Thirty-two years ago, Dr. David Cudmore moved to Antigonish, N.S., in search of new medical experiences.

When he arrived, he instantly felt a connection to the small university town, its hospital and the people who live in the area.

A family physician and a devoted sports fan, Dr.Cudmore was recruited to work as the sports physician at St. Francis Xavier University (St.F.X.) in 1988. It was there he discovered a passion for concussion care, and the need for a clinic that served not only the university athletes but also the greater community.

Community calls for concussion cure

It was in his early years working as sports physician at the university and as a family doctor in town that showed Dr. Cudmore the need for a concussion clinic.

“I would see an array of patients with concussions at my family clinic and the emergency room. Anyone from injured youth to athletes to labour workers needed help,” he said. “But it was difficult to manage. We didn’t have the resources or the time to give them the attention and care they needed.”

With such a diverse group of patients coming to him with concussion concerns, Dr. Cudmore wanted to put his experience to work in hopes of helping those in need. But it didn’t happen overnight.

In fact, it took almost 20 years. Finally, combining his passion for sports medicine, a great deal of experience and with a strong team of athletic therapists behind him, Dr. Cudmore opened the Antigonish Concussion Clinic (ACC) in 2007.

Preventative measures

Each patient recovers from concussion at a different rate, however; research states that 15 per cent of concussion sufferers have a “slow” recovery. According to Dr. Cudmore, this means recovery can take anywhere from two weeks up to several months. The ACC provides concussion patients a perfect venue for both assessment and ongoing care during recovery.

“A concussion can cause serious consequences if not treated immediately,” said Dr. Cudmore.

“There’s a risk for mental health issues and delayed mental and physical processes, which keeps the patient from returning to a normal way of life. That’s why it’s imperative that we see those patients early on at our clinic and do what we can to get them back to a healthy, functioning state.”

With concussions becoming an increasing concern in sports – for example, a concussion kept Sidney Crosby out of the game for months – and the workplace, Dr. Cudmore and his colleagues at the ACC launched a local awareness campaign in 2007.

The campaign continues today.

They put up posters in gymnasiums and rinks, and held educational sessions with coaches and kids who are involved in contact sports.

“We wanted to put the information out there for people to see so they could be aware of the signs and symptoms, in addition to understanding how to prevent concussions from happening, at an early age,” he said.

“There’s so much more awareness surrounding concussions today compared to 10 or even five years ago because of efforts like this,” he said. “Teachers, coaches and employers have a better understanding [of concussion], which allows them to implement their own safety measures and know what to look for.”

A plan that works

When a concussion patient displays problematic symptoms such as dizziness, drastic mood swings or headaches, they are typically assessed in the emergency room at St. Martha’s Regional Hospital.

They are then examined by using a unique and standardized assessment process based on the Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport (2012). The patient is then directly referred to the ACC where Dr. Cudmore and his diverse team of health-care professionals will repeat the same assessment process, allowing them to compare recent results to those found during the patients’ emergency visit.

“We have a great set-up here at the ACC,” said Dr. Cudmore. “The initial questionnaire that we provide to patients asks them to rate their symptoms on a scale one to six. From there we’re able to gather a detailed report on the patient’s medical history. The therapists will then meet with the patient and assess them for memory, cognitive ability and balance, while also taking into consideration their symptom score and neurological exam.”

Dr. Cudmore will then see the patient to discuss the results of their tests in detail. A unique care plan is then created for the patient’s individual needs.

“This often means specific exercises, sometimes medication and sometimes a letter to the school, coach or employer. In addition to that, we’ll make referrals to seek additional therapy, depending on the severity of the injury, for example, to physio, a psychologist, occupational therapist, psychiatrist or rehab. After a few regular visits to the ACC, the patient comes back to the ACC to repeat testing, evaluate their condition and modify their care plan.”

This process is repeated until the patient returns to the ACC with no symptoms. Then the care team implements a gradual return-to-work or physical activity plan.

Dr. Cudmore feels confident about the processes in place at the ACC and the work the ACC team has accomplished. “We see a lot of patients and each injury is different,” he says. “Our team brings a wealth of knowledge and experience to each case, allowing us to provide comprehensive care and one-on-one counselling – something we are very proud of.”

A patient’s voice

Jessica MacDonald, a nutrition student at St.F.X., was involved in a head-on collision in May 2014. Jessica originally received treatment in Halifax for her concussion symptoms before returning to university for her fourth year. Still suffering from her symptoms months after the accident, she went to the emergency room at St. Martha’s Regional Hospital and was referred to Dr. Cudmore at the ACC. She says she is incredibly happy with the level of care she received and continues to receive today.

“I was so impressed by the interdisciplinary work that was being done at the ACC,” she said.

“Dr. Cudmore offered alternative treatment from other health-care professionals, like massage therapists, psychologists and acupuncturists, in addition to medication. It’s incredibly important to have those options there so the patient can get the necessary treatment while benefiting from different disciplines, adding to the overall recovery process.”

As a result of her concussion, Jessica has suffered from a great amount of pain in addition to re-occurring nightmares – a unique side-effect. She laughs when she says she’s still in need of a good night’s sleep, but says she ultimately hopes to be pain-free at the end of her recovery.
“They’ve worked so closely with me to examine every aspect of my concussion,” she said. “When I do fully recover it will be a result of Dr. Cudmore’s dedication to providing me with the best possible care.”

Inspiration in motivation

Dr. Cudmore says he’s passionate about concussion care and believes his patients are his biggest source of inspiration. He applauds their motivation and will to recover.

“It’s very satisfying to work with someone who’s extremely symptomatic, who’s had a complete disturbance in their life and watch them over come that,” he said. “Being in a position to help them get back to their normal way of living is pretty incredible.”

 This is a reprint of a story that was originally published in the April 2015 issue of doctorsNS magazine.