Overview

Concussion and mild traumatic brain injury (mTBI), used synonymously in the literature, have received enormous attention in recent years, both in the popular press and the scientific literature, especially those related to hockey and football. The Centers for Disease Control has estimated that 1.6 to 3.8 million cases of sport-related concussions occur annually in the United States. Sport and recreational activities contribute to about 21% of all traumatic brain injuries among children in the US.

Concussions are caused by a direct blow to the head or other body part resulting in a rotational movement of the brain within the skull. It is important to recognize that a concussion can occur with or without loss of consciousness and symptoms can be subtle, including headache, confusion, nausea or dizziness, and may not appear for hours or days. Recommended treatment includes both physical and mental rest. If an individual returns to activity too soon and a second concussion is sustained before recovering from the first, a condition known as second-impact syndrome may occur: a swelling of the brain that can result in brain damage causing severe disability or even death. Furthermore, an individual is three times more likely to sustain a second concussion during recovery from a concussion.

Dr Babul's recent initiatives include looking at trends and patterns of concussions in BC; and knowledge translation activities to raise awareness of concussion and mTBI among targeted audiences, including medical professionals; parents, coaches, and athletes; as well as school professionals. She is the Chair of the BC Concussion Advisory Network, and is also a co-investigator on the "Safe to Play" and the "Alberta Program in Youth Sport and Recreation Injury Prevention" grant-funded projects.

Publications

Return to learn after concussion in children.
Canadian family physician Medecin de famille canadien
Irvine A, Babul S, Goldman RD
PubMed: 29138156
11/2017

Preventing Concussion in Youth Ice Hockey: The Effect of Local Bodychecking Policy Change
British Journal of Sports Medicine
Amanda M. Black and Brent E. Hagel and Kathryn J. Schneider and Willem H. Meeuwisse and Luz Palacios-Derflingher and Shelina Babul and Martin Mrazik and Carolyn A. Emery
DOI: 10.1136/bjsports-2016-097372.39
02/2017

A systematic review and best evidence synthesis of brain biomarkers of recovery in children and youth with mild traumatic brain injury (mTBI)
Brain Injury
2017

The Burden of Sport & Recreational Injuries
Canadian Injury Prevention Resource: An evidence-informed guide to injury prevention in Canada
09/2015

Brain Injuries
Canadian Injury Prevention Textbook: An evidence-informed guide to injury prevention in Canada
09/2015

Addressing the need for standardized concussion care in Canada: Concussion Awareness Training Tool.
Canadian family physician Medecin de famille canadien
Babul S
PubMed: 26273074
08/2015

A qualitative review of sports concussion education: prime time for evidence-based knowledge translation
British Journal of Sports Medicine
Martin Mrazik, Christopher R Dennison, Brian L Brooks, Keith Owen Yeates, Shelina Babul, Dhiren Naidu
DOI: 10.1136/bjsports-2015-094848
08/2015

Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics
BMJ Open
P. A. Cripton, H. Shen, J. R. Brubacher, M. Chipman, S. M. Friedman, M. A. Harris, M. Winters, C. C. O. Reynolds, M. D. Cusimano, S. Babul, K. Teschke
DOI: 10.1136/bmjopen-2014-006654
01/2015

Bicycling crash circumstances vary by route type: a cross-sectional analysis
BMC Public Health
Kay Teschke, Theresa Frendo, Hui Shen, M Anne Harris, Conor CO Reynolds, Peter A Cripton, Jeff Brubacher, Michael D Cusimano, Steven M Friedman, Garth Hunte, Melody Monro, Lee Vernich, Shelina Babul, Mary Chipman, Meghan Winters
DOI: 10.1186/1471-2458-14-1205
11/2014

Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case–crossover design
Injury Prevention
M Anne Harris, Conor C O Reynolds, Meghan Winters, Peter A Cripton, Hui Shen, Mary L Chipman, Michael D Cusimano, Shelina Babul, Jeffrey R Brubacher, Steven M Friedman, Garth Hunte, Melody Monro, Lee Vernich, Kay Teschke
DOI: 10.1136/injuryprev-2012-040561
02/2013

Personal and trip characteristics associated with safety equipment use by injured adult bicyclists: a cross-sectional study
BMC Public Health
Kay Teschke, Jeff R Brubacher, Steven M Friedman, Peter A Cripton, M Anne Harris, Conor CO Reynolds, Hui Shen, Melody Monro, Garth Hunte, Mary Chipman, Michael D Cusimano, Nancy Smith Lea, Shelina Babul, Meghan Winters
DOI: 10.1186/1471-2458-12-765
09/2012

