After Michelle Tobin-Forgrave fell and hit her head more than five years ago, she developed a constellation of symptoms that began to derail her day-to-day life.
The Miramichi, N.B., resident knew she had a concussion — her second one — and expected to have a quick recovery, just like her first experience years earlier. But this round felt different.
Tobin-Forgrave went back to her job in the education sector after taking two months off work, then realized she needed to take hourly breaks from her computer. Sometimes she’d just lay on a yoga mat in her office, wracked by fatigue. The busy mother of two also started experiencing insomnia, couldn’t remember basic words like the names of household appliances, and developed issues with her vision and depth perception.
“The symptoms just never, ever went away,” she said, “and got worse — much worse — over time.”
Michelle Tobin-Forgrave writes on a mirror to help keep track of her day-to-day life after suffering a severe concussion. (Philip Boudreau/CBC)
The latest available data suggests hundreds of thousands of Canadians get concussions every year, and federal guidance last updated in 2021 suggests while recovery times can vary, most people get better in “10 days to 4 weeks.”
Yet a growing body of research indicates that many take much longer to recover than previously thought — or don’t ever fully recover at all.
Many with concussions don’t recover quickly, if at all
A study published in the journal Brain in February found that almost half of people with concussions still show symptoms of brain injury six months later, likely due to damage in an area of the brain called the thalamus, which relays information from the senses.
Researchers analyzed the brain scans of 108 patients in Europe who had recently had a concussion to look for structural changes in the brain, and found a marked increase in the activity between the thalamus and the rest of the brain shortly after a concussion.
“It’s almost like they were doing more work than those areas normally do. They were trying to communicate harder,” said Emmanuel Stamatakis, lead author of the study and head of the Cognition and Consciousness Imaging Group at the University of Cambridge in England.
“We found that the more hyper-connected those areas were, the more likely it is that you will have one of the symptoms that are associated with concussion — such as headaches, fatigue and sleep disturbances.”
The researchers used a less-common type of scan called a resting-state functional MRI — which isn’t widely available to patients — to analyze structural changes in the brain. Stamatakis said he hoped the findings would better inform patient care in the future and potentially lead to new concussion treatments.
“What I hope this study will achieve is to have clinicians think twice or three times before they send somebody with a concussion home and tell them: ‘You’re healthy,'” he said.
Dr. Charles Tator, an internationally renowned neurosurgeon and head of the Canadian Concussion Centre at Toronto Western Hospital’s Krembil Brain Institute, said the study points to the thalamus as an important area for concussion research for the first time.
“We’ve always known that it’s a more or less waystation — it’s the Union Station for pain,” he said, referring to Toronto’s bustling downtown transit hub. “But what this paper has identified is that in concussion it’s also an important structure and we didn’t really know that beforehand.”
Dr. Charles Tator says the estimated 400,000 Canadians who experience concussions each year is a ‘phenomenal’ figure and that many ‘don’t get better.’ (Alex Lupul/CBC)
Lingering concussion symptoms can be life-altering
The long-term impacts of brain injuries — from concussions among the general population, to reports of chronic traumatic encephalopathy (CTE) among professional athletes who’ve sustained repeated hits to the head — has been a growing field of study, and concern, in recent decades.
The latest European study’s sample size was fairly small, noted Toronto-based neurologist Dr. Matthew Burke, the medical director of the Traumatic Brain Injury program at Sunnybrook Hospital Health Science Centre, and the number of patients experiencing lasting symptoms was higher than most previous estimates, which range from around 15 to 30 per cent.
But he agreed the paper shows a “strong signal” that concussions can directly cause an array of cognitive and emotional issues that “might persist longer than we anticipate.”
Those lingering impacts may also be broader, and more life-altering, than the acute injury itself.
NHL enforcers die 10 years younger than other players, study suggests
Researchers at Columbia University in New York conducted a study comparing former NHL enforcers to their peers and found the enforcers were dying a decade earlier and were more likely to die from suicide or drug overdose.
Even children aren’t immune to potential ripple effects on the brain, other Canadian research recently suggests. A population-based retrospective cohort study led by the Ottawa-based CHEO Research Institute, published in 2022 by JAMA Network Open, found young people who sustain a concussion are at a 40 per cent higher risk of mental health issues, psychiatric hospitalization, and self-harm compared to those who sustain an orthopedic injury like a broken bone.
Ongoing research is still needed, Burke added, to understand what drives lasting symptoms, and what puts some people more at risk than others — a key piece of the puzzle so medical teams can ensure patients get long-term supports.
