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Charlotte Ball
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1 the remove from play testing a guide to making changes that keep our child athletes safe from concussions

2 Dear Team Mom, I am writing to you with a passion for the change I hope this digital playbook will make in the lives of our children. As a mother of kids who play sports, I cringe when I hear of a child who has died from a concussion or has suffered from a hard hit to the head. Thank you for taking the steps to join me in my quest to make the playing field safer for our children. A dear friend recently introduced me to Charlie Felker and Don Carducci, two West Point graduates and combat veterans that conducted seven tours to Iraq and Afghanistan. As the mom of a West Point Cadet, I was very honored to have the opportunity to speak with these gentlemen and learn about how they are currently working to change the lives of millions of young people. Both Charlie and Don witnessed the long-term effects of head injuries during their time in the military and the need for an immediate, accurate, and objective concussion-screening tool. After leaving the military, Charlie and Don founded Remove From Play Testing and partnered with the founder of the King-Devick Test to change the way sports programs detect concussed athletes. You may have heard in the news recently about the effects of concussions on professional athletes, but did you know that nearly 4 million American athletes suffer sports-related concussions annually? Athletes are suffering from sports-related concussions daily, and approximately 85% of those concussions go undetected. I m passionate about what Charlie and Don are doing because I have been the scared mother riding in the back of an ambulance with her son after a sports-related concussion. I know that we owe our young athletes a better sideline treatment during their favorite games. I also know that with the help of other concerned parents we can make our voices heard and demand that our principals, athletic directors, and coaches have these sideline concussion screening tests available. Remove From Play Testing is leading a change in sports injury protocols across North America. The RFP Testing provides a safer sporting environment for teams with quick, accurate, and objective concussion screening that determines whether or not to remove athletes from play. The test can be administered by parents and coaches in minutes and an accurate and reliable method for identifying athletes with head trauma. Remove From Play Testing has particular relevance to: football, hockey, soccer, basketball, lacrosse, rugby, baseball, softball, cheerleading, and all other contact and collision activities. I have created this digital toolkit to equip any mom with information about RFP Testing and provide tips on how to obtain this test for your child s school and club sports. I encourage you to share this information within your communities. Please show your support for Remove From Play Testing online by using the #RemoveFromPlay hashtag, following them on and liking them on Facebook at facebook.com/removefromplay2test. I appreciate you for taking the time to read this letter and review The RFP Team Mom Playbook. I know that together we can make sports safer for our children. Warm regards, Maria Bailey

HOW THE KING-DEVICK TEST WORKS Remove From Play Testing features the

that can be administered by parents and coaches in less than two minutes.

determine whether an athlete should be removed from play.

repetitive concussions caused by premature return to play after a head

The accurate and reliable test can be applied to: football, soccer,

Visual Processing Concentration Attention Speech Language Other correlates

3 HOW THE KING-DEVICK TEST WORKS Remove From Play Testing features the King-Devick test, which is a timed, sideline concussion screening test that can be administered by parents and coaches in less than two minutes. The objective method uses rapid number naming to identify head trauma and determine whether an athlete should be removed from play. As a result, the King-Devick test can help prevent the serious effects of repetitive concussions caused by premature return to play after a head injury. The accurate and reliable test can be applied to: football, soccer, lacrosse, hockey, cheerleading, rugby, baseball, martial arts, and all other contact and collision activities. WHY IT WORKS Vision alone accounts for more than 55% of your brain s pathways. The King-Devick Test quickly screens for impairments of: Eye Movements Visual Processing Concentration Attention Speech Language Other correlates of brain function ACCORDING TO THE RESEARCH Screens for witnessed, un-witnessed, and un-reported concussions Physical exhaustion is not a factor Testing subjects as young as 5-years-old Can be administered by parents, medical professionals, athletic trainers, coaches, school nurses AS SEEN ON

