The University of Michigan Concussion Center is proud to announce that Dr. Douglas Wiebe, director of the University of Michigan Injury Prevention Center, will be joining our Executive Committee as the associate director of the Outreach & Engagement Core.

Dr. Wiebe joins the Concussion Center from the University of Pennsylvania, where he served as the director of the Penn Injury Science Center and professor of Epidemiology at the Perelman School of Medicine.

“I’m energized about what I can do to be supportive of the great capacity and trajectory the University of Michigan Concussion Center has built thus far,” Wiebe said. “Wearing the hat of an epidemiologist, I can help think in complementary ways about opportunities for research, concussion prevention, and outreach, with Michigan high schools representing a potential opportunity.”

“We are thrilled to have Doug join our Executive Committee and welcome him to the U-M Concussion Center. His knowledge and expertise will strengthen our ability to disseminate key research findings and scientifically-based information to impact policy, education, identification, and prevention methods for the general population,” said Steve Broglio, director of the U-M Concussion Center.

Wiebe discovered his passion for epidemiology during his PhD program when he learned about case study control designs and the vast opportunities for injury prevention through epidemiology. He became interested in peoples’ interactions with the environment and grew to understand opportunities that make communities safer. This is especially true in the world of concussions.

Wiebe uses the Haddon matrix, a solution-oriented model in injury prevention developed by William Haddon in 1970, to look at the factors related to the personal, occurrence, and environmental attributes before, during, or after an injury. For example, concussion education can influence or change a person’s behavior, such as teaching football players safer tackling techniques. However, changing behavior is generally challenging as a prevention strategy. At the same time, changing the social environment (e.g., gameplay rules) and the physical environment (e.g., wrapping goalposts in foam to soften the impact when players run into it) can be used as additional prevention strategies.

“Detecting concussion when they occur is key, along with guiding athletes through a return-to-play protocol to help long-term outcomes. But in public health, those count as secondary and tertiary prevention. Ideally, we can find opportunities for primary prevention – preventing injuries in the first place,” Wiebe said. 

Wiebe currently leads the Ivy League – Big Ten Epidemiology of Concussion Study, a multi-site research effort designed to understand sports-related concussions. The study collects epidemiologic data regarding the incidence, mechanism of injury, and return to academic and sport participation timeline of concussions for all varsity and some club sports endorsed by the Ivy League and Big Ten schools. 

“It’s created great opportunities to learn about the management and prevention of sports-related concussions,” Wiebe said. 

One of the study’s findings came in the sport of football. Ivy League coaches noticed a disproportionate number of concussions during kickoff returns. They proposed an experimental rule change: change the kick-offs from the 30-yard-line to the 35-yard-line to increase how deep into the endzone the ball traveled. This approach reduced the number of times the returner would run the ball out of the endzone, thus eliminating highspeed collisions that commonly occur during kickoff returns.

Wiebe’s analyses evaluated if the rule change decreased the number of concussions occurring during kick-off returns. The findings, published in the Journal of the American Medical Association article “Association Between the Experimental Kickoff Rule and Concussion Rates in Ivy League Football,” showed an “abrupt and sustained drop in the rate of concussion in the year that the rule was introduced,” Wiebe said.

They also published “Progression through return-to-sport and return-to-academics guidelines for concussion management and recovery in collegiate student athletes: findings from the Ivy League–Big Ten Epidemiology of Concussion Study.” This paper examined the progression of student athletes through the five stages of return-to-activity following sport-related concussion. 

They found evidence that the sequential progressions were consistent with current recommendations from the Sport Concussion Consensus Group, including brief initial rest and the initiation and relative timing of each stage impacting the final return-to-sport outcome.

He also serves as the co-director of the data core for the Connect TBI study, a multicenter study of brain banks in North America and the United Kingdom. The centers share data in a common repository to characterize traumatic brain injury-related neurodegeneration (TREND) and what puts people at risk. The National Institute of Neurologic Disorders funds the study, led by co-directors Dr. Doug Smith (University of Pennsylvania) and Dr. Willie Stewert (Glasgow University).

Wiebe is excited at the prospect of implementing the Recovering Concussion Update on the Progression of Symptoms (Recoups) concussion tracking application developed in cooperation with sports medicine physicians at Children’s Hospital of Philadelphia. Wiebe described when physicians reevaluated patients two weeks after their initial in-clinic evaluation, they found patients had difficulty recalling how their concussion symptoms had progressed or whether anything may have impacted their recovery.

To address this challenge, Wiebe developed a phone app that prompted patients to complete a 22-question symptom survey daily. The results are immediately available on a dashboard for the clinician.

“The clinician on the receiving end can then monitor all of the patients under their care and see their symptom timeline,” Wiebe explained. “On a given day, if they see a spike, they can now text or call and say, ‘I see that you were feeling worse today. How are you doing? What’s going on?’”

Wiebe added they found the symptoms reported through Recoups app “had an excellent agreement with symptoms reported at a clinical visit on the same day,” as reported in the Clinical Journal of Sports Medicine.

“We aim to make the app available to athletic trainers for managing athletes with a concussion and clinicians managing patients from the emergency department or other clinics in the health system,” he said. “To be able to provide this zero-cost method for monitoring patients and connect patients with a provider in this telehealth kind of way is a great opportunity.”

He is also hoping to make this available to high schools.

Globally, with funding from the Fogarty International Center at the National Institute of Health, Dr. Wiebe also directs an injury prevention training program with the University of Botswana, where the University of Pennsylvania has been collaborating on HIV/AIDS research and prevention for years. 

In addition to being the director of the Injury Prevention Center, Wiebe will hold academic appointments with the Department of Emergency Medicine in the School of Medicine and the Department of Epidemiology at the School of Public Health. One area he is looking forward to when coming to U-M is the opportunity to build connections across campus. 

“I’m excited to begin connecting with faculty working in their respective departments and finding ways to inspire more multidisciplinary research to take on these issues like sport concussion prevention that are so multifaceted,” he said. “There are opportunities to get people involved who have different types of methodologic and policy expertise. I’m excited to navigate the campus environment and help identify opportunities for collaboration and support them through resources at the Injury Prevention Center and U-M Concussion Center.”