Tracking concussions could lead to safer sports for Texas student athletes

UIL partners with hospitals to create first of its kind concussion study

SAN ANTONIO – Big hits are a big part of the action under the Friday night lights, but just how many of those violent collisions result in traumatic brain injuries?

The answer may be surprising: No one knows.

But the KSAT-12 Defenders have learned that the state of Texas could be the first in the nation to establish its own concussion research database to find out. In 2011, Texas legislators passed House Bill 2038, known as Natasha's Law, which established a statewide concussion protocol to be followed by all schools.

"What that specific law did was require every school district to adopt a concussion oversight team. The concussion oversight team has one charge — to develop the return-to-play protocol for any student suspected of having a concussion." said Jamey Harrison, deputy director of the University Interscholastic League, which oversees most high school sports in Texas. "If they suspect a student has suffered a concussion, the student must be removed from play and go through the return-to-play protocol before they can re-enter play."

Clark High School football player Michael Oliver went through the protocol when he suffered a concussion during practice last year.

"I knew as soon as it happened, because I felt it," Oliver said, recalling about the hit.

Oliver said he knew instantly something was wrong, so he went to the sideline and told a coach, who then sent him to see a team trainer. The trainer pulled Oliver from practice and told him he needed to see his personal physician to be evaluated for a concussion.

Oliver's doctor, Evan Ratner, diagnosed him with a concussion and ordered him to rest his brain, removing him from school for a few days and ending his football season.

"I wasn't allowed to use electronics or drive," Oliver said. "It was constant pain. My head hurt all the time."

According to numbers provided to the Defenders by several local districts, Oliver was just one of several hundred student athletes to suffer a concussion last year.

Northside ISD provided the most detailed numbers, offering up to two years worth of concussion injury data kept by district trainers.

The numbers revealed 527 concussions were logged by the district's high school and middle school student athletes, 230 were suffered by football players, while girls soccer had the second most concussion injuries with 85.

The numbers may seem high but not when you consider how many student athletes participate in NISD's sports programs.

"We're around 1.6 percent to 2 percent out of 14,000 athletes, and that's middle school and high school," said Paul Rost, coordinator of NISD's Athletic Trainers. "They (numbers) pretty well stay the same. We'll have years just like any other injury or sport where you'll see years that you have a lot of knee injuries or ankle injuries the next year, it goes up and down."

Rost said any student suspected of having a concussion is immediately pulled from the game or practice and placed into the state mandated five-day concussion protocol established by Natasha's Law.

"Once we are told that they have a concussion, we have to get the doctors note. We hand them the form and they have to go through our protocol before they can go back on the field," Rost said.

Even if a doctor finds the student didn't have a concussion, they must still wait five days to return to play.

NISD takes it a step further when it comes to middle school athletes, requiring those students to sit out at least eight days.

"Mainly because if you get a concussion and the symptoms reoccur during your evaluation period, you have to go back to the doctor. So we just wanted to give those middle school athletes a little more time. Younger brain, a little bit more time to heal up," Rost said.

In addition to establishing the concussion protocols, the UIL was the first organization of its kind to also set limits on full contact practices to reduce concussions. Texas schools are limited to 90 minutes of full contact practice per player per week. Even with those measures in place, some feel the UIL could do more to reduce the impact of concussion injuries in the state.

Since 2011, the UIL has been collecting information on concussion injuries as part of its injury reporting system, but it only included a handful of schools and only for concussions that occurred on the football field.

"Right now, our injury reporting is only a sample of schools. It is not a scientific study. It was never intended to be a scientific study. It merely provides a snapshot of data," Harrison said. "It sounds very easy in the general public to say you should collect concussion data, but just knowing that someone was concussed or suspected of having a concussion doesn't do us much good. It has to be a scientifically based study and we're not a medical research institution."

That's why the UIL is now partnering with the University of Texas Southwestern Medical Center and the Texas Institute for Brain Injury and Repair to launch the first comprehensive study of sports-related concussions called ConTex. For now, the study is a voluntary pilot program, but Harrison expects that to change.

"Our hope is that for as early as next school year, it would become mandatory for all schools to report suspected concussions to that registry through their module for every sport," Harrison said. "That would include all sports, boys and girls, sub-varsity and varsity. So it would be a very comprehensive data collection and simply the most comprehensive model in the country. Concussions are a problem in every single sport, even swimming and diving," he said. "Every sport we have, there is a concern about concussions. And how to go about addressing those concerns may differ from sport to sport, but we have to get that information so we know how to move forward."

Harrison said the UIL hope the study will help them identify best practices that can be applied to reduce concussions. It could potentially identify what some Texas schools are already doing well that could be shared with other with schools in the state, such as teaching different techniques and identifying which schools are doing a better job of returning students to play after a concussion with less instances of reoccurrence.

"Ultimately, what we hope to do in getting the information back from those medical researchers is to make the games we provide as safe as they possibly can be," Harrison said.

Ratner said one thing schools could start doing in the meantime is requiring student athletes to undergo baseline concussion testing prior to starting their sport each season.

The computer program Ratner uses puts the athletes through a series of tests and creates a score that can then be used to evaluate a student after suffering a concussion.

"Everybody's baseline concussion testing is unique. It's not an IQ test. It doesn't tell me how smart the person is. It doesn't tell me how good of a student they are. But different people think differently and their brains react differently and their reaction time is different," Ratner said. "So what may be a normal baseline for someone, might represent an injured brain for someone else. I can compare someone not just to age and gender controls, but I can compare them to themselves."

Ratner said having the baseline test can help determine when an athlete has recovered from a concussion, allowing a physician to clear them for return to play when their bodies are actually ready. He said the danger of returning a student to play too soon could have long term effects.

"Until a concussion is healed, the threshold for re-injury is much lower. So if they're back to their routine activity and they're taking big hits, every single one of them exceeds the threshold. Every single one of them is going to make things worse," Ratner explained. "And by worse I mean more severe symptoms, symptoms that last longer even potentially permanently and in pretty rare conditions you can get something called second impact syndrome which is unfortunately even fatal."

When it comes to creating a statewide concussion database and clinical study, Ratner believes the UIL is taking a big step in the right direction.

"We still don't know exactly who's going to have long-term effects and who's not going to have long-term effects. So, by gathering the data and gathering this information it will really help us determine over the long-term who's at higher risk for chronic injuries over many, many years," Ratner said. "If we can keep track of concussions well it gives us an idea of really the scope of the problem and what we'll come to realize is we're not doing enough for them in San Antonio and we need to increase what we're doing, including adding the baseline concussion studies."


Interactive Map- https://www.thinglink.com/scene/834916583036944384

Natasha's Law- http://www.uiltexas.org/files/health/UIL-CMP-FAQ-Resources.pdf

UIL- http://www.uiltexas.org/health/concussions

ConTex- http://www.utsouthwestern.edu/research/brain-injury/research/con-tex.html

Dr. Evan Ratner- http://iuc.nextcare.com/plan-your-visit/services/concussion-care/

KSAT Digital Team Story on Concussion Helmets- http://www.ksat.com/sports/big-game-coverage/tmi-thinks-outside-helmet-to-soften-effects-of-football-injuries-concussions

Web Extra Videos: 

1.) UIL Deputy Director Jamey Harrison: "Advice for Parents"

2.) Paul Rost, NISD's Coordinator of Athletic Trainers: "How NISD Handles Concussions"
3.) Dr. Evan Ratner: "How Baseline Concussion Testing Can Help Athletes"    


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