Making the subjective objective; how technology helps evaluate concussions

 BY: PHIL PALMER

In the current climate of the ‘Wild West‘ of concussion clinics, many tools are being used to assess this type of serious injury, also known as traumatic brain injury (TBI), or acquired brain injury.

Assessments can include physical and mental status examination, Glasglow Coma Scale, Immediate Post-Concussion and Cognitive Testing (ImPACT) computer-based system, Balance Evaluation Scoring System (BESS), Inertial Sway measuring devices, and Optogait assessments.1-3

Each assessment method is designed to evaluate the different aspects of the complex physical, cognitive, emotional and sleep disturbances that can result from a concussion4.

Cognitive Symptoms of Concussion: difficulty remembering, feeling slowed down, feeling mentally foggy, difficulty concentrating, confused about recent events

Establishing a ‘baseline’ with patients before a concussion occurs is useful in evaluating a person post-concussion to determine how the injury has affected them.1,3,5  This is not always possible given how and when a brain injury can occur. An assessment baseline can always be performed when commencing treatment and as an introduction to a rehabilitation program. 

One tool we are using to establish a person’s pre-injury baseline is the Optogait, which is considered a ‘gold-standard’ device for measuring gait (how a person walks), balance and movement symmetry.6-9

The simple 30-60 second test of walking on a treadmill can be recorded by a computer system using lasers to establish the individual characteristics of the patient’s gait, which can then be remeasured throughout the rehabilitation program.

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The amount you move when standing still, (your postural sway) is measured by 3D accelerometers (which track acceleration), gyroscopes (which track orientation), and magnetometers (which, according to the journal, Karger, ‘measure the ‘magnetic fields emitted by the brain, generated by neuronal activity)10. These tools allow a much more precise measurement of sway – up to 1,000 times per second more – compared to the manual use of a stop watch.

3

We also determine the speed of cognitive processing during walking by testing patients walking while counting backwards. The eyes and head together (Vestibular Ocular Reflex) are tested in order to determine concussive symptoms.

Screen Shot 2017-08-02 at 2.12.48 PMThese tests are useful when a patient may feel their concussion symptoms have resolved, but in fact their cognitive processing is still poor.

The Gyko component of the protocol also tests sway, which is the movement of the centre of mass, and upper vs. lower body plus compensatory movement patters made by the brain to return to a normal set point so it would make sense that the tests are not highly correlated like the march in place and BESS, performed using the OPTOGAIT.

At Genesis Rehabilitation, Physiotherapy and Sports Injury Clinic, where I am the clinical director, we also use the Gyko system to determine changes in physical functioning with changes in body position.

More recently, a validation study was conducted to utilize the Optogait® equipment for evaluating the march-in-place test traditionally used for vestibular (inner ear) testing, called the Fukuda or Unterberger Stepping Test.3,13-15  This study validated BESS testing, but was not highly correlated to the ImPACT testing.3 ImPACT does not specifically measure various aspects of balance, postural stability, or a physical asymmetry, so it would make sense that the tests are not highly correlated like the march-in-place and BESS.

4

ImPACT is widely used because of the ability to use a computer in the field to perform the assessment, however recent validity studies on ImPACT suggests that approximately 20% of the time underperformance of the test in group/team settings may result in athletes returning to play too soon.2,16 This error creates the ability of a patient to, in a sense ‘cheat’ on their baseline test, so in the event of a concussion they can return to play faster, since their post-concussion score would be low and close to the baseline score.17

Using objective physical characteristics of the pathophysiology of TBI, the data collection with the OPTOGAIT equipment cannot be easily altered by the patient, thus “ you can’t cheat” testing of gait, postural sway, or marching in place tests with your eyes open or closed.

Screen Shot 2017-08-02 at 2.13.07 PM


Dr. Philip Palmer is a chiropractor serving Toronto and the surrounding area. He is the clinical director of Genesis Rehabilitation, Physiotherapy and Sports Injury Clinic.

