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Doctors need help with diagnosing and treating concussions

Snowboarder Allison Haggart suffered a concussion while training that ended her racing career.

While parents and coaches are increasingly aware of the hazards of concussions, physicians' knowledge about the identification and management of the brain injury may be falling short.

A new article published in the Canadian Medical Association Journal is taking aim at educating doctors who aren't comfortable or confident of dealing with concussions, offering them guidelines for diagnosing the injury, assessing risk factors and managing short- and long-term effects.

"We want practitioners to be fully aware of potential issues related to concussion – doctors can be a significant force for the prevention of concussions," said Dr. Charles Tator, founder of ThinkFirst Canada and project director of the Canadian Sports Concussion Project at the Krembil Neuroscience Centre in Toronto.

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In a survey of Canada's medical schools published last November, Tator found that only four of the 14 schools that responded said they provided concussion-specific education. Six offered head-injury education that incorporated concussions and four reported no concussion instruction in their curriculum.

Doctors, Tator said in his latest report, can play a key role in the diagnosis and management of concussions, especially in facilitating individualized timetables and activites for return to play, school and work.

Currently, the only way someone can be diagnosed with a concussion is by a doctor. Even then, there are no concrete measures based on imaging, blood tests or computerized neuropsychological screening tools that exist right now. Tator said it's not even known where a concussion happens in the brain.

"We should have more objective tests. If you've had a heart attack, you can have a blood test and confirm it's a heart attack. But you can't do that with a concussion," Tator said.

Recent research has found females may be more susceptible to concussions than males. Young children are also at an increased risk. And, contrary to previous belief, you can sustain a concussion without hitting your head. The injury can be caused by the jiggling of the brain in the head through sudden movements, including whiplash.

The Canadian Sports Concussion Project, led by Tator, is the world's first project that aims to address the still-unknown long-term effects caused by concussions.

Allison Haggart is an 18-year-old who suffered a concussion last winter while snowboarding. She has teamed up with Tator and has now raised more than $120,000 through her own site, The Allison Project, to support Tator's research.

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"A lot of physicians aren't fully aware of how frequent concussions are, and about the complications of concussions," Tator said.

Though a first concussion is usually mild, and symptoms are likely to pass within two weeks, a second concussion can have longer-lasting effects, including post-traumatic cerebral swelling, post-traumatic epilepsy or psychosocial or emotional consequences, including depression, anxiety or a combination of the two.

Concussions are commonplace in Canada because Canadians are very active, Tator said. "We drive our cars quickly. We play aggressively – in fact, too aggressively – in some sports like hockey. Hockey produces a huge number of concussions both at the amateur level and at the professional level."

Because symptoms of concussions are similar to those of commonplace ailments (headaches, dizziness), diagnoses are difficult. When Haggart complained of a "wicked headache," being disoriented and dizzy, some people told her she was was probably okay, and encouraged to get back out on the slopes. It wasn't until she saw a doctor that she realized she had a concussion.

The effects for Haggart will be life-long. She had previously travelled the country participating in snowboarding competitions. Now, it's unlikely she will ever ride again. She's planning on attending the University of Guelph in September to study biological science instead.

"I have other, bigger plans and I'm going to focus on those for a while" she said.

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