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Hundreds of thousands of Canadians get concussions each year — many don’t recover



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 is no longer able to work, and has no clear roadmap to a full recovery years after a concussion.
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 is photographed at Toronto Western Hospital in Toronto on May 11, 2023.
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.

Research on sports-related brain injuries has found links to degenerative brain disease that can manifest in major personality changes, or even early-onset dementia.

A new peer-reviewed Columbia University study on former National Hockey League players even showed being an enforcer, a role known for violent fights involving knocks to the head, was associated with dying approximately 10 years earlier — and more frequently of suicide and drug overdose — than control groups of other players who avoided fighting.


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 is seen at his office in Sunnybrook Hospital on April 26, 2023.
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.”

Even so, the estimate amounts to more than 400,000 Canadians with concussions across the country each year.

“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 at Toronto Western Hospital in Toronto on May 11, 2023.
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.”



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Member of Canada Soccer support team detained in France for alleged drone use




PARIS – The Canadian Olympic Committee says a “non-accredited” member of Canada Soccer’s support team has been detained by French authorities in Saint-Étienne for allegedly using a drone to record New Zealand’s women’s soccer team during practice.

The New Zealand Olympic Committee said in a statement Tuesday that team support members alerted police after a drone was flown over the women’s soccer team’s practice on Monday, leading to the detention.

The NZOC said it registered a complaint with the International Olympic Committee’s integrity unit and asked Canada for a full review.

The COC said in a statement released Tuesday it is “shocked and disappointed” over the allegation and apologized to the NZOC and New Zealand Football.

“The Canadian Olympic Committee stands for fair-play and we are shocked and disappointed,” the statement said. “We offer our heartfelt apologies to New Zealand Football, to all the players affected, and to the New Zealand Olympic Committee.”

Canada, the defending Olympic women’s soccer champion, is scheduled to open its tournament against 28th ranked New Zealand on Friday in Saint-Étienne.

The COC said it is reviewing next steps with the IOC, Paris 2024, Canada Soccer and FIFA. The COC said it will provide an update Wednesday.

“Canada Soccer is working closely and cooperatively with the Canadian Olympic Committee on the matter involving the Women’s National Team,” Canada Soccer communications chief Paulo Senra said it a statement. “Next steps are being reviewed with the IOC, Paris 2024, and FIFA. We will provide an update (Wednesday).”

It’s not the first time a Canadian soccer team has been involved in a drone controversy involving an international rival’s training session.

In 2021 at Toronto, Honduras stopped a training session ahead of its men’s World Cup qualifier against Canada after spotting a drone above the field, according to reports in Honduran media. The teams played to a 1-1 draw.

French security forces guarding Paris 2024 sites are intercepting an average of six drones per day, Prime Minister Gabriel Attal said Tuesday.

Attal added the drones are often operated by “individuals, maybe tourists wanting to take pictures.”

“That’s why it’s important to remind people of the rules. There’s a ban on flying drones,” he said, according to multiple news outlets.

“Systems are in place to allow us to very quickly intercept (drones) and arrest their operators.”

This report by The Canadian Press was first published July 23, 2024.

The Canadian Press. All rights reserved.

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Physicality and endurance win the World Series of perhaps the oldest game in North America




CHOCTAW, Miss. (AP) — As the drummers walk onto the field, the players behind them smack their hickory sticks to the beat. The rhythm envelops the stands and a palpable sense of anticipation flows through the crowd.

Indigenous peoples have been playing stickball for hundreds of years, and every summer since 1975, teams have competed in Mississippi to become champion of perhaps the oldest game in North America.

A game of physicality and endurance, stickball is often referred to as the grandfather of field sports and the annual tournament in Mississippi is the game’s premier event. The Mississippi Band of Choctaw Indians has been producing some of the country’s best players for generations. A team from Mississippi will almost certainly be the one to beat in any tournament or exhibition game in the country.

No pads, no timeouts, no mercy

As the July sun set on another sweltering day, hundreds of people gathered at the Choctaw Central High School football field and sat down on the Indian blankets they had draped across the metal seating. Others lined their folding chairs along the chain-link fence to get a glimpse of the action.

Stickball, known as ishtaboli in the Choctaw language, is played with 30 players on the field, each carrying two netted sticks called kabotcha, and a small woven leather ball painted bright orange, called a towa.

Stickball fans say it remains pure. There are no pads, no timeouts and no mercy. Players typically don’t even wear shoes. It is not uncommon for people to leave the stickball field with broken bones from full contact, or gashes from taking a stick to the face. Any player possessing the ball can expect to be tackled or torn down by their jersey or breechcloth.

“It makes your heart just beat like a drum. Just the intensity of the sport,” Mississippi Band of Choctaw Indians Chief Cyrus Ben said. “At the end of the day, it doesn’t matter what color jersey or what team, it’s being Choctaw.”

Although the game is high-contact, it is so respected by the Choctaw, and so central to their cultural identity, that no hit is taken personally, no matter how intense. Players often slam each other so hard that their sticks go flying through the air, and they simply get back up, nod to each other, and race down the field after the ball.

Variations on stickball have traditionally been played by several tribal nations using rules created by the Mississippi Band of Choctaw Indians.

Players are not allowed to hit each other with their sticks, although that happens routinely when players huddle around a loose ball. Late and early tackles are prohibited, and anything above the shoulders is off-limits.

The field is never empty

Chief Ben, like many here, was given a pair of sticks as soon as he could walk. Some recall sleeping with them above their pillows and a ball underneath. Boys and girls play together in the youth tournaments the night before the men’s and women’s championship games every year at the Choctaw Indian Fair. All over town you will see kids with sticks poking out of their backpacks.

