Episode Summary
The conversation focuses on brain injuries, their classifications, and the rehabilitation process, featuring insights from Dr. Chantel Debert, a physiatrist and academic lead at the Calgary Brain Injury Program. Dr. Debert discusses the spectrum of brain injuries, the importance of early supportive discharge programs, and the challenges faced by patients and families during recovery. The conversation explores the complexities of managing symptoms following a traumatic brain injury, emphasizing the importance of a multidisciplinary approach and the role of education in recovery. Dr. Chantel Debert discusses various strategies for managing fatigue, the significance of sleep hygiene, and ongoing research into innovative treatments for brain injuries.
Takeaways
Understanding brain injury spectrum
Importance of early rehabilitation Multidisciplinary approach essential
Education aids recovery process
Chapters
00:00 Introduction to Brain Injury Rehabilitation
05:55 Understanding Brain Injury Severity
14:31 The Invisible Challenges of Recovery
17:10 Innovative Rehabilitation Approaches
20:01 Criteria for Rehabilitation Programs
22:57 Managing Expectations in Recovery
28:06 Navigating Good and Bad Days
29:39 Collaborative Care in Brain Injury Management
30:39 Understanding and Managing Fatigue
33:32 Chronic Symptoms and Their Impact
36:31 Hormonal Effects Post-Injury
38:02 Current Research and Innovations
42:45 Getting Involved in Research and Resources
45:37 Key Takeaways for Recovery and Support
Guest Bio
Dr. Chantel Debert is a physiatrist (specialist in physical medicine and rehabilitation) and Associate Professor in the Department of Clinical Neurosciences at the Cumming School of Medicine, University of Calgary, and a member of the Hotchkiss Brain Institute. She is the Academic Lead of the Calgary Brain Injury Program, where she cares for people with mild, moderate and severe brain injuries in both outpatient and inpatient settings. Her research focuses on brain injury recovery and persistent symptoms, with the goal of moving new approaches from the lab into clinical care so that patients and families see the benefit.
Resources
• Calgary Brain Injury Program (Alberta Health Services)
• Hotchkiss Brain Institute, University of Calgary (hbi.ucalgary.ca)
• Brain Injury Canada (braininjurycanada.ca): national education and caregiver resources
• Brain Injury Alberta (braininjuryalberta.ca): provincial support network
• ARBI, Association for the Rehabilitation of the Brain Injured, Calgary (arbi.ca)
• Southern Alberta Brain Injury Society, Calgary (sabis.ab.ca)
• Brain Care Centre, Edmonton (braincarecentre.com)
• Victoria Brain Injury Society (vbis.ca) and Fraser Valley Brain Injury Association (fvbia.org) for BC listeners
• Ohana Care brain injury and home care services (ohanacare.ca)
Transcript
Melissa (00:01)
Hello and welcome back to Caring Conversations. Today’s podcast is after the discharge: life at home with a brain injury. I am very excited to introduce Dr. Chantelle Bebert. She is a physiatrist and academic lead at the Calgary Brain Injury Program and member of the Hotchkiss Brain Institute at the University of Calgary. Welcome, Chantel Biebert.
Chantel Debert (00:24)
Hi.
Melissa (00:25)
Thank you so much for joining us today. I think this is a topic that, you know, may seem a little one off for us, you know, given our current demographic that’s primarily made up of seniors, but certainly we have lots of clients out there or lots of families that have a loved one with a brain injury. And so we wanted to chat with you today about all the exciting work that you’re doing, and also just provide some resources for people.
who may be struggling or maybe thriving and just looking for the next step in their journey of you know supporting a loved one with a brain injury or they themselves with a brain injury. So I would love to pass it off to you to give us a little bit of an introduction and share what you’re up to these days.
Chantel Debert (01:08)
sure.
Thanks, Melissa. so I’m a physical medicine and rehab physician. so clin I have kind of worn multiple hats. so clinically I continue to see patients in the outpatient venue. So I see across the spectrum those with mild, moderate, and severe acquired brain injury. these individuals have e you know hit their head and then go on to have persist.
persisting symptoms. And then we I see them throughout their their their recovery. And then often those who have more severe injuries, I’ll see them annually as you as we know that individuals with brain injury, they can continue to have some difficulties lifelong. And so that’s my outpatient clinic and I have the fantastic opportunity to work with Allied Health, so social work.
occupational therapy, physiotherapists, nursing, both both inpatient but also long term wise outpatient. And so it’s a nice multidisciplinary approach to patient care. And from an inpatient perspective, I continue to to see patients on our tertiary neural rehab unit, which is at Foothills Medical Center. And those individuals are more subacute and they’re required
requiring more intensive focused neural rehabilitation for brain injury. And then I do see patients in the acute care hospital that have acute head injuries and that will go on to require some type of neural rehabilitation. So that’s my clinical hat. It fills my cup. I, you know, I feel lucky every day to have the opportunity to work with with patients
Melissa (02:43)
Mm-hmm.
Chantel Debert (02:44)
and to help patients as well as caregivers and loved ones.
the second hat that I wear is that I I am an academic and clinical researcher. I’m the lead of the Brain Neurore Rehabilitation Lab here at the University of Calgary, in association with the Hotchkiss Brain Institute, as well as the Matheson Mental Health Center as well. And so there I have the great opportunity to work with graduate students, research coordinators, research assistants,
other professionals in in the academic world to answer questions. and I really utilize what I see in clinic to then translate to research. and so for example, you know, if I I’ve seen patients come back over and over and over again asking a certain question, well, does this work? And if we don’t have an answer to it, well, I have the ability to then turn around and translate that to research and start answer asking that question.
So a lot of my research stems from working with patients. I’m very much interested in the physiology and pathophysiology behind brain injury, so the mechanisms that are involved following hitting your head, but then those mechanisms that are involved to cause persistent symptoms afterwards. So very interested in that. and then I’m also very interested in looking at novel interventions and treatments for traumatic brain injury.
So that’s what my lab does. I’m situated at the Foothells Medical Center footprint as well as the health science center footprint. and yeah, it’s that that’s that’s where I actually glean a lot of my my my thinking and excitement you know, late
Melissa (04:21)
Yeah.
