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It has been a long and hot summer — perfect weather for a host of activities such as bicycling, rollerblading and skateboarding. But while these summer sports are fun and healthy exercise, there are risks involved. Falls and collisions can lead to serious head wounds and traumatic brain injuries (TBI). These can be fatal or cause permanent or long-term disabilities.

"Irresponsible cyclists, rollerbladers and skateboarders also put pedestrians at risk," explains Mitra Feyz, TBI program director. "Each year, about 450 to 500 patients, on average between 30 and 50 years old, are admitted to the MUHC adult TBI program at the Montreal General Hospital (MGH) site. Although 40 percent of TBIs occur as a result of MVAs (motor vehicle accidents), the number of TBIs related to cycling represents 10 percent of the annual TBI admissions.

Nancy Hebert is one of these unfortunate statistics. The twenty-five-year-old financial officer was struck by a cyclist as she left her office and stepped out on to the sidewalk of a street in downtown Montreal on May 12, 2005. Nancy cannot remember any of the events that unfolded after the collision. Once her head hit the pavement, she sustained a severe traumatic brain injury and slipped into a coma.

"As a tertiary care trauma centre, we have the medical facilities and a multidisciplinary team of health care experts — including an in-house trauma surgeon — to deliver comprehensive trauma services to our patients during their acute care hospitalization. We are also able to provide our patients with continuity of care," says Dr Tarek Razek, Director of the MUHC Trauma Centre (adult site). "In cases like Nancy's, it is imperative that the initial trauma assessment and treatment be done in the 'golden hour' (timely, comprehensive care delivered in those critical moments that make the difference between life and death)."

Due to the severity of her brain injury, Nancy was admitted to the MUHC adult intensive care unit, where neurotrauma experts and the Early Rehab Team (a multidisciplinary group of medical professionals that includes physiatrists, physiotherapists, occupational therapists, nutritionists, speech and language therapists, neuropsychologists, social workers and nurses) began immediate treatment. Thanks to the rapid response of the MUHC adult TBI Program, Nancy is on her way to recovery.

"We determined that due to the extensive injuries to her head Nancy needed immediate treatment," says neurosurgeon Dr Judith Marcoux. "The situation was critical. Nancy was on a ventilator to help her breathe and I was concerned about the increasing pressure in her head — it could have potentially been fatal."

It wasn't until about two weeks later and after a long struggle for her life that Nancy came out of her coma, confused and disoriented. Her life has changed dramatically since the accident. She says, "I am constantly tired, I can't concentrate — I 'zone out' — and I have trouble coordinating my speech with my thoughts. I have had to be re-educated in simple things like balance and walking. I am no longer able to work and I can't finish my master's degree."

"Nancy has come a long way, but her journey is only beginning," says Dr Simon Tinawi, MUHC physiatrist. "The severity of her brain injury has had a major impact on her daily living activities, making routine things very challenging at times. She has had to reset some of her goals and needs to be reintegrated into her daily life in a safe manner — a process that will require a lot of time, patience and treatment by rehabilitation professionals."

The long-term impact of TBIs also affects the patient's entire social structure. "Family support and education is provided to help the patient's entire social network adapt to the changes brought on by the brain injury," adds Tinawi.

"Canadian statistics indicate that bicyclists who wear helmets reduce their risk of brain injury by 88 percent, yet among our TBI patients involved in a bicycle accident this year, approximately 87 percent were not wearing a helmet — that's four out of five cyclists not wearing proper head gear," notes Feyz. "I think our government should pass a law to make the wearing of a helmet mandatory in Quebec for individuals of all ages. With evidence that not only cyclists can sustain TBI, but also the pedestrians surrounding cyclists, it is crucial that cyclists respect the standard traffic regulations and the road safety rules, and practice awareness of their surroundings. Perhaps we need to establish stricter and more severe penalties for cyclists who do not follow the required regulations."

The MGH site of the MUHC is one of two adult tertiary care trauma hospitals on the island of Montreal and will be a conerstone mission of the redeveloped MUHC Mountain campus. The modernization of the ICU (intensive care unit) at the MGH is part of this redevelopment.

On August 17, 2005, MUHC trauma experts and members of the Early Rehab Team at the MGH site of the MUHC invite the media into the TBI centre to learn more about TBIs and to meet this brave young patient, Nancy Hebert.