IMPACT

ImPACT: A Computerized Concussion Assessment Tool

Overview and Development

  • Developed in 1999 by Dr. Mark Lovell and Dr. Joseph Maroon at the University of Pittsburgh Medical Center, ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was the first computerized concussion assessment tool designed to help evaluate and manage concussions effectively.

  • First Adoption: The Center: Orthopedic & Neurosurgical Care & Research in Bend, OR, was the first to adopt ImPACT in 2001, demonstrating its early acceptance in the medical community.

  • Evolution: As technology progresses, various methods have been implemented to enhance the accuracy and effectiveness of the test, reflecting ongoing research and development efforts in the field of sports medicine.

Usage and Popularity

  • ImPACT is widely utilized not only in professional sports leagues including the NFL, NHL, NBA, and MLB but also in a myriad of colleges and universities across the United States, establishing itself as a crucial tool in sports-related concussion management.

  • It is regarded as the most widely used and scientifically validated computerized concussion evaluation system, having been administered over 12 million times since its FDA approval in 2006.

Testing Methodology

General Information

  • Cost: Generally ranges between $500-$750, purchased in packages which might include multiple tests or additional resources for practitioners.

  • Testing Duration: The test typically takes about 30-45 minutes for completion, although some athletes may require over an hour if they are experiencing a concussion.

  • Environment: It is critical that the testing occur in a quiet environment free from distractions to ensure the athlete can focus effectively on the tasks at hand.

Structure of the ImPACT Test

The ImPACT test is segmented into three critical sections:

  1. Section 1: Subject Profile and Health History Questionnaire

    • This section collects essential demographic and background information such as:

      • Height

      • Weight

      • Sport and Position

      • History of concussions

      • Learning Disabilities

      • Other relevant medical background.

  2. Section 2: Current Symptoms and Conditions

    • It inquires about:

      • The date of the athlete's most recent concussion.

      • Amount of sleep the previous night.

      • Current medications.

      • Severity rating of 22 concussion symptoms using a 7-point Likert scale to give a detailed view of the patient’s condition.

  3. Section 3: Neurocognitive Tests (6 modules)

    • Comprising six specific modules that assess different cognitive functions:

      • Module 1: Word Discrimination - Assesses attentional processes and verbal recognition memory through word recall tasks.

      • Module 2: Design Memory - Similar methodology to Module 1, focusing on visual recognition and memory.

      • Module 3: X’s and O’s - Evaluates visual working memory and processing speed through a pattern recognition test.

      • Module 4: Symbol Matching - Assesses visual processing speed through symbol recognition tasks.

      • Module 5: Color Match - Tests impulse control by measuring response patterns to color-word discrepancies.

      • Module 6: Three Letter Memory - Evaluates working memory through sequential letter recall tasks.

Scoring and Composite Scores

  • The test yields a Total Symptom Composite and five additional composite scores based on the performance in various modules, providing a comprehensive view of cognitive functions affected by concussions:

    • Composite 1: Verbal Memory Composite

    • Composite 2: Visual Memory Composite

    • Composite 3: Processing Speed Composite

    • Composite 4: Reaction Time Composite

    • Composite 5: Impulse Control Composite

    • Total Symptom Composite: Compiles the overall severity of all reported symptoms.

Validity and Reliability Concerns

  • Some studies raise questions regarding the reliability of ImPACT scores and the potential for false positives, leading to criticisms from some medical professionals about the test's accuracy.

  • It has been suggested that the tool's popularity stems from its marketing rather than its clinical efficacy. Despite these concerns, ImPACT maintains the largest database of clinical research on concussion management, providing valuable data for ongoing work in the field.

Final Thoughts on ImPACT

  • ImPACT serves as a critical tool to assist clinicians in determining if an athlete has sustained a concussion. However, the ultimate diagnosis and management depend on trained clinicians or athletic trainers who synthesize data from ImPACT with other clinical observations and assessments.

  • While there may be instances of false positives, the role of trained professionals in interpreting ImPACT results is vital for ensuring athlete safety and proper management of concussive injuries. It should be noted that ImPACT is not intended as the sole determinant for concussion diagnosis, but rather as an additional tool in the assessment process.