Her name was Rowan Stringer. She was the captain of her high school rugby team, she loved her sport and would do anything for her teammates. But the decision to not put her brain health first eventually led to her death two years ago.
“It was her spirit and her sense of responsibility and belonging to the team that overshadowed her decision making, and kept her playing in spite of the warning signs,” said brain injury expert, neurologist Dr. Charles Tator.
“The evidence did show that she has sustained prior concussions while playing rugby, on a Friday and then again on the following Monday before her catastrophic brain injury on the Wednesday, from which she never recovered,” said Tator.
During a game on May 8, 2013, Rowan fell and struck her head on the ground. She died a few days later in hospital from Second Impact Syndrome, where a pre-existing injury followed by another head injury can be fatal. According to Tator she had suffered two concussions earlier that week that were undiagnosed.
The incidence of concussion in youth has been steadily rising, according to Statistics Canada. As many as 23 per cent of adolescents reported having sustained a head injury within the previous year.
“It is becoming an epidemic problem,” said Dr. Lisa Fischer, a primary care sports medicine physician.
The clinic where Fischer treats patients in London, Ont., the Fowler Kennedy Sport Medicine Clinic, had 2,000 visits for concussions last year.
“There’s been a lot of attention paid to elite athletes, but the real problem and the real focus needs to be on youth,” said Fischer. “These kids are getting hurt. And they don’t understand concussion. They don’t act on concussion, or they’re ignoring concussion.”
Since Rowan’s death in 2013, the 17-year-old’s parents, Gordon and Kathleen Stringer, have been on a mission to raise awareness about concussions and youth.
Their work with a committee and an Ontario MPP has resulted in the first-ever proposed legislation to address concussions, Rowan’s Law, “to ensure greater awareness and better treatment for concussion-related injuries.”
All 50 U.S. states have laws outlining the management of youth concussions. If passed in Ontario, it would be the first concussion-related legislation in Canada.
As the bill faces second reading, a group of medical and prevention experts gathered to express their concern about concussions and traumatic brain injury (TBI) and kids. They all agreed the culture of sport and playing when injured needs to stop. That education for kids, coaches, parents and athletes is paramount. This also means standards to identify and treat concussion.
Dr. Michael Strong, the dean of the Schulich School of Medicine & Dentistry at Western University, worries about the long-term impact of head injury – like dementia.
“We also look at those individuals who through head injury have developed a degenerative process and we know about the dementia that can occur with these individuals,” said Strong.
“So here’s a devastating degenerative disorder for which we have no treatment, that once it starts you are going to die from that disorder and yet I can identify why it occurs. So why aren’t we starting it?”
Strong believes that is why identifying brain injury, understanding the risk factors, knowing when to return to the field, and when to get medical help is so important.
“Why wouldn’t we be doing it? Actually it’s a nonsensical question, ” said Strong.
The Canadian government is also watching Rowan’s Law.
The new federal ministers for sport and health announced a few weeks ago that preventing concussions in youth sport is a priority and they plan to “work together on a national strategy to raise awareness for parents, coaches and athletes on concussion treatment,” they said in a statement.
Tator was a special consultant at the inquest into Rowan’s death. Tator, a neurologist at Toronto Western Hospital has worked on concussion and head injury treatment and prevention for 25 years. He has helped to create guidelines and rules to increase awareness for years. After reviewing hundreds of pages of documents for the inquest, he said it’s clear that Rowan’s “death was entirely preventable,” said Tator.
He hopes this legislation will protect young athletes.
“Never again will a youngster die playing sports because of insufficient knowledge among players, teachers, coaches, parents about the recognition and management of concussion. That this knowledge must reach the field, the rink and the classroom,” said Tator.
When should your child or teenager return to play after a concussion? Check out this infographic for steps to follow. Information and advice from national injury prevention charity, Parachute Canada, it advises that each step must take a minimum of one day, and could last longer.