FAQ (Frequently Asked Questions)

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ORDERING THE SOFTWARE

• Can I get a demo of the ImPACT program?

  Yes, simply send an email to Doug Tauchen . Please note that you can not view your test results from the demo. If you would like to see your demo test results, please request it from Doug after you take the demo.

• Who do I call for more information?

  Please Call (877) 646- 7991, type in the proper extension.

• How do I obtain a W9 for ImPACT?

  Please send an email request to our administrative assistant and she can fax or email you a copy.

• What is the Play It Safe Concussion Care Solution?

  Please view the Play It Safe Concussion Care Solution to learn more.

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ImPACT TEST: Administering the Test

• Who can administer ImPACT?

  An Athletic Trainer, Physician, Nurse, Neuropsychologist, Sports Medicine Clinician, Psychologist, Coach, Athletic Director can administer the baseline and post injury test. The administrator needs to have taken the test and be familiar with the testing protocol, we also suggest you take our free Getting Started with ImPACT webinar. Although many people can administer the tests a medical professional who is legally allowed to make the return to play decision must be the one who interprets the post injury test results.

• Do you have forms to introduce the program to the parents and also get permission from the parents on testing their children?

  Yes, Please download this sample form:
  Sample Consent/Letter 1
  

• Do we need to use a Social Security Number as the identification number when we take the test or can we use a different number?

  Online ImPACT does not require a Social Security Number or other identification number. Name and date of birth are the only identifiers required.

• How does ImPACT compare to SCAT2?

  The SCAT is an on-field measure and should never be used beyond the acute stages of the injury due to its lack of sensitivity/specificity. ImPACT is a post-injury office tool that allows one to document recovery and eventual RTP.

• Is the test available in languages other than English?

  The test is available in 15 languages currently: English, Portuguese, Swedish, Norwegian, German, French, Spanish, Italian, Czech, Russian, Mandarin, Finnish, Afrikaans, Hungarian and Cantonese,

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TECHNICAL SUPPORT: Online

• What are the computer requirements for online ImPACT?

  ImPACT Online Tech Facts

• How do I switch to Online ImPACT?

  If you would like to switch to Online ImPACT or you have any questions about the product, simply give us a call, 1.877.646.7991.

• I am already using the desktop version of ImPACT, what is the cost to switch to online ImPACT?

  Online ImPACT is sold on an annual subscription basis. If you’re already an ImPACT annual subscription client you can make the switch for free and your annual renewal date will remain the same. Consult the price sheet to find your Online ImPACT annual subscription rate. Please contact the ImPACT team to have your account changed to online ImPACT.

• What are the advantages of Online ImPACT?

  Online ImPACT offers the advantage of not having to install software to your PC before testing. It only requires Adobe Flash Player 10.1 or later and an active internet connection to take the test and view results. The program functions on PC’s and MAC’s.

• What happens to my desktop ImPACT data if I switch to online?

  The online and desktop databases are not compatible. You would need to keep the desktop system active until everyone was tested on the Online ImPACT platform.

• I have a baseline in Desktop ImPACT and just did the follow up using Online ImPACT. Can I compare them?

  Yes, the data can be directly compared. Within this context, there are slight variations in the data when comparing the online to desktop versions. More specifically, the reaction time scores are slightly different between the two systems, whereas the other composite scores (Verbal Memory, Visual Memory, Visual-Motor Speed scores) are nearly equivalent. The best way to directly compare data between the two systems is to use the normative data and percentile scores for comparison, rather than the raw scores. In this fashion, the data is identical as you are using the same metric for comparison. As norms are based upon comparisons to a normal population, the data are similarly converted to this common metric and percentile. Thus, for example, if someone scored .52 on the desktop version and is at the 51st percentile, this would be equivalent to someone scoring at .56 and at the 51st percentile for the online system. Using percentile scores rather than raw scores allow for a direct comparison of these data.

• What does it mean if the 'Saving Data' screen doesn't go away?

