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Exploring Sex-Based Differences in Concussion Knowledge, Attitudes and Resources in Young First Nations Hockey Players: A Cross-Sectional Survey from Ontario, Canada

Published online by Cambridge University Press:  25 June 2019

Cindy Hunt ,
Alicja Michalak ,
Elaine Johnston ,
Leila Macumber ,
Tony Jocko  and
Donna Ouchterlony
Cindy Hunt*
Affiliation:
Senior Research Associate, Trauma & Neurosurgery Program, St. Michael’s Hospital, Toronto, ON, Canada
Alicja Michalak
Affiliation:
Case Manager, Trauma & Neurosurgery Program, St. Michael’s Hospital, Toronto, ON, Canada
Elaine Johnston
Affiliation:
Chief of Serpent River, Serpent River First Nation, Toronto, ON, Canada
Leila Macumber
Affiliation:
Community Wellness Manager, Kenabutch Health Centre, Serpent River First Nation, Cutler, ON, Canada
Tony Jocko
Affiliation:
Health Policy Analyst, Union of Ontario Indians, Canada
Donna Ouchterlony
Affiliation:
Director of Special Projects, Head Injury Clinic, Trauma & Neurosurgery Program, St. Michael’s Hospital, Toronto, ON, Canada
*
*Corresponding author. Email: huntci@smh.ca
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Abstract

Objective:

Indigenous youth are vulnerable to concussion when playing hockey. A clear characterisation of sex differences among Indigenous youth could assist in tailoring future education programmes for prevention and management of concussion. The purpose of this study was to compare and contrast concussion knowledge, attitudes and resources in First Nations girls and boys playing recreational hockey.

Method:

The cross-sectional survey was conducted in partnership with a First Nations’ chief, other Indigenous community leaders and a tertiary care head injury clinic. In Canada, researchers engaging with Indigenous peoples are expected to adhere to principles of Ownership, Control, Access and Possessions. The study included Indigenous boys and girls between the ages of 10 and 18 years of age.

Results:

More girls attending the hockey tournament participated in the study as compared to boys (girls n = 46, boys n = 29). More girls reported they had never experienced a concussion (73.9%), as compared to boys (58.6%) self-reports. Less than half of all study participants were able to identify some signs and symptoms of concussion such as vomiting/nausea, memory problems, fatigue and blurred vision and recognition of several concussion symptoms varied by sex.

Conclusions:

We created a unique partnership between Indigenous leaders and tertiary care clinic staff. Among Indigenous youth reasons for not reporting concussion symptoms to the coach varied by sex (although not reaching statistical significance), suggesting concussion education warrants tailoring for girls and boys.

Keywords

concussionIndigenousice hockeysport
Type
Articles
Information
Brain Impairment , Volume 20 , Special Issue 2: Brain Impairment in Indigenous Populations , September 2019 , pp. 107 - 119
Copyright
© Australasian Society for the Study of Brain Impairment 2019 

