What is this ImPACT concussion testing all about?

Concussion research has evolved so much over the years- we all know this. It is a widely discussed topic these days- even when we are watching our favorite professional sports teams.

ImPACT testing is a neurocognitive test that was developed in the early 1990's by two doctors whom felt a neurocognitive test was needed to evaluate the signs and symptoms, visual memory, processing speed and reaction time. It is an objective test and to the best of its ability, we can use the data to determine the effects the concussion is having on each individual. It is important to understand that this is not the only "tool" that is to be used in making decision regarding a players participation status. For example if an athlete "passes" ImPACT and is still suffering from symptoms of a concussion, we may not return them to play. (resource: ImPACT website)

The test is made up of 5 sections (taken from ImPACT website)

1. Demographics/Health Questionnaire
2. Current symptom and conditions inventory
3. Neuropsychological testing (6 modules in this section)
4. Injury Description
5. Test scores (only administrator can see this after testing)

* we often do another symptom/condition inventory at the end of the test to determine if the testing caused any increase or addition of concussion symptoms/conditions. This is an option we often chose- it is not mandatory for the test.

This "meat" of the test is section 3 where 6 modules are administered. (taken from ImPACT website)
Modules:

1. Word discrimination: assesses attentional processes and verbal recognition memory
2. Design Memory: assesses attentional processes and visual recognition memory
3. X's and O's: assesses visual working memory and visual processing speed
4. Symbol Matching: assesses visual processing speed, learning and memory
5. Color Matching: assesses reaction time, impulse control, and response inhibition
6. Three Letter Memory: assesses working memory and visual-motor response speed

I suggest taking a demo test yourself to get a better understanding- you will be amazed what the test actually is and what your athletes or even your own child is experiencing when taking this test.
http://www.impacttestonline.com/impacttestdemo/

Now many ask can athlete "throw the test off" or "sandbag" the test- goal being if they score really poorly on the baseline- if they were to sustain a concussion, when they take the test again they would not appear to do so badly and we may not think they actually have a concussion. Another thought is that we often hear- "they probably couldn't pass even if they weren't concussed". ImPACT test red flags and has a built in validity index that would signal to the administrators potential problems. All baseline invalid tests must be re-tested.

The medical world has been working very hard at concussion testing, education, prevention, etc. What we all have to keep in mind is that when put in a situation, an athlete will often want to put the game before their long term health. We know through research that there are long term effects such as early onset of dementia, Alzheimers disease, and depression to name a few. In order to protect our athletes- each and every member of the athletics team needs to educate themselves on the current research.

Here are some useful resources:
http://impacttest.com/concussion/overview
http://impacttest.com/concussion/primary_prevention
http://impacttest.com/concussion/diagnosis
http://www.sportsconcussions.org/ibaseline/
http://www.cdc.gov/concussion/sports/
http://www.ncaa.org/wps/wcm/connect/public/NCAA/Health+and+Safety/Concussion+homepage/

Now that you have an idea of some of the basic terms associated with concussions, we will talk a bit about what the signs and symptoms are and the evaluation process.

Signs and symptoms of a concussion are much more complex than just a headache. We now know that concussions effect various parts of the brain which in turn leads to various signs and symptoms depending on the part of the brain that is damaged.

Physical Signs and Symptoms
Headache
Fatigue
Dizziness
Photophobia (sensitive to light)
Sensitivity to noise
Nausea
Balance problems
Loss of consciousness
Vision difficulty

Cognitive Signs and Symptoms
Difficulty remembering
Difficulty concentrating
Feeling slow
Feeling foggy
Slowed reaction time
Altered attention
Amnesia- both short and long term

Emotional Signs and Symptoms
Behavioral changes
Irritability
Sadness
Depressed
Feeling emotional
Anxiety
Nervous

Sleep Signs and Symptoms
Drowsiness
Sleep more than usual
Sleep less than usual
Difficulty falling asleep

These symptoms although we often think of how it effects someone on the field, certainly impact their everyday life both in the short term and long term aspects of their life which is part of the reason concussion management has changed over the years.

If an concussion is suspected, an onfield assessment will be performed. An important note is that if a concussion is suspected, the athlete WILL NOT BE ALLOWED to return to sport that day. Further neurological, neurocognitive and neuromotor/neurocognitive testing will be performed as well as a signs and symptoms inventory will be noted. ImPact Testing is recommended to be completed on all athletes (including those who did not have baseline completed) within 48 hours of initial concussion or reporting of concussion signs and symptoms. Referral will be made if deemed necessary. Instructions while symptomatic includes no athletic involvement inluding recreationally, rest, limited scholastic work, limited computer/games. Frequent neurologic exam, neurocognitive exams, and neuromotor/neurocognitive evaluations will be completed to determine the athletes progress or lack of progress. Ideally, daily check ups will be completed. Once an athlete is deemed cleared via evaluation, testing and/or a doctor, a progressive return to play guideline will be used to introduce physical activity safely to ensure no symptoms return which can often happen. The term "cleared" does not mean the athlete is able to jump right into a practice or game- it means they begin a progressive return to full activity. More on the return to play guidelines in the next blog.

Hopefully this gives you a bit more of an understanding of signs and symptoms and evaluations. Please note also that any loss of consciousness, spinal injury, progressive symptoms, drastic deterioration of mental status, focal neurologic defect, complex signs/symptoms and assessements will be referred to a doctor.

Some resources to check out regarding concussions:
http://www.cdc.gov/concussion/HeadsUp/youth.html
http://www.sportsconcussions.org/ibaseline/index.php