  It means the internet connection was lost during the testing procedure. Unfortunately the test has been lost and you will need to retest the athlete. To help limit this possibility, don't log in to Online ImPACT until the athlete is ready to start testing.

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ImPACT TEST: Baseline Testing

• What is the best way to test large numbers of athletes?

  Reserve your schools computer lab and retrieve your group baseline testing link. We suggest having students sit every other computer so they can concentrate and get the best possible baseline. The test is 20-30 minutes long, you can schedule athletes every forty minutes to take the test. This way you will be able to explain what the test is before the students take it and allow all the students to finish the test before the next group of students shows up for their baseline test. Athletes should be supervised by someone they are familiar with so they take the test seriously. For more tips on testing large numbers of students please take our free Getting Started with ImPACT webinar, this can be found in the ImPACT training section of our website.

• How often should athletes be given a baseline test?

  We suggest that athletes are tested every two years from 6th grade to senior year of high school. In college, athletes should only be tested once. At the professional level, each athlete should be tested once.

• What if I don't have a baseline on an athlete?

  ImPACT has a very large amount of normative data available for athletes 10 and older, so if an athlete does not have a baseline they still should receive a post injury test. Our program allows you to compare the athletes post injury test to individuals like themselves to help provide an additional assessment tool to their medical licensed provider.

• Who should I baseline?

  We suggest baselines for all athletes. Some schools only test contact sports based on the American Academy of Pediatrics guidelines. View the American Academy of Pediatrics recomendations.

• Can an athlete who is color blind be tested?

  Color blindness can be accounted for after the patient takes the ImPACT test. First, it should be stated that it is VERY rare to have achromatic color blindness and minimal color blindness will not affect the test in any way shape or form. If achromatic color blindness does truly exist in the patient, the only test this condition will affect is the Color Match test (module 5), as all other tests do not depend on color recognition. On the Color Match test, there is a sample prior to taking the test. If the patient cannot complete this, they will skip that test and zeros will be entered in the raw data of the report (Page 3 under Module 5). If this does occur (again, this is a very infrequent condition), the only composite score that will be affected is the Reaction Time score. This score will be artificially lowered (and hence improved). Any test administrator who reviews the data and see that this error has occurred can also readjust the scores using the attached file (see attached handout under Color Match Error). No other composite score or test should be affected by true color blindness. Even if the patient is truly color blind, it is recommended that baseline testing be completed per usual protocol and these raw score adjustments occur after collection of the data. If this condition is not recognized in the patient, post injury data will also be affected in the same fashion and scores should theoretically be the same across both testing sessions.

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DOCTORS: Credentials

• Can a Chiropractor purchase ImPACT?

  In order for a person that is a Chiropractor to purchase ImPACT you must have the following credentials:
  United States: Diplomat of the American Chiropractic Board of Sports Physicians (DACBSP)
  Canada: Royal Canadian Chiropractic Sport Sciences (RCCSS)
  Or work within a Clinic environment with an approved medical or neuropsychological provider, as allowed by state law.

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DOCTORS: Billing

• What code is recommended for billing for baseline test for athletes and a what is a reasonable cost?

  I do not use a billing code for baseline testing where there has never been a concussion. It is not reimbursable thus no need for the code. I give a billing statement to the patient with procedure code (96118 if I do the testing myself) charge amount, etc. If there was a previous recent concussion sometimes you can make a connection and submit the baseline testing to the insurance company. In this case you can use a dx of concussion (850's with date of previous concussion) or post-concussion syndrome (310.2).

• What is the best way to bill so that the insurance company will reimburse?

