Sideline Test Can Diagnose Concussions Quickly

Drs. Amanda Martin and Lawrence Lemak on the sidelines at Jacksonville State University.

Player safety is a priority in all sports, from the youth level to professional teams. Of particular concern are concussion injuries, which have gained increased attention in recent years. To more accurately assess athletes who may have concussion, a simple vision test has been adapted for use on game sidelines and is being introduced to sports teams in Alabama and on the national level through a partnership between Lemak Sports Medicine & Orthopedics and Schaeffer Eye Center in Birmingham.

According to a 2013 Institute of Medicine and National Research Council report, concussions occurred in college athletes approximately every 4.3 out of 10,000 times they were on the field, either to practice or play. “Concussions are one of the greatest concerns right now for all parents who have children in sports,” says Lawrence J. Lemak, MD. “They wonder whether or not their child play sports because of concussions. Because of that, concussions are very important to us.”

The biggest danger of concussions is that the injury will go unrecognized and untreated, Lemak says. The risk of a second, more serious concussion is greatly increased when someone is still symptomatic from a first concussion. Second impact syndrome is a condition in which the brain irreversibly swells after suffering a new head injury before symptoms from an earlier one have subsided. The average death rate from second impact syndrome is 50 percent, and for those who survive, the risk of disability is almost 100 percent. “The result can be a traumatic brain injury, and that’s devastating,” he says.

The King-Devick Test, a vision test developed more than two decades ago, was initially used to evaluate children for learning disabilities. In 2011, New York University researchers published findings showing that the test helped detect brain injury in boxers and mixed martial arts fighters. Use of the test now has spread to all types of sports teams where concussions can be a significant danger.

The three-minute test, which can be conducted on the sideline, capitalizes on an important symptom of brain injury – a disruption in the eyes' ability to travel smoothly across a page and to shift direction upon the brain's command. The test-taker is asked to read several pages of single-digit numbers that are arrayed left to right in columns that don't vertically align. The individual must read the numbers quickly and accurately, which requires smooth and steady eye movement across and down the page, as well as concentration, the rapid recognition of numbers and fast language production. A concussion can compromise some or all of these, making the test a good measure of whether an athlete should be removed from play and be assessed for concussion.

The test uses pre-concussive baseline testing to determine each athlete’s normal cognitive function. When an athlete is tested following a potential injury, the baseline score is used to measure against the scores after the injury. Lemak says they have done baseline testing on about 6,000 young people in preparation for possible injuries.

“This simple, validated reading test gives us a real window into brain function. The baseline testing is not a new concept, and it is so important,” Lemak says. “When a player goes down, everyone wants to know if he has a concussion. Now, when he comes to the sideline, we can look at his baseline. If he deviates from the baseline, there’s no question that he’s had a concussion. Being able to get the answer quickly makes everyone more comfortable because nobody wants a child to go back into a game and risk a traumatic injury.”

Lemak says that the test was brought to his attention by one of the best sport scientists in the country, and the physicians at Schaeffer Eye Center knew all about it. “The Schaeffers have all the high-performance machines in their offices where they can check the vision of injured athletes and follow their progress as they heal to make sure they are safe to return to play,” he says. “Another advantage of our partnership is that a lot of these athletes have not had eye exams, and Schaeffer can do that for them as well. You may be a good athlete, but if you can’t see the ball, you’re not going to be as skilled an athlete as you could be. So this partnership with Schaeffer is a good relationship for us, and we are happy that we’re doing a joint venture with them.”

Medical evaluations are done at Lemak Sports Medicine’s offices by physicians who specialize in concussions, including Robert Agee, MD; Stanford Faulkner, MD; James Sedlis, MD, and Robert Flannery, MD. Every injured athlete must be cleared by a physician before returning to play.

Lemak said they also are working with school nurses on a “Return to Learn” program. “When you’ve had a concussion, you can’t just start using your brain right away. You can’t be studying for exams the next day because your brain needs a rest,” he says. “We do the medical evaluations and Schaeffer does the eye evaluations, and we determine the safest way for a patient to return after a concussion. We communicate that to the school nurse so they can ensure proper protocol is followed in the school setting.”

Lemak points out that what we know about concussions continues to evolve and more education is needed. President Obama brought the issue to the national forefront earlier this year with a White House summit on the subject. A panel of experts discussed the issue and money was raised to assist in ongoing research and treatment.

“This is not a static topic. We have to continue to research the nature of the brain injury and brain function,” Lemak says. “In a year or two, we will know even more than we know today. It is an ongoing area of research and investigation.”

Larry Lemak, MD examines an athlete who has suffered a concussion.


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