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FACE TO FACE with Dr. Isabelle Gagnon, a researcher who goes beyond borders to better understand childhood concussion
- Member of the Child Health and Human Development Program (CHHD) and of the Centre for Outcomes Research and Evaluation (CORE)
- Associate professor at the School of Physical and Occupational Therapy, McGill University
What led you to research head trauma in children?
Dr. Isabelle Gagnon: As a clinician in pediatric physiotherapy, head trauma was something that sparked my interest. So when I was deciding on the research topic for my doctorate, trauma was a natural choice. At the time, concussions weren’t studied very much, so we didn't know a lot about them.
What do you research specifically?
I.G.: I do research on children who sustain mild traumatic brain injuries, which are commonly referred to as concussions. I test children from ages zero to 17 for different projects. I evaluate them, track their recovery, and perform clinical trials on treatments.
What types of treatment can rehabilitate the brain?
I.G.: These treatments can include, for example, physical tasks such as walking, running or jumping. They can also include vision exercises with virtual reality. Research has demonstrated that these activities increase brain plasticity while alleviating headaches and improving mood and cognition. This is mainly what I have been helping to develop for about a decade now. We test the effectiveness of these treatments on groups of children of different ages who have experienced different severities of trauma. Recently, we began studying babies and very young children who have had concussions.
Does working with children add an additional challenge to your research?
I.G.: I wouldn’t say that it is a challenge, but it’s a different approach using activities that are more fun. We use games quite a bit, as we can’t simply give children instructions. We try to convince them it’s a good idea for them to do what we’re asking. The other difference is that families come with them, whereas adults come to physiotherapy alone. In the case of children I see, parental stress can play a role in the child’s stress.
How do you recruit your subjects?
I.G.: In 2007, I worked with the Trauma Centre to create the Concussion Clinic of the Montreal Children's Hospital of the MUHC, which is more of a clinical program. However, it was designed for integration with research. The clinic is like a living lab where the young patients who are treated can take part in our research projects. Our research results are then translated into clinical practice.
You said that research in this field wasn’t popular when you started out. Then interest in concussions is quite recent?
I.G.: Yes, because at the end of the 1990’s, people didn’t know how serious this type of injury was. People would tell kids to get back up and keep playing. It’s true that this injury can be invisible. Hospitals would focus more on treating severe trauma cases, such as coma patients. However, we started seeing people with very mild injuries go on to experience lingering effects. That’s when I wondered if we should be looking at these situations more closely. In the 2000’s, it was recommended that patients rest for a few weeks before starting rehabilitation. Today, we try to start treatment as early as the first week after the trauma to prevent chronic problems.
With this field still in its infancy, do concussion researchers have good prospects for collaboration?
I.G.: Yes, indeed. Researchers don’t really have a choice if they want to advance science more quickly. For example, I coordinated a study at six sites in Canada on concussions in children aged six to seventeen. We also participate in multicentre studies, as this is the only way to access larger samples. The idea is to get funding for Canada-wide studies, which speeds up research quite a lot.
There are also national and international consortia that focus on traumatic brain injury. The goal is to break down barriers between countries and jurisdictions so that researchers from around the world can share their data to create larger analysis samples.
Do we now know the exact impact of concussions on children's brains?
I.G.: We’re still missing a lot of answers. For example, the greater proportion of children who sustain concussions is in the group aged zero to four years, as kids fall a lot at these ages, but not a lot of research is done in that group. Another example would be that when we use regular scans to see what’s going on inside the brain, we really can’t detect the true damage. We need to use more advanced techniques that are currently only used in research.
You’re on academic sabbatical leave this year. What are your projects?
I.G.: I had two more important projects planned for this year. The first is a book on concussions that I am coediting with researcher Alain Ptito from the Brain Repair and Integrative Neuroscience Program (BRaIN). The book is almost ready, and it’s for clinicians who treat this kind of sports-related injury. We tried to create a practical guide with concrete case histories.
My second project will be a visit to a colleague named Vicki Anderson who works at the University of Melbourne in Australia and who also researches mild traumatic brain injuries. She is doing a study with very young children, similar to what I’m doing here, and she is also studying interventions. I want to see how we can collaborate and learn more with this same population.
Dr. Isabelle Gagnon was featured in a McGill University video on brain injury awareness. Watch it here.
─ June 2017