ImPACT: Beyond the
Numbers
Elizabeth M. Pieroth, PsyD, ABPP
NorthShore University HealthSystem
COGNITIVE
•Fogginess
•Concentration
•Memory deficits
•Cognitive fatigue
SLEEP
DYSREGULATION
SOMATIC
Headaches
Falling asleep
Dizziness
Fragmented sleep
Light/noise sensitivity
Too much/too little sleep
MOOD
DISRUPTION
Irritability
Adapted from Camiolo
Reddy, Collins & Gioia, 2008
Sadness
Anxiety
Tinnitus
“Horseplay”
Failure to Understand Directions
“Sandbagging” or Faking
Not Using Mouse/Malfunctioning Mouse
Incentive different at baseline/post-injury
PERCENTILE RANGES
•
•
•
•
•
•
Superior/Very Superior
High Average
Average
Low Average
Poor
Impaired
90 – 99th %ile
75 – 89th %ile
26 – 74th %ile
16 – 25th %le
6 – 15th %ile
< 5th %ile
Average
Low
average
Poor
Impaired
High average
Superior
Very superior
Computerized Neurocognitive Testing
To Test or Not to Test
When Symptomatic?
- Is there “added value” in completing neurocognitive
testing during symptomatic phase of recovery?
- What is prognostic value of doing testing?
- What is sensitivity/specificity of subacute
testing in predicting protracted recovery?
VAL I D | R E L I AB L E | S AF
ImPACT yields summary
composite scores for:
- Verbal Memory
- Visual Memory
- Reaction Time
- Visual Motor Speed
ImPACT
Summary Scores
VAL I D | R E L I AB L E | S AF
Iverson G. CJSM; 2008
Predicting Simple versus Complex Concussion
At three days post-injury, if athlete exhibit three or more RCI
changes on ImPACT composite scores (relative to baseline),
there is a 94% chance that recovery will require >10 days.
Exhibiting a high symptom score did not improve classification
accuracy over neurocognitive test scores in isolation.
Athletes with prior history of concussion were not statistically more
likely to have “protracted” recovery from concussion.
VAL I D | R E L I AB L E | S AF
Predicting Outcomes Following Sports
Concussion: Evidence Summary
- Neurocognitive and symptom evaluation during symptomatic phase of
recovery “adds value” in prognosis and determining severity of injury
- Migraine symptom cluster and ImPACT cognitive composite scores most
predictive of outcome
- Migraine= headache, photo/phonophobia, dizziness, nausea, vomiting, vision
- ImPACT= Reaction Time, Verbal Memory, Visual Memory
- Testing while symptomatic allows for understanding of severity of injury,
prognosis of outcome, considerations for academic accommodations,
and consideration of physical exertion recommendations
Lau B, Collins MW, Lovell M. American J Sports Med, In Press
VAL I D | R E L I AB L E | S AF
Exam Type
To the Right Highlighted in Red
are the Verbal Memory
Composite components.
Average:
Word Memory – Total Percent Correct
Symbol Match – (Total correct/Hidden)/9*100
Three Letters – Percent Total Letters Correct
C o p yr i g h t © 2 0 1 1
Baseline
Date Tested
9/21/2004
Word Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
WG = 1
12
12
100%
11
8
79%
90%
Design Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
8
9
71%
9
9
75%
73%
X's and O's
Total correct (memory)
Total correct (interference)
Avg. correct RT (interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
8
115
0.45
7
0.37
Symbol Match
Total correct (visible)
Avg. correct RT (visible)
Total correct (hidden)
Avg. correct RT (hidden)
27
1.19
8
1.06
Color Match
Total correct
Avg. correct RT
Total commissions
Avg commissions RT
9
0.78
1
0.57
Three Letters
Total sequence correct
5
Total letters correct
15
Pct. Of total letters correct
100%
Avg. time to first click
1.95
Avg. counted
VAL I D | R E L I21.2
AB L E
Avg. counted correctly
21
| S AF
Exam Type
To the right, highlighted in
Green are the Visual Memory
Composite components.