Chantel Debert (04:23)
at night. Those those are the questions that wake me up late at night, right? And that I that I really enjoy.
and then I do also have an administrative role. So throughout Border Health Services and leadership role in that regard for physical medicine rehabilitation. So I’m the deputy corridor director for physical medicine and rehabilitation. we have close to 60 physiatrists here in Calgary. when I started close to 15 years ago, there was 15. So we’ve
Melissa (04:48)
Wow.
Chantel Debert (04:49)
had this exponential growth as a community.
It’s been fantastic. We have in physiotrists that work in hospital, but also quite a few that work in the community with a large breadth of clinical care. so I very much enjoy that hat too. It’s just very different than the other two. Yeah. I’m also a mom. I have three kids. So
Melissa (05:07)
No kidding. Well, my goodness. So how you made time
to meet with us today, I have no idea, but I’m very thankful for it. it and it sounds very fascinating. I love actually the idea that you are meeting with patients and then able to translate that directly into research and continuing to provide like real time data related to that. I think that’s very cool. So
Yeah, thank you. okay, so let’s start kind of at the beginning and let’s talk about the spectrum of brain injury. You kind of spoke to that initially in in your introduction of like mild, moderate, severe brain injuries. So can you share with us what those mean? And then also kind of specific to what we’re talking about today, where how do you communicate that to families?
Chantel Debert (05:55)
Yeah. So there are certain criteria in t to define how severe a head injury is. So this is just specifically discussing traumatic brain injury. So brain injury that would occur when you would, for example, hit your head, somewhere, whether it’s a car accident, whether it’s a fall, whether it’s a sporting event, whether it’s at work, it’s where you physically, you know, hit your head or have some type of traumatic translation to to
injure your brain. this doesn’t apply to, for example, an anoxic brain injury. So one like with cardiac arrest or if you were drowning or substances, though that’s a different type and we call that it’s under the umbrella of an acquired brain injury. brain bleeds, so like aneurysms, strokes, those are all under acquired brain injury. But specifically for traumatic brain injury, which is a the
primary population that I definitely study, but I also definitely see. there we want to grade the how severe the brain injury is because that really helps us determine what type of symptoms the patient’s gonna have and then prognosticate their outcomes going forward. So when it comes to mild traumatic brain injury, that’s often that term is often interchanged with concussion. So it’s a mild head injury. So one in which most people recover from,
right?
And most people recover from a mild traumatic brain injury or concussion within a month to three months in post injury. And it really doesn’t matter the mechanism of injury, whether it’s a sport-related concussion, whether whether it was a fall. No, most people do recover from a mild traumatic brain injury within this time frame. Now over the years that, you know, we’re learning more and more about how
Melissa (07:38)
Mm-hmm.
Chantel Debert (07:38)
long that takes and what that looks like, but you know, most people do recover.
There’s this small percentage, so around 20 to 30 percent of individuals that will have more prolonged symptoms beyond three months. and so it’s those patients that we often scratch our head and say, okay, well, why are we seeing that they have more prolonged symptoms? What are some of the factors that are contributing towards their protracted recovery or their persistent symptoms going forward? So that’s
mild traumatic brain injury a concussion and actually that’s where a lot of my research lies is in the mild traumatic brain injury. We know the majority of head injuries in general are mild.
Melissa (08:19)
Okay.
Chantel Debert (08:20)
So we know one in three individuals will have a concussion in their lifetime. So that’s huge. Like
Melissa (08:25)
Wow.
Chantel Debert (08:26)
that’s that’s billions of people who
Melissa (08:28)
Yeah.
Chantel Debert (08:28)
will have a concussion in their lifetime. And actually that’s thought to potentially be an underreported number because a lot of people will hit their head
have concussion type symptoms but not present to healthcare, right?
Melissa (08:41)
Mm.
Chantel Debert (08:41)
And so these are just the numbers that we can record. But we know about one in three individuals will sustain a concussion at at least one time in their life. Okay, so that that’s huge. And then if you think
Melissa (08:52)
Mm-hmm.
Chantel Debert (08:53)
about that, twenty to thirty percent of them going on to having persistent symptoms, well th that’s
Melissa (08:57)
It’s a lot.
Chantel Debert (08:57)
a that that’s a huge number, right? So in
Melissa (09:00)
Yeah.
Chantel Debert (09:00)
Canada alone, on average
We know there’s about 450 to 500,000 individuals annually that will sustain a mild traumatic brain injury. and twenty to thirty percent of those will go on to have persistent persistence symptoms. And the most common symptom after a mild traumatic brain injury is headache. So people will have headaches within the acute phase and then within the subacute phase. And on average, most people do recover and kind of go back to their previous
Baseline prior to. However, we know that 58% of individuals will, at one year post-concussion, have a change in their headache phenotype, meaning their how the headaches present to
Melissa (09:43)
Mm.
Chantel Debert (09:43)
them had changed after hitting their head compared to before they hit their head. So it it is a symptom that does go on and persist often. The second most common symptom is dizziness.
and then after that it’s cognition, sleep disruptions, mental health difficulties, emotional lability, vision changes, fatigue. These are are often other very common symptoms after a mild traumatic brain injury. So that’s mild traumatic brain injury, and we use clinical markers such as neurological changes acutely. So confusion.
Headache, dizziness, feeling fatigue, and sometimes loss of consciousness that is brief. So within minutes, so transient, less than 30 minutes, or post-traumatic amnesia. So you have a period of time after you hit your head that you can’t remember. And for a mild traumatic brain injury, that again is brief. It’s not long. just hours, right? And so if you do present like this, then
As a clinician, we say, okay, you have a mild traumatic brain injury, and this is more likely your prognosis, meaning you’re more you’re likely to recover. if you and you and then if we were to scan your head, like for example, do a structural neural imaging like a CT head or an MRI, it would be normal. We like wouldn’t see any bleeds on it. if you hit your head and you lose consciousness for longer.
Or you can’t remember for longer, like over a day or two days, or often if it’s a severe head injury, like it’s weeks, right?
Melissa (11:22)
Mm. Mm.
Chantel Debert (11:23)
like I saw five patients yesterday, they couldn’t remember for a week to a month post injury, right?
Melissa (11:30)
Wow.
Chantel Debert (11:31)
So it’s very disconcerting, obviously. then that’s considered a moderate or severe traumatic brain injury. And those individuals, if we were to scan their head, which we do,
We see focal bleeds, so like hemorrhages in certain areas of the brain, something called diffusic zonal injury, where we see little brain bleeds all over the b brain related to shearing of the axons.
