The Agenda with Steve Paikin (Audio) - How do Concussions Affect the Brain?

Episode Date: November 22, 2024

How do head injuries and concussions increase risk for brain disease? And what can we do to prevent people from getting hurt? We explore these risks, as well as new science that may help identify brain disease sooner. See omnystudio.com/listener for privacy information.

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you didn't know you could become. Exciting, isn't it? Visit tvo.org slash giving Tuesday to make your donation today and discover your two point TVO. Tonight, we're going to show you a short documentary Tonight, we're going to show you a short documentary called My Brain on Sports. We hope to raise awareness about the dangers of head injuries and concussions, particularly for young athletes.

Now, to help set the table for what you're about to see, we're joined by Tim Fleiser, who's executive director of the Concussion Legacy Foundation Canada. He's a former player in the Canadian Football League and a four-time Grey Cup champion. Tim Fleiser, who's executive director of the Concussion Legacy Foundation Canada. He's a former player in the Canadian Football League and a four-time Grey Cup champion. And Dr. Carmela Tartaglia, clinician scientist at the Canadian Concussion Centre, which is part of the University Health Network's Cremble Brain Institute. She's also a professor at the U of T's TAN Centre for Research in Neurodegenerative Diseases. And it's great to have both of you here in our studio for this.

I want to start with you, Doctor. What makes concussions different from other kinds of injuries? Well, it's an invisible injury because a lot of other brain injuries you could see if you did some imaging, but concussions we don't see. We have no way of making a diagnosis. It's a clinical diagnosis, and so you basically need a person to tell you something happened to them, and then they tell you about all the symptoms.

And so you could imagine that that could be missed. Sometimes people don't wanna tell you, or they don't realize how significant it is and don't report it. And there's also this idea that maybe these repetitive head injuries that don't actually give you all the concussion symptoms might also be something that we need to think about. So there's a lot of unknowns about concussion.

Tim, you played how many years in the CFL? Ten years. Ten seasons. How many blows to the head do you estimate you took? Well, I think the data for football players shows that you take somewhere between 300 and 1,000 hits a year. And when you think I was a soccer player as a kid, I played hockey, I played rugby year-round. So it's very rare that I speak to anybody that's had less cumulative exposures than I did. That's the bad news.

The good news is that so far I've been asymptomatic. And so that's one of the things that we're trying to figure out is why are there former teammates of mine, friends of mine who are in our brain bank that had a tenth of the cumulative exposures that I did. But far more difficulties than you have experienced. Exactly. We're about to look at the documentary. It's not too long, but you were patient, I guess,

00001 in as much as they put you inside one of those tubes, they shot you full of dye, and they looked at you. What do they want to find out? So the goal of that, and this is the work of Dr.. Vasdev and Dr. Bualo at CAMH and as a proud Canadian I'm thrilled to say that just like Dr. Tartaglia sitting next to me we have absolutely fantastic researchers here in Canada leading the world in some of the work that's being done and the imaging that's being done at CAMH is a great example of that where we're trying to diagnose CTE in vivo.

Meaning as you are... During life. During life. Right now we can only diagnose it by autopsy, which is the work that Dr. Tartaglia and Dr. Kovacs do at the Canadian Concussion Center, which we're proudly partnered with. But the goal is to be able to try and diagnose this disease during life to start to think about treatment strategies to address it. OK.

We have set the table for the documentary, so let's take a look at that. And then we'll come back and chat afterwards, OK? Sheldon, if you would, let's roll it. If they are, they're doing, okay, well, we're sending some amoeba over or something, you know. The hall button is in your right hand. That's where your thumb is. You press that any time, right?

Yeah. Just in case we get you into a scanner. Lying here, getting ready to have my head scanned for a potentially life-altering diagnosis of brain disease is not where I thought I'd be 10 years ago. But in a weird way, I'm glad I'm here. So here we go. I'm Tim Fleiser, executive director of the Concussion Legacy Foundation Canada, and I spent the last decade trying to inform the public that the prevention of concussions and CTE, chronic traumatic encephalopathy, are really important to the health of our brains.

I've lobbied international sporting bodies in Amsterdam, raised awareness to, well, anyone who would listen, and even taken my cause to parliament. So why am I so obsessed with head injuries? I played 10 years in the Canadian football league. I would estimate that I've endured at least a hundred concussive episodes to my head during my career. Back then it just wasn't a big deal, right? It was what you would call a ding.

