Tackling concussions in the OUA

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Concussions are a hot topic in sporting circles, and for good reason. Suffering multiple brain injuries has been linked to degenerative neurological diseases, like Alzheimer’s. Recent research has discovered improved methods of treatment and diagnosis, but implementation of that research is lagging behind.

The lack of policy and awareness has already had real-world consequences on Canadian Interuniversity Sport. One CIS football player is suing his university for brain injuries sustained in a game, claiming the training staff “ordered” him to play after disclosing symptoms of a concussion.

Ontario University Athletics– the governing body of university sport in this province– does not have a concussion policy for their member schools. Currently, schools adhere to their own procedures. The OUA plans to implement a conference-wide policy next season. Through interviews with medical staff at McMaster and executives in the OUA, it appears that a policy may not be enough to improve the treatment athletes receive when they suffer a brain injury.

Athletes at McMaster are protected, though. The university has been ahead of the concussion treatment curve and work to educate coaches and athletes about the dangerous injury.

With concussions being so prevalent in all levels of sport, The Silhouette looks at how the issue is being addressed at Ontario universities and what the risks are if organizational stances remain stagnant.

The case of Kevin Kwasny

It has not been a great year for Bishop’s University football.

Their regular season was a wash, going 1-7 on the year. Something larger looms over the program, though– something that could alter the landscape of university football in Canada.

Kevin Kwasny is a 23-year-old Winnipeg native who suited up for the Bishop’s Gaiters as a defensive end. His football career ended on Sept. 10, 2011 in a game against Concordia.

According to a lawsuit filed by the Kwasny family, Kevin suffered a hit to the head and reported feeling dizzy with blurred vision to coaching staff. The lawsuit alleges that Kwasny was told to reenter the game, where he would suffer another hit. The athlete’s condition worsened and he was brought to the hospital. Bleeding in the brain put Kwasny in critical condition.

Kwasny was in a coma for two months and upon waking up, it was determined that the football player had irreversible brain damage and will never be able to work again. In a Globe and Mail interview, Kevin’s father discussed the issues his son is battling.

“He lost his whole right side, as if someone drew a line down him. He’s got some of it back – his fingers and his arms moving– and his leg is a little bit moving but not fully,” said Greg Kwasny.

The Kwasny family lawyer told the CBC that the university has not apologized or offered any help.

This is one of the most dramatic brain injury stories from Canadian university sport, providing an example of what can happen when athletes attempt to play through concussions. While CIS sport may not be the most glamorous level of athletics, it is not immune to the serious damage that comes with head trauma.

And it’s not just playing through a concussion that is a problem. Suffering multiple severe blows to head can have ramifications later in life.

There can be serious long-term implications on a person who does not have their concussions properly treated. The National Football League is (reluctantly) coming to terms with this reality. In the summer of 2014, the NFL settled a class-action lawsuit filed by a group of former NFL players who claimed the league was negligent in its treatment of concussions. According to an Associated Press article from July 2014, the league agreed to pay $870 million over 65 years to “cover retirees who develop Lou Gehrig’s disease and other neurological problems.”

It is unclear whether one of those “other” problems includes chronic traumatic encephalopathy. CTE is a degenerative brain disease that can only be determined post-mortem and has been found in athletes who play contact sports and experience repetitive head trauma. Though CTE originally believed to be a disease that took a lot of time to appear, that belief was shattered a 17-year-old was found to have early onset of the disease in 2010.

McMaster athletes will not face this problem, as the university has adopted strict return-to-play protocols based on the research of brain injury experts. The Marauder athletic department has worked to ensure that their athletes are well-protected.

Concussion treatment at Mac

In 2011, McMaster athletics overhauled their concussion protocol. The department provided The Silhouette with a copy of the concussion guidelines that was emailed to McMaster coaches, student athletes, therapists and student therapists.

Those guidelines “are based on consensus from the 3rd International Conference on Concussions in Sports.” Major changes include preseason baseline concussion assessment, a series of tests used to evaluate an athlete after they suffer any kind of head injury. Mac uses the latest version of the Sport Concussion Assessment Tool (SCAT3) and ImPACT, a computerized concussion evaluation system.

Dr. David Robinson joined McMaster in 2011. As team doctor for the men’s football program, concussions play a major role in his day-to-day work. Dr. Robinson explains what happens when medical staff suspects an athlete suffers a concussion.

“For instance, if it’s a football game, it’s identified that a person may have a concussion, probably by Chris Puskas, the athletic therapist. The player is removed from play. On the sidelines, I do some screening and if there’s any concern at all, the player is removed,” said Dr. Robinson, who is also the team doctor for the American Hockey League Hamilton Bulldogs.

