using impact in concussion management - cbirt · 2018-04-27 · baseline testing with
TRANSCRIPT
Using ImPACT in Concussion ManagementVIVIANE UGALDE, MD
PHYSICAL MEDICINE & REHABILITATION
MEDICAL DIRECTOR CONCUSSION MANAGEMENT PROGRAM FOR THE CENTER FOUNDATION, BEND, OR
“Mandatory” Baseline neurocognitive (ImPACT) Testing for high risk sports Football
Girls and Boys soccer
Girls and boys basketball
Wrestling
Recommended for Lacrosse, rugby, alpine skiing, volleyball, others
Paid for by OSAA for mandatory testing, offered $a fee for all others, Call 541-382-2321at the Center
Tests memory, reaction time and ability to do “new learning”
Baseline testing
How old and when to test?
Baseline every 2 years for high school age
Ages 12-59, now with a new Pediatric ImPACT test for 5-11
The original is controversial for <14
Sandbagging – deliberate poor performance on baseline Difficulty in protocol review of valid baselines (impulse control composite score) Learning effect with repeated tests Effects on test performance if <7 hours of sleep, environmental distractions
(testing >20 at a time), caffeine consumption, anxiety/distress etc. Sensitivity 79-95%, Specificity 89-97% (4 peer reviewed papers) Validity ranged between .2 -.88 compared to traditional NP test Reliability – test/retest was poor for shorter intervals, better for longerResch, et al. Neuropsychol Rev (2013) 23:335-349McClure, et al. Testing in Sports-Related Concussion. Am J Sports Med 2014;42:472-8
ImPact testing controversies
Be aware of limitations
ImPACT continuing to improve
Recent adjustment of “Reliable change” or statistically significant differences reported for comparison with baseline to post-injury scores
Should be considered only a part of a multi-dimensional approach to concussion management
With “passport” any clinician can access ImPACT scores, but interpretation is a concern.
Recommendations for computerized NT testing
Adult SCAT 5
ADULT SCAT 5
CHILD SCAT 5 (ages 5-12)
CHILD SCAT 5
No longer in protocol for automatic post-injury test within 72 hours if it is clearly a concussion. Yes, if any question that there was a concussion.
Athlete and parents are given instructions for cognitive and physical rest.
Academic accommodations are provided to student and school.
Immediate IMPACT post injury test
Athlete is symptom free
BESS testing is within a normal range or back to baseline
School performance is at baseline (no longer needing accommodations)
ImPACT testing is performed at that time
Asymptomatic ImPACT test
Is the test valid?
Quick check: Look at percentile scores
For baseline testing, none of the scores should be <1%
For baseline testing Impulse Control Composite Score <25
For post injury testing:
A/B student percentiles should be >65-75%
B/C student percentiles should be >35-40%
D/F student percentiles should be >20%
Average C Student Raw Scores
Word Memory 11-12
Design Memory 9-10
X/O’s 9
Symbol Match Total Correct Hidden 9
Color Match 9
Unexpected Scores
Baseline testing with <1%
If visual motor speed composite is <1% - possible that the X and O’s testing where you are supposed to count backwards from 25, the test taker may not have understood the directions and counted upwards from 1 instead. The score for Three Letters – average counted correctly would be 0.
May have unidentified learning disability or ADHD
May reflect poor effort, especially if academic performance is high.
Analysis of Results
Composite scores: raw and percentile score Composite scores are a combination of performance on different parts of the
test. Verbal Memory Visual Memory Visual Motor Speed Reaction Time Impulse Control Total Symptom Score Cognitive Efficiency Index
Interpretation of results
If you have a baseline – look for any highlighted reliable change
Reliable change means that the score is statistically significantly poorer than the baseline score. (poor performance in that category compared to how they performed prior to a head injury)
If they have 2 areas of highlighted reliable change, then the person would be considered to still be performing cognitively poorer than prior to injury and is still recovering.
If you don’t have a baseline, then compare their scores to expected norms for their reported academic performance, i.e. an A student would be expected to score >65%.
https://concussioncaretraining.com/course-category/free-courses/