4 SAMPLE REQUEST LETTER To help you formalize your request to the athletic decision-makers in your child s life, we ve created a sample letter for you to use. You are welcome to use this letter however you wish to help bring The King-Devick Test in partnership with Remove From Play Testing to your child s athletic team. On the page following this letter, you will see that we have created a document that you can print out and use to gather the signatures of other parents who support the decision to bring Remove From Play Testing to your child s school or sports team. In addition to sending the letter and support signature sheet, we recommend requesting a face-to-face meeting with your child s principal, league director, or other appropriate person in charge to maximize the impact of your request. Dear (Insert Principal, Coach, League Director, etc.) As you may know, I am the parent of a (Insert your sport) player. Each year, nearly 4 million American athletes suffer sports-related concussions, and approximately 85% of those go undetected. I know you share the concern of parents like myself and believe that every precaution should be taken to properly evaluate players on the sideline. With proper sideline concussion screenings we can avoid sending our students back into a game with a concussion. I know that you share the goal to keep our children safe on the field. The first step in ensuring our children s safety and avoiding costly litigation is developing a concussion protocol that is simple, effective, and protective. Without having an economic safeguard, we believe it exposes our children to unnecessary risk that can lead to frivolous lawsuits and medical bills. It was recently brought to my attention that there is a sideline test that can be easily administered by a parent or coach to screen for concussions. The King-Devick Test from Remove From Play Testing is an objective rapid number naming test that identifies head trauma and determines whether an athlete should be removed from play. This accurate and reliable test can be applied to (as well as all other contact and (Insert your sport) collision activities). We ask that you take concussion protocol seriously, as there is no reason NOT to implement this test; which costs less than a mouth guard. For an annual fee of only $5.00 per athlete, we can keep our children safe. I am enclosing research and other information about the King-Devick Test from Remove From Play Testing. I hope you take the time to read them and evaluate the opportunity to bring this testing to. I know you will see the value in the (Insert your school or team) test. You may contact Sean Mele from Remove From Play Testing at smele@ or to get more information and order a testing package for our team. Thank you for your continued effort in supporting our children and protecting their well being. Best, (Insert your name and contact information)

5 PARENTS IN SUPPORT OF RFP TESTING We the undersigned, being concerned parents of hereby request that (City or School) (League, Team or School) implement RFP Testing as the standard head injury protocol for our athletes. Date Name Signature To learn how to bring the RFP Test to your team, please contact Sean Mele at or

FIND THE KING-DEVICK TEST PACKAGE FROM REMOVE FROM PLAY TESTING THAT IS RIGHT FOR YOU Each King-Devick Concussion Screening Test Package from Remove From Play Testing includes unlimited tests per

6 FIND THE KING-DEVICK TEST PACKAGE FROM REMOVE FROM PLAY TESTING THAT IS RIGHT FOR YOU Each King-Devick Concussion Screening Test Package from Remove From Play Testing includes unlimited tests per athlete per year. Every King-Devick Concussion Screening Test Package Includes: ONE YEAR ACCESS TO THE KING-DEVICK TEST ONLINE SYSTEM The secure browser-based King-Devick Test Online System allows you to administer the test from a computer, laptop, or ipad that is connected to the internet. Conveniently manage athlete data, print score sheets, organize team/individual baseline scores, and more with the King-Devick Test Online System. KING-DEVICK TEST PHYSICAL TESTS AND K-D TEST PRO IPAD APPS You now have the option to customize your package and choose how many physical tests and K-D Test Pro ipad Apps you would like for your organization. The King-Devick Test Physical Test is a portable and durable flip chart that is easy to use for baseline testing and concussion screening. The K-D Test Pro ipad App is a portable companion to the King-Devick Test Online System that allows you to administer tests and access subject data even when WiFi is not available. KING-DEVICK TEST SCORE SHEETS King-Devick Test Score Sheets help coaches, athletic trainers, parents, and medical professionals objectively determine in minutes whether players should be removed from games after suspected head trauma. KING-DEVICK TEST STOPWATCH Easily administer and time the King-Devick Test Physical Test with a stopwatch for baseline testing and concussion screening. You will receive the same number of stopwatches as physical tests selected within your package. King-Devick Concussion Screening Test Packages range from $5.00-$10.00 per athlete per year

