ImPACT Test

Subject's Background Information and Native Language
The athlete should always be questioned regarding their fluency in other languages as this may affect test results.

Subject's Education, Special Needs YEARS COMPLETED should be recorded along with any history of LD or ADD/ADHD.

Subject's Sport and Concussion Background
This part of the report allows for the careful tracking of injury and recovery and documents important markers of injury severity concussion severity.

Other Background Information that May Affect the Outcome of the Clinical Report
Pre-existing medical problems may effect recovery from concussion and should be carefully recorded.

Verbal Memory Composite
This composite score represents the average performance on the Word Memory (module 1), the Symbol Match (module 4) and the Three letters (module 6), expressed in percent correct. Scores are also represented in age-referenced percentile (Version 3.0 only). This athlete demonstrated a large initial decline in performance with a return to baseline levels within 12 days of injury.

ImPACT provides a graphic representation of scores across multiple neurocognitive domains. This allow for a direct graphic comparison of performance on testing across different evaluation periods.

Visual Memory Composite
Measures visual attention, scanning, visual learning, and attention. This score represents a new composite score for ImPACT 2.0, which is currently undergoing field-testing.

This score in its current form is comprised of the average of:

- Total percent correct score from module 2 (Design Memory).

- Total correct-memory score from module 3 (X's & O's).

Visual Motor Speed Composite
This athlete demonstrated no significant drop in performance initially after injury and progressive improvement over subsequent evaluations. This is likely reflective of practice effects.

Is comprised of the average of following scores:
- Total number correct /4 during interference of module 3 (X's & O's).
- Average counted correctly x3 from countdown phase of module 6 (3 Letters).
Graphic Display of Visual Motor Speed over time:

Reaction Time Composite Score
Is comprised of the average of the following scores:
- Average Correct RT of interference stage of module 3 (X's & O's).
- Average Correct RT /3 of module 4 (Symbol Match).
- Average Correct RT of module 5 (Color Match).
Graphic Display of Reaction Time Composite over time:

Impulse Control Composite
This provides a measure of errors on testing and is useful in determining test validity. For this athlete, errors are within acceptable levels. Scores above 20 should be viewed as invalid.

This score indicates the sum of errors committed during different phases of the test, and while clinical decisions should not be based on this composite, its inclusion may help in the interpretation of other composites. This score is obtained by adding:

- Total errors on the interference phase of module 3 (X's & O's).
- Total commissions from module 5 (Color Match).

Graphic Display of Impulse Control Composite over time

This score presents summary information regarding the athlete's self reported symptom data. A higher score reflects a higher symptom total.

This score represents the total for all 22-symptom descriptors:

Headache Vomiting Dizziness Trouble falling asleep Sleeping less than usual Sensitivity to light Irritability Nervousness Feeling more emotional Numbness or tingling Feeling slowed down Feeling mentally foggy Difficulty concentrating Difficulty remembering Visual problems (blurry or double vision)		Nausea Balance Problems Fatigue Sleeping more than usual Drowsiness Sensitivity to noise Sadness

This table provides basic information regarding the characteristics of the injury. This information is tabulated from information entered by the ATC or other professional regarding the characteristics of the injury.

Drs. Lovell and Collins are available to provide assistance in the interpretation of test results. Their contact information is printed on the clinical report.

Hits (immediate)	The number of correctly identified words (out of 12).
Correct Distracters (immediate)	The number of correctly identified distracter items (out of 12).
Learning Percent Correct	Hits + correct distracters/24 X 100.
Hits (delay)	The number of correctly identified words (out of 12).
Correct Distracters (delay)	The number of correctly identified distracter items (out of 12).
Delayed Memory % Correct	Delay hits + correct distracter delay items (out of 12).
Total Percent Correct	Average percent correct (learning percent correct + delayed percent correct/2).

- Evaluates attentional processes/verbal recognition memory.
- Utilizes a word discrimination paradigm.
- Twelve target words are presented for 750 milliseconds each. (Twice to facilitate learning of the list)
- The subject is then tested for recall via the presentation of a 24-word list that is:

- Comprised of 12 target words and 12 non-target disctacter words.
- Disctacter words chosen from the same semantic category as the target word.
- EX: the word "ice" is a target word, while the word "snow" represents the non-target word.
- The subject responds by mouse-clicking the "yes" or "no" buttons.
- Individual scores are provided both for correct "yes" and "no" responses.
- In addition, a total percent correct score is provided.

- There are five different forms of the word list.

Delay Condition: Following the administration of all other test modules (approximately 20 minutes), the subject is again tested for recall via the same method described above. The same scores that are described above are provided for the delay condition.

Hits (immediate)	Number of correctly identified designs (out of 12).
Correct Distracters (immediate)	Number of correctly identified incorrect distracter items (out of 12).
Learning % Correct	Hits + correct distracters/24 X 100.
Hits (delay)	The number of correctly identified designs (out of 12).
Correct Distracters (delay)	The number of correctly identified distracter designs (out of 12).
Delayed Memory % Correct	Delay hits + correct distracter items (out of 12).
Total Percent Correct	Average percent correct (learning percent correct + delayed percent correct/2).

- Evaluates attentional processes and visual recognition memory.
- Utilizes a design discrimination paradigm.
- Twelve target designs are presented for 750 milliseconds each. (Twice to facilitate learning).
- The subject is then tested for recall via the presentation of the 24-designs.

