Neurocognitive Testing for All Student Athletes

March 26, 2013

The Honorable Eddie Lucio III
PO Box 2910
Austin, TX 78768

RE:  Opposition to House Bill 68

Dear Representative Lucio:

Thank you for your leadership in promoting the health and safety of young Texas athletes. Participating in physical activity and organized sports is an important factor in a healthy lifestyle. Texas physicians share your concern about sports-related head injuries.

During the interim, our physician leaders continued their investigation into the science behind student concussions. We found there isn’t sufficient evidence at this time to recommend widespread baseline neurocognitive assessments for student athletes as proposed in House Bill 68. Although some school districts are conducting baseline testing, the Texas Medical Association and the Texas Orthopaedic Association do not believe there is proven scientific evidence to require this standard for ALL school districts.

We recognize the serious risks concussions present to adolescents, and we will continue to monitor emerging research on concussion management. While available data have helped identify neuropsychological testing as a potential tool in concussion management, these data also identify research gaps on best practices. More data are needed to identify whom to test, which instruments are most effective, and the role of these assessments and tools in concussion management and prevention. 

We have concerns surrounding the implementation of any baseline assessment program. These include barriers such as unavailability of trained professionals, costs for the athlete, and lack of insurance payment.

TMA has highlighted the issue of sports-related head injuries through the creation of new education tools for physicians and others involved in the care of student athletes.  This includes measures protecting athletes, such as guidelines on returning to play — an approach you championed last session.

TMA is a strong advocate for one of the most fundamental approaches promoting health and safety: a thorough pre-participation physical exam for all active students. These exams, when conducted by a trained expert following a standardized approach, are ideal opportunities to screen for injuries and illness. The physical exams also provide an opportunity for physicians to discuss important health issues with young patients and their families, including concussion prevention.  

TMA recognizes the importance of a statewide resource for students like the University Interscholastic League (UIL) in providing information to all school districts and students. UIL’s Medical Advisory Committee is a valuable resource as additional data on concussions evolve because this committee is charged with reviewing the latest evidence to implement best practices for school athletes. We pledge to assist this committee in gathering evidence-based guidance available for all students.

Once again, we applaud your leadership in protecting student athletes and thank you for continuing to raise awareness on this topic. We look forward to continuing our advocacy for safe and healthy participation in sports. 


Gilbert Handal, MD, Chair
TMA Committee on Child and Adolescent Health

David Mansfied, MD, President
Texas Orthopaedic Association