Sport dominates concussion landscape but domestic violence impact is just as widespread

Sport dominates the concussion conversation, but a more insidious cause is having just as big an impact on lives and families across Australia. Research into domestic violence-related concussion, as well as traumatic and hypoxic brain injuries, is in its infancy, but the more data that is uncovered reveals a scourge that can no longer be discussed in hushed tones. Australian Institute of Health and Welfare data for 2022-23 revealed 72 per cent of women admitted to hospital due to spouse or domestic partner assault involved injuries to the head and/or neck. Of those admissions, 12 per cent had brain injuries. “I feel as though we are scratching the surface into really understanding the significant nature of it,” said Amanda Simmonds, director and senior physiotherapist at PROmotion Health and a performance health manager at the West Australian Institute of Sport. As a physiotherapist, Mrs Simmonds treats patients with concussion and while there are those who reveal their head trauma is a result of domestic violence, others are reluctant to reveal the cause. “We understand there are is so much research when it comes to athletes facing concussion injuries and we have the stats around that,” Mrs Simmonds said. “But as far as domestic violence-related concussion is concerned, what are we doing in the community? Probably not enough in terms of actually understanding the severity of the problem. “The problem is many patients won’t divulge how they were injured. We have had a number of females come forward and more recently been more open.” Australia’s National Research Organisation for Women’s Safety data shows one in four women has experienced intimate partner violence. “It’s very hard to take that in,” Mrs Simmonds said. “That is something that myself as a female sitting here and hearing that it is super challenging to even process that and understand how did we get to this point? “I’ve felt frustrated that I haven’t been able to do enough to do something about that statistic.” Until there is full transparency, Mrs Simmonds said “we won’t really have the true numbers”. “Out of the DV-related concussions that I have seen in clinic, I would say 50 per cent are very open about how their injury was sustained and their GP has provided the context and handover on that,” Mrs Simmonds said. “So I was prepared as a clinician for that conversation and to provide that support. “However, those that have come in privately or without GP referral, we are often the first person they discuss this with on that frontline. “From that group that come in, it is clear there are a number of individuals who aren’t ready to have that conversation or feel they are able to seek help. “All we can do is offer to prove that listening ear and let them know when they are ready to discuss that we are there to help connect them with the right people.” WA Department of Health inpatient data over the past five years reveals that of the concussion injuries, fewer than 5 per cent were reported as DV, compared to 17 per cent related for sport. In metropolitan Perth it is 3 per cent DV, 17 per cent sport. However, in regional WA it is much higher, 10 per cent DV compared to 18 per cent sport. Mrs Simmonds said while early access to health care assessment and intervention was crucial to preventing long-term health issues from concussion, the recovery time in females was generally longer than in males. “There are a number of factors that can predict recovery. We know there are some other factors there in terms of the number of potential concussion episodes as well, as well as the severity of symptoms,” Mrs Simmonds said. “We know that females are more affected and can have that more prolonged recovery period. We don’t know the full reasoning behind that. All we have is when we look at more of those persistent concussion symptoms the female cohort sits in that.” “There is a need for further understanding of sex differences in concussion, as well as the short-term and long-term consequences it may have”. Dr Kate Ferguson has witnessed the scourge of DV and concussion in her time at the Sexual Assault Resource Centre at King Edward Memorial Hospital and while working on improving medical and nursing responses to family domestic violence in the emergency department at Sir Charles Gairdner Hospital. She is currently on a break from her clinical duties to complete a PhD on non-fatal strangulation (NFS) and acquired brain injury in family and domestic violence victim survivors. “What has been found is about one-third of all sexual assaults for women aged 30-39, who have been sexually assaulted by their intimate partner, had also been strangled at the same time,” Dr Ferguson said. “But what the evidence from American and Canada is showing is that women in FDV relationships aren’t only experiencing NFS, they are also experiencing blunt force trauma to the head. “Not only are their brains being deprived of oxygen through NFS, possibly resulting in a type of brain injury, they are also experiencing head knocks, like a classic sports concussion. “This combination of NFS and head trauma is being referred to as ‘concussion plus’. The research is now showing that those with concussion-plus have much worse daily functioning outcomes than those with NFS or concussion alone. “There is the visible shake to the head and you don’t necessarily need to lose consciousness to sustain a concussion. You can have a heavy impact to your body and then not necessarily to your head and then sustain a concussion as well. Then you can have that direct impact to your brain where everything is shaking. “This core of patients also experience NFS, so you have not only blunt force trauma to the head but you are also getting an anoxic or hypoxic