- comprised of 12 target designs and 12 non-target designs.
- EX: non target designs are target designes that have been rotated in space.
- The subject responds by mouse-clicking the "yes" or "no" buttons.
- Individual scores are provided both for correct "yes" and "no" responses.
- In addition, a total percent correct score is provided.

- There are five different forms of this task.

Total Correct (memory)	Measures the number of correctly identified items (total possible correct=12).
Total Correct (interference)	This score provides a measure of the number of errors made on the interference test.
Avg. Correct RT (interference)	Measures the average reaction time for correct responses on the interference (distracter) test.
Total Incorrect (interference)	This score measures the number of errors on the distracter test.
Total Incorrect RT (interference)	This score provides an index of the reaction time for incorrect responses on the interference test.

- Measures visual working memory, visual processing speed, and visual memory.
- Incorporates a distracter task.
- The subject can practice the distracter task prior to presentation of the memory task.
- The distracter is a choice reaction time test: the subject is asked to click the left mouse button. if a blue square is presented and the right mouse button if a red circle is presented.
- Once the subject has completed this task, the memory task is presented.

- Memory task: a random assortment of X's and O's is displayed for 1.5 seconds
- For each trial: three of the X's or O's are illuminated in YELLOW (the subject has to remember the location of the illuminated objects).
- Immediately after the presentation of the 3 X's or O's, the interference task re-appears on the screen.
- Following the interference task, the memory screen (X's and O's) re-appears and the subject is asked to click on the previously illuminated X's and O's.
- Scores are provided for correct identification of the X's and O's (memory), reaction time for the interference task, and number of errors on the interference task.

- For each administration of ImPACT, the subject completes 4 trials.

Total Correct (visible)	This score is the number of correct matches out of 27 when the symbol number pairings are visible.
Total Correct RT (visible)	The average reaction time for the 27 matches.
Total Correct (hidden)	This represents the number of items correctly recalled when symbol number pairings are hidden.
Total Correct RT (hidden)	The average reaction time for recall of the memory items.

- Evaluates visual processing speed, learning and memory
- Initially, the subject is presented with a screen that displays 9 common symbols (triangle, square, arrow, etc).
- Directly under each symbol is a number button from 1 to 9
- Below this grid, a symbol is presented.

- The subject is required to click the matching number as quickly as possible and to remember the symbol/number pairings
- Correct performance is reinforced through the illumination of a correctly clicked number in GREEN. Incorrect performance illuminates the number button in RED.
- Following the completion of 27 trials, the symbols disappear from the top grid.
- The symbols again appear below the grid and the subject is asked to recall the correct symbol/number pairing by clicking the appropriate number button.

- This module provides an average reaction time score and a score for the memory condition.

Total Correct	Number of correct matches.
Avg. Correct RT	Average reaction time for correct matches.
Total Commissions	Number of incorrect for color/word matches.
Avg. Commissions RT	Average reaction time for commissions.

- Represents a choice reaction time task and measures impulse control/response inhibition.
- First, the subject is required to respond by clicking a red, blue or green button as they are presented on the screen. This procedure is completed to assure that subsequent trials would not be affected by color blindness.
- Next, a word is displayed on the screen in the same colored ink as the word (e.g. RED), or in a different colored ink (GREEN or BLUE).

- The subject is instructed to click in the box as quickly as possible only if the word is presented in the matching ink.

- In addition to providing a reaction time score, this task also provides an error score.

The three letters test measures both memory and neurocognitive speed. The athlete is required to learn and retain 3 letters, while being distracted by a backward number tracking test. The number clicking test measures visual scanning and cognitive speed.

Total sequence correct.	Total number of letter sequences correct (out of 5).
Total Letters correct	Total letters correct (out of 15).
% of total letters correct	Percent letters correctly identified.
Avg. time to first click	Time to initiation of first click of mouse.
Avg. Counted	The average # of numbers clicked, irrespective of errors.
Avg. Counted correctly	The average # of numbers clicked that are in correct sequence.

- Measures working memory and visual-motor response speed
- First, the subject is allowed to practice a distracter task

- Consists of 25 numbered buttons (5 x 5 grids).
- The subject is instructed to click as quickly as possible on the numbered buttons in backward order starting with "25" (has an initial practice task).
- Then they are presented with three consonant letters displayed on the screen.
- Immediately following display of the 3 letters, the numbered grid re-appears and the subject is instructed to click the numbered buttons in backward order, again.
- After a period of 18 seconds, the numbered grid disappears and the subject is asked to recall the three letters by typing them from the keyboard.
- Both the number placement on the grid and letters displayed are randomized for each trial.

- Yields a memory score (total number of correctly identified letters) and a score for the average number of correctly clicked numbers per trial from the distracter test.
- Five trials of this task are presented for each administration of the test.

The ImPACT symptom scale is currently utilized throughout professional and amateur sports and is a measure of symptoms reported by the athletes.

Individual symptoms are indexed on a scale for 0 to 6. Reported symptoms should reflect the past 24 hours.

The sleep and medication sections of the ImPACT report may provide valuable information regarding the current medication regimen of the athlete and also provides the opportunity to document additional issues that may affect test performance such as sleep difficulties or computer/environment issue (e.g. noise in exam room, interruption of testing session).

This information can be found in ImPACT's Clinical Interpretations Manual.

PDF of Clinical Interpretation Manual

Sample Clinical Report - Overview