CWRU tackles concussions with protocol


In 2017, the word elicits plenty of responses from shock and fear to worry and sadness. The sport of football is said to have a concussion epidemic, as with each passing year more is known about the frequency of the injury and its potentially long-lasting effects, including chronic traumatic encephalopathy.

The constant stream of news about the injury may lead many to wonder how college football teams, particularly those at the Division III level, deal with the injury. Everyone on the Case Western Reserve University football team treats concussions very seriously, from the trainers to the coaches to the players. It’s no surprise, given that CWRU has one of the top ranked medical schools in the country.

According to football head coach Greg Debeljak, the team has had a concussion protocol in place since at least 2004, his first year as head coach. He takes the issue very seriously and demands his assistants do the same.

“It’s up to us in the coaching profession to do things in a different manner… to do our job to teach the game the right way, the correct way, the safe way,” he said.

Debeljak added that his players are “cared for well.”

But who cares for the players? That would be the training staff, led by head athletic trainer Jessica White, and team doctors, led by head team physician Dr. Shana Miskovsky.

The concussion protocol, as explained by White, is a multi-step process.

First, a player suspected of having a concussion is evaluated by White or one of the team doctors, though only a doctor can diagnose the disease. Once the player enters protocol, he sees the team physician within one to three days. During that time frame, the player doesn’t go to class and is advised to rest, hydrate and stay away from stimuli like computer screens and cell phones.

White described a concussion as “a bruise on the brain,” and as with any other bruise, it can only get better with rest. Thus, the prescribed rest.

After the player is seen by a physician, they are given a post-concussive scale sheet, commonly referred to as symptom score sheet, that they must complete every day while they are in the protocol. It is a list of 25 questions about common symptoms of a concussion, which an athlete answers on a scale of one to six. Generally, after the first day, the athlete’s responses drop in severity and the sheet is used to track his progress in the protocol.

Additionally, the injured player must take an ImPACT test, a computerized neurological test that “defines how far out” the player is, according to White. The results of the player’s test are compared to their baseline results from a test taken before the season. Only select players are required to take the baseline ImPACT test, but all football players must take the test.

The results are evaluated by Christopher Bailey, PhD, or Philip Fastenau, PhD, who both work in the neuropsychology department at University Hospitals (UH) Cleveland Medical Center. Dr. Bailey serves as director of the Sports Medicine Concussion Center at UH as well as the director of the Neurological Institute Concussion Program at the hospital. Dr. Fastenau is the Director of Neuropsychology at UH and also is a professor at the CWRU School of Medicine.

Few schools have the resources of CWRU, and players take notice. Fourth-year offensive lineman Ryan Merlau said, “I think we’re really blessed at Case.”

Once the player is symptom-free and the doctors feel he is ready to return based on the symptom score sheet, he enters the exertion protocol. The protocol is four days of activity with severity increasing each day. White describes the first day as light, the second as medium, the third as heavy and the fourth as non-contact practice. If the player experiences a recurrence of symptoms at any point during the exertion protocol, they must immediately stop practicing and see the doctor again to be re-evaluated. If they are symptom-free, the player can return to regular activity.

Obviously with this process there is a lot of trust placed on the student-athlete to accurately portray how they are feeling. Players are not watched by coaches or trainers all the time, so they need to recognize the severity of the symptoms.

White said, “It comes down to honesty and getting to know the athletes.”

According to Merlau, the trust has been placed in the right hands.

“We all consciously make an effort to try to make sure that everyone’s okay all the time,” he said. “It’s definitely something we take seriously, absolutely.”

Though having an excellent protocol to treat concussions is important, what may be even more important is trying to prevent them in the first place. There are many ways the team attempts to limit the number of opportunities a player can sustain a concussion and also limit its severity when the injury does occur.

First, the team orders a “plethora of helmets,” according to White. The most common is the Riddell SpeedFlex, one of the top helmets in reducing concussion risk according to studies done at Virginia Polytechnic Institute and State University. Debeljak added that the team also orders helmets made by both Xenith and SG Helmets, both highly rated manufacturers.

Merlau mentioned that he has been issued a new helmet every season at CWRU—an important fact to note as helmets, like any other protective equipment, get worse with age.

Second, Debeljak and the coaching staff limit heavy contact in practice and consistently teach technique, as mentioned earlier. Players are never tackled to the ground during practice and most heavy contact is made with bags instead of people.

However, despite all of the attention paid to trying to prevent them, concussions cannot yet be prevented. All teams and players can do right now is properly treat and recognize symptoms. In both of those regards, CWRU is in very good hands, and the word “concussion” does not prompt harsh or negative responses.