Written by Theressa Jabbour

Header & Thumbnail photo by Buddhi Kumar Shrestha

The brain is one of the most important organs in the human body. It functions as the epicentre of all bodily functions, controlling every system in the body. A complex composition of fat, protein, carbohydrates, water and salt, it contains blood vessels and nerves that are vital to human survival. Although the skull is the brain’s natural protector, it is not strong enough to protect the brain from extreme external physical blows that can damage and disrupt its natural processes. A brain injury can change a person’s life within a split second, and have long-lasting effects. Canada’s two most popular sports are hockey and American football, which both happen to be mediums that unfortunately foster an environment that exposes athletes to repetitive head injuries. Protecting the brain is a conscious effort, and being aware of the causes and effects of brain injuries, as well as how to prevent them, can be crucial to athletes’, and people’s, wellbeing.

Not all brain injuries are the same. Concussions, for example, occur when the brain is shaken within its skull. A mild form of traumatic brain injury (TBI), concussions typically occur through accidents, falls or playing sports. Some signs include headaches, vision changes and an inability to focus. However, this list is not exhaustive, and one should always seek medical attention in case of a suspected head injury. The recovery period ranges from seven to 14 days, but some symptoms may persist for longer as not everyone recovers the same way.

An acquired brain injury (ABI) can be defined as any brain damage “that occurs after birth and is not related to a congenital or a degenerative disease.” Either traumatic or non-traumatic, the former is caused by forces outside the body, while the latter is caused by forces inside. TBIs can be brought on by assault, sports, car accidents and intimate partner violence (IPV), to name a few. IPV, in particular, involves hits to the face and head, with 35-80% of affected women experiencing TBI symptoms. More serious than concussions, TBIs can induce changes in behaviour, cognitive function, and emotion. The challenge remains in prognosticating the recovery period. As every brain is unique, the recovery plan for each person and injury will vary. Your doctor’s advice should be the only one you take, so watch out for symptoms after a suspected brain injury to receive the quickest care possible.

Chronic traumatic encephalopathy (CTE) is described as a “neurodegenerative disease linked to repeated blows to the head.” Often occurring in contact sports, like boxing, or military combat, its symptoms are said to include cognitive difficulties with changes to thought, emotion, and behaviour typically accompanying heightened aggression and mood disorders. However, a CTE diagnosis can only be made post-mortem by analysing the degeneration of the brain tissue and the “tau-based lesions'' in the folds of the brain’s frontal lobes, and as such CTE cannot be diagnosed in living patients. Due to the difficult detection of CTE, there has been minimal research conducted on the topic. One thing that is certain is that the effects of CTE can develop decades after the onset, so be mindful of protecting your brain from multiple head injuries and always seek medical help.

Contact sports, in particular, carry a higher risk of injury to the brain, with American Football leading the statistics. According to a 2018 report by the American Association of Neurological Surgeons, an estimated 454,407 sports-related head injuries were treated at American hospitals, with 51,892 being a result of American football, 24,516 being a result of baseball, and 38,898 as a result of basketball. While hockey is ranked lower down the list at 7,668 treated head injuries, similarly reported data would likely be higher at Canadian hospitals due to the increased popularity of the sport. In competitive sports especially, coaches have a responsibility to educate and monitor their athletes for head injuries. The Coaching Association of Canada (CAC) is working to strengthen the skills of coaches regarding the prevention of concussions. Although safety has been improving in many contact sports, with advances in helmet technology and playing strategies, players are not completely safe from head injuries. So whether it is a minor concussion or a more serious TBI, athletes should always be encouraged to put their health first.

Prevention is perhaps the most straightforward course of action pertaining to head injuries, as there are several precautionary measures one can take to ensure the continued health and safety of the brain. For one, the head should be protected when one is participating in sports that pose a risk to one’s head. This could range from playing hockey to riding a bicycle; no matter the sport, one should make a conscious effort to wear a helmet. With the increasing popularity of electric scooters in Halifax in recent years, it is important to note that Clause 9 of the amended Motor Vehicle Act, passed in 2022 in the Nova Scotia House of Assembly, dictates that all operators of electric kick-scooters must “wear appropriate helmets while operating them.” Helmets increase the safety of riders by absorbing any blows to the head, and decrease the risk of traumatic brain injuries by 53%, according to the Cleveland Clinic. Car accidents can also carry a significant amount of risk regarding head injuries, to drivers, passengers and pedestrians, so remembering to wear a seatbelt and never driving while under the influence of drugs or alcohol can reduce that risk. Finally, being proactive about fall supports can help prevent head injuries in those at risk of losing balance easily, particularly children and the elderly.