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References

Bay, E., Sikorskii, A., & Saint-Arnault, D. (2009). Sex differences in depressive symptoms and their correlates after mild-to-moderate traumatic brain injury. Journal of Neuroscience Nursing, 41(6), 298–309. https://doi.org/10.1097/JNN.0b013e3181b6be81.CrossRefGoogle ScholarPubMed
Bazarian, J. J., Blyth, B., Mookerjee, S., He, H., & McDermott, M. P. (2010). Sex differences in outcome after mild traumatic brain injury. Journal of Neurotrauma, 27(3), 527–539. https://doi.org/10.1089/neu.2009.1068.CrossRefGoogle Scholar
Beckett, M., Firestone, M. A., McKnight, C. D., Smylie, J., & Rotondi, M. A. (2018). A cross-sectional analysis of the relationship between diabetes and health access barriers in an urban First Nations population in Canada. BMJ Open, 8(1), e018272. https://doi.org/10.1136/bmjopen-2017-018272.CrossRefGoogle Scholar
Browne, G. J., & Lam, L. T. (2006). Concussive head injury in children and adolescents related to sports and other leisure physical activities. British Journal of Sports Medicine, 40(2), 163–168. https://doi.org/10.1136/bjsm.2005.021220.CrossRefGoogle ScholarPubMed
Cancelliere, C., Donovan, J., & Cassidy, J. (2016). Is sex an indicator of prognosis after mild traumatic brain injury: A systematic analysis of the findings of the World Health Organization Collaborating Centre Task Force on Mild Traumatic Brain Injury and the international collaboration on mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 97(2Suppl), S5–18. https://doi.org/10.1016/j.apmr.2014.11.028.CrossRefGoogle ScholarPubMed
Cassidy, J. D., Carroll, L. J., Peloso, P. M., Borg, J., von Holst, H., & Holm, L. (2004). WHO Collaborating Centre Task Force on Mild Traumatic Brain, I. Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43 (Suppl), 28–60. https://doi.org/10.1080/16501960410023732.CrossRefGoogle Scholar
Chrisman, S. P., Quitiquit, C., & Rivara, F. P. (2013). Qualitative study of barriers to concussive symptom reporting in high school athletics. Journal of Adolescent Health, 52(3), 330–335.e3. doi: 10.1016/j.jadohealth.2012.10.271. Epub 2012 Dec 23.CrossRefGoogle ScholarPubMed
Christensen, J., Pedersen, M. G., Pedersen, C. B., Sidenius, P., Olsen, J., & Vestergaard, M. (2009). Long-term risk of epilepsy after traumatic brain injury in children and young adults: A population-based cohort study. Lancet, 373(9669), 1105–1110. doi: 10.1016/S0140-6736(09)60214-2. Epub 2009 Feb 21.CrossRefGoogle Scholar
Covassin, T., & Elbin, R. J. (2011). The female athlete: The role of gender in the assessment and management of sport-related concussion. Clinical Journal of Sports Medicine, 30(1):125–131, x. doi: 10.1016/j.csm.2010.08.001.CrossRefGoogle ScholarPubMed
Covassin, T., Swanik, C., & Sachs, M. (2003). Sex differences and the incidence of concussions among collegiate athletes. Journal of Athletic Training, 38, 238–244.Google ScholarPubMed
Cusimano, M. D., Topolovec-Vranic, J., Zhang, S., Mullen, S. J., Wong, M., & Ilie, G. (2017). Factors influencing the underreporting of concussion in sports: A qualitative study of minor hockey participants. Clinical Journal of Sports Medicine, 27(4), 375–380. doi: 10.1097/JSM.0000000000000372.CrossRefGoogle ScholarPubMed
Davis, G. A., Anderson, V., Babl, F. E., Gioia, G. A., Giza, C. C., Meehan, W., … Zemek, R. (2017). What is the difference in concussion management in children as compared with adults? A systematic review. British Journal of Sports Medicine, 51(12), 949–957. https://doi.org/10.1136/bjsports-2016-097415.CrossRefGoogle ScholarPubMed
Deepa, P. R., McFaull, S., Thompson, W., & Gayatri, C. J. (2018). Public Health Agency of Canada: At a glance – traumatic brain injury management in Canada: changing patterns of care. Retrieved from https://doi.org/10.24095/hpcdp.38.3.05.CrossRefGoogle Scholar
Ellis, M. J., Ritchie, L. J., McDonald, P. J., Cordingley, D., Reimer, K., Nijjar, S., … Russell, K. (2017). Multidisciplinary management of pediatric sports-related concussion. Canadian Journal of Neurological Sciences, 44(1), 24–34 https://doi.org/10.1017/cjn.2016.312.CrossRefGoogle ScholarPubMed