Melissa (11:52)
Mm.
Chantel Debert (11:53)
and it’s those individuals who will often go on to have permanent persisting symptoms for the rest of their life.
Melissa (12:00)
Mm.
Chantel Debert (12:01)
So most often they’ll go on to have some type of symptomatology that will be there long term. And and
Those can be very variable. So I often present my talks by saying there’s no two brain injuries that are the same.
Melissa (12:14)
Mm-hmm.
Chantel Debert (12:16)
because there aren’t, right? Like if you or I gonna if you or I were to hit our heads the exactly the same way, doing exactly the same thing, we’d have different outcomes. We just would because we’re different people.
Melissa (12:23)
Right. Right.
Chantel Debert (12:27)
but it could be anything from vision changes, vision loss, hearing loss, loss of sense of smell and taste.
difficulty swallowing, difficulty speaking, difficulty breathing, we could lose the ability to to move half our body, we could lose bowel and bladder control, we can could lose sensation, we could get increased ri rigidiness or we call increased tone or spasticity. and then obviously cognitively so how we think, so our memory, our attention,
our focus, our processing speed is altered afterwards as well, too. And these can definitely get better. And there is this this period I I call it tell to patients like there’s this sweet spot in recovery. And it’s so important. where you you you’re given this fantastic gift to be here in Canada in a great hospital and
Melissa (13:24)
Mm.
Chantel Debert (13:25)
to have access to great rehabilitation and
This is the time, this is the sweet spot to utilize and participate. Because if you, you know, if you do it outside of the sweet sweet b sweet spot, your long-term recovery isn’t gonna be as good. We we know from science and research that we have a certain period of time where rehab really does make it the biggest difference. Now, rehab in general can make a difference at any point, right?
Melissa (13:51)
Mm.
Chantel Debert (13:51)
But it makes the biggest difference during this really important recovery period.
this sweet spot in recovery. And and that’s more for moderate severe traumatic brain injury patients, because we know their prognosis is different. Yeah.
Melissa (14:04)
Mm-hmm.
so so much of what you mentioned is hidden, right? It’s not visible out externally
being able to see a physical injury. And certainly I can imagine that that creates some big challenges in someone’s recovery and especially for the family that is supporting them in that.
Chantel Debert (14:24)
a hundred percent,
Melissa (14:25)
Yeah.
Chantel Debert (14:25)
right? So I mean many of the symptoms that I’m describing, so for example, emotional ability. I mean you
Melissa (14:31)
Mm.
Chantel Debert (14:32)
you can’t see emotional ability, but it it’s huge in
Melissa (14:36)
Yeah.
Chantel Debert (14:37)
following a a brain injury. Or personality change is also
Melissa (14:40)
Mm.
Chantel Debert (14:41)
huge, right? So depending on where you injure your brain, that that’s a a big piece of it.
And then then cognitive issues. Again, you you you can’t see that, but someone could be just struggling so much to process what you’re saying to them that
Melissa (14:55)
Mm.
Chantel Debert (14:56)
maybe they don’t respond, right? And then that seems like like they’re rude, but they’re really not rude. They’re their brain is working overtime just to process their environment and what you’re trying to say to them. attention, attention can be very impaired afterwards. and so it takes a lot of of
effort to even a focus and attend to to for example this conversation, right? and so if someone, you know, says I have to leave or gets angry or irritable or doesn’t speak or participate in a conversation, it’s not necessarily that they don’t want to, it’s that their brain just at this point doesn’t have the capacity to. But you can’t see that. Like how do you quantify that? Yeah.
Melissa (15:36)
Mm. Yeah. Yeah.
And and you know, like I think of all the times I’ve hit my head or my kids have hit their head and you know, we don’t make a big deal of it. But then, you know, you think of how invisible this injury is and some of the severe consequences of hitting your head and what that looks like. that’s really scary actually. but it’s it’s good it’s good to know that the rehab is successful.
and that these side effects are temporary. but certainly, you know, I imagine that there are times when it’s not temporary and you have families and patients that are still struggling. And I think in the hospital, you know, everyone’s focus is on rehab, right? We isolate everything else away from our life and focus strictly on this is recovery, this is rehabilitation.
w and so what do what do people say to you when they come after being discharged? What does that look like? Are people surprised by what home life looks like? Are is that a easy transition? How are you seeing
that?
Chantel Debert (16:40)
Yeah, yeah, no, it it it really it depends on the patient and it depends on the family. we actually so we’re one of the first centers in the world to implement something called early supportive discharge for moderate severe traumatic brain injury patients for rehab. So what is that? So traditionally the time course of rehab for a moderate
to severe traumatic brain injury was, you know, you hit your head, you’re admitted, for example, to ICU, then you
Melissa (17:08)
Mm.
Chantel Debert (17:09)
then you then do a step down to an acute care ward. And then you come to our inpatient tertiary rehab ward, where you get inpatient rehab. And it’s intense, and we do that because we knew and we know that it makes people better. And again, like I described, the sweet spot is so important. But
What we were finding is that contextually, once patients were going home, it was hard to translate what they did in hospital to home. And
Melissa (17:37)
Right.
Chantel Debert (17:38)
so initially, what we would do is we’d send patients on passes. So for example, we
Melissa (17:43)
Mm.
Chantel Debert (17:44)
say, okay, we’re working on this this week, this weekend, go home, practice it on the weekend, right? but doing that, there wasn’t, for example, like a therapist in the home, or there wasn’t initial immediate feedback. And so
The ESD program, our early supported discharge, was something that started within the stroke realm and was successful here. And so I saw that it was successful and I thought, okay, well, if it’s successful for stroke, it could also be successful for potentially traumatic brain injury. Now, patients are a bit different in traumatic brain injury and they often have quite a bit of cognitive impairment. And then as we described, they have more
More personality changes, irritability,
Melissa (18:23)
Mm.
Chantel Debert (18:24)
emotional ability, agitation, et cetera. But, you know, th that can be managed. So we started an early supportive discharge program just for exactly that reason that you described, in that it provided the patients, if they were safe to be at home, to get intensive contextualized therapy within their home. So the therapist would go to their home
Melissa (18:44)
Hm. Wow.
Chantel Debert (18:46)
and there they would receive the therapy that they needed within their home five days a week.