It's, you know, you get hit and feel a little bit weird or see stars or feel a little bit off balance or get a dull headache or those things. But back then it just wasn't a big deal. It's something that you played through. Strides to turn it up, it's a loose ball. My risk factor for chronic traumatic encephalopathy and all the nasty things associated with it

is extremely high. Bakers kick his back, Grant takes it at the 22. And oh, he is hammered at the 32 yard line. Oh boy. Take it from me. I know what's at stake. I've lost friends to suicide and addiction. What did they have in common? A history of brain injuries.

So my goal is now to stop it from impacting others, especially kids. The bottom line is, kids should not be taking headshots. And kids that do sustain a brain injury need their injury to be taken seriously and treated properly. And I'm happy to say our work has helped support an Ontario law that is doing just that. Rowan Stringer was rushed by ambulance to an Ottawa hospital on May 8th, 2013, after receiving a brutal head injury during a rugby game.

She would pass away four days later from Second Impact Syndrome, an uncontrolled swelling of the brain that witnesses said Stringer incurred after being thrown to the ground by an opponent. She was unconscious with her eyes dilated, both symptoms of a severe brain injury. Sadly, Rowan's Law, which is now six years old, came about due to the tragedy that afflicted Gord and Kathleen Stringer when their daughter Rowan died

as a result of multiple head injuries sustained on the rugby field in 2013. They believe there were three concussions over a period of six days. The final concussion being the one that ended up being fatal. Second impact syndrome is a situation that happens with catastrophic swelling of the brain when there are multiple undiagnosed and untreated concussions. It is a completely preventable condition. So one of the things that we've looked at is why athletes fail to report concussions.

And particularly at the youth level, one of the ones that you see is not wanting to let their teammates or their coach or their parents down. One problem with head injuries is they are invisible. So if your child goes to play peewee soccer and they break their wrist, they put a cast on it, and nobody questions it.

And that's the unfortunate thing with head injuries, is that it's hidden. But one thing we learned is that her friends actually knew that she had got hurt. She had Googled concussion, so she knew that she maybe had one. The unfortunate thing in 2013 was when she did that Google search, it didn't give her all the information she needed to know. The good news is that today, Rowan's Law and concussions

are being explained to school kids across Ontario. The bad news? The rest of the provinces and Ottawa are dragging their feet. And so that's the challenge now, is to try to engage the other provinces. We have the Rowan's Law Handbook. We've done like the groundwork, and the other provinces could work off that quite easily.

The template is there, and to my mind, I've looked internationally, and Ontario right now has, in my opinion, the gold standard to be emulated. Yeah, this is a good thing. We should all be doing this. The Stringers aren't alone in pushing governments to follow Ontario's lead with Rowan's Law. Long-time Canadian Football League star running back, and now Ontario's Minister of Sport is also on the case. My name is Neil Lumsden and I grew up in this area around Northern Secondary School.

I played three years of football here before I went up to the University of Ottawa. Three of the greatest years of my life. But back then, concussions, CTE and brain injuries were far from top of mind. As a matter of fact, in those days, you were taught to lead with the front part of your helmet, your forehead, on contact. So that was your center point on how you made contact with people. But it was never a thought that it was translating into something down the road that was much more serious. He made it! The hit that was, in a word, wow! That might be the hit of the year. A good friend and a teammate many years ago, they thought that he ended up committing suicide

because they thought he was suffering from CTE. I see way more of it than I wish I have, sadly. So for me, thanks to Rowan's Law and Rowan Stringer's family, based on what happened to her, that people need to be more aware of what an ongoing impact to the head and neck can mean long term. The impact that Rowan's law has made in her family and the previous minister, Lisa McLeod, changed the landscape completely. I do want to talk to you about the seriousness

of head injury and also the possibility of it being fatal. You can't put your kid back on the ice or on the pitch or on the field or on the court if they have a head injury. But like the Stringers, Neil Lumsden also sees other provinces and the federal government delaying when it comes to head injuries. It's been very frustrating when I sit down at those meetings. It does seem like a no-brainer. frustrating when I sit down at those meetings. It does seem like a no-brainer. So, for now, guided by Rowan's Law, the Ontario government simply wants to ensure every parent recognizes the concussion signs.

