Q&A: Dr. Utpal Patel on concussions in sports

By Greg Pogue, For The Daily News Journal - published November 28, 2015

Link to article: http://www.dnj.com/story/news/2015/11/24/q-dr-utpal-patel-concussions-sports/76333130/

MURFREESBORO — For more than 13 years, Murfreesboro physician Dr. Utpal Patel has been a team doctor for MTSU athletics in general and the football program in particular. He has been instrumental in developing the athletic department’s concussion protocol and management policies.

The policies come as national awareness for concussions in athletes has risen dramatically in recent years. It is estimated that anywhere from 4 to 5 million athletes at all levels of competition — from the pros to colleges to high schools to middle schools to youth sports — suffer concussions during competition.

The policies arrive squarely with mainstream awareness earlier this year when a collection of 5,000 former NFL players won a $1 billion settlement against the NFL because of its handling of concussion prevention, awareness, diagnosis and treatment.

A new major motion picture titled “Concussion” starring actors Will Smith and Alec Baldwin chronicles the findings about CTE — chronic traumatic encephalopathy — in NFL players and the league’s actions and will be released Christmas Day.

Two years ago, the Tennessee Senate unanimously passed a bill sponsored by State Sen. Jim Tracy that would provide protection for youth athletes who suffer concussions by preventing them from returning to play until cleared by a doctor.

Dr. Patel has been a strong proponent of local implementation of ImPact, an online and immediate post-concussion assessment and cognitive test that is the most widely used and most scientifically validated computerized concussion evaluation system available.

ImPACT provides trained clinicians with neurocognitive assessment tools and services that have been medically accepted as state-of-the-art practices to determining safe return to play decisions.

Recently, Dr. Patel sat down with DNJ sports guest columnist Greg Pogue to discuss ImPact, the concussion program for MTSU athletics and the current and future state of concussion prevention, diagnosis and management on a variety of fronts.

Here is their discussion:

What exactly is ImPACT?

Patel: ImPACT is the online neural cognitive testing. It was first put together in the 1970s by neuropsychologists. They wanted to find some way to better have objective testing for athletes, using it as baseline testing. Then when somebody has a concussion to assess them — not to diagnose a concussion, but to better assess their symptoms and what deficit they might be experiencing with a concussion. And then as we follow these athletes — and also for non-athletes — through their management of their concussion, we can see how well they are improving. Part of it is used to return to play and for managing their concussion episode.

How does it work?

Patel: It’s a (program) on a computer, and it takes about 20 minutes to perform. … It goes through about four or five different brain functioning assessments on the computer. So, you are assessing visual memory. You are assessing reaction speed. You are assessing verbal memory. It’s almost like taking the ACT, but you are assessing different components of the brain. Each segment takes about five minutes or so. Once you finish it, you have a composite score. Like with any test, there are some limitations. You have to go through training for that, and then you can use that score compared to a normative data base and then compare to that athlete one week later or two weeks later.

I understand that trainers, coaches, parents, athletes, everybody can use it so they can have that access to ImPACT. How do you get that access?

Patel: The schools, professional organizations, that purchase the program have access to implementing it in their institutions. So, physician offices can purchase the program and provide it for their students that come in, their athletes that come in. MTSU has it. Sewanee has it. All the NFL and Major League baseball teams, NASCAR, they all have it. So, they implement it, and they do it as preseason baseline testing. Most of the (Rutherford County) high school athletes go through that testing as well. Athletic trainers at the high schools will implement that test. And then when the athlete has a concussion, the physician that is managing that athlete will say, “You should have an ImPACT test done within 24 hours or one week later.” So, they work with the athletic trainers in managing that athlete.

Who developed IMPACT?

Patel: Mark Lowell was the main person in charge of it in the '70s. It actually began because Chuck Noll, the Pittsburgh Steelers coach, wanted to have some sort of objective way to assess the football players when they were concussed or had symptoms of a concussion. It began at the University of Pittsburgh.

Did it take NFL players and their collective lawsuit against the NFL to garner the first national awareness of concussions in athletes?

Patel: I think so. I think it began when you had some very unfortunate and tragic cases where the players had died and then the pathologists did the autopsies. They found CTE cases, and that’s when it led to other athletes coming forward with their concussion symptoms. Realized that it was more problems than what they had thought it was. And so, it got more people behind the educational process and the training process, and the awareness increased. As they talked about it, then yet other sports programs — NASCAR in particular and Major League Baseball and now (youth) soccer — it sort of trickled down into high school athletics and soccer. Pretty soon, I think you will see it at the (youth) travel (teams) level. It’s not hit quite there yet. But you see a lot of these organized sports that don’t have the level of supervision being affected.

