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

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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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Alberta unveils new municipal election and political party rules |

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Alberta’s Municipal Affairs Minister Ric McIver has unveiled new municipal election and political party rules. The rules make sweeping changes, including regulations new municipal political parties in Edmonton and Calgary will have to follow ahead of next year’s municipal election. The government says these rules will make local elections more transparent. (Oct. 18, 2024)



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One Direction was the internet’s first boy band, and Liam Payne its grounding force

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Liam Payne’s voice is the first one heard in the culture-shifting boy band One Direction’s debut single: “What Makes You Beautiful” launches into a bouncy guitar riff, a cheeky and borderline gratuitous cowbell and then, Payne.

“You’re insecure, don’t know what for / You’re turning heads when you walk through the door,” he sings, in a few words assuring a cross-section of generations that he’s got your back, girl, and you should like yourself a little bit more.

Payne, who died Wednesday after falling from a hotel balcony in Buenos Aires, Argentina, at just 31, was also the last solo voice on the band’s final single, “History” — effectively opening and closing the monolithic run of one of the biggest boy bands of all time.

While the exact circumstances of his death remain unclear — Buenos Aires police said in a statement that Payne “had jumped from the balcony of his room,” although they didn’t offer details on how they established that or whether it was intentional — in life, Payne was a critical part of the internet’s first boy band, one that secured an indelible place in the hearts of millennial and Gen Z fans.

How One Direction became the internet’s first boy band

Before One Direction became One Direction, its members auditioned for the U.K.’s “The X Factor” separately. The judges decided to put five promising, but not yet excellent, boys into a group. They were Harry Styles, Niall Horan, Louis Tomlinson, Zayn Malik and Payne, who together finished third in the 2010 competition.

As Rolling Stone contributing editor Rob Sheffield points out, it was an “unprecedented” way for a boy band to get their start.

“They were sort of assigned to be together. And you don’t expect longevity out of that situation. Honestly, you don’t even expect one good pop record to come out of that situation,” he says. And yet, not only did it work, but One Direction essentially created “a new template for pop stardom, really.”

The show allowed Day 1 fans to follow their career before their official 2011 launch with “What Makes You Beautiful.” Nascent fans could use rising social media platforms like Twitter and Tumblr to find community, draw attention to the group and, in the earliest days, speak directly to the members.

“I honestly made a Twitter so that I could keep up with One Direction, and that’s how I made so many different friends,” says Gabrielle Kopera, 28, a fan from California who remembers the band hosting livestreams and chats. “Sometimes they would say something back and it was so much fun. I feel like that fan interaction doesn’t even happen anymore.”

That feeling of accessibility reinforced the group’s personality and relationship with fans, says Maura Johnston, a freelance music writer and Boston College adjunct instructor.

“The fact that they came up on this British TV show and they became this worldwide phenomenon, I don’t think that would have happened as acutely and as quickly and as immersive without social media, without Twitter or without people being able to mobilize around the globe,” she says.

One Direction and their fans

Millennial and Gen Z audiences practically grew up with One Direction, but the band was truly ubiquitous. That, Johnston says, is at least partially attributable to arriving in a very different media environment from today’s.

“It was a lot more focused,” she says of the early 2010s. “Algorithmic sorting of stuff hadn’t really taken hold. So, there was this broader, mass approach. … They were one of the last gasps of that mass phenomenon, that anyone of any age, even if they weren’t a fan, had to take notice to.”

But it takes more than omnipresence to cultivate a loyal fanbase. And there were myriad reasons why listeners were attracted to One Direction.

“They were five very different musical personalities, along with five very different personalities,” says Sheffield.

They broke the rules associated with traditional boy bands, too: “They co-wrote many of their songs. They didn’t do, you know, corny, choreographed steps on stage,” he said.

After the news of Payne’s death, Kopera says she “got so many messages from people I haven’t talked to in years reaching out because I think everyone kind of realized that it does feel like we just lost a family member.”

That sentiment was mirrored in the masses of fans who gathered Wednesday outside Buenos Aires’ Casa Sur Hotel, feeding a burgeoning makeshift memorial of flowers, candles and notes as police stood guard.

“I’ve always loved One Direction since I was little,” said Juana Relh, 18, outside Payne’s hotel. “To see that he died and that there will never be another reunion of the boys is unbelievable, it kills me.”

Liam Payne’s place in the band, and its legacy

Payne was a “brooding” older brother-type in One Direction, says Johnston. He also co-wrote many songs, especially in their later career — like the Fleetwood Mac-channeling “What A Feeling” and “Fireproof.”

“He was this grounding force in the band,” Johnston says.

