The Athletic Trainer s Guide to ImPACT Testing Basic Understanding of Testing Environments & Composite Scores

Transcription

1 The Athletic Trainer s Guide to ImPACT Testing Basic Understanding of Testing Environments & Composite Scores. Janna Fonseca MEd, LAT, ATC Head Athletic Trainer Carolina Family Practice & Sports Medicine ImPACT CIC All rights reserved. No part of this publication maybe reproduced in whole or in part or transmitted in any form or by any means without the prior written permission of ImPACT Applications, Inc. For information regarding permission, please write to ImPACT Applications, Inc., copyright@impacttest.com ImPACT and associated logos are trademarks of ImPACT Applications, Inc.

2 ImPACT and the ImPACT Logo are trademarks of ImPACT Applications, Inc. and are used herein with the express written permission of ImPACT Applications, Inc. and may not be duplicated, removed or altered without ImPACT Applications, Inc. s written consent. The ImPACT Applications, Inc. software is a tool that provides basic data related to neurocognitive functioning. The software does not provide treatment recommendations or a specific medical diagnosis with respect to any particular end user. Training provided or facilitated by ImPACT Applications, Inc. on the use of its software is intended to provide users with the ability to properly administer the tests embedded in the software and to become familiar with the types of data generated by the software. Treatment decisions that you and/or your organization make based on the data generated by the software is in you and/or your organization s sole and absolute discretion. By participating in the training, you and your organization acknowledge and agree that ImPACT Applications, Inc., its officers, directors, employees, or agents and affiliates and their respective successors and assigns will not be held liable for claims of medical malpractice, practicing medicine without a license or similar claims made by you, your organization or any third party. To the fullest extent permitted by applicable law, you and your organization agree to hold ImPACT Applications, Inc., its officers, directors, employees, agents, and affiliates and their respective successors and assigns harmless and to indemnify ImPACT Applications Inc. and its officers, directors, employees, agents, and affiliates and their respective successors and assigns against any and all such claims.

3 Webinar Goals Tips for successful baseline testing Guidelines for post-injury testing Reviewing the clinical report Raw scores Composite scores Reliable Change Index What ImPACT is A clinically useful, reliable, and valid concussion management program A tool to help determine recovery from injury to help manage concussion (e.g. return to academics, return to exertion, return to play) to communicate post-concussion status to athletes, coaches, parents, clinicians

4 What ImPACT is NOT A stand-alone assessment program Effective if the clinician is naïve to specifics and complexities of data A substitute for thorough medical evaluation, treatment, or more extensive neuropsychological testing The role of the Athletic Trainer in Concussion Management Why is your role so important? Knowledge base Desire to stay up-to-date on developments in sports medicine Integral part of the team RELATIONSHIPS Student-athletes, patients, coaches, parents, healthcare providers/specialists

5 Successful baseline testing starts with A Good ENVIRONMENT Quiet Minimal traffic Minimal disruptions One empty workspace between each student-athlete linafamilypracticeandsportsmedicine customercenter

6 Successful baseline testing starts with The right PEOPLE supervising the testing process. You? Coaches? Administrators? Parents? Needs to be someone who has taken the test! Successful baseline testing starts with Giving the right INSTRUCTIONS Encourage student-athletes to be honest & give a good effort It s not an intelligence test! Sport & Health history It s okay to leave spots blank if he/she has not experienced a concussion Current Symptoms & Conditions Have them answer based on how they feel on a NORMAL day (take into consideration the last 24 hours)

7 Successful baseline testing starts with Reviewing the results Use the ImPACT Customer Center Site to generate a roster Check to ensure baseline tests were valid What do I do with invalid results? Review reasons for invalidity Word Memory Learning % Correct < 69% Design Memory Learning % Correct < 50% X s & O s Total Incorrect Interference >30 Impulse Control >30 Three Letters Total Letters Correct <9 Three Letters Average Counted Correctly <10

8 Sample Invalid #1 Invalid results, continued Review test with athlete Misunderstanding of instructions? Poor testing environment? Distractions? Incentive is different at baseline Administer a re-test

9 Post-Injury Testing Environment Supervision Give post-injury tests through the Customer Center site When should I give the first post-injury test? No hard and fast rule; done at providers discretion Within hours post-injury? Not until asymptomatic? Use post-injury testing to guide accommodations/changes in management: Returning to school? Increasing cognitive exertion? Beginning an exertional protocol? Returning to play? No more than two tests in a seven day period

10 Post-Injury Testing What if post-injury scores are better than baseline? Management becomes more conservative Consider final post-injury test new baseline Reviewing the Clinical Report

11 Page 1 Don t ignore the demographic page Some items to note: Diagnosis of ADD/ADHD Concussion history Headache/migraine history Skip to Page 3 Raw data Look at each module and then go back and see what makes up the composite scores

12 Instructions Scoring Word Memory What is a distractor? A word that was NOT shown in the original list Immediate vs. Delay Design Memory Instructions Scoring What is a distractor? A shape that has been rotated in any way Immediate vs. Delay

13 X s and O s Instructions Scoring Memory Interference the higher the better First subtest where reaction time is taken into consideration (the lower the