And you can tell, because I've had to do it, and you look your son or your daughter in their eye after you think something's wrong, you know something's wrong. And that's when you step in and say, okay, you're not playing tomorrow, you're not playing next week, we're going to the doctor and we're going to get you looked at. In Ontario, we know that so many kids have less injury and are more educated. We don't want to see that ever happen to another family. The loss of a child is so devastating that it's hard to put it into words and I don't want other people to understand it because I would never want you to go through it. And so that was hard because of course her friends have jobs and

they're getting married and they're having children. But for me, I feel like Rowan's fulfilled her dream of helping children because the law has saved children's lives and also prevented injury. So in that way, Rowan's been hugely successful in what her dream has been and that was making the lives of children better. She's not here but it was our job to deliver on the potential that she had. The work we are doing with Rowan's Law is changing concussion behavior, as well as the understanding of what happens with severe blows to the head.

But the new science is also highlighting that even smaller hits to the head, repeated over and over again, also leads to massive problems. It's called CTE. Chronic Traumatic Encephalopathy is a brain disease that's associated with repetitive impacts over time. So in other words, your risk factor for Chronic Traumatic Encephalopathy is not how many concussions you've had, but how many repetitive head impacts you've had.

And unfortunately, the disease continues to spread even after the impacts stop. So in other words, after athletes retire. So what you often see is people presenting with symptoms sometimes decades after their careers are over. He spent like five minutes with me and I got in the car and said to my dad, I want to go play. My name is Bruce Murray and I'm a former U.S. World Cup Olympic soccer player and I'm in the Hall of Fame 2011. Back in the day, we would do corner kick practice

and they'd whip balls in at 80 miles an hour and you'd get 30, 40 reps and you'd stumble back to the line and hit another one and you knew it wasn't right. I had a number of serious concussions when I was playing. I was in Riyadh, Saudi Arabia, and I got a guy who ran his knee right through my skull, and I swallowed my tongue.

I had a seizure on the field. Right now, it's kind of tough. I get bad headaches. Light headaches, decision-making, impulse control, we're drinking too much. So that's what happens with CTE, where it's these non-concussive impacts that total up over time. What's historically happened is that a lot of these issues, you know, whether it be impulse control behavioral problems, whether it be addiction issues, whether it

be violence, these are all things that people thought were just a result of mental health issues. This is going to be the death of me. I have a really bad short-term memory and I have to work really hard to remember anything. And my phone is like number one, because I've lost my phone and my credit cards, but the problem is I lose the phone. And I've replaced my license five times this year,

credit cards 10 times. I mean, it's a constant battle, but it's exhausting. It's really... But it's exhausting. It's really... So where the discussion of the disease started was with boxers. I don't think it's news to anybody that boxers would end up with long-term issues. It was punch drum syndrome or dementia pugilistica was the clinical term that they were using. And what it all boils down to is a protein called tau, a usually healthy protein in our brains that turns bad.

And the way to think about tau is it's almost like a mortar within the microtubule. So it holds together the superhighways that the electric impulses travel up and down from the brain to the rest of the body. And what happens is the towel ends up getting misplaced in the brain. So it ends up in places where it's not supposed to be, and that's where it ends up binding onto healthy cells and killing them. The University of Ottawa and Riverdale School in the Bronx are working to reduce the number of head impacts athletes receive over the course of their career. My name is John Peasey. I am the Director of Athletics at Riverdale Country School. We're here in the Bronx. Unfortunately, there's no good data on head injuries in soccer. We're working with the University of Ottawa to discover where headers happen on the field. Again, again, again!

This is revolutionary science. This high school soccer pitch is quite literally being mapped by videotape to show where exactly every head hit transpires. We want to share our film so that they can just do basic research to understand this area of the field is where the most headers come from. These are how many headers happen during a game per player. If you're a defender, this is how many headers happen. If you're an attack player, this is how many headers happen. So step one is for University of Ottawa researchers to take the film and count the exact number of headers.

From here, the tape of each game is quickly sent to this world-leading lab at the University of Ottawa, where doctors Blaine Hajisaki and Clara Carton are conducting mind-rattling science. What we specialize in is trying to understand the event that creates trauma to the brain. One of the really exciting things at Riverdale that John Peasey is really looking at is changing the game. And that is unique in that he's looking at ways

to modify the game so they can decrease trauma load to his athlete. So they're making modifications to the game so that they can decrease that trauma load that would then maintain less risk to mental health. That's pretty exciting but the data really creates facts so they're looking at as you say midfield impacts headers at midfield or headers into the goal and what we can do for them is when we see it, we can count the frequency of that and the magnitude of those impacts. We capture the simulated headers at 2000 frames per second so that we can look at detail in a slow motion camera.