In an Instagram tribute, Tomlinson called Payne “the most vital part of One Direction.”

“His experience from a young age, his perfect pitch, his stage presence, his gift for writing. The list goes on. Thank you for shaping us Liam,” he wrote.

“I always remember that he was the responsible and the sensible one of the group, and I feel like he wore his heart on his sleeve,” Kopera says.

Payne had recently been vocal about struggling with alcoholism, posting a YouTube video in July 2023 where he said he had been sober for six months after receiving treatment. Buenos Aires police said they found clonazepam — a central nervous system depressant — and other over-the-counter drugs in Payne’s hotel room, along with a whiskey bottle in the courtyard where he was found.

“Looking at what happened to Liam, it just makes you feel even more sad, that it just feels like he needed help,” Kopera says. “And it’s so scary to think about how the entertainment industry can just, like, eat up artists.”

After One Direction disbanded in 2016, Payne’s solo career — a single R&B-pop album in 2019, “LP1,” and a number of singles here and there — never took off the same way as some of his bandmates. He was “the least successful,” Sheffield says. “It’s safe to say that on the terms that he was going for, he didn’t really find what he wanted to do.”

“It’s hard, transitioning from being a boy bander to be a pop star,” Johnston says.

At Payne’s solo shows, Sheffield explains, “He would show a little montage of One Direction performing, which is the kind of thing you don’t do when you’re starting out as a solo artist. But fans took that in the spirit it was offered, which is a very generous statement that he’s like, ‘Yep, you’re here because of this history that we share, and I’m here because of that same history.’”

Despite Payne’s struggles and the tragedy of his death, Kopera is confident “his legacy is going to always point back to One Direction.”

For fans, the same is true.

“When I look back on One Direction, I’m like, that was my girlhood. One Direction was the soundtrack to growing up, and I’m so thankful for it,” she says. “They really were just a group of normal boys.”

____

AP journalist Brooke Lefferts contributed to this report.



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Fledgling Northern Soccer League expected to announce first player signings soon

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The Northern Super League will likely start rolling out player signing announcements next week but its full schedule isn’t expected until early next year, according to co-founder Diana Matheson.

The former Canadian international said the fledgling six-team women’s pro league, which is scheduled to kick off in April, is having to wait on others for the full schedule although an update on the start and end of the season plus transfer window information is expected soon.

“The reality is we share venues with other teams. We’re either second, third or fourth tenant in some places,” Matheson explained.

The new league has to wait for the CFL to sort out its schedule and broadcast information, so the full NSL schedule likely won’t come out until late January or early February.

“It’s a starting point. We’ll get better,” said Matheson,

In some cases, as in the PWHL, teams may also play several games outside their primary venue, which adds to the complexity.

Matheson said teams have already started signing players, with news to follow.

“Player announcements will just keep coming until February-March,” she said. “We operate, as you know, in a global market. All the players out there are under contract right now so there’ll probably be some incredible Canadian stories signed early that you’ll start to learn about.

“And then the reality is the clubs actually get more leverage over players and agents the closer we get to the season so there’ll be some patience of clubs to sign players too, to sign the strongest possible rosters across the league from Day 1, the kickoff in April. And then we’re in market and we’re competing against the rest of the world.”

Matheson said there will be no requirement in the new league to play a certain number of young players, at least in its early stages. The 20- to 25-woman team rosters will be limited to seven internationals.

Matheson is headed to Spain next to help with the Canadian women’s team.

Sixth-ranked Canada will be coached by committee for the Oct. 25 friendly with No. 3 Spain in Almendralejo, Spain. With coach Bev Priestman suspended for a year in the wake of the Olympic drone-spying scandal, the coaching will be handled by returning assistant coaches Andy Spence, Jen Herst and Neil Wood.

Katie Collar, head coach of Whitecap FC Girls Elite, will serve as interim technical assistant and Maryse Bard-Martel as interim performance analyst.

The 40-year-old Matheson, who won 206 caps for Canada in a senior career that stretched from 2003 to 2020, is serving in an interim team support role, “providing leadership and serving as a resource for both staff and players.”

Matheson said it is likely a “one-off … as someone who has lived the program on the players’ side.”

But she said it was “an honour” to be part of the Canadian setup — and also a chance to answer any questions from players about the new league.

The NSL league will kick off with teams in Vancouver, Calgary, Toronto, Montreal. Ottawa and Halifax.

Matheson hopes veteran midfielder Desiree Scott, who is returning at the end of the NWSL season, can play a role with the new Canadian women’s league — hopefully when her native Winnipeg joins the circuit.

This report by The Canadian Press was first published Oct. 18, 2024

The Canadian Press. All rights reserved.



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