Rehabilitation Measures Instrument
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King Devick Test

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Purpose

The King Devick Test (K-D Test) is a baseline measure and concussion sideline screening assessment test of rapid number naming that requires eye movements, language function and attention in athletes. 

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Instrument Details

Acronym K-D Test

Area of Assessment

Cognition

Assessment Type

Other

Administration Mode

Computer

Cost

Not Free

Actual Cost

$60.00

Cost Description

1-99 subjects: $20/subject
100-199 subjects: $15/subject
200+ subjects: $10/subject
Note: there is a minimum of 3 subjects required to purchase

Populations

Non-Specific Patient Population
Brain Injury

Key Descriptions

  • 3 test cards or computer-based application
  • Total time to complete each card is recorded as well as number of reading errors
  • All three test card scores are summed for a total score
  • Best trial of 2 recorded as baseline score if completed pre-season
  • 1 trial completed if suspected concussion and score recorded
  • Mayo Clinic owns the rights to the test and available via website/app purchase
  • Apple App: https://apps.apple.com/us/app/king-devick-test-w-mayo-clinic/id1033607954
  • Windows App: https://play.google.com/store/apps/details?id=com.kingdevicktest.androidPro&hl=en_US
  • Computer/Laptop App: https://kingdevicktestapp.com/Account/LogOn

Number of Items

3 separate test cards with increasing difficulty

Equipment Required

  • Paper Version:
  • Stop watch
  • Score card
  • Test cards
  • Application Version:
  • Standard iPad (9.7+ in), Android (10.1+ in), Laptop/Computer (13+ in)
  • Score cards

Time to Administer

2 minutes

Required Training

No Training

Age Ranges

Pediatric

5 - 17

years

Adults

18 +

years

Instrument Reviewers

Initially reviewed by Rebecca A Bliss, PT, DPT, NCS in 2017. 

Body Part

Head

ICF Domain

Body Function

Measurement Domain

Cognition

Professional Association Recommendation

  • The King-Devick Test has been specifically determined to have FDA pre-amendment status as a tool for evaluation of saccadic eye movement
  • Health Canada designated King-Devick Test as an approved and licensed medical device
  • King-Devick Test is registered as a Class I Medical Device in the European Union
  • King-Devick Test is a registered medical device with the Australia TGA

Considerations

  • King-Devick Test is for assessment purposes only and any suspicion or indication of concussion should be evaluated by a licensed professional.
  • The K-D Test has shown to have practice effects to include reported 3.53 second improvement from trial 1 to trial 2 and the best score should be recorded (Heick, 2016)
  • It has been suggested in order to decrease practice effect for baseline scores the administrator can add trials to the measurement schedule until a performance plateau occurs (Heick, 2016)
  • There is no literature reported on the use of the K-D Test as an objective outcome measure for progress in rehabilitation
  • Systematic Review and Meta-Analysis performed reports weighted normative data with little heterogeneity (Galetta, 2016)
  • Currently Mayo Clinic has the rights and in order to comply with license cost may be a barrier to utilization
  •  King-Devick Test has FDA pre-amendment certification for the assessment of saccadic eye movements. K-D Balance is FDA 510(k) cleared as a balance assessment tool.

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Healthy Individuals: (Heick, 2016; n=60; mean age=19.9(3.74) years)

  • SEM for entire sample all 3 trials (n=60) 2.29
  • SEM for males all 3 trials (n=30) 2.33
  • SEM for females all 3 trials  (n=30) 2.33
  • SEM for entire sample trials 2 and 3 only (n=60) 2.00
  • SEM for trials 2 and 3 only male (n=30) 1.43
  • SEM for trials 2 and 3 only female (n=30) 2.40

Minimal Detectable Change (MDC)

Healthy Individuals: (Heick, 2016; n=60; mean age=19.9(3.74) years)

  • MDC for entire sample all 3 trials (n=60) 6.35
  • MDC for male all 3 trials (n=30) 6.45
  • MDC for females all 3 trials  (n=30) 6.18
  • MDC for entire sample trials 2 and 3 only (n=60) 5.55
  • MDC for trials 2 and 3 only male (n=30) 3.96
  • MDC for trials 2 and 3 only female (n=30) 6.66

Healthy Adolescents:

(Oberlander, 2017; n=68; mean age = 15.4 (1.9) years)

  • MDC for entire group 8.76

 (Weise, 2017; n=619; mean age=14.2 (1.7) years)

