Transforming Concussion Research and Care in Canada

Every year, approximately 400,000 Canadians experience a concussion, a type of brain injury that occurs when the brain moves within the skull as the result of an impact to the head, neck, or body. Concussions are common across the lifespan and have many different causes, including falls, sport injuries, workplace accidents, motor vehicle collisions, and intimate partner violence.  

Although public attention has accelerated in recent years, a lot remains unknown about how to care for people who experience a concussion.  

Most previous research has taken place within hospitals or universities and has focused solely on young adults, high-performance athletes, and military personnel. Unfortunately, this means that current treatment approaches may not be appropriate for other demographic groups (for example, older adults) and causes of injury, or those who receive care in more common community settings like a local concussion clinic.  

To address these gaps in research evidence and clinical care, RSI faculty member and Canada Research Chair (Tier 2) in Pediatric Concussion, Dr. Nick Reed, helps lead the TRANSCENDENT Concussion Research Program.  

The TRANSCENDENT program is a $5.4-million research initiative funded by the Ontario Brain Institute (OBI) to help improve concussion care. Within TRANSCENDENT, Dr. Reed works alongside a team of over 30 researchers from 20+ universities and health institutions across Canada and the United States, including many of the world’s leading concussion experts. The program is led by Dr. Roger Zemek, a Pediatric Emergency Physician and Senior Scientist at the Children’s Hospital of Eastern Ontario (CHEO), who is a long-time collaborator and mentor of Dr. Reed.  

Advancing concussion research through interdisciplinary collaboration  

TRANSCENDENT is one of five Integrated Discovery Programs administered by the Ontario Brain Institute (OBI). These unique programs offer a platform for province-wide research spanning multiple sites across Ontario, allowing for greater reach. They also support interdisciplinary research teams blending expertise from various scientific fields, and facilitate collaboration with healthcare partners, industry groups, patient advocates, and other community organizations.  

Leveraging the vast expertise of their large and experienced research team, TRANSCENDENT will collect large volumes of data using cutting-edge research methods including physiological assessments like heart rate and blood pressure, biological analyses of blood and saliva samples, and advanced neuroimaging techniques to identify objective measures of recovery. These datasets will be made available through OBI’s central research platform called Brain-CODE, allowing for further partnerships and cross-referencing with other similar datasets using neuroinformatic analysis techniques.  

In keeping with OBI’s mission to advance brain health innovation, TRANSCENDENT will also serve as a platform for industry partnerships to evaluate new tools for concussion assessment and treatment, accelerating their clinical impact for patient care and stimulating economic activity through technology commercialization. 

An innovative model bringing concussion research to local clinics 

TRANSCENDENT is unique in its approach to conducting research through direct patient care in community-based clinics, facilitating discoveries across the full spectrum of concussion injuries.  

Rather than the traditional method of recruiting participants to attend studies on hospital or university campuses, data is being collected from multiple locations of 360 Concussion Care, a network of interdisciplinary clinics. Patients can voluntarily consent to have their de-identified clinical data included in the research database and may also choose to enrol in sub-studies involving additional testing on-site or at local facilities.  

The full research protocol for TRANSCENDENT has been published in the journal BMJ Open.  

This integrated clinical research partnership allows for more diverse study samples that better reflect the range of demographics, mechanisms of injury, and comorbidities among people who experience concussions. It may also enable participation for patients who would otherwise experience barriers to attending study visits at academic institutions.  

Research driven by patient priorities 

While there are many gaps in our understanding of concussions, TRANSCENDENT is shaped around top patient-centred research priorities determined by members of the TRANSCENDENT team in previous work utilizing the James Lind Alliance Priority-Setting Partnership (PSP) process. 

Led by Dr. Martin Osmond, a Senior Scientist at the CHEO Research Institute, the Concussion PSP project involved surveys and workshops with patients, caregivers, and healthcare professionals across Canada to identify and prioritize unanswered questions about concussion. In 2023, they published their findings on the top 10 concussion research priorities, which included topics such as predictors of recovery, strategies for returning to activities, biological changes in the brain, and optimal care and treatment.  

