Leading schools will confront concussion problem head-on

NEXT season the senior squads from five prominent rugby-playing secondary schools in Dublin will take part in a ground-breaking pilot study aimed at improving the understanding and treatment of concussion.

In a programme devised and conducted by eminent sports medics, including leading authority on sports concussion Professor Paul McCrory, the Sports Surgery Clinic (SSC) will screen about 200 teenagers from Blackrock, St Michael’s, St Mary’s, St Andrew’s and Gonzaga.

In August the players will undergo a battery of eight cutting-edge tests — cognitive, vestibular, eye-movement and others — and then will be monitored throughout the season. Any concussive event experienced during play will result in immediate access to treatment, monitoring of symptoms and rehabilitation.

A safety net for privileged kids playing a privileged sport? No. The idea is that the data collected goes towards creating a framework for the safe management of all adolescent athletes who have suffered a concussion.

The programme, to be announced officially later this week, should help to reduce concerns about an injury that threatens to reduce rugby’s popularity as a participation sport. Already there is anecdotal evidence of reduced playing numbers in first and second year of certain rugby-playing schools.

Nor has rugby’s image been helped by the proliferation of documentaries on concussion. RTE’s Hidden Impact told the disconcerting story of Jake Warde, a Blackrock schoolboy whose concussive episodes left him watching TV through sunglasses, being unable to recall conversations soon after they happened, and suffering migraine in his Leaving Cert year.

Oral maxillofacial surgeon Cliff Beirne, an ex-team doctor like so many of the research team and heavily involved in the IRFU’s Charitable Trust, says parents and players should be encouraged by a programme which took two years to put in place and which is being funded entirely by the SSC, to the tune of €700,000.

“There’s a lot of fear about concussion and a lot of negativity,” says Beirne. “Everyone is a concussion spotter and team doctors are often under incredible scrutiny. There have been well-documented cases that haven’t been managed well in different sports but this study shows parents and their children that we’re looking to rehabilitate their concussion in the same way as we’d rehab any injury, using the best of medical knowledge and evidence-based research.

“There’s been very little good research done on concussion in adolescents. What’s happening is they are treated almost like mini-adults, just given longer rest periods post-concussion. Obviously there will be strict adherence to the 23-day ‘time out’ guideline prescribed by the IRFU. The key is that we’ll be able to come up with individualised rehab programmes, rather than the ‘one-size-fits-all’ protocol that’s currently in place.”

The schools involved were chosen because of their proximity to St Vincent’s University Hospital, and pre-existing pathways of clinical care for their concussed players with the hospital’s emergency department.

However, according to Dr Andy Franklyn-Miller, the SSC’s director of rehabilitation and research, the aspiration is to acquire funding for a much broader scheme, ultimately available to all secondary schoolchildren involved in contact sports. “Two-hundred is the minimum number we can have to get good data but this evidence should be enough in order for us to apply for significant funding. As soon as we can unlock some funding for it, we’ll be very keen to broaden its availability,” says Franklyn-Miller.

“Most concussion research has been about making a diagnosis of concussion but that’s not our area of expertise. We see patients for rehabilitation and at the moment, nobody has yet to do a study which uses all of the various evidence-based tools at the one time.

“What we’d like to be able to do in a year’s time is to say: Look, we think that say, three or four out of these eight tests are important in creating a ‘concussion passport’ and that passport can follow the boy through school or club or even across sports.

“Initially it will be by a web-based platform, but half-way through the year we hope to have it app-based so they’ll be able to show their GP or show A&E what their base-line tests were, so it will improve patient care.”

How refreshing to report a positive, Irish-led initiative towards managing a thorny issue.

For further information please contact sportsmedicine@sportsrgeryclinic.com

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