There has been growing concern in Canada about TBIs of varying severity, according to the 2020 report by the National Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Prevention efforts are reportedly difficult to regulate due to the differences in causes of brain injuries. Since 2009, visits to the emergency department regarding TBIs in Ontario and Alberta have been increasing, with sports being a frequent cause amongst those between the ages of 5 and 19. If left untreated, the quality of life of those with brain injuries can decrease drastically. TBIs have been known to cause dementia, seizures, sleep disorders and psychiatric problems, amongst others. Brain injuries can also lead to difficulties with socialising, with those suffering from injuries experiencing social isolation and depression.

The issue of brain injuries has been tackled at the government level without widespread success. The Nova Scotia Legislature was presented with a bill by Minister Barbara Adams in the 3rd session of the 63rd General Assembly, in 2021. Titled the Concussion Strategy Act, this bill calls for the development of a “comprehensive provincial concussion strategy” in conversation with several different health and advocacy institutions. This bill aims to establish guidelines for identifying and preventing concussions, promote research, and raise awareness through the use of educational materials, amongst others. While the bill has not reached a second reading yet, the topic is relevant to both Nova Scotians and Canadians more broadly. The people of this province could be reassured that the provincial government is doing its part in the conversation around brain injuries, should this bill be legislated. In 2012, MLA Chuck Porter put forward a bill entitled the Concussion Awareness Act. Its aims are directing the Minister of Health and Wellness to develop “education on the impact of a concussion and respecting procedures” and to protect school-aged athletes after sustaining a head injury. However, it is still in its first reading.

Similarly, Member of Parliament Alistair MacGregor introduced a bill in the House of Commons titled National Strategy on Brain Injuries Act in 2022, which has just had its second reading on the 12th of June of this year. It calls for the Minister of Health to work together with the provincial governments, as well as Indigenous groups, to create a nationwide strategy “to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of persons living with a brain injury.” This issue is seemingly important to Canadians, and raising awareness is the first step to tackling the wider issue of brain injuries.

To encourage the passing of these bills in the House of Commons and the Nova Scotia House of Assembly, one can take action at the individual level. If you or someone you know is directly affected by a head injury, or undertakes an activity that increases his/her chances of suffering from one, you can write to your local representatives to stress the importance of researching brain injuries and raising awareness. The Premier of Nova Scotia, the Minister of Health and Wellness, your Member of Parliament or your Member of the Legislative Assembly are all people with the power to induce change. Research into CTE and its impact on young athletes are particularly relevant topics to highlight, as there have not been substantial measures taken to address them. You could also urge them to implement stricter regulations around sports safety protocols and increase funding for research on the issue. No matter how you choose to advocate, making your voice heard is the first step in the process.

There are several organisations in Canada that are focused on the awareness, prevention and treatment of brain injuries. Brain Injury Canada has several resources for those struggling with the effects of a brain injury, as well as for people who want to learn more. Project Enlist Canada is another organisation whose primary goal is to expedite the research on TBI, CTE and PTSD in veterans, as they state that brain injuries do not only affect athletes. They hope to achieve their mission by way of brain donation, to better study the effects of brain trauma exposure in the military. Working with Project Enlist is the Concussion Legacy Foundation Canada, with a vision of “a world without CTE” that they hope to achieve in the near future.

While it seems that awareness and action regarding head injuries has been increasing, there is still room for improvement regarding government initiatives and intervention. At the personal level, brain injuries can affect your emotions, cognition, and behaviour, so being aware of the signs may end up helping you in the future. Awareness can only go so far if one doesn’t actively work on prevention, and while action on behalf of the government can help inform people, it is up to each person, whether an athlete or not, to mind his/her brain. Prevention is key, so if you know you have a high risk of being subjected to brain injuries, take all the proper precautions, and encourage those around you to do the same.

Minding Your Brain: Head Injuries

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