UBC Okanagan professor Paul van Donkelaar and Kelowna Women's Shelter executive director Karen Mason at a recent international brain injury conference in Toronto.

Image Credit: SUBMITTED/Paul van Donkelaar

KELOWNA - Treatment for concussions have come a long way. When an athlete suffers a blow to the head during a game, they know now to get treatment immediately so 90 per cent recover within a week.

Dr. Paul van Donkelaar of the School of Health and Exercise Sciences at UBC Okanagan in Kelowna has studied sports concussions for the last 20 years but lately he’s been looking beyond athletes to another, more hidden segment of society prone to concussions and often not treated — women in violent relationships. He says of 40 cases of abused women he has studied, nearly all of them have a history of untreated concussions and suffer from chronic brain injuries from blows to the head, often with significant impacts in their lives.

“In the context of sports concussion, if a person comes back too soon and tries to do too much too soon, it causes the recovery to be lengthened,” van Donkelaar told iNFOnews.ca. “If a woman is in an abusive relationship, just trying to mother and do all the things she needs to do the very next day, that has some potential to make the symptoms worse and make the recovery take longer.”

He expanded his research focus beyond sports after meeting Karen Mason, executive director of Kelowna Women’s Shelter a couple of years ago. They now describe each other as life partners.

Mason read an article about a woman who suffered early onset Alzheimer’s after living through an abusive relationship and suggested van Donkelaar look into the connection between spousal abuse (she calls it “intimate partner violence”) and chronic brain injuries.

“A lot of people are doing sports concussion research,” van Donkelaar said. “That’s changed the conversation around contact and collision sports and how we play them and how safe they are. This research on this population is also going to change the conversation and how we provide supports.”

While many people don’t see battered women in the same context of high-profile athletes, Mason noted the number of women possibly suffering such brain injuries is “staggering.”

“We make up half the population and, statistically, one third of us have been involved in intimate partner violence - probably more because lots are not reported,” she said. “This is lots and lots of women. Most of the physical abuse that happens in a physically violent intimate relationship constituted blows to head, neck and face.”

NOT EASY TO STUDY
“In the world of sports concussion, quite often there are witnesses - coaches, parents, medical personnel, teammates - who see the event, see the impact, see the person is lying motionless and having trouble getting up onto their skates afterwards,” van Donkelaar said. “People would do an initial assessment. Ask them where they are? What day it is? What time it is? If they have trouble answering those questions or they have signs and symptoms, the best practice is to refer them to a sports concussion specialist who can do a proper diagnosis and set up a treatment management plan.”

In a spousal abuse situation, the only witness is the perpetrator.

When it gets bad enough, the woman will flee and can end up at the Women’s Emergency Shelter where workers are trained to deal with trauma but not with brain injuries.

And it can be hard to differentiate between the two.

“Women who have experienced intimate partner violence typically have a lot of emotional disturbances that go along with it, so things like Post Traumatic Stress Syndrome, depression and anxiety and substance abuse, are typically present in this population and much less so in young athletes who have concussions,” van Donkelaar said. “Some of the things that go along with the trauma can have an impact on brain function that has nothing directly to do with the impact to the brain itself.  So, from a scientific perspective, we need to disentangle those various contributions.”

A series of questionnaires were given to the study subjects to determine what symptoms were caused by trauma and what were from a physical brain injury.

In the end, he concluded that all 40 subjects were suffering from some degree of chronic brain injury.

HARD TO LIVE WITH
It’s one thing to diagnose a brain injury, but what does that mean to the women going into the shelters?

“A woman may be staying with us at the shelter and, day after day, she may be unable to do whatever chores she might have been assigned or, despite multiple meetings and lists that have been created, she might not be able to get it together to make the phone calls she needs to find support for her housing situation,” Mason said. “So in the past, workers may have just grown frustrated with the women and they may have become incredibly frustrated with themselves, not knowing this could, in fact, be the implications of a physical injury they may have suffered.”

People with brain injuries may also experience rages.

“They may come across as being difficult and we have a communal living situation in the shelter,” Mason said. “This way, we can look at it through a different lens and it create more opportunity for empathy and finding new ways to work with the women.”

NEXT STEPS
There are three components to the ongoing research.

One is to continue doing the basic research into the connection between assault and brain injury.

The second, which is underway, is to develop training materials for front line staff to recognize and deal with brain injured clients.

The B.C. Children’s Hospital has developed training materials for parents and others dealing with sports concussions and have expanded those to deal with workplace and other concussions.

van Donkelaar is working with them to develop training material for workers in women’s shelters. That will take about a year to roll out.

“The key is going to be training the front line staff about what the implications of traumatic brain injuries are, to learn the signs and symptoms, to learn the tools and tactics they can use to support the women who are dealing with a brain injury, in addition to everything else they are dealing with,” Mason said.

But all of that will mean little if the third component is not created as well – which is getting the medical resources in place so, once identified with a brain injury, there is treatment available.

As van Donkelaar pointed out, this research, along with the resources put to it and to treatment, is where research on concussed athletes was 20 or so years ago.

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