We look at the velocity details because you're going to get different velocities if it's a throw in versus a corner kick or a goalie kick to midfield. The main thing is that when the ball hits the head it accelerates the skull and the skull accelerates the brain which then distorts the brain tissue and therein lies a problem that you can have changes in the molecular structure of the brain tissue, the proteins of the neurons, that you can damage the neurons. So we place the ball here in order to accelerate the ball

into the head form to simulate the header. Now this is one of our adult head forms, but we also have head forms for women and children. And we have sensors inside the head form so we can measure how the head moves so that we could then look at the brain tissue response. And what we have inside are nine accelerometers to measure the head motion essentially,

linear and rotational head motion. So then we can look at what's subsequently happening in the brain tissue. tissue. Mapping the number of hits on a field or to my head is the science I wish I had decades ago. And that's why I'm here at CAMH in Toronto, the most cutting-edge lab in the world on brain imaging. I volunteered to be the first patient ever to have my brain scanned with this man's new radioactive tracer. We're not disrupting anything in the brain.

Dr. Neal Vazdev is the world's foremost brain expert on radiochemistry for CTE and other neurodegenerative diseases. Dr. Vazdev's goal here is to detect if CTE is starting to show up in my still very much alive brain. All right, well, welcome to our CAMH Brain Health Imaging Center. The center's been around for about 35 years. We're one of the largest facilities in the world dedicated solely to brain health. We have a total of two labs and 17 hot cells where we manufacture new radioactive pharmaceuticals

for imaging the living human brain. Hey Tim, thanks so much for coming today. This is awesome, we appreciate you being a patient 0001. This is a first in human brain imaging study. This is a historic moment for us at CAMH and we appreciate you helping us try to solve the concussion crisis. As you know, CTE can only be detected post-mortem, but we want to be the first lab in the world

to detect CTE in life. What you're seeing here is a state-of-the-art positron emission tomography, or PET scanner, which is combined with CT, or CAT scanning, which gives you an X-ray. So we can get an X-ray of the brain, which gives you the structure and a PET scan of the brain, which tells us about the function at the exact same time. Tim's gonna be going into the scanner. We're gonna be injecting him

with a brand new radioactive tracer that was developed here at CAMH. And we're so excited about this because this is the first in human scan with this tracer. This ring is full of detectors so when the two detectors on this side or this side get a hit it starts to draw coincidence lines and that's how we localize the radioactive source and that's what gives PET its exceptional resolution. So they put it on L-DOPA and my boss, he injected his boss. I'm pretty honoured to be able to be the first guy to go into the scanner and to have my

brain looked at. They need healthy controls for this study. Trying to figure out why after years and years and years of football and hockey and soccer and repetitive head impacts that I'm asymptomatic when so many of my colleagues are not and have suffered. If I'm going to ask people to sign up for research and to be part of this stuff I better be the first guy in. So here we go. But the good news is that if we're able to diagnose this during life, the chances of them coming out

with treatment strategies before this becomes an issue for me is very, very good. So far, the only way to diagnose the accumulation of this protein called tau was through autopsy. But now, with this new potential biomarker, we might be able to identify in vivo. In vivo means when the patient is still alive, of course, and that's where we want to have an impact. And that's ultimately our aim, to identify potential therapies that could affect, interfere with this accumulation of tau. Now I'm going to walk you through and show you what's happening in real time.

Tim is in the PET CT right now. The radioactivity was injected about an hour and a half ago. And we're watching the radio tracer distribute in the brain over the course of two hours. What's happening now is we're also taking blood samples from him so we can analyze how the radiotracer is being metabolized in real time. Right now they're analyzing the blood from Tim that's being drawn.

This is actually Tim's brain. He was scanned here last night and this is a cross section going through his actual brain. And we're going to use this for structural information as we overlay it with the PET scan so we can see the different brain regions and we'll be able to see what regions are lit up with the PET scan. With reading going on to cancer and we're seeing big strides in cancer and look at the money that's been put behind that to find that. Now it's mental health time. Chem-H and Dr. Neil Vasdev's lab, which is just absolutely amazing. For first time, we're able to look at the brain

of live people and determine what is going on with this state of concussed brain. I look at this equipment and I'm stunned with some of the stuff that's going on here. They just shocked me with what they've learned and what they're doing. I know one thing, I can raise money. And that's what we're after. And we're trying to get the best donors and all I want is the donors to come down and go through that building.

