Upside the Head

Corey Calicat-Wayans looks like he was born to cause concussions.

A noseguard at the Haverford School, he’s a six-two, 330-pound freshman, with room to grow. If you saw him playing in one of the $200 helmets that Haverford buys its team, he’d look like a monster. But on this Thursday in early summer, dressed only in a white sleeveless T-shirt and long black shorts, he looks surprisingly vulnerable from the neck up, with a big-baby face, a skull barely shielded by very close-cropped hair, and wide, uneasy eyes.

Corey is here before practice as a subject in a scientific experiment—one that’s largely unknown to a public deluged by media coverage of sports head injuries, but that’s being closely watched by experts around the world because it could revolutionize the diagnosis of concussions. He stands not on the football field, but along the carpeted bleachers for the school’s squash courts, surrounded not by coaches, but by earnest, preppy students holding clipboards and stopwatches.

One of the eager young men hands Corey a set of four laminated cards bound with a white spiral. On each card is a set of random numbers in varying positions. Corey is told to read the numbers in order, out loud, as fast as he can. “Two, five, eight, zero, seven,” he begins. His time is recorded as his baseline.

Later, during football season, if he takes a powerful blow to the head—actually, it’s more like when he takes a blow, since the average high-school player gets hit on the helmet up to 1,400 times each season—he can quickly be retested on the sideline. All the other sideline tests used to diagnose concussions involve a battery of complex questions and subjective scoring—and they often take longer than the time left in the game. This test—named the King-Devick for the pair of optometry students who developed it in 1976—takes less than a minute, and it’s pass/fail. A team mascot could administer it: The athlete just reads the cards again. If he’s concussed, he won’t be able to say the numbers as quickly as before.

King-Devick is believed to be able to diagnose concussions even in athletes without traditional symptoms. Moving your eyes together rapidly, reading quickly, and saying the numbers out loud accesses about 50 percent of the brain’s functional areas. No matter how hard they try, athletes with head injuries won’t be able to replicate their baseline speed.

Corey doesn’t understand much of this. He’s just a freshman hoping to get some playing time. But this test could save his life.

The number of concussions in high-school athletes is high, and rising—more than 136,000 are diagnosed each year, with the highest rate among the nation’s estimated 1.2 million high-school football players. Yet one of the biggest problems with sports head injuries is that concussions frequently go untreated—because the player doesn’t immediately feel hurt, or won’t admit to feeling hurt.

(Studies show more than 50 percent of student athletes will lie about symptoms to stay in the game.) And the brain is most vulnerable to serious, irreversible injury when the athlete already has an unhealed concussion.

Which is why any incremental improvement in understanding, treating or diagnosing concussions is such a big deal—and why the King-Devick test in particular is so important. So far, in two small studies published in the past eight months in top neurology journals, the test has performed as well as or better than other tests identifying concussions—and it can be administered during a time-out. The results have been so positive, in fact, that the Flyers have signed on to be part of a wider study this fall, joining the varsity football teams at Penn and the Haverford School. Flyers and Eagles team doctor Gary Dorshimer expects other NHL and NFL teams to use the test more informally this year, to see what it adds to their armamentaria.

And the two Penn neuro-ophthalmologists testing King-Devick—Steven Galetta and Laura Balcer—are starting to draw attention for their work. Based on their studies, Ralph Nader just called for mandatory use of the test in all high-school and youth sports. In May, Balcer and Galetta presented at the One Mind conference in Boston—a sort of Woodstock for the future of brain sciences—appearing on a special panel alongside the most renowned, high-profile researchers in sports head injuries, including neurologist Robert Cantu and his colleagues from the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University.

Researchers there have been performing autopsies on athletes’ brains—including that of Penn football star Owen Thomas, who hanged himself last year. His was among the first autopsies to find early-stage trauma-related damage in a young football player’s brain. CSTE has been generating headlines across the country for years with a very loud safety message that has raised awareness and forced some rule changes, but it has also fueled a good bit of fear and confusion—to the point where it’s much harder for kids to convince their parents to let them play contact sports anymore. (“Not long ago,” laments one Philadelphia-area football coach, “we’d have over a hundred kids come out. This year, I’m not sure we’ll have enough for a team, and it’s mostly because of concern with concussions.”)

Lanky, loping, contagiously affable Galetta, 54, and his energetically serious 46-year-old colleague Balcer are new to this hard-hitting world of concussions, and surprisingly easygoing. Neuro-ophthalmologists are considered the dorks of neurology, Galetta explains: “We’re like the Rodney Dangerfields of the brain, no respect.” He views the new field of sports concussion research he’s entered as dominated by “expert opinion, the lowest form of medical evidence.” He and Balcer didn’t become interested in King-Devick and concussion testing because of all the headlines. In fact, they were sought out by King-Devick’s inventor because they’d spent more than a decade doing pro bono research in the decidedly unglamorous field of analyzing eye tests to see how well they pick up early symptoms of neurological conditions.

Besides being new to the concussion industrial complex—which has a surprising number of Philadelphia and Pennsylvania ties, going back to old Flyers, Eagles and Steelers head injuries, both suffered and inflicted—this group adds a very family-style, very Penn operation to the field. Laura Balcer was Steve Galetta’s resident at HUP (where, among other jobs, he runs the neurology residency program) and rose in the department as his protégée. Kristin Galetta—daughter of Steve—is a medical student at Penn and was lead author on both papers on the King-Devick research. (Another Penn connection: I’ve known Galetta since he and I were freshman there, and he has treated members of my family.)

A big part of the reason the research has been done at Penn and the Haverford School is that Galetta played on a football team at Penn, and is a longtime adviser to the university’s athletic program. He sent his two sons to Haverford. (The younger is currently a junior.)