UPFRONT | Roundup SPORTS CFL adopts new concussion testing tool, some not convinced The CFL and NFL have teamed up to add a two-min-ute test to standard sideline examinations for suspected concussion, with the aim of quickly determining whether a player should be pulled from the field or can safely return to play. But just how effective is the King-Devick test for di-agnosing concussion? And is its implementation merely a public relations gambit by the football leagues – both de-fendants in lawsuits launched by groups of former players – or a bona fide means of looking after their athletes’ brain health? The timed test, which in-volves rapidly reading aloud lines of irregularly spaced, non-sequential numbers on flip cards or smartphone/ tablet apps, was initially de-veloped by American optom-etrists Alan King and Steven Devick in 1976 to diagnose eye movement dysfunction that affects reading ability. But in the last five years, research groups around the world began studying the test to see if it could detect con-cussion, a brain injury that can affect attention and con-centration. Dr. David Dodick, a neu-rologist at the Mayo Clinic in Phoenix who specializes in concussion, said numerous studies have concluded the King-Devick test is highly accurate in picking up the brain injury. “And that’s what makes it a very valuable tool,” said Dodick, noting that the time-based test is more objective than standard balance and cognition assessment tests like the SCAT3 and is not affected by player fatigue. Players are given K-D www.canadianchiropractor.ca tests before the start of their season to establish a baseline time for recounting all 120 numbers, which are laid out in increasingly difficult-to-fol-low patterns. If a player is suspected of having sustained a concus-sion during play, he or she is retested and the results com-pared. Should the task take longer to complete or include errors, the athlete should be removed from play and seen by a doctor. The Mayo Clinic, a non-profit U.S. health-care insti-tution, this year endorsed the test for school-based, ama-teur and pro contact sports in a licensing agreement with King-Devick Test Inc. “The reason we got in-volved with this is because we recognized the need for a simple, rapid and cost-effec-tive sideline test,” said Dod-ick, who was born in Ontario and grew up in Nova Scotia. “So to have an objective and reliable test, we felt it was very important and we saw the potential for this King-Devick test to make a huge difference in increasing the likelihood of identifying concussion on the sidelines.” The test, sold through annual subscription, costs US$20 per user per year and can be downloaded using the company’s new app, which uses Cloud-based data stor-age so parents, coaches or health professionals can eas-ily enter and access test re-sults, co-inventor Steven Devick said from Chicago. “You need a baseline every year for the test to work,” he said, explaining that a per-son’s ability to fire off the numbers improves over time until about age 40. The company now has about 75,000 annual users, despite not spending “a dol-lar” to market the repurposed product, said Devick. “But we expect to roll this out in a big worldwide way very soon.” Dr. Richard Wennberg, a neurologist at Toronto West-ern Hospital, said that while studies suggest the test is ef-fective in detecting concus-sion, he’s not sure how big a problem it’s addressing. “They are making the point and you’ll read all the hype ... saying this is a huge step forward because now we’ll be able to get players on the field out of the game and to the treatment they need,” he said. “That’s probably a pretty small group of individ-uals that really accounts for because most times it’s pretty obvious who’s had a concus-sion.” Dr. Paul Echlin, a Burling-ton, Ont., sports medicine physician who treats young athletes with head trauma, doesn’t use the K-D exami-nation and questions the ability of a two-minute test to diagnose the complex condi-tion with any certainty – es-pecially when it’s adminis-tered by parents or coaches. “One test can’t say some-one is concussed or non-con-cussed,” said Echlin, adding that if there’s any suspicion a player might have sustained the brain injury, they should be removed from play and fully evaluated by a physician. Dodick at the Mayo ac-knowledged that some of his colleagues have voiced a similar criticism, saying the test should be given to youth athletes by qualified profes-sionals – not lay people like parents or coaches. “By the same token, do we not do anything? When we do have the tool, do we not administer it? “What would the harm be? You identify someone slower and you take them out. You err on the side of caution.” Still, Wennberg and Ech-lin worry the King-Devick test is just one more money-making scheme to cash in on fears about the high-profile brain injury, which they say has become big business. “It doesn’t address the bigger issue that you don’t want the concussion in the first place,” said Wennberg. “So we have to curb our en-thusiasm here. As for the CFL, the league is trying out the test for play-ers on four teams – the B.C. Lions., Edmonton Eskimos, Calgary Stampeders and Winnipeg Blue Bombers – to determine if adding the King-Devick to other side-line examinations will im-prove identification of poten-tial concussions in players. “It’s really just to collect some numbers to see if this gives us an additional tool,” said Kevin McDonald, CFL vice-president of football operations. The CFL is facing a $200-million lawsuit filed in May by two former players, who are seeking class-action status on behalf of all retired players going back to 1952. The suit, which has not been proven in court, alleges the league, former commissioner Mark Cohon, a Toronto doc-tor and clinic withheld infor-mation about how repeated concussions can lead to long-term cognitive disorders. --Sheryl Ubelacker The Canadian Press October 2015 Canadian Chiropractor 13
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