Tag Archives: concussion

Ontario Concussion Rates Are Much Higher Than Previously Reported

Written By: William Harding and Christina El-Azzi, Summer Student

Study from the Journal of Head Trauma Rehabilitation

A concussion  is  a brain injury that results from a blow to the head or body which causes the brain to hit the walls of the skull, resulting in bruising or swelling. Though many concussions heal quickly, they have the potential to have lasting effects and can sometimes result in death.

A recent study by Toronto’s University Health Network suggests that concussion rates in Ontario are almost twice as high as previously recorded. They state that approximately 150,000 concussions get diagnosed in Ontario annually, with children under 5, women over 65 and populations in rural communities being the most susceptible.[1]

Are We Dealing With a Concussion Epidemic?

Though the dramatic increase in the rate of reported concussions appears to be alarming, the team at Toronto’s University Health Network believes the dramatic spike is influenced by increased public awareness surrounding brain injuries rather than an increase in the actual number of concussions.

Public education surrounding concussions has ramped up in recent years. This is likely due, in part, to the highly publicized death of Rowan Stringer. Rowan was a 17-year-old Ottawa girl who died after sustaining multiple concussions while playing high school rugby. Rowan’s Law, legislation which establishes safety protocols for young athletes suspected of having a concussion, was born out of this tragic incident. The NFL concussion class action also played a role in publicly highlighting the serious risks associated with repetitive brain injuries.

The limited scope of previous studies done in Ontario with regards to concussion rates may have also contributed to the skewed statistics. Previously, studies only considered smaller jurisdictions, single causes of injury, or they focused on specific pockets of the population. By using a larger research sample (records were pulled from a province-wide health data repository), the research team at Toronto’s University Health Network was able to offer a much more comprehensive look at concussion rates in the province.


The importance of public awareness and education surrounding concussions persists because concussions are invisible injuries, unseen by the naked eye or on many forms of diagnostic imaging. They can easily be downplayed by the patient or misdiagnosed by the treating physician.

Concussions range in severity from mild to debilitating. If left untreated, symptoms such as headaches, mental fog, and fatigue can persist for years.

The more information we have about concussions, the better equipped we are to prevent and efficiently treat them. Keep the following in mind:

  • The best way to prevent a head injury is to protect the head. Always wear a properly fitted helmet that is appropriate for the activity you are participating in.
  • Always ensure that you and your fellow passengers are wearing seatbelts when in a vehicle.
  • Know the signs and symptoms of concussion which includedizziness, headaches, nausea, sensitivity to light, blurred vision, ringing in the ears, lack of concentration, problems with balance, and trouble speaking. Note: You do not always lose consciousness when you sustain a concussion.
  • Remove yourself from the situation immediately if you suspect that you have been injured.
  • Do not take a chance! If you are having any symptoms, it is important to seek medical attention.
  • Do not return until all symptoms have dissipated and you have been medically cleared. The risks associated with concussions are exacerbated if multiple concussions are suffered, especially if they happen within a short period of time!

If you or someone you know has suffered from a severe concussion, contact one of the critical injury lawyers at McLeish Orlando LLP for a free consultation.

[1] Langer, Laura & Levy, Charissa & Bayley, Mark. (2019). Increasing Incidence of Concussion: True Epidemic or Better Recognition? Journal of Head Trauma Rehabilitation.

Summer Safety Series: How to Keep Your Kids Safe in Sports

As I watched the closing ceremonies of the Pan Am Games, I couldn’t help but reflect on how they have brought our city and whole country together, inspired our youth, and shown us the power of sport.  I had the pleasure of attending many of the events and I congratulate all of our athletes. I know the sacrifices they must have made to be able to achieve such great results.

I saw so many kids in the audience cheering loudly as they watched our Canadian athletes win gold.  My children felt so much pride whenever our flag was raised at an event, listening to our national anthem, and touching a gold medal when one of our Canadian athletes walked into the PanAm Park with it around her neck.

Now my kids, and so many kids all over Ontario, are eager to get out and try all these sports themselves!

Summertime is a great opportunity for them to do that, but as parents, we should be ready for the risks that come with athletics. No, I’m not being paranoid or overly cautious because I’m a personal injury lawyer. Statistics show that 1 in 5 sport-related injuries are concussions and between 5 and 10 percent of athletes in an average sport will experience a concussion in a given season.[1]  Concussions are often minor, but they can have lasting effects if they’re not recognized and treated properly. The time it takes for a concussion to heal can vary widely. If adequate rest and rehabilitation are not allowed, a relatively minor concussion can cause lasting damage to a child’s brain.

As parents, coaches and volunteers it is not possible to prevent every concussion. We therefore must be mindful of the risk of concussions, their warning signs, and what action to take if we are concerned that a child has sustained a concussion.

Some signs of a concussion include:

  • General confusion
  • Headaches
  • Dizziness
  • Ringing in the ears
  • Sleepiness
  • Seeing double.
  • Stomach pain
  • Nausea
  • Poor coordination
  • Poor concentration
  • Strange or inappropriate emotions.

As a personal injury lawyer, I have seen the long-term damage concussions can do and I want to help prevent that. Children who are suspected to have suffered a concussion should immediately stop playing the sport or activity.  They should not be left alone and should be taken to see a doctor as soon as possible.

In the case of unconsciousness, an ambulance should be called immediately.  If the unconscious child is wearing a helmet, leave the helmet on.  Even if the child feels better later that day, it is important to allow them the time to fully heal; young children and teens take longer to heal from concussions than adults.  Slowly increasing the level of physical and mental activity the child performs, in accordance with their medical professional’s advice, is the best route to recovery.

