Bereaved parents speak out on concussion

It is a weary and banal cliché that time heals all wounds, and for Kathleen and Gordon Stringer, the deep gash left by their daughter’s passing remains raw more than a year after her death.

17-year-old Rowan cherished sport. She played rugby union, lacrosse, ringette (a Canadian, female-dominated variation of ice hockey) and soccer, and snowboarded in her native Barrhaven, a suburb of Ottawa, Canada.

She was a little naïve, never afraid of appearing ditsy, never one of the high school trendsetters, but always her own person, smiling and laughing and taking on all that life threw at her with relentless zeal; her friends treasured her for it.

She was the archetypal team player, a friend, a confidant, a mentor and a role model at school, with a fiercely competitive edge on the sports field. Helping others was her passion, and it came as no surprise to her parents that so many youngsters gravitated to their daughter, drawn in by her unique spark.

That spark was cruelly doused on May 12th 2013, as an illegal tackle during a high school rugby match sent her flying through the air, her head bouncing off the turf, the impact plunging her into a four-day coma from which she never awoke.

Post-mortem examination of her brain, informed quite by chance by a visit from a classmate in hospital, confirmed Rowan had died from a rare condition known as second impact syndrome. Most prevalent in adolescents whose brains are not fully developed, it arises from a second or third concussion sustained before the individual has recovered from the first. It results in severe and often catastrophic brain swelling.

The attending neurosurgeon commented that the damage to Rowan’s brain was reminiscent more of a mass motorway pileup than a rugby tackle.

In the days leading up to the fatal blow, she had twice injured her head playing rugby. She had displayed minor but tell-tale symptoms of concussion, felt dizzy and light-headed, but confided only in friends rather than a parent, teacher or coach.

Now, her parents are striving to bring new education initiatives in an effort to avert tragedy striking another family.

“They’ve come out with new guidelines in Canada for paediatric concussion and I was quite upset to see that everything about it is geared towards parents, coaches, and community workers,” says Kathleen.

“None of it is geared towards the actual children.

“I think the angle to take with teenagers from about 13 to 18 is educating them. I don’t think we give them enough credit. If Rowan had known this could have happened she would not have played.

“We had never heard of second impact syndrome; it’s not a phrase I’d ever heard and I’m a nurse. I don’t know if Rowan’s friends would have known enough to tell someone, but you would hope that within the circle of friends, if someone knew about it they would have told an adult, and stopped her playing somehow. If they had known.”

In Tasmania, their views are shared by Damian Lawler, one of many campaigning for a culture change within Australian sport. Through his organisation, Smart HeadPlay, he aims to roll out and implement standardised protocols, management procedures and education packages across the nation.

“The scientists affiliated with peak sports bodies tend to say that change should start from the elite level down,” says Lawler, a strength and conditioning coach by trade whose 15 years as an acquired brain injury consultant have allowed him to work alongside the weekend warriors right up to Australia’s sporting stars.

“We think that while elite-level sport has a vested interest with dollars and cents in keeping players on the field, there will never be a change.

“We think the change will come from community-based sport where we can improve the culture, the behaviour, the understanding and education of parents, teachers and the actual students themselves.

“Talking to teachers, there is a definite concern over the lack of communication after a child has been concussed and their return to school; children really can’t be the ones who are responsible for that.

“But if we educate them on just how important it is that even if it’s a small bump on the head, it’s not a sign of courage or bravery or being tough to get up and play on – they really need to get to the sideline and talk to their coach or parent and tell them what’s going on.”

Amid a storm of controversy over the past year, the IRB has committed to driving cultural change within the game, and rolled out a much-improved education programme for the grass-roots. At elite level, the body’s pitchside assessment tool remains contentious, with several prominent researchers expressing concerns over the ‘independence’ of the scientific trial study that led to its development.

Their cross-code cousins in the NRL and AFL have enhanced their own respective head injury protocols at the top of the tree, and though these encourage Lawler, he urges the sporting powerbrokers to look further down the trunk.

“I think education will be far more effectively executed with 10 to 12-year-olds, they will be the next elite sportsmen and women in their codes,” he says.

“It’s a very basic level of understanding just now. Concussion is still viewed with a bit of humour attached to it – the picture of the player getting up and staggering around and falling over a couple of times draws more humour than it does concern. We want to change that culture, so if someone is concussed, it is treated very seriously.”

Sparked initially by research findings in the USA that strongly link repeated head trauma with early-onset dementia, the global awareness and concern for sports concussion is rising sharply. In the UK, it has reached government level, with debate ongoing in the House of Lords.

“There is a complete lack of understanding of how dangerous concussion is,” says Lord Mike Storey, a former headteacher and Education Spokesman for the Liberal Democrats.

“If you were to go to schools throughout the UK and ask teachers their understanding of anaphylactic shock, dyslexia, cystic fibrosis, and finally concussion, I bet you concussion would come bottom of the list – they wouldn’t have a clue.

“I bet very few physical education teachers would have a basic understanding, which is shameful.”

Several weeks ago, the Stringers had a visit from a concerned neighbour that bolstered their convictions. Her son, several years Rowan’s junior, had been concussed in a high school American football match, and was still suffering from headaches several days later.

Knowing the fate that had befallen his friend, he resisted the innate air of hormone-fuelled invincibility inherent in teenage boys, and the simple desire of sportsmen to play sport, and told his mother of the symptoms; he wasn’t sure if he should take part the next game.

“I said, ‘No, he can’t do anything until he’s 100 per cent better.’ He’s exactly in the right range for second impact syndrome,” says Kathleen.

“Normally they wouldn’t have thought too much about the headaches but because they knew Rowan’s story, they came and talked to us. We’ve had other people say they got hit at the start of a rugby game, and where normally they would have kept on playing, they didn’t – they sat themselves out. And it’s the kids that are taking the initiative.

“I hope that because we’ve been on television and there’s been a load of doctors and neurologists talking about it that people are getting the message.”

“Part of our key message is educating the kids because I think they will make the right decisions more often than not if you give them the knowledge and the information,” adds Gordon.

“They’ll err on the side of caution, or they’ll have a friend that will do it for them.

“That is what we hope comes out of this. Maybe you are the star player on the team, but if you don’t have your brain, you’re not going to be star of anything.”