REFERENCES

  1. Hirsch MA, Grafton L, Runyon MS, et al. The Effect of Cognitive Task Complexity on Postural Sway in Adults Following Concussion. Archives of Physical Medicine and Rehabilitation. 2015;96(10):e51.
  2. Gaudet CE, Weyandt LL. Immediate Post-Concussion and Cognitive Testing (ImPACT): a systematic review of the prevalence and assessment of invalid performance. The Clinical neuropsychologist. 2017;31(1):43-58.
  3. Engelson MA, Bruns R, Nightingale CJ, et al. Validation of the OptoGait System for Monitoring Treatment and Recovery of Post-Concussion Athletes. Journal of chiropractic medicine.
  4. Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. British journal of sports medicine. 2013;47(1):15-26.
  5. Alberts JL, Hirsch JR, Koop MM, et al. Using Accelerometer and Gyroscopic Measures to Quantify Postural Stability. Journal of athletic training. 2015;50(6):578-588.
  6. Lienhard K, Schneider D, Maffiuletti NA. Validity of the Optogait photoelectric system for the assessment of spatiotemporal gait parameters. Medical Engineering & Physics. 2013;35(4):500-504.
  7. Lee MM, Song CH, Lee KJ, Jung SW, Shin DC, Shin SH. Concurrent Validity and Test-retest Reliability of the OPTOGait Photoelectric Cell System for the Assessment of Spatio-temporal Parameters of the Gait of Young Adults. Journal of physical therapy science. 2014;26(1):81-85.
  8. Gomez Bernal A, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME. Reliability of the OptoGait portable photoelectric cell system for the quantification of spatial-temporal parameters of gait in young adults. Gait & Posture. 2016;50:196-200.
  9. Ammann R, Wyss T. Comaparison of Three Gold-Standards to Measure Ground Contact Time in Runners. SPORTWISSENSCHAFTLICHE. 2011.
  10. Neville C, Ludlow C, Rieger B. Measuring postural stability with an inertial sensor: validity and sensitivity. Medical devices (Auckland, NZ). 2015;8:447-455.
  11. Iosa M, Morone G, Bini F, Fusco A, Paolucci S, Marinozzi F. The connection between anthropometry and gait harmony unveiled through the lens of the golden ratio. Neuroscience letters. 2016;612:138-144.
  12. Iosa M, Bini F, Marinozzi F, et al. Stability and Harmony of Gait in Patients with Subacute Stroke. Journal of Medical and Biological Engineering. 2016;36(5):635-643.
  13. Zhang YB, Wang WQ. Reliability of the Fukuda stepping test to determine the side of vestibular dysfunction. The Journal of international medical research. 2011;39(4):1432-1437.
  14. Honaker JA, Boismier TE, Shepard NP, Shepard NT. Fukuda stepping test: sensitivity and specificity. Journal of the American Academy of Audiology. 2009;20(5):311-314; quiz 335.
  15. Grommes C, Conway D. The stepping test: a step back in history. Journal of the history of the neurosciences. 2011;20(1):29-33.
  16. Maerlender AC, Masterson CJ, James TD, et al. Test–retest, retest, and retest: Growth curve models of repeat testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Journal of clinical and experimental neuropsychology. 2016;38(8):869-874.
  17. Schatz P, Glatts C. “Sandbagging” baseline test performance on ImPACT, without detection, is more difficult than it appears. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 2013;28(3):236-244.

PHOTOS: Optogait Technologies Inc.

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How to best return to work following a concussion in the computer driven 21st century

BY: COLIN HARDING

One in five Canadians will experience a concussion from sport in their lifetime. Suffering a concussion can lead to a range of debilitating symptoms such as constant fatigue, changes in mood, headaches and difficulty concentrating.

Returning to work after a concussion can be challenging and if not done properly may slow recovery. There are activities and techniques that allow for the smoothest transition back to normal life and the best chance for a full recovery.

The following are some tips on how to recover from a concussion and return back to work while maintaining your health.

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health.

Say yes to help & support

The Centre of Disease Control and Prevention recommends gathering support as an important part of recovery and may help lift the burden of a concussion off an individual’s shoulders. Support can come from many places: a partner, a family member, a healthcare professional or a manager at work.

Having open channels of communication can lead to a greater understanding and empathy during recovery. It is easier for your peers to understand your situation and support you through the process if they know what has happened.

For example, a manager who knows their co-worker has recently experienced a concussion should lessen the workload initially as the individual begins the transition from rest back to work and this may help decrease their symptoms and stress.

Woman at her desk with head in her hands
PHOTO: enerpic.com

Avoid triggers

Once someone has experienced a concussion it is important to recognize what triggers his or her symptoms. Every concussion is different and these triggers may range from person to person. The backlight on a computer screen may cause headaches, exercise may cause nausea, and conversations may cause fatigue.