And if you walk out of there and don't get made a dollar, you haven't got no soul on my side. You just have to get in there and see what's going on and you're going to come out and write a check. As for me, well, after three hours of brain tests I am done. Literally and figuratively. And as I look at the pictures of my brain, to my layman's eye, it seems, well, okay. But only time will tell. I can only hope I am lucky enough to live a long, healthy brain life, because too many, like Rowan Stringer, have not. And that is why we must advance Rowan's Law, to honor her and the Stringer family's legacy.

We are back now with Tim Fleiser and Dr. Carmela Tartaglia for more on this discussion. Concussion awareness has increased, especially for kids in sports. Do you think most people are now aware of the fact that there are long-term side effects on your health if you sustain a concussion? So I think people are aware that brain injuries is an important topic. I'm not sure they necessarily fully understand

the risk factors. And one of the biggest misconception which does get addressed in in the film that was just watched is the fact that you know there are concussions and it's not to say concussions are a good thing they're not but even if you haven't had a concussion you can still be at risk for some of the long-term consequences. And the risk factor for that is repetitive head impacts. So if you've had your career, and even if you've never had a diagnosed concussion, you could still be at risk if you've played sports and been exposed.

And we also see this in military and with violent survivors as well. Now, I'm going by memory here. You played for the Tiger Cats, played for the Ottawa Rough Riders. They were called the Renegades at that time. The Renegades, that's right. And you played for Edmonton, who were the Eskimos then, Elks now. Yes. Okay.

Coincidentally, so did the Minister of Sport for the province of Ontario, Neil Lumsden, who has also sustained numerous blows to the head and for whatever reason seems to be symptom-free. So Dr. Tautalia, I'll ask you, do you have any idea why some people can be perfectly fine while others are completely debilitated by those blows to the head? Yeah, I think that's a great question and a million dollar question. That is what we're trying to study is to understand how, you know, a concussion, a brain injury happens on the landscape of the person. So you have a genetic makeup. You have your environmental makeup,

your lifelong experiences. And we know that some people are more resilient to them. We know that some people, many of the players that we have who have generously donated their brains to our program, they have many different diseases in the brain. And some of them, actually even at older ages, are functioning very well, still working in their late 70s, early 80s, doing fine.

And when we look at the brains, we still see that there's CTE in there, that there's other pathologies also, but they were doing fine. And so trying to understand that in, you know, we have participants who come into our program who, you know, undergo imaging, undergo lumbar punctures or blood draws or all kinds of things to try to understand what gives you resiliency, but also to be able to detect this disease early on so that we could intervene to stop the progression from either into other diseases like Alzheimer's, Parkinson's,

or even this CTE. Have you seen his brain scans? No, I have not seen his. Have you seen your brain scans? I have, but it's, I'm unfortunately not expert in that. No, but can, have they told they told you whether they see anything there that concerns them? The way the study is constructed,

I won't find out until the study is completed. Which is when? I believe it's three years. Are you concerned? Not necessarily. I am definitely conscious of taking care of my brain. And so I do lots of things to maximize my brain health. I try and exercise, I try and eat a diet

that's good for your brain, I make sure I sleep, and I spend time building what they call cognitive reserve, which is doing things like playing chess and listening to music and reading and things that stimulate your brain. So I am conscious of my brain health, but no, I don't sit around stressing about things that I really can't control. And the good news for me is that my father was a football player and was exposed quite

a bit to impacts and is a physician in his late 70s and still sharp as a tack. So that's good news for me. I'm guessing when you learned how to play football that you were coached to put your head down and tackle with the head, which we now know is a terrible idea. And they now, thankfully, don't teach young kids to tackle that way. It's more with the shoulder as opposed to the head.

