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Moran RN, Bretzin AC. Long-term test-retest reliability of the vestibular/ocular motor screening for concussion in child athletes: A preliminary study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:300-305. [PMID: 36592365 DOI: 10.1080/21622965.2022.2163172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Vestibular/Ocular Motor Screening (VOMS) is a sport-related concussion screening tool that assesses vestibular ocular reflex (VOR) and oculomotor symptom provocation. Long-term test-retest reliability of the VOMS over multiple athletic seasons has not yet been established in a pediatric population. Fifty-one child athletes (females = 28, 54.9%) 8-13 years of age, completed a baseline VOMS assessment at two timepoints, 18 months apart. Cronbach's alpha was used to examine the internal consistency at both time points. Two-way mixed intra-class correlation coefficients and Cohen's Kappa statistics were used to evaluate test-retest reliability. High internal consistency existed at both initial (α = 0.91) and follow-up (α = 0.95) for VOMS symptom provocation items. Strong inter-item correlations were noted between vertical VOR (r = ≥0.70) and visual motion sensitivity (VMS) (r = ≥0.70). Fair agreement was produced for convergence (κ = 0.23, vertical VOR (κ = 0.25) and VMS (κ = 0.25), as well as reliability on NPC distance (ICC2,k = 0.31). All other VOMS scores yielded poor agreement between time points. Symptom provocation was the same for 49% of athletes between timepoints, while 31.4% had a decrease in scoring at follow-up. Symptom provocation from VOMS tasks lessened with increasing age and time; therefore, clinicians should consider annual baseline testing to improve accuracy for concussion evaluation and management in pediatrics.
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Affiliation(s)
- Ryan N Moran
- Department of Health Science, Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa, AL, USA
| | - Abigail C Bretzin
- Department of Emergency Medicine, University of Michigan Injury Prevention Center, The University of Michigan, Ann Arbor, MI, USA
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Le RK, Ortega J, Chrisman SP, Kontos AP, Buckley TA, Kaminski TW, Meyer BP, Clugston JR, Goldman JT, McAllister T, McCrea M, Broglio SP, Schmidt JD. King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes. J Athl Train 2023; 58:97-105. [PMID: 34709396 PMCID: PMC10072097 DOI: 10.4085/1062-6050-0063.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The King-Devick (K-D) test is used to identify oculomotor impairment after concussion. However, the diagnostic accuracy of the K-D test over time has not been evaluated. OBJECTIVES To (1) examine the sensitivity and specificity of the K-D test at 0 to 6 hours postinjury, 24 to 48 hours postinjury, the beginning of a return-to-play (RTP) protocol (asymptomatic), unrestricted RTP, and 6 months postconcussion and (2) compare outcomes between athletes with and those without concussion across confounding factors (sex, age, sport contact level, academic year, learning disorder, attention-deficit/hyperactivity disorder, migraine history, concussion history, and test administration mode). DESIGN Retrospective, cross-sectional design. SETTING Multiple institutions in the Concussion Assessment, Research and Education Consortium. PATIENTS OR OTHER PARTICIPANTS A total of 320 athletes with a concussion (162 men, 158 women; age = 19.80 ± 1.41 years) were compared with 1239 total collegiate athletes without a concussion (646 men, 593 women; age = 20.31 ± 1.18 years). MAIN OUTCOME MEASURE(S) We calculated the K-D test time difference (in seconds) by subtracting the baseline from the most recent time. Receiver operator characteristic (ROC) curve and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across time points. We identified cutoff scores and corresponding specificity at both the 80% and 70% sensitivity levels. We repeated ROC with AUC analyses using confounding factors. RESULTS The K-D test predicted positive results at the 0- to 6-hour (AUC = 0.724, P < .001), 24- to 48-hour (AUC = 0.701, P < .001), RTP (AUC = 0.640, P < .001), and 6-month postconcussion (AUC = 0.615, P < .001) tim points but not at the asymptomatic time point (AUC = 0.513, P = .497). The 0- to 6-hour and 24- to 48-hour time points yielded 80% sensitivity cutoff scores of -2.6 and -3.2 seconds (ie, faster), respectively, but 46% and 41% specificity, respectively. The K-D test had a better AUC when administered using an iPad (AUC = 0.800, 95% CI = 0.747, 0.854) compared with the spiral-bound card system (AUC = 0.646, 95% CI = 0.600, 0.692; P < .001). CONCLUSIONS The diagnostic accuracy of the K-D test was greatest at 0 to 6 hours and 24 to 48 hours postconcussion but declined across subsequent postconcussion time points. The AUCs did not differentiate between groups across confounding factors. Our negative cutoff scores indicated that practice effects contributed to improved performance, requiring athletes to outperform their baseline scores.