Every individual has a different set of factors that will influence their symptoms. If an activity makes symptoms worse, then it is important to stop that activity and rest. For instance, if conversations’ are overwhelming, take a break from social engagements.

Manage your energy

It may sound simple, but managing symptoms and energy amongst all of the different aspects in your life can be a real challenge. Once the symptoms are resolved someone may wish to return to work. Returning with a decreased workload, taking scheduled breaks and being cognisant and respecting symptoms are helpful to ensure that transition goes smoothly.

Accepting that an injury has happened, and that it will take some time to recover from, is another important aspect to consider when living with a concussion.

Be patient

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health. The recovery process and managing setbacks can be incredibly frustrating, and patience can be one of the most important aspects of a recovery.

A person should focus on the activities that they can control and feel like they are making progress on, as opposed to the activities that are out of their control. Light exercise (As long as a person does not experience worsening symptoms), a balanced diet, and getting enough sleep are part of the foundation to achieve health and could be part of a recovery plan.

Having a concussion can initially be draining and frustrating. Having the support from work and peers, being aware, managing symptoms, and accepting that recovery takes time can go a long way towards making the transition back to normal life successful.

 


Colin Harding is the CEO and founder of Iris Technologiesa Canadian healthcare technology company that is improving the lives of peoplewho have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.

A version of this article originally appeared on the Iris Technologies Blog

Post Concussion Syndrome: Why giving up screen time is part of the solution & problem

LCD screens surround us. Many people stare at computer screens throughout their workdays, taking breaks only to check social media on their smartphones.

While there are far fewer concussions in the world than there are screens, the frequency with which these injuries occur has been increasingly acknowledged in the mainstream media. Athletes such as Sydney Crosby, Steve Young, and Eric Lindros just to name a few, have brought the severity of Post Concussion Syndrome (PCS) to the forefront of public discourse.

A person who suffers from PCS will experience symptoms such as dizziness, nausea and headaches for an extended period of time after the initial injury. This can last for weeks or months, and there is no clear answer as to how it can be minimized.

image of an office with a laptop and no one at the desk, next to a close up of a man who looks like he has a headache

The few treatment options that health professionals agree to are: rest, and a complete break from LCD screens.

While all cognitive activity can worsen the severity of headaches and dizziness in people with concussions, there are several reasons why the use of LCD screens in particular can exacerbate these symptoms:

  • Images that appear on LCD screens are made up of pixels that refresh at a rate of 60 times per second, even when the content on the screen is not changing.
  • The rapid movement of these pixels means when we look at screens for too long, we strain our eye muscles.
  • For someone who has suffered a brain injury, this strain can be detrimental.
  • Further, the backlighting of LCD screens can cause cognitive fatigue, headaches, dizziness and nausea in concussion patients.

22-year-old Maggie Callaghan, a varsity athlete who has suffered several sports related concussions over the past few years says she tried to avoid computer screens all together for weeks after her first concussion.

“I couldn’t look at a screen for more than a few minutes without feeling intense pain behind my eyes that would quickly evolve into a full blown migraine” Callaghan said. “I tried to avoid computer screens altogether for as long as I could.”

Maggie is one of many young concussion victims for whom the inability to study using a computer screen resulted in severe stress.

“It sort of becomes a cycle,” says Joe Ross, a 20-year-old student who, like Maggie, has suffered from concussions. “You feel sick when you use your computer to do school work, but when you aren’t able to keep up with your school work you feel anxious which can be harmful to the recovery process.”

Anxiety is just one of many mental health problems that disproportionately affects concussion patients. In fact, two out of three concussion patients experience depression following their recovery.

The social isolation that comes from being unable to communicate using computer and phone screens, as well as the stress associated with being unable to complete day-to-day tasks, are thought to be two of the primary causes of depression in concussion victims.

As difficult as it can be for students to abstain from using screens following their concussions, the struggle to recover from PCS without the use of computers can be even more intense for working adults.

“The recovery process would have been even more stressful if I had been working in a professional environment at the time of my concussions,” says Maggie. “So many jobs involve, if not completely revolve around, using computers. Being unable to work and not knowing when I would get better would be seriously nerve-wracking.”

Currently, treatment options for PCS do very little to account for the importance of screens in the average person’s everyday life. Patients have to work hard to engage in society and keep up with school or work without the use of their computer screens.

