Isla’s battle is a warning of how little we know about concussion

If Robyn Randall knew in 2018 what she knows now about concussion, she could have saved four-years seeking relief for her daughter Isla, whose symptoms were severe enough to derail her final years of school.

“It would have cut years off the process,” says Robyn, who was at the game when her sporty and academic Year 10 daughter received “an awful sling tackle” playing football.

Robyn Randall, right, is seeing “light at the end of the tunnel” having found multidisciplinary treatment in Chicago for her daughter, Isla.Credit:Simon Schluter

It was the first of three concussions in two years, leaving Isla unable to absorb information or learn, and transforming her from a student whose grades led careers councillors to advise her to shoot for medicine, to one who ended Year 12 without a score.

“She is a high-achieving perfectionist,” says her mother, “You can’t hold Isla down”.

Yet, repeated head trauma caused Isla to lose three months of Year 10, then to drop her two-year International Baccalaureate study for the single-year VCE, then to scale back her VCE exam aspirations to two.

A year after she had her final concussion, in Year 11, Isla could not sit any Year 12 exams.

Having not even realised she was concussed after the sling tackle, she developed “severe migraines, light and sound sensitivity, and I had blurry vision … with just a fog over your vision.

“My co-ordination and balance were off, I was really irritable and frustrated, I slept a lot, and I had severe anger after I got knocked,” she says.

Isla felt her personality was affected, something her mother noticed. “I could tell straight away something wasn’t right; she changed,” says Robyn.

Isla Randall wants young people who feel there is something not right after a concussion to keep pushing for medical support.Credit:Simon Schluter

She was not knocked out by any of the impacts (the second received while playing netball). But after the third and worst, during a Year 11 school football match, Isla developed postural orthostatic tachycardia syndrome (POTS). The nervous system disorder caused her heart rate and blood pressure to spike, triggering convulsions and collapses.

Meanwhile, Robyn took her to 23 health providers over four years. One, an ophthalmologist, suggested Isla should perhaps “visit an ashram”.

Now 20, Isla is nannying until she has recovered fully enough to retain information for study.

But she is optimistic, having seen strong improvements after two weeks at the Neurological Wellness Institute in Chicago, where Swans player Paddy McCartin was rehabilitated following three years on the sidelines due to repeated head trauma.

Paddy McCartin was rehabilitated at a specialist neurological clinic in Chicago, after three-years on the sidelines due to repeated head trauma.Credit:Rhett Wyman/SMH

As a Senate committee into concussion and head trauma in contact sports hears from athletes who have experienced severe concussion effects – and dozens of AFL players prepare a class action – Isla and Robyn want others to know there is a way out of the “maze” for the 15 per cent of patients who suffer prolonged symptoms.

Women come off worse

Robyn has shared information about interdisciplinary therapies and technologies in Chicago with the AFL, and hopes all sports where head trauma may occur devote more attention to it. For female athletes there is much at stake; research shows they are more likely than men to receive it playing the same sport.

Now defined as “mild traumatic brain injury”, concussion is the most common injury in the AFL. But as girls and women flow into it and other collision sports, they have rarely been included in research.

A 2021 article published by the Royal Australian College of General Practitioners noted more than 550,000 girls and women now play a form of football, but they perform worse in neurocognitive testing after concussion. The reasons are not completely understood.

A 2022 analysis of 171 studies used to inform global management of concussion found only 19.9 per cent of participants were female – and 40 per cent of studies had no female representation at all.

What data is available prompted prestigious Sydney girls’ school, Queenwood, to phase out football.

On February 6, principal Elizabeth Stone said the school loved everything about AFL, except the risk of brain trauma. After consulting research and experts, “what we found concerned us”.

Growing evidence showed adolescents are at a greater risk of injury, females suffer more frequent and severe concussion, and damage from head impacts accumulates.

“This meant our students, teenage girls, were in the highest risk category,” Stone said.

In the UK, University of Glasgow neuropathologist and brain injury researcher Dr Willie Stewart has warned British parliament that females face double the risk of concussion and developing brain injuries, but this is “largely ignored”.

He has growing concerns for long-term consequences for women, and called for urgent research.

A 2021 study by the Murdoch Children’s Research Institute found that after serious concussion, one third of children and adolescents develop a mental a health problem which could last for years.

Isla Randall experienced this after her third head trauma: “I had mood problems; I could not think logically,” she says. “I had severe anxiety, nervousness and panic attacks which would cause a bit of hallucination.”

The MCRI paper recommended mental health should be evaluated as part of concussion treatment.

Researcher and former concussion patient Catherine de Hollander (in black) has kicked off Australia’s first study into the impact of concussion on women.Credit:Michael Serenc

Anatomy tutor and PhD student Catherine de Hollander had to research and create her own rehabilitation after being concussed five years ago and needing six months off work at James Cook University.

“I couldn’t concentrate, I got dizzy standing up, I couldn’t remember what I read, I had a slur, I’d forget words mid-sentence and forget what I was doing, and I had pressure in my head all the time,” she says.

‘Nowhere to go’ for many with long symptoms

De Hollander has designed Australian-first research into the impact of concussion in women athletes. She is collecting data from specially designed mouthguards worn by women playing rugby and AFL football. They measure player movements including acceleration, velocity and direction of impact.

Catherine de Hollander has designed special mouthguards with the technology to record real-time impact data in female athletes.Credit:Michael Serenc

She hopes to establish if female athletes are more likely to get concussions because they endure more head injuries, or if they are more susceptible. She is also working on a diagnostic test using saliva.