  Insurance companies vary in how they will reimburse. A physician may use the typical exam/consult code and then a testing code such as 96118. These codes can be used on the same day or separate days. More commonly, the 96116 neuropsych exam code (can only be used once per medical problem/incident) is paired with the 96118 testing code, instead of the physician’s typical consult/exam code. These codes require a medical diagnosis such as CONCUSSION. With these codes there is an expectation of a report. Testing on a followup visit should also be 96118, a code that can be used repeatedly. But you cannot use the 96116 exam code again on the next visit. If a technician performs the testing, then use 96119. If the patient is not in the company of the doctor and is being tested by a computer, then use the computer testing code 96120, but this is a one time use code. Currently, the APA, NAN and other agencies are working with AMA/CMS and others because of the misinterpretation and problematic way the codes are being defined and reimbursed by insurers. Thus, we are all working with insurers to find out what will be reimbursed and by whom. WHAT IS MOST IMPORTANT is to document the time and activity of the doctor that justifies the code that was used, and then bill the proper codes to match the time and activity. Remember 96116 and 96120 are one time per incident codes. 96118 and 96119 can be used repeatedly on a per hour basis. Physician’s may also use their exam and consultation codes in conjunction with the 96119, 96118, 96120 codes.

• In addition to the E&M codes, would MDs use CPT codes 96118 and/or 96120, or should they just use a higher E&M code? Should they use modifiers?

  ImPACT has found that its best to use the appropriated E&M or consult code with a -25 modifier and use CPT 96120. The -25 modifier indicates that there was work the same day that occurred in addition to the procedure (testing) performed. ImPACT does not recommend upcoding.

• Do you have any helpful information or documents on billing?

  Yes, please download our Guide To Billing: Q&A by ImPACT Clients.

• What kind of reimbursement can be expected from insurance?

  Reimbursement rates depend on the procedure codes you bill and who is billing them (MD, Ph.D., nurse, etc) and if it is OP or hospital based. The rates are locally-based because of cost of living issues, etc., but are often based on the Medicare rate (often a percentage of the Medicare rate). You can call your local insurance carrier and ask for the rates. You can also search the Medicare database (see below) to get a sense of the rate for your area.
  Medicare Database

• How do I become part of the Play It Safe Provider Network?

  Please view the Play It Safe Provider Network brochure to learn more.

• Where can I learn more about my billing questions?

  ImPACT provides free billing webinars for you in the training section of our website.

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HELPFUL FORMS

• Our school has purchased the ImPACT software and now we would like to send information to the parents. Do you have any sample parent letters or consent forms?

  Yes, Please download these sample forms:
  Sample Consent/Letter 1
  Sample Consent/Letter 2
  

• I am trying to gather a medical team to help manage our concussions. Do you have a sample Concussion Management Protocol that you recommend to high schools?

  Yes, please download the Concussion Care Model.

• Where can I find the Center for Disease Control Concussion Toolkit?

  Please click on the links below.
  Fact Sheet for Coaches
  Fact Sheet for Parents
  Fact Sheet for Athletes
  Quiz
  Clipboard
  Poster
  Magnet
  PowerPoint Presentation on the Toolkit
  

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Consultation Assistance

• Is there any way to get a copy of an patient's baseline test from another school/clinic to compare to the athlete's post-injury test?

  The ImPACT program allows you to print and/or save baseline tests to your desktop. If you need a students baseline you can have the school print it and give it to the student to bring to you, they can also email it to you.

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ImPACT: BEST PRACTICES

• What are ImPACT's Best Practices Recommendations for Schools and Teams? What type of multidisciplinary team should we have in place to use ImPACT?

  Best Practices Recommendations: View ImPACT's Best Practices Recommendations.

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DOCTORS: Working with your Local Schools

• Do you have any marketing materials I can use?

  Yes, you can download the sample materials below. Please email doug@impacttest.com if you would like to order any of the materials below.
  Small Brochure
  Sideline Concussion Card
  

• I would like to use video clips on concussion. Do you have any clips that would be helpful?

  Yes, below are some clips from different sources that you may find helpful. PBS - The News Hour with Jim Lehrer
  ESPN Video Clip on Second ImPACT Syndrome
  Second ImPACT Syndrome 2
  Concussions and Atheltes
  ImPACT also has a YouTube channel that has a great collection of videos.

