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term effects. The league will maintain an updated list of individuals and organiza- tions authorized by UIL to provide the training.


The law says coaches and health care


professionals who are on a concussion oversight team and who either volunteer or work for the school district must take a training course at least once every two years.


The DSHS Advisory Board of Athletic


Trainers is responsible for courses for athletic trainers.


Out with old guidelines According to Dr. Spinks, a panel of in- ternational experts developed the most authoritative consensus statement on concussion and presented it at the 3rd International Conference on Concussion in Sport held in Zurich in November 2008. The panel recommends a multi- disciplinary treatment team develop in- dividualized return-to-play and return- to-school guidelines for each patient, he says. The Clinical Journal of Sport Medi- cine published the consensus statement in May 2009.


“House Bill 2038 was clearly written with this plan in mind, and for that rea- son, it is laudable for promoting state-of- the-art management over older, ‘rule-of- thumb’ type guidelines,” Dr. Spinks told the House Committee on Public Health in March. “However, our understanding of concussions is still evolving and has changed markedly over the past several years. Because of this, one of the great- est challenges at the state level is to cre- ate a system that is flexible enough to incorporate new scientific guidelines as they develop.” A big shift in concussion manage- ment occurred about seven years ago, Dr. Spinks says. A study published in the January 2004 American Journal of Sports Medicine by the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program found the injury grading scales and return-to-play guide- lines for mildly concussed high school athletes allowed them to return to play too quickly and increased their risk of additional injury. Past guidelines permitted athletes whose on-the-field symptoms vanished


40 TEXAS MEDICINE September 2011


within 15 minutes to return to play immediately. In a study of 43 mildly concussed athletes, UPMC researchers discovered that in all but four athletes, memory decline and/or other symptoms continued for days following the game in which they were injured.


Other studies on concussion show athletes can generally recover from mild concussions when their brains have time to heal before playing contact sports again. That first concussion, though, makes an athlete prone to more serious brain damage and reinjury, studies say. “Concussions, even if they’re mild, have lingering neurocognitive effects on student athletes,” Dr. Spinks said. “Sub- sequent studies have revealed that kids seem to recover more slowly from con- cussion than adults, and we don’t know why. We’ve also learned that loss of con- sciousness associated with a concussion, although important, is not the greatest predictor of recovery rate.”


New law protects athletes Jason Terk, MD, chair of the TMA Coun- cil on Science and Public Health and a Keller pediatrician, says primary care physicians who treat school-age patients are typically familiar with sports-related concussions. He says health care profes- sionals now understand a concussion is a potentially serious traumatic event to the brain. Strong scientific evidence supports a


standardized approach to the care of ath- letes who experience concussions, says Dr. Terk, who was a member of the TMA committee on concussions. “Patients who have this kind of injury commonly experience headache, nau- sea, and a clouded sensorium that can last for days, even when no loss of con- sciousness occurs at the moment of im- pact. This can have an effect on patients’ ability to perform tasks when working or attending school and can affect how they respond to others around them,” Dr. Terk said. Dr. Spinks is all too familiar with the short-term health effects of concussions in children. He serves as codirector of the Dell Children’s Medical Center and Seton Healthcare Family Concussion Pro- gram.


“I see a lot of kids who haven’t been


treated appropriately and in whom con- cussions haven’t been recognized. Many times they don’t realize they have a con- cussion. Their symptoms include poor academic performance in school, daily headaches, light or noise sensitivity, nau- sea, balance problems, or dizziness,” he said. Dr. Spinks hopes Natasha’s Law will facilitate proper assessment and treat- ment of concussions in Texas student athletes.


“Because some athletes don’t know


they’re concussed, they’ll keep partici- pating in sports or other activities and reinjure themselves. It’s very dangerous. In severe cases, they can wind up uncon- scious and on a ventilator,” Dr. Spinks said. Representative Price says “Texas’ stu- dent athletes deserve better protection.” Before Natasha’s Law, Representative


Price explains, state law protected only those student athletes knocked uncon- scious during practice or a game. Under previous law, an athlete knocked out during practice or competition could not return to the sport until being medically evaluated and cleared by a physician’s written authorization. “While that is sound practice, the law did not require intervention when an athlete suffered a concussion but did not lose consciousness,” Representative Price said. “This was troubling to me given that medical statistics reveal the overwhelming majority of athletes who sustain concussions do not present in an unconscious state.” With passage of HB 2038, he says, all student athletes suspected to have sustained a concussion now will re- ceive timely medical evaluation and be cleared by a physician before they can resume play. “Quite simply, I believe this protocol will save lives,” Representative Price said.


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