“It’s not too hard to make the diagnosis that a guy is concussed. That’s just a hard and fast rule; we do not put guys back in if they suffered a concussion.”

From there, Mac has a return-to-play policy that takes a minimum of seven days to complete. Dr. Robinson says it’s “iffy” for a player to play only a week after the injury happens.

“90 percent [of athletes] recover within 10 days time. 95 percent recover within a month and the remaining 5 percent may take months to cover or may not recover completely,” explained Dr. Robinson. “Younger athletes (i.e. adolescents and teens) may take a little longer than these time frames.”

Concussions can be confusing to personally interpret because they differ from other physical injuries. Bones break and muscles tear, but an injury to your brain is not as simple. If you break your hand, you understand that you will not be able to use your hand for the things you usually do. Concussions do not work that way, as symptoms can show up after the injury is sustained. The complicated understanding of the injury can lead to athletes wanting to reenter games or return to play too early.

“The issue is, if you’re not completely recovered, your threshold for a second concussion is remarkably lowered. It will take less of a blow to concuss you, and your recovery is going to be prolonged,” said Dr. Robinson, noting he has never had a Mac athlete resist being pulled from a game due to a concussion.

Athletes are understanding of those health risks. Dr. Robinson says athletes may believe they are fit to return, but when they are shown their failing test scores, they will change their tune.

Coaches are just as receptive. There has not been “one bit of resistance” on concussions diagnosis from anyone in the athletic department. McMaster coaches have the benefit of working alongside a cutting-edge sport medicine clinic. Not all schools have this, and the OUA is working to help those departments.

The OUA's missing policy

As it stands, the OUA does not have a concussion policy.

“What is in place right now is that each university has their own policy in place,” said Gord Grace, OUA CEO.

“That’s something we’re reviewing right now. We have some language around [concussions] but we’re looking to review our policies on it.”

Grace says the OUA was prompted to change its policies because of the attention that concussions have received. Conversations with the CIS and other sporting groups have led the conference to a review of their approach to the brain injury.

When asked about limited resources available to smaller athletic departments, Grace said that he does not expect anyone to have an issue.

“Whether you have in-house capabilities or you outsource it, all universities have access to [athletic health care], working with the local medical community … That’s what everyone is doing right now,” said Grace. He pointed out that concussions are not isolated to student athletes, so universities will already have treatment in place.

Grace believes that schools have “established good protocols.” But this past OUA football season had a glaring misstep in concussion treatment.

Will Finch, quarterback for the Western Mustangs, took a big shot in a regular season match-up with McMaster. Despite taking a substantial hit and being removed from the game, Finch returned to play. At the time, the university would not confirm Finch’s injury, but Western’s The Gazette spoke with a source close to the team who said the quarterback had a concussion.

The quarterback would then suffer a concussion– this was confirmed by Western– against Windsor and face a prolonged recovery. Finch took a full week of rest, lying down in a silent, dark room. He is medically cleared to play now, but Finch told the Hamilton Spectator that if he gets another serious hit to the head, he doesn’t know if he could move forward in the sport.

Grace was asked if the OUA has heard any concerns about any member school’s policies.

“It hasn’t been expressed to me. Nothing has come across my desk where somebody has questioned the protocols of certain universities, but it is an issue out there. It’s an insurance issue as well,” said Grace. “There’s a number of reasons motivating us to take a look at this, but that’s not one of them – that somebody is not at a standard that is expected.”

“We haven’t heard that, but that’s one of the goals of a global policy, that schools are adhering to what the international standards are.”

And there are limitations to what the OUA can actually enforce. Grace, who took over as CEO in Sept. 2014, contrasts the league against professional leagues. Schools have their own existing protocols on campus that apply to all students and they cannot tell the schools what they have to do. Grace says it’s about coming to a consensus and working with member schools to implement policies to keep athletes safe.

Moving forward, the OUA plans to present a concussion policy to the universities at the annual general meeting, where the conference could decide to officially endorse the policy or not.

The future of treatment

Kevin Kwasny’s family continues to battle Bishop’s University in court. There have been many hurdles in their fight for justice, and they will have to continue to wait for their day in front of a judge as the university tries to bring the case to the Quebec court system.

It is clear the OUA is trying to get concussion treatment right by implementing new policies. But the organization only has so much power, and the success of those policies relies on buy-in from athletic administration. Given the recent track record, it is unclear whether all schools will approach concussions with the respect that brain injuries require.

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