  • MDC for entire group (n=619) 8.9
  • MDC for 9th grade and below (n=354) 10.2
  • MDC for 10th grade and above (n=257) 6.5

Normative Data

Collegiate, Amateur and Professional Athletes: (Galetta, 2016; n=1419; weighted mean age 14.8 (14.1,15.4 95% CI) years preseason)

  • Pooled analysis K-D Test mean score with weighted estimate 43.8 (40.2, 47.5 95% CI)

Adolescent Athletes: (Weise, 2017; n=619; mean age=14.2 (1.7) years preseason)

  • Median (IQR) K-D Test score 41.5 (12.0)
  • Median (IQR) K-D Test scores in adolescents with history of concussion; 38.5 (14.4)

 

Youth/Collegiate Athletes: (Galetta,2015; n=332; age=13.3 (12.8,13.8 95% CI) years preseason)

  • Mean baseline K-D Test scores 54.3 +-21.6 ( 24.3-159.8) for all athletes
  • Mean baseline K-D Test scores 60.6 +-22.3 (27.5-159.8) for youth athletes
  • Mean baseline K-D Test scores 38.4 +-6.3 (24.3-56.1) for collegiate athletes

Collegiate Athletes: (Galetta,2011; n=217; age=20.3 (20.1,20.5 95% CI) years preseason)

  • Median baseline K-D Test scores 38.6 (23.4-58.0)

Youth Athletes: (Munce et al, 2014); n=15, age=13.3 (12.9, 13.6 95% CI) years preseason)

  • Mean 49.6 (45.7-53.4 95% CI)

Test/Retest Reliability

Healthy Adolescents: (Oberlander, 2017; n=68; mean age=15.4 (1.9) years)

  • Excellent test-retest reliability (ICC=.81)

High School Athletes: (Alsalaheen, 2016; n=62; mean age=15.2(1.1) years)

  • Excellent test-retest reliability (ICC=.89)

Healthy Individuals 14-24 years: (Heick, 2016; n=60; mean age=19.9(3.74) years))

  • Excellent test-retest reliability mean of 3 trials (ICC=.95)

Collegiate Athletes: (Leong, 2015; n=127; mean age=19.6(1.2) years)

  • Excellent test-retest reliability (ICC=.95)

Adolescent Athletes: (Weise, 2017; n=619; mean age=14.2(1.7) years preseason)

  • Excellent test-retest reliability (ICC=.92)

Collegiate, Amateur and Professional Athletes: (Galetta, 2016; n=1419; weighted mean age 14.8 (14.1,15.4 95% CI) years preseason)

  • Excellent test-retest reliability (ICC=.92)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity: 

Healthy Controls (Rizzo, 2016; n=42; mean age=32 (range 18-53) years)

  • Excellent correlations with intersaccadic intervals (r= .79)

Predictive Validity: 

Healthy Controls (Rizzo, 2016; n=42; mean age=32 (range 18-53) years)

  • Excellent predictive validity of K-D Test times with combination of intersaccadic intervals and number of saccades (r=.88)

Construct Validity

Convergent Validity:

Concussion (Tjarks et al, 2013; n=35; 12-19 years)

  • Excellent correlation with ImPACT Reaction Time Scores (RT) (r=0.63)
  • Excellent correlation with ImPACT Visual Motor Speed (VMS) (r=-0.696)

Discriminant Validity:

Healthy Athletes: (Yorke et al, 2017; n=105)

  • Poor correlation to Vestibular Ocular Motor Screening Tool (VOMs) (rs= -.03-0.18)

Brain Injury

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Internal Consistency

Concussion: (Galetta,2011; n=217; age=20.3 (20.1,20.5 95% CI) years preseason)

Adequate internal consistency (Cronbach’s alpha 0.70, 0.76 and 0.77, Test card’s 1,2 and 3 respectively)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity: 

Concussion (Rizzo, 2016; n=25; mean age=31 (range 16-64) years)

  • Excellent correlations with intersaccadic intervals (r= .73)

Predictive Validity: 

Concussion (Rizzo, 2016; n=25; mean age=31 (range 16-64) years)

  • Excellent predictive validity of K-D Test times with combination of intersaccadic intervals and number of saccades (r=.89)

Concussion (Galetta et al, 2016; n=112)

  • High specificity (86%) for predicting concussions
  • High sensitivity (90%) in positive prediction of concussions