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Affiliation(s)
| | - Justus Ortega
- Department of Kinesiology and Recreation Administration, Humboldt University, Arcata, CA
| | - Sara P. Chrisman
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington
| | | | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Briana P. Meyer
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa
| | - James R. Clugston
- Department of Community Health and Family Medicine, University Athletic Association, University of Florida, Gainesville
- Department of Neurology, University Athletic Association, University of Florida, Gainesville
- Division of Sports Health, University Athletic Association, University of Florida, Gainesville
| | | | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa
| | - Steven P. Broglio
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor
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King-Devick testing and concussion recovery time in collegiate athletes. J Sci Med Sport 2022; 25:930-934. [DOI: 10.1016/j.jsams.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022]
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Annual Baseline King-Devick Oculomotor Function Testing Is Needed Due to Scores Varying by Age. Sports (Basel) 2021; 9:sports9120166. [PMID: 34941804 PMCID: PMC8707896 DOI: 10.3390/sports9120166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To document baseline King-Devick (K-D) oculomotor function scores for male and female participants aged between 4 and 20 years old. Methods: Utilising a cross section of schools, rugby clubs and gymnastic clubs, 1936 participants (1300 male, 636 female) completed the spiral-bound K-D test for the identification of disturbed oculomotor function. Results: This study identified that overall, the baseline scores of the K-D test became faster by 1.4 (0.3 to 4.5) s per year, when compared with the previous age group in the same number of reading card groups. When comparing normative values of the original K-D validation study with the same age groups of the current cohort, participants aged 6 to 11 years recorded a faster baseline time (range 3.5 to 8.6 s), while those in the 12 to 14 years. age group recorded slower baseline times (range −3.9 to −7.9 s). Discussion: In general, there were age group differences, but not sex differences, for K-D test times in the current cohort. Analysis of single card times, across all age groups, showed changes likely due to improved reading time. Conclusion: The results support the need for individualised annual pre-injury baseline testing of the K-D test.
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Glendon K, Blenkinsop G, Belli A, Pain M. Does Vestibular-Ocular-Motor (VOM) Impairment Affect Time to Return to Play, Symptom Severity, Neurocognition and Academic Ability in Student-Athletes following acute Concussion? Brain Inj 2021; 35:788-797. [PMID: 33896286 DOI: 10.1080/02699052.2021.1911001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Research indicates Sports-Related Concussion (SRC) impairs Vestibular-Ocular-Motor (VOM) function. The aim was to explore if VOM impairment correlates with longer Return To Play (RTP), symptom burden, neurocognitive performance and academic capability.Participants: 40 (61.4% male) Loughborough University, UK, rugby union student-athletes who sustained 42 SRCs.Methods: Student-athletes completed an assessment battery during pre-season (baseline), 2, 4, 8 and 14 days post-SRC and prior to RTP and were managed according to the rugby Football Union' community pathway.Outcome measures: Vestibular Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Test, Post-Concussion Symptom Scale, Perceived Academic Impairment Tool questionnaire and percentage of academic activities specifically missed due to SRC.Results: VOMS scores were significantly (p < 0.005) greater than baseline at all time points except RTP. Presence of VOM dysfunction at 14 days post-SRC significantly correlated with a longer RTP, greater symptom burden and increased odds ratio at 2, 4 and 8 days and academic time loss at 2, 4 and 8 days post-SRC.Conclusion: VOM impairment is associated with an increased symptom burden and impaired academic capability, and a longer time to RTP when present at 14 days post-SRC.