Advertisement
Research Article| Volume 334, ISSUE 1-2, P148-153, November 15, 2013

Comparison and utility of King-Devick and ImPACT® composite scores in adolescent concussion patients

Published:September 05, 2013DOI:https://doi.org/10.1016/j.jns.2013.08.015

      Abstract

      The King-Devick (KD) oculomotor test has recently been advocated for sideline diagnosis of concussion. Although visual processing and performance are often impaired in concussion patients, the utility of KD as a concussion diagnostic tool is not validated.

      Purpose

      To examine the diagnostic value of KD, by comparing KD with post-concussion symptom scale (PCSS) and ImPACT® composite scores. We hypothesized that KD would be correlated with visual motor speed/memory (VMS, VIS) and reaction time (RT), because all require cognitive visual processing. We also expected parallel changes in KD and PCSS across recovery.

      Methods

      Thirty-five concussed individuals (12–19 y; 18 females, 17 males) were evaluated with PCSS, ImPACT® composite and KD scores over four clinical visits (V).

      Results

      KD times improved with each visit (ΔV1–V2: 7.86 ± 11.82; ΔV2–V3: 9.17 ± 11.07; ΔV3–V4: 5.30 ± 7.87 s) and paralleled improvements in PCSS (ΔV1–V2: 8.97 ± 20.27; ΔV2–V3: 8.69 ± 14.70; ΔV3–V4: 6.31 ± 7.71), RT (ΔV1–V2: 0.05 ± 0.21; ΔV2–V3: 0.09 ± 0.19; ΔV3–V4 0.03 ± 0.07) and VMS (ΔV1–V2: −5.27 ± 6.98; ΔV2–V3: −2.61 ± 6.48; ΔV3–V4: −2.35 ± 5.22). Longer KD times were associated with slower RT (r = 0.67; P < 0.0001) and lower VMS (r = −0.70; P < 0.0001), respectively.