This can often be one of the most unexpected challenges of dealing with PCS.

So where does this leave people needing to return to a pre-concussion life while dealing with PCS?

While there are no solutions, one recent pilot study commissioned by the Canadian Concussion Centre indicated that people experiencing PCS were able to use a non-LCD screen, thus enabling a quicker return to school or work life.

PHOTOS via pixabay


Colin Harding is the CEO & Co-founder of Iris Technologies – a Canadian healthcare technology company that is improving the lives of people who have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.
 
A version of this article appeared on the Iris Technologies Blog

The strength in her heart: Hero of Brain Injury Elizabeth Farquharson

BY: JENN BOWLER

Are you ready, heroes?  The BIST 5K is just days away!

Sign up or donate today: www.bist.ca/5k

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Meet Elizabeth Farquharson – the final hero we’re showcasing in our Heroes of Brain Injury Series – we can’t wait to see her and all the heroes on October 1st!

Our ABI hero Elizabeth Farquharson doesn’t need to run as fast of the speed of light to impress us, she’s worked in the field of brain injury for over two decades and is still going strong! Find out more about this amazing hero of brain injury below!

BY: JENN BOWLER 

 Elizabeth Farquharson
A true hero: Elizabeth Farquharson

 Tell us a bit about your work:

I have been a physiotherapist for 34 years and working in brain injury for about 20 of those years at Sunnybrook Hospital, as a clinician and more recently as a coordinator of care for trauma patients. I am a member of the ABI Network Transitions Committee and also have been involved in development of best practice guidelines for brain injury through the Ontario Neurotrauma Foundation. Despite the often devastating nature of trauma and brain injury, it has been a very rewarding career and I am often in awe of the patients and families that I have worked with. I admire the way people have managed to conquer so many obstacles and continue along chosen paths or find new meanings and different ways of doing things.

Why do you participate in the BIST 5K?

The BIST 5K is a way to support our brain injured patients and families and for our trauma ward to come together in a social event that is fun and inclusive. This year will be my fifth year participating!

I have run one year and walked all the other times – hoping one day there will be a prize for the slowest! I love that the BIST 5K doesn’t care how you do it; only that you do it. There are people cheering you over the finish line regardless of how fast or slow you are!

What does being a hero of brain injury mean to you?

It means doing your best to provide the best patient care that you can. It means supporting and advocating for your patients and families and being involved in that journey of recovery. Even if I’m only involved for a short time while they are part of the early acute care phase at Sunnybrook, it is still a privilege and honour to work with brain injured clients and families and see their progress and resilience. It is so rewarding when these individuals come back to visit us at the hospital, and we are able to follow their journeys.

What is your favourite part about Race Day?

It’s a lot of fun and I love meeting different people from survivors of brain injury to the whole spectrum of care involved in recovery. I love the park, the fresh air, the healthy competition and the family involvement!


Jenn Bowler is a social worker in the Trauma Program at Sunnybrook Health Sciences Centre and is a member of the BIST 5K Run, Walk, & Roll Committee.

Up, up and away! Meet Ellie Lapowich #BISTRUN’s heroic TOP fundraiser

What can’t we say about Ellie Lapowich? Not only does she sit on our Mix and Mingle Committee and is a proud BIST supporter – but Ellie also manages to be one of our (if not the top) fundraiser at our 5K each and every year.  We challenge you to take her on and see if you can beat her fundraising amounts this year! 

 
That’s just one reason why Ellie is an ABI Hero – read more about her below!
 
5K Poster 2017
Be an ABI Hero! Register today! www.bist.ca/5k
BY: JENN BOWLER

Tell us a bit about your work:

I have had the privilege of working with people who have sustained brain injuries for almost twenty years now. Since 2004, I have owned and operated Innovative Case Management Inc. (ICM), which is a community-based company that provides case management and occupational therapy services, as well as Catastrophic and medical legal assessments.

Why do you participate in the BIST 5K?

I have participated in the BIST Run for the past several years because it is a great event that raises much needed funds for the wonderful programs offered by BIST. It is amazing to see such a great turnout year after year as members of our community, along with their families and friends (and often pets), cover the 5k while enjoying the camaraderie this event promotes.

BIST 5k top fundraiser Ellie Lapowich
ABI Super Fundraiser Ellie Lapowich

What does being a hero of brain injury mean to you?