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Wallace J, Learman K, Moran R, Covassin T, Deitrick JM, Delfin D, Shina J. Premorbid anxiety and depression and baseline neurocognitive, ocular-motor and vestibular performance: A retrospective cohort study. J Neurol Sci 2020; 418:117110. [PMID: 32882438 DOI: 10.1016/j.jns.2020.117110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Concussion has become a growing concern among sport and healthcare practitioners. Experts continue to investigate ways to advance the quality of concussion evaluation, diagnosis and management. Psychological conditions have been reported to influence concussion assessment outcomes at baseline and post-concussion; however, little evidence has examined psychological conditions and their effect on multifaceted measures of concussion. A retrospective cohort design was employed to examine differences between those with and without a premorbid psychological condition for high school and collegiate athletes who completed a preseason baseline battery, consisting of symptom reporting, computerized neurocognitive assessment, Vestibular-Ocular Motor Screening (VOMS), and the King-Devick (KD) test. Forty athletes within the sample self-reported a diagnosed psychological risk factor, consisting of depression and/or anxiety, and each were matched with a discordant control. Controls were matched on sex, age, sport, concussion history and ocular history. Athletes with psychological conditions reported higher symptom severity and had worse visual motor speed than controls. There were no differences between groups on other neurocognitive domains, VOMS, or KD. These results suggest that vestibular-ocular tools may be more consistent or less likely to vary between those with and without a premorbid psychological diagnosis, adding value to tools such as the KD and VOMS.
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Affiliation(s)
- Jessica Wallace
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America; Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Ken Learman
- Department of Physical Therapy, Youngstown State University, 1 University Plaza, Cushwa Hall B307 Youngstown, OH 44555, United States of America.
| | - Ryan Moran
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, 105 IM Sports Circle, East Lansing, MI 48824, United States of America.
| | | | - Danae Delfin
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - James Shina
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America
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A COMPARISON OF THE PAPER AND COMPUTERIZED TABLET VERSION OF THE KING-DEVICK TEST IN COLLEGIATE ATHLETES AND THE INFLUENCE OF AGE ON PERFORMANCE. Int J Sports Phys Ther 2020; 15:688-697. [PMID: 33110687 DOI: 10.26603/ijspt20200688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Sport-related concussion is a public concern with between 1.6 and 3.8 million sport- and recreation-related injuries occurring annually. An estimated 65% to 90% of concussed athletes show oculomotor disruption such as difficulty with saccades, accommodation, smooth pursuit, and fixation. A rapid number-naming saccade test, the King-Devick (K-D) test, has shown promising results as part of a multifaceted concussion assessment tool. Purpose The purpose of the current study was to evaluate the two versions of the K-D in collegiate aged (18-24) athletes to determine the agreement between versions. A secondary purpose was to investigate the association of K-D scores with sport, sex, use of glasses or contacts, and age of the athlete. Study design Descriptive laboratory study. Methods Division 1 NCAA collegiate athletes across ten sports were recruited to participate in baseline concussion assessments at the beginning of their respective athletic season. Correlations and multivariable logistic regression analyses were used to investigate the association of K-D scores with sex and age. Results One-hundred and nine athletes (69 males, 40 females; mean age = 20.40 ± 1.38 years) were baseline tested. There was excellent agreement (ICC=0.93, 95% CI: 0.90, 0.95) between the paper and computer version. Preseason K-D scores were statistically different (r2=0.873, p<0.05) with athletes scoring a mean of 37.58 seconds on the paper version (95% CI, 36.21, 38.96) and athletes scoring a mean of 41.48 seconds for the computerized tablet version (95% CI, 40.17, 42.91). There were no significant differences in sex, sport, or use of glasses noted for both versions. Age differences were identified; eighteen-year-old athletes took statistically longer than their peers for both K-D versions. Pairwise comparisons showed statistically significant differences between 18-year olds up to the age of 21-year-olds (p<0.05) for the computer version and statistically significant differences between 18-year olds up to 22-year-olds (p<0.05) for the paper version. Conclusion This study supports the use of either version of the K-D test as a potential part of a multifaceted concussion assessment. The age of the athlete influences scores and therefore a K-D baseline should be repeated annually for collegiate athletes. Clinicians should not substitute K-D versions (computer vs. paper) in comparing baseline to a post-concussion K-D score as the scores are quite different. Level of evidence Level 3.
