When Cody Kusch successfully lobbied Seafair Minor Hockey to introduce a concussion management protocol in 2010, knowledge about the type of traumatic brain injury was only in its infancy.

Seven years later awareness has grown, but clearly there is still a lot more to learn.

“More appropriate measures have been put in place, but the true management within the respective associations still falls on the volunteers to ensure that proper concussion management and certification is being completed and carried out,” says Kusch, who is vice-president of the local youth sports group. “I believe community concussion clinics should be in place, so that more players have equal access to the best care available. At least, the hospitals should all have a concussion clinic attached to their facility.“

Since Seafair introduced its concussion management protocol, Hockey Canada has also adapted and now implemented "contact to the head" penalties, regardless if there is intent or not. A minor or match penalty is assessed to the player who commits the head contact. And BC Hockey has mandated that all its member associations now have a concussion management protocol in place. At the same time, all volunteers must complete on an annual basis concussion management training on-line before they can volunteer.

And now, Harvard Medical School has stepped up to fund Seafair’s baseline testing this year.

“They were extremely impressed with how effectively a minor hockey association has been able to utilize trained athletic therapists over the past seven years,” says Kusch. “They are wanting to see the validity of testing data, along with better understanding the player/family flow through this process—from when the child has a suspected concussion to how and when they return to play.”

Despite the advances in concussion knowledge however, Kusch says there has not been a clear reduction in the number of concussions over the past seven years. But he says this may be due to the fact that more people are now coming forward to admit that their child is experiencing a suspected concussion “whereas in the past, without legislation and mandates, the families were not self-reporting as accurately.”

“So even thought the number of concussions has not reduced, it may actually have reduced if every family was truly self-reporting where needed,” Kusch suggests. “It will be interesting over the next five years to see if we start to see a shift in number of concussions decline due to rule changes, mandated education programs and concussion management protocols.”

Kusch’s next push is to educate all the public schools with these changes in protocol, noting that Seafair itself will be making changes to its own current concussion management flowchart to ensure that the education piece is not lost.

“And I will continue to follow up with the families to ease their concerns when their child experiences a suspected concussion,” he says. “Risk manager leads have grown significantly at the minor hockey level over the past few years, and this role is necessary to ensure proper management of these players experiencing a suspected concussion (is addressed), along with their respective family members being properly educated of the resources and healthcare professionals available to them.”

Following Seafair’s lead, Kusch is encouraged that the mindset of many other organizations regarding concussions has also shifted positively. He says now having data in the 10- to 18-year-old age group has resulted in many important findings, including an algorithm of electroencephalogram (EEG) tests that are able to predict with 95 per cent accuracy whether a child has experienced a concussion and the length of time needed for return to play.

“We have helped many other minor sports associations in Richmond and beyond with respect to establishing their own concussion management program,” Kusch says. “Richmond FC is now heavily involved with the UBC Brain and Research Centre as well with EEG testing for their athletes.”

Parachute Canada (a national, charitable organization dedicated to preventing injuries and saving lives) and other provincial and national sport governing bodies have also reached out to Seafair for feedback with respect to development of their practical resources.The Return to Learn flowsheet and Return to Play protocols are two concussion management tools currently being used by many local associations to ensure proper and consistent management of concussions, and that the athlete is at the forefront of safety.Also, vestibular ocular motor screening has been used in recent years at Seafair to test more accurately with baseline testing, and as a result, a Harvard University study—with the largest pre-season participation—was achieved through Seafair’s baseline testing program.

A new Parachute of Canada flowsheet was created following recommendations at the fifth international Concussion in Sport Group meeting last April in Zurich, Switzerland. That meeting attracted many of the top medical concussion experts in the world.

“They are no longer recommending baseline testing as they feel that some of the questioning in the younger child population was inconsistent,” Kusch says. “Now that EEG testing is very accurate, they feel that this is a more valuable source of diagnosing a concussion's existence, through algorithm testing.”

But Kusch says one challenge is that educating parents and families needs to be managed by someone, as not all healthcare professionals are trained to the same degree. Seafair currently uses a flowsheet designed in conjunction with the UBC Brain and Research Centre that Kusch says needs updating.

“I am hoping that we can fast track these few players into a more streamlined approach, (accessing the) appropriate healthcare professionals who can properly assess and manage the players and their families through this transition,” he says.

In the past, Kusch and Evolution Sport Therapy athletic therapists started the communication process, connecting the players and families to the appropriate healthcare professional to properly manage the medical side of the concussion. The UBC Research Centre through Naznin Virji-Babul, head of the university’s department of physical therapy, would then be able to administer care to the player, while testing the most advanced technology for concussion screening and diagnosing.

“My fear is that now we’ll go back to sending out literature to the families at the beginning of the year, the parents don't pay attention to the information until their child experiences a suspected concussion, and then they follow up with their GP (doctor),” Kusch says. “For some, the vicious cycle of where do I go now starts again. There are many organizations out in the community but some are business-oriented and not everyone has the private funds to support this means of treatment and management. So in the end it will fall onto the shoulders of the unpaid volunteer within the organization to properly manage once again.”

Kusch has reached out to Richmond FC chair Rein Weber to co-host a concussion information session for parents, coaches and volunteers hopefully later this month. The plan is to also invite trained healthcare professions who have been immersed in concussion management for many years to answer questions. The list of professions may include Babul; Paul Korn, a paediatrician at BC Children’s Hospital; William Panenka, a neurology psychiatrist at UBC; Dr. Bill Mackie, a sport medicine physician at Richmond Olympic Oval; Dr. Shelina Babul, associate director of sport injury at BC Children’s Hospital; and Jonathon Sun, athletic therapist and owner of Evolution Sport Therapy.

“This medical team has greatly helped us over the years and will continue to do so in the future,” Kusch says.