So sports can change. Do you think more needs to change in the way that these games are played to ensure healthy heads? So our data's clear. Exposing children to head impacts is really, really bad for their long-term development. If there was one single policy change

that we can make in Canada, which would impact the health of young athletes, it would actually be banning headers in soccer, just like they've done in the US since 2016, and since they've done in the UK since last year. So we're actually lagging behind on that, and that should be for children, certainly under the age of 12,

and probably under the age of 14. And kids of that age should not be tackling in football or rugby, they should not be body checking in hockey. And even if you don't care about the ethics and the long-term health consequences, it'll actually also ruin their reaction time, which from a sports performance standpoint. So even if you don't care, it's just a bad way to train athletes. Let me throw a couple of numbers your way and get you to react to them, because apparently StatsCan collected data a couple of years ago and it showed that

about two-thirds of youth who got concussions got them playing sports almost two-thirds but only a quarter of all Canadians who got concussions got so playing sports so there's clearly a lot of other stuff going on here that is giving the rest of the population you know whether they're banging their heads on railings or low ceilings or something like that there's a lot of other stuff going on here that is giving the rest of the population, whether they're banging their heads on railings or low ceilings or something like that, there's a lot of other stuff going on. Question, are we paying enough attention to the other ways people get concussion,

off the pitch, off the gridiron, off the ice, et cetera? Yeah, no. I think we are not paying enough attention. We have focused on sport, and probably that was the low-hanging fruit. But the military, as Tim has already mentioned, unfortunately women and men who are victims of intimate partner violence is a group that has been completely ignored.

Elderly people who are at high risk of falls and all kinds of accidents that you think, well, why would they not get concussed? So there's many people, people at work in all kinds of situations, car accidents, there are so many car accidents. And so all those people have largely been ignored because the focus has been on sport. But now we recognize all these people can suffer from concussions and can

have debilitating consequences. Do you know players? Do you have former teammates who have suffered CTE? And well, I don't know of any in the CFL, but I know players in the NFL who have been lost to suicide because they couldn't deal with the pain anymore. Yeah, unfortunately, there's several of my friends and former teammates who are in our

brain bank and we do have a helpline that we operate both in the US and Canada but also now in the UK and Australia and there's been a significant number of athletes that have come through that we train home. How do you help them because clearly they are in significant distress. So it depends on the symptoms. I mean, that's one of the difficult parts about brain injury is there's not just kind of a template in terms of treatment that you can apply.

And so you have to treat the symptoms, so it totally varies based on what somebody's experiencing. Is it your view that football is still the kind of game based on what somebody's experiencing. Is it your view that football is still the kind of game which if you play it the way it is meant to be played, you run too high a risk of getting CTE? I hope the game can be modified. I mean, it was one of the things that we did. So in the film, we've been working

with Riverdale in New York City for quite a while. And one of the things that we did with Riverdale is they came and approached us because they were going to have to cancel the football program because enrollment had declined so significantly. And so we came in and made a number of suggestions. One of them was getting rid of the kickoff, which you see in the NFL with the modified kickoff.

It's a very dangerous play. About 30% of head injuries in football happen on the kickoff. And so I'd like to think, so the first one is certainly you want to have kids playing flag up until they're teenagers. As I mentioned, certainly for sure 12 and maybe even 14. And what you've seen now at the pro level,

and it needs to happen everywhere in football, is taking impacts out of practice. Again, it's not about the number of concussions you sustain, it's about the number of times these athletes get hit in the head. And so, football is a game that can be practiced using bags, sleds, all kinds of different things to try and reduce those impacts.

So I'd like to think that we're gonna be able to make the game sustainable but we are not gonna be able to totally eliminate the risk with participating. I don't know how much hockey you watch but I mean you're from Montreal you must be a Habs fan. Yes. Have they done enough to take the headshots out of hockey so that they can reduce the number of life-altering concussions? I think overall they haven't done enough for hockey. That game could be made a lot safer. There doesn't need to be as many hits. Of course people will fall, you know, be checked into the boards and stuff, but they can do a lot more for that game. Even the speed on the ice, the amount of time people stay on the ice,

people even talked about the ring size. So there's a lot of changes. I think just because a sport has been in a certain way for many years doesn't mean it has to stay that way. I know in football, which I don't know nearly enough about like you do, but I saw a documentary on the evolution of football and the game has been completely transformed

and people I think still love it today as they did long ago and- They love it more. I mean it's the biggest league in the world now. Exactly, so why can't we do the same thing for other sports, make them safer for people? I don't know, you're gonna help me on my chronology here. You remember Richard Nursi used to play for the Tiger

Cats? Did you play with him? I did not. You did not. OK. His son Darnell plays for the Edmonton Oilers and got absolutely waylaid not too long ago by a member of the Toronto Maple Leafs.