Average of:
(Design Memory- Total Percent Correct)
(X’s and O’s- Total Correct/Memory)/12
C o p yr i g h t © 2 0 1 1
Baseline
Date Tested
9/21/2004
Word Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
WG = 1
12
12
100%
11
8
79%
90%
Design Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
8
9
71%
9
9
75%
73%
X's and O's
Total correct (memory)
Total correct (interference)
Avg. correct RT
(interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
8
115
0.45
7
0.37
Symbol Match
Total correct (visible)
Avg. correct RT (visible)
Total correct (hidden)
Avg. correct RT (hidden)
27
1.19
8
1.06
Color Match
Total correct
Avg. correct RT
Total commissions
Avg commissions RT
9
0.78
1
0.57
Three Letters
Total sequence correct
5
Total letters correct
15
Pct. Of total letters correct
100%
Avg. time
to first
VAL
I Dclick| R E L I1.95
AB L E
Avg. counted
21.2
| S AF
Exam Type
To the right, highlighted in Blue are
the Visual-Motor Speed Composite
components.
Average of:
(X’s and O’s- Total Correct/Interference) /4
(Three Letters-Average Counted Correctly) X 3
C o p yr i g h t © 2 0 1 1
Baseline
Date Tested
9/21/2004
Word Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
WG = 1
12
12
100%
11
8
79%
90%
Design Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
8
9
71%
9
9
75%
73%
X's and O's
Total correct (memory)
Total correct (interference)
Avg. correct RT
(interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
8
115
0.45
7
0.37
Symbol Match
Total correct (visible)
Avg. correct RT (visible)
Total correct (hidden)
Avg. correct RT (hidden)
27
1.19
8
1.06
Color Match
Total correct
Avg. correct RT
Total commissions
Avg commissions RT
9
0.78
1
0.57
Three Letters
Total sequence correct
5
Total letters correct
15
Pct. Of total letters correct
100%
Avg. time to first click
1.95
VAL I D | R E L I AB
Avg. counted
21.2L E
| S AF
Exam Type
To the right, highlighted in Brown
are the Reaction Time
components.
Average of:
X’s and O’s - Average Correct RT Interference
(Symbol Match - Average Correct RT/Visible)/ 3
Color Match - Average Correct Reaction Time
C o p yr i g h t © 2 0 1 1
Baseline
Date Tested
9/21/2004
Word Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
WG = 1
12
12
100%
11
8
79%
90%
Design Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
8
9
71%
9
9
75%
73%
X's and O's
Total correct (memory)
Total correct (interference)
Avg. correct RT
(interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
8
115
0.45
7
0.37
Symbol Match
Total correct (visible)
Avg. correct RT (visible)
Total correct (hidden)
Avg. correct RT (hidden)
27
1.19
8
1.06
Color Match
Total correct
Avg. correct RT
Total commissions
Avg commissions RT
9
0.78
1
0.57
Three Letters
Total sequence correct
5
Total letters correct
15
Pct. Of total letters correct
100%
Avg. time
to first
VAL
I Dclick| R E L I1.95
AB L E
Avg. counted
21.2
| S AF
Exam Type
To the right, highlighted in purple
are the Impulse Control Composite
components.
Total of:
X’s and O’s - Total Incorrect/Interference
Color Match- Total Commissions
C o p yr i g h t © 2 0 1 1
Baseline
Date Tested
9/21/2004
Word Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
WG = 1
12
12
100%
11
8
79%
90%
Design Memory
Hits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory pct. Correct
Total percent correct
8
9
71%
9
9
75%
73%
X's and O's
Total correct (memory)
Total correct (interference)
Avg. correct RT
(interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
8
115
0.45
7
0.37
Symbol Match
Total correct (visible)
Avg. correct RT (visible)
Total correct (hidden)
Avg. correct RT (hidden)
27
1.19
8
1.06
Color Match
Total correct
Avg. correct RT
Total commissions
Avg commissions RT
9
0.78
1
0.57
Three Letters
Total sequence correct
5
Total letters correct
15
Pct. Of total
letters
VAL
I D correct
| R E L I100%
AB L E
Avg. time to first click
1.95
| S AF
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.
“I just got an email from one of my athletic
trainers. Apparently, an athlete went to a
pediatric neurologist with an ImPACT report.
The doc took one look at it with the cognitive
efficiency index and said that the kid was
‘mentally retarded’ and said that he was going
to hold him out longer because of that.”