Post-Concussion Management
The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) is a computer-based neurocognitive battery. This test, comprising of visual memory tasks for shapes and words, reaction time, and basic executive function tasks, takes roughly 30-minutes to complete and is the most studied
computerized neurocognitive test on the market. ImPACT supplies tables of normative data for high school & college level athletes however it has not yet been validated in ages younger than 13 years old. As such, Complete Concussion Management only utilizes this test as a part of our comprehensive battery in athletes 13 years or older. A recent study found that comparison of concussed individuals to a pre-injury baseline test is superior to using age-adjusted normative data as normative comparisons identified fewer symptomatic, concussed athletes than baseline comparisons using reliable change indices (37).
ImPACT testing has come under scrutiny in recent years as many clinicians are using this test as the sole determination of both injury diagnosis and return-to-play decision-making. Numerous studies in recent years have found poor test-retest reliability (38,39) and low- to moderate effect sizes (40), which has lead researchers and experts to strongly oppose the use of ImPACT as a stand-alone measure for baseline and post-injury testing (13,41,42). These same statements suggest however that when used as a part of a comprehensive concussion evaluation, these tests can be quite useful in the overall concussion evaluation. ImPACT testing has been shown to demonstrate ongoing impairment in 25% of individuals who have been cleared to return-to-play following sports physician clearance based on examination and passing of baseline SCAT parameters (43). ImPACT test is therefore a useful test to include as part of a comprehensive concussion testing battery both at baseline and post-injury, but should not be used in isolation.
Two recent studies have also found that high-intensity physical exertion, completed prior to test administration effects neurocognitive function (11,12). As such, the current recommendation is to perform ImPACT tests following intensive physical exertion when making return-to-play clearance decisions, as this may be a more sensitive measure of ongoing cognitive deficits. In lieu of these studies, Complete Concussion Management Inc. performs our entire testing battery following the completion of the Chicago Blackhawks physical exertion test prior to making return-to-play clearance decisions. Athletes must remain symptom free throughout the duration of the Chicago Blackhawks test as well as complete ALL physical and cognitive measures (including ImPACT if 13 years or older) to a level at or above their pre-season baseline test results immediately following the Blackhawks test. If no baseline test is available, the clinician can compare results to age-adjusted normative data however this may result in less than optimal return-to-play decisions.
CCMI Baseline and Concussion Management Summary
Complete Concussion Management Inc. was developed from the necessity to provide high-risk athletes with evidence-based concussion management strategies. The concussion baseline testing protocol outlined above was developed through years of research to establish the most comprehensive testing battery to assess both acute injuries and the readiness to return to high-risk sporting activities. The period of brain vulnerability prior to full recovery from concussion injuries has been shown to result in long lasting and potentially permanent or fatal outcomes should an individual suffer another concussion during this time. It has been well established through the literature that symptoms alone do not reflect the true recovery of the brain, making it imperative that objective measures be incorporated into the decision making process. In addition to this, healthcare practitioners often face pressure from athletes and/or their parents to provide clearance because the symptoms have dissipated. Having rigorous objective testing parameters can relieve this pressure and provide the clinician with the needed evidence to hold an athlete back from an early return to competition.
As was demonstrated above, no single concussion test is adequate to be used in isolation for either diagnosis or return-to-play decision-making. The Complete Concussion Management protocol conducts the most extensive concussion baseline testing available and clearance of any athlete is not granted until there is a complete return to baseline of ALL preseason measures following the passing of all step-wise return-to-learn and return-to-play stages including a 2-step process of physical exertion testing.
Concussed patients, both with and without a baseline, can be referred to any of our 130+ partnered clinic locations in Canada by downloading our PDF referral pads here. Complete Concussion Management facilities also provide rehabilitation for chronic concussion symptoms (i.e., headaches, vestibular/visual problems, cognitive impairments, etc.). If you wish to receive a progress report on the referred patient, please indicate this on your referral.