So that program has been quite successful for us and has been ongoing for more than 10 years now for traumatic brain injury, and long even longer for stroke. And we’ve also now started it for spinal cord injury as well. Just for that reason, for the right patient, it makes a lot of sense to receive the rehab in your home because that’s where you’re gonna be living, right?
Melissa (19:14)
Yeah.
Chantel Debert (19:14)
Those are the people that you’re gonna be living with. That’s
Melissa (19:17)
Yeah.
Chantel Debert (19:17)
the bed you’re gonna be sleeping in.
so from a contextual perspective and a recovery perspective it makes a lot of sense. Now everyone isn’t a candidate for that. but when they are it’s a good option.
Melissa (19:29)
Sure. I mean that one-to-one support in your home environment surrounded by the people that are going to be supporting you long term. I I can totally appreciate why that’s successful for sure. Yeah, that makes a lot of sense. And what a phenomenal program to be able to offer people having those supports in home. That’s fantastic. and so what are the qualifications to get into a program like that?
Chantel Debert (19:53)
well, you know, first and foremost, any rehabilitation program, you need to need it. So it’s so interesting. You know, just
Melissa (19:58)
Sure.
Chantel Debert (20:01)
you just because someone hits their head doesn’t mean that they need this intensive rehabilitation program. You know, there’s a variety of ways that we can provide tools to help someone recover. So that’s the first thing. The second thing that is they have to be able to participate in it. So all depending on where you are in the spectrum of
Symptoms and severity, you might not be able to participate in 30 minutes of therapy. So it doesn’t make sense for a therapist to drive to your home and sit there for five minutes and provide five minutes of therapy that you know you you you you’re just not ready to receive. Yeah.
Melissa (20:34)
Not ready. Yep, for sure.
Chantel Debert (20:36)
So you so you need to be ready to receive that therapy and be ready to to participate and have carryover within it for at least 30 minutes.
and you need to ha need at least more than one type of therapy. So for example, it just can’t be walking. So for example, if all you need to to your help with is to to to mobility,
Melissa (20:59)
Mm.
Chantel Debert (20:59)
then you know, there’s a variety of other ways that we can give that to you. But if you need help with mobility and community integration and speech and cognition, well all of a sudden like four therapists can come to your house and provide you with like two to three hours of therapy, right? So
there ha you know there is a there’s a need for that right and and to coming back to prognosis you have to have the ability to improve so sometimes there’s certain brain injuries that you know they’re they’re permanent and and we’re not going to see improvement so
Melissa (21:31)
Mm-hmm.
Chantel Debert (21:31)
there’s some metabolic etiologies where someone will have an injury to their brain and it’s it’s damaged and it’s not going to get better.
Per se.
Melissa (21:42)
Mm.
Chantel Debert (21:42)
And there’s some types of neurodegenerative diseases that once you get to a point, you can provide rehab, but you’re not necessarily gonna see the improvements from the rehabilitation given, right?
Melissa (21:54)
Right.
Chantel Debert (21:54)
So you it has to be a type of brain injury that’s going to respond to therapy. And then finally, safety like these therapists are like coming into your home and providing therapy one as you said before, one on one. you know, if you have a
really
excitable dog that maybe doesn’t like strangers or, you
Melissa (22:11)
Sure.
Chantel Debert (22:14)
know, if there’s substance use within the home or if it’s just unsafe then then you’re not
Melissa (22:21)
Okay. Well that’s good to know. And I mean it sounds like a phenomenal program. When you talk about someone may not be ready for therapy, I imagine we’re talking about some of the the symptoms that are persistent. you know, how how do you support someone to work through that? And how do you support families to hear the news that you’re not ready for rehab yet? And so what does that look like? Like I’d hate for someone to hear that and be like, Well, I’m giving up.
then ’cause I’m not moving fast enough, right?
Chantel Debert (22:49)
Yeah, you know, I if if I’m honest, I think there’s just so many different types of rehab that if
Melissa (22:54)
Of course.
Chantel Debert (22:54)
I say you’re not ready for rehab, then I don’t think that’s a true statement. I think it’s more like you’re not ready for ESD right now. Right?
Melissa (23:00)
Got it. Okay.
Chantel Debert (23:01)
Like that’s a certain type of rehab, right? you can always do rehab and you know, all our patients can have some type of rehab going forward. You you might be five years post injury, right?
Melissa (23:12)
Mm.
Chantel Debert (23:13)
and you decide you want to you know strengthen this arm, well, you can. Like there are ways to do that, right? And that’s a certain type of rehab.
Melissa (23:20)
Yeah. Totally.
Chantel Debert (23:23)
so I would never say to a family, you know, you there’s no rehab that can be that you
Melissa (23:27)
Of course.
Chantel Debert (23:28)
can do here. it’s it’s actually it’s meeting the patient and the family where they’re at and providing them the tools they need at that point in their recovery.
Melissa (23:36)
Okay. And it actually brings up an interesting question then. How do you manage the expectations for recovery with these sorts of injuries? Because it’s so invisible, because, you know, the symptoms may be things that you know were something that they were dealing with previously, or may not be really like a massive, you know, ninety degree shift from a personality or otherwise.
Chantel Debert (24:00)
Yeah. so
I I two things come to mind immediately and I’m sure there’s lots of others, but one, you know, my my I don’t know. Like so I sometimes I don’t know, right? Like we
Melissa (24:10)
I love it. Yeah.
Chantel Debert (24:12)
know we know th I know as a field, medicine in general, we know thirty percent.
Melissa (24:16)
Yeah.
Chantel Debert (24:17)
Like that’s it. Like I’m not I’m not magical. I know like
Melissa (24:20)
Mm.
Chantel Debert (24:20)
this is like I’ve been doing this for a long time, but
Melissa (24:23)
Yeah.
Chantel Debert (24:23)
I’m I I I can say I don’t know and I can say here I’m gonna sit with you. And we’ll both not know together and we’ll work work through this. Right. So that’s probably that’s a really strong tool
Melissa (24:34)
Mm.
Chantel Debert (24:35)
in terms of like you know, you know, this is we’re we’re all just and I say this lots to patients, but we’re all just physiology. That’s that’s all we are. Like you’re
Melissa (24:44)
Mm.
Chantel Debert (24:45)
special, I’m special, we’re not special because we’re all just the same physiology, right?
Melissa (24:49)
Yeah.
Chantel Debert (24:49)
And so
I have studied really hard to understand a certain part of that physiology, and so I can share what I’ve learned and then I can go on this process with you in the journey. But you’re unique
Melissa (25:02)
Mm.