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IMPACT TEST: Baseline Testing - INVALID?

• When should I begin to question if a student did not understand some of the test, or if they tried to sandbag it? What is an unacceptable impulse score?

  Typically, at baseline, any impulse control score above 30 indicates that something went wrong with the test. Typically, this would indicate that they did not read the directions correctly for the x's and o's interference test (left/right click), the three letters test (they may have counted forward instead of backwards) or the color match test. Below is a link to a form highlighting the most common errors on ImPACT, how to create the composite scores, and how to recalculate their scores if these errors do occur. Again, a score of greater than 30 indicates something went wrong with baseline. Post concussion, however, this score may be highlighted simply due to the concussion and not that it is invalid. Also, the check the validity of a baseline test, be sure their normative data is commensurate or equal to where you might expect that student/athlete to be. For example, an Average to Above Average student should be at least 50th percentile or higher across the composite scores, etc.
  ImPACT Test Invalidity
  Composite Score Formulas

• What if an athlete intentionally scores low on their baseline test?

  We have received several calls recently regarding news articles that have discussed the potential for professional athletes 'sand bagging' or attempting to set an artificially low baseline test. Obviously this is disturbing in that it suggests continued lack of awareness regarding the potential long-term effects of concussion and the athlete's responsibility in monitoring their own symptoms. Based on these new stories, it does not appear that the athletes are describing the ImPACT test. However it is important to point out that ImPACT is designed with a 'built in' validity index that screens for athletes who may be attempting to set a low baseline. In fact, the ImPACT report 'flags' all suspicious test results after the completion of each baseline test. This feature is thoroughly discussed on the ImPACT website and is covered in all ImPACT training activities. It is extremely important that this feature is correctly utilized by the clinicians who are using the ImPACT program. Any athlete suspected of sandbagging should be immediately retested

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ImPACT Training - Workshops/Webinars

• Where can I get a copy of the sample Clinical Documents & Handouts from the ImPACT Training Workshop?

  Follow-up Interview
  PCSS Single Day
  Clinical Physical Education Notes
  Baseline Worksheet
  Clinical Protocol
  Clinic Exertion Form
  Best Practices
  Rehab Services
  Rehab Protocol 2008
  PCSS Multi-Day
  Clearance Form
  Academic Accommodations
  

• Where can I find information about upcoming training events?

  Please visit the training section of our website!

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ImPACT TEST: Interpretation

• What is the new Cognitive Efficiency Index measure? What is the formula?

  The Cognitive efficiency Index measures the interaction between accuracy (percentage correct) and speed (reaction time) in seconds on the Symbol Match test. This score was not developed to make return to play decisions but can be helpful in determining the extent to which the athlete tried to work very fast on symbol match (decreasing accuracy) or attempted to improve their accuracy by taking a more deliberate and slow approach (jeopardizing speed). The range of scores is from approximately zero to approximately .70 with a mean of .34. A higher score indicates that the athlete did well in both the speed and memory domains on the symbol match test. A low score (below .20) means that they performed poorly on both the speed and accuracy component. If this score is a negative number, the test taker performed very poorly on the reaction time component. Click here to download a document about Cognitive Efficiency Index

• If any given athlete did not have baseline testing, and then clearly had a concussion or symptomology during competition, what, if anything, would repeat testing tell the training staff. I presume that there are norms by age, sex, etc?

  Yes, the program can, and should, be used even without a baseline. In the report summary scores (composite scores), the norms are printed out and automatically tabulated. The raw score is accompanied by a percentile which indicates where they fall relative to healthy age and gender-matched controls. For example, if the composite score falls at the 5th percentile…that would indicate 95 out of 100 non-concussed individuals would perform better than the athlete that is being tested. By understanding their pre-injury status, this data can be extremely informative and helpful. For example, a typical A/B student should be around the 60th percentile or higher on all composite scores, those that are C students should typically fall around the 40th percentile or higher and those with learning disability or very poor students could fall as low as the 20th percentile or so and be considered within normal limits. We use the program all the time without baselines and the data is very helpful for clinical management.

