ImPACT Testing
SAVING LIVES
What is a Concussion?
 A disturbance in brain function that occurs following either
a blow to the head or as a result of the violent shaking of the
head
 It is a chemical change that cannot be detected on MRI or
CT Scan.
 In a survey of football players, when asked if they’d
sustained a concussion during the season, 15% said yes.
When removing the word “concussion” and just supplying a
description of the symptoms, 50% said yes.
More on concussions…
 Most of what we know about concussions, we’ve learned in the last 5
years
 The CDC just called sports related concussions an “epidemic”
 There are 7.5 million high school athlete in the US and an estimated
1.6-3.8 million sports related concussions each year. (CDC Toolkit for
Physicians, In Press)
 Athletes in a contact sport have a 19% chance of sustaining a
concussion in one season (impacttest.com)
 Athletes who sustain a first concussion are more susceptible to
sustaining a second concussion.
Signs & Symptoms of a Concussion
 Physical
• Headache
• Nausea
• Vomiting
• Balance Problems
• Dizziness
• Visual Problems
• Fatigue
• Sensitivity to light
• Sensitivity to noise
• Numbness/Tingling
 Cognitive
• Feeling mentally "foggy"
• Feeling slowed down
• Difficulty concentrating
• Difficulty remembering
 Emotional
• Irritability
• Sadness
• More emotional
• Nervousness
 Sleep
• Drowsiness
• Sleeping less than usual
• Sleeping more than usual
• Trouble falling asleep
SECOND IMPACT SYNDROME
 “Occurs when an athlete sustains a second impact before being
completely healed from a first concussion”
 Causes increased pressure in the skull
 50% OF ALL SIS CASES ARE FATAL
 If not fatal, permanent deficits occur (reports of coma from 3 days to
3 months)
 Only occur in the adolescent brain because it is not fully developed
 In 2008, 5 football players died from SIS
 Please take a minute to watch
http://espn.go.com/video/clip?id=3651929&categoryid=null
Why some athlete don’t tell of their symptoms
 They don’t want to let their team down
 They don’t want to let their parents down
 They don’t want to appear weak
 They want more than anything to be playing
ImPACT Test Background
 Designed by Director of Neuropsychology, Mark Lovell,
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PhD , Chief Clinical Officer of University of Pittsburgh
Medical Center, Michael Collins, PhD, and Chief Medical
Officer of University of Pittsburgh Medical Center, Joseph
Maroon, MD.
A user-friendly computer based test designed for the
management of sports-related concussion.
The test has been designed after 10-years of Universitybased, grant-supported research.
ImPACT is currently the most widely used computerized
program in the world.
ImPACT is used effectively across high school, collegiate,
and professional levels of sport participation.
ImPACT Test
 Computerized test which takes about 20 minutes
 Components include:
Subject Profile and Health History
 Current Symptoms and Conditions
 Neuropsychological Tests
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Word Discrimination
Design Memory
X’s and O’s
Symbol Matching
Color Match
3 letters
Injury Description
 Graphic Display of Data
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What do these tests measure?
 Attention span
 Working memory
 Sustained and selective attention time
 Response variability
 Non-verbal Problem Solving
 Reaction time
What ImPACT testing is NOT
 Not a substitute for medical evaluation/treatment
 Not a substitute for comprehensive
neuropsychological testing when needed
Tips for Recovery
 REST, REST, and REST!!!
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No TV, No video games, may need to stay home from
school/work (concentration makes symptoms worse)
 Avoid activities that could result in a second concussion
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Gym class, roughhousing at home, participation in any sports
 Do not operate heavy machinery
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Eg. Driving
 Take only the drugs your doctor has approved
Timeline for Recovery
 Since every athlete and every concussion are
different, there is no set time for expected return to
play.
 The protocol at SESD is as follows:
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Athlete must be completely symptom-free for 24 hours
Athlete then takes the post-concussion test through
impacttest.com
If they pass and there are no return of symptoms, they begin a
5 day gradual progression to return-to-play. Athlete must
remain symptom-free through each day. (progression on next
slide)
If they DO NOT pass the test, they are given approximately 3
to 4 more days of healing time and are then re-tested.
