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Toronto Rehab researcher examines sex and gender in brain injury

​​​​Dr. Angela Colantonio
“It is increasingly necessary to give explicit consideration to sex and gender on all aspects of TBI research to produce more effective and sensitive health care. In over 200 studies, only seven per cent separated men and women. It’s not acceptable that we don’t have sex-specific data,” says Dr. Angela Colantonio, Senior Scientist at TR. ​(Photo: UHN)


Dr. Angela Colantonio, senior scientist at Toronto Rehab (TR), has dedicated her career and research to Traumatic Brain Injury (TBI), including trailblazing work on women with TBI.

To celebrate International Women's Day on March 8, we asked Dr. Colantonio what drives her interest in addressing sex and gender differences in rehabilitation research, what her research has uncovered so far, and how she hopes gender and sex-specific research will improve prevention and treatment of TBI for men and women.

Historically, there has been little attention on how Traumatic Brain Injuries (TBI) exclusively impacts women's bodies.

Guidelines for TBI care are not typically gendered, meaning men and women receive the same rehabilitation despite differences in physiologies, reproductive systems and gender roles.

Dr. Angela Colantonio wants to see this change.

Related to this story

Last month, a supplement to the Journal Archives of Physical Medicine and Rehabilitation was published and guest-edited by Dr. Colantonio, entitled "Sex, Gender and Traumatic Brain Injury".  Dr. Colantonio wrote the opening commentary for this unique supplemental issue, addressing research and knowledge gaps in rehabilitation research.

"It is increasingly necessary to give explicit consideration to sex and gender on all aspects of TBI research to produce better scientific knowledge and provide more effective and sensitive health care to women and men, boys and girls," explains Dr. Colantonio, also the Director of the Rehabilitation Sciences Institute at the University of Toronto (U of T).

This research is important as previous work on the topic has led to new patient education materials tailored to women with TBI.

"A review found that in over 200 studies on mild TBI outcomes, only seven per cent separated men and women. It's not acceptable that we don't have sex-specific data," adds Dr. Colantonio.

Traumatic brain injury: a gendered condition

One of the reasons research on TBI hasn't historically focused on sex/gender differences or on women specifically, is because overall it is an injury that is more common among men, explains Dr. Colantonio.

However in some situations, including mild to severe occupational brain injuries, close to half are sustained by women. Among older adults – the fastest growing segment of our population –the incidence of brain injuries becomes more equal by sex.

"More severe injuries however do occur in higher rates among men because they tend to engage more frequently in high-risk behaviours and occupations such as professional contact sports, construction or military populations," explains Dr. Colantonio.

"Research on concussions and TBI in women athletes has been limited, even though some studies have reported high rates for girls and women in particular sports."

Brain injuries are also common in intimate partner violence, which disproportionally affects women. In fact, up to 92 per cent of partner violence results in injuries to the head. A new collaborative study co-led by Dr. Colantonio is currently addressing brain injury in this population.

Rates for TBI are also higher among women working in government/health care than among men. Dr. Colantonio is also co-leading other collaborative work to address gender and brain injuries in the workplace funded by CIHR and Ontario's Ministry of Labour.

"The more we understand sex/gender-specific causes of TBI, the more likely we can tailor more effective prevention strategies," says Dr. Colantonio, also the founder and co-chair of American Congress in Rehabilitation Medicine Task Force on Girls and Women with Acquired Brain Injury, which was established in 2010.

Understanding differences

The goal of integrating gender and sex into research on TBI is to understand differences impacting men and women, and to eliminate gaps in clinical practice and knowledge.

Historically, pre-clinical research has been done on male rodents. However, studies using both male and female rodents have led to important discoveries such as different pain mechanisms between sexes.

"It's important to understand how biological differences between men and women affect outcomes, as well as how gender norms and societal expectations influence health and behaviour," explains Dr. Colantonio. "It is also necessary to establish what is common."

For example, following a TBI, women report concerns regarding irregular menstrual cycles and pregnancy, and also reported they were less likely to receive rehabilitation if they return to housework versus paid work.

Men report being less likely to discuss difficulties associated with TBI. Dr. Colantonio cites societal norms and gender expectations as the likely reason for this.

Advancing sex and gender research

Canada has the only research institute in the world with a dedicated mandate of gender, sex and health research – the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health​.

Dr. Colantonio was awarded a Research Chair in Gender, Work and Health by the CIHR in 2013. She credits federal funds, other grants, and the Saunderson Family Chair in Acquired Brain Injury Research for supporting this research and understanding the importance of exploring how sex/gender affects treatment and prevention of TBI.

"I would love to see UHN be a leader in giving explicit consideration to sex and gender in all the research, clinical care and education that we're doing," says Dr. Colantonio.

"There is much work to be done with respect to advancing sex/gender research, not only for TBI, but for all areas of rehabilitation research."​

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