Once thought to be a brain injury that would most often resolve itself quickly, evidence now shows that the long-term consequences of concussion are significant and that management requirements are more complex than was the case understood even 20 years ago.
“We believe this guideline will give people strategies to help them better cope when a concussion does not heal according to their expectations,” says Dr Shawn Marshall, an Ottawa-based physician and researcher associated with The Ottawa Hospital Research Institute, and the Chair of the ONF Concussion Guidelines project team. “The team had feedback that patients would benefit from access to understandable and reliable information.”
As with past guidelines and standards developed by ONF, the third edition of the concussion guidelines for healthcare providers is grounded in recent research and the knowledge of healthcare providers from physicians and nurse practitioners to neuropsychologists, physiotherapists and organizations representing patients.
Dr. Marshall has heard from patients and colleagues that patients often showed up in their doctors’ office with a copy of the healthcare provider guidelines in hand, hoping they would provide helpful information during their discussion. “Frankly we know patients, family and general practice physicians have to work as a team using dependable and evidence-based quality information.”
The new patient guidelines were reviewed by patients themselves. One patient who participated in the review process says, “With the knowledge comes power, in terms of referrals. So, had I had the knowledge…I would've gone forward to request other referrals sooner, and that may have made a difference, not only to access supports and services, but to rehabilitation in a faster form.”
“This patient-focused guideline has been developed by the Ontario Neurotrauma Foundation (ONF) in consultation with patients, their families and a broad team of healthcare professionals and researchers with knowledge of the most up-to-date information,” says Corinne Kagan, Senior Program Director, Acquired Brain Injury (ABI). “We heard through our healthcare provider networks and directly from patients that there was a gap in the kind of practical, evidence-informed information available in simple, clear language. The patient version address this gap.”
The Ontario Neurotrauma Foundation marks 20th anniversary
Taking leadership to improve the lives of Ontarians living with neurotrauma
In the late 1990’s a group of people and organizations familiar with the difficulties and gaps in the care and treatment for those with neurotrauma made a bold decision to establish the Ontario Neurotrauma Foundation (ONF). With a focus on research, ONF soon became the go-to resource for evidence-based best practices and knowledge about acquired brain injury (ABI), spinal cord injury (SCI) and prevention.
In 1998 following the confirmation of government funding to a partnership group known as the Ontario Neurotrauma Initiatives Partnership (ONIP). ONIP partners included the Rick Hansen Foundation, Canadian Spinal Research Organizations (CSRO), the Canadian Paraplegic Association (a precursor organization now known as Spinal Cord Injury Ontario) and the Ontario Brain Injury Association (OBIA).
Over the years, ONF has broadened and strengthened it connections with those living with neurotrauma. ONF has built and supported networks of researchers and advocates working to find and implement health care solutions that address the needs of those living with neurotrauma. The Foundation is known and respected for its leadership in sharing knowledge and establishing standards and guidelines that support care that tackles the serious health issues related to ABI and SCI. And the Foundation has taken the lead to bring together individuals and organizations seeking to prevent neurotrauma across the lifespan.
Over the past two decades ONF has invested $100-million and, as the list of achievements below notes, supported hundreds of thousands of Ontarians to access better care and services.
New standards to guide post-concussion care in Ontario
Right Care, Right Time, Right Provider
The Ontario Neurotrauma Foundation (ONF) has moved to fill a gap and support people in Ontario requiring post-concussion care with the release of new “Standards for Post-Concussion Care”. The document offers 15 criteria to guide interdisciplinary clinics and healthcare providers in processes used to provide care. These criteria will also help patients ask the best questions around how their care is delivered.
As the short and long-term health effects of concussions have become better understood, there has been a proliferation of Ontario clinics offering concussion care. This has resulted in some confusion over the match between how, when and what care is offered by such clinics for those who experience persistent symptoms.
“The Standards provide guidance to clinicians that will help support them to work within their scope of practice and provide the interdisciplinary care that is required,” says Corinne Kagan, Senior Director Acquired Brain Injury at ONF. “It’s important that there is a common understanding across the system regarding the processes around post-concussion care and particularly for people who experience persistent symptoms. This includes the timing of treatment and the need to have strong connections to primary care clinicians who are most likely to see these patients.”
ONF initiated the development of the new Standards at a spring 2016 summit and established an Advisory Committee to guide the process. The goals of the Concussion Advisory Committee include reducing inconsistent care processes; encouraging development of interdisciplinary clinics or formal care networks; empowering patients to ask questions about how care is provided; and creating a platform to encourage and inform continuous improvement in post-concussion care.
The INESSS-ONF Guideline is specific to adults who have sustained a moderate or severe TBI. It covers all areas affected following a TBI that pertain to rehabilitative care; addressing physical, sensory, cognitive, behavioral and emotional components as well as associated conditions such as behavioral, mental health and addiction issues. The CPG provides recommendations for the organization of rehabilitative services and systems of care; covering all phases of the rehabilitation process (subacute, intensive functional rehabilitation and community integration and participation).
The development of the Guideline was based on both the adaptation of recommendations available in existing CPGs and the formulation of new recommendations based on scientific evidence and expert opinion.
Large Canadian Study Could Change Concussion Care for Children
A new study based on the largest prospective cohort of children with concussion in the world was published in the Journal of the American Medical Association (JAMA). The study introduces a validated clinical prediction score that will help health providers and researchers to predict the duration of pediatric concussion symptoms.
ONF is proud to confund this study in partnership with the Canadian Institutes of Health Research (Institute of Neurosciences, Mental Health and Addiction). To find out more about this study please click here.
Preventing and Treating Pressure Sores: A Guide for People with Spinal Cord Injuries
The Ontario Neurotrauma Foundation funded Spinal Cord Injury Ontario to develop and release a consumer guide for people with Spinal Cord Injury on preventing and treating pressure sores.
Understanding the gaps in care for those living with neurotrauma injuries is key to the work we do at ONF. Today, on December 3 we were proud to celebrate International Day of Persons with Disabilities with March of Dimes Canada and Spinal Cord Injury Ontario.
Topics in this edition of NeuroMatters include a researcher profile on Injury Prevention contributor, Dr. Alan Salmoni, a round up of the Fall Prevention Month campaign and highlights of the awarded ONF/CIHR Fellowship, among other topics related to neurotrauma research and implementation.
Dr. Cindy Gauthier is the recipient of the Rick and Amanda Hansen Fellowship, in Partnership with the Ontario Neurotrauma Foundation and the Rick Hansen Institute. Her research will focus on the use of functional electrical stimulation to improve balance and hand/arm function in people with SCI.