Variability of the modified Balance Error Scoring System at baseline using objective and subjective balance measures.

AIM: To investigate preseason modified Balance Error Scoring System (mBESS) performance in a collegiate football cohort; to compare scores to an objective mobile balance measurement tool. MATERIALS & METHODS: Eighty-two athletes completed simultaneous balance testing using mBESS and the King-Devick Balance Test, an objective balance measurement tool. Errors on mBESS and objective measurements in the double-leg, single-leg (SS) and tandem stances were compared. RESULTS: Mean mBESS error score was 7.23 ± 4.65. The SS accounted for 74% of errors and 21% of athletes demonstrated the maximum error score. There was no significant correlation between mBESS score and objective balance score. CONCLUSION: The high variability and large number of errors in the SS raises concerns over the utility of the SS in identifying suspected concussion.

The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature.

BACKGROUND: Vision encompasses a large component of the brain's pathways, yet is not represented in current sideline testing. OBJECTIVES: We performed a meta-analysis of published data for a vision-based test of rapid number naming (King-Devick [K-D] test). STUDIES & METHODS: Pooled and meta-analysis of 15 studies estimated preseason baseline K-D scores and sensitivity/specificity for identifying concussed versus nonconcussed control athletes. RESULT: Baseline K-D (n = 1419) showed a weighted estimate of 43.8 s (95% CI: 40.2, 47.5; I2 = 0.0%; p=0.85 - indicating very little heterogeneity). Sensitivity was 86% (96/112 concussed athletes had K-D worsening; 95% CI: 78%, 92%); specificity was 90% (181/202 controls had no worsening; 95% CI: 85%, 93%). CONCLUSION: Rapid number naming adds to sideline assessment and contributes a critical dimension of vision to sports-related concussion testing.

The King-Devick test for sideline concussion screening in collegiate football / Test de King-Devick para el screening en la banda de la conmoción cerebral en el fútbol universitario

Purpose: Sports-related concussion has received increasing attention as a result of neurologic sequelae seen among athletes, highlighting the need for a validated, rapid screening tool. The King---Devick (K---D) test requires vision, eye movements, language function and attention in order to perform and has been proposed as a promising tool for assessment of concussion. We investigated the K---D test as a sideline screening tool in a collegiate cohort to determine the effect of concussion. Methods: Athletes (n = 127, mean age 19.6 ± 1.2 years) from the Wheaton College football and men’s and women’s basketball teams underwent baseline K---D testing at pre-season physicals for the 2012---2013 season. K---D testing was administered immediately on the sidelines for football players with suspected head injury during regular games and changes compared to baseline were determined. Post-season testing was also performed to compare non-concussed athletes’ test performance. Results: Concussed athletes (n = 11) displayed sideline K---D scores that were significantly higher (worse) than baseline (36.5 ± 5.6 s vs. 31.3 ± 4.5 s, p < 0.005, Wilcoxon signed-rank test). Postseason testing demonstrated improvement of scores and was consistent with known learning effects (35.1 ± 5.2 s vs. 34.4 ± 5.0 s, p < 0.05, Wilcoxon signed-rank test). Test-retest reliability was analyzed between baseline and post-season administrations of the K---D test resulting in high levels of test-retest reliability (intraclass correlation coefficient (ICC) = 0.95 [95% Confidence Interval 0.85---1.05]). Conclusions: The data show worsening of K---D test scores following concussion further supporting utility of the K---D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion (AU)

Objetivo: Cada vez se presta más atención a las conmociones cerebrales relacionadas con el deporte, como resultado de las secuelas neurológicas que se han visto en los atletas, lo que incrementa la necesidad de encontrar una herramienta validada y rápida de detección diagnóstica. El test de King-Devick (K---D) abarca el análisis de la visión, movimientos oculares, función del lenguaje y atención, habiéndose propuesto como una herramienta prometedora para la evaluación de las conmociones cerebrales. Realizamos una investigación sobre el test K---D, como herramienta para usar en la banda de screening en un grupo universitario, para determinar los efectos de la conmoción cerebral. Métodos: Los atletas (n = 127, edad media 19,6 ± 1,2 años) de los equipos de fútbol y baloncesto masculino y femenino del Wheaton College se sometieron a un test K---D de referencia, durante los exámenes físicos de la temporada 2012-2013. Se realizó el test K---D de manera inmediata en la línea de banda a los jugadores de fútbol con sospecha de lesiones en la cabeza durante los partidos regulares, determinándose los cambios con respecto a los valores de referencia. También se realizaron pruebas al finalizar la temporada, para comparar el resultado de las pruebas en aquellos atletas que no habían sufrido conmoción cerebral. Resultados: Los atletas con conmoción cerebral (n = 11) mostraron unas puntuaciones K---D suplementarias que fueron significativamente superiores (peores) a las basales (36,5 ± 5,6s frente a 31,3 ± 4,5s, p < 0,005, test de los rangos con signo de Wilcoxon). La prueba al finalizar la temporada reflejó una mejora de las puntuaciones, siendo consistente con los efectos conocidos del aprendizaje (35,1 ± 5,2s frente a 34,4 ± 5,0s, p < 0,05, test de los rangos con signo de Wilcoxon). Se analizó la fiabilidad test-retest entre las realizaciones del test K---D basal y al finalizar la temporada, existiendo unos niveles elevados de fiabilidad test-retest (coeficiente de correlación intra-clase (ICC) = 0,95 [95% Intervalo de confianza 0,85 - 1,05]). Conclusiones: Los datos reflejan el empeoramiento de las puntuaciones del test K---D tras la conmoción cerebral, lo que refuerza la utilidad de dicha prueba como herramienta adicional y realizable en la banda de screening visual objetiva, fiable y efectiva, para la identificación de los atletas con conmoción cerebral (AU)

The King-Devick test for sideline concussion screening in collegiate football.

PURPOSE: Sports-related concussion has received increasing attention as a result of neurologic sequelae seen among athletes, highlighting the need for a validated, rapid screening tool. The King-Devick (K-D) test requires vision, eye movements, language function and attention in order to perform and has been proposed as a promising tool for assessment of concussion. We investigated the K-D test as a sideline screening tool in a collegiate cohort to determine the effect of concussion. METHODS: Athletes (n=127, mean age 19.6±1.2 years) from the Wheaton College football and men's and women's basketball teams underwent baseline K-D testing at pre-season physicals for the 2012-2013 season. K-D testing was administered immediately on the sidelines for football players with suspected head injury during regular games and changes compared to baseline were determined. Post-season testing was also performed to compare non-concussed athletes' test performance. RESULTS: Concussed athletes (n=11) displayed sideline K-D scores that were significantly higher (worse) than baseline (36.5±5.6s vs. 31.3±4.5s, p<0.005, Wilcoxon signed-rank test). Post-season testing demonstrated improvement of scores and was consistent with known learning effects (35.1±5.2s vs. 34.4±5.0s, p<0.05, Wilcoxon signed-rank test). Test-retest reliability was analyzed between baseline and post-season administrations of the K-D test resulting in high levels of test-retest reliability (intraclass correlation coefficient (ICC)=0.95 [95% Confidence Interval 0.85-1.05]). CONCLUSIONS: The data show worsening of K-D test scores following concussion further supporting utility of the K-D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion.

The effect of saccadic training on early reading fluency.

BACKGROUND: Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency. METHODS: In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks. RESULTS: The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005). CONCLUSION: Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.