Based on these priorities, sub-studies underway within TRANSCENDENT focus on identifying autonomic dysfunction (a physiological imbalance in the nervous system), assessing exercise tolerance using a bike test, evaluating visual disturbances with eye-tracking technology, neuroimaging (MRI scans), and biological analyses of saliva samples. The team hopes that findings from these studies can be used to develop individualized concussion treatment plans based on each patient’s unique characteristics and biological profiles.   

To further ensure that TRANSCENDENT research reflects the needs of patients, Dr. Reed led the formation of a Community Advisory Committee (CAC) comprised of individuals with lived experience of concussion. The CAC helps guide the program’s work by providing a better understanding of community needs for research and education. CAC members contribute in a variety of ways across the program, including research activities like advising on study design, supporting community outreach, and reviewing educational materials to ensure their relevance.  

Dr. Reed shares that “the TRANSCENDENT Community Advisory Committee is a crucial component of the research program where people with lived experience of concussion can have a voice to shape the direction of the research that matters most to them, and those with similar experiences and needs. It is these voices that bring life to the work and help us all achieve the impact we want with TRANSCENDENT.” 

Translating knowledge to maximize research impact 

As knowledge translation lead for TRANSCENDENT, Dr. Reed directs the program’s strategy on community engagement to help share its scientific discoveries with the public for maximal research impact.  

Knowledge translation refers to the process of applying research findings into actionable information and practical tools that can be easily understood and used in practice by the people who need it. For TRANSCENDENT, this means working alongside knowledge users like healthcare professionals, coaches, teachers, persons with lived experience, and their families. 

The TRANSCENDENT knowledge translation team, which includes RSI PhD students Brynna Kerr and Daniela Testani, has launched several initiatives to help make concussion research more accessible and usable. Brynna shares that “Knowledge Translation is at the center of everything that TRANSCENDENT and OBI do. Our team is working hard to make sure that we are sharing the research and learnings with those who can use it in their everyday lives in ways that will resonate with them and have a greater impact on the community."  

Through a quarterly newsletter called Concussion News You Can Use, the team shares updates on the latest evidence, along with expert opinions and practical resources to support people living with concussion. They also offer educational outreach events in the community and run an online speaker series featuring concussion experts sharing insights on cutting edge studies, innovative protocols, and real-world experiences. Their upcoming and past events can be found on the TRANSCENDENT website.  

In the future, the team plans to launch a podcast in which Dr. Reed will interview TRANSCENDENT team members to discuss their work.  

Implementing research findings in real-world clinical practice 

Under the leadership of Dr. Zemek and co-leads like Dr. Reed, the TRANSCENDENT team is well-positioned to rapidly implement their research findings directly into clinical care to improve recovery among people with concussion.  

As a learning health system, 360 Concussion Care applies knowledge generated through its real time research model to continuously improve its clinical services. The clinic also helps share new evidence within and beyond the healthcare community through active communication across its network of referring clinicians, schools, sport groups, and workplaces, as well as other partner organizations they work with. It’s all part of their mission to deliver and study the most current evidence-based concussion care to help people return to life as quickly and safely as possible.  

Beyond the walls of 360 Concussion Care, the clinical impact of TRANSCENDENT’s work could have global reach through changes to international guidelines for concussion care.   

Dr. Reed and Dr. Zemek lead the Living Guideline for Pediatric Concussion, an online resource that provides up-to-date clinical practice recommendations and tools for the prevention, diagnosis, and management of concussion in children and youth. The Living Guideline team is comprised of concussion experts from across Canada and the US, including RSI faculty members Dr. Mark Bayley, Dr. Anne Hunt and Dr. Shannon Scratch. An equivalent guideline is also available for adults.  

Expert panels for the pediatric and adult living guidelines each work together to review the latest research and update clinical recommendations according to the evolving evidence. This provides an avenue to quickly integrate new discoveries from innovative research initiatives like TRANSCENDENT into best practice standards.   

Ultimately, what excites Dr. Reed most about TRANSCENDENT is the opportunity to share new evidence with those who need it most (including patients, families, health care professionals, schools, and sports organizations) in ways that are meaningful to them.  

By leveraging interdisciplinary collaboration, cutting-edge research methods, and real-world clinical data, the TRANSCENDENT program is poised to transform how concussions are understood and treated across the full range of people affected by the injury.