Lack of regulation creating a ‘Wild West’ of concussion clinics

A significant increase in concussion care providers may be driven by less qualified opportunists

Concussions have become a major health concern among Canadians, and the increased demand for treatment for brain injuries is giving rise to a new, unregulated industry, according to a report by CBC News.

One new service arising from the panic is the concussion hotline, a private number that people can call for free concussion advice, 24 hours a day. However, it is totally unnecessary, according to a neurosurgeon at St. Michael’s Hospital.

“Hotline advice already exists and it is part of the publicly funded health-care system,” said Dr. Michael Cusimano. Due to lack of provincial or federal oversight, it seems anyone interested can set up a practice or hotline offering treatment for concussions. The same lack of regulation opens the field to a wide variety of practitioners: more than 200 concussion clinics across Canada offer wildly differing treatments such as meditation, acupuncture, and even oxygen therapy.

The Ontario College of Physicians and Surgeons told CBC news that unless someone files a complaint against concussion hotlines, there’s no problem. But some medical experts would beg to differ. “The brain will recover on its own in 80 to 90 per cent of concussion cases, and so a lot of what's offered to people isn't improving on the natural course,” said Cusimano.

Another neurosurgeon, meanwhile, is concerned about the possibility of misdiagnoses. “We have seen kids that have had medical conditions such as hypertension, cancer, epilepsy, depression and migraines – a whole host of neurological and medical conditions,” said Dr. Michael Ellis, who runs the only provincially sponsored concussion clinic in Manitoba.

One procedure used to diagnose concussions, baseline testing, is encouraged by minor league sports teams on the theory that one’s performance under a battery of physical and neurological tests will change after getting concussed. However, expert groups such as the International Conference on Concussion in Sport and the Canadian Concussion Collaborative have found no evidence that baseline testing is reliable enough for widespread use.

Toronto-based occupational therapist Nick Reed offers the test even though he knows about the debate surrounding it. He said he does it only because patients ask for it, and it would at least ensure that they get publicly funded doctor-supervised services, which they might not get at less-qualified clinics.

“I would say [the space for concussion care clinics] is a Wild West, and I think unfortunately the people who suffer in this culture are kids and families,” Reed said.


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