All About Kids Research

'We' the North

April 28, 2016 by Dr. Michael J. Ellis

Working together to optimize the multi-disciplinary management of pediatric concussion in Canada.

Canada North Concussion Network

About my research:

Sports-related concussion (SRC) is a form of traumatic brain injury (TBI) that represents an important public health concern that affects thousands of Canadian children and adolescents annually. Despite the explosion in SRC research over the past few decades (1), there remains modest empirical evidence to help guide the evaluation and multi-disciplinary management of this patient population.

To address this issue in the province of Manitoba government, healthcare, and community stakeholders have partnered to establish the Pan Am Concussion Program in Winnipeg; a provincial government-funded clinical program devoted to the multi-disciplinary management of children and adolescents with sports- and non-sports related concussion and TBI. As Medical Director of this program, I currently lead a team of provincial leaders in neurosurgery, neuropsychology, neurology, neuro-ophthalmology, rehabilitation medicine, sports medicine and exercise science who are not only dedicated to optimizing the care of Manitoba’s pediatric concussion patients but also working towards contributing important scientific advances related to the epidemiology, pathophysiology, diagnosis, and management of this condition through our multi-disciplinary, multi-institutional research group; the Canada North Concussion Network.

In the past three years our group has completed research aimed at evaluating the role of sideline assessment tools (2), clinical neuroimaging (3) and vestibulo-ocular dysfunction (4) in pediatric SRC. We have completed a study examining the prevalence, risk factors, and management of post-injury psychiatric outcomes in our clinical population (5) as well as a systematic review of health-related quality of life in pediatric mild TBI and concussion (6). In collaboration with our colleagues at the University of Buffalo we have established a novel classification system for post-concussion syndrome (7) and initiated a randomized clinical trial investigating the effect of early aerobic exercise prescription in adolescents with acute SRC. More recently, we have worked to validate a novel neuroimaging tool that is capable of detecting qualitative and quantitative alterations in resting cerebral blood flow and cerebrovascular reactivity in individual concussion patients (8,9,10). Lastly, we have completed a critical appraisal of the current state of concussion healthcare in Canada (11) and continue to highlight how multi-disciplinary collaboration between TBI experts can optimize care of pediatric concussion patients especially those with rare clinical presentations and prolonged symptoms (12,13,14,15).

In addition to advancing our understanding of pediatric concussion, our research has had an important impact on shaping public health policy in Manitoba and our evolving institutional approach to pediatric concussion and PCS. It is clear from our preliminary work that pediatric concussion is truly a form of TBI that requires the coordinated efforts of healthcare professionals with nationally and provincially-recognized training in TBI working together from within, and not outside of their respective scopes of practice. Sadly, this standard of care is not universally available to all children and adolescents in Canada. At present, concussion healthcare in Canada is highly variable and mostly undertaken by healthcare professionals with limited clinical training in TBI that are often working in isolation and offering diverse healthcare services they are simply unqualified to provide (10). This is exemplified by the practice of widespread baseline computerized neurocognitive testing for which there is limited supportive evidence in the pediatric population (16,17,18) but that remains a service offered by sports medicine, physiotherapy, and chiropractic clinics across Canada, often conducted without the supervision of a certified clinical neuropsychologist, and at a cost that varies from $30-$100 per test.

Given the current landscape of concussion healthcare in Canada and the absence of international guidelines defining the qualified roles and responsibilities of healthcare professionals that can safely participate in the multi-disciplinary care of this patient population, there appears to be an urgent need for a national discussion about how government, healthcare, and community stakeholders can partner to optimize the care of pediatric concussion patients in Canada. Such a discussion is particularly relevant as Canada appears poised to follow our neighbors to the south and consider provincial and/or federal legislation requiring that every child and adolescent with a concussion receives medical evaluation and clearance prior to returning to school and sports activities.

In my opinion, only by working together and acknowledging the strengths and limitations of our clinical training and experience, will the standard of concussion healthcare be elevated to an acceptable level in our country. Our preliminary experience at the Pan Am Concussion Program suggests this is an achievable goal and one that would have a significant impact on lives of thousands of Canadian children and adolescents.

Clinical and research affiliations:

Department of Surgery and Pediatrics, Section of Neurosurgery, University of Manitoba
Medical Director, Pan Am Concussion Program
Co-Director, Canada North Concussion Network
Scientist, Children’s Hospital Research Institute of Manitoba

Research focuses:

My main research interests include the clinical epidemiology and evidence-based management of pediatric sports-related concussion as well as the advancement of novel cerebrovascular neuro-imaging and exercise science tools in concussion.

