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Jane Clark recalls how difficult it was just to travel to her family doctor’s office while suffering concussion symptoms.
Once there, she had to answer pointed questions “through the haze and pain” of a concussion, about what she was experiencing.
“Without scans or bio-markers, it falls to the injured patient to convey the condition,” Clark told a capacity crowd of about 150 at the inaugural concussion march Saturday afternoon.
“The referral system is inadequate,” Clark noted. It took her 15 months to get diagnosed, setting back her recovery.
Improving concussion care is one of the reasons Clark helped launch the Concussion Injury Group, out of the University of Ottawa Brain and Mind Awareness Research Institute.
Over the past decade, concussion research and awareness have exploded.
Playing catch-up are the medical guidelines and services to meet the needs of patients.
Nobody knows more about concussion guidelines than Dr. Shawn Marshall, medical director of the acquired brain injury rehabilitation clinic at the Ottawa Hospital Rehabilitation Centre. Marshall was the lead author on a comprehensive set of provincial guidelines that continue to be updated and improved. The third set of documents is on the horizon.
Marshall was asked what presents the greatest challenge for a person who has suffered a concussion — knowing where to go for treatment, or the wait times to see a specialist?
“It’s both,” Marshall says. “Sometimes for physicians, to know where to refer a patient can be a challenge.
“Wait times are not unique to concussions, it’s one of the burdens for Canadian health care,” Marshall adds, noting the length of wait for hip replacement surgery, for example. “We’re looking at putting research dollars and physician resources into trying to assess wait times.”
The Rehabilitation Centre’s brain trauma clinic is now in its third go-round of tackling wait times, which can be six months or longer.
“I can tell you we’ve made some very significant headway, and it’s been a lot of work,” says Marshall, who spoke at Saturday’s march, along with vascular biologist Dr. Baptiste Lacoste (his theme: “See the invisible, repair the visible”).
“We’re seeing patients sooner but don’t have the (wait) list optimized yet,” Marshall says. “That has to do with availability of physicians and system resource. This problem is not unique to Ottawa.”
Left to right: Meg Milne, Jane Clark, Natalia Rybczynski, and Frances Casey are all members of the Concussion Injury Group, advocating for concussion survivors. The CIG is a branch of the University of Ottawa Brain and Mind Research Institute. March 16,2018. Errol McGihon/Postmedia
Concussion treatment has come a long way. Marshall notes that up until the early 2000s, “no one even believed people could have persistent symptoms with concussion.”
Today it is recognized that while 85 to 90 per cent of people with concussions will get better in a matter of days or weeks, the so-called “miserable minority” have symptoms that persist.
Marshall and a group of experts put together a comprehensive set of standards for concussion care in Ontario, along with a set of evidence-based clinical practice guidelines. These were developed with the help of patient input. Dr. Roger Zemek of CHEO published companion guidelines for children’s care.
“It was bit of a dog-and-pony show — the wild west out there — as far as what services were available for patients,” Marshall says. “And what’s effective. And it was very confusing.”
Now, there are provincial standards for treating concussions in adults, children, and for sports participants, thanks to the Rowan’s Law legislation, developed in honour of Rowan Stringer, an Ottawa high school athlete who died after returning to action too soon following a concussion.
“These are the tenets for how it should be managed early on,” Marshall says, of the guidelines.
What should an individual and his or her family do in the event of a suspected concussion?
First, it should be formally assessed, by a physician or nurse practitioner.
“Your No. 1 job with a concussion is to identify it,” Marshall says. “Diagnose it. I know that sounds strange, but really, a concussion is a brain injury and you have to assess the magnitude of it.”
Among the determinations is whether or not there is severe brain trauma. Yet another Ottawa specialist, Dr. Ian Stiell, developed the Canadian CT Head Rules, a guide to determine who requires a scan of the brain. For example, if a patient lost consciousness or is confused.
The greatest challenge involves work with the minority who are experiencing symptoms for longer than three months.
“We need to develop a system where we develop secondary and tertiary levels of intervention,” Marshall says. “What I mean by that is, if recovery is not going well, you might need to visit someone who sees more of this (i.e.. ongoing symptoms). That’s how a health care system works. You have to have experts.”
Saturday’s panel talk and walk featured the moving personal stories of four survivors on the CIG panel — Clark, Natalia Rybczynski, Meg Milne and Frances Casey.
Casey envisions a day when there is a “Concussion Central” care centre, looking after acute and chronic patients, with tentacles to other resource outlets.
There were nearly 150,000 diagnosed concussions in Ontario in 2013, nearly double the number from 2004.