And this guy was lying in a pool of his own blood on the ice. He had his head down. He got a head shot. And the player for the Leafs who did it got suspended five games. But the same question, have they done, and Ken Dryden has been excellent on this, trying to get the NHL to clean up its game,

have they done enough to take the head shots out of hockey in your view? So I'm a season ticket holder for the Montreal Canadiens. I was at the game earlier this week with my older son. I'm a hockey coach, three boys, and I'm a hockey coach for the two older guys. The little guy's not old enough yet to participate, but he likely will.

And the NHL has a responsibility to address this, because watching those kind of games and seeing those kind of hits with my kids is not what I want them to see. And I will tell you the good news is, a couple of weeks ago at our Boston gala seeing those kind of hits with my kids is not what I want them to see. And I will tell you the good news is a couple of weeks ago at our Boston Gala with our US group is the NHLPA has formed a player-led CT committee to look and to address that. And so the players have a powerful part of this equation and getting them to understand

the risks and getting them to commit to making the game safer is going to be a critical part of this equation and getting them to understand the risks and getting them to commit to making the game safer is going to be a critical part of this. So my hope is that the players and the league will start to clean it up and where this will change is when people stop tuning in. And if you get too many more hits like the nurse hit, I think people will start to look away. The commissioner always says the players are our partners in the creation and growing of the game. I mean, this would be an opportunity for him

to actually put some money where his mouth is, right? Do you see that happening? I sure hope so. Unfortunately, I don't sit in those meetings, but I know Scott Delaney, his role as a medical director, there's a lot of good people advising them over there. In terms of recovery, is the name of the game still rest and turn all the lights out?

No. No. Actually, you know, I think there's been a misconception of what rest means. So it made sense, because we always paid attention to concussion in sport, to of course take the person out of harm's way, get them to rest away from the game. I think that got generalized to people resting for months

in dark rooms, especially since a lot of them had headaches. We now have evidence, good evidence, that you actually need some low impact aerobic exercise to improve your rate of recovery, to improve your rate of recovery, to improve your chance of recovery. And so we don't ask people to rest, except for the first 24-48 hours, take it easy, but afterwards, you know, try to do as much activity as you can within the limitation of the symptoms that you have. As the documentary showed, Ontario seems to be at the head of the game when, for example, Rowan's Law.

Rowan's Law is very farsighted and shows the province can be leading. But on the other hand, Tim just told us that we're behind when it comes to eliminating headers in soccer. What's it going to take, do you think, for us to figure this all out? Yeah, I think, you know, I mean, thanks to Rowan Stringer's parents for leading that, you know, out of this tragedy came this law that is, I think, has been quite beneficial for Ontarians. It would be nice if the law actually was expanded to the rest of Canada. It's not.

We remain the only province with this law. And you know, even though Ontario is doing well on the Canadian level, at the world level, Canada is not doing well. And so we need to up our game for children and to continue to be able to, you know, promote participation in all these sports to our children because it's important, but not when it's so risky. Tim, you've dedicated your life to this. What do you want to see happen at the end of the day?

I'd like to see that legislation go coast to coast to coast in Canada. We've certainly engaged the FPT group, the ministers of sport across the country. FPT is a federal, provincial and territorial leaders? Correct. I'm also encouraged by our progress with bill C277 at the federal level, which is calling for a national strategy on brain injury. And so I am hopeful that we're going to be able to put these laws in place. You think about the success of the seatbelt law and what that's done in terms of people's awareness around the need to buckle up.

And hopefully you'll see Rowan's law extended across the country and have the same sort of effect in preventing brain injuries. Well, as we wish you both well with your work, that is so important now. I want to do one last thing. And that is, Tim, I don't know why you decided to come here today and be so offensive

in your choice of jewelry. You've won four Grey Cups. You can show it to the camera. You won a Grey Cup with Hamilton in 1999. Where's your Thai Cat Grey Cup rank? If I, so listen, I have four of them. So I tend to. Well, listen to how he says that.

I have four of them. I tend to try and select them, you know, so that they're relevant for whatever I'm doing on a day-to-day basis. Boy, you know, so that they're relevant for whatever I'm doing on a day-to-day basis. Boy, did you blow it today. Had I known, you're such a big Thai Cats fan. Next time you come to the studio,

you will rectify this outrage, okay? I will. Dr. Carmella Tartaglia, Tim Fleiser, thank you both so much for coming into TVO today. Thanks for having us. Thank you.