“There are no objective diagnostic tests with concussion,” she said. “Tests can show changes, but because concussion is also on a spectrum, no one test fits all yet.” She found there is also a serious lack of specialist rehabilitation.

“It was so frustrating not being able to get help,” she said.

Former Queensland AFLW player, Lydia Pingel, is one of an increasing number of sportswomen (including former Collingwood vice captain, Emma Grant, and Western Bulldog Kirsten McLeod) speaking about concussion risks and education. McLeod lost her vision while driving at 110km/h down a freeway after a game.

Emma Grant in action for Collingwood in the first AFLW game.Credit:Michael Dodge

Grant was forced to early retirement due to head trauma and has just launched civil action against Collingwood for allowing her back on field three weeks after a serious head injury.

Neuroscientist and concussion expert, Associate Professor Alan Pearce, will raise mandatory stand downs at the Senate inquiry’s Melbourne hearing, as well as better medical policies across all levels and more clinical education for GPs.

“Treatment is very limited at the moment because clinical education in this space is almost negligible,” he said. “We do not upskill a lot of our medical and allied health professionals, many GPs – and it’s not their fault – do not understand the injury.”

‘Nobody wants to know, they just handball it’

Professor Vicki Anderson, a paediatric neuropsychologist at MRCI, said while more than 70 per cent of children will recover from concussion within 10 days, there is often little consistent information given to those who do not.

“Of people who go to pediatric emergency departments across Australia, about 40 per cent get information about how to support a young person’s recovery, the rest get nothing.

“They go to a neurosurgeon if they want an MRI, or go to an osteopath or a chiropractor, and the more places they go, the more different advice they get, which is a disaster.”

Her group is involved in multidisciplinary with Chicago experts, but Anderson also wants parents and GPs to have greater access to concussion guidelines.

A new consensus statement is imminent, and will recommend patients be treated by a multidisciplinary team, “and the intervention needs to be symptom-based”, she said.

Lydia Pingel struggled to get help until she found Alan Pearce, and told the Senate inquiry seven concussions in three years had left her with symptoms that changed all aspects of her life.

“My symptoms include light sensitivity, noise sensitivity, headaches, migraines, pressure in my head, dizziness, blurred vision, brain fog, fatigue, mood swings, irritability, impulsive behaviours, memory loss, confusion, impaired judgement, impulse control problems and speech difficulties at times,” she told the inquiry.

She has on and off battles with depression and anxiety and has a continuing cognitive impairment, making it hard to make decisions, concentrate, remember and learn new things.

Kirsten McLeod has spoken about losing her vision while driving on a freeway after concussion sustained during a VFLW game. Credit:Getty Images

Pingel told this masthead she had been “none the wiser” about concussion’s potential impact. “The number one thing is education for players, and the importance of [concussion] being treated like a serious injury,” she said.

“I’ve seen everyone under the sun, even when I was playing, nobody wants to know, they just sort of handball it,” said Pingel, whose last concussion was two years ago.

“I’ve found there’s not been anyone in the medical profession who knows what to do and has a specialty in that field for them to give you the right recovery and guidance – because it’s so different for everyone.”

In its submission, the Royal Australian College of General Practitioners said a lack of consistent definitions of concussion was producing confusion and an inconsistent approach to treatment and management, and differences in sports protocols added to the problem.

Professor John Olver, medical director at Epworth Concussion Clinic, one of Australia’s few interdisciplinary centres, said it was “recognised that if a man and a woman get hit with the same force, the woman comes off worse”.

Neck differences between the sexes and differences in blood flow in the brain, plus hormonal factors may contribute. Research shows women are also more likely to report symptoms than men.

Diagnosis of acute concussion was improving, and 85 per cent of those who have it should get better within two weeks. But until recently, those with persistent symptoms “didn’t have anywhere to go”, said Olver, who believes more such multidisciplinary centres are needed.

His centre, which opened in 2016 with experts in vestibular problems, dizziness and balance, a clinical neuropsychologist and a physiotherapist with expertise in neck problems, has expanded significantly in the last seven years to meet growing demand.

It has treated 700 patients.

Girls are over-represented

Post-concussion syndrome researcher Professor Karen Barlow, a consultant and chair of pediatric rehabilitation at the University of Queensland, said 1000 Australian children currently have symptoms that have lasted a year or more. Girls are over-represented in that group.

“This causes huge morbidity [rate of disease] in Australian society, and there’s very little help for them,” she said. “We have a lack of services. People have to seek services privately … I would prefer this was available through the public sector, in many rural areas it is not existent at all.

“We need more research to understand why women are more likely to have persistent symptoms, and also more research to know what the best treatment is for their symptoms.”

Isla Randall hopes telling her story will help others understand concussion and seek treatment.Credit:Simon Schluter

Her centre only has resources to treat “the worst cases” among 2200 to 2500 children who come to it every year for concussion treatment.

Like the Randalls, Professor Bowman said better awareness of mild traumatic brain injury is vital, “but you’ve got to have resources to back it up”.

Robyn Randall believes many parents would struggle to find solutions in an often disjointed system, saying: “What we would really love is to see all sporting clubs and the TAC, anywhere there is head trauma, combine their resources and implement the Chicago model here.”

“We all love sport, and there’s always going to be accidents … there’s always going to be brain trauma. So, we just have to have a place where everyone can go to get help to recover, and in the right way.”

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