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Increase awareness of concussion in your practice, community
Conduct baseline King-Devick testing on any patient who participates in sports.
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We constantly encounter news stories about the latest professional football player suffering from brain damage due to recurring concussions sustained on the gridiron. Did you know that we, as eye care providers, can play a role in preventing recurring concussions?
Mild traumatic brain injuries (mTBIs), or concussions, splash the media on a weekly basis. The CDC estimates that 1.6 million to 3.8 million recreation- and sports-related concussions occur in the U.S. each year (Langlois, et al.), and the numbers are growing.
The Physical Activity Council reported that 60% percent of all children ages 5 to 18 years are playing “recreational” sports, and 36 million of them are involved in “organized” sports. In 2015, the National Collegiate Athletic Association reported that there are 420,000 student athletes. We encounter these people every day in our practices. We prescribe glasses, contact lenses and sun wear for their needs on the fields, courses and courts, but have you thought about incorporating a test that can detect a concussion?
King-Devick Test
The King-Devick Test was originally designed to detect oculomotor dysfunctions, but now it is being applied as a “remove-from-play” sideline concussion screening test. It takes 1 minute to 2 minutes to administer.
The patient reads numbers on the three test cards as quickly as possible without making a mistake. The baseline score is the quickest time in two trials. This score can be compared to the test taken after a head injury. If the patient performs slower or makes any uncorrected errors, more than likely he or she is suffering from a brain injury and should not return to play.
Clinical studies have shown injured athletes with no observable symptoms exhibiting an impairment measured on a functional MRI. This “subconcussion” is sensitive to further damage if another insult occurs. It is these repetitive occurrences that lead to brain damage. An athlete who returns to play within the vulnerable recovery period risks permanent disability and, in some cases, even death.
Although concussion awareness in the media has been centered around professional athletes, the scope of the problem is most critical at the youth level. Children are much more vulnerable to mTBI with their developing neurology, with girls having twice the number of concussions as boys.
Start with education, baseline testing
How do we as primary care providers handle the “concussion crisis”? It starts with educating your patients, parents and coaches. As you conduct your exam, ask the patient about sports and hobbies. Contact sports and cycling should prompt you to discuss potential head injuries. Bike accidents contribute more to sports-related head injuries than any other activity (O’Connor) and are often overlooked as a risk for concussion.
Outside your exam room, you can reach out to parents and coaches, letting them know they can be proactive in preventing damage from head injuries. Send introductory letters to your local high school and college coaches, particularly to football, soccer, lacrosse and baseball programs, as well as your local youth clubs. Your letter should include the latest research concerning concussion awareness.
Use the King-Devick Test in your exam room on all those patients involved in contact sports or cycling. It can be performed by your technician or you at the end of the exam. Record the baseline score in the patient’s chart and give it to the patient to keep on hand, because coaches and trainers may have this test on their sideline. Explain to the patient to return to your office for a repeated test if he/she suffers a head injury, whether it was caused during play or any other reason, such as a car accident. If the score is 3 seconds slower with any errors, there is a good indication that the patient has a concussion. Advise the patient not to return to play and quickly refer him/her to a neurologist for further assessment. Remember, a second insult to the brain may cause permanent damage.
Offering concussion testing is a great way to introduce sports vision to your practice and connect with your sports-minded patients. You do not have to be sports-minded to save a mind.
I have found that most people never connect their eyes with brain injury. We may not be able to prevent the first mTBI, but the second impact is preventable. As primary care providers, we can take the lead in educating our patients and parents about this epidemic. By incorporating this simple test, we can play a significant role in concussion awareness.
- References:
- Bailes JE, et al. J Neurosurg. 2013;doi:10.3171/2013.7.JNS121822.
- Kick-Devick Test website. http://kingdevicktest.com.
- Langlois JA, et al. J Head Trauma Rehabil. 2006;21(5):375–378.
- Lincoln AE, et al. Am J Sports Med. 2011;doi:10.1177/0363546510392326.
- Marar M, et al. Am J Sports Med. 2012;doi:10.1177/0363546511435626.
- Moreno MA, et al. Arch Pediatr Adolesc Med. 2012;doi:10.1001/archpediatrics.2012.79.
- NCAA College Athletics Statistics. Statistic Brain website. Updated April 26, 2015. http://www.statisticbrain.com/ncaa-college-athletics-statistics.
- O’Connor A. Really? Cycling is the Top Sport for Head Injuries. New York Times. June 13, 2013. http://well.blogs.nytimes.com/2013/06/03/really-the-claim-cycling-is-the-top-sport-for-head-injuries/?_r=0.
- Youth Sports Statistics. Statistic Brain website. Updated October 15, 2015. http://www.statisticbrain.com/youth-sports-statistics.
- Zuckerman SL, et al. Neurosurg Focus. 2012;doi:10.3171/2012.10.FOCUS12279.
- For more information:
- Elisa F. de Junco, OD, practices primary care and sports vision in Throggs Neck, Bronx and Great Neck, N.Y. She can be reached at idoctoredj@gmail.com.
Disclosure: de Junco reports no relevant financial disclosures.