Interpreting Change on ImPACT Following Sport Concussion

Iverson, Grant L.; Lovell, Mark R.; Collins, Michael W.

doi:10.1076/clin.17.4.460.27934

Cited by 451 publications

(356 citation statements)

References 30 publications

Supporting

Mentioning

338

Contrasting

Unclassified

Order By: Relevance

“…In a study of concussed high school and college athletes, verbal memory measured with the ImPACT has been shown to decrease after a single season of football. 59 In our study, the correlation between diminished verbal memory score and number of abnormal DTI voxels was found in athletes without clinically diagnosed concussion. The cognitive data further support our imaging findings that cumulative head impacts from a season of high school varsity football can produce changes in the brain, even in the absence of clinically diagnosed concussion.…”

Section: Discussionmentioning

confidence: 74%

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Whitlow

Urban

et al. 2014

Journal of Neurotrauma

195

155

View full text Add to dashboard Cite

The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITSÔ) during all practices and games. All players received pre-and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWE Linear ), rotational (RWE Rotational ), and combined components (RWE CP ), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, C L , C P , and C S , respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N = 24). Regression analysis revealed a statistically significant linear relationship between RWE CP and FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWE CP and RWE Linear ) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

show abstract

Section: Discussionmentioning

confidence: 74%

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Whitlow

Urban

et al. 2014

Journal of Neurotrauma

195

155

View full text Add to dashboard Cite

show abstract

“…28 For the computerized neurocognitive assessment, we were powered to detect minimal clinically significant differences (a difference of 9% in Verbal Memory, 17% in Visual Memory, 15% in Reaction Time, and 14% in Processing Speed). 23 …”

Section: Calculation Of Sample Sizementioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

View full text Add to dashboard Cite

OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P , .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P , .03) and slower symptom resolution.CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest. WHAT'S KNOWN ON THIS SUBJECT:Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion. WHAT THIS STUDY ADDS:Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1-2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. Dr Thomas developed the study concept and design, obtained funding, supervised the study, acquired data, analyzed and interpreted data, and drafted and revised the manuscript; Dr Apps assisted with study concept and design, supervised the study, provided technical support, analyzed and interpreted data, and critically revised the manuscript; Dr Hoffmann assisted with study design, analyzed data, provided statistical expertise, and critically revised the manuscript; Dr McCrea assisted with study design, analyzed and interpreted data, provided technical support, and critically revised the manuscript; Dr Hammeke assisted with study concept and ...

show abstract

“…15,16 The ImPACT yields 5 quantitative composite scores: verbal memory, visual memory, visual motor speed, composite reaction time, and composite impulse control. Researchers 15,17,18 have supported ImPACT as a valid measure for neurocognitive deficits after sport-related concussion, especially when compared with a baseline. Although ImPACT is a valid construct for concussion assessment and yields high sensitivity (91.4%), specificity has been only moderate (69.4%).…”

Section: Neuropsychological Battery: Impactmentioning

confidence: 99%

“…4,6,8,15 The instrument contains 3 domains of concussion assessment (demographics, symptoms, and neuropsychological testing) with 6 measures that yield 5 quantitative composite scores: verbal memory, visual memory, visual-motor speed (processing speed), reaction time, and impulse control. 15,16 The ImPACT yields 5 quantitative composite scores: verbal memory, visual memory, visual motor speed, composite reaction time, and composite impulse control. Researchers 15,17,18 have supported ImPACT as a valid measure for neurocognitive deficits after sport-related concussion, especially when compared with a baseline.…”

Section: Neuropsychological Battery: Impactmentioning

confidence: 99%

An Examination of Adolescent Athletes and Nonathletes on Baseline Neuropsychological Test Scores

Tomczyk

Mormile

Wittenberg

et al. 2018

Journal of Athletic Training

View full text Add to dashboard Cite

Context: An estimated 15.3 million adolescent students are enrolled in US high schools, with approximately 7.8 million participating in athletics. Researchers have examined various demographics in high school athletes; however, athletic participation may play a larger role in test performance than previously thought. Currently, investigations of concussion assessment may rely on uninjured athletes as controls. However, due to the intense nature of athletics, this may not be an appropriate practice. Objective: To examine differences between athletes and nonathletes using a common computerized neuropsychological test. Design: Retrospective cross-sectional study. Setting: High schools from a school district in Columbus, Ohio. Patients or Other Participants: A total of 662 adolescent high school students (athletes: n = 383, female n = 18; nonathletes: n = 279, female n = 193). Main Outcome Measure(s): Participants were administered a computerized neuropsychological test battery (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) during baseline concussion assessment. Differences between groups were established for output composite scores. Results: Differences were found between athletes and nonathletes in composite reaction time (F1,522 = 14.855, P < .001) and total symptom score (F1,427 = 33.770, P < .001). Nonathletes reported more symptoms, whereas athletes had faster reaction times. No differences were present in composite verbal memory, composite visual memory, composite visual motor speed, or composite impulse control (P > .05). Conclusions: Symptom reporting and reaction time differed between high school athletes and nonathletes. Participation in extracurricular activities may lead to cognitive differences in adolescents that can influence performance on the Immediate Post-Concussion Assessment and Cognitive Test battery. Researchers should account for these differences in baseline performance when making concussion diagnostic and management decisions.

show abstract

Interpreting Change on ImPACT Following Sport Concussion

Cited by 451 publications

References 30 publications

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

An Examination of Adolescent Athletes and Nonathletes on Baseline Neuropsychological Test Scores

Contact Info

Product

Resources

About