brain injury. “Anoxic is when you have no oxygen, hypoxic is when you have low oxygen. “Because your brain uses 20 per cent of your oxygen consumption but is only 2 per cent of your body mass the brain cells die really quickly. “Generally speaking the two come in hand in hand as . . . precursors to the concussion or mild TBI (traumatic brain injuries).” Dr Ferguson said published research revealed those who were strangled by their intimate partner were 7.4 times more likely to be killed by that partner at a future date. “It is a high-risk precursor, a warning sign of potential future violence and homicide,” Dr Ferguson said. This recognition of future risk is why NFS-specific legislation was introduced in WA in October 2020. Mrs Simmonds said untreated prolonged concussion was a major area of concern. “We now look at a prolonged recovery closer to 28 days. We know most concussions will resolve within 14 days. There are a number of concussions that if they have not sought or received the appropriate management within that 14 to 28-day period it can lead to those persistent symptoms we see,” Mrs Simmonds said. “There is a huge connection with mental health, an increase in anxiety and depression, sleep can be affected and there is a flow on affect that comes with that as well. “Then we are looking at focus, attention, how that looks for them in terms of their workplace. “When we are working with a client recovering from concussion, we know how to safely guide them through a graduated return back to work, study if a student or sport if an athlete. “But when we are looking at DV we don’t have those resources available to assistant somebody in a return to life, whether that is looking after two kids, running a business, still at uni, there is a lot more that we need to do go make sure we are able to prevent some of those long-term symptoms. “Other symptoms are more physical — we are looking at headaches, change in vision, disturbances around their physical capacity like their balance, their cardiovascular conditioning. “There are a raft of different symptoms.” Domestic violence is a leading cause of traumatic brain injury for First Nations women. A Medical Journal of Australia study by Lisa Jamieson published in 2008 found that Indigenous people, particularly women, were disproportionately represented among those hospitalised for head injury due to assault. Between 1999 and 2005 it found the rate of head injury among Aboriginal and Torres Strait Islander women was 69 times higher than other Australian women. Even that figure was “likely to be an underestimation due to factors that affect the reporting of violence, including the stigma associated with experiencing family violence and fear of retaliation from the perpetrator”. National independent not-for-profit organisation Connectivity’s mission is to improve the outcomes of TBI sufferers. It is currently is liaising with State and Federal governments for funding and support for education for both victims and frontline workers. Their data reveals one in six Australian women and one in 18 men have experienced physical or sexual violence from a partner since the age of 15. “The economic and social costs of TBI in FDV have not been quantified but must be substantial, not only for the victim survivors but also for workplaces and the broader community,” a Connectivity report suggests. In July, two women who endured decades of partner violence were diagnosed with the degenerative brain disease, chronic traumatic encephalopathy (CTE). They were the first cases of CTE in domestic violence victims in Australia — with most cases discovered in male contact sports players who had suffered repeated head injuries. Kelda Oppermann, chief executive of Zonta House Refuge Association, called for “urgent national attention and action to prevent, support and treat this pervasive issue in our country”. “We have seen an increase in conversation of the dangers and implications of concussion and repeat concussion in sports. This has rightly so led to actions being taken at younger ages through to professional sports to decrease the risk of harm,” she said. “There has been a lack of information, research, support and treatment on victim/survivors of FDV who are living with the potential short and long term impacts of TBI and mild TBI. “The lack of oversight on this issue has, and will continue to have, devastating implications on the lives of victims and survivors, as in most cases they unknowingly deal with the physical and mental symptoms. “We are continuously putting the onus on people who have experienced harm and injustice to manage the consequences of perpetrator’s actions.” Centre for Women’s Safety and Wellbeing chief executive Dr Alison Evans said the link between concussion and FDV underlines the importance of information sharing, referring to the WA Government’s 17-point FDV system reform plan, released in November 2023. “Concussions are not confined to the sporting field. It is critical we create pathways so women can get safe, culturally-appropriate treatment for head injuries,” Dr Evans said. “Inadequate funding for FDV and crisis accommodation services means they cannot meet the needs of all women who are desperately turning to them for help. There is an opportunity for frontline services to be funded to respond to head injuries so that women can receive the care and support they deserve so they can recover. “We need to make sure that when women who are being hurt in their homes reach out, they are seen and believed and get the help they need. And ultimately, we need men to stop hurting women, to realise it cannot continue and to change.” 1800RESPECT (1800 737 732)

Sport dominates concussion landscape but domestic violence impact is just as widespread

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