Chantel Debert (25:02)
in a certain way, but you’re not unique in another way. And you know, these our tissues are gonna just gonna all gonna heal in a certain way, and I can’t change that.
Melissa (25:11)
Mm.
Chantel Debert (25:11)
You know, my and from a research perspective, I’m looking at ways to change that, and we can talk about that later, but
When I see a patient, I have certain tools available to to me, but really we’re physiology, right? So I think that’s the biggest one of the biggest things I can say is I don’t know, but I’m willing to go on this journey with you. And then this the second thing I can say is is stick to my words and go on that journey with a family and patient. So
Melissa (25:37)
Mm.
Chantel Debert (25:38)
one of the greatest gifts I have as a physiatrist is that I can stay with that family and patient long term. So
Melissa (25:44)
Yeah, wow.
Chantel Debert (25:45)
I have
patients that I look actually the one of the first patients I ever saw as a resident, she’s now my my patient and she’s still my patient. I see her annually or when something comes up and that was that was twenty one years ago. Right. So
Melissa (26:00)
Wow.
Chantel Debert (26:01)
like I have you know I have this gift of being able to have long term relationships and being able to say, I don’t know but I can I’ll I’ll be with you along this journey to to see what comes up. Right.
Melissa (26:12)
Mm.
Chantel Debert (26:13)
So
So y you know, those are probably my two big
Melissa (26:17)
Mm.
Chantel Debert (26:19)
because I I mean I’m not gonna I I’m not magical and I don’t think anyone is, right?
Melissa (26:24)
Yeah, for
sure. I mean, I think what you’re presenting is pretty magical and your research is pretty magical as far as the advancements that you’re making. But I certainly, you know, I can appreciate the I don’t know and how that can be both empowering and frustrating for a family, right? Like empowering in a way of like, okay, we’re not in this alone, and even the experts don’t know what this trajectory looks like and how we’re going to manage.
But also, you know, frustrating because it is such an invisible condition and because every day is different, we have good days, we have bad days, we have progress forward and two steps backwards, right? And I think in that sense, you know, because the brain is just such a incredible body part, it sounds unjust to even call it a body part. There’s so much more to it, but
Yeah, I think that you know, it’s it’s so interesting and fascinating to understand that they’re, you know, one person’s you know, success is another person’s, you know, I’m not there yet kind of thing. And I think that’s really interesting.
the distinction between a good day, bad day, you know, for a patient, for someone in the rehabilitation process, and for a family member. How do you determine what needs action, what doesn’t need action and and how do you support people to work through those ups and downs?
Chantel Debert (27:45)
Well, I I you know, when I teach residents, you know, whether they’re on call or whether they’re you know, you know, seeing a patient, I I it’s first like what’s safe and what’s unsafe.
Melissa (27:54)
Okay.
Chantel Debert (27:55)
What’s harmful, what’s not harmful, you know, and then if it’s harmful, who’s it harmful to? And and can and can we shift our perspective to make it not harmful?
Melissa (28:06)
Mm-hmm.
Chantel Debert (28:08)
So the biggest thing is safety, right? Is what
is happening in the situation unsafe. And if it’s unsafe, you need to do something about it. Right.
Melissa (28:18)
Okay.
Chantel Debert (28:19)
So whether that’s go to the emergency department, whether that’s call a physician, whether that’s call nine one one, you you need to do something about it. So safe, unsafe, right?
Melissa (28:27)
Okay.
Chantel Debert (28:29)
If it’s safe, whatever that is, you know, you know, they’re not gonna the person isn’t a harm to themselves or others.
Melissa (28:36)
Mm.
Chantel Debert (28:38)
is it detrimental?
Right. And if it’s detrimental, then identifying it and then finding the tools, the pattern and the tools to deal with it. Right.
Melissa (28:49)
Mm.
Chantel Debert (28:51)
and so reaching out for help is always one of the best first steps. And so figuring out where to reach out for help for is really important.
Melissa (28:59)
Okay.
Chantel Debert (28:59)
So that’s, you know, whether it’s a like if it’s a very bad day, that’s you know, that’s where I that’s where I start.
Melissa (29:05)
Yeah. Okay. And do you find that you’re spending most of your time with the patients themselves, or you know, do you split that time with family members as well? Like how how are they involved?
Chantel Debert (29:17)
Yeah, it it depends. It
Melissa (29:18)
Okay.
Chantel Debert (29:19)
really depends on on the situation. I mean we also so in our outpatient brain injury program we have excellent social workers and
Melissa (29:26)
Mm.
Chantel Debert (29:26)
in our inpatient programs we have excellent social workers as well too and psychologists and neuropsychologists. So, you know, it’s really a team approach.
Melissa (29:36)
Mm.
Chantel Debert (29:36)
This is not a one man show. It’s it’s fantastic. And
Melissa (29:40)
Mm.
Chantel Debert (29:42)
I on the daily call many friends
Melissa (29:45)
Pick up the phone, call for some support. Yeah.
Chantel Debert (29:48)
Yeah.
Melissa (29:49)
Okay. you did touch on the symptoms. Let’s go back a little bit and talk about some of the symptoms. Now, for me, I know fatigue is one of the big symptoms that tend to be persistent with a a a head injury, mild, if we may call it that. how do you manage?
a a symptom like fatigue and and what would you tell someone that’s contending with that right now or struggling with that? What are some key pieces that they can take away from this?
Chantel Debert (30:17)
yeah, so it really depends on where they are in the recovery process. So acutely, so right after hit your head, its activity is tolerated. So current guidelines recommend that you you rest,
Melissa (30:30)
Mm.
Chantel Debert (30:30)
do relative rest for the first twenty four to seventy two hours, and then gradually increase activities to to previous baseline to previous activities. so it’s pacing.
and it’s gradually, you know, for example, if you’re struggling with reading on a computer screen, so it’s starting
Melissa (30:47)
Mm.
Chantel Debert (30:48)
out with 10 minutes and then resting and then increasing it to 12 minutes and then you know gradually increasing the amount of time that you’re doing the activity. so I give talks where I say rest is not best, right?
Melissa (31:01)
Mm.
Chantel Debert (31:01)
So it’s just the first few days to kind of let yourself rest. Now this is just mild, right?