The field is never empty. Children play stickball before every game — living out their fantasy of one day claiming victory on the same field. Between that, the snow-cone stand, and the almost fanatical way the assistant coaches scream from the sidelines, it’s as familiar as any Friday night high-school football game.

This year, Koni Hata, the 2023 men’s champion and one of the most dominant teams in the modern era of stickball, defended its dynasty in both the men’s and women’s title games against neighboring Choctaw communities such as Pearl River and stickball powerhouse Bok Cito.

The finals started with the women’s championship, Bok Cito Ohoyo taking on Koni Hata Ohoyo, which was looking for its second threepeat in the last seven years. Scoreless at the end of regulation play, the game was decided in sudden death when Bok Cito Ohoyo center shooter Leia Phillips scored with a running midfield shot.

“I said, ‘yeah, it’s my time to shine, this is my shot right here, you worked all year for this,’” Phillips, the women’s tournament MVP, said after the game.

Blood, gashes and breaks

The men’s game between Koni Hata and Pearl River was highly physical, and several skirmishes for the ball ended with sticks shooting through the air “like my 9-iron,” one announcer said. Several players were treated by medics for a variety of injuries including a bleeding eye and a gash across the forehead. Earlier in the tournament a player suffered from a broken nose.

Pearl River had no trouble scoring during tournament play, racking up an impressive 41 points in its first three games. They scored in the first half, but the point was negated for having 31 players on the field. Koni Hata scored in the second half but that point was also taken away for having too many players on the field. But Pearl River scored late in the fourth quarter and took home the ceremonial drum presented by Chief Ben.

As the Choctaw Indian Fair was winding down, Jackie Morris, the coach of the team from the community of Bok Cito, waited in line for a hot dog. He made sure that every passing Bok Cito player had a chance to sign the drum slung over his shoulder.

“This is what we play for,” he said, patting the trophy. On the field nearby, drums and sticks beat together.

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Runners set off on the annual Death Valley ultramarathon billed as the world’s toughest foot race




DEATH VALLEY NATOINAL PARK, Calif. (AP) — During a rainstorm that partially obscured the light of a a nearly full moon, 97 runners pushed off in desolate Death Valley with the launch of a 48-hour annual ultramarathon billed as the world’s toughest foot race — the Badwater 135.

After starting late Monday night, the men and women ranging in age from 19 to 69 and hailing from 21 countries and 26 U.S. states, are running amid an excessive heat warning. With daytime temperatures as high as 120 degrees Fahrenheit (48.8 Celsius) and night heat above 100 F (37.7 C), they are traveling over roadways open to traffic and passing through places with names like Furnace Creek, Devil’s Golf Course and Devil’s Cornfield.

“For me it’s all about seeing what I can do, you know, testing my own limits, seeing how well I can do these extreme things,” said 46-year-old runner Jessica Jones from Dauphin Island, Alabama, who was running her second Badwater 135, which starts in the valley’s Badwater basin.

Luke Thomas, 44, from San Diego, was running his fourth 135-mile (217-kilometer) ultramarathon this calendar year.

Thomas didn’t know if the humidity from the late Monday storm would make the first part of the race harder or easier. While running an ultramarathon race in Brazil in January “the humidity almost killed me,” he said.

The race, which started in 1987, always takes place in mid-July, when temperatures peak in Death Valley National Park. The park has seen record-setting temperatures this month, including nine straight days of 125 F (51.6 C) or above.

It’s so dangerous that a motorcyclist traveling in the park died from heat-related illness on July 6, and several more in his group fell ill. A woman with heat illness was rescued in the park on Thursday after she and a man got lost on a hike in an area called Badlands Loop as temperatures hit around 110 F (43.3 C) at 9:30 a.m.

No runner has died during the race, but a few people have landed in the hospital, said race director Chris Kostman, of AdventureCORPS, which organizes the race. The route actually dates back to a decade earlier when it was successfully completed by a solo runner, he said.

Participants start at the lowest point in North America at 282 feet (86 meters) below sea level. The finish line is 8,300 feet (2,530 meters) high at the Whitney Portal, the trailhead to California’s Mount Whitney, the highest point in the contiguous U.S.

Unlike more traditional marathons in which runners race close together, participants in the Badwater 135 are well spaced out on the road. The race is invitation only and limited to 100 runners who have run ultramarathons of at least 100 miles (160 kilometers) or longer over the span of three years. Only one-third of the runners each year can be repeat participants to allow others a chance.

When this year’s runners set out late Monday, temperatures were around 108 F (42.2 C). Their northbound path was illuminated by headlamps and the slightly obscured moonlight.

Organizers do not provide support along the course, which means each runner must bring a personal support team, usually three to four people in a minivan. There are no medical stations along the route, but Kostman said there is a small medical team that patrols the roadway.

The race is held from late Monday through Wednesday to avoid weekend visitors to the national park and increased traffic of people driving through the area from Las Vegas. Organizers coordinate with various federal, state and local government agencies, some of which must provide permits all along the route.

The current fastest record for the race was set by 31-year-old Yoshihiko Ishikawa at 21 hours, 33 minutes and 1 second for the men’s division in 2019, and 41-year-old Ashley Paulson at 21 hours, 44 minutes and 35 seconds in the women’s division in 2023.

Kostman said the runners, support team members and race employees all consider themselves part of a family, often coming back to the park for family vacations.

“There’s a very collegial feel about it,” he said. “Everybody wants the other runners to do as best as they can.”


Snow reported from Phoenix.

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