Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, November 25, 2015

The Rowan's Law Act

"Would knowledge of concussions have prevented her death? I think there's a good chance it would have, if she had been more clued in. In fact, she did try to clue herself in. One of her texts indicated she had Googled 'concussion'. But she didn't read enough, or it didn't sink in enough, to prevent her from playing in that final game that took her life."
"We found out in the Rowan Stringer inquest that some [amateur football] leagues had done nothing about concussions -- zero." 
"We do think the adolescent brain is the most sensitive brain to the effects of concussion. We used to think the infant brain was the most sensitive to trauma, but it appears now, because of the huge number of connections that are being made during adolescence, there's a reason to worry more about adolescents getting concussed. They certainly take longer than adults to recover."
Dr.Charles Tator, neurosurgeon, Krembil Neuroscience Centre, Toronto Western Hospital

"I'm totally shocked, because typically in Canada we're more progressive as far as health care goes and safety."
"In the States, they realized this is serious, this is dangerous, and this is worth having legislation."
Kathleen Stringer, Ottawa
Concussion death inspires push for 'Rowan’s Law'
17-year-old Rowan Stringer died in hospital after suffering injuries in a high school rugby game in May 2013.
"When I see the kids, they're often pretty down. They're pretty fed up. They've had persistent headaches, often for months. They find it more difficult to do their schoolwork, because they find it difficult to concentrate and attend."
"They haven't been allowed to go back to play sports, so they're feeling socially isolated from their friends. When we see these kids, it's often quite sad."
Dr. Karen Barlow, pediatric neurologist, Alberta Children's Hospital
Facebook    Rowan Stringer, right, carries the ball in a picture on her Facebook page 
"If I had a dollar for every time I heard, 'Suck it up and play through it' during my career, I wouldn't be on a student budget. All of us seem to feel the team can't win without us, and that's a great feeling to have, because you feel like you're imoportant and contributing. But there's no win that will ever be more important than your ability to function."
"I knew I was doing the wrong thing [playing through a concussion], but it didn't matter at that point. I was still too young to realize that your brain isn't something you can put in a cast and hope it will get better."
Molly Tissenbaum, Ontarian, hockey goalie, Harvard University

"She was Jekyll and Hyde. As brilliant as she had been, she couldn't come up with any answers at school. She was so frustrated by it [post-concussion syndrome]. She was like the Tasmanian Devil. Not the real one, the one we all know from the Warner Bros. cartoon. Things were all over the house. She couldn't remember where anything had been put, so she would just whirl around looking for what it was that she thought she put down, and it was always right beside her. She was not on her game at all."
Lisa Tissenbaum, Molly's mother

"Nothing can stop me! Unless I'm dead", Rowan Stringer wrote in a text message she sent to her best friend the night before she was to play her last rugby game for her school team. She played after two concussions in the space of a week, while exercising her talent for sports. She had been an exuberant volunteer at Children's Hospital of Eastern Ontario, preparing to attend University of Ottawa's nursing program in the fall of 2013. But CHEO was where she died on May 12, 2013, from the results of exacerbating the concussions she had suffered.

A coroner's inquest that followed pointed out starkly the laissez-faire attitude of authorities, sport officials and the public in a massive failure to understand just how serious the effects of repeated blows on the cranium can be, both in the short term and long-range into the future. This 17-year-old girl who loved playing rugby and had a zest for life and anticipated a fulfilling future surrendered her life to a lack of understanding of what her headaches presaged.

While Canada and the provinces have no laws respecting youth concussions, all 50 States in the U.S. do have such laws. Ontario has just now passed the first of such laws in Canada, and it has been called 'Rowan's Law', meant to bring awareness to the problem of youth concussions and to prevent situations such as Rowan's from re-occurring, robbing a young life of a future. Among professional athletes concussions have taken the headlines in recent years.

The National Football League was accused of masking risks of repeated head injuries and is now facing a $1-billion settlement with thousands of former players. The National Hockey League and the National Football League have, over the last few years, both adopted protocols to address concussions. Players are required to leave the bench and report to a quiet room for assessment by a doctor after a hit to the head, with the NHL. The NFL has addressed the critical issue through requiring a player with a suspected concussion to have a team doctor clearance plus an independent neurologist go-ahead, before being permitted to return to the game.

For youth sports in Canada, however, few such rules exist despite that in 2012 the Canadian Paediatric Society pointed out that a statute requiring all regional sporting associations and school boards was required for the development of a written concussion recognition and management policy. The Paediatric Society pointed out that concussions account for nine to 12 percent of all high school sports injuries.

Six years ago Washington was the first state to bring forward a concussion law, named after a 13-year-old football player who had suffered a life-threatening brain injury after a return to the game following a hard strike earlier in the game. Three years earlier at the Alberta Children's Hospital traumatic brain injury program 100 to 150 children were treated annually with persistent concussion symptoms. That number has risen and will hit 400 this year.

A 2014 Ontario study discovered the total number of pediatric concussion visits to emergency departments and physician offices rose to 14,886 in 2010 from 8,736 in 2003. The rate per 100,000 population increased to 754 from 467 for boys and to 441 from 209 for girls, during that period. In a 2013 study out of North Carolina it was found that up to 40 percent of concussions that occurred to American high school athletes failed to be reported to coaches or to medical officials.

Molly Tissenbaum, remembering her own experiences when she was a younger athlete feels relief that Ontario has finally passed a concussion-protection law. "I think this law is going to be a very important first step in recognizing that say, 'I'm injured, I cannot play', is not a sign of weakness. It's mind-blowing the number of kids who are in organized sports, and they're vulnerable to these things, because there's nothing protecting them except their own ability to say, 'I'm hurt', or 'I'm not'. Having been an athlete, I know that might be the single most difficult thing to say."

Management of the adolescent concussion victim. Abstract

Increasing awareness and understanding of the implications of concussion have shaped a more proactive management approach to this problem. Although the incidence of brain injuries in adolescent athletes is probably in the range of 1.6 to 3.8 million per year (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Facts for physicians about mild traumatic brain injury. Available at:, difficulties in recognizing and diagnosing this condition mean that as many as 80% go unrecognized and have led to its being known as "the silent epidemic." Attempts to improve the evaluation on the sidelines, in the outpatient clinic, and in the home are helping to improve management. Better understanding of the prognosis and clinical course of concussion, as well as the importance of physical and mental rest, have also helped healthcare providers to make better decisions about allowing athletes to return to play.  Congeni J1. Adolesc Med State Art Rev. 2009 Apr;20(1):41-56, viii. Review. U.S. Library of Medicine, National Institutes of Health

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