Fralic, M., Thiruchelvam, D., Tien, H. C, & Redelmeier, D. A. (2016). Risk of suicide after a concussion. Canadian Medical Association Journal, 188(7), 497–504. doi: 10.1503/cmaj.150790.CrossRefGoogle Scholar
Fridman, L., Scolnik, M., Macpherson, A., Rothman, L., Guttmann, A., Grool, A. M., … Zemek, R. L. (2018). Annual trends in follow-up visits for pediatric concussion in emergency departments and physicians’ offices. Journal of Pediatrics, 192:184–188.CrossRefGoogle ScholarPubMed
Graff, D. M., & Caperell, K. S. (2016). Concussion management in the classroom. Journal of Child Neurology, 31(14), 1569–1574. https://doi.org/10.1177/0883073816666205.CrossRefGoogle ScholarPubMed
Greenwood, M. L., & de Leeuw, S. N. (2012). Social determinants of health and the future wellbeing of Aboriginal children in Canada. Paediatric Child Health, 17, 381–384.Google Scholar
Hunt, C., Michalak, A., Johnston, E., Lefkimmiatis, C., Macumber, L., Jocko, T., & Ouchterlony, D. (2018). Knowledge, attitudes and concussion information sources among First Nations in Ontario. Canadian Journal of Neurologic Science, 45(3), 283–289. doi: 10.1017/cjn.2017.299.CrossRefGoogle ScholarPubMed
Kamins, J., & Giza, C. (2016). Concussion-mild TBI: Recoverable injury with potential for serious sequelae. Neurosurgery Clinics of North America, 27(4), 441–452.CrossRefGoogle ScholarPubMed
Karmali, S., Laupland, K., Harrop, A. R., Findlay, C., Kirkpatrick, A. W., Winston, B., … Hameed, M. (2005). Epidemiology of severe trauma among status Aboriginal Canadians: A population-based study. Canadian Medical Association Journal, 172(8), 1007–1011. https://doi.org/10.1503/cmaj.1040432.CrossRefGoogle ScholarPubMed
Kenzie, E. S., Parks, E. l., Bigler, E. D., Lim, M. M. Chesnutt, J. C., & Wakeland, W. (2017). Concussion as a mutli-scale complex system: An interdisciplinary synthesis of current knowledge. Fontiers in Neurology, September (8), 1–17.Google Scholar
King, M., Smith, A., & Gracey, M. (2009). Indigenous health part 2: The causes of the health gap Lancet, 374, 76–85.CrossRefGoogle ScholarPubMed
Kristman, V. L., Côté, P., Yang, X., Hogg-Johnson, S., Vidmar, M., & Rezai, M. (2014). Health care utilization of workers’ compensation claimants associated with mild traumatic brain injury: Ahistorical population-based cohort study of workers injured in 1997–1998. Archives Physical Medicine and Rehabilitation, 95(3 Suppl), S295–302. doi: 10.1016/j.apmr.2013.08.296.CrossRefGoogle Scholar
McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, R. C., Dvořák, J., Echemendia, R. J., … Turner, M. (2013). Consensus statement on concussion in sport: The 4th international conference on concussion in sport, Zurich, November 2012. Journal of Athletic Training, 48, 554–575. https://doi.org/10.4085/1062-6050-48.4.05.CrossRefGoogle Scholar
McKay, C. D., Meeuwisse, W. H., & Emery, C. A. (2014). Informing body checking policy in youth ice hockey in Canada: A discussion meeting with researchers and community stakeholders. Canadian Journal of Public Health, 105(6), e445–e449.CrossRefGoogle ScholarPubMed
Ministry of Indigenous Affairs. (2012). Indigenous peoples in Ontario. Retrieved from https://www.ontario.ca/document/spirit-reconciliation-ministry-indigenous-relations-and-reconciliation-first-10-years/indigenous-peoples-ontario.Google Scholar
Mrazik, M., Perra, A., Brooks, B. L., & Naidu, D. (2015). Exploring minor hockey players’ knowledge and attitudes toward concussion: Implications for prevention. Journal of Head Trauma Rehabilitation, 30(3), 219–227. https://doi.org/10.1097/HTR.0000000000000018.CrossRefGoogle Scholar
OCAP: Ownership, control, access and possession. First Nations Information Governance Committee. Ottawa: National Aboriginal Health Organization. (2014). Retrieved from https://fnigc.ca/sites/default/files/docs/ocap_path_to_fn_information_governance_en_final.pdf.Google Scholar
