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Time for more concussion discussions

Sport

FLASHBACK Dr Seán Moffatt is pictured helping Lee Keegan off the pitch after the Mayo defender displayed concussion symptoms following a collision during a National League match against Cork in January 2016. Pic: Sportsfile
Dr Seán Moffatt is raising awareness about dealing with concussion


Feature
Mike Finnerty

COACHES of all sports teams are becoming more aware of the need to recognise the symptoms of concussion, as well as the importance of rehabilitating players back to full health after they suffer a concussion, according to one of the country’s leading experts in this area.
Dr Seán Moffatt, who is the Mayo GAA team doctor, and a former member of the GAA’s Medical, Scientific and Player Welfare committee, is keen to highlight the importance of concussion awareness for all involved in contact sports, including team managers, coaches and parents.
“I would feel that everything revolves around preparation,” Dr Moffatt told The Mayo News.
“If you’re a coach of a team then a basic knowledge of the main injuries that you’re likely to be dealing with, and that definitely includes concussion, is helpful.
“Ensuring that a player who seems to have sustained a concussion injury is removed from play, isn’t left alone as it’s an evolving injury, and is medically evaluated as soon as possible by the player’s GP, Emergency Department, or an out-of-hours GP service is essential.
“If you’re involved with a team, and want to become more aware of the whole area of concussion, I recommend looking up the guidelines for that specific sport which are all readily available and comprehensive.”
Dr Moffatt, and his team at the Mayo Sports Clinic in Ballina, are also part of the UPMC Concussion Network and have spent time upskilling in concussion management in Pittsburgh, a leading centre worldwide for concussion management.
At UPMC, concussion is diagnosed using a detailed history, clinical exam and the ImPACT neurocognitive test. Crucially, patients are    actively managed and rehabilitation programmes individually tailored based on pre-injury risk factors and post-injury symptoms and ImPACT scores.
“This model is a move away from the ‘one fits all rest and recovery timeline model’ and has been adopted by the GAA as the appropriate pathway for concussion rehabilitation, with our clinic in Ballina one of six national treatment centres,” he explained.
Dr Moffatt was the keynote speaker at a recent UPMC Concussion Network Educational Workshop in Ballina that was attended by soccer and rugby coaches, GPs, physios, and a number of Mayo GAA Academy coaches and managers.
“There were a number of main points that we tried to get across at the workshop,” explained Dr Moffatt, who is also a UPMC clinical lead.
“We wanted to raise awareness regarding concussion, giving coaches and parents examples of what symptoms a player may exhibit and what signs to look for, with the basic principle being ‘If in doubt, sit them out’ for a suspected concussion.
“I also wanted to move the discussion away from just sport. Recovery from concussion is initially about ‘return to learn’ as well — it’s about getting the person back safely to school or back to work.
“Everyone is focused on sport, but it’s also so important to get the person back to school or work safely. Shifting the focus to proper diagnosis and recovery is crucial.”

Complex issue
DR Moffatt has a wealth of experience and expertise in the area of concussion diagnosis and management from his time as the Medical Director of Mayo GAA, and working at the coal-face with the Mayo senior footballers.
However, he admits that assessing and treating players with a suspected concussion is a complex issue and widely recognised as one of the most complex sports injuries to treat.
“Previous models of assessing and treating concussion post injury were based on self-reported symptoms scores with a player telling you how they are feeling. But all players want to play so there was always a danger of a player returning to play too soon.
“I think incidents of concussion in the GAA are probably still being under-reported, and also the game has got faster, resulting in more high-speed collisions with increasing likelihood of concussion injuries,” he added.
“A point that I would have made last week is that it doesn’t need to be a direct hit to the head for a concussion to occur.
“Concussion can be caused by a heavy fall or by a shoulder challenge causing a transmitted force to the brain.
“Also, physios and medical personnel should keep in mind that a primary injury, like a shoulder injury following a heavy hit, also carries a risk that a player may have emerging concussion and needs additional assessment once the initial injury is dealt with.
“I tend to watch out for a few things in relation to a possible concussion when I get to an injured player on the field,” he continued.
“If the player hasn’t moved for the first five seconds post-injury; if the player exhibits a vacant stare post-injury, clutches his or her head post-injury or any balance issues on getting the player to their feet — these are all signs of a concussion injury.
“On field, I only have around 40 to 50 seconds to assess the player, but with Mayo, if the game was maybe being televised, you may be able to get some video feedback from other members of our medical team. This  additional feedback is also a help in assessing our players following a collision.”
During his presentation at the recent educational workshop in Ballina, Dr Moffatt highlighted a ‘Take Home Message’ slide for the audience that contained 10 crucial bullet points.
The first of those points – ‘Recognise, remove, rehabilitate’ – is at the core of the message for sports coaches everywhere.
“Over the years, between my work at the Mayo Sports Clinic and with Mayo GAA, I have a lot of experience of dealing with concussion.
“And I’m acutely aware that we need to do more to raise awareness of this important injury, diagnosis and crucially post injury care and rehabilitation.
“The GAA, to be fair, place great importance on player welfare, and awareness and education around concussion.
“And if people want to get more information on the whole issue, they can visit either the GAA, Mayo Sports Clinic or the UPMC Concussion Network websites.”