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A timed vision test that involves rapidly reading numbers off of cards can be a valuable sideline tool for detecting whether a concussion occurred while playing sports, according to a meta-analysis and systematic review led by NYU Langone Medical Center concussion specialists.
Researchers at the NYU Langone Concussion Center reviewed studies that involved athletes who sustained a concussion during sporting activities and found the vision test, known as the King-Devick test, was 86 percent sensitive in detecting whether a concussion had occurred, as confirmed by clinical diagnosis. When combined with rapid assessments of balance and cognition, the testing battery was able to detect 100 percent of concussions that occurred among athletes in the studies that measured this outcome.
The study was published Thursday, September 10, 2015, in Concussion.
“There is no diagnostic substitute for a medical professional when it comes to evaluating an athlete for concussion, but physicians are not always on the sidelines during practice or a game when an injury might occur,” says senior study author Laura Balcer, MD, MSCE, Co-director of the NYU Langone Concussion Center and a professor of neurology, population health and ophthalmology at NYU Langone. “Our study shows that an easy to administer vision test is a simple, effective tool that empowers parents, coaches, trainers – and even physicians – on the sidelines to have a protocol for deciding if an athlete should be removed from play.”
For the rapid number naming test, athletes are given a baseline test before the season starts where they are asked to read numbers as quickly as they can off a series of three reading cards while being timed with a stopwatch. People who don’t experience a concussion or head injury tend to have faster reading times when tested again during the season; however, those who are tested immediately after they may have sustained a concussion experience slower times.
Vision is important in concussion diagnosis because the visual pathways have extensive connections throughout the brain, and disruptions in these pathways could suggest a brain injury occurred. Previous studies have shown worsening scores on rapid number naming tests correlate with neurological conditions including Parkinson’s disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS).
Balcer and her colleagues conducted a meta-analysis review of 15 previously-completed studies where a rapid number naming test was utilized. All the studies were conducted on athletes, and all concussions were defined by a witnessed or reported blow to the head with neurological symptoms.
The review included 1,419 athletes, 112 of whom sustained a concussion. Professional hockey players, along with youth, collegiate and amateur players of football, hockey, soccer, lacrosse, basketball, boxing and rugby were among those studied.
Concussed athletes on average completed the King-Devick test 4.8 seconds longer than their baseline score, whereas non-concussed athletes improved their score by an average of 1.9 seconds. The test detected 96 out of 112 concussions (86 percent), and showed 90-percent specificity in distinguishing a concussed athlete versus a non-concussed, healthy control subject. Overall, if an athlete had a worsening in their time score compared to their baseline reading, they were five times more likely to have sustained a concussion.
Some studies included the review utilized other tests including the SCAT3 symptom checklist and timed tandem gait (walking) test, and importantly, a worsening in scores of at least one of the three tests was observed in 100 percent of concussed athletes.
“This tool as part of a simple battery of tests assessing cognition and balance can raise a flag for those athletes that require follow-up with a medical professional,” says study co-author Steven Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of Neurology at NYU Langone Medical Center. Dr. Galetta, himself a former collegiate athlete, added, “In the heat of a game, there is a lot of chaos and confusion on sidelines, so anything that helps eliminate guesswork is needed.”
A March study led by Dr. Galetta and Dr. Balcer, published in the Journal of Neuro-Ophthalmology, found the King-Devick test effective at helping to detect a concussion in student athletes as young as 5 years old.
A concussion is caused by a force transmitted to the head as a result of a direct blow to the body that results in new neurological symptoms. An estimated 4 million sports-related concussions occur each year in the United States each year, with long-term consequences on brain function becoming an increasingly prominent concern among those who play contact and collision sports.
Drs. Balcer and Galetta have no relevant financial disclosures or conflicts of interest with the sideline tests studied. Co-author, Dr. Danielle Leong, is an employee of King-Devick Test, LLC.
In addition to Drs. Balcer and Galetta, the co-authors of the study were: Kristin M. Galetta, Mengling Liu, Danielle F. Leong, and Rachel E. Ventura.
(Editor’s Note: What follows is an excerpt from an article that appeared in the September issues of Concussion Litigation Report. For the full story, please subscribe athttp://concussionpolicyandthelaw.com/subscribe/)
By Elaine Iandoli, of New York Institute of Technology
Athletes who undergo pre-season concussion baseline testing, combined with education about concussion prevention, symptoms, and treatment, are likely better prepared to deal with the possibility of a concussion injury or the aftermath of one, says sports medicine expert Dr. Hallie Zwibel.
Concussion education should start early before players hit the fields and courts, and it should remain part of the athletic program throughout the season, with coaches, parents, and student-athletes learning about prevention, diagnosis, and treatment, says Zwibel, acting director for New York Institute of Technology Center for Sports and Wellness.
“For student-athletes, it’s important to know the signs and symptoms of concussion, work on your balance and muscle strength, be aware of where you are in the space of a playing field or court and the actions you’re taking, and of course make sure your helmet fits properly, is well-maintained, and is worn correctly,” Zwibel says.
Practice is a common time when athletes suffer concussions. But even before practices begin, pre-season baseline testing is an important part of a comprehensive approach focusing on education and awareness.
“With baseline testing, we can screen for increased risk factors, such as ADHD or history of a previous concussion,” says Zwibel. “We can test for memory, processing speed, and reaction time — information that’s useful when we have a patient who later suffers a suspected concussion. The baseline testing gives us more information to compare against testing after an injury.”
Zwibel notes that it’s important that …
ImPACT Applications and Mercy Sports Medicine Implement Comprehensive Concussion Management Services and Training Program
ImPACT Applications, Inc., developer of the ImPACT® test and ImPACT Concussion Management Model, has announced that Mercy Sports Medicine, a division of Mercy, will administer ImPACT baseline and post-injury testing at 100 Ohio and Michigan locations.
In addition, Athletic Trainers at Mercy Sports Medicine will receive specialized training in ImPACT neurocognitive baseline and post-injury test administration and the implementation of ImPACT’s Concussion Management Model. At the completion of the training, the Athletic Trainers will become credentialed ImPACT Trained Athletic Trainers (ITATs).
“ImPACT is excited to provide our baseline and training services to Mercy Sports Medicine facilities,” said Michael Wahlster, chief executive officer of ImPACT Applications. “Our ITAT program will provide Mercy’s experienced Athletic Trainers with further education on concussion awareness, identification and treatment as well as continuing education credits.”