The simple concussion test the NFL does not use

PHOENIX – When Ziggy Ansah drove his helmet into the side of Jimmy Clausen's head in an NFL game in December, it looked like a semi-truck hitting a Mini Cooper. Anyone who saw the hit could feel the headache coming on.

Yet not only did Clausen stay in for the rest of the drive, the last that day for the Chicago Bears, the team later said he passed all of the necessary testing.

A few hours later, Clausen had developed concussion symptoms severe enough to send him to a hospital. The next day, in an unusually swift decision, the Bears ruled him out of the next game.

"We have to accept that the idea of letting someone pass the concussion protocol on the sideline is flawed in itself," said Chris Nowinski, co-founder of the Sports Legacy Institute, the non-profit dedicated to advancing the treatment and prevention of concussions in athletes.

"There will be some percentage of people who will pass the test, but will have symptoms later," Nowinski said. "It's inherent in concussions."

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There is another test that could help. But the NFL isn't using it.

"I can't tell you why," said Steve Devick, co-creator of the King-Devick Test. "They know about us, that's for sure."

The King-Devick Test measures saccadic, or rapid, eye movement. A person suspected of having a concussion is given three cards, each with several lines of numbers on them, and asked to read them, left to right. When there's been a concussion or some other brain injury, the time it takes to read the numbers will be slower than the person's baseline test. (The test also can be administered using an app, with the numbers presented on three different screens.)

Unlike the NFL's Sideline Concussion Assessment, part of which requires the medical professional administering it to make a judgment on whether a player is showing signs of a head injury, the King-Devick test is completely objective. It takes just two minutes to complete, compared with five minutes or more for the NFL's current test.

"You don't have to look at a guy and say, `Gee, I wonder if he has a concussion?'" Devick said. "You just have to have him read the numbers and, if he's slower, he's got a concussion."

There has been little, if any, talk about concussions in the lead-up to the Super Bowl, especially after a season with attention focused on the NFL's handling of domestic violence cases and, for the last week, Deflategate.

The NFL doesn't question the science behind the eye movement tests – a few teams are using the King-Devick – and one will likely be included in the protocol in coming years, said Dr. Richard Ellenbogen, co-chair of the NFL's Head, Neck and Spine Committee and chair of the Neurological Surgery department at the University of Washington.

But there are other such tests, Ellenbogen said, and the NFL hasn't determined which is best for the entire league.

"Yes, the King-Devick test is a good one, but there are many out there," Ellenbogen said. "It's like everything else: There's a fair amount of research, and people will argue that their eye movement test is better."

The Mayo Clinic weighed in on Tuesday, throwing its support behind the King-Devick with a first-of-its-kind licensing agreement.

"Mayo Clinic certainly wouldn't endorse, support or be associated with something they didn't thoroughly vet, and this was thoroughly vetted. The data speaks for itself," said Dr. David Dodick, a neurologist who heads Mayo's Concussion Program.

"Is it perfect? No, nothing is perfect," Dodick said. "But is it a valuable tool that can be used pitchside, rinkside and on the sideline to report the suspicion of a concussion? Absolutely."

Useful tool

There is no longer any dispute that concussions and blows to the head can have devastating long-term effects – or that football players are particularly vulnerable. Though the NFL's approach is vastly improved even from a few years ago, there is still no way to prevent concussions – no equipment, no helmet, no medication.

No foolproof diagnosis, either.

With so much at stake, the King-Devick test seems too simple. Too easy.

Devick and Alan King developed their test when they were in optometry school and wondered if there was a link between poor reading performance and rapid eye movement. That same principle makes it effective in identifying concussions, Dodick said.

"Over half of the pathways in our brain are dedicated to vision and eye movement," Dodick said. "So it's very difficult to injure the brain anywhere without causing an abnormality in vision."

"That underlying anatomy … is what makes this test, while simple, very elegant and very accurate."

Eye movement is immediately impacted when a brain is damaged, meaning the King-Devick test can identify a concussion even when there are no obvious or immediate symptoms. Research also has shown it can identify "silent" brain injuries, those that are caused by repetitive hits – a season's worth, for example – rather than a single violent collision.

Fatigue, exhaustion and physical exertion have no effect on the test results.

"When you present the data and the simplicity of it and the (small) expense of it, one has to ask those questions: Why haven't I heard of this? And why isn't this being used on every sidelines?" Dodick said.

Impact on rosters?

Devick and Nowinski have their suspicions. If there was a test that could immediately identify players with suspected concussions, how many would have to come out of each game?

This season alone, Pittsburgh Steelers quarterback Ben Roethlisberger stayed in a playoff game after a vicious blow to the head. In October, the San Diego Chargers admitted safety Jahleel Addae was allowed to continue playing despite suffering an obvious concussion.

"If you're going based on evidence, (King-Devick) should be part of the program," Nowinski said. "I'm wondering if tests like that could be too sensitive if you want to be able to put guys back in."

Dodick wasn't as cynical, praising the NFL for the strides it's made in identifying and treating concussions. There are on average 27 medical professionals at each game, including independent neurologists on the sidelines and injury spotters in the press box.

The return-to-play protocol is specific and science-based, and the NFL is spending millions on research on everything from tests to helmets.

But the science is evolving so rapidly it takes time to vet something like the King-Devick test. In Dodick's opinion, that's now been done.

"It has now emerged as a gold standard, I think, for sideline diagnosis for concussions," Dodick said. "So it's only a matter of time, I believe, once the word gets out, where there's going to have to be a very good reason for them not to use it."