You are a team physician for MTSU football in charge of concussion protocol. When you are on the sideline during a game, what are you watching?

Patel: We have to watch every play, and it’s oftentimes easy to see an athlete who comes off (the field), and they are shaking their head, or they have been down on the ground, and they take a few extra seconds to get up, and they are walking a little bit staggered. That sometimes is easy. But we have to watch for the athletes with more subtle symptoms. They have been hit, and you can feel or hear that impact, and you have to watch them for the next play, and you have to watch them coming off to the sideline. Sometimes even whey look fine, we will go up to them and talk to them and assess them. Often times, they won’t have concussions, but we have to be pre-emptive and talk to them and make that initial assessment.

How long have you been working on the implementation of the concussion protocol at MTSU?

Patel: The concussion part, we really started implementing that about six years ago. And every year, it has involved; it has improved. We meet with the trainers. We do it for all the athletic programs. I work now with Sewanee as well. I see a lot of high school and middle-school athletes as well.

The Southeastern Conference has a person independent of the teams to assess possible concussions during games. Do they have that in Conference USA?

Patel: There is in the SEC. There is in the Big Ten (conference). … They had that when (MTSU) played at Illinois. We were given the option of opting in and using their doctors, but Conference USA does not.

During a game, how difficult is to go to MTSU coach Rick Stockstill and take out a key player during an important part of a game? You have to have that relationship with him that he trusts your decision.

Patel: Absolutely, and we are fortunate at MTSU. There is an incredible group of coaches. Their priority is to take care of their athletes from not only an academic and athletic perspective but also from a health perspective. Any coach would want their star athlete and their best athlete to play, but if I were to go and tell them that this athlete — whether it is the starting quarterback or the starting running back — cannot play, I believe they would trust my decision.

Are the athletes being better protected with their equipment? Are they being taught to perform safer when it comes to concussion prevention?

Patel: The key thing is the techniques that are taught differently in tackling and blocking. The (game) penalties that are sustained from those type of tackles and blocking, it makes that athlete think differently about doing that, so they are less inclined to do that now. But the flipside of that is: are they going to have other types of injuries because they are not tackling the way they were tackling. Are they going to have ankle or knee injuries? That is for someone else to make that decision. But I think they are learning differently.

How far are we off in the overall concussion process to where it needs to be?

Patel: I think we are probably in the first few innings of this ball game. Our protocol and policies at MTSU have evolved so much. It looks so much different now than what it was even two or three years ago. I think the research and science is changing; finding objective ways to diagnose it is changing. The management part of it is changing. For example, we are being more aggressive with how the athletes return to learn, which is getting them back into the academic part of it, getting them accommodations from their education and their studies in the classroom. That’s something that has really become more mainstream the past year or so and that will look different a year or two from now. We tend to rest athletically and physically, but we have them resting academically and cognitively. We have learned more about that. So, we are just in the first few stages of this process. … What I hope to see also is that we improve concussion management in the county for middle school and high school athletes. I think there is a lot more things to be done here. There is a lot of outreach that we have to do for the trainers. We have a wonderful group of trainers that go out to all the high school games and put a lot of time and effort and work into it. We have to outreach to the coaches locally. I think that Mr. (Tim) Tackett, the director of (Rutherford County schools) athletics, does that. There is more that probably can be done. We also have to educate our parents and the physicians. Again, we are in the first part of this game — the learning part of it, the education part of it — where we know now is much different than what we knew a few years ago. So, we all have to do better.

Greg Pogue is host of The Greg Pogue & Big Joe Show on WNSR 560 AM. E-mail him at grpogue@gmail.com and follow on Twitter @ThePoguester.

Meet Dr. Utpal Patel

Age: 49

Family: Wife Tina; son Eshan, 15; daughter Mira, 12

Education: UT-Martin, B.S. Biology , 1988; University of Tennessee Health Science Center, Memphis, Medical Degree, 1992; Internship, 1992-93; Residency 1993-95

Professional Affiliations: Tennessee Medical Association, American College of Physicians, American Society of Internal Medicine

Civic Organizations: Physician Excellence Committee of Saint Thomas Rutherford Hospital, Blue Raiders Athletic Association, Stones River Regional Independent Physician Organization

Hobbies: Landscape gardening, travel, basketball, tennis and reading