San Antonio Express News
November 18, 2021
One Saturday night in October, Warren Oliver — a 6-foot-3, 180-pound tight end for Texas Military Institute — ran through a gap between the center and guard to block a middle linebacker from El Paso Cathedral.
The blitzing linebacker lowered his head. Oliver dropped his, too.
Their helmets collided.
Oliver didn’t feel pain — until a little later when his head started to hurt. Then he got dizzy and saw stars.
“I knew that was the hit that did it,” he said.
A physician diagnosed him with a concussion, a moderate traumatic brain injury that could affect brain function for months or years ahead. Symptoms can include headaches, dizziness, nausea, confusion and blurry vision.
TMI’s athletic trainer talked Oliver through the school’s return-to-play concussion protocols, which required him to sit out for seven days. He missed his Senior Night game against Savio Catholic High School. A bye week kept him rested another seven days.
In the meantime, Oliver checked in with Marzieh Hajiaghamemar and Morteza Seidi, professors of biomedical engineering at the University of Texas at San Antonio.
By then, the academics, a married couple, were familiar faces on the sidelines of TMI’s Howell Field on the far North Side. They’d been collecting data from Oliver and many of his teammates for a research project to learn more about what happens to the brain when players take hits to the head.
They took blood from one of Oliver’s fingers so they could analyze his protein levels, potentially giving them insight into what happened to his brain when he rammed, helmet to helmet, into the linebacker.
In what could be the first study of its kind in Texas, the UTSA professors followed the TMI football team for the entire season, gathering data from the teenage athletes through blood tests and mouthpieces equipped with sensors. The mouthpieces were Bluetooth-enabled and fed data through the researchers’ cellphones and into their brain and injury risk-assessment models.
Their goals for the UTSA-funded research: to develop tools to detect and monitor brain injuries, and to develop techniques to evaluate brain damage in real time. They also want to learn how to design headgear to prevent concussions and sub-concussive hits, which are repeated blows to the head that don’t produce concussions but can cause degenerative brain disease.
The project ended Nov. 13 when the TMI Panthers lost to Trinity Christian Academy in the Texas Association of Private and Parochial Schools Division V Championship. The Panthers finished their season 9-1.
Now the professors are analyzing the data and eventually will brief the football team and school administrators on their findings.
“The information from this brain-monitoring approach will help coaches and athletic physical therapists to develop proper assessment and recovery plans for the athletes who experienced high-risk head impacts,” Hajiaghamemar said.
It also will help coaches devise “more-informed strategy for players who may unintentionally put themselves at higher brain damage risks and help them to play safer and smarter,” she said.
In 2012, NFL linebacker Junior Seau committed suicide. It was later discovered that he suffered from chronic traumatic encephalopathy, or CTE, a degenerative brain disease linked to frequent head hits that can cause memory loss, heightened aggression and depression.
Three years later, the movie “Concussion” introduced football parents to Dr. Bennet Omalu, a forensic pathologist who battled with the NFL over its suppression of his research on CTE and who was portrayed by Will Smith.
In the ensuing controversy, the NFL and NCAA adopted concussion protocols that include giving physicians the final say in whether a player returns to the field after being hit in the head. And lawmakers and education organizations across the country crafted a bevy of laws and rules meant to protect teen and preteen athletes.
The Texas Legislature has passed a host of bills on sports-related concussions, including Natasha’s Law in 2016, which requires schools to create return-to-play concussion protocols. The law also requires the University Interscholastic League and the state Department of Health Services to approve school-created, mandatory training courses on concussions for coaches and athletic trainers.
More recently, the UIL began requiring the largest public schools in Texas to report players’ concussions to the organization. The Texas Association of Private and Parochial Schools, or TAPPS, also started requiring its members — including TMI, a co-ed private Episcopal preparatory school — to report players’ concussions.
About 220 of TMI’s 370 students play school sports. In its latest report to TAPPS, the school said six of its students suffered concussions in the 2021-22 school year, including two football players, three cheerleaders and one soccer player.
