I wrote this blog post over a week ago. I was waiting for the right time to publish it. Well, yesterday 3 elite NFL quarterbacks suffered concussions (Michael Vick, Jay Cutler, and Alex Smith). I guess the good news is that they were removed from play and received prompt medical attention. But what about their futures? and the future of all the student athletes who play on?
CTE is chronic traumatic encephalopathy. It is a progressive degenerative disease process that is associated with repetitive brain trauma, such as concussions. CTE is most often associated with boxers, but more recently, retired football players have been diagnosed with CTE post mortem. The symptoms of CTE include memory loss, aggression, inappropriate emotional responses, depression, and progressive dementia.
CTE is associated with the build up of a brain protein called tau. Tau is associated with normal neuronal function. But mutations to the protein cause it to malfunction and form plaques that are then deposited in the cortex of the brain. These abnormal depositions occur over an extended time. While it is not clear how repetitive trauma causes these mutations and the deposition of tau proteins, there is not doubt that it is associated with CTE and other degenerative brain diseases such as Alzheimer’s disease.
The mounting evidence of the association between repetitive brain trauma and CTE has caused significant consideration of how to protect athletes. The NFL has responded with a combination of rule changes, better equipment, more comprehensive policies concerning the evaluation of players who may have suffered a concussion, and more education of players about the signs, symptoms and consequences of concussion and repetitive head trauma. Greater awareness is trickling down to college and high school sports and recreational leagues, but with fewer resources, it is more difficult to put effective policies into place. High schools are not likely to have a board certified neurologist on the sidelines making decisions about whether a player returns to play or sits down for a week.
Return to play decisions are even more important for young athletes because of Second Impact Syndrome. If a young athlete sustains a 2nd head injury before the symptoms and pathopysiology of the 1st injury have resolved, this second brain trauma can cause very severe and very rapid brain swelling. This can result in permanent brain damage or death.
Parents, school administrators and coaches are beginning to realize the importance of protecting young athletes and preventing the long-term consequences of repetitive head trauma. There is now a fast, easy to administer and reliable test that can be used on the sidelines to facilitate return-to-play decisions. The King-Devick (K-D) test was developed by optometrists to evaluate reading eye movements in children. The test requires approximately 2 minutes to administer and simply asks the student to read aloud a series of numbers arranged in horizontal rows on each of three test cards. Although the task appears very simple, rapid number naming requires the integration of many areas of the brain. An increase in the time to complete the task when compared to a baseline measurement is the result of impaired eye movements and indicative of suboptimal brain function.
Every optometrist must educate the coaches and parents in their communities about the King-Devick Test. The test should be administered to all student athletes at the beginning of the season to establish a baseline. The test should be re-administered on the sidelines if there is even the slightest concern that an athlete has sustained a concussion. If the time to complete the test has increased by even 1 second, the athlete should be removed from play and sent for a complete concussion evaluation.
This is a public health issue and the time to act is now. A small investment of both time and money can begin the process of reducing the impact of repetitive head trauma and protecting our children from a devastating illness.
Read more about concussion and the King Devick Test here.
Read more about CTE here.