Mild TBIs or concussions, but you rest your brain and then you gradually increase activity over time with pacing measures put in place. And so for the acute and subacute period of time, that’s our recommendations. we know, for example, physical activity is good and can incre in improve fatigue.
We know getting appropriate sleep is very, very important and we
Melissa (31:31)
Mm.
Chantel Debert (31:32)
know that sleep is altered after you hit your head. So sleep onset and staying asleep, sleep hygiene for a certain period of time, limiting daytime naps or or rests as well can be quite helpful because then you get actually get into REM sleep at night. and if if you’re kind of periodically resting or sleeping throughout the day, then you lack that ability to get into deep sleep throughout the night.
So sleep hygiene is huge for fatigue in the acute, subacute, and chronic phase as well. physical activity is also huge. So we we know that that’s important. You want to do it based on how much you can do and tolerate. if you can only or if you can tolerate 10 minutes, fantastic. Do 10 minutes, right?
Melissa (32:13)
Mm, mm.
Chantel Debert (32:15)
If you can tolerate eight minutes, fantastic do eight minutes. I had a patient, he was so fatigued, it was quite difficult. but he had this goal of doing this this bike trip. And so we started he started out a minute a day on a stationary bike
Melissa (32:29)
Wow.
Chantel Debert (32:30)
and we just gradually increased it over time and there were setbacks, but he was per he persevered, and we got him on that bike trip, right? So, you know, I I
you it’s that pacing, it’s listening to your body, but also I think education too, realizing that by doing what you’re doing, you’re not causing brain damage, you’re not injuring
Melissa (32:50)
Mm.
Chantel Debert (32:51)
your brain. This is not detrimental. You might feel icky and I a hundred percent appreciate that.
Melissa (32:57)
Mm.
Chantel Debert (32:58)
Then you take a step back, but then you revisit it the next day. And so that’s in the acute and subacute period of time that the pacing and ac and activities as tolerated is so important.
Melissa (33:09)
Mm.
Chantel Debert (33:11)
If you then flip over into more chronic symptoms, there are sometimes other reasons why. So you can have vision changes. So there’s something called vestibu vestibular ocular motor dysfunction where your eyes and your your ability to know where you are in space is disrupted. and so things like reading on a computer screen with your eyes or being in a busy environment like grocery shopping.
or watching a big movie screen where there’s lots of movement can cause symptoms which as soon as you’re symptomatic and for example you have pain or headache and you feel dizzy, well that can overwhelm your system. and you get really tired.
Melissa (33:48)
Mm.
Chantel Debert (33:49)
you just do. Like your your tank is depleted because
Melissa (33:52)
Right.
Chantel Debert (33:53)
now all of a sudden your brain is working overtime to deal with all these symptoms. But also for example in this case me trying to listen to you and talk, right? So that
It’s doing two things at once where it normally would just do be doing one thing. So it’s overwhelming, right? So vestibular ocular motor dysfunction is one of the things can de that can definitely contribute towards fatigue. Pain. We know that pain can contribute towards fatigue. So those who have chronic post-traumatic headaches, that goes alongside with pain. As well to, for example, if someone has a past medical history of migraine headaches.
Or then they after they hit their head they present like migraine. Migraines aren’t just headaches. It’s not just pain. There’s this whole group constellation of symptoms g that go along with migraines. and one of those symptoms is fatigue. So some people have prodromes pr some people have post dromes where they, you know, maybe their prodrome was they get hungry,
Melissa (34:48)
Mm.
Chantel Debert (34:48)
right? Or they see little squiggly lines in their vision or
They get more irritable or they have word finding difficulties. Like that, and they’re like, okay, I know I’m I’m getting a migraine, right?
Melissa (34:59)
Great.
Chantel Debert (35:00)
And so then and then they get their the maybe they get the headache period, maybe they don’t,
Melissa (35:04)
Mm.
Chantel Debert (35:04)
right? they get the headache period, and then post they get really tired and super fatigued.
Melissa (35:09)
Mm.
Chantel Debert (35:10)
And so, you know, seeing someone who has that understanding of that that that can happen is also really important because that’s treatable. That’s very treatable, right?
Melissa (35:17)
Mm.
Chantel Debert (35:19)
And then not as common as all the other things I describe well described w actually I can just take a step back. Other things that can cause it. If if I said to you, Melissa, you know what, you need to sit in your house and you can’t work and you can barely see your kids and I don’t know if you should drive and let’s not go outside in that sunshine. Like let’s just
Melissa (35:41)
Yeah.
Chantel Debert (35:41)
keep you as a mushroom in this house. What’s gonna happen to you? You’re gonna get sad.
you’re gonna get anxious. And so other symptoms after hitting your head, depending on the journey that the patient has, is depression and anxiety. And
Melissa (35:55)
Mm, yeah.
Chantel Debert (35:56)
that makes you feel tired. It makes
Melissa (35:58)
For sure.
Chantel Debert (35:59)
you feel very fatigued. So being able to acknowledge that and then work through those symptoms is really important. And then there is an entity in which is hormonal in nature. So 20
28% of individuals who hit their head, whether it’s a mild to severe TB TBI, will have some type of hormone change at some point in their recovery. Chronically, so that greater than one year, if you continue to have symptoms, the most common hormone deficiency is growth hormone deficiency. So in kids, you need it to grow, but in adults like us, we need it for the following: we need it to for appropriate sleep, so to actually get into
To REM sleep. We need it for executive function. So working memory, remembering, processing speed, attention. We need it for energy. So if you don’t have growth hormone, you’re tired all the time. You want a nap in the afternoon. and we need it for exercise tolerance. So if you’re growth hormone deficient, you just you can’t, like it’s really hard for you to exercise. and then you also long-term wise need it for bone and muscle health as well.
So, you know, in patients that have this kind of group of symptomatology or one year post injury, I will assess them for growth hormone deficiency. And if they are growth hormone deficient, I’ll treat them and a lot of them do get much better.
Melissa (37:15)
Yeah,
Chantel Debert (37:12)
that’s my approach to fatigue post head injury.
Melissa (37:16)
I mean I never knew about the growth hormone and the deficiency that is a potential in a post head injury. So that’s really interesting.
Talk to me about what you’re researching and what is, you know, a big topic that you’re working on right now. what’s your focus? Yeah.
So much.
