Chicago schools adopt visual function test for mTBI

October 30, 2012

Amid continuing concern over potentially deadly or debilitating head injuries in sports, the Chicago Public Schools announced all of the city’s public high schools this year are screening athletes for possible mild traumatic brain injury (mTBI) during games using a visual function test.

Under the new sideline concussion screening program, any athletes who may have sustained head injuries during games are assessed using King-Devick (K-D) tests to determine if they should be removed from play. Using an assessment protocol developed by researchers at the Illinois College of Optometry (ICO), athletic departments at all Chicago public high schools now administer K-D tests to athletes in the preseason to establish baseline scores on the ocular motility test.

Students are then retested during games when they are suspected of sustaining a head injury. Any increase in the time necessary to complete the test is considered evidence of a possible concussion. Athletes with suspected concussion are only allowed to return to competition following a comprehensive examination and clearance by an appropriate health care professional.

The new Chicago concussion screening program officially began with an Aug. 24 press conference at which the Dave Duerson Foundation, established by the family of a former Chicago Bears star to help fight sports-related concussions, donated a total of 80 K-D tests to the school district in order to provide testing at each of the city’s public high schools.
Duerson, who played on two National Footfall League (NFL) championship teams, took his life last year, despondent over the effects of concussions he sustained during his athletic career.

Chicago optometrist Steven Devick, O.D., who co-developed the K-D test, and Illinois Eye Institute (IEI) Executive Director Leonard Messner, O.D., who helped establish K-D concussion protocols, volunteered to personally train the city’s public high school athletic staff on the use of the test.

Developed in the 1970s by Dr. Devick and then-fellow ICO student Alan King, O.D., the K-D is widely used in optometric practices to help diagnose developmental vision problems but has drawn increasing attention over recent years as a potential sideline concussion screening tool for sporting events, Dr. Messner noted.

The Chicago concussion screening program is designed to bring the city’s public schools into compliance with recent state legislation, league rules and even a city ordinance requiring concussion management programs for high school athletes.

While the Chicago public school system is among the first to recognize the importance of the visual system in spotting potential concussions and adopt the K-D test as a screening tool, it will not be the last, Dr. Devick predicted.

Some 38 states as well as nearly all major professional, collegiate and high school sports sanctioning organizations now require teams to have formal concussion management programs under which players who are suspected of sustaining a concussion are immediately removed from play. A coalition of athletic, health care, and social service organizations is lobbying for enactment of concussion safety laws in the states that do not now have them.

Federal legislation to set minimum state standards for concussion management programs in public schools – the Protecting Student Athletes from Concussions Act of 2011 (HR 469) – is pending in Congress.

Chicago in January 2011 became one of two U.S. cities (along with Washington, D.C.) to require sideline concussion screening for high school athletes. On July 25, 2012, the Chicago City Council passed a resolution in which aldermen urged Chicago Public Schools to recognize the King-Devick test as a means of preventing long and short-term brain injuries resulting from sports-related concussions. Other municipalities may follow suit, Dr. Devick said.

Concussion screening options

Virtually all of the new concussion laws and rules place top priority on preventing athletes who have suffered concussion from returning to play. As a result, the new laws have created new demand for effective but practical sideline screening tools.

While most mTBI will heal with sufficient time and rest, risk for serious injury greatly increases when athletes sustain a second concussion while still suffering the effects of an initial head injury, Dr. Messner noted.

Until recently, common concussion screening tools have generally involved checklists administered verbally to the suspected concussion victim to check for symptoms (headache, double vision) or cognitive ability (with athletes asked typically asked the day of the week, the period of the game, or the name of their opponent). Other concussion assessment tools range from balance tests, to recently developed laptop computer programs, to magnetic resonance imaging (MRI).

The K-D test is the first commonly used sideline concussion screening methodology based on visual function, Dr. Devick said. It has drawn considerable attention in sports and health care circles, as well as the media, over recent months as a quick, practical, easily accessible, sideline screening tool that can be administered by coaches without the assistance of a licensed health care professional onsite, or any additional technology such as a computer (although a cell phone app version of the test is now available).

In all, more than a dozen noninvasive tests are commonly used in testing concussion, according to a recent study by University of Pennsylvania Perelman School of Medicine researchers. The Military Acute Concussion Evaluation (MACE or ACE) and Standardized Assessment of Concussion (SAC) are perhaps the best established and most widely used concussion screening methodologies overall.

However, the K-D test has already joined the Sport Concussion Assessment Tool (SCAT) and SAC as the most commonly used sports sideline assessment tools, the study found.

The K-D test began to draw interest as a concussion screening tool two years ago after a pilot study of rugby players by the Sports Performance Research Institute at the Auckland (New Zealand) University of Technology concluded the test was not only useful in identifying changes in players who had been seen to sustain head trauma, but in identifying changes in players with an unwitnessed but suspected concussion.

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