ImPACT Testing

1. ImPACTTesting Saving Lives

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. ImPACT Test Background Designed by Director of Neuropsychology, Mark Lovell, 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 University-based, grant-supported research. ImPACTis currently the most widely used computerized program in the world. ImPACT is used effectively across high school, collegiate, and professional levels of sport participation.

8. ImPACT Test • Computerized test which takes about 20 minutes • Components include: • Subject Profile and Health History • Current Symptoms and Conditions • Neuropsychological Tests • Word Discrimination • Design Memory • X’s and O’s • Symbol Matching • Color Match • 3 letters • Injury Description • Graphic Display of Data

9. What do these tests measure? Attention span    Working memory Sustained and selective attention time Response variability     Non-verbal Problem Solving    Reaction time

10. What ImPACT testing is NOT Not a substitute for medical evaluation/treatment Not a substitute for comprehensive neuropsychological testing when needed

11. Tips for Recovery • REST, REST, and REST!!! • 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 • Gym class, roughhousing at home, participation in any sports • Do not operate heavy machinery • Eg. Driving • Take only the drugs your doctor has approved

12. 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: • 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.

13. 5 Day Gradual Return to Play • Day 1 • aerobic exercise (.e.g., stationary bicycle, jog 1 mile) • Day 2 • sport specific training (e.g., running, skating) • Day 3 • non-contact drills (includes cutting and other lateral movements) • Day 4 • full-contact controlled training • Day 5 • full-contact game play

14. 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.

15. 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

16. 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

17. 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

18. Frequently Asked Questions Q: When will my child be able to return to sports? 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.

19. 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.

20. 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.

21. 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

22. References “Knocking Heads” Dan Rather Reports www.impacttest.com Presentation by Dr. Mark Lovell, UPMC