I think the real heroes of brain injury are our clients who have sustained these injuries and work incredibly hard every day to overcome the many obstacles they now have to face. I have had the good fortune of meeting some amazing people who are true inspirations. I believe that our clients’ loved ones and caregivers are also heroes.

What is your favourite part about Race Day?

My favourite part of race day is watching brain injury survivours triumphantly cross the finish line.


Jenn Bowler is a social worker in the Trauma Program at Sunnybrook Health Sciences Centre and is a member of the BIST 5K Run, Walk, & Roll Committee.

BIST Heroes 5K Dynamic Duo: Charles Gluckstein and his Sidekick Duke

Are you ready, heroes? Meet Charles Gluckstein – he says it’s his sidekick Duke who brings him out to the BIST Heroes 5K Run, Walk or Roll every year – but we’re pretty sure nothing on Earth could keep this ABI hero away from our 5K!

5K Poster 2017
Register today! www.bist.ca/5k

BY: JENN BOWLER

Tell us a bit about your work:

It is always heart wrenching, yet inspiring, to meet and work with individuals who have survived trauma including brain injuries. Most have a great will to persevere no matter the barrier. As a youngster my father exposed me to the places such as Variety Village and the Active Living Alliance where I could volunteer as a photographer for their special events and was amazed at the accomplishments and great spirit of individuals who had suffered from physical and mental challenges.

Once becoming a lawyer I immediately volunteered as a Director of the former BIST. Our firm [Gluckstein Personal Injury Lawyers] has always supported the Ontario Brain Injury Association of which my father was a founding director and similar organizations. I’m very passionate about helping individuals living with brain injuries as they are the most vulnerable victims, and the ones who need the most help with their recovery and changes in their lifestyle.

Charles Gluckstein swims in a lake with his dog Duke
True ABI Heroes: Charles Glucksten and Duke

Why do you participate in the BIST 5K?

It’s Duke (my dog) who forces me to run the BIST 5K! He loves outdoor activities and being around people so he brings me along to drive him to the event. But in all seriousness, I participate in the BIST 5K event with my family because I believe it supports a great cause and one that is and has been close to our hearts.

What does being a hero of brain injury mean to you?

To me, a hero of brain injury is someone who has sustained an injury and is working hard every day to overcome the challenges they face, and tries every day to be better than they were the day before. I try to help those with brain injuries to receive financial, moral and medical support, but I am by no means the hero, they are.

What is your favorite part about race day?

My favorite part of race day is seeing everyone come together on an equal footing. You have brain injury survivors, community leaders and medical and legal professionals bringing their families to participate together towards the same goal. Once the suit and ties are off and the medical gowns are put away, the egos are put away as well. We are all there to have a good time and interact with one another, not as professionals, patients, referral sources, caregivers but instead as humans.


Jenn Bowler is a social worker in the Trauma Program at Sunnybrook Health Sciences Centre and is a member of the BIST 5K Run, Walk, & Roll Committee.

Meet the fastest ABI heroes in the park: Garvin Moses & Kathleen Lawrence

BY: JENN BOWLER

As we gear up for BIST’s Heroes 5K Run, Walk or Roll on October 1st, we’re launching our 2nd Annual Heroes of Brain Injury Series, highlighting some ordinary folk with extraordinary ABI superpowers who come out to our 5K each year.

Read about our fastest heroes on Race Day – Garvin Moses and Kathleen Lawrence – below. But just so we’re clear, we know everyone who comes out to our 5K is a hero – no matter how fast they run, walk or roll!

Fastest BIST Run runners Garvin Moses and Kathleen Lawrence
 

REGISTER TODAY! WWW.BIST.CA/5K

 

 

Fastest Female: Kathleen Lawrence

RUN TIME: 21 min 33 sec

  1. Tell us a bit about your work:

    I work as an Occupational Therapist (OT) with Function Ability Rehabilitation Services, as an OT for approximately seven years now and with my role at Function Ability for over two years. With Function Ability, I work with people who have sustained a variety of traumatic injuries including brain injury; most of the clients I work with have been involved in motor vehicle collisions. I work with my clients to help support their recovery process and enable them to return to their activities of normal life and re-engage in their meaningful occupations. I love what I do and it has been a very fulfilling career thus far.

Kathleen Lawrence holds up her race number after a race
BIST Heroes 5K Run, Walk & Roll Fastest Female –  Kathleen Lawrence
  1. Why do you participate in the BIST 5K?

