ImPACT & Concussion Management

South Salem High School's Sports Medicine Department and Training Room is proud to use cognitive testing program called ImPACT as an ally in our treatment of head injuries. This tool will be used to assist in determining when athletes are ready to return-to-play after sustaining a concussion. The following information will help educate you on this exciting opportunity for your student athletes!

Contents
1.  What is a concussion?
2.  What is ImPACT?
3.  Where can I find more information?
4.  Why is it so important to utilize tools like ImPACT to gather more information about the concussion?
5.  What does the test look like?
6.  Who will be tested?
7.  What are the return to play guidelines after a concussion? 

What is a concussion?
A concussion is a brain injury in which trauma to the head results in a temporary disruption of normal brain function. The injury occurs when a person’s brain is violently rocked back and forth or twisted inside the skull as a result of a direct or indirect force. A concussion disturbs brain activity and should be handled as a serious injury. An individual does not have to lose consciousness (“knocked-out”) to suffer a concussion. Proper healing and recovery time following a concussion are crucial in preventing further injury.
 
Athletes who are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences for a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return to play decisions are carefully made. No athlete should return-to-sport or other at-risk participation when symptoms of concussion are present and recover is ongoing. In summary, the best way to prevent difficulties with concussion is to manage the injury properly when it occurs. 

 What is ImPACT?
ImPACT stands for Immediate Post-concussion Assessment and Cognitive Test. It is a sophisticated software program developed to help sports-medicine clinicians evaluate recovery following concussion. ImPACT is a computer test that evaluates multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time and post-concussive symptoms.

 ImPACT is currently the most widely utilized computerized concussion management program in the world and has been implemented effectively for high school, collegiate, and professional athletes. This program was developed through research by neuropsychologists, neurologists and physicians at the University of Pittsburgh Medical Center (UPMC).

Athletes, especially those who participate in contact sports, should take a “baseline” test prior to the start of their athletic season. The baseline test takes approximately 30 minutes and can be done through the Internet. Taking a baseline is like “giving your brain a physical” and establishes a normal level of performance.
 
After an athlete suffers a concussion, a medical evaluation followed by a “post-concussion” ImPACT test is performed. Post-concussion testing should be taken within 48 to 72 hours after the injury. Diagnostic testing may be ordered, such as a MRI or a CT scan, to rule out structure injury to the skull or brain. In spite of the fact that these tests are usually normal, a serious concussion may still have occurred.
 
If an athlete has not taken the baseline test, ImPACT Inc. has developed norms that can be used to evaluate the recovery process of a concussed athlete.
 
ImPACT assists in:
·       Protecting the student athlete
·       Determining safe return to sport
·       Preventing the cumulative effects or repeated concussions
·       Providing objective data to help assess an athletes’ recovery. IT IS NOT THE DETERMINING 
FACTOR FOR RETURN TO PLAY.
 
TEST FEATURES:
 Baseline Test:
    ·      The baseline test is a pre-injury measurement of an athletes’ cognitive function. Should an athlete sustain a concussion, post-injury tests can be compared to a baseline data and provide valuable information that aids in the return to sport decision.
    ·      Baseline tests are recommended for any athlete ages 13 and up and especially for those who participate in contact sports.
 
Post-Concussion Tests:
    ·      If a concussion occurs a post-concussion test would be administered 48-72 hours after injury, and interpreted by medical clinicians.
    ·      These results are then compared with the baseline data to assist in determining the degree of recovery. Additional post-injury tests may be required until complete recovery has occurred.
 
Where can I find more information?
If you would like more information, please click here to visit the ImPACT Website. 

Why is it so important to utilize tools like ImPACT to gather more information about the concussion?
 It is important to note that ImPACT is not designed to make all the decision about when an athlete has sustained a concussion or when they are ready to return. It is just another tool that can be utilized to gather more information about the injury. Click here to see a video and read an article about the diagnosis of concussions and the importance of preventing Second Impact Syndrome. 

What does the test look like? 
To see what the test entails, including some sample questions, please click here to see the power point provided by ImPACT. 

Who will be tested?
All South Salem Athletes are required to have an established baseline test before they may compete in their sport.  This testing will be scheduled between the coach and Athletic Trainer at the beginning of the season.  All athlete who suffer a head injury will take a post-concussion test.

What are the return to play guidelines after a concussion?
The Hope Athletic Trainer program has a unified return to play guideline under the guidance of Dr. Koester (Slocum Center for Orthopedics and Sports Medicine out of Eugene, OR). The Return-to-Play Guidelines are as follows:
  • Step 1 - NO ACTIVITY.  The athlete must complete the following items before moving on to step 2"
    • Is self-reported as symptom free on the SCAT3 Symptom Form
    • Has returned to school full time
    • Has returned to their ImPACT Baseline
  • Step 2 - Light Exercise**.  The athlete may engage in light , non-contact, low-impact aerobic activity such as walking. swimming. or riding an exercise bike with the goal of elevating their heart rate (<70% of age-predicted maximum heart rate) while being supervised.
  • Step 3 - SPORT SPECIFIC ACTIVITIES.  The athlete may engage in vigorous, non-contact, sport specific drills with the goal of challenging concentration and increasing impact associated with elevated heart rate, without the threat of contact from others.  No helmet or other equipment should be used at this time.  
  • Step 4 - NON-CONTACT TRAINING DRILLS IN FULL EQUIPMENT.  The athlete may participate in non-contact practice, with the goal of simulating sport participation without the opportunity for re-injury.  Resistance training can begin/resume at this point.
  • Step 5 - FULL CONTACT PRACTICE OR TRAINING.  The athlete may return to full practice or training, but no competition at this step.
  • Step 6 - RETURN TO FULL PLAY.  The athlete may return to full participation including games.  
** Clearance from a licensed health care professional must be obtained before the athlete moves on to this step, per Max's Law OAR 581-022-0421.  Per Max's law, a Health Care Professional means a Physician (MD), Physician Assistant (PA), Doctor of Osteopathic (DO), licensed by the Oregon State Board of Medicine, Nurse Practitioner licensed by the Oregon State Board of Nursing, or a Psychologist licensed by the Oregon Board of Psychologist Examiners.