5 Day Gradual Return to Play
 Day 1
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aerobic exercise (.e.g., stationary bicycle, jog 1 mile)
 Day 2
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sport specific training (e.g., running, skating)
 Day 3
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non-contact drills (includes cutting and other lateral
movements)
 Day 4
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full-contact controlled training
 Day 5
 full-contact game play
Family Doctors
 Without ImPACT it’s very difficult for any doctor to make an educated
decision on whether the athlete is safe to return to play.
 Family doctors do not SPECALIZE in concussion management. Many
feel if the athlete is symptom free, they are healed. All of the old
concussions scales are no longer used. Scientific studies have disproved
their efficiency.
 Athletes that report being symptom free are still not scoring as well as a
control group.
 A study by the Nationwide Children’s Hospital showed that 41% of
athletes with a concussion returned to play too early.
Risks Associated with NOT taking ImPACT
 No Baseline to determine “normal” cognitive
function
 No post-concussion test determining the extent of
brain injury
 Clinician has no data to make informed decision on
return-to-play.
 Premature return-to-play leading to second impact
syndrome
Professionals that ImPACT test
 NFL
 MAJOR LEAGUE BASEBALL
 NASCAR
 USA OLYMPICS
 US LACROSSE
 NATIONAL HOCKEY LEAGUE
 WWE
 CIRQUE DU SOLEIL
 ALL MAJOR LEAGUE SOCCER
 US ARMY
 US NAVY
A few Colleges in PA that use ImPACT
 Alvernia College
 Bucknell University
 Carnegie-Mellon University
 DeSales University
 Dickinson College
 Drexel University
 Duquesne University
 East Stroudsburg State University
 Edinboro University
 Gettysburg College
 Indiana University of PA
 Juniata College
 Lafayette College
 LaRoche College
 Lebanon Valley College
 Lock Haven University
 Millersville University
 Penn State University
 Philadelphia University
 Robert Morris College
 Shippensburg University
 Slippery Rock University
 Temple University
 University of Pittsburgh
 Villanova University
 West Chester University
 Widener University
 York College of PA
Frequently Asked Questions
 Q: When will my child be able to return to sports?
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A: Athletes return to play after being symptom-free for 24 hours, passing the
ImPACT test, and gradually progressing through a 5 day regimen.
 Q: Do I need to take my child to the doctor?
 A: Not every concussion requires physican referral. However, physician visits
are never discouraged. There are some cases in which they are encouraged.
When dealing with a head injury, a neurologist is the most trained in dealing
with concussions and neurological issues stemming from them.
 Q: Does age matter for recovery time?
 A: Doctors at UPMC have researched and found that the adolescent brain does
not heal as quickly as the adult brain. Therefore, high school athletes take
longer to recover than college athletes.
More FAQs
 Q: How close to the baseline scores do my child’s post-concussion
scores have to be before returning to play?
 A: Reliable change indices (RCI) are used for determining when an athlete's
post-injury test has satisfactorily approached baseline levels. If the scores are
outside of the RCI, they are considered atypical and show the athlete’s brain
has not completely healed from the injury. RCI is not be the only criteria in
determining when an athlete's test scores are back to baseline. Symptoms and
exertional testing are a part of the process.
 Q: What if my child has a learning disability?
 A: They can still take the test and the results will be specific to them. There is a
specific box to “check” notifying the examiner of their condition. The test also
wants to know of any current medications the athlete may be taking so they can
type in any special medications at the appropriate place.
FAQs
 Q: How often can my child take the ImPACT test after a
concussion?
 A: If the athlete does not pass the ImPACT test, they are given 3 days to
heal and are then allowed to retake the test. If the concussion is severe,
they will be permitted to take it once a week.
 Q: What is the frequency of baseline testing?
 A: All athletes will be tested at least once in high school. It is our goal at SESD
that they be tested twice so we have the most accurate baseline information on
hand.
Informative Sites
 Feel free to view a sample of clinical results at
http://www.impacttest.com/scr.php
 http://www.cdc.gov/ncipc/tbi/TBI.htm
 www.impacttest.com
References
 “Knocking Heads” Dan Rather Reports
 www.impacttest.com
 Presentation by Dr. Mark Lovell, UPMC