“How can someone have all of these symptoms after this somewhat trivial head injury? Well, in a vulnerable brain, that can absolutely happen,” Burke said.
“If they’re already predisposed or at risk for mental health conditions, or already experiencing things like anxiety, depression or chronic headache or chronic pain disorders, those are known risk factors for having longer recovery periods after a concussion.”
Dr. Matthew Burke says ongoing research is still needed to understand what drives lasting concussion symptoms, and what puts some people more at risk than others. (Craig Chivers/CBC)
Over 400,000 Canadians have concussions each year
As scientists strive to understand the full mechanisms behind post-injury health issues, basic data on the true number of Canadians actually affected by concussions in the first place remains hard to find.
One 2020 study in the Journal of Head Trauma Rehabilitation analyzed Ontario medical billing records and found close to 150,000 per year from 2008 to 2016 — or 1.2 per cent of the population.
Keith Yeates, head of the psychology department and Ward Chair in pediatric brain injury at the University of Calgary, said the number is likely an underestimate because the study is based on physician visits and many concussions don’t result in medical attention.
“The ‘real’ number is undoubtedly higher,” he said. “But we don’t know how much higher because we lack some of the surveillance systems that are in place in the U.S.”
“Which is just phenomenal when you think about it,” said the Canadian Concussion Centre’s Tator. “And they all don’t get better.”
Multiple clinicians and advocates who spoke to CBC News stressed that frontline medical teams may still not be aware of those long-term risks, leaving many patients struggling to get ongoing treatment and support after their initial injury.
“Brain injuries are happening far more often than I think anybody realizes, and I think the long term consequences of brain injuries are far more severe than anybody realizes,” said Tim Fleiszer, a former professional Canadian football player who is now the executive director of Concussion Legacy Foundation Canada.
“And the system is just not caught up with that yet.”
Health Canada concussion guidelines out of date
Health Canada’s latest guidelines, which state that most people recover from a concussion within a month, also note that Canadians who get a concussion should talk to their doctor or health-care provider about when to return to work, school and sports.
But Tator said that guidance is woefully out of date and the percentage of people who recover within a month can range from as low as five per cent to as high as 35 per cent — with a generally agreed upon estimate of about 25 per cent with persistent symptoms.
“I’m surprised that it hasn’t been brought up to date,” he said of the Health Canada guidelines. “That doesn’t give it the credibility that it’s a significant problem at all.”
Dr. Charles Tator is photographed in his office at Toronto Western Hospital in Toronto on May 10. (Alex Lupul/CBC)
In a statement to CBC News, Health Canada and Public Health Agency of Canada (PHAC) spokesperson Mark Johnson said PHAC regularly tracks scientific findings on traumatic brain injury, including concussion.
“New recommendations on sport-related concussion evaluation and management are expected to be released by summer 2023, based on findings from the 6th International Consensus Conference on Concussion in Sport,” he said. “These recommendations will be taken into consideration when updating Canada’s guidance on concussion.”
Tator said current Health Canada guidelines also fail to address the fact that many family physicians aren’t up to date on the evolving research on concussion treatments and protocols and don’t know how to help their patients.
“And it plays out in the fact that when the patient goes to their family doctor they are often not directed appropriately,” he added.
Community-based resources are also lacking, particularly since patients often experience such a broad range of symptoms that don’t fit neatly into one form of treatment. “If you have a non-sports concussion, and it’s been longer than, say, 12 months… there really is just no resources out there,” Fleiszer said.
‘I couldn’t find my old self’
That’s an experience Tobin-Forgrave understands well. As the years passed following her concussion, she bounced between more than a dozen specialists. None knew how to handle her full spectrum of symptoms. Some didn’t know how to treat a concussion at all.
Certain treatments did help more than others, she said, such as specialized glasses to help mitigate a communication breakdown between her eyes and her injured brain, allowing her to walk around more safely.
But given her host of cognitive issues, Tobin-Forgrave — who is now 51-years-old — is no longer able to work, and has no clear roadmap to a full recovery. Until the medical system catches up with how to treat long-term concussion impacts, she’s had to come to peace with her challenging new reality. That process, like everything else now in her day-to-day life, hasn’t been easy.
“There was grief,” she said, “because I couldn’t find my old self.”
VANCOUVER – Contract negotiations resume today in Vancouver in a labour dispute that has paralyzed container cargo shipping at British Columbia’s ports since Monday.
The BC Maritime Employers Association and International Longshore and Warehouse Union Local 514 are scheduled to meet for the next three days in mediated talks to try to break a deadlock in negotiations.