Ono, K. E., Burns, T. G., Bearden, D. J., McManus, S. M., King, H., & Reisner, A. (2016). Sex-based differences as a predictor of recovery trajectories in young athletes after a sports-related concussion. American Journal of Sports Medicine, 44(3), 748–752. https://doi.org/10.1177/0363546515617746.CrossRefGoogle ScholarPubMed
Ontario Ministry of Health and Long Term Care. (2018). Retrieved from http://www.health.gov.on.ca/en/public/programs/concussions.Google Scholar
Pfister, T., Pfister, K., Hagel, B., Ghali, W. A., & Roksley, P. E. (2015). The incidence of concussion in youth sports: A systematic review and meta-analysis. British Journal of Sports Medicine, 50, 292–297.CrossRefGoogle ScholarPubMed
Sady, M. D., Vaughan, C. G., & Gioia, G. A. (2011). School and the concussed youth: Recommendations for concussion education and management. Physical Medicine and Rehabilitation Clinics of North America, 22(4), 701–719. https://doi.org/10.1016/j.pmr.2011.08.008.CrossRefGoogle ScholarPubMed
Sicard, V., Moore, R. D., & Ellemberg, D. (2018). Long-term cognitive outcomes in male and female athletes following sport-related concussions. International Journal of Psychophysiology, 132(Pt A), 3–8. https://doi.org/10.1016/j.ijpsycho.2018.03.011.CrossRefGoogle ScholarPubMed
Smylie, J. & Firestone, M. (2015). Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada. Statistical Journal of IAOS, 31(1), 67–87.Google Scholar
Smylie, J., Kaplan-Myrth, N., McShane, K., Ontario, M., Nation, P. F., & Centre, T. I. F. R. (2008). Indigenous knowledge translation: Baseline findings in a qualitative study of the pathways of health knowledge in three indigenous communities in Canada. Health Promotion Practice, 1–11.Google Scholar
Smylie, J., O’Brien, K., Xavier, C. G., Anderson, M., McKnight, C., Downey, B., & Kelaher, M. (2018). Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study. Canadian Journal of Public Health, 109(1), 117–127. https://doi.org/10.17269/s41997-018-0034-9.CrossRefGoogle ScholarPubMed
Statistics Canada. (2013). Aboriginal peoples in Canada: First Nations people, Métis and Inuit. National Household Survey, 2011. Retrieved from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.pdf.Google Scholar
Styrke, J., Sojka, P., Bjornstig, U., Bylund, P. O., & Stalnacke, B. M. (2013). Sex-differences in symptoms, disability, and life satisfaction three years after mild traumatic brain injury: A population-based cohort study. Journal of Rehabilitation Medicine, 45(8), 749–757. https://doi.org/10.2340/16501977-1215.CrossRefGoogle ScholarPubMed
Tanveer, S., Zecavati, N., Delasobera, E. B., & Oyegbile, T. O. (2017). Gender differences in concussion and postinjury cognitive findings in an older and younger pediatric population. Pediatric Neurology, 70, 44–49. https://doi.org/10.1016/j.pediatrneurol.2017.02.001.CrossRefGoogle Scholar
Teasdale, T. W., & Engberg, A. W. (2001). Suicide after traumatic brain injury: A population study. Journal Neurology Neurosurgy & Psychiatry, 71(4), 436–440.CrossRefGoogle ScholarPubMed
Topolovec-Vranic, J., Zhang, S., Wong, H., Lam, E., Jing, R., Russell, K., & Cusimano, M. D. Canadian Brain Injury and Violence Research Team. (2015). Recognizing the symptoms of mental illness following concussions in the sports community: A need for improvement. PLoS One, 10(11): e0141699. doi: 10.1371/journal.pone.0141699.CrossRefGoogle Scholar
Truth and Reconciliation Commissions of Canada: Calls to Action. (2015). Retrieved from http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf.Google Scholar
Wallace, J., Covassin, T., & Beidler, E. (2017). Sex differences in high school athletes’ knowledge of sport-related concussion symptoms and reporting behaviors. Journal of Athletic Training, 52(7), 682–688. https://doi.org/10.4085/1062-6050-52.3.06.CrossRefGoogle ScholarPubMed
Zemek, R. L., Grool, A. M., Rodriguez Dugue, D., DeMatteo, C. Rothman, L., Benchimol, E., … Macpherson, A. (2017). Annual and seasonal trends in ambulatory visits for pediatric concussion in Ontario between 2003 and 2013. Journal of Pediatrics, 181, 222–228.CrossRefGoogle ScholarPubMed