Enhanced Safety for Rowing with Epilepsy

More and more people are rowing with epilepsy and the adaptive rowing community has been supporting this growth with intensified information to help row safely. British Rowing relatively recently updated its guidance on rowing with epilepsy. A special interest sub-group to the Community Adaptive Group has been set up for “Rowing with Epilepsy” (email me if you would like to join the sub-group) to share ideas and support.

Some athletes row in crew boats with other crew members there to stabilize the boat and help them in the event of a seizure. This mitigates the risk of capsize. Some athletes row with adaptive squads at clubs where they can get special safety cover and support, especially if they want to row in a smaller boat like a double scull.

Marlow Rowing Club currently has 3 members of its adaptive/pararowing squad with epilepsy who have suffered seizures in the past year. One member suffered a couple of seizures in the gym during the winter land training season, which raised concern about whether the conventional protocol was sufficient risk management. So, the adaptive coaching squad conferred with two experts in epilepsy (both senior professionals at the Epilepsy Society) and also the rowers themselves.

The result was the “enhanced protocol” shared below. It is “enhanced” because it goes beyond the official advice of British Rowing; but not all aspects should be considered appropriate for all athletes in all situations. Probably the key consideration with athletes who have epilepsy is how much the condition varies in both frequency and (more importantly) severity/nature. The MRC has been applying may of these measures since it resumed water training in March, learning and further refining them. As it happens, one of the athletes did suffer a seizure on the water just this past weekend, and the situation was managed very effectively applying the protocol.

SEIZURE RISK ASSESSMENT

At the heart of the concern lies the question of how one can determine the following risks to the athlete:

• Risk of capsize – One can never fully eliminate the risk of capsize (eg.  a wayward cruiser could always run your boat over).  Adding lots of capsize mitigation measures is untenable in practicality and cost, and it dramatically reduces the satisfaction of the participation. For example, in addition to the standard safety floats we use, the coaches proposed crafting a special outrigger for maximum stability, but it would have expensive, awkward to use and reduce the boat movement. Mitigation: See section on capsize risk below.
• Risk of falling out of the boat – My coaches were quite concerned about this eventuality and proposed putting netting up on the riggers to try to catch the athlete.  From my experience and investigation, the risk of falling out of an upright boat is minimal.  The vast majority of individuals would fall backward whilst experiencing a seizure in a seated position. Mitigation: Support rower providing stability from behind.
• Risk of drowning – Risk of drowning is inherent in all water sports. The standard BR advice requires individuals who have suffered a seizure within the last 12 months to wear an auto-inflate life jacket. We wanted to give some consideration to the possibility that, even with a life jacket, seizure could result in an individual’s face in the water and risk drowning. Mitigation: Support rower will be in the water with a capsized individual suffering a seizure to assist that individual if their face is in the water despite their auto-inflate life jacket (which should generally position the person with head about water).

Adaptive sport is athlete-centric, particularly for individuals with epilepsy. There are 13 specific types of seizures that have been identified by the medical community. Furthermore, presentation doesn’t just vary from person to person. Presentation can vary within individuals, as well. Nonetheless, with that caveat, it is still useful to understand how the condition typically presents for each individual to be best prepared. The chart below outlines the most common types of seizures and their impact on rowing (Note: This table is a considerable simplification intended to provide people with an overview of the variations in presentation and possible impacts. This table can help guide an initial conversation with the athlete to better understand their condition, but the details will likely be more complicated).

* Risk Mitigation in addition to (a) auto-inflate life jacket use, (b) limitation to crew boats, and (c) support rower awareness of the condition and readiness for possible seizures, how they will present, and how to steady the boat in such an event.

CAPSIZE MITIGATION

Despite all reasonable efforts to prevent a capsize, such an event is always possible.  Marlow Rowing Club considers that the following 3 measures are appropriate to mitigate the risks inherent in the event of capsize:

• Wearing an auto-inflate life-jacket.  This is the primary risk-mitigation to drowning if an athlete falls into the water.
• Rowing in a crew boat (minimum 2 rowers) to provide a support rower who can assist the athlete in the water in the event of a capsize.
• Safety Launch coverage within 50 metres of the boat and the athlete with epilepsy being the primary (though not necessarily the only) focus of the launch.

CAPSIZE PREVENTION

In addition to these measures, MRC has implemented the following added risk mitigation measures as part of its standard practice:

• Wider Adaptive Boat – When feasible, the squad uses one of the wider adaptive boats for an athlete with epilepsy to provide extra stability in the event of a seizure.
• Extended Safety Floats – When feasible and appropriate, the squad uses extended safety floats on boats for an athlete with epilepsy (PR1 Angled Bracket – Adaptive Rowing UK).
• Presentation-Specific Measures – Epilepsy presents in a variety of manners and severities.  While epilepsy presentation can change at any time, past experience is a strong indicator of how any seizure might present in the future.  Certain seizures (eg. Focal) might require only moderate mitigation, while more severe forms (eg. convulsive clonic or tonic/clonic) would require advanced mitigation (and possibly exclusion from water rowing). Marlow RC will introduce added mitigation measures for athletes who report historically more severe seizure patterns.
• Seizure Support Protocol – We have done a number of practice sessions and drills to train support rowers in seizure response (see photo below).  Our three athletes concerned present with (a) tonic and atonic seizures (which means they stiffen/collapse), AND (b) they experience a warning aura (sensation) prior to seizure onset.  The Seizure Support Protocol we have devised has proven in drills to be straightforward, and to provide a high degree of boat and athlete stability.
  • Athlete informs support rower about a possible seizure onset.
  • Support Rower comes up slide, securing blade handles by tucking them between knees and chest.
  • Athlete reclines back to rest on the Support Rower’s shins and the Support Rower secures the Athlete by holding their shoulders.

This protocol is demonstrated in the video at the bottom and was actually applied just this past weekend when one athlete suffered a seizure on the water. He said, “I think I’ll lie back” and the support rower steadied the boat and supported him as he reclined during his seizure, which lasted less than a minute.

A high-level flow chart of the risk-assessment process is provided below as a starting guide: