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Cheryl Lea Wellington, a professor of pathology and laboratory medicine, poses for a photo at the University of British Columbia, in August.ETHAN CAIRNS/The Globe and Mail
Kristen Sandborn was forgetting basic things: appointments, conversations, the sequence of some events. Her vision was changing drastically and she was avoiding social gatherings.
She knew this was most likely because of a head injury that followed another violent attack by her ex-husband. But she was never formally diagnosed: Going to the doctor or reporting the injury to police, she worried, came with the risk of her being found incapable of keeping her children should her partner contest custody.
“When you get punched in the head [by your partner], and you have kids, you don’t go to the doctor about that. You just don’t because you don’t want your kids taken away. It’s almost like the only option you have is to fight your body,” Ms. Sandborn, who is from Victoria, said in an interview with The Globe and Mail.
According to 2024 data released by Statistics Canada last October, Canadian police services reported 356 victims of intimate partner violence per 100,000 people aged 12 and older. In all, there were 128,175 victims of intimate partner violence in 2024. Those are the figures that are reported; such violence is widely believed to be under-reported by victims.
Yet, Canada has no standardized screening protocol for emergency rooms, primary care settings or transition houses – a safe, temporary home for women and their children leaving abusive or violent relationships – to ensure brain injury is documented when intimate partner violence is reported or suspected.
Scientists at the University of British Columbia, working as part of the ASCEND-IPV (Advocates, Academics, Survivors and Clinicians to End Intimate Partner Violence) initiative, are getting closer to figuring out a simple blood test that would indicate the presence of a brain injury. The innovation could ensure vulnerable women get the health care they need and provide documented evidence of changes in the brain that could be used in court.
“Without a screening standard, there is no reliable diagnosis. And without a reliable diagnostic standard, there is no pathway to provincially fund brain-injury support or justice in family courts for identifying such injuries,” said Tori Dach, manager at the Cridge Centre for the Family, B.C.’s only established program that offers direct services to the victims of brain injury from intimate partner violence.
Cheryl Wellington, a professor of pathology and laboratory medicine at UBC, is among the researchers who published a paper in BMJ Journals last fall detailing ASCEND-IPV’s work.
The researchers studied blood samples of 177 survivors, looking for brain-related proteins.
“These proteins are released when the brain is hurt, like crumbs left behind after damage, which leak into the blood,” said Dr. Wellington in a recent interview with The Globe.
Finding them is difficult because brain proteins in blood “are very dilute; like needing to count a few grains of sugar in an Olympic-sized swimming pool,” she said.
But technologies to measure brain-related proteins in blood are advancing rapidly, and the UBC team has Canada’s largest and most comprehensive program for detecting blood-based biomarkers for brain disorders, Dr. Wellington said.
“We are creating a biological baseline of truth,” she said.
The research found about eight out of 10 of the women studied likely have some kind of brain injury from the abuse.
“What we’re trying to do is build a blood-testing system in emergency departments so that when someone comes in after intimate partner violence, clinicians can collect evidence that the brain is involved, something we don’t do right now,” Dr. Wellington said.
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UBC neuroscientist Paul van Donkelaar studies concussions in hockey and football players by using tools designed to track how repeated hits changed the brain. He is working on the ASCEND-IPV research with Dr. Wellington.
“We started applying the same tests to survivors of IPV,” he said. “We see the same sorts of changes in brain function as in young athletes and sometimes even worse because of everything else that comes with living through violence.”
In sport, he points out, the culture has shifted from “shake it off” to “if in doubt, sit them out.”
Coaches now pull players from the game and insist on a proper assessment after a hard hit.
“With IPV, we’re only at that beginning stage,” he said. “People are finally recognizing it’s happening, but now we need it written into policy and into health care and legal reforms so the brain injury is actually taken into account.”
The courts are starting to take notice of the impact of IPV.
In a landmark family law judgment in May, the Supreme Court of Canada created a new legal basis for people to seek damages for alleged intimate partner violence in relationships marred by coercive control.
The decision could make it easier for people who suffer wide-ranging abuse in an intimate partner relationship to win cash compensation in the civil courts.
Dr. Wellington believes the blood test could give the legal system something it has never had: objective proof that intimate partner violence can injure the brain.
“It is biological evidence that something has been done to this person to cause damage,” she said. “It’s kind of like the DNA of a brain injury, or an X-ray of a broken bone.”
In custody disputes, a diagnosis of brain injury has been used to argue cognitive unfitness to suggest a mother cannot reliably recall events, manage a household or protect her children.
“In our society, no one questions an athlete’s cognitive integrity or their fitness as a parent simply because they’ve sustained a concussion on the field,” Dr. Wellington said.
“Yet for a survivor of intimate partner violence, a brain injury is often weaponized against [women] in custody battles to suggest they are unstable or unfit.”
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Karen Mason is an advocate and co-founder, along with Dr. van Donkelaar, of the non-profit Supporting Survivors of Abuse and Brain Injury through Research, or SOAR. She said, “While attitudes towards women who suffered brain injury from domestic violence are changing slowly, the efforts at a reliable diagnosis will be a game-changer for mothers embroiled in custody battles with their abusive partners.”
She added, “One of the challenges that we’re seeing coming up is that barrier with diagnosis; the court wants a hard line doctor’s diagnosis, which is difficult to get.”
For survivors, Dr. Wellington said, a diagnosis would change several things at once. It gives women a biological explanation for symptoms that are too often dismissed. “There is a reason they might be a bit forgetful,” she said. “It’s not just in their mind. There could be a biological basis that may be treatable or recoverable in some cases.”
It would also open eligibility for support and rehabilitation programs already used in concussion care, and for any new therapies developed down the road.
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Dr. Wellington said a diagnosis of a brain injury could give women a biological explanation for symptoms that are too often dismissed.ETHAN CAIRNS/The Globe and Mail
Dr. Wellington said her research team’s ambition is to enable every emergency room to perform blood tests for brain injury in suspected IPV cases, and to enable transition houses to refer clients to medical and support services.
But that’s going to take “a massive shift in both funding and public consciousness,” she said.
Evidence of a brain injury, while allowing access to treatment, could also be used against mothers in custody battles, as Ms. Sandborn was originally afraid of when she avoided her diagnosis. When Dr. van Donkelaar’s team asked family lawyers directly if a brain injury diagnosis could be turned against a mother in a custody fight, he said the answer was unanimously yes. When the researchers asked if the lawyers were acting for the alleged perpetrator, would they use a brain injury diagnosis, the answer was also yes.
“They even said they felt awful saying it, but it’s just the reality of the system,” Dr. van Donkelaar said.
Ms. Sandborn left the marriage, and she was able to keep her children, primarily because during a later assault, she was able to reach her sister before her ex-husband took the phone away; her sister called the police, who arrived on the scene.
Ms. Sandborn’s ex-husband received a conditional sentence after he was charged.
When his probation ended, his record disappeared, which is standard practice for conditional sentences treated as first offences by the court. He continued working in his white-collar profession.
“People don’t think that happens,” Ms. Sandborn said.
“They think it happens in poverty. But it happens at all different levels of the community, different statuses, ethnicities and religious groups. It’s just everywhere.”