A B.C.-wide study is trying to improve the diagnosis of brain injuries in survivors of intimate partner violence.
The physical and mental impact of intimate partner violence often lasts longer than the incident itself and sometimes even goes unseen and undiagnosed, says Hannah Varto, a forensic nurse practitioner at Embrace Clinic in Surrey.
Research has shown that up to 92 percent of survivors of intimate partner violence have experienced a concussion or strangulation that can cause a brain injury, but evidence-based methods of diagnosing survivors' injuries are lacking.
"Right now, the way that we diagnose concussions or brain injuries, even for sports, motor vehicle accidents, or assaults, is by subjective questions," Varto said. The clinician will ask the patient if they have a headache, ringing in their ears, if they are dizzy or having sleeping problems.
"We don't have like an X-ray or a CT scan or a blood test that can actually objectively tell us, does this person have a brain injury? It's all done based on symptoms," Varto added.
A study out of the University of British Columbia that Embrace Clinic at Surrey Memorial Hospital is taking part in is looking at ways to improve the diagnosis of brain injuries in survivors of intimate partner violence.
The study, which started in 2023, recently received a $3.4 million grant from the United States Department of Defence as part of the United States Army Medical Research and Development Command.
Researchers will obtain and analyze blood samples from survivors at Surrey's Embrace Clinic, Nanaimo Regional and Cowichan District Hospitals and community-based organizations in Kelowna. Plasma collected from the process will be used to look for biomarkers for brain injuries.
"By having a blood test, that might give us a better idea of actual diagnosis and possibly prognosis," Varto said. The study will also look at any potential connections between brain injuries from intimate partner violence and Alzheimer's disease.
The Embrace Clinic is an outpatient clinic in the Shirley Dean Pavilion across from Surrey Memorial Hospital (9634 King George Blvd.) and is a part of Fraser Health’s forensic nursing service. The clinic offers short-term medical care to mature minors and adults of any gender who are survivors of recent violence, including screening and treatment of injuries and infections and referrals to specialists and community resources. The clinic also runs a strangulation clinic for patients who have experienced this type of violence.
Lindsay, a recent patient of Embrace Clinic who is using a pseudonym for safety reasons, agreed to be a part of the study.
"I want to be part of ongoing research that will provide more insight into the links between intimate partner violence and brain injury,” Lindsay said.
“The injuries are unique to each individual,” says Lindsay. "It wasn’t until I went to Embrace Clinic that someone also explained the effects of strangulation on the brain. I was strangled many times, and it was a real eye opener to hear about the effects of that. I can’t help but feel like there are a lot of other women who may not be aware of this."
Varto said strangulation has not been studied extensively.
“It doesn’t happen in sports like concussion does, so we don’t have the same body of research to help inform clinical practice.“
What has been seen is the potentially fatal consequences of strangulation.
"We know that sustained pressure on the blood vessels in the neck for six to 10 seconds will cause unconsciousness, and that is when brain death starts," Varto said. "And you don't need enough pressure put on those blood vessels to cause bruising. So it's a very small amount of pressure that's needed to close off those blood vessels."
Varto said, “a woman who is strangled by her domestic partner is at 700 times more risk to be killed by her partner in the future, and that is profound."
A previous study that Varto was a part of concluded the importance of early and adequate screening for survivors of intimate partner violence.
"Women experiencing strangulation were 2.24 times more likely to report (brain injury) BI-related symptoms compared to those who reported no strangulation. In conclusion, women experiencing IPV (intimate partner violence) are prone to BI (brain injury), suggesting early screening and appropriate management are warranted," reads the study.
Varto hopes the UBC study will also aid the work they do in the legal system.
Part of the services that the Embrace Clinic offers is "modified forensic examination and documentation of injury," which can be used in court proceedings.
"It's not like an X-ray, where if you see a broken arm, you can say, 'Look, there's a broken arm, and the court can say, Look, her arm is broken.' As for someone with a suspected brain injury, I say, 'Well, she told me that she had all these symptoms, and I believe she has those symptoms, and I diagnosed her as a brain injury,'" Varto explained.
"I'm hoping that with an objective test, we might also better be able to advocate for recognition of serious injuries that occur after partner violence, and that maybe our court system will recognize this, both strangulation, which is a brain injury from lack of oxygen to the brain, and concussion, which is like a hit to the head where your brain hits the inside of your skull, that these are serious medical conditions,"
To book an appointment, call 604-807-5406 to talk with a nurse practitioner, or email embraceclinic@fraserhealth.ca.