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Bretzin AC, Anderson M, Moran RN, Covassin T. Long-term test-retest evaluation of the King-Devick test in youth soccer athletes. J Neurol Sci 2020; 416:116951. [DOI: 10.1016/j.jns.2020.116951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
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Wallace J, Moran R, Beidler E, McAllister Deitrick J, Shina J, Covassin T. Disparities on Baseline Performance Using Neurocognitive and Oculomotor Clinical Measures of Concussion. Am J Sports Med 2020; 48:2774-2782. [PMID: 32804545 DOI: 10.1177/0363546520946753] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion. PURPOSE To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual's participating high school was a Title I or non-Title I school. A series of multivariable linear regression analyses were conducted to evaluate the association of computerized neurocognitive test scores (verbal memory, visual memory, motor processing speed, and reaction time), symptom severity scores, and KD scores by race and SES. RESULTS White/non-Hispanic individuals performed significantly better than Black/African American individuals on verbal memory (P < .01), visual memory (P < .01), visual motor processing speed (P < .01), and reaction time (P < .01) and had a lower symptom score (P < .01). Regarding SES, individuals from non-Title I schools performed better on visual memory (P = .05) and reaction time (P = .02) than individuals from Title I schools. Examination of cumulative KD test reading time revealed that there was no association between race on baseline reading times (P = .12). There was a significant association between cumulative reading time and SES (P = .02). Individuals from non-Title I schools performed significantly faster than individuals from Title I schools on KD test time. CONCLUSION Overall, race and SES influence neurocognitive and oculomotor concussion baseline performance in high school athletes. These findings add to the growing literature on the influence of race and SES on neurocognitive and oculomotor function baseline concussion assessments; they highlight the necessity for individualized concussion baseline measurements or race-specific normative reference values.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ryan Moran
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | - James Shina
- Youngstown State University, Youngstown, Ohio, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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Abstract
Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a clinical challenge. The heterogeneity in presentation following injury provides an additional level of complexity, requiring the screening and evaluation of diverse body systems, including oculomotor, vestibular, autonomic, psychiatric, cervical, and cognitive symptoms. While a few tools, such as the Vestibular/Ocular Motor Screening and Balance Error Scoring System, have been developed specifically for concussion, the vast majority of tests are adapted from other conditions. Further complicating the process is the overlapping and interactive nature of the multiple domains of postconcussion presentation. This commentary illustrates how clinicians can conceptualize the multiple profiles that present following concussion and describes tools that are available to assist with screening and evaluation of each area. The multifaceted nature of concussion warrants broad clinical screening skills and an interdisciplinary approach to management. J Orthop Sports Phys Ther 2019;49(11):787-798. doi:10.2519/jospt.2019.8855.
