High-tech, low-tech and concussion!July 11, 2013
Patients who have experienced a traumatic brain injury (TBI) or concussion often experience numerous eye and vision abnormalities. These frequently include binocular vision, accommodative and oculomotor dysfunctions, as well as vision information processing disorders and numerous pathological sequelae. It is important for AOA members to ensure their patients are aware of the risks and signs of concussion associated with sports and how technology is helping in the areas of on-field safety and diagnosis of this life-threatening disorder.
The Centers for Disease Control and Prevention note that concussions can occur in any sport. Almost 2 million injuries result in TBI with 30 percent of these contributing to injury-related deaths in the U.S. Seventy-five percent of these injuries cause concussions or mild TBI.
Each year there are an estimated 173,285 emergency room (ER) visits involving TBI and concussions among those from birth to 19 years. During the last 10 years, ER visits for TBI/concussions for children and adolescents increased by 60 percent, with bicycling, football, playground activities, basketball, and soccer being most often associated with head injury.
Technology, however, is only now attempting to improve field-side diagnosis of TBI and concussion, as well as meet the needs and limit the consequences of concussion and TBI for those who play sports. One such technological breakthrough includes the Guardian Cap, which is said to reduce the force of an impact by 33 percent. This is a soft-shell football helmet cover the National Federation of State High School Association allows for high school football practice and games.
Other high-tech advances in on-field diagnostics and prevention of concussion include the Xenith X2 football helmets and the X2IMPACT mouth guards (http://es.pn/NijOWq). The football helmet was designed by a former Harvard quarterback who was pursuing his medical degree at Columbia University. This helmet uses shock absorber technology that adapts to minimize the effect of any impact. The mouth guard noted above evaluates hits in real time. The embedded sensors store impact data during the game and can wirelessly send a notification to the coach if a player is hit with great force. An app can then assist in determining the effect of the impact.
The British Journal of Sports Medicine article “What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery?” notes technologies that aid in sports concussion diagnosis and management are being introduced at a rapid rate.
They also state that although many of these technologies show promise, few have the research to support their use.
The King-Devick Test (KD) is one solution that is relatively low-tech but has high-tech abilities and research supporting its use for TBI/concussion and sports. This test has been available for more than 25 years to assess oculomotor dysfunction. There is not only a “hardcopy” version, but also an online version allowing one to administer the test from a computer, laptop or iPad. There is also a subscription-based iPad app as well. This app allows one to test up to three subjects. To store data for additional individual, practitioners must purchase an in-app annual subscription. Access to the King-Devick Test Online System is included for the first year when using the app.
AOA member, co-chair of the Chicago Concussion Coalition and the Illinois College of Optometry Professor Leonard Messner, O.D., noted the KD Test has greater than 90 percent reliability for the sideline detection of concussion (meta-analysis of multiple studies in Neurology and Journal of the Neurological Sciences), takes less than two minutes to give and can be administered by health care and non-health care personnel alike.
A recent two-year study out of New York University compared KD to SCAt 2 (Sport Concussion Assessment Tool 2 available at http://bit.ly/o9rA1e) and found the KD to be vastly superior. Publication of the study is pending.
“The bottom line is that vision/visual motor testing for concussion is more effective and more reliable than cognitive and balance testing,” said Dr. Messner.
The president of the Neuro-Optometric Rehabilitation Association (and a 33-year AOA member), Carl Garbus, O.D., said he often uses the KD test, the red lens fusion test (watching for diplopia, a common sequelae of brain injury), and one or more tests of spatial localization (stick in straw).
Optometrists should play a major role in educating and protecting patients from the possibly devastating outcomes of TBI and concussion. Technology will allow practitioners to do just that.
The views expressed are those of the authors and do not necessarily reflect the views of the AOA.
Geoffrey G. Goodfellow, O.D., is an associate professor of optometry at the Illinois College of Optometry (ICO), ICO’s assistant dean for Curriculum and Assessment and the president of the Illinois Optometric Association. He can be contacted at email@example.com. Dominick M. Maino, O.D. is a professor of pediatrics and binocluar vision at ICO and a Distinguished Practitioner of the National Academies of Practice. He can be contacted at firstname.lastname@example.org.