Athletes can experience concussions in all sports. Yet much of the anxiety about head injuries has focused on football, which may be one reason participation in high school football continues to plummet across the country.
But in Texas, not surprisingly, high school football is still a very big deal. Here, more than 165,000 boys and girls play on 11-player school teams, more than in any other state, according to the National Federation of State High School Associations.
At TMI, 43 students signed up to play football in the fall, a jump from 25 players in 2018.
Brandon Palomo, TMI’s athletic director for over a decade, said the school nurses, the coaches and their assistants are trained to identify symptoms of concussions in their players.
For its football players, the school uses air-compression sensors to check the foam lining of helmets before each game to make sure the gear fits properly. It’s like pumping air into a tire. If the liner needs more air, then pump it in. If it needs less, then release it.
The school also outfits players with Guardian padded helmets for practices — the bulky “soft shell” caps that slip over helmets that have become the norm on teams at all levels in Texas and across the U.S. The cap was designed to be an additional buffer against head hits.
Last spring, Palomo received an email from UTSA asking for permission to bring the research project to TMI that fall. He jumped at the opportunity.
He met with the professors. Both Hajiaghamemar, 38, and Seidi, 39, grew up in Isfahan, the third-largest city in Iran. They played football as kids — but not American football.
They got their bachelor’s and master’s degrees in Iran before completing their Ph.D.s in mechanical engineering at the University of Maine. Seidi took a job as an assistant professor at Villanova University outside Philadelphia. Hajiaghamemar started her postdoctorate in the bioengineering department at the University of Pennsylvania. Both later worked in biomedical engineering at Georgia Institute of Technology.
Along the way, they sometimes attended college football games.
“When in Philadelphia, we used to root for the Eagles,” Hajiaghamemar said. “When we move, our teams change.”
UTSA hired the couple in August 2020.
They introduced themselves to Palomo and told him about studies they’d done on helmet design and concussions. They had completed research on pigs showing that head hits “can stretch and tear brain tissue and cells,” she said. They asked if they could monitor players over the season to identify head injuries as they happen.
“I said yes because TMI Episcopal is trying to lead the movement to bridge the gap between how we understand concussions and brain impact injuries and how we’re able to mitigate those by data,” Palomo said. “This study will provide the data to keep our kids safe and build the groundwork data on how to better prepare our athletes.”
Hajiaghamemar and Seidi hope their research can help protect Oliver and his teammates from brain injuries.
“Usually, the athletes want to stay in the game and keep playing, and they may not report their symptoms or may not feel their symptoms,” Hajiaghamemar said. “But now we’re not waiting on them to report it. We’re tracking them. And if the chance of brain damage is even a little bit high, we want to monitor them and help them.”
Before Palomo started handing out the Bluetooth mouthpieces, he invited football parents to meet in August with the professors to learn about the research project. About half of the 43 players signed on to participate in the season-long study.
At the start of the season, the professors fitted Oliver and 21 other volunteers with a Prevent Biometrics mouthpiece, which features gyroscopes and accelerometers that measure hits players take to the head — the frequency, the force of the impact, and the directions their skull and brain jolted when blocking, tackling or falling during practices and games.
Data from the mouthpieces flowed to the cellphones of three on-field researchers and into their computer models.
The professors pored over the data “to evaluate the chance of brain damage for every player due to every head impact,” Hajiaghamemar said.
They also reviewed the gravitational acceleration, or “G-forces,” of the players’ head hits. Jumping generates 3 to 5 Gs, roller-coaster rides about 10 Gs and car crashes up to 100 Gs. Collisions at 70 Gs can cause concussions.
The professors also drew Oliver’s and other volunteers’ blood to measure, among other things, protein levels after sustaining hits to the head. The readings opened a view into possible cellular damage as the proteins enter the bloodstream from the brain.
Ray Purifoy, TMI’s head football coach, said there’s been “a huge shift” in how his coaching staff runs practices and teaches the athletes how to block and tackle — at least compared to when he last played a decade ago.
