Increasing numbers of teenagers suffering from chronic brain injuries linked to concussion are being seen at the National Rehabilitation Hospital (NRH) as concerns grow over a lack of rigid concussion safety protocols in schools.
Dr Sarah O'Doherty, Clinical Paediatric Neuropsychologist at the NRH, is concerned the "fractured management" of concussion injury in schools and sports clubs is allowing some "chronic" cases to go "unnoticed or unreported".
Although it is common to suffer problems with memory, concentration and dizziness after a concussive injury, the small number who suffer "persistent and worsening" symptoms has increased by 50pc at the NRH - most of whom were involved in rugby or football clashes.
Ten teenagers were treated for lingering symptoms of concussion - including memory loss, fatigue, low energy and chronic headache - at the NRH in just two years, new figures reveal.
The hospital, which provides specialist rehabilitation services to patients with a physical or cognitive disability due to accident or illness, say this is a significant rise in medical referrals.
"Where symptoms persist there needs to be greater clarity around how to access appropriate services and greater investment in developing dedicated specialist multi-disciplinary services to meet this increasing need," Dr O'Doherty told the Sunday Independent.
And these "chronic" cases are thought to be just the tip of the iceberg of sports-related concussion cases involving schoolchildren reporting head injuries to A&E departments, GPs and private hospitals across the country.
St Vincent's Hospital in Dublin confirmed there has been a growing number of young people presenting with concussion.
Reports of concussion in Gaelic football and hurling, camogie and basketball and other field sports are also being registered for the first time at St Vincent's.
Most of those presenting at the NRH and St Vincent's were aged 14 years and over and are from both sexes.
Greater public awareness around concussion is a major factor in the increase in reports, but medical experts this weekend appealed for a more uniform approach to school guidelines.
"I think there is a much greater awareness. Some people are looking out for symptoms and are quicker to ask for help," said Dr O'Doherty.
Although she said she was encouraged by national and political discussions on concussion, she said more concrete action was needed. "There needs to be a protocol as to what happens in all cases. I know there are guidelines about returning to play, but it would be better if that was a sort of uniform regime across the country," she said. "Schools need more information, with a cohesive plan around educating parents, children, teachers and coaches."
Although concussion-management guidelines are available from the IRFU and the GAA, it is unclear how many schools have adopted them.
The Departments of Education and Transport, Tourism and Sport were unable to provide this information.
However, the Department of Health revealed it was discussing plans for an awareness campaign for schools in conjunction with the Department of Education & Skills. A spokesman for the Department of Health said: "This would look at all areas where concussion can occur during activities in a normal day in a child's life. It is important that we describe concussion as it is in order to convince everybody of the severity of the problem."
A spokesman for the Department of Health also said it was studying the recent report from the Joint Oireachtas Committee on Health and Children on concussion in sport. One of the main recommendations is that the Government considers establishing a Task Force on Sports Concussion, which would comprise a broad membership consisting of relevant government departments and sporting bodies.
Although the NRH and St Vincent's Hospital figures are not reflective of the number of concussions that actually occur, they both stressed that concussion is mild traumatic brain injury which needs to be recognised and acted upon immediately.
"The word 'mild' does not suggest that it is a lesser type of brain injury than a severe or moderate one. Even a tiny thing like not being able to sleep can have a devastating impact," said Dr O'Doherty,
Lingering symptoms can, without intervention, last indefinitely.
Despite awareness measures from sporting bodies and star athletes, Dr O'Doherty feels some areas are being overlooked.
"The psycho-social aspects of a child not being allowed to play sports again for a year or longer can cause anxiety, leading to a decline in overall school performance," said Dr O'Doherty, who provides her patients with education and skills to enable them to function as independently as possible.
"Most people walk away, but we really are at the point where we don't know the lasting impact of consecutive, accumulative, mild traumatic brain injury," she said.
Professor John Ryan, consultant in emergency medicine at St Vincent's Hospital, said: "I am starting to see concussion in GAA, camogie, hurling, basketball - sports we wouldn't have really seen that much in previous years," he said. He equated the rise with more awareness of concussion.
Prof Ryan also commended the proactive work and courses offered to schools by the IRFU, particularly around "return to play and SAFE-Rugby courses.
"It would be great to see transition-year students undergo the programme and then cascade this down to younger school students," he said. "It would be good if all sports could adopt the same approach," he added.
However, he suspects some schools may "lag behind others" in implementing change.
"Like all things it is unfortunately difficult to completely change a culture overnight," he said.
Although Prof Ryan was encouraged by the Government's recent report on concussion in sport, he said: "It would be helpful to see some funding for ongoing research in this area".
That view is shared by Dr Barry O'Driscoll, who is a first cousin of the father of Irish rugby legend Brian O'Driscoll.
"A consistency is needed across all sports and guidelines should be in every school and there should then be a route to a concussion clinic for the child who doesn't recover exactly according to those guidelines," said Dr O'Driscoll, who added that Irish schools should adopt a management model similar to that in the US.
"The awareness culture has to spread now and schools are the place to really do it".