      Conclusion

      Cognitive visual performance testing using KD has utility in concussion evaluation. Validation would further establish KD as an effective ancillary tool in longitudinal concussion management and research.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control, Prevention
        Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤19 years — United States, 2001–2009.
        MMWR. 2011; 60: 1337-1342
        • Centers for Disease Control, Prevention
        Nonfatal traumatic brain injuries from sports and recreation activities — United States, 2001–2005.
        MMWR. 2007; 56: 733-737
        • Langlois J.A.
        • Rutland-Brown W.
        • Wald M.M.
        The epidemiology and impact of traumatic brain injury: a brief overview.
        J Head Trauma Rehabil. 2006; 21: 375-378
        • Buzzini S.R.
        • Guskiewicz K.M.
        Sport-related concussion in the young athlete.
        Curr Opin Pediatr. 2006; 18: 376-382
        • Toledo E.
        • Lebel A.
        • Becerra L.
        • Minster A.
        • Linnman C.
        • Maleki N.
        • et al.
        The young brain and concussion: imaging as a biomarker for diagnosis and prognosis.
        Neurosci Biobehav Rev. 2012; 36: 1510-1531
        • Blumbergs P.C.
        • Scott G.
        • Manavis J.
        • Wainwright H.
        • Simpson D.A.
        • McLean A.J.
        Staining of amyloid precursor protein to study axonal damage in mild head injury.
        Lancet. 1994; 344: 1055-1056
        • Blumbergs P.C.
        • Scott G.
        • Manavis J.
        • Wainwright H.
        • Simpson D.A.
        • McLean A.J.
        Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury.
        J Neurotrauma. 1995; 12: 565-572
        • Bazarian J.J.
        • Zhong J.
        • Blyth B.
        • Zhu T.
        • Kavcic V.
        • Peterson D.
        Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: a pilot study.
        J Neurotrauma. 2007; 24: 1447-1459
        • Ciuffreda K.J.
        • Kapoor N.
        • Rutner D.
        • Suchoff I.B.
        • Han M.E.
        • Craig S.
        Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.
        Optometry. 2007; 78: 155-161
        • Kraus M.F.
        • Little D.M.
        • Donnell A.J.
        • Reilly J.L.
        • Simonian N.
        • Sweeney J.A.
        Oculomotor function in chronic traumatic brain injury.
        Cogn Behav Neurol. 2007; 20: 170-178
        • Glass I.
        • Groswasser Z.
        • Groswasser-Reider I.
        Impersistent execution of saccadic eye movements after traumatic brain injury.
        Brain Inj. 1995; 9: 769-775
        • Crevits L.
        • Hanse M.C.
        • Tummers P.
        • Van Maele G.
        Antisaccades and remembered saccades in mild traumatic brain injury.
        J Neurol. 2000; 247: 179-182
        • Heitger M.H.
        • Jones R.D.
        • Macleod A.D.
        • Snell D.L.
        • Frampton C.M.
        • Anderson T.J.
        Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression. Malingering or intellectual ability.
        Brain. 2009; 132: 2850-2870
        • Lepore F.E.
        Disorders of ocular motility following head trauma.
        Arch Neurol. 1995; 52: 924-926
        • Schlageter K.
        • Gray B.
        • Hall K.
        • Shaw R.
        • Sammet R.
        Incidence and treatment of visual dysfunction in traumatic brain injury.
        Brain Inj. 1993; 7: 439-448
        • Capo-Aponte J.E.
        • Urosevich T.G.
        • Temme L.A.
        • Tarbett A.K.
        • Sanghera N.K.
        Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury.
        Mil Med. 2012; 177: 804-813
        • Kapoor N.
        • Ciuffreda K.J.
        Vision disturbances following traumatic brain injury.
        Curr Treat Options Neurol. 2002; 4: 271-280
        • Resch J.
        Reliability of a computerized neuropsychological test [Doctoral dissertation].
        University of Georgia, Athens, Georgia2010
        • Galetta K.M.
        • Brandes L.E.
        • Maki K.
        • Dziemianowicz M.S.
        • Laudano E.
        • Allen M.
        • et al.
        The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort.
        J Neurol Sci. 2011; 309: 34-39
        • Galetta K.M.
        • Barrett J.
        • Allen M.
        • Madda F.
        • Delicata D.
        • Tennant A.T.
        • et al.
        The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters.
        Neurology. 2011; 76: 1456-1462
        • King D.
        • Clark T.
        • Gissane C.
        Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: a pilot study.
        J Neurol Sci. 2012; 320: 16-21
        • King D.
        • Brughelli M.
        • Hume P.
        • Gissane C.
        Concussions in amateur rugby union identified with the use of a rapid visual screening tool.
        J Neurol Sci. 2013; 326: 59-63
        • Eckner J.T.
        • Kutcher J.S.
        Concussion symptom scales and sideline assessment tools: a critical literature update.
        Curr Sports Med Rep. 2010; 9: 8-15
        • Bland J.M.
        • Altman D.G.
        Calculating correlation coefficients with repeated observations: part 1—correlation within Subjects.
        BMJ. 1995; 310: 446
        • Harmon K.G.
        • Drezner J.
        • Gammons M.
        • Guskiewicz K.
        • Halstead M.
        • Herring S.
        • et al.
        American Medical Society for Sports Medicine position statement: concussion in sport.
        Clin J Sport Med. 2013; 23: 1-18
        • McCrory P.
        • Meeuwisse W.H.
        • Aubry M.
        • Cantu B.
        • Dvorak J.
        • Echemendia R.J.
        • et al.
        \Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.
        Br J Sports Med. 2013; 47: 250-258
        • Lovell M.R.
        • Iverson G.L.
        • Collins M.W.
        • Podell K.
        • Johnston K.M.
        • Pardini D.
        • et al.
        Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale.
        Appl Neuropsychol. 2006; 13: 166-174
        • Chen J.K.
        • Johnston K.M.
        • Collie A.
        • McCrory P.
        • Ptito A.
        A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI.
        J Neurol Neurosurg Psychiatry. 2007; 78: 1231-1238
        • Sterr A.
        • Herron K.A.
        • Hayward C.
        • Montaldi D.
        Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome.
        BMC Neurol. 2006; 6: 7
        • Fazio V.C.
        • Lovell M.R.
        • Pardini J.E.
        • Collins M.W.
        The relation between post concussion symptoms and neurocognitive performance in concussed athletes.
        NeuroRehabilitation. 2007; 22: 207-216
        • Van Kampen D.A.
        • Lovell M.R.
        • Pardini J.E.
        • Collins M.W.
        • Fu F.H.
        The “value added” of neurocognitive testing after sports-related concussion.
        Am J Sports Med. 2006; 34: 1630-1635
        • Lovell M.
        • Collins M.
        • Maroon J.
        • Cantu R.
        • Hawn M.
        • Burke C.
        • et al.
        Inaccuracy of symptom reporting following concussion in athletes.
        Med Sci Sports Exerc. 2002; 34: S298
        • Lieberman S.
        • Cohen A.H.
        • Rubin J.
        NYSOA K-D test.
        J Am Optom Assoc. 1983; 54: 631-637
        • Moser R.S.
        • Schatz P.
        A case for mental and physical rest in youth sports concussion: it's never too late.
        Front Neurol. 2012; 3: 171
        • Richman J.E.
        • Walker A.J.
        • Garzia R.P.
        The impact of automatic digit naming ability on a clinical test of eye movement functioning.
        J Am Optom Assoc. 1983; 54: 617-622
        • Oride M.K.
        • Marutani J.K.
        • Rouse M.W.
        • DeLand P.N.
        Reliability study of the Pierce and King-Devick saccade tests.
        Am J Optom Physiol Opt. 1986; 63: 419-424