Safe cycling: how do risk perceptions compare with observed risk?
Canadian journal of public health = Revue canadienne de sante publique
Winters M, Babul S, Becker HJ, Brubacher JR, Chipman M, Cripton P, Cusimano MD, Friedman SM, Harris MA, Hunte G, Monro M, Reynolds CC, Shen H, Teschke K
PubMed: 23618088
2012

Route Infrastructure and the Risk of Injuries to Bicyclists: A Case-Crossover Study
American Journal of Public Health
Kay Teschke, M. Anne Harris, Conor C.¿O. Reynolds, Meghan Winters, Shelina Babul, Mary Chipman, Michael D. Cusimano, Jeff R. Brubacher, Garth Hunte, Steven M. Friedman, Melody Monro, Hui Shen, Lee Vernich, Peter A. Cripton
DOI: 10.2105/ajph.2012.300762
2012

Vision screening of older drivers for preventing road traffic injuries and fatalities
Cochrane Database of Systematic Reviews
Ediriweera Desapriya, Harshani Wijeratne, Sayed Subzwari, Shelina Babul-Wellar, Kate Turcotte, Fahra Rajabali, Jacqueline Kinney, Ian Pike
DOI: 10.1002/14651858.cd006252.pub3
03/2011

Developing injury indicators for Canadian children and youth: a modified-Delphi approach
Injury Prevention
I. Pike, S. Piedt, L. Warda, N. Yanchar, C. Macarthur, S. Babul, A. K. Macpherson
DOI: 10.1136/ip.2009.025007
06/2010

Youth injuries in British Columbia: type, settings, treatment and costs, 2003–2007
International Journal of Injury Control and Safety Promotion
Bonnie Leadbeater, Shelina Babul, Mikael Jansson, Giulia Scime, Ian Pike
DOI: 10.1080/17457300903564561
06/2010

Comparison of On-Reserve Road Versus Off-Reserve Road Motor Vehicle Crashes in Saskatchewan, CanadaA Case Control Study
Asia Pacific Journal of Public Health
Ediriweera Desapriya, Takeo Fujiwara, Pamela Verma, Shelina Babul, Ian Pike
DOI: 10.1177/1010539510361787
05/2010

Head Restraints and Whiplash: The Past, Present and Future
Protective Devices: Types, Uses and Safety
2010

Vision screening of older drivers for preventing road traffic injuries and fatalities
Cochrane Database of Systematic Reviews
Sayed Subzwari, Ediriweera Desapriya, Shelina Babul-Wellar, Ian Pike, Kate Turcotte, Fahra Rajabali, Jacqueline Kinney
DOI: 10.1002/14651858.cd006252.pub2
01/2009

Misuse of child restraint seats
Consumer Product Safety Issues
2009

Effectiveness of cataract surgery in reducing driving-related difficulties: a systematic review and meta-analysis
Injury Prevention
S Subzwari, E Desapriya, G Scime, S Babul, K Jivani, I Pike
DOI: 10.1136/ip.2007.017830
10/2008

The appropriate and inappropriate use of child restraint seats in Manitoba
International Journal of Injury Control and Safety Promotion
John Blair, Angeliki Perdios, Shelina Babul, Kevin Young, Janice Beckles, Ian Pike, Peter Cripton, Debbie Sasges, Krishore Mulpuri, Ediriweera Desapriya
DOI: 10.1080/17457300802340980
09/2008

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994–2005
International Journal of Injury Control and Safety Promotion
E. Desapriya, T. Fujiwara, G. Scime, S. Babul, I. Pike
DOI: 10.1080/17457300802080602
06/2008

An analysis of sport-related injuries: British Columbia children's hospital Emergency Department 1999 – 2003
International Journal of Injury Control and Safety Promotion
S. Babul, S. Nolan, M. Nolan, F. Rajabali
DOI: 10.1080/17457300701440659
09/2007

A randomized trial to assess the effectiveness of an infant home safety programme
International Journal of Injury Control and Safety Promotion
S. Babul, L. Olsen, P. Janssen, P. McIntee, P. Raina
DOI: 10.1080/17457300701272474
06/2007

Health benefits of physical activity
Canadian Medical Association Journal
E. Desapriya
DOI: 10.1503/cmaj.1060093
09/2006