7 A SIMPLE FLASHCARD TEST TO DETECT CONCUSSIONS Source: An easy, two-minute vision test administered on the sidelines after a young athlete has hit his or her head can help to reliably determine whether the athlete has sustained a concussion, according to a new study of student athletes, some as young as 5. The test is so simple and inexpensive that any coach or parent potentially could administer it, the study s authors believe, and any league afford to provide it as a way to help evaluate and safeguard players. Those of us who coach or care for young athletes know by now that an athlete who falls or collides with something during play or seems dazed, dizzy, loses consciousness or complains of head pain should be tested for a concussion, which occurs when the brain is physically jostled within the skull. But most of us are clueless about how to test young athletes. The most commonly recommended sideline test is the Standardized Assessment of Concussion, a multipart examination during which athletes are asked to name the date, describe how they feel, memorize and recall lists of words, and do jumping jacks and other tests of coordination. Ideally, this assessment should be administered and evaluated by a medical professional. But while the sidelines of college and professional games are crowded with doctors and certified athletic trainers, few high schools and youth leagues have those resources. Most of the time, concussion testing in youth sports falls to volunteer coaches or parents with little if any medical experience. That situation prompted researchers at New York University s Langone Concussion Center to begin wondering recently whether there might be other, easier diagnostic tools to check young players for concussions. Their thoughts soon turned to vision. About 50 percent of the brain s pathways are tied in some to way to vision and visual processing, said Dr. Steven Galetta, chairman of neurology at N.Y.U. Langone Medical Center and senior author of the study, which was published in The Journal of Neuro-Ophthalmology. Eye tests can tell evaluators a great deal about how well someone s brain is working. But for the most part, visual tests have not been part of the standard protocol for sideline concussion testing of young athletes. However, the N.Y.U. researchers knew that in recent years, trainers working with athletes in sports such as boxing and mixed martial arts, where concussions are common, had begun supplementing the Standardized Assessment with a simple vision exam, known as the King-Devick test, during which someone reads slightly jumbled lines of numbers printed on three cards as quickly as possible. (See below for more information.) The King-Devick test measures rapid eye movement, visual tracking and related cognitive responses and is a reliable indicator of cognitive problems. If an injured adult reads the numbers more slowly after a head impact than in baseline testing, he or she is considered to have sustained a concussion. The test requires no medical training. (continued on next page)

8 But it had not been evaluated for use in young athletes. So the N.Y.U. researchers decided to test it. They recruited 243 young hockey and lacrosse players between the ages of 5 and 18, and 89 collegians from the same sports. These athletes all completed a baseline Standardized Assessment of Concussion exam during preseason and walked as fast as possible along a narrow 10-foot long strip of athletic tape to measure their balance. They also completed the King-Devick test. Then they went out to play. During their subsequent competitive seasons, 12 athletes hit their heads and were put through the full battery of sideline concussion tests by parents or coaches, under the supervision of N.Y.U. medical personnel. Fourteen agematched uninjured athletes in the same sports completed the same tests, to serve as controls. Neurologists later confirmed that the 12 injured athletes had sustained concussions. Then the N.Y.U. researchers compared how well the various sidelines tests had done at pinpointing the brain injury. The Standardized Assessment of Concussion had performed rather miserably, correctly identifying only two of the concussed athletes, missing 10, and finding that three of the uninjured control athletes had supposedly sustained a concussion, since their scores had declined compared with their baseline (almost certainly, the study s authors believe, because these young athletes were physically tired). The King-Devick test did much better, correctly assessing concussion in 75 percent of the young injured players and inaccurately identifying it in only one. The pace-along-the-tape test was also relatively accurate. Ten of the 12 injured athletes were slower now, but so were five of the unhurt players. Overall, the King-Devick test had by far the greatest accuracy and lowest risk of false positives. The upshot, Dr. Galetta believes, is that parents and coaches should absolutely consider familiarizing themselves with the King-Devick test and administering it to young athletes before the season starts, then having those baseline numbers and the test itself handy on the sidelines. If an athlete hits his or her head and is then slower than baseline by even a fraction of a second at reading off the numbers, Dr. Galetta said, it is very probable he or she has a concussion and needs to be taken from play and seen by a doctor. It is still too early to say, however, whether the King-Devick test can replace other, more conventional concussion evaluations for young athletes, including the standardized assessment, despite its shortcomings in this study, Dr. Galetta cautioned. For now, he says, it probably should be used in conjunction with other tests. (continued on next page)

9 How to Administer the King-Devick Concussion Test During preseason, use a stopwatch to time the athlete as he or she reads off the numbers on each line from left to right as quickly as possible. The cards should be read in order. This establishes a baseline time. For the greatest precision, you might want to have athletes perform the test twice and use their best reading. During the season, if an athlete is suspected of sustaining a concussion, have him or her repeat the test on the sidelines. If the time is slower, even by a small amount, he or she probably has a concussion, according to neurologists. Interestingly, uninjured athletes are almost always faster at reading the numbers during games or practices, because physical exertion sharpens the kind of visual performance being tested.

