Program makes treating concussions in rural areas as easy as logging on
Dr. Kenneth Podell’s long-ago predecessors were circuit riders, going from town to town to treat patients with no access to big-city hospitals.
Today, Podell does the same from his office at Houston Methodist’s Texas Medical Center location, using a Microsoft tablet computer to diagnose and treat concussions among high school athletes in seven rural counties to the east and north of Houston.
Telemedicine is nothing new, but Podell, a neuropsychologist who consults with the Texans, Astros and Dynamo as director of the hospital’s concussion center, has high hopes for a pilot program that enabled him to examine injured athletes while sparing them a day of missed classes and travel time to Houston.
“We get a lot of calls from people saying, ‘I don’t know what to do, I live two hours away,’ so this is how we help out,” Podell said.
Nineteen school districts participated in the $100,000 program, which was funded by GE and the Texans. Using Microsoft Surface Pro tablet computers, Podell said he examined and diagnosed about 20 students, some of whom he consulted with two or three times.
“We put the Surface Pro on a stand and look into their eyes,” he said. “If I need to see them standing up, they back up and I can examine them from head to toe. We can do neurological tests, balance tests, strength and neck exams and recommend accommodations.”
Podell said football and soccer produced the largest number of concussions in the East Texas schools participating in the telemedicine program but that he also saw injuries associated with baseball, lacrosse and basketball.
While there have been no injuries that he described as “life or death cases,” one football player did require an appointment with a primary care doctor because of the possibility of spinal cord involvement before doctors were able to proceed with the concussion assessment.
No minor injuries
A couple of dozen cases across a large swath of Southeast Texas may not sound like much, but each represents a crisis to a student and family.
Caleb Richardson, a junior varsity player at Hardin High School in Hardin, 75 miles east of Houston, was double-teamed on a running play in a game against Hardin-Jefferson last year and struck the back of his head on the ground when he was knocked to the turf.
“I kept playing, because I didn’t know any better at the time, but I felt a tingling in my back and had double vision and a really bad headache,” he said. “The next day, I couldn’t focus in school because my head hurt so bad and the light was hurting my eyes.”
Teachers sent him to see an athletic trainer provided by Houston Methodist, and Podell conducted an exam and tests that confirmed a concussion. He was required to sit out games before being cleared to return to play later in the season.
The exam via tablet computer, said Richardson’s mother, Penne, “was just like sitting in a doctor’s office. We didn’t have to pull him out of school or drive to Houston, and about a week later he wasn’t having any more headaches.”
Richardson works near the school and said she could have arranged to drive her son to Houston for treatment. But for other families, she said, “it would have been tough to get care like this” without telemedicine.
Schools offer limited insurance coverage for athletes involved in schoolsanctioned events, and Podell said he has worked with school district officials to accommodate families without insurance. Houston Methodist also provides a translator to assist with families where the parents or guardians do not speak English.
Hardin has a certified athletic trainer who lives in the area and works as a volunteer with the school. Many smaller schools lack certified athletic trainers, and Podell said he presumes that some concussions are being missed by parents, coaches and students.
Accordingly, the Houston Methodist program also includes training in the telemedicine project for athletic trainers and educational programs for coaches. Patients also work with Dr. Vijay Jotwani, a Houston Methodist primary care physician in Baytown, on the statemandated return-to-play procedures before athletes can again compete.
Sooner the better
In areas where medical resources are scarce, Podell said telemedicine can mean quicker treatment and quicker recovery.
“The sooner we treat the better,” he said. “The notion of rest until you feel better doesn’t seem to work. We find that too much rest over too much time only makes individuals feel worse.
“Imagine that you hurt your knee and didn’t start walking until you felt better. Your knee would stiffen up or tighten up.”
Once the year-long project is completed after the 2017 football season, Podell said sponsors will consider its future. Schools participating in the program are in Chambers, Jasper, Newton, Liberty, Polk, San Jacinto and Trinity counties.
“It absolutely could work out in a larger geographical area,” he said. “As with any new program, there are roadblocks and hurdles, but I would be interested in expanding this.
“Inevitably during football season, I get calls from around the country about not having proper care in rural areas, and a lot of them come from the west and northwest (of Houston).”