PUBLIC ATTITUDES, EPIDEMIOLOGY AND CONSEQUENCES OF DRINKING AND DRIVING IN BRITISH COLUMBIA
IATSS Research
E. DESAPRIYA, I. PIKE, S. BABUL
DOI: 10.1016/s0386-1112(14)60160-6
2006

Barriers to Exercise
Canadian Medical Association Journal
2006

Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury
Cochrane Database of Systematic Reviews
Michael H Bennett, Thomas M Best, Shelina Babul-Wellar, Jack E Taunton
DOI: 10.1002/14651858.cd004713.pub2
10/2005

Strategies for prevention of soccer related injuries: a systematic review.
British journal of sports medicine
Olsen L, Scanlan A, MacKay M, Babul S, Reid D, Clark M, Raina P
DOI: 10.1136/bjsm.2002.003079
PubMed: 14751956
02/2004

Effects of Intermittent Exposure to Hyperbaric Oxygen for the Treatment of an Acute Soft Tissue Injury
Clinical Journal of Sport Medicine
Shelina Babul, Edward C. Rhodes, Jack E. Taunton, Michael Lepawsky
DOI: 10.1097/00042752-200305000-00003
05/2003

The effects of intermittent exposure to hyperbaric oxygen therapy for the treatment of delayed-onset muscle soreness
Medicine & Science in Sports & Exercise
S Babul and E C. Rhodes and J E. Taunton and M Lepawsky
DOI: 10.1097/00005768-200105001-01643
05/2001

Hyperbaric Oxygen Therapy to Enhance Recovery from Delayed Onset Muscle Soreness
Clinical Journal of Sport Medicine
Lawrence E. Hart, Mark Tarnopolsky, Ann Lotter, Shelina Babul
DOI: 10.1097/00042752-200010000-00021
10/2000

The Role of Hyperbaric Oxygen Therapy in Sports Medicine
Sports Medicine
Shelina Babul, Edward C. Rhodes
DOI: 10.2165/00007256-200030060-00002
2000

Pathology of sudden death in the young.
The Canadian journal of cardiology
McManus BM, Babul S
PubMed: 9191507
11/1996

The Autopsy
Anderson's Pathology, 10th Edition
1996

Commissural region dehiscence from the stent post of Carpentier-Edwards bioprosthetic cardiac valves
Cardiovascular Pathology
Michael F. Allard, Christopher R. Thompson, Robert J. Baldelli, Joan S. McNab, Shelina A. Babul, Janet M. Betts, Bruce M. McManus, W.R.Eric Jamieson, Hilton Ling, Robert T. Miyagishima
DOI: 10.1016/1054-8807(95)00027-3
07/1995

Metastatic Tumors
Atlas of Heart Diseases
1995

Cardiovascular manifestations of lyme disease
Journal of Spirochetal and Tick-Borne Diseases
1995

Research

Concussion Awareness Training Tool - CATT
The new Concussion Awareness Training Toolkit (CATT) is based upon the established international principles of the 4th Zurich Concussion Consensus Statement. The aim of CATT is to standardize concussion recognition, diagnosis, treatment and management. Good concussion management may decrease the risk of brain damage and potentially reduce long-term health issues.

The Canadian Paediatric Society recommends that anyone involved in child and youth sport should be educated about the signs and symptoms of concussion and the appropriate management of a child with a concussion.

CATT is FREE, available 24/7, updated every two weeks, and available online at www.cattonline.com

CATT for Medical Professionals

Funded by the BC Children’s Hospital Foundation and Child Health BC, and in collaboration with the BC Medical Association (now Doctors of BC), the Concussion Awareness Training Tool for Medical Professionals (CATT MP) was developed by a team of injury prevention researchers and Emergency Department physicians with extensive provincial and national review.
CATT MP features a learner-directed online training module supplemented with diagnostic tools (both adult and child SCAT3) and links to clinical resources, patient handouts, journal articles, related websites and concussion videos. CATT qualifies for MainPro M2 credits for clinicians.
CATT MP has demonstrated a statistically significant increase in practices among physicians and nurses.
CATT for Parents, Players and Coaches