The concussion treatment guidelines are free and available at ConcussionsOntario.org.
查看原文...
Once there, she had to answer pointed questions “through the haze and pain” of a concussion, about what she was experiencing.
“Without scans or bio-markers, it falls to the injured patient to convey the condition,” Clark told a capacity crowd of about 150 at the inaugural concussion march Saturday afternoon.
“The referral system is inadequate,” Clark noted. It took her 15 months to get diagnosed, setting back her recovery.
Improving concussion care is one of the reasons Clark helped launch the Concussion Injury Group, out of the University of Ottawa Brain and Mind Awareness Research Institute.
Over the past decade, concussion research and awareness have exploded.
Playing catch-up are the medical guidelines and services to meet the needs of patients.
Nobody knows more about concussion guidelines than Dr. Shawn Marshall, medical director of the acquired brain injury rehabilitation clinic at the Ottawa Hospital Rehabilitation Centre. Marshall was the lead author on a comprehensive set of provincial guidelines that continue to be updated and improved. The third set of documents is on the horizon.
Marshall was asked what presents the greatest challenge for a person who has suffered a concussion — knowing where to go for treatment, or the wait times to see a specialist?
“It’s both,” Marshall says. “Sometimes for physicians, to know where to refer a patient can be a challenge.
“Wait times are not unique to concussions, it’s one of the burdens for Canadian health care,” Marshall adds, noting the length of wait for hip replacement surgery, for example. “We’re looking at putting research dollars and physician resources into trying to assess wait times.”
The Rehabilitation Centre’s brain trauma clinic is now in its third go-round of tackling wait times, which can be six months or longer.
“I can tell you we’ve made some very significant headway, and it’s been a lot of work,” says Marshall, who spoke at Saturday’s march, along with vascular biologist Dr. Baptiste Lacoste (his theme: “See the invisible, repair the visible”).
“We’re seeing patients sooner but don’t have the (wait) list optimized yet,” Marshall says. “That has to do with availability of physicians and system resource. This problem is not unique to Ottawa.”
Left to right: Meg Milne, Jane Clark, Natalia Rybczynski, and Frances Casey are all members of the Concussion Injury Group, advocating for concussion survivors. The CIG is a branch of the University of Ottawa Brain and Mind Research Institute. March 16,2018. Errol McGihon/Postmedia
Concussion treatment has come a long way. Marshall notes that up until the early 2000s, “no one even believed people could have persistent symptoms with concussion.”
Today it is recognized that while 85 to 90 per cent of people with concussions will get better in a matter of days or weeks, the so-called “miserable minority” have symptoms that persist.
Marshall and a group of experts put together a comprehensive set of standards for concussion care in Ontario, along with a set of evidence-based clinical practice guidelines. These were developed with the help of patient input. Dr. Roger Zemek of CHEO published companion guidelines for children’s care.
“It was bit of a dog-and-pony show — the wild west out there — as far as what services were available for patients,” Marshall says. “And what’s effective. And it was very confusing.”
Now, there are provincial standards for treating concussions in adults, children, and for sports participants, thanks to the Rowan’s Law legislation, developed in honour of Rowan Stringer, an Ottawa high school athlete who died after returning to action too soon following a concussion.
“These are the tenets for how it should be managed early on,” Marshall says, of the guidelines.
What should an individual and his or her family do in the event of a suspected concussion?
First, it should be formally assessed, by a physician or nurse practitioner.
“Your No. 1 job with a concussion is to identify it,” Marshall says. “Diagnose it. I know that sounds strange, but really, a concussion is a brain injury and you have to assess the magnitude of it.”
Among the determinations is whether or not there is severe brain trauma. Yet another Ottawa specialist, Dr. Ian Stiell, developed the Canadian CT Head Rules, a guide to determine who requires a scan of the brain. For example, if a patient lost consciousness or is confused.
The greatest challenge involves work with the minority who are experiencing symptoms for longer than three months.
“We need to develop a system where we develop secondary and tertiary levels of intervention,” Marshall says. “What I mean by that is, if recovery is not going well, you might need to visit someone who sees more of this (i.e.. ongoing symptoms). That’s how a health care system works. You have to have experts.”
Saturday’s panel talk and walk featured the moving personal stories of four survivors on the CIG panel — Clark, Natalia Rybczynski, Meg Milne and Frances Casey.
Casey envisions a day when there is a “Concussion Central” care centre, looking after acute and chronic patients, with tentacles to other resource outlets.
There were nearly 150,000 diagnosed concussions in Ontario in 2013, nearly double the number from 2004.
The concussion treatment guidelines are free and available at ConcussionsOntario.org.
查看原文...