• How do I get the baseline and post-injury test to show up on the same report?

  After looking up the athlete under Test Look Up, click on the baseline test so it is highlighted blue. Then click on the post-injury test while holding down the control key. Both tests should now be highlighted blue. They will now both be on the report when you click Generate Report.

• I am trying to locate articles that discuss the use and validity of ImPACT for patients other than the athletic population, ie trauma patients. Where can I find these?

  Below are links to some helpful articles:
  Neurocognitive Function of Emergency Department Patients With Mild Traumatic Brain Injury
  Neurocognitive Assessment of Concussion in the Emergency Department Using ImPACT
  Neurocognitive Evaluation of Mild Traumatic Brain Injury in the Hospitalized Pediatric Population
  The diagnostic accuracy of the Revised Westmead PTA Scale as an adjunct to the Glasgow Coma Scale in the early identification of cognitive impairment in patients with mild traumatic brain injury

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ImPACT TEST: Post Injury Testing

• What do we do after a concussion? Who should interpret the test results?

  After a concussion is suspected immediately remove the athlete from play, 24-72 hours after the athlete was pulled from play they should take a post injury test. Coaches, school nurses, certified athletic trainers and athletic directors can all administer the post injury test. Although these individuals can administer the test a licensed medical professional must make the return to play decision (the individuals who can do this vary by state). The computer can then compare the results of the post injury test to the athletes original baseline test. If a student does not have a baseline test they still should receive a post injury test. ImPACT has normative data that their post injury test can be compared to. The comparison will give you six pages of information, this information can be saved on your computer and emailed, or printed and given to the student. After the computer compares the baseline and post injury tests a diagnostic or return to play decision should be based on an evaluation by medical personnel in accordance with usual and standard medical practices in your state. ImPACT provides medical professionals an additional tool to help them evaluate patients, ImPACT is not a replacement for a medical evaluation. If you are looking for a doctor trained in ImPACT to interpret your post injury tests you can find individuals in your area on ImPACT's website. ImPACT also offers training webinars and events to help individuals learn how to interpret post injury tests, these can be found on our website as well.

• When should ImPACT be given following a concussion?

  We suggest initial evaluation 24-72 hours after injury. Consult an physician for interpretation of ImPACT test results. If ImPACT results are abnormal continue to refrain from practice and competition. The second post injury test should be administered one to two weeks after the initial post injury test. We strongly discourage testing more than once a week. Once scores have returned to baseline level and symptoms have resolved an exertion test should be performed.

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DOCTORS: Return-to-Play Issues

• When should I return an athlete to play following a known skull fracture with additional complexities including expressive dysphasia, a stable traumatic subarachnoid hemmorhage and frontotemporoparietal bone fracture along with a small acute SDH?

  The return to play decision can be controversial. The first step is to have the neurosurgeon assess whether the player is at any increased risk for re-injury, based on the player's skull fracture. The next step is to determine whether an athlete with a known structural injury, such as a hemorrhage, is at increased risk for tearing of ht brain tissue in that area. The final step is to ensure that the athlete is neuropsychologically normal prior to return to play. Until the dysphasia and any memory problems subside, the athlete should not return to play.

• Where can I find information on a student-athlete's return to the classroom after a concussion?

  Supporting the Student-Athlete's Return to the Classroom After a Sport-Related Concussion by Neal McGrath, PhD, Journal of Athletic Training

• How close to the Baseline scores must the Post-Injury scores be before the athlete can return to play?

  Reliable change indices are a helpful tool for determining when an athlete's post-injury test has satisfactorily approached baseline levels. On newer versions of ImPACT, a composite score is BOLDED if the post-test composite exceeds the reliable change index, and is thus considered atypical and representative of cognitive impairment related to injury. Once the composite is within the reliable change index, it is no longer printed in bold text. The RCI should not be the only criteria in determining when an athlete's test scores are back to baseline. An examination of the athlete's performance on individual tests should happen as well. In addition, symptoms and exertional testing should be a part of the process. And, of course, the ATC would need to first determine that the baseline was valid and representative of the athlete's non-injured functioning.