I participate in the BIST 5K because I love running and because of my work with people living with brain injury. This race is helping further community participation, raise money and increase brain injury awareness. To me, running is all about setting my own personal goals and working to achieve them, the BIST 5K allows opportunity to meet my own goals.

I started running in 2011 as I had always enjoyed doing physical activity and I found it to be an easy activity to integrate into my weekly schedule and to be a great form of stress management and effective to support my own work / life balance. In order to help motivate myself to commit to running, I registered and ran my first half-marathon in the fall of 2011. I definitely experienced a ‘runner’s high’ after that race and since then, I’ve completed many half marathons and races from 5 to 30 km. I ran my first marathon in 2015 and have since completed four full marathons including qualifying for and running the Boston Marathon this past spring! I enjoy running many races over each year but I always look forward to running the BIST 5K – this will be my third year participating in the event.

  1. What does being a hero of brain injury mean to you?

To me, heroes are people who overcome obstacles and challenges to achieve something great. I think the true heroes of brain injury are the survivors, they are the ones working hard to overcome brain injury barriers to engage in their daily activities. In my role as an OT, I try to listen to my client’s concerns and challenges while reflecting and utilizing their strengths to help them progress towards their goals. Being a hero of brain injury could be providing support, having a positive attitude, engaging in reflective listening or simply just being there at the right time. There are brain injury heroes all around us, survivors, friends, family, caregivers, health care and legal professionals, and other rehabilitation team members. We all work together to fight brain injury.

  1. What is your favourite part about race day?

I enjoy the whole atmosphere of the race. The BIST 5km always has a special atmosphere about it where people come together to achieve a common goal, not only about participating in the event but creating brain injury awareness. I like the social atmosphere of the race and being able to spend time with other people to learn about their personal victories related to the event. There are always so many great success stories that occur at the BIST 5K; from just being able to attend the race, to running a first 5 km, to setting a personal best time – it is all about celebrating personal accomplishment. I also enjoy the feeling of crossing the finish line!

Fastest Male: Garvin Moses

RUN TIME: 19 min 40 sec

Fastest male runner at the BIST 5k Run, Walk or Roll every year - Garvin Moses
Faster than a speeding bullet: Garvin has won fastest male at our 5K since we began doing this race in 2011!
  1. Tell us a bit about your work:

The Neurologic Rehabilitation Institute of Ontario (NRIO) was my introduction to ABI and this field. I applied here shortly after graduating from the University of Windsor. I started off working as a rehabilitation therapist and slowly worked my way through the organization. I have been with NRIO for almost nine years and I currently manage two of their residential programs in Mississauga and south Etobicoke. Although at times it can be difficult managing two programs I have a great team of staff and therapists around me. I also really love the diversity of the two sites. The Mississauga program deals with more slow to recovery and non-ambulatory individuals, the south Etobicoke residence known as the SLA (supported living apartments) deals with higher functioning individuals and allows them to engage in rehabilitation in a much more independent environment. Working at the two different sites gives me an opportunity to work with two very different sub-groups of individuals as well as work with them in different points of their recovery.

  1. Why do you participate in the BIST 5K?

Put quite simply, I run the BIST 5K every year because I enjoy it. I have participated in the BIST run since it first started in 2011* and really enjoy the crowd that it attracts. I remember a few years where it was pouring rain and passing people on the road wearing ponchos and a huge smile on their face. I think BIST is about community and bringing people together and this is definitely an opportunity to do just that

  1. What does being a hero of brain injury mean to you?

I would never really categorize myself as a hero. As I mentioned earlier, I’m only able to do what I do because of the great people I work with. More times than not, I’m telling my clients that they are the ones who motivate me whether it’s being able to say a family member’s name for the first time, ambulating stairs, or finishing high school when they thought they would never be able to. In some cases, it could be finishing that 5K race they have been training for all year long.

  1. What is your favourite part about Race Day?

I really do like the sense of community that is involved in this race. It allows survivors and service providers to come together in a non-threatening environment. From a selfish perspective, I also enjoy hanging out by the finish line to see the smiles and looks of fulfillment as people cross the finish line.


Jenn Bowler is a social worker in the Trauma Program at Sunnybrook Health Sciences Centre and is a member of the BIST 5K Run, Walk, & Roll Committee.