'I didn't want my son to give up rugby after he was concussed'
Ahead of the World Head Injury Awareness day, we report on the growing problem of concussion among our sports players
Paula Lenihan remembers standing in hospital, willing the consultant to say her son's days of playing rugby were over.
"I really hoped he'd say 'never again'," she recalls. "But instead he said Luke could go back to playing again after three or four months. I remember being devastated because I didn't want to be the one to say 'you can't do this', I wanted someone else to do that dirty work for me."
Her 17-year-old son was playing schools rugby when he took a knee to the side of his jaw. "The force was so strong that his brain bounced off his head," says the Cork mum of two. The collision knocked him out cold and left him concussed. His teacher and coach took him to hospital. Paula wasn't at the game but she remembers getting the phone call and the long drive with her husband to the hospital.
"The most scary thing, looking back, is that at the hospital he seemed fine," she says. "He was a little bit groggy. But I remember the queue at A&E was long and he kept saying 'let's go home'. It wasn't like he was in agony with a broken limb so one of the most difficult things was persuading him to stay."
When Luke was seen by doctors, a scan revealed a brain bleed and he was immediately admitted to hospital.
"You hear the words brain bleed or brain haemorrhage and you panic," says Paula, editor of RSVP magazine. "Luke had broken fingers before but a broken finger will heal, with the brain you just don't know."
This Sunday marks World Head Injury Awareness Day. Concussions have hit the headlines lately due to the high-profile debate over Ireland international Johnny Sexton's head injuries on the rugby pitch.
Confusion still surrounds what causes a concussion, what to do and the potential dangers. What we do know is that young people are more at risk.
"Children are a lot more susceptible to concussions. That's a fact," says paediatrician Dr Niamh Lynch.
"Younger brains are chemically different than adults and children and adolescents can suffer more serious consequences if they sustain a concussion."
Information is emerging all the time about what exactly happens in the brain during a concussion. Put simply it is a brain injury. The head sustains an impact, causing it to be bruised, altering the balance of chemicals in the brain or causing damage to nerve fibres.
The impact doesn't have to be directly to the head - a sudden movement like whiplash could cause a concussion. Nor does the person have to lose consciousness - 95pc of concussions involve no black outs. There's not necessarily a correlation between the severity of the concussion and the force of impact.
"Different people react differently to various degrees of blows," explains Dr Lynch. "It's a common misperception and a dangerous one to assume that it has to be a big knock to result in a concussion."
Children are also more vulnerable to Second Impact Syndrome (SIS), where the brain swells rapidly and catastrophically if they sustain a second concussion before the symptoms of an earlier one have subsided.
In January 2011, 14-year-old Benjamin Robinson from Carrickfergus, Co Antrim was playing rugby for his school when he collapsed on the pitch and later died in hospital.
The coroner ruled that the schoolboy had died of SIS; he'd sustained a concussion in the first four minutes of the second half but had been allowed to play on. It's largely because of his parents' tireless campaigning that concussions and SIS are finally getting attention.
Early intervention is critical in any brain injury. And a growing body of evidence suggests a long period of rehabilitation is needed for repair.
Sonya Gallagher is a senior psychologist at Headway, an Irish charity supporting people with brain injuries. "The vast, vast majority of concussions are temporary," she says. "I don't want to frighten people off playing sport. But all concussions are serious and the best thing is early treatment so it doesn't turn into something more sinister."
She's worked with people who have developed post-concussion syndrome, a complex disorder where symptoms such as headaches and dizziness can persist for months after an injury.
One problem that can prevent early treatment is that the symptoms relating to a concussion can be quite vague - headaches, mood swings, confusion, problems with sleep - and they might not present until days or even weeks after the head injury.
"The problem is there's a status thing to playing on," says Sonya. "We hear all these stories of players playing on with broken hands and noses and the message is 'isn't he great' but when it comes to the brain you can't take that chance."
She believes the ethos in sport needs change. Children need to realise they're not 'letting the side down' by coming off. But it's down to the coaches, parents and the sports heroes they look up to to instil that.
"A kid on the pitch is never going to be thinking 'I should come off'," she says. "They are the least qualified to make that decision, especially if they're concussed."
"No child should be asked if they are okay to play on," agrees Dr Lynch. "That should be banned from the lingo of sport."
Next month Dr Lynch will launch a concussion clinic for children at Bon Secours Hospital Cork. "I felt children in the Munster area deserved a rapid access service," she explains.
She's also emphatic about the importance for time out following a head injury. "It's not like you have one one day and it's gone the next, you need to give the brain time and energy to repair. You need to press pause on your life," she says.
She suggests at least 10-14 days of complete physical rest and a reduced school schedule - studies suggest looking at screens or books can worsen symptoms.
"If you had a broken leg and kept walking on it, it wouldn't heal. The more demands you put on your brain, the longer it will take to recover."
Rugby has found itself at the centre of attention for sports-related concussions. A report published by the University of Ulster revealed one-in-five injuries sustained in one season of schools rugby were due to concussion, with approximately three concussions per team.
In the professional game players are bigger. As former Ireland international David Irwin recently observed: "Because of the way the game has changed and the way the rules have changed it's very much a physical contest. There's no room to do anything other than run into each other."
There's a general perception that this has filtered down into the under 18s game, with school boys bulking up. "A collision between two 6ft boys weighing 14 stone is a bit different to two 5ft 10 stone boys," says Dr Lynch.
But all sports carry an element of risk. Research carried out in Vancouver found cycling to be the leading cause of sports-related concussion among young people. And most of the concussions Dr Lynch sees are not sports related, caused instead by falls and other accidents.
Scott Walker, director of rugby development at the IRFU, oversees the 230 clubs, 295 school players and 600 children playing mini rugby in Ireland. He wants to reassure parents that the concussion issue is being taken seriously by the IRFU.
"In the amateur game we're quite clear, if the referee suspects any form of concussion, the player is immediately stood down and assessed."
The IRFU runs compulsory concussion courses for coaches and ensures their level of training is matched to the grade of play they oversee. They've launched a three-year study, and this season a new five-year study will begin.
"You have to balance the risks of sport but also the benefits, the social benefits, fitness and the culture of respect and integrity, the values of Irish rugby," adds Scott.
Paula agrees. It's four years since Luke had his accident, but months later he returned to playing rugby, completely recovered. "His school were fantastic and what happened was an accident."
Her desire for the doctor to ban him from play was "just a very brief moment in time" she says, although she admits that her husband, radio broadcaster Neil Prendeville "still doesn't really watch rugby any more".
"But I could never have asked Luke to give up, nor would I have wanted him to," she explains. "The positives of sport - working as a team, seeing the greater good, the bigger picture and the friends he made - have benefited him and made him the person he is today. What he's gained far outweigh that incident.
"It was an awful dreadful thing to go through, and it's important that safety always comes first, but it would really bother me if I thought any school was going to stop playing sport because of the fact that it could be dangerous."