10 MAYO AND KING-DEVICK TEST HAVE LICENSING AGREEMENT FOR SIDELINE CONCUSSION TEST Source: ine-concussiontesting/ Phoenix, AZ Concussions are in the national spotlight for the damage being done to student and professional athletes. Determining when an athlete should be removed from play is a major challenge in preventing injury. Athletes routinely deny symptoms. The Centers for Disease Control and Prevention estimates that between 1.6 and 3.8 million students have concussions every year. In an effort to bring awareness and increase concussion screening, Mayo Clinic has agreed to a licensing agreement with King-Devick Test Inc., which has developed a proven indicator of ocular motor, visual and cognitive function for concussion detection and evaluation on the sidelines of sporting events to help with the decision to sideline athletes to prevent injury. Under the terms of the agreement, King-Devick and Mayo Clinic will form a scientific governance committee and Mayo will have membership on the company s board of directors. Packaging for the test will indicate it is offered in association with Mayo Clinic. Revenue Mayo receives will be used to support its nonprofit mission in patient care, education and research. The King-Devick Test is a quick, accurate and objective concussion screening tool that can be administered on the sidelines by parents, coaches, athletic trainers, school nurses and medical professionals, and a Mayo Clinic study indicated it detects concussions and possible 'silent' concussions. Youth athletes are at a higher risk for concussion and a longer recovery time than adults, says David Dodick, M.D., Mayo Clinic neurologist and director of Mayo Clinic s concussion program who studied its use in high school hockey players. Our studies show this test detects potential brain injuries in athletes who have not reported symptoms of concussion. We are committed to making sports safer through our comprehensive concussion program and Sports Medicine Center. While concussion testing doesn t eliminate concussions, it can guide return-to-play decisions and minimize complications and more serious neurological injuries that may occur with a repeat concussion. It s a privilege to be associated with the premier health care brand in the world, says Steve Devick, Founder and CEO of King-Devick Test. This agreement will help us accomplish our goal of having a tool on the sidelines to help determine remove from play for athletes to prevent further injury and be referred to qualified professionals for follow up care. The test requires an athlete to read single-digit numbers displayed on cards or tablet computer. After suspected head trauma, the athlete is given the test, which takes about two minutes, and the results are compared to a baseline test administered previously. If the time needed to complete the test takes longer than the baseline test time, or if the subject shows any other symptoms of a concussion, the athlete should be removed from play until evaluated by a medical professional. A new baseline is required annually. Peer reviewed published research has shown that The King-Devick Test requires eye movements, speech, language, and concentration, all of which can be impaired as a result of concussion. Recently more than 20 studies showing the effectiveness of the test as a quick, objective and accurate remove from play sideline test have been presented or published in elite scientific journals. Numerous other recent studies have been published regarding King-Devick Test as it relates to MS, Parkinson s disease, ALS, hypoxia, extreme sleep (continued on next page)

11 deprivation and reading fluency. Under the agreement, Mayo Clinic will provide ongoing medical consultation in future development of the test. The King-Devick Test has also been proven to detect un-witnessed, un-reported and silent concussions in athletes. Although concussion awareness has been a trending hot media topic at the professional and collegiate sport levels, more information must be disseminated to the high school and youth levels, Dr. Dodick added. Concussion guidelines are rapidly changing. Just a few years ago, athletes were expected to shake it off and continue to play after suffering a concussion or a ding. Today, we now know that it is unsafe for any athlete to return-to-play the same day they have suffered a concussion, and it is recommended that every athlete not return-to-play until they have been cleared by an appropriate professional.

12 For more information about The King-Devick Test from Remove From Play Testing, or to purchase a test package, please contact: Sean Mele, VP of Sales smele@ REMOVEFROMPLAY2TEST

There is no such thing as a tough brain.

There is no such thing as a tough brain. King-Devick Test in association with Mayo Clinic is an evidence-based, accurate and objective remove-from-play sideline concussion screening test. According to