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The King Of All Concussion Tests


Like it or not, concussions are part of the NFL landscape. The league administration has to try to minimize them, players have to try to avoid them, and fans have to continuously read about them. It’s not fun for anyone.

Given the recent rise in concussion awareness, there is a race to catch technology up with the modern game. If the athletes are getting faster and stronger, how do they stay safe? While Roger Goodell is busy banning blows to the head and other dangerous hits, there is another way to protect the players: the King-Devick test.

Developed in 1976, the King-Devick (KD) Test consists of three cards, each with a list of numbers arranged in a different pattern across the page. Each page becomes more spaced out and consequently more difficult to read quickly. The subject must read the numbers out loud without making any errors. After two tests, their baseline score is established.

The test technically evaluates saccade, more simply explained as rapid movements of the subject’s eye as they shift focus from one point to another. This was originally used to assess dyslexia and other learning disabilities, but in 2011 researchers determined it could be used in a sports context, too.

The KD Test serves as a “remove from play” test and is actually more suited to a sports role than one might think. Since players can only be on the sidelines for a few minutes between plays or drives, time is of the essence. The player has to be assessed immediately; continued play with head trauma can be increasingly dangerous. “We do know that if you put a kid back in with concussive symptoms, he’s at really high risk to get hit again,” says Dr. Gillian Hotz of the University of Miami’s Miller School of Medicine.

You don’t need a doctor to administer the KD Test, though. It can be administered by anyone who has been trained, from a parent in youth sports to a trainer at higher levels. It will be done in no more than a few minutes. Most importantly, there is no judgement calls to make. “There’s really nothing else,” Hotz says. “People use a little sideline mental test, they see how confused the kid is, maybe they do a balance test. But this [the KD] is something quick and dirty that has some sort of objectivity and standardization to it.”

The ideal integration of the test would be something as follows: on the first day of training camp or practice, all of the players would take a baseline screening. That test would be administered as soon as the players stepped off the field so as to best mirror a game environment. By adhering to this structure, teams would be able to immediately asses a player during a game anytime he was subjected to a big hit.

If your time is the same or faster, you’re good to go. If not, game over and time to see a doctor. No ifs, ands or buts. “The KD is a nice, fast, objective measure to be used on the sideline,” Hotz says.

It can also save time and resources by ensuring the player is properly assessed in order to avoid unnecessary treatment. While we primarily think of a concussion test ending in an injury, that is not always the case.

“It helps identify are they in or are they out; should they be pulled or should we buy the ticket,” Hotz says. “Buy the ticket means, because we have legislation here in the state of Florida, that yeah they got rocked, yeah they’ve got post-concussive issues. They’re out this game, they need to be cleared by a physician to go back to play, and they may have to go through a gradual return to play. That’s a lot of stuff for an athlete to go through if they really didn’t get rocked.”

Ultimately, there is still a huge amount of uncertainty when dealing with concussions. “We really don’t know a lot about it yet. There’s this whole idea about repeated concussions: how far apart can they be, do we have subconcussive blows, every time you line up and hit each other is that a subconcussive blow, what force do we need to cause a concussion,” Hotz says. “Also, there’s genetics, size, what position a guy is playing, how many [concussions] they’ve had. All of these things have to be taken into consideration so we need a lot more information and research. We don’t know all this information yet.”

Even the recovery phase isn’t simple. “We have a protocol that has been recommended by the AAN [American Academy of Neurology] that says depending on the severity of the concussion they have to be cleared by a physician, they have to be out, asymptomatic for seven to ten days and then they have to do a gradual return to play,” said Hotz. “What if you take a kid who says ‘I’m fine, I don’t have a headache’ for seven days, so he’s been out doing nothing and you say ‘ok you can start running track, lifting weights, and get on a bike’ but as soon as he does that, his headaches and dizziness come back? He needs to start back at square one.”

As for football itself, Hotz feels the sport can be made safer but cannot not fully prevent head injuries. “Basically we have to teach better technique with head position,” she says. “Now we have to talk about all these different kinds of helmets people are making. Can they be concussion-proof? I don’t think so. We may be able to prevent some of the spearing and improve technique of how to hit, but the nature of football is that you’re always going to have people hitting their heads.”

While it may be a small step to adopt, the KD Test could help make football safer. While it cannot prevent a concussion, it could potentially save a player from stepping on the field with an undiagnosed head injury and making his situation worse. Ultimately, that’s what we all want: the best possible situation for the sport we love and the athletes we support.

Joe Kozlowski is an editorial intern for TDdaily. Follow him on Twitter @koz2393.