A little about myself…

Dr. Michael J. Ellis</a>

I grew up in the small town of Orangeville, Ontario where everyone lived and breathed hockey and lacrosse. My brother Dan is a 11-year veteran goaltender of the National and American Hockey Leagues. During my neurosurgery residency at the University of Toronto I originally became interested in pediatric stroke and cerebrovascular disease. However, during my final year of residency I decided to undertake a fellowship in concussion spectrum disorders with Dr. Charles Tator and pursue research examining the cerebrovascular physiology underlying pediatric concussion and TBI. I spend all of my spare time with my wife Vanessa and my one- and three-year old daughters Cooper and Cali and am a big fan of smoked BBQ, wine, and country music.

References:

  1. Russell K, Ritchie L, Vis S, Chu S, Selci E, McDonald PJ, Ellis M: Measuring the scientific impact of sports-related concussion research: a citation analysis study. Current Research Concussion 2: 113-121, 2016
  2. Ellis M, Cordingley D, Morrisette M, McDonald P, Leiter J: Retrospective review of baseline Sport Concussion Assessment Tool 3 scores in elite adolescent hockey players during a preseason physiological testing combine. Current Research Concussion 1: 15-18, 2014
  3. Ellis M, Leiter J, McDonald P, Hall T, Sawyer S, Silver N, Bunge M, Essig M: Neuro-imaging in pediatric sports-related concussion. Journal of Neurosurgery Pediatrics 16: 248-55, 2015
  4. Ellis M, Cordingley D, Vis S, Reimer K, Leiter J, Russell K: Vestibulo-ocular dysfunction in pediatric sports-related concussion. Journal of Neurosurgery Pediatrics 16: 241-7, 2015
  5. Ellis M, Ritchie L, Koltek M, Hosain S, Cordingley D, Chu S, Selci E, Leiter J, Russell K: Psychiatric outcomes after pediatric sports-related concussion. Journal of Neurosurgery Pediatrics 16, 709-718, 2015
  6. Fineblit S, Selci ELoewen H, Ellis M, Russell K: Health-related quality of life after pediatric mild TBI and concussion. Journal of Neurotrauma (published online), 2016
  7. Ellis M, Leddy J, Willer B: Physiological, Vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment. Brain Injury 29: 238-248, 2015
  8. Mutch WA, Ellis M, Leiter J, Graham R, Wourms V, Raban R, Mikulis D, Fisher J, Ryner L: MRI brain stress testing: a pilot study in concussion. PLoS One 17:e102181, 2014
  9. Mutch, W.A.C., Ellis, M.J., Ryner, L., Graham, R., Dufault, B., Hall, T., Bunge M, Essig M, Fisher, J., Duffin, J., and Mikulis, D. Brain magnetic resonance imaging CO2 stress testing in adolescent post-concussion syndrome. Journal of Neurosurgery (published online), 2015
  10. Ellis M, Ryner L, Sobczyk O, Fierstra J, Mikulis D, Fisher J, Duffin J, Mutch WAC: Neuroimaging assessment of cerebrovascular reactivity in concussion: current concepts, methodological considerations and review of the literature. Frontiers of Neurology- Neurotrauma (published online) 2016
  11. Ellis M, Ritchie L, Selci E, Chu S, McDonald PJ, Russell K: Googling Concussion Care: a critical appraisal of online concussion healthcare providers and practices in Canada. Clinical Journal of Sports Medicine (published online), 2016
  12. Ellis M, McDonald P: Co-existent adolescent sports-related concussion and SCIWORA: case report and considerations for evaluation and management. Current Sports Medicine Reports 14: 20-22, 2015
  13. Ellis M, Wennberg R: Convulsions in a 17 year-old boy after a head injury sustained while playing hockey. Canadian Medical Association Journal (Published online), 2015
  14. Ellis M, Ritchie L, Cordingley D, Essig M, Mansouri B: Traumatic optic neuropathy: a potentially unrecognized diagnosis after sports-related concussion. Current Sports Medicine Reports 15, 27-32, 2016.
  15. Ellis M, McDonald PJ, Cordingley D, Mansouri B, Essig M, Ritchie L: Retirement-from-sports considerations following pediatric sports-related concussion. Neurosurgical Focus 40: E8
  16. Echemendia RJ, Iverson GL, McCrea M, Broshek DK, Gioia GA, Sautter SW, et al: Role of neuropsychologists in the evaluation and management of sport-related concussion: an inter-organization position statement. Arch Clin Neuropsychol 27:119-122, 2012
  17. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al: Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 47:250-258, 2013
  18. Randolph C, McCrea M, Barr WB: Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train 40:139-152, 2005
  19. Kirkwood M.W., Randolph C, Yeates K.O: Returning pediatric athletes to play after concussion: the evidence (or lack thereof) behind baseline neurospcyhological testing. Acta Paediatrica 98: 1409-1411, 2009
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The opinions expressed in this blog post are the author’s own.

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