 

Construct Validity

Convergent Validity: 

Concussion (Galetta et al, 2015; n=26)

  • Excellent Receiver Operator Characteristic (ROC) =0.92

Concussion (Tjarks et al, 2013; n=35; 12-19 years)

  • Excellent correlation with ImPACT Reaction Time Scores (RT) (r=0.63)
  • Excellent correlation with ImPACT Visual Motor Speed (VMS) (r=-0.696)

Bibliography

Alsalaheen,B., Haines,J., Yorke,A., Diebold, J. (2016). King-Devick Test reference values and associations with balance measures in high school american football players. Scandinavian Journal Medicine and Science in Sports, 26, 235–239.

Benedict, P. A., Baner, N. V, Harrold, G. K., Moehringer, N., Hasanaj, L., Serrano, L. P., … Balcer, L. J. (2015). Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center. Journal of the Neurological Sciences, 353, 111–115.

Galetta, K. M., Brandes, L. E., Maki, K., Dziemianowicz, M. S., Laudano, E., Allen, M., … Balcer, L. J. (2011). The King–Devick test and sports-related concussion: Study of a rapid visual screening tool in a collegiate cohort. Journal of the Neurological Sciences, 309(1–2), 34–39.

Galetta, K. M., Morganroth, J., Moehringer, N., Mueller, B., Hasanaj, L., Webb, N., … Balcer, L. J. (2015). Adding Vision to Concussion Testing: A Prospective Study of Sideline Testing in Youth and Collegiate Athletes. Journal of Neuro-Ophthalmology : The Official Journal of the North American Neuro-Ophthalmology Society, 35(3), 235–41.

Galetta, K., Mengling, L., Leong, D., Ventura, R., Galetta, S., & Balcer, L. (2016). The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Future Medicine, 1(2).

Heick, J. D., Bay, C., Dompier, T. P., & Valovich McLeod, T. C. (2016). The Psychometric Properties of the King–Devick Test and the Influence of Age and Sex in Healthy Individuals Aged 14 to 24 Years. Athletic Training & Sports Health Care, 8(5), 222–229.

Leong, D. F., Balcer, L. J., Galetta, S. L., Evans, G., Gimre, M., & Watt, D. (2015). The King-Devick test for sideline concussion screening in collegiate football. Journal of Optometry, 8(2), 131–9.

Munce TA, Dorman JC, Thompson PA, Valentine VD, Bergeron MF. Head impact exposure and neurologic function of youth football players. Med. Sci. Sports Exerc. 47(8), 1567–1576 (2014).

Oberlander, T. J., Olson, B. L., & Weidauer, L. (2017). Test-Retest Reliability of the King-Devick Test in an Adolescent Population. Journal of Athletic Training, 52(5), 439–445.

Patricios, J., Fuller, G. W., Ellenbogen, R., Herring, S., Kutcher, J. S., Loosemore, M., … Schneider, K. J. (2017). What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. British Journal of Sports Medicine, bjsports-2016-097441.

Rizzo, J.-R., Hudson, T. E., Dai, W., Birkemeier, J., Pasculli, R. M., Selesnick, I., … Rucker, J. C. (2016). Rapid number naming in chronic concussion: eye movements in the King-Devick test. Annals of Clinical and Translational Neurology, 3(10), 801–811.

Seidman, D. H., Burlingame, J., Yousif, L. R., Donahue, X. P., Krier, J., Rayes, L. J., … Shaw, M. K. (2015). Evaluation of the King–Devick test as a concussion screening tool in high school football players. Journal of the Neurological Sciences, 356(1–2), 97–101.

Tjarks, B. J., Dorman, J. C., Valentine, V. D., Munce, T. A., Thompson, P. A., Kindt, S. L., & Bergeron, M. F. (2013). Comparison and utility of King-Devick and ImPACT® composite scores in adolescent concussion patients. Journal of the Neurological Sciences, 334(1–2), 148–153.

Weise, K. K., Swanson, M. W., Penix, K., Hale, M. H., & Ferguson, D. (2017). King-Devick and Pre-season Visual Function in Adolescent Athletes. Optometry and Vision Science, 94(1), 89–95.

Yorke, A. M., Babcock, M., & Alsalaheen, B. (n.d.). (2017)Validity and Reliability of the Vestibular/Ocular Motor Screening and Associations With Common Concussion Screening Tools. Sports Health. Mar April. 174-180.

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