• How often do you administer the ImPACT test during an athlete's injury?

  I evaluate the athlete within 72 hours of injury and then at weekly intervals, until they are asymptomatic at rest, asymptomatic with exertion, and all normal on ImPACT (return to play criteria). For those who take a long time to recover, this time interval can be extended. If the case is milder, I might evaluate them a few times within the first week. You should never test more than twice in a week.

• Do you administer the test when an athlete still has self reported symptoms?

  Yes, I do test athletes when they are symptomatic, to help monitor progress and help to determine school issues, return to exertion, etc.

• Have you found that athletes who perform the test have increased symptoms following the test because of increased cognitive function?

  Yes, I do find that athletes will complain of symptoms when taking ImPACT, this is actually very frequently reported.

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ImPACT: ONLINE VERSION

• What are the similarities and differences between the desktop version and the online version?

  Please download Desktop vs Online version

• How do you deal with patient data?

  ImPACT is HIPPA compliant for all system components. ImPACT does not share test information with anyone and access is restricted to the authorized users for your school or organization.

• Could I call ImPACT and ask for a test score?”

  No, the school or organization is your administrator. They can give you a copy. You have to return to where the test was administered to retrieve a copy.

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CONCUSSION

• In regards to athletes getting hit in certain areas of the brain and affecting different functions, do you have some sort of a list or general description of types of blows to certain areas of the brain which may cause; ie athlete gets a frontal hit look

  By Micky Collins, PhD...Here are some general points of reference. Please consider these general points, as the injury and presentation is very complicated and may not always present as outlined below....though we often see 'subtypes' of concussive injury. The brain can be thought to be composed of different systems, and each system plays a different role in behavior (and symptom presentation). When examining concussion, two systems may be affected differently. The subcortical system, or deeper (and posterior) parts of the brain control attention, speed, sleep/wake cycles, balance, fine motor movements, visual functions, etc. The reticular activating system is also deeper in the brain (though pathways extend anteriorly towards the frontal regions), and controls arousal. Hence, if you have a blow to the posterior or back portion of the cranium, you may expect to have a loss of consciousness, and acute symptoms will typically (not always) include brief visual changes, balance deficits, fatigue, slowness, and arousal difficulties. With posterior concussions, lingering symptoms may include include a lot of fatigue, distractibilty, potential sleep/wake issues, and deficits on ImPACT may include reaction time and visual-motor speed deficits. The cortical (or frontal/temporal) functions include memory, multi-tasking, problem solving, mood/behavior, reasoning, and exective functioning. Thus, a cortical concussion will more likely involve amnesia (both retrograde, post-traumatic), deficits with memory, concentration, multi-tasking and potential emotional changes. On ImPACT, you will often see deficits with verbal memory, as well as visual memory. For more chronic symptoms, you may see a sense of 'fogginess' (which is an attentional deficit), academic difficulties characterized by concentration deficit/memory difficulties, and potential mood related changes (depression, anxiety, etc). Obviously, if you have a posterior blow, and have all of these symptoms (with amnesia, mood, etc, along with speed/arousal difficulties), it is a more serious concussion and visa versa with a frontal blow. That is why when all four scores on ImPACT are impaired, it is a more serious concussion and you may expect a more protracted recovery. As an FYI, there are also vestibular or labyrynthine concussion (inner ear and not necessarily intracranial). With this type of injury, you will see positional dizziness, disequilibrium, and similar symptoms. It is typical that you will have concussion symptoms, in addition to the vestibular deficits that you have to account for.

• What number of symptoms is considered significant?

  Any symptom that is not normally present or is normally present but elevated post concussion should be taken seriously.

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