Even after a child has fully recovered and returned to play, it is important to maintain a high level of awareness of the possibility of further injury.  A child is 1-2 times more likely to receive a second concussion with the likelihood of further concussions increasing with each subsequent concussion.[2]

There are all sorts of educational resources on the web that can provide further information on preventive measures to keep our children safe. Here’s a great article by Parachute about how to safely play summer sports if your child has caught the Pan Am fever: http://www.parachutecanada.org/blog/item/catch-the-pan-am-fever-and-have-an-active-summer

[1] Brain Injury Association of Waterloo-Wellington, “Stats”(2012), online: http://www.biaww.com/stats.html; Sport Concussion Institute, “Concussion facts” (2012) online: http://www.concussiontreatment.com/concussionfacts.html.

[2] Sport Concussion Institute, “Concussion facts” (2012) online: http://www.concussiontreatment.com/concussionfacts.html.

Guidelines targeted at long-lasting concussion symptoms

New guidelines reporting symptoms and treatment of post-concussion syndrome have been released which represent a positive step towards determining the effects of concussion, John McLeish, Partner of McLeish Orlando talks to Advocate Daily about what this means for diagnosis and treatment of post-concussion syndrome .

Click here to read the article on Advocate Daily.

Study highlights need for brain injury awareness

As seen on AdvocateDaily.com

Brain injuries are occurring at an alarming rate among Ontario teenagers, a new study has found, making education and awareness on the effects of a blow to the head crucial for parents, says Toronto critical injury lawyer Dale Orlando.

“I think there’s a common misconception where people talk about a concussion without understanding that a concussion is considered to be a brain injury,” says Orlando, partner with McLeish Orlando LLP. “A concussion, by definition, is a mild or moderate brain injury.”

The study found that one in five teens in Ontario has had a concussion or another brain injury in their lifetime that was serious enough to leave them unconscious for five minutes or to send them to hospital overnight, CTV reports.

As well, a total of 5.6 per cent reported they had had a concussion or significant brain injury in the past year, it adds.

“Statically, the majority of people who suffer mild traumatic brain injuries go on to have full symptom resolution, but there is a percentage that have significant ongoing difficulties as a result of their mild traumatic brain injury,” says Orlando. “But even for the people that do go on to have a good recovery and are symptom free, they become much more vulnerable to more significant impairments if they suffer a second head injury.”

The study used data from the 2011 Ontario Student Drug Use and Health Survey, CTV reports, noting it used responses from almost 9,000 students from Grades 7-12.

The survey found that the majority of traumatic brain injuries for the teens occurred during sports: 47 per cent for girls and 63.5 per cent for boys, with hockey and soccer accounting for more than half the injuries, the report says.

“I think as parents we have to be hyper vigilant and aware that a concussion isn’t just a minor thing like a scrape or a bruise that happens through the course of childhood that isn’t a big deal,” says Orlando.

“Many Canadian boys and girls grow up chasing the dream of making a living playing hockey, but Peewee games and Bantam games – they’re not the NHL,” he says. “Rules regarding hits to the head should be stringently enforced. Any hit directed to the head should have serious consequences for the person delivering the hit. Hitting from behind, driving somebody’s head into the boards … the penalty should be increased to eliminate it from the sport.”

On the soccer field, Orlando says it’s common to see injuries from regular activities, like heading the ball.

“That may not be appropriate for children of a certain age,” he says.

Orlando says while improvements have been made in sporting rules, more can be done to prevent serious injury.

“I think we’ve come a long way from the days of somebody suffering a concussion and having the coach say ‘Get back out there for your next shift.’ There are practices and protocols in place,” he says. “Parents have to recognize that a concussion is a mild traumatic brain injury and the restrictions associated with return to play are there for a reason.”

Brain Injury Series Part 2: The Ways a Brain Can Be Injured

This is the second of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.

We first discussed the anatomy of the brain, including the structure of neurons.  Here we will discuss the ways that our brain can be injured and the implications that flow from the various kinds of injuries.

The brain is very delicate and is considered to be the consistency similar to that of gelatin.  If a brain is suddenly jolted or banged or twisted, it will cause a traumatic impact that ripples through the entire brain and can cause complications.  The brain is made up of billions of neurons that can be damaged by trauma to a person’s head.

Some of the ways damage can occur to a human’s brain is as follows:

Mild Traumatic Brain Injury or Concussion

The term mild traumatic brain injury is used interchangeably with the term concussion.  A concussion is caused by a blow or jolt to the head that disrupts the function of the brain.  Unlike more severe traumatic brain injuries, the disturbance of brain function from a concussion is caused more by dysfunction of brain metabolism rather than by structural damage.  The current understanding of the neuropathophysiology of a mild TBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events.  After an impact causing a concussion, there is an increase in glucose metabolism, and then a subsequent reduced metabolic state.  These events interfere with the neuronal function in the brain and may lead to cell death after the injury.

Diffuse Axonal Shear

In a diffuse axonal shear injury many of the nerve cell pathways (axons) may be torn apart or stretched. This can cause a loss of connection between brain cells and can lead to a breakdown of overall communication among neurons in the brain. Information processing may be disrupted.  A diagram demonstrating the process of axonal shear appears below:

Coup – Contre-Coup

A coup contre-coup injury to the brain occurs when there is a sudden impact to the head, which causes the brain to first slam into one side of the skull wall, then bounce off that wall and slam into the wall on the opposite side of the skull.  Continue reading