Holland Bloorview’s groundbreaking research in youth concussion

Dr. Michelle Keightley going through physical tests with Sean Killin, who suffered his first concussion at 12 years old.

Sixteen-year-old Sean Killin remembers his first concussion, sort of. He was chasing a hockey puck when two opposing players body checked him, sending him headfirst into the boards. What followed was a blur, ending with Sean sustaining a significant concussion at just 12 years old.

Holland Bloorview Kids Rehabilitation Hospital is widening the lens on concussion research to include children and youth. Despite the frequency of youth sports-related concussion in Canada and around the world, very little is known about its impact on young brains.

Dr. Michelle Keightley, senior scientist at the Bloorview Research Institute’s Centre for Concussion Research is striving to fill that knowledge gap by researching how the youth brain recovers following mild traumatic brain injury. Using that information, she and her team are developing an evidence-based recovery process that includes more accurate and cost-effective assessment and rehabilitation protocols.

“Until now, concussion research has largely focused on the adult population, but we know that the brains and bodies of youth and children are continually developing, which appears to make them more vulnerable to the effects of a concussion,” says Dr. Keightley.

The Concussion Research Centre estimates that minor hockey players in Ontario alone experience approximately 36,000 concussions every year, which translates into two to three hockey players per team. And while it is known that concussions can impact daily life in the short and long term, research from Dr. Keightley’s lab sheds additional light on the consequences of concussions for children and youth.  She and her team have found that concussed youth hockey players may experience reduced upper and lower body strength, contributing to repeat injuries and future concussions.

The Concussion Research Centre also found that post-concussed youth, even those no longer experiencing outward concussion symptoms, still showed poorer mental performance compared to their non-concussed peers in real world multi-tasking tests.   Dr. Nicholas Reed, a clinician scientist in the Concussion Research Centre, explains that scientists have developed “return-to-activity” guidelines for adults with mild traumatic brain injury, but that there are no such evidence-based guidelines for children and youth.  “Without specific research support for the pediatric population, current recommendations for rest alone may be doing kids more harm than good,” says Dr. Reed.

Dr. Keightley and Dr. Reed have embarked on a long-term project, “NeuroCare,” which focuses on three crucial paths to improving concussion treatment: identification, assessment, and management. This year, the Canadian Institutes of Health Research (CIHR), the Ontario Brain Institute (OBI) and the Ontario Neurotrauma Foundation (ONF) have all lent support to NeuroCare’s concussion research through grants totaling $1.2 million dollars over the next five years.

The NeuroCare project is among the first in the world to study the influence of pediatric concussion on thinking, balance and strength over a multi-year period, with the aim of reducing future injury. It is also one of the first studies to use brain imaging to determine how a young brain responds to concussion, and to bring concussion testing into the real world (like hockey arenas).

Sean Killin, the youth hockey player who suffered his first concussion at 12, was lucky that his hockey team had previously partnered with the Concussion Research Centre at the Bloorview Research Institute to conduct baseline studies on young hockey players who had not experienced concussions. Following his injury, Sean repeated the tests and not surprisingly, did not perform as well as he had on the baseline testing.

After four months of strength, balance and cognitive exercises, Sean was ready for supervised hockey practice. He encourages other young athletes to take concussions seriously. “It’s your brain,” says Sean. “What do you value more, the rest of your life or the next three weeks in playoffs?”

To learn more about the concussion research happening at the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital, contact Dr. Nicholas Reed at NReed@hollandbloorview.ca.