— of physical activity. There are the cardiovascular benefits, the social benefits, and the mental health benefits. So we want individuals to continue to participate in all these daily activities, but to take the necessary measures. If you're skiing or snowboarding, or biking, wear a certified helmet. We don't recommend buying used helmets at garage sales or anything like that because we don't know what the history is on that helmet.
When mountain biking, wear the right gear. We're talking about brain injuries and concussions, but there's also lacerations, sprains, contusions, all those things. So, just wear the necessary equipment to prevent that from happening and be responsible. A lot of times, people feel that they have the skills to go faster than they do. Stay within your limits and stay within the boundaries, I think as long as you take all these necessary measures, continue with all these activities. But if something does occur, make sure that you recognize it immediately and get the necessary help you need. Go see a licensed healthcare provider who can then assess you and give you the right guidance for your recovery.
Learn more on the BC Children’s Hospital website.
