Ms Barbara O'Connell:

I thank the joint committee and the Chairman for inviting Acquired Brain Injury Ireland to present at this hearing today. I am the chief executive and co-founder of Acquired Brain Injury Ireland. We set up the organisation 14 years ago to fill the gap in the provision of neuro-rehabilitation for people with a brain injury and their families. Ms. O'Boyle has been responsible for our education and awareness programmes on concussion and is here to answer any questions the committee might have. Mr. Macauley is our all-star ambassador and role model for our concussion campaigns.

We are pleased to be recognised as a significant player in the high-profile debate on concussion that is currently taking place. As stated in our written submission, we have to date carried out a number of activities and collaborations to raise much-needed awareness on the issue of concussion. Only 10% of people who experience a concussion are actually knocked out. That leaves 90% of concussions to be reported by the player, observed by the coach or the team doctor. How can people observe something that they do not understand or do not recognise? If one asks a player whether they have ever been concussed, most will say that they have not. If one asks players whether they have seen stars, most will say that this has happened many times. Players will admit to having thrown up after a match or having felt dizzy, but do not always relate that to the fact that they may have had a concussion. That is why we need education and to implement agreed protocols to ensure that concussion is managed correctly on every playing pitch across Ireland and at every level, from grass roots to elite.

Concussion campaigners call for change in concussion education and guidelines, along with increased awareness among young players, coaches and parents in order to protect the safety and well-being of our sportspeople. Acquired Brain Injury Ireland's concussion awareness and education campaign was driven from a grass-roots level at a local sports club, where it became evident that nobody knew what to do when a bang to the head happened. It is that basic. Knowledge, education and awareness of how to respond when a concussion happens should be available to all parents, coaches, and players in any sport. We argue that it should be mandatory but unfortunately that is not the case, so concussion continues to be mismanaged or not managed at all, which puts our children and families at risk. It is a manageable injury, but when it is not dealt with correctly it can be fatal. Think of Ben Robinson. He had a repeat concussion before the first concussion had healed. This is seriously dangerous and often fatal. We call for players to be removed from play if a concussion is suspected to prevent the possibility of second impact syndrome.

I want to say a few words on concussion care pathways. The abnormality of concussion is the same as with any brain injury, so we must start linking concussion with mild brain injury, making the role of a healthcare professional essential in monitoring a player through the rehabilitation process. Players are being concussed every weekend of the year throughout the country but there are no specialist services available. Dr. Ryan stated earlier that they have some concussion clinics scattered around the country but these services are not readily available and GP awareness is not there. Concussion care pathways services should be available nationally in the public health service to anyone in need of a mild brain injury rehab following a brain injury. No concussion is the same, so each one should be treated individually and cared for specifically.

Children require a particular mention because they are not small versions of adults; they are physiologically different. What we call "return to play" guidelines for adults we call "return to learn" guidelines for children. These must be implemented in schools for parents and teachers. Return to learn should be facilitated by inter-disciplinary teams, made up of the coach, the teacher, the family member and the clinician. I recently came across a young boy who returned to school the day after a concussion and was dribbling in class, completely disorientated. He became a spectacle for his peers, who were laughing and joking at him, when really this boy was clinically suffering from a concussion.

We carried out a research project that found that 42% of GAA players who sustained a concussion reported that they had played on and did not remember any of the rest of the game. These players are putting themselves at risk and must be educated about the dangers. As we have called for in our written submission, a sustained national collaborative concussion campaign is required to bring together all involved bodies to outline best practice, education, messaging and protocols. The sporting bodies have the information, but it is not enough for this information to be on a website or in a booklet. It must systematically be put into protocols so that people are trained. The Acquired Brain Injury Ireland ambassador and role model, Mr. Macauley, knows only too well what it means to be concussed, so I will hand over to him.