There is no data in soccer or hockey regarding helmet manufacturing and a reduction in the incidence or severity of concussion. In short, I personally do not endorse or recommend soccer headgear, etc. Obviously, the best way to prevent problems with concussion is to be certain the athlete has recovered fully prior to RTP. In football, we have done some research with the Revolution Helmet and found that to slightly reduce the incidence, though not the severity of concussion.

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 conscioussness, 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, distractibility, 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 vica versa with a frontal blow. That is why when all four scores on ImPACT are impaired, it is a more serious concusssion 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, dysequilibrium, and similar symptoms. It is typical that you will have concussion symptoms, in addition to the vestibular deficits that you have to account for.

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.

Mark Lovell, PhD - Director, UPMC Sports Concussion Director, NFL & NHL Neuropsychology (412) 432-3670 or Micky Collins, PhD - Asst. Director, UPMC Sports Concussion Program (412) 432-3668

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.

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. ou should never test more than twice in a week.

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

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

An Athletic Trainer, Physician, Nurse, Neuropsychologist, Sports Medicine Clinician, Psychologist, Coach, Athletic Director. The administrator needs to have taken the test and be familiar with the testing protocol.

Yes. You can insert your school logo in the document and send it home with all the athletes. There is also a one-page intro that tells the parents everything they need to know.

Using the Social Security Number is not required. However, some unique identification number must be used. Many schools opt to use student identification numbers instead of Social Security Numbers for security reasons. The identification number field can also configured to accept letters and numbers.

1) Schedule groups of athletes in the computer lab. We suggest only using every other computer (more space means better baseline results). The test is 20 minutes long and you can schedule athletes every half hour to take the test. Athletes should be supervised by someone familiar with the program. 2) Schedule the test to be taken during your annual physicals. Install the program on the computers where you conduct your physicals and have the athletes take the test as part of their physical. Test athletes twice in high school (freshman & junior yrs.) and once in college (freshman yr.). 3. Online ImPACT users can provide students with a website where they can take the test.

Although each athlete can be tested only once in high school, we recommend testing 2 times - freshman and junior years (in high school the brain is still developing). In college, the athlete should be tested during his or her freshman year. At the professional level, each athlete should be tested once.

ImPACT performance following a concussion can be compared to our large normative database to assist in determination of recovery.

We suggest baselines for all athletes. Some schools only test contact sports based on the American Academy of Pediatrics guidelines. Visit this link to view the American Academy of Pediatrics recomendations: www.impacttest.com/pdf/MedicalConditionsAffectingSportsParticipation.pdf

These are supplemental research scores. These graphs can be turned off if desired.

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.

Once taken, ImPACT generates a 6-page clinical report. The ImPACT Clinical Team will train you, your staff, and your team doctors on reading and interpreting the test results. 1) 24-48 hours post injury, have the athlete sit down to take the Post-Concussion Test. 2) Ask your athletic trainer / team physicians / medical staff to get involved. We have found that MANY clinicians want to be involved. We find that many sports medicine clinicians want to learn to interpret the test results AND WE WILL TRAIN THEM ON USING THE INSTRUMENT. We can also provide names of specialists (e.g. neuropsychologists) in your area who are trained in proper interpretation. 3) If you don't have anyone at your school to do the interpretation, consult our website (DOCTOR LOCATOR) to find a specialist in your area. Consultation can be established through one of our specialists at the University of Pittsburgh Medical Center. ImPACT test results should be used as only one source of information regarding the athlete's level of functioning. Diagnostic or return to play decisions should be based on an evaluation by medical personnel in accordance with usual and standard medical practices. Post Injury testing consultation may be charged to athlete's insurance

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 ImPACT test should be administered once the athlete is asymptomatic. Once scores have returned to baseline level and symptoms have resolved an exertion test should be performed. Please attend an ImPACT workshop for contact Dr. Collins for a detailed return to play protocol.

Yes, contact Doug Tauchen at 1.800.942.8632 to receive a demo.

Labiba Russo, Director of Sales & Marketing, 1.877.646.7991

$100/year - High Schools; $150/year - Colleges/Universities; $150/year - Professional

- Operating Systems Windows 98+ w/SP 6 or later - Internet Explorer 4.01 w/Service Pack 2 or later - 32 MB of RAM and Pentium Class Processor Speed of 200 Mhz - Hard Drive Space 20 MB for the software plus, 4KB per test saved. - Laptop computers require use of an external mouse and AC connection.

Technical support is available by phone at 1.800.942.8632. General office hours are 8-6 central time.

1. Decide a location on the server for the database. a) This can be done though a mapped drive or UNC. b) The server location must have full privileges for all users that will be accessing the database. c) Make sure that the location of the database is scheduled for backup every night. 2. Install the software to the workstation. Restart the computer if prompted and then start ImPACT using the desktop icon. 3. The program will ask, 'The database doesn't exist, do you want to create it?' Click NO. 4. A browse window will appear. Browse to the folder location you want to save the database on the server. 5. The program will ask, 'The database doesn't exist, do you want to create it?' Click YES. 6. Then it will ask if you want to make this your default location, choose YES. 7. Use the online registration code provided in the email to register your software. If this doesn't work, call to register. Make sure you have the computer on the registration screen when you call. 8. Quit out of ImPACT. 9. Restart the program to verify all changes have registered.

Call technical support to get the password or have the system reset.

The software takes 20 MB of hard drive space plus 4 KB per test saved.

The online registration codes are set to work one time. If you receive this message it means that the code has already been used once. However, you can call Technical Support at 1.800.942.8632 and tell them that you need to register ImPACT on more computers and they will set your code to work as many times as you need. If you are getting a different message then try to the online registration code again. If it fails to work please call Technical Support.

Call Technical Support at 1.800.942.8632. They will reset your account with a temporary master password. After this, open ImPACT and click on Tools at the top of the screen. Click on Options and then User Accounts. Click on the account that you had been locked out of and click Privileges. Uncheck the box that says 'Account is locked out.' It is advisable that you now change your password, but it is not necessary.

You will only be prompted to register if your subscription is expired. If the program does ask to register, then call Technical Support at 1.800.942.8632 to check the status of your account. If your system is not registered, you cannot save the data from any new tests.

The organizational firewall is blocking the registration. If this is happening then call Technical Support at 1-800-942-8632 and register ImPACT by phone. If the message says that the code has already been used then you can call Technical Support and they can reset the password to work as many times as needed.

Yes, the online version works with MAC internet browsers.

We have a MAC based program. We are in the process of gathering enough baseline data to do a validity study of the MAC version. Once this is completed, we can release the final version. The program is currently being Beta tested in high schools across the nation.

If you would like to switch to Online ImPACT or you have any questions about the product, simply give us a call, 1.800.942.8632.

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.

Online ImPACT offers the advantage of not having to install software to your PC before testing. It only requires Macromedia Flash Player 7.0 or later and an active internet connection to take the test and view results. The program functions on PC’s and MAC’s.

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.

The latest version of Sideline ImPACT can be run on Pocket OS 2002, 2003 and Windows Mobile 5. If you are interested in testing the product, please contact Doug Tauchen: doug@flantech.net

Sideline ImPACT will run on phone/PDA combination devices. The screen resolution must be 320x240. While we haven't tried Sideline ImPACT on every available PDA phone, we have yet to find one that doesn't support Sideline ImPACT. Please contact technical support if you have any questions about a specific device.