Developed in partnership with the BC Ministry of Health, the Concussion Awareness Training Tool for Parents, Players and Coaches (CATT PPC) provides up-to-date educational training on the recognition, management and prevention of concussions.
CATT PPC features an Online Training Video for Parents and for Coaches; Frequently Asked Questions for Parents; Concussion Videos appropriate for youth; Printable handouts for parents and coaches; the Concussion Response Tool for parents (Smartphone fill-able); Questions to ask your Doctor; the Return to Learn Communication tool for parents and educators; and the Return to Play Communication tool for parents and coaches.
CATT PPC has demonstrated a statistically significant increase in concussion knowledge among parents with a child registered in an organized sport.
CATT for School Professionals

Launching in Spring 2015, the Concussion Awareness Training Tool for School Professionals (CATT School Professionals) will provide school professionals the necessary resources for supporting a concussed student in his/her integration back to school. This resource is being developed in partnership with the BC Ministry of Health, Ministry of Education and the GF Strong Rehabilitation Centre.
Evaluation of CATT School Professionals is currently underway.

Evaluating the effects of a change in body-checking policy in youth ice hockey
Ice hockey is one of Canada’s most popular sports, with over 510,000 youth participants, and over 25% of male youth participating. It is amongst the top three injury-producing sports in youth in Canada, leading to a substantial public health burden. Concussion and other significant injuries have been an increasing concern in Canada, particularly in age groups where body checking is permitted. Policy related to body checking is determined provincially, in conjunction with national Hockey Canada policy.

Our study aims to answer the following questions: 1) Does the risk of concussion and other hockey-related injury differ significantly between players exposed to rules that permit body checking (Alberta) and players in similar divisions exposed to rules that do not permit body checking (British Columbia’s non-elite divisions; the lower 70%)? 2) What is the cost-effectiveness of such a policy change in youth ice hockey?

Burden of Concussion in Children & Youth Report (commissioned by Child Health BC)
Evidence suggests that children and youth are at greater risk of concussions and more serious head injury than the general population, take longer than adults to recover following a concussion, and that concussions can permanently change the way a child or youth talks, walks, learns, works and interacts with others. Concussion management and appropriate return to activity is crucial, particularly in the pediatric and adolescent populations. Active and timely rehabilitation is essential for concussion patients who remain symptomatic longer than a six week period. This may include physiotherapy, occupational therapy, educational support, neuropsychology and in some case neuropsychiatry.

The purpose of the report is to provide details on the burden of concussion among children and youth in BC, to be used to facilitate discussion of the need for standardized concussion prevention, diagnosis and management in BC specific to children and youth. Concussions are the most common form of head injury, yet it is believed that they are under-reported owing to both a lack of consensus on the minimum requirements of the definition of a concussion, and the presence of misconceptions among the general public regarding concussions.

The findings of this report indicate that concussions remain a significant health issue and require further attention given the long-lasting effects. This may include concussion prevention, education and awareness, standardizing care, ensuring correct treatment protocols are adhered to, and appropriate concussion management is employed.

Concussion in BC Campaign – in partnership with Preventable (preventable.ca)
British Columbians may not consider concussions to be a serious preventable injury. They regard it as an outcome of accidents or inevitable occurrences. The focus of this campaign was to raise awareness about concussion in sports, targeting parents (25-55 years of age) of school-aged youth in British Columbia. Key objectives were to raise awareness that concussions can happen to anyone, raise awareness that we may not recognize all the symptoms of concussions, highlight the importance of consulting with health practitioner when unsure about whether a concussion has occurred, and to be aware that severe concussions can result in death.

Honours & Awards

Prevention and Awareness Award, Brain Injury Association of Canada - September 2014

Research Group Members

Atousa Zargaran, Researcher/BCIRPU
Dian Leung
Ian Pike, Investigator, BC Children's Hospital, AUTO21 Network Researcher, Co-Executive Director, The Community Against Preventable Injuries, Principal Investigator, CIHR Team in Child and Youth Injury Prevention, Director, BC Injury Research and Prevention Unit (BCIRPU)
Fahra Rajabali
Kate Turcotte
Megan Oakey
Diana Samarakkody
Jennifer Smith
Rachel Ramsden, Research Assistant
Aygun Ibrahimova
Colleen Pawliuk
Alex Zheng
Emilie Beaulieu
Denise Beaton, Research Assistant/BCIRPU
Maureen Nolan, Researcher/BCIRPU
Reed Huber, Summer Student
Kyle Scoten, Summer Student
Mojgan Karbakhsh, PostDoc/BCIRPU
Samantha Bruin, Communications Coordinator
Aayushi Joshi, Student