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Moran RN, Wallace J, Murray NG, Covassin T. Effects of attention deficit hyperactivity disorder and learning disability on vestibular and ocular baseline concussion assessment in pediatric athletes. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:276-282. [PMID: 31650856 DOI: 10.1080/21622965.2019.1683453] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vestibular and ocular motor assessment has gained popularity as a tool for sport-related concussion among healthcare professionals. With awareness of premorbid risk factors, such as attentional problems, it is imperative to understand their effects at baseline. The purpose of this study was to examine the effects of attention deficit/hyperactivity disorder (ADHD) and diagnosed learning disability (LD) on vestibular and oculomotor baseline concussion assessment in pediatrics. Pediatric athletes between the ages of 8 and 14 years with ADHD/LD (n = 30) and match controls without ADHD/LD (n = 30) completed baseline concussion testing, consisting of symptom provocation on the Vestibular/Ocular Motor Screening (VOMS) and oculomotor performance on near point of convergence (NPC) and King-Devick (K-D) tools. Those diagnosed with ADHD/LD performed worse on baseline saccades (p range = .02-.10), convergence (p = .04), vestibular ocular reflex (VOR) (p = .03) and visual motion sensitivity (VMS) (p = .04) of the VOMS. Base rate analyses revealed that 26% of athletes in the ADHD/LD group had ≥1 and 13.3% had ≥2 VOMS domains over clinical cutoff levels, compared to 3.3% (≥1 domain) and 0 (≥2 domains) of controls. Individuals with ADHD/LD also performed worse on K-D assessment (p = .005). However, no differences were reported on NPC distance (p = .19). These findings suggest worse baseline concussion assessment scores on vestibular/ocular motor assessment domains in pediatric athletes diagnosed with ADHD/LD. Additional research is needed on assessment outcomes to determine if special consideration to those diagnosed with ADHD/LD is warranted.
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Affiliation(s)
- Ryan N Moran
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jessica Wallace
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Nicholas G Murray
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Tracey Covassin
- Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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Moran RN, Meek J, Allen J, Robinson J. Sex differences and normative data for the m-CTSIB and sensory integration on baseline concussion assessment in collegiate athletes. Brain Inj 2019; 34:20-25. [DOI: 10.1080/02699052.2019.1669824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ryan N. Moran
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jeff Meek
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jeff Allen
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - James Robinson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
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Legarreta AD, Mummareddy N, Yengo-Kahn AM, Zuckerman SL. On-field assessment of concussion: clinical utility of the King-Devick test. Open Access J Sports Med 2019; 10:115-121. [PMID: 31686924 PMCID: PMC6709031 DOI: 10.2147/oajsm.s171815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Sport-related concussion (SRC) is an important public health concern with up to 3.8 million SRCs occurring each year. As the incidence and rate of SRC increases, reliable and valid tools for diagnosis and management are needed. The King-Devick (K-D) test assesses a patient’s visual function based on reading a series of numbers as well as counting both time to completion and errors. Its rapid administration time and simplicity make the K-D test a potentially useful SRC diagnostic tool, though limitations exist in baseline testing and what constitutes an abnormal score. Additionally, the K-D tests should never be used in isolation to diagnose a concussion, but rather as one test in conjunction with additional clinical measures, as part of an individualized approach to each patient. The current review examines the clinical utility of the K-D test.
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Affiliation(s)
- Andrew D Legarreta
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nishit Mummareddy
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Moran RN, Covassin T, Wallace J. Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes. J Neurosurg Pediatr 2019; 23:465-470. [PMID: 30641840 DOI: 10.3171/2018.10.peds18425] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Migraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes. METHODS Pediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time). RESULTS Individuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002-0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment. CONCLUSIONS Pediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.