The union, which represents more than 700 longshore supervisors at ports, including Vancouver, Prince Rupert and Nanaimo, has been without a contract since March last year.
The latest talks come after employers locked out workers in response to what it said was “strike activity” by union members.
The start of the lockout was then followed by several days of no engagement between the two parties, prompting federal Labour Minister Steven MacKinnon to speak with leaders on both sides, asking them to restart talks.
MacKinnon had said that the talks were “progressing at an insufficient pace, indicating a concerning absence of urgency from the parties involved” — a sentiment echoed by several business groups across Canada.
In a joint letter, more than 100 organizations, including the Canadian Chamber of Commerce, Business Council of Canada and associations representing industries from automotive and fertilizer to retail and mining, urged the government to do whatever it takes to end the work stoppage.
“While we acknowledge efforts to continue with mediation, parties have not been able to come to a negotiated agreement,” the letter says. “So, the federal government must take decisive action, using every tool at its disposal to resolve this dispute and limit the damage caused by this disruption.
“We simply cannot afford to once again put Canadian businesses at risk, which in turn puts Canadian livelihoods at risk.”
In the meantime, the union says it has filed a complaint to the Canada Industrial Relations Board against the employers, alleging the association threatened to pull existing conditions out of the last contract in direct contact with its members.
“The BCMEA is trying to undermine the union by attempting to turn members against its democratically elected leadership and bargaining committee — despite the fact that the BCMEA knows full well we received a 96 per cent mandate to take job action if needed,” union president Frank Morena said in a statement.
The employers have responded by calling the complaint “another meritless claim,” adding the final offer to the union that includes a 19.2 per cent wage increase over a four-year term remains on the table.
“The final offer has been on the table for over a week and represents a fair and balanced proposal for employees, and if accepted would end this dispute,” the employers’ statement says. “The offer does not require any concessions from the union.”
The union says the offer does not address the key issue of staffing requirement at the terminals as the port introduces more automation to cargo loading and unloading, which could potentially require fewer workers to operate than older systems.
The Port of Vancouver is the largest in Canada and has seen a number of labour disruptions, including two instances involving the rail and grain storage sectors earlier this year.
A 13-day strike by another group of workers at the port last year resulted in the disruption of a significant amount of shipping and trade.
This report by The Canadian Press was first published Nov. 9, 2024.
The Royal Canadian Legion says a new partnership with e-commerce giant Amazon is helping boost its veterans’ fund, and will hopefully expand its donor base in the digital world.
Since the Oct. 25 launch of its Amazon.ca storefront, the legion says it has received nearly 10,000 orders for poppies.
Online shoppers can order lapel poppies on Amazon in exchange for donations or buy items such as “We Remember” lawn signs, Remembrance Day pins and other accessories, with all proceeds going to the legion’s Poppy Trust Fund for Canadian veterans and their families.
Nujma Bond, the legion’s national spokesperson, said the organization sees this move as keeping up with modern purchasing habits.
“As the world around us evolves we have been looking at different ways to distribute poppies and to make it easier for people to access them,” she said in an interview.
“This is definitely a way to reach a wider number of Canadians of all ages. And certainly younger Canadians are much more active on the web, on social media in general, so we’re also engaging in that way.”
Al Plume, a member of a legion branch in Trenton, Ont., said the online store can also help with outreach to veterans who are far from home.
“For veterans that are overseas and are away, (or) can’t get to a store they can order them online, it’s Amazon.” Plume said.
Plume spent 35 years in the military with the Royal Engineers, and retired eight years ago. He said making sure veterans are looked after is his passion.
“I’ve seen the struggles that our veterans have had with Veterans Affairs … and that’s why I got involved, with making sure that the people get to them and help the veterans with their paperwork.”
But the message about the Amazon storefront didn’t appear to reach all of the legion’s locations, with volunteers at Branch 179 on Vancouver’s Commercial Drive saying they hadn’t heard about the online push.
Holly Paddon, the branch’s poppy campaign co-ordinator and bartender, said the Amazon partnership never came up in meetings with other legion volunteers and officials.
“I work at the legion, I work with the Vancouver poppy office and I go to the meetings for the Vancouver poppy campaign — which includes all the legions in Vancouver — and not once has this been mentioned,” she said.
Paddon said the initiative is a great idea, but she would like to have known more about it.
The legion also sells a larger collection of items at poppystore.ca.
This report by The Canadian Press was first published Nov. 9, 2024.