“It used to be when you got your bell rung you’d go two or three days after the game and continue to have nausea or couldn’t sleep,” said Purifoy, 29, a former high school wide receiver from North Carolina. “That was just part of football. But now we know that is a condition that is directly related to head impact and injuries.
“We still do contact drills, but there’s no Bull in the Ring” — an outdated exercise where one player gets in the center of a circle of teammates who take turns hitting him.
The athletic director also remembered the rougher old days.
“When I was playing, we called it getting your bell rung, but you didn’t sit — you were sent back in the game,” said Palomo, 44, a former quarterback for Marshall High School in San Antonio. “But now, with the research, there’s a lot more scrutiny and there’s more attention paid to the concerns and symptoms of concussions.”
A few days before TMI’s championship game Nov. 13, the team reported 36 of its 43 players were healthy enough to play. Oliver would be back on the field, and none of the inactive players had concussions. The team’s athletic trainer was treating them for various soft-tissue injuries.
Purifoy said he welcomed the UTSA research project since “concussions will unfortunately happen in football.”
“I’m a fan of making the game as safe as possible and doing so in a way that it doesn’t take away from the integrity of the game,” he said. “There’s a light shining on concussions now, and there should be light on it.”
Throughout the season, the professors’ data collection was “minimally invasive,” he said.
Hajiaghamemar and Seidi said they remained on the sidelines while their three researchers — undergraduates James Wallace and Sammy Elashy, and Ph.D. student David Zhang, all from UTSA’s biomedical engineering department — assisted them with on-field data gathering and blood tests.
It was their first time working with a sports team. Their dealings with coaches and players were cordial yet clinical.
“But the topic was important to all of us,” Hajiaghamemar said.
She chose Wallace as a researcher “because I thought he could connect with the players, since he experienced concussions several times and used to play football.”
Every now and then, players — such as Oliver — who habitually chew their mouthpieces would come to them to get fitted for a new one. Oliver bit through his mouthpiece when he suffered the concussion against El Paso Cathedral, interrupting the flow of information about the hit he’d sustained.
The professors sometimes alerted the coaches to players they’d noticed who were maybe playing a little too aggressively. The real-time data showed some of the players were hit in the head often or with a lot of force.
Parents checked in with the pair throughout the season to ask about the health and safety of their sons, especially after hard hits.
“Sometimes when they’re watching the game and see impacts that are concerning, they ask us what happened — if they needed to be worried or not,” Hajiaghamemar said.
End of the season
Last week, the professors sat on a bench near the 50-yard line of Howell Field. They watched Oliver practicing with a helmet and shoulder pads, setting blocks and running routes, preparing to play against Trinity Christian Academy.
Oliver walked toward the sideline and said he felt healthy enough to play again.
“My head’s not hurting,” he said while thumbing his chewed-on mouthpiece. “I’m not feeling any symptoms.”
Like most of the starters on the squad, Oliver’s family bought a Riddell SpeedFlex to use in both practices and games. He had been wearing the Speedflex when he got a concussion against El Paso Cathedral.
That was Oliver’s third concussion, which he suffered a few weeks shy of his 18th birthday. He got a concussion in a car wreck and two in football games — one in middle school, the other a few weeks ago.
Despite his struggles, he finished out a strong season with 10 sacks, just one shy of the school record held by his brother. The multisport athlete doesn’t know yet whether he’s going to play football or lacrosse in college.
On the practice field, Lance Kahl, a 6-foot, 180-pound running back and linebacker, took a break. He also played football and lacrosse but had never suffered a concussion. Still, he volunteered for the UTSA research project because he believes it can help the coaches, himself and future football players learn how to play safer.
The senior with a spotless academic record didn’t know yet if he’ll play sports in college. But he has decided to study physics.
“I want to stay healthy,” said Kahl, 17. “We’re only in high school. We got a whole life ahead of us. Football is not our whole life.”