Concussion: Vision Testing Effective for Detection

Researchers at the NYU Langone Concussion Center have found that using a timed vision test involving rapidly reading numbers off of cards on the sidelines can be invaluable for detecting concussions in sports.

The researchers took the King-Devick test, a vision test used on the sidelines to detect concussions, and observed it's effectiveness. They found that when used alone, it was 86 percent successful, according to EurekAlert. 

The study, published in Concussion, also found that when the King-Devick test was coupled with rapid assessments of balance and cognition, detection of concussions rose to 100 percent accuracy.

"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," said senior author Dr. Laura Balcer, 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." 

The rapid number naming test is given to athletes in two parts.  

Part one takes place before the season starts, athletes are asked to read numbers off a series of three cards, as quickly as possible, while being timed with a stopwatch. This gives a baseline number for each athlete.

Part two is administered when the athlete is being tested for an actual concussion after trauma, later on. those who are tested immediately after they may have sustained a concussion experience slower times, according to MedicalXpress.

Visual pathways have elaborate connections throughout the brain, and when these pathways are disrupted, it can suggest a brain injury, like a concussion. Studies have shown that patients with neurological conditions like Parkinson's disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS) score increasingly slower times on rapid number naming tests when tested multiple times.

The review included 1,419 athletes, 112 of whom sustained a concussion. On average, athletes who were concussed completed the King-Devick test 4.8 seconds slower than their original time, whereas non-concussed athletes actually improved their times by 1.9 seconds. 

The test detected 96 out of 112 concussions, or 86 percent. Athletes with a decrease in time proved to be five times more likely to have sustained a concussion, than those who had improved their scores, according to Science Daily.

When additional testing, like the SCAT3 symptom checklist or the tandem gait walking test, was used with the King-Devick test, the percent of concussed athletes detected rose to 100 percent.

"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 Dr. Steven Galetta, the Philip K. Moskowitz, MD Professor and Chair of Neurology at NYU Langone Medical Center. "In the heat of a game, there is a lot of chaos and confusion on sidelines, so anything that helps eliminate guesswork is needed." 

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