Monday, December 29, 2014

ImPACT Test: How It's Used To Determine Concussion Recovery

Yesterday, Eagles quarterback Michael Vick failed his second concussion test of the week, meaning he has not been cleared to return to football activities. Robert Franks, D.O., takes a closer look at the testing used to make such determinations.

ImPACT Test: How It's Used To Determine Concussion Recovery

Yesterday, Eagles quarterback Michael Vick failed his second concussion test of the week, meaning he has not been cleared to return to football activities. Robert Franks, D.O., takes a closer look at the testing used to make such determinations.
Yesterday, Eagles quarterback Michael Vick failed his second concussion test of the week, meaning he has not been cleared to return to football activities. Robert Franks, D.O., takes a closer look at the testing used to make such determinations.

By Robert Franks, D.O.

Editor’s Note: Yesterday, Eagles quarterback Michael Vick failed his second concussion test of the week, meaning he has not been cleared to return to football activities. Robert Franks, D.O., takes a closer look at the testing used to make such determinations.

As concussion remains at the forefront of sports health with two prominent Eagles players continuing to be treated for symptoms, it has not been uncommon to hear about reports of them being tested. Often I am asked, what is this test and how does it work?  More importantly, how does it help a physician to make the decision to return an athlete to play? 

The testing of which we are speaking is used to gauge the cognitive part of the concussion, or the part that deals with how the brain is functioning. There are two ways to do this. One is formal neuropsychological testing. This is still considered the ‘gold standard’ when testing a patient’s cognition and is done by administering several cognitive tests over several hours by a trained neuropsychologist.

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Obviously, this is time consuming and not every concussed athlete reaches the severity of concussion where it is necessary to perform these tests with every incident. However, those athletes with a more severe concussion or those who are recovering slower than anticipated or are showing signs of worsening are often tested in this manner.

Most athletes, however, are tested a second way—a computerized neurocognitive test. There are several computer testing batteries used in practice today. The most common is ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing. Several others do exist such as CogSport, HeadMinder, and CNS Vital Signs. The best ways to administer these examinations are to perform the baseline test before an athlete is concussed, and then administer a post-injury test once the athlete has been injured. The two are then compared to see deficiencies between pre- and post-concussive cognitive function. Using ImPACT as an example, if a baseline is not available, the athlete is compared to their sex and age matched peers to determine in what percentile their score falls.  

Again, using ImPACT as an example, the test asks for demographics on the patient and a history of both present and past concussions. It also asks for a symptom score reported by the athlete across 22 different concussive symptoms. The bulk of the test then tests the athlete’s verbal memory, visual memory, visual motor speed, and reaction time through 6 different modules. These numbers are then reviewed by the physician and can be used to track recovery or lack thereof.

An impulse control score under a certain number is used to validate the test. These numbers are given to the physician both numerically and graphically. Athletes do not have to get the exact baseline numbers they scored before a concussion, but must score within a certain range.

Physicians use these numbers to assist in return to play decisions. An athlete is considered recovered cognitively once their scores return to baseline.  Neurocognitive testing is one part of the total return to play decision. The athlete must also be symptom free, on no medications, and go through normal daily activities for 24-48 hours without symptoms before they can begin a return to play protocol and ultimately return to their sport.

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Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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