June 2017

Concussion Therapy with Dr. William Clarke

Concussion Therapy with Dr. William Clarke Team

Being in the nation’s capital, our city is lucky to play host to professional sports teams, and national and international sporting events. Go Team!

When athletes need help with concussion prevention and vision, one of our Doctors – Dr. William Clarke is on the scene, and has had some cool opportunities to work with athletes from our NHL team, the Ottawa Senators, as well as Special Olympics athletes. He couldn’t get his hands on any autographed jerseys just yet – so we decided to chat with him about his specialty with concussions – if you play sports, even recreationally, this will be a great read!

Why is concussion awareness important?

It’s important to recognize that, in Canada, acquired brain injury has become a silent epidemic, becoming the number one killer and / or disabler of Canadians under the age of 44yrs. The social, emotional and economic consequences of brain injury are devastating to the survivors, their family members and inflict complicated challenges for their care givers, support workers and the community at large.

Automobile accidents, sports injuries, falls, incidents of violence, domestic violence, stroke, tumours, and aneurysms are all causes of acquired brain injury in Canada.

 That doesn’t sound good. How common are sports concussions and how do they affect our vision?

Incidents of concussion in youth have been steadily rising. In Canada as many as 23% of adolescents reported having sustained a traumatic brain injury (TBI) within the previous year.

It’s estimated that 1.6 -3.8 million sports and recreation related concussions occur in the United States each year. Of the  2.5 million sports related emergency department visits per year of children 5-18 years of age, 6% or 135,000, involved a TBI.

Acquired brain injuries affect both our binocular and visual functions, in a number of ways:

A drop in a person’s visual acuity (sight), extreme photophobia (light/glare sensitivity), diplopia (double vision), visual hallucinations (objects are warped, moving), difficulty in shifting gaze (near to far or far to near), inability for our visual system to adapt to changing environment when there is movement in our periphery and horror fusionalis (ghosted images) are forms of visual dysfunction.

Binocular vision abnormalities resulting from TBI include strabismus (a turned eye), divergence excess (both eyes abduct-turn outwards) and a person’s loss of her/his ability to converge and/or accommodate (focus) to an object of regard.

A person who sustains a TBI can report a number of symptoms:

-headache

-double vision

-objects appear to move

-poor concentration and/or attention span

-staring

-glare sensitive

-asthenopia (visual fatigue)

-balance is off

-co-ordination is off

-a change in their body posture

– a spectacle or contact lens prescription that doesn’t work anymore

Good to know! How did you become specialized in sports vision / concussion management (diagnosis / rehabilitation)?

I graduated in 1992, and had the opportunity to mentor with Dr. John Peroff, North Bay and Dr. John Granda, Manotick – both sports vision specialists.

In 1993 we provided a sports vision assessment for both our Canadian and the English National Rugby Union Teams prior to friendly match in Ottawa. Since then, I have worked with various professional teams, Olympic athletes, local amateur recreational and competitive athletes and teams in Ottawa, as well as having the opportunity to volunteer with the Special Olympics Opening Eyes Program.

My concussion co-management of athletes / patients started through attending a Concussion Symposium developed by the Ottawa Senators and having the opportunity to lecture and work with neurologist Dr. Kristian Goulet, Medical Director, CHEO Concussion Clinic.

That’s pretty impressive. But when you’re not around, how can we prevent concussions and their negative effects on our vision?

The best way to prevent concussions and their negative effects on our vision are:
-Getting athletes to play by the rules. Teaching younger athletes to respect the rules of their sport through good coaching.
-Wearing the appropriate equipment for your sport. Wearing it properly and ensuring it is good working order and the correct size for the athlete as she / he grows. It’s important to note that wearing a mouthguard only prevents oral /dental injury(s) and wearing a properly fitted helmet with chin strap, if required, will help prevent facial injury and/or skull fractures, not a concussion.
-Core / neck strength conditioning in the offseason and during the season.
-Making sure the playing field, ice surface or court are safe.

-Practice good sportsmanship, respect for your teammate and opponent and referees. Avoid unnecessary aggression, win at all cost attitude, during the game.

Education is the key to prevention! This goes for athletes, coaches, trainers and parents / guardians.  Be aware, many concussions go unreported and the risk of second impact syndrome is real, and a matter of life and death or long-term disability.  It’s extremely important that everyone involved in sports and recreation understand how to recognize the risk factors that could lead to a concussion, recognize the signs and symptoms of a concussion and what to do if a concussion is even suspected to have occurred before, during or after the game.

Tell us about your work with the Sens and Special Olympics? What are the challenges that come with working with such high-profile patients? And … can we get an autograph?

The Senators require all players to complete a thorough medical examination prior to starting their preseason training with their respective teams, which includes numerous vision components that need to be tested and fall within normal range.

Special Olympic Opening Eyes Program is an opportunity for those athletes representing their country to have an opportunity to receive a thorough ocular visual examination and vision correction. The emphasis is on providing care to those athletes from other countries who don’t have the quality health care delivery system all Canadians should have access to.  We also utilize the Pacific Sports Vision Performance Profile to analyze specific components of their visual and binocular vision systems, to help identify areas of deficiency and better train the visual systems of athletes to their sport(s).

The challenge with working with high profile athletes (amateur or professional) is establishing accurate baseline data pre season, to use as starting point to refer back to in the event a TBI occurs during the game / season. Working with, educating the athletes, their trainers and their coaches, to abide by the findings to ensure the player is symptom free, prior to initiating any return to play protocols is paramount to preventing concussions.

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