Part four of a series on the people who have suffered concussions as well as those who treat them. For other stories, click here.
It was the shoes that gave them away.
Thirteeen years ago Shauna Leduc was on the sidelines for her first game with the University of Calgary Dinos football team. She was one of several students there to assess concussed players. Picking out who was injured wasn’t difficult — they’d be the ones writing X’s and O’s on their shoe tape of plays they couldn’t otherwise remember.
Speaking with those players broke Leduc’s heart.
“It was amazing to see,” she says. “It was like, ‘oh where are we?’ ‘We’re in Edmonton.’ ‘Are we winning?’ ‘No we’re not winning.’ ‘Where’s my helmet?’ ‘I have your helmet.’ ‘Where are we?’ ‘We’re in Edmonton.’ And it was kind of like a stop, restart.”
Leduc, who operates OPTM Athletic Therapy, is the primary consultant for all hockey-related concussions in Nelson. She has worked alongside Dr. Kevin McKechnie for the Nelson Leafs for the past four seasons as well as with the Nelson Minor Hockey Association.
BC Hockey doesn’t require KIJHL teams to employee athletic therapists, which makes Leduc’s employment an exception to the rule in Junior B. But her importance can’t be understated.
Prior to each game, Leduc goes through an emergency action plan. She checks defibrillators, makes sure no one is parked in spots designated for ambulances and speaks with players and coaches on both teams. Her role isn’t limited to concussions, but when a brain injury occurs Leduc says she treats her patients for what they are — children.
“At Junior B, very few of these kids are going to the NHL,” she says. “My concern is high school.”
Leduc recalled a player who didn’t initially report a concussion and tried to play through. Then he took what seemed like a small hit in the playoffs.
“He missed three months of school in his Grade 12 year because he didn’t report that first hit,” she says. “And the second hit can be so minor and so insignificant … [Hockey], I know it seems like it matters, but in the grand scheme of things it doesn’t matter.”
When a Leafs player is injured during a game, they are taken off the ice and assessed on the sidelines by team trainers Timmo Suomi and Stathis Dimopoulos using the third edition of the Sport Concussion Assessment Tool (SCAT3). The player is asked to go through a series of symptoms they might have, such as dizziness or confusion.
If there’s evidence a concussion has occurred, the player is removed from the game and the team calls Leduc. Their recovery is judged against a pre-season baseline test done by every player, the results of which Leduc is able to help McKechnie analyze.
Leduc sympathizes with doctors who aren’t trained to treat concussions.
“We’re looking to physicians to clear all of our children for concussions and I don’t believe at this point they have been given the tools to safely and accurately make that decision,” she says. “I think it’s a tremendous amount of responsibility to put on them. Because it’s not really fair to not give them the training and say, ‘Okay, you say my kid’s not going to die when he goes back out. Sign here.’ They’re not going to want to do that.”
Even though SCAT3 was approved at 2012’s International Conference on Concussion in Sport, Leduc acknowledges the test is problematic. It relies on symptoms, which don’t always have to be present for a concussion to have occurred, as well as the player’s honesty.
“The SCAT3, it’s not a great tool,” says Leduc. “It’s the easiest to administer and it gives us something to go on.”
Leafs staff will also have extra training prior to the upcoming season. BC Hockey announced last month it requires all bench staff and volunteers to take the Concussion Awareness Training Tool online course, which was developed by the BC Injury Research and Prevention Unit, before they participate in any practice or game.
Leduc would prefer to see players removed from play every time. She recalled a game last season when a Leaf delivered a hit so hard it essentially gave him a concussion even though there was no contact to his head. On his next shift he delivered another hard check, which gave him post-concussion syndrome. “It’s really hard to identify,” says Leduc. “Do you need to sit out this period to find out if when you delivered that hit it was too much? That’s where it gets really complicated.”
The Leafs don’t publicly disclose concussions during the season as anything but an upper-body injury. This is common practice in hockey from Junior B up through the NHL. The belief, at least among the Leafs, is that this protects injured players from being targeted by opposing teams.
Whether or not this is true doesn’t matter to Leduc, who agrees with non-disclosure.
“My number-one concern is their safety and I’m not prepared to take that risk whether it’s a boogey man or not for public knowledge,” she says. “[The public] can find out after the season, I’m happy to disclose how many concussions we had. During the season safety is my number-one job and I will not do anything to compromise their safety.”
McKechnie sees the Leafs the day after they’ve been concussed, but Leduc is the point person. She knows the players well (she took a call from one Leaf during her interview with the Star, and later took a break from seeing another player in her clinic to have her picture taken) and touches base with them every day.
“In clinical practice, that’s not realistic,” she says. “You see them once a week. You say, ‘how are you feeling?’ You ask the mom how they are feeling. You get a bit of a guide.
“I’m there all the time with [the Leafs]. So I notice their personality changes. If they’re out at a party drinking, their friends tell on them. You have daily contact. It’s a lot easier to manage.”
That isn’t the case in minor hockey.
Two years ago Sandy Boyd, then working as risk management director with NMHA, wanted to do something about concussions. Teams each had a safety person who had completed Hockey Canada’s online concussion course, but Boyd wasn’t satisfied with how some concussions were being assessed.
“As long as kids haven’t blacked out, aren’t seeing stars, it’s like well okay, keep going,” says Boyd, who stepped down from the NMHA board after last season. “It’s kind of an old school way of doing it. Even if they were seeing stars, suck it up, right? Especially in hockey, which has a very old-school mentality to it. What I wanted to bring in was more information. That’s what people really need is the information of what it is and how to deal with it.”
He asked Leduc to speak with minor hockey coaches. She trained them to use the Maddocks test, which poses four questions to kids under 13 years old on the sideline. One wrong answer and the child is removed from play. It’s not entirely ideal, but Leduc says it takes the onus off volunteer coaches.
“They’re afraid too, from a liability reason, but they also don’t want to send their son’s friend out or one of their players out and have something happen to them,” she says. “So we’re putting them in a really tough position.”
Minor hockey is also unique in Nelson for providing baseline testing to its athletes. Last year was the first year NMHA offered pre-season testing to its 165 players, which the association paid $2,500 for.
Boyd says it’s the responsibility of sports organizations to offer the service regardless of the cost. He also doesn’t understand why some parents choose to skip the testing.
“You go to the rink and you’ll see parents there that, their little Johnny is going to be the next Great One right? They see this as a threat because they don’t understand it. …,” says Boyd. “A lot of parents are probably saying, ‘Baseline tests, why do we need it done?’ And you explain it and they go, ‘I don’t want my kid to be missing hockey.’ It’s like, well, with this it will help the health of your child but also it foreseeably could get them back playing sooner because you follow the protocol.”
Boyd and Leduc hope this changes. Parental responsibility is key in minor hockey. The NMHA doesn’t require a doctor’s note for a child to return to the ice, and coaches rely on parents to make sure their children have properly recovered from a concussion.
Educating parents and coaches is important to Leduc, who can’t be present on the sidelines of every hockey game and is herself a luxury most sports organizations can’t afford. But simply recognizing when a child needs to be removed from play, she says, is something coaches and parents can and should do in her stead.
“If we don’t remove them from play, we risk everything else,” says Leduc. “That’s the most cost effective, best thing we can do for our kids.”