As medical revelations shine a spotlight on the lasting effects that traumatic brain injuries have had on professional athletes, Plano ISD trustees are asking themselves one question: How can the district update its procedures to better handle student concussions?
The improvements that trustees have already implemented—hiring more trainers, educating coaches and teachers and providing consistent communication with parents—have been drafted above the minimum standards outlined in Texas law.
Other than requiring that districts form a concussion oversight committee and develop a recovery protocol for students, Texas law does not provide specific guidelines for districts in reporting and monitoring concussions, a University Interscholastic League spokesperson said.
Armed with reports compiled by district staff and a health committee, PISD trustees still want to invoke more meaningful change in the district’s current concussion procedures. Trustees have openly discussed expanding a testing service that monitors the progress of student-athletes’ concussion recovery to all students—regardless of whether they participate in UIL athletics.
Dr. Martha Grimm, the medical director of the Texas Health Ben Hogan Concussion Center Plano, has commended PISD for educating staff on the importance of keeping concussed players off the field. In the district’s efforts to better record and track students’ recovery progress, records obtained by Community Impact Newspaper show that 174 students entered concussion-recovery protocol in the 2016-17 school year, and 402 entered protocol since the 2015-16 school year.
“We’re really trying to tackle the whole process—from prevention to an injury to recovery to getting [the student]to the classroom,” PISD board President Missy Bender said.
Districts like PISD design their procedures and make accommodations for students in accordance with a 2012 Texas law, UIL spokesperson Kate Hector said. That law mandates that each district forms a concussion oversight committee and implement return-to-play protocol, but the UIL lays out the framework for return-to-play.
“The return-to-play is designed by UIL, so there are definite benchmarks or procedures that the school would go through for students to return to play,” said PISD spokesperson Lesley Range-Stanton, who also serves on the concussion oversight committee.
For students who have sustained a concussion to return to the playing field, they must first consult a physician to be cleared to begin the district’s return-to-play protocol, according to a PISD athletics department document. Once cleared by a physician, the student will begin partaking in guided physical activity of varying levels of intensity before they can return to game participation.
But returning to the classroom works a little differently.
“Return-to-learn doesn’t mean return-to-play, necessarily,” Range-Stanton said. “[Return-to-learn] is just what can be done to ease the students back into the classroom after injury.”
Students should still take their time in the return-to-learn procedure before beginning return-to-play, said Grimm, the medical director at Texas Health.
“To me, they have to be symptom- free and able to be back at school getting their normal grades before we start return-to-play,” Grimm said.
And as part of their efforts in helping students transition back into the classroom, PISD staff is trying to strengthen the awareness of what concussion symptoms look like, Assistant Superintendent for District Services Kary Cooper said at an Oct. 3 school board meeting. Cooper said educating people about the symptoms of concussions is important because, unlike other physical injuries like a broken limb, concussions are less visible.
“The dominoes can start to fall and the things can be put in place for that student for whatever accommodations need to be made, individually. [The accommodations] are all going to be different based on the grade of the concussion,” Cooper said.
Although developing a return-to-learn protocol is not mandated by state law, the district is still seeking other ways of improving its existing guidelines for handling incidents of student concussions.
Trustees pushing for more
As part of a series of recommendations brought to the table by PISD’s student health advisory committee for the 2017-18 school year, the district has moved forward with two additional updates beyond developing the return-to-learn protocol.
The district has hired six new athletic trainers to be staffed throughout PISD high schools, and has expanded concussion education to now include coaches, nurses, teachers, parents and students. Part of that education includes recognizing concussion symptoms.
Grimm said concussion symptoms typically include headaches, dizziness, irritability and sensitivity to light and sound.
Bender, the board president, said one of her desires is to revamp the way the district communicates with parents of children who have sustained a concussion.
“Are we doing all we can in that process to make students, teachers and parents aware of how that process works so they know what to expect?” Bender said. “As [parents]are experiencing this process for the first time—it’s not something they invited into their lives.”
Trustees have also discussed offering a concussion baseline test—a test that student athletes take once in the preseason and again if they are suspected of having sustained a concussion—to all students.
Bender said she is willing for the district to pay for a baseline test for the students who do not participate in UIL activities, but who may want the test.
But for district staff to provide the necessary accommodations for a student, including baseline testing and putting them through the return-to-learn protocol, they first need to know that a concussion took place. Bender said that is something the district is still working on.
“We just have to have staff members informed about what to look for because the triggers might not all be the same,” Bender said.
Not all concussions are sustained through participation in athletic events.
Former PISD trustee Carrolyn Moebius said her daughter sustained a particularly serious concussion in a non-sports related event in October 2016. Moebius continues to advocate for greater accommodations for students who have sustained concussions and better training for educators to recognize telltale concussion symptoms.
The uniqueness of each child’s recovery process and the difficulty of getting them back in school is something Moebius said she has become familiar with. Now over a year since her daughter’s concussion, Moebius said they are still dealing with the recovery process.
“From the end of October to right before spring break in March, we were trying to get her to be able to stay a whole day in school, and it just wasn’t working,” Moebius said. “She would call me maybe after two hours of school, and I would have to go get her.”
Moebius said her daughter received accommodations during the hours that she was able to attend school: constant access to the nurse’s clinic, permission to wear sunglasses in class and extra time for testing in a secluded room.
But with her history as a PISD trustee combined with her experience as the parent of a child who sustained a serious concussion, Moebius said she still sees areas where the district has room to improve.
“We know enough now that school districts in particular and athletic departments need to be better about learning what they need to look for. Because a kid, especially an athlete, is going to tell you, ‘Oh, I’m fine,’” Moebius said.
Of those athletes who have sustained concussions, the concussion records provided by PISD revealed that nearly half of all 402 sports-related concussions since the 2015-16 school year were sustained by football players. Basketball was the second-highest contributor at 15 percent of all concussions, followed by soccer at 11 percent.
And those numbers just reflect the cases that have been documented. Grimm said she suspects there are likely concussions that go unnoticed.
“We are probably only seeing the tip of the iceberg. Probably most people get concussions, and either A, we don’t recognize, or B, they minimize it because they don’t want to stop doing what they are doing,” Grimm said.
Bender acknowledged how it can be difficult for parents of injured students to not have a process in place for communicating with the district after a concussion.
“That’s frustrating. That’s upsetting to the whole family, and we can do a better job of laying out the process,” Bender said at the Oct. 3 meeting.
Still, Grimm said PISD is making meaningful progress in recognizing the seriousness of head injuries.
“Plano ISD has done a wonderful job of making sure that all the coaches and athletic trainers and even the parents are getting educated,” Grimm said. “If [the players]don’t feel right, or something feels off, they keep them out of the remainder of the game in order to have them evaluated.”
While trustees and staff members continue to hone their procedure in aiding students and their parents in the wake of a traumatic brain injury, Moebius points to resources that are already available in the community as reference material.
“I know schools are responsible for so much in a kid’s life, but there is enough good material out there that just having one sheet that the Ben Hogan Concussion Center already has drafted would be wonderful,” Moebius said.