Chantel Debert (37:34)
Yeah,
so I I have a few research projects that are ongoing right now. So one of the ones is is that we’re recruiting from the emergency department acute traumatic brain injuries across the age age spectrum and very importantly in the older individual because less is known about particularly mild traumatic brain injury in older individuals
Melissa (37:54)
Mm.
Chantel Debert (37:55)
because the presentation is often different and often people say, they’re delirious.
Melissa (37:59)
Mm.
Chantel Debert (38:00)
Well
Is it delirium or is it a head injury?
Melissa (38:03)
Yeah.
Chantel Debert (38:03)
Right? and so a major focus of this of this project is actually to look at the trajectory of recovery in older individuals and see if we can prognosticate outcomes using blood biomarkers. So
Melissa (38:17)
Interesting.
Chantel Debert (38:17)
we just finished doing it in all comers, like all age groups, all adults.
due to all mechanisms, so car accidents, sports, falls, assaults, et cetera, IPV, and looked at their recovery over time and looked at blood biomarkers that might help us understand, diagnose and prognosticate outcomes as they recover. And now we’re applying that same approach to the older individual because it’s so important because we think, well, they just recover the same way, you know, as you get older, we’re gonna recover the same way
you would when you’re younger or some of your physiology will be exactly the same. Well it’s not.
Melissa (38:53)
Mm.
Chantel Debert (38:54)
and so that’s that’s one of the the projects we have ongoing. Also linked to that project is understanding cerebrovascular reactivity. So what does that mean? So brain blood flow post concussion because one of a very debilitating symptom after you hit your head it can be postural symptoms. So for example when you get up quickly you feel really lightheaded
you can’t exercise because you’re just not getting enough blood flow to the brain. so you have postural symptoms and we call that autonomic dysfunction.
Melissa (39:24)
Mm.
Chantel Debert (39:26)
but we we know what happens after a mild traumatic brain injury or brain injury in general, but we don’t have a good understanding of the physiology of it. So that’s another clinical trial that we have ongoing that’s linked to our acute brain injury.
program in the emergency departments here.
Melissa (39:45)
Hmm.
Chantel Debert (39:46)
So that’s one of my areas of interest. And then my other area of interest is is actually looking at novel interventions. So we do have a growth hormone
Melissa (39:54)
Mm.
Chantel Debert (39:54)
ongoing study for individuals with symptoms that are ongoing past one year. And so that is an ongoing trial that we have right now. We have another trial actually this is this trial
stems
from patients. I was getting so many questions about, you know, I don’t want to take medication for my treatments. I don’t like I don’t I I want something different. What about nutraceuticals? So we we did a this observational study where we just give questionnaires to patients coming through our program and said, you know, what are you taking? What kind of vitamins are you taking? Like what other type of nutraceuticals are you doing? What what
What are you interested in taking? What are you interested in
Melissa (40:34)
Mm.
Chantel Debert (40:34)
in exploring? And and one of the things that came up frequently, and one of the things I was getting in my clinic was was well, like I I hear about the psilocybin thing.
Melissa (40:44)
Mm.
Chantel Debert (40:46)
you know, what does that work, Dr. Uber? Is that I’m like, well, I have no idea if it works.
Melissa (40:48)
Mm.
Chantel Debert (40:51)
So so we were lucky enough to have Dr. Leah Mayo come in.
here and take a position at the Hodges Brain Institute as a psychedelic chair.
Melissa (41:00)
Mm.
Chantel Debert (41:01)
And so with her knowledge and her guidance, we’ve started two clinical trials, one looking at persistent symptoms after concussion with treatment of psilocybin-assisted therapy, and the other one in intimate partner violence patients
Melissa (41:15)
Mm.
Chantel Debert (41:15)
with post tra post-traumatic stress injury and concussion as a treatment to treat PTSD. So
Melissa (41:21)
Mm, mm.
Chantel Debert (41:23)
So that one directly stemmed that from chatting with patients.
and and then we have I collaborate with with fantastic researchers over in kinesiology,
Melissa (41:34)
Mm.
Chantel Debert (41:35)
through k sports medicine and Cypressy, so Dr. Carolyn Emery and and through that through that program we’re also looking at kiddos who’ve had
concussion or mild traumatic brain injury in sport and then looking at blood biomarkers and following them over time. So yeah, that’s just a few of the studies that are ongoing right now. yeah.
Melissa (41:58)
How do you keep track of it all? My goodness.
Chantel Debert (42:02)
I I am super lucky. I have fantastic grad students and
Melissa (42:05)
Yeah.
Chantel Debert (42:07)
great lab managers. So yeah.
Melissa (42:08)
That’s amazing.
so if someone wanted to be a part of any of these research projects, how would they get involved? How would they contact you?
Chantel Debert (42:16)
yeah, so there’s a couple ways. One, we have a we have a a website, so it’s the Brain Neuro Rehabilitation Lab. So you can just type that in, it’ll come up. We also have an Instagram as well, so you can type that in too. And we’re also on Facebook as well. So just those are mostly to well you can you can reach out and participate in studies, but it’s also to celebrate some of the s the successes of the students within the lab.
Melissa (42:40)
Mm.
Chantel Debert (42:42)
and and some of the successes of
publications as well. So trying to disseminate research within the field of traumatic brain injury. and then also there’s some educational tools on there as well too too. So for example, if you were interested in getting some support through for example Southern Alberta Brain Injury Society, that link is there, or through Brain Canada
and then there’s some also really great websites that patients can tap into. So for example, the living concussion guidelines or the concussion assessment tool website, these are great websites to get gain more education and information, and that’s all through the Instagram account as well as the website.
Melissa (43:23)
Yeah. Mm-hmm.
Chantel Debert (43:26)
also Alberta Health Services has if you just go onto the Alberta Health Services website, there’s
links to great education as well for all those different links and tools. And then also the integrative concussion research program through the University of Calgary has a really fantastic website with even more resources that patients can click onto and get more information.
Melissa (43:47)
Amazing. it truly sounds like there’s a lot of resources, and lots of support and lots of opportunity and hope, right? because, you know, all of the time and effort that you and your team are putting into, you know, advancing the research and knowing what the brain is capable of or the little that we know the brain is capable of. you know, I think it sounds very exciting and very positive. And I’m
I really thank you for sharing some of that with us. I think, you know, whether it be a brain injury in a young person or a a brain injury traumatic or otherwise in an older person, there’s people around them that are struggling to support, right? That want to very much be part of the support and the the fix to each of these stumbling points. And I think knowing that there are resources out there to support both families and the patient.
as a person recovering from the injury is pretty fantastic. So I very much appreciate what you’re doing there and thank you.
