Sports-Related Concussion Testing and ImPACT Testing Program
At the forefront of concussion management is the implementation of neurocognitive testing in athletic programs. Such evaluation can help to objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion or returning an athlete to play too soon who has not fully recovered.
Neurocognitive testing can be in the form of a pencil-and-paper test (SAC, SCAT2) or a computerized test (ImPACT, ANAM, HeadMinder, CogState). Pencil-and-paper tests remain an effective tool for coaches to use on the sideline to assess athletes with potential head injury. But pencil-and-paper tests lack sufficient sensitivity over an extended period of time for medical and health care professionals to base critical return to play decisions. After 2-3 days post-injury, pencil-and-paper tests are ineffective and may not reveal the presence of a concussion injury (false-negative). While concussion recovery often necessitates 1-3 weeks or more, computerized neurocognitive testing is much more sensitive to brain function for many weeks and months post-injury.
Computerized applications have been available in recent years to individual schools and teams at an annual cost of $500 - $750 or more, making it cost-prohibitive to many schools. Recently, ImPACT Testing Services, Inc. has fashioned a testing program model for larger health care networks having met specific medical criteria with access to specific resources. As a result, the Nebraska Sports Concussion Network & Testing Program was developed in the spring of 2010 and will assist athletic programs by funding the baseline testing in schools and communities throughout Nebraska.
ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)
is an on-line, user-friendly computer-based testing program specifically designed for the management of sports-related concussion. ImPACT is a research-based software tool developed at the University of Pittsburgh Medical Center - Center for Sports Medicine that evaluates multiple aspects of neurocognitive function, including memory, attention, brain processing speed, reaction time, and post-concussion symptoms.
Current ImPACT clients include the NFL, NBA, NHL, MLB, including all umpires, and numerous NCAA Division I Football Programs, including the University of Nebraska-Lincoln. Other athletic programs in Nebraska currently implementing the program include: Doane College, Concordia Univ., Peru State College, UNO, all 6 high schools in Lincoln Public Schools, Lincoln Pius X HS, Norris HS, and Waverly HS, among a group of Nebraska high schools that is growing expotentially each year since 2010.
Baseline Testing refers to neurocognitive testing under normal conditions before injury, often conducted in the pre-season. The baseline test provides a snapshot of how one’s brain functions in normal, everyday circumstances. Baseline testing is conducted on-site at schools by trained school staff with assistance from athletic trainers trained as test administrators by the Nebraska sports Concussion Network. Using a school’s computer lab and internet to log onto an on-line testing website, multiple users (~10-20) can be tested at the same time. It takes ~25 minutes to complete the baseline test. The testing application formulates “baseline data” which are stored on a secure, HIPPA compliant server at ImPACT Testing Services, Inc. which can be retrieved anytime at a later date if an athlete sustains a concussion.
In the event an athlete sustains a concussion, the athlete is tested again post-injury. Post-injury testing composite scores are then compared to the baseline scores acquired earlier before a concussion injury affected brain (neural) function. Therefore, baseline testing only becomes of value if, and when, post-testing is utilized after a concussion injury. We estimate 10% of athletes on average (~15%-20% of football players) in collision and contact sports will risk concussion injury necessitating post-injury testing.
Post-Injury Testing is conducted by medical or appropriate health care professionals having specialized training and credentialing by ImPACT (Credentialed ImPACT Consultant) to interpret and evaluate post-testing composite scores for deficiencies or abnormalities. These trained professionals will objectively base concussion management decisions and the the decision for return to play on post-test comparisons, depending on when post-test scores return to baseline, among other clinical considerations. Hence, more consistent, objective, and safer decisions can then be made about an injured athlete returning to play. Subjectivity is much less apparent, and an athlete can potentially be allowed back sooner, rather than their return to play being delayed by uncertainty.
Post-Injury Testing is usually conducted once a concussed athlete is symptom-free (asymptomatic), or as early as 24-72 hrs. post-injury, depending on the clinician managing the athlete’s condition. When post-concussion testing is opted for on-line, another form of the test is selected having a different word and design lists, as well as other randomized stimuli. This feature is incorporated into ImPACT to help reduce the practice or learning effects often associated with neuropsychological measures. Given this issue, multiple forms are utilized for each post-injury testing session. On occasion, multiple post-tests (serial testing) may be conducted to monitor an athlete’s recovery over time.
If post-testing scores have not recovered in sufficient time, (usually within 3-4 weeks) the athlete may be referred to a neuro-specialist with advanced, formal training in treating head injuries, i.e. Neurosurgeon, Neuropsychologist, or Neurologist.
Baseline testing being funded by the Nebraska Sports Concussion Network will be available for 9th through 12th grade athletes participating in collision and contact sports having the highest incidence of concussions [football, volleyball, basketball, wrestling, diving, soccer, track-jumpers, baseball, and softball]. Schools wanting to baseline test non-contact sports [cross-country, golf, tennis, swimming, track-runners] or any other groups, i.e. middle school athletes, will have the option to arrange for and purchase baseline tests at $5/test.
In the 1st year of testing by a school or sports organization, baseline testing will be conducted on everyone within the group(s) identified. Thereafter, an athlete’s baseline test is then conducted on a 2-year cycle, with testing of incoming 9th graders preformed each year, and during the 11th grade year. Anyone new to an athletic program, or having sustained a concussion the previous year, is tested each year as well.