TORONTO — They may not yet be in the big leagues, but hockey-playing youngsters, their parents and coaches need to be mindful of concussion safety and the warning signs of brain injuries that have sidelined some of the game's biggest stars, experts say.
Concussions forced Pittsburgh Penguins captain and Canadian superstar Sidney Crosby to miss out on 41 games in 2011 — including the Stanley Cup playoffs –as well as most of the 2012 regular season as symptoms lingered.
His high-profile injury brought greater awareness about concussions, the importance of making a quick diagnosis and taking preventive measures, noted Toronto neurosurgeon Dr. Charles Tator, a sports concussion and brain injury expert.
While a diagnosis should come from a medical doctor, Tator said it's important for parents, coaches and players to look out for red flags.
"The parent really has to know what the signs and symptoms are: headaches, dizziness, ringing in the ears, sensitivity to light, sensitivity to noise, irritability to a whole bunch of symptoms as tall as this room (and) if they persist that is a concussion," said Tator.
"Not all is apparent right at the beginning. So a child, right after the concussion, may be different from what he or she is like a few hours later. So that continuing vigilance is very important."
On Monday, federal Health Minister Rona Ambrose announced funding from Ottawa and partners for research aimed at improving prevention, diagnosis and treatment of these injuries in kids and youth.
Tator said underreporting of concussions is a significant issue, not only in sports but in everyday activities like riding a bike or slipping on the ice while walking outdoors. He said it's estimated 200,000 concussions occur each year in Canada.
Tator has joined two-time Olympic champion hockey player Cassie Campbell-Pascall in speaking out on concussion safety and prevention as part of Chevrolet's Safe & Fun Hockey Program. This season, players born in 2008 who register to play with Hockey Canada can receive a free helmet as part of the program.
The former women's team captain vividly recalled her own experience with injuries. During the last game of the season in April 2004, she suffered a major concussion and a serious neck injury simultaneously. She returned to the ice three months later but immediately re-injured herself during practice. She was sidelined another four months.
"Concussions really aren't necessarily just a hockey problem," said Campbell-Pascall, a "Hockey Night in Canada" commentator. "Hopefully, we can try to eliminate them as much as we can, especially when it comes to our kids playing sport."
The hockey helmet with a cage offers "terrific protective features" and can reduce some of the concussions that happen from the front, Tator noted.
He said a hockey helmet should have good padding that can sustain several blows and act as a shock absorber. The shell also has to be properly constructed so that it withstands multiple impacts, compared to a bicycle helmet, which is designed to withstand only one blow, he added.
When purchasing a helmet, Tator said parents should look for the Canadian Standards Association sticker to ensure it's been properly manufactured. It also has a limited shelf life.
"We use to say: 'Well, buy one for the whole family and hand it down from one kid to another.' That is out the window now. Probably two or three seasons is what the shock absorbency is going to last and what the shell will last."
Campbell-Pascall said she considers the helmet "the most important piece of equipment."
"I understand hand-me-down skates and gloves and all of those kinds of things," she said, acknowledging hockey is an especially expensive sport for families.
"But if you can make it happen, I think you should get your child a new helmet right from the start."
If a parent does opt for second-hand, don't purchase it if it's got a crack or the clips are damaged or bent, Tator said.
And of course, the fit has to be right. Tator said it shouldn't slide around the head. And to ensure it's properly secured, adhere to the one finger rule: only one digit should be able to fit between the child's chinstrap and chin to ensure tightness.
"As a brain surgeon I'm perfectly aware — too aware — of what lack of a helmet or a poorly fitted helmet can do."
The first concussion usually takes more force to produce. But if it's the fifth, a "significant jiggle" of the brain within the skull — and no direct impact to the head — can be the trigger, said Tator.
"The severity of the blow to cause a concussion varies tremendously. It may be an elbow or shoulder of even moderate severity that can cause a concussion with lasting symptoms. So I think that's really why we want to emphasize prevention."
As for children who've suffered concussions, Tator advised they be eased back into physical and mental activity gradually.
"We don't want kids to go back to school too early or to sit there in class holding their heads because they have a headache and they're dizzy. You don't say: 'Oh, suck it up, be a man about it and get on with it,"' he said.
"We now want people to rest at the beginning and then use exercise as a means of telling (you) if your brain is ready to return to action. And by doing that, we can preserve the brain so that kids, in fact, can return to play and can continue to enjoy games."
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