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Affiliation(s)
- Ryan N Moran
- 1Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, Alabama
| | - Tracey Covassin
- 2Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University, East Lansing, Michigan; and
| | - Jessica Wallace
- 3Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, Ohio
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Lawrence JB, Haider MN, Leddy JJ, Hinds A, Miecznikowski JC, Willer BS. The King-Devick test in an outpatient concussion clinic: Assessing the diagnostic and prognostic value of a vision test in conjunction with exercise testing among acutely concussed adolescents. J Neurol Sci 2019; 398:91-97. [PMID: 30690413 PMCID: PMC7038786 DOI: 10.1016/j.jns.2018.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study investigated the diagnostic and prognostic value of the King-Devick (K-D) test in conjunction with treadmill testing in adolescents after sport-related concussion (SRC) in an outpatient concussion management clinic without baseline measures. DESIGN Prospective cohort. METHODS The K-D test was administered pre- and post-exercise on a graded treadmill test to acutely concussed (AC, <10 days from injury, n = 46, 15.4 ± 2.1 years) participants for 2 clinic visits (1 week apart) and to matched controls (MC, n = 30, 15.8 ± 1.4 years) for 2 visits (1 week apart). Initial K-D test times were compared between MC and AC. Changes in times from pre- to post- exercise during a treadmill test were compared for MC and AC and from Visit 1 to Visit 2. Smooth pursuits and repetitive saccades were compared with initial visit K-D test performance. RESULTS Comparison of pre-exercise K-D test times at Visit 1 distinguished MC from AC (46.1 ± 9.2 s vs. 53.7 ± 13.0 s, p = .007). Comparison of pre- and post-exercise K-D test times revealed significant improvements for MC (46.1 ± 9.2 s vs. 43.1 ± 8.5 s, p < .001) and AC who recovered by Visit 2 (Fast Recovery Group [FRG], n = 23, 50.4 ± 10.0 s vs. 47.3 ± 9.8 s, p = .002). No significant difference was seen in pre- and post-exercise K-D test times on Visit 1 for AC who took longer than 2 weeks to recover (Slow Recovery Group [SRG], n = 23, 57.0 ± 15.0 s vs. 56.0 ± 16.3 s, p = .478). At Visit 1, AC had more abnormal smooth pursuits than MC (17% vs. 3%, non-significant, p = .064). AC, however, had significantly more abnormal repetitive saccades than MC (37% vs. 3%, p = .001) and AC with abnormal repetitive saccades took significantly longer to complete the Visit 1 pre-exercise K-D test than AC with normal repetitive saccades (58.6 ± 16.0 s vs 50.8 ± 10.2 s, p = .049). CONCLUSION The study supports utility of the K-D test as part of outpatient concussion assessment. Lack of improvement in K-D test performance after an exercise test may be an indicator of delayed recovery from SRC.
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Affiliation(s)
- Justine B Lawrence
- Department of Neuroscience, University at Buffalo, SUNY, Buffalo, NY 14214, United States.
| | - Mohammad N Haider
- Department of Neuroscience, University at Buffalo, SUNY, Buffalo, NY 14214, United States; UBMD Department of Orthopedics and Sports Medicine, University at Buffalo, SUNY, Buffalo, NY 14214, United States
| | - John J Leddy
- UBMD Department of Orthopedics and Sports Medicine, University at Buffalo, SUNY, Buffalo, NY 14214, United States
| | - Andrea Hinds
- UBMD Department of Orthopedics and Sports Medicine, University at Buffalo, SUNY, Buffalo, NY 14214, United States
| | | | - Barry S Willer
- Department of Psychiatry, University at Buffalo, SUNY, Buffalo, NY 14214, United States
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Hood EA, Klima DW, Chui KK, Avallone NJ. Pre-season concussion assessment utilizing the King-Devick Test. Res Sports Med 2018; 27:467-472. [DOI: 10.1080/15438627.2018.1535434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ethan A. Hood
- Doctor of Physical Therapy Program, DeSales University, Center Valley, PA, USA
| | - Dennis W. Klima
- Department of Physical Therapy, University of Maryland- Eastern Shore, Princess Anne, MD, USA
| | - Kevin K. Chui
- School of Physical Therapy and Athletic Training, Pacific University, Forest Grove, OR, USA
| | - Nicholas J. Avallone
- Department of Orthopaedic Surgery, St. Luke’s University Health Network, Phillipsburg, NJ, USA
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Moran RN, Covassin T. King-Devick test normative reference values and internal consistency in youth football and soccer athletes. Scand J Med Sci Sports 2018; 28:2686-2690. [DOI: 10.1111/sms.13286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/13/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Ryan N. Moran
- Athletic Training Research Lab; Department of Health Science; The University of Alabama; Tuscaloosa Alabama
| | - Tracey Covassin
- Sports Injury Research Lab; Department of Kinesiology; Michigan State University; East Lansing Michigan
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