And
if if
Chantel Debert (44:45)
You’re welcome.
Melissa (44:47)
someone wanted to look into the brain injury program of Calgary, what does that look like? And how would someone become a part of that separate from the research part?
Chantel Debert (44:57)
it’s a referral through their family physician.
Melissa (44:59)
Okay, perfect. Very good. And w if you had to leave people with a couple takeaways today, what would you what would you leave them with?
Chantel Debert (45:08)
I guess the biggest thing is I get it.
Melissa (45:12)
Yeah.
Chantel Debert (45:13)
You know, and you’re not alone. and there are resources out there. It’s just finding the right ones. And yeah, you know, we th the it’s the that that kind of I wish I was the way I were. Well, you know what? I’m not the same person I am today as I was yesterday. I we I’ve lived life and now I’m different today.
And it just so happens with the brain injury, you lived it in a certain way that day.
Melissa (45:38)
Mm.
Chantel Debert (45:39)
And and it’s hard and it’s really hard. But there’s there’s resources out there, there’s treatments out there that maybe like we ch we briefly chatted about today, maybe and we just skimmed the surface, right?
Melissa (45:49)
Mm. Totally. Yeah.
Chantel Debert (45:54)
that maybe you haven’t thought about. but there’s also a piece of acceptance too.
and that we’re all given gifts in different ways and so yeah, it you’re the biggest piece is you’re you’re not alone and I I get it, it is a silent injury or an invisible injury often. but you don’t need to struggle alone.
Melissa (46:16)
Yeah. Yeah, and and and if I may, you know, recognize the struggle, right? And not be ashamed or, you know, afraid to ask
Chantel Debert (46:24)
Yeah.
Melissa (46:24)
the question about the struggle, right? You know, mm people tend to just say, brush it off as something else, right? But, you know, I think definitely seeking the support, asking the questions of the physician community and yeah, I think is very helpful because once you open that door, there’s a ton of resources.
Chantel Debert (46:42)
And actually, you know what? Maybe I’ll leave it at this too. You know, you if you think about it, your brain’s the most important organ in your body. It does everything.
Melissa (46:49)
mhm, ya
Chantel Debert (46:51)
So don’t you wanna take care of it?
Melissa (46:54)
Mm-hmm. Yeah.
Chantel Debert (46:55)
You know, and and and don’t you wanna do the the right things for it, particularly during recovery?
also from a preventative per s perspective. Like so if you’re climbing on your bike and you’re just gonna go to the corner store to get milk, well, wouldn’t it be a good idea to put a helmet on, right? If
Melissa (47:14)
Yeah.
Chantel Debert (47:14)
you’re throwing your kids on a pair of skates and getting them on the ice, we know that mouth guards help decrease symptoms after concussion. Don’t you think it’s worth taking the thirty minutes to boil the mouth guard and shove it in their mouth? you
Melissa (47:28)
Ha ha
Chantel Debert (47:29)
know you know, so like
Or you know isn’t don’t you think it’s worth maybe, you know, as a parent, learning that the concussion protocols when your kid’s on the soccer pitch?
Melissa (47:40)
Mm.
Chantel Debert (47:41)
you know, like this is your brain. It’s the most important thing you’re gonna have for your entire life. And there’s
Melissa (47:47)
Absolutely.
Chantel Debert (47:47)
many preventative things that we can do to help with that, right?
Melissa (47:51)
Mm-hmm.
Chantel Debert (47:53)
Even if like, hey, you’re driving out to the the ski hill, right?
We know that that 50% of the head injuries that occur on a ski hill happen during dusk and dawn, as well as during really busy high seasons, okay? And and when there’s poor visibility. So it’s okay to wear the fluorescent pink outfit. That is just fine. Right? Make
Melissa (48:14)
Yeah, own it.
Chantel Debert (48:16)
sure that make sure that helmet fits really well. You have MIPS in it,
Melissa (48:18)
Yeah. Yeah.
Chantel Debert (48:20)
right? Wear the bright outfit.
And maybe have a a cup of hot chocolate at nine AM and get yourself out there at nine thirty or ten where not during that period of time, right? Like there are th particularly if you’re not like a very skilled skier, right?
Melissa (48:35)
Mm.
Chantel Debert (48:36)
So you know, there are things that you can do because really your brain is the most important thing. And also too as adults for kids, we can be role models.
And we can be cool role models. Like I have a whole I have a presentation of like for snowboarders that I gave about like kind of how you can have good head care and be still be cool, right? And I don’t maybe I think it’s cool, I have no idea but but you know, like I you y you know, they’re there it’s just it’s the important most important organ in your body.
Melissa (49:06)
Yeah. Yeah.
Chantel Debert (49:08)
and you c you know, so be smart about it. Yeah.
Melissa (49:11)
Yeah. I think that’s very valuable.
and and why not? Like give me a good reason not to. Yeah.
Chantel Debert (49:18)
Yeah. Yeah. it’s not
cool. I know and or I can’t it’s gonna take me two minutes to go grab that helmet from the garage.
Melissa (49:23)
Yeah.
Chantel Debert (49:24)
Like I don’t you know, th those are that’s not a good excuse. In my mind anyways, it’s not a good excuse. Yeah.
Melissa (49:27)
No. No, for sure.
Well, thank you very much for joining us, Dr. Debert. And you know, thank you for all the work that you’re doing, the advancements that you’re doing, and the support that you’re providing all of these families that are going through this journey. and and thanks for spending the time with us today to share some of your knowledge. just a brief snippet of I’m sure what you have to offer. but really appreciate the time you took out of your day to join us today.
Chantel Debert (49:53)
Well thanks for inviting me. It was a ple pleasure chatting with you.
Melissa (49:54)
Of course. Yeah. And
I look forward to hearing some of the results of your research as it comes out. it’s very exciting.
Chantel Debert (50:01)
Me too.
Melissa (50:02)
Very good. Well, thank you very much everybody for joining us today. I look forward to chatting with you all again for our next episode. And if you have any questions, please don’t hesitate to reach out to us. We’d be happy to connect you with
Dr. Debert or with the resources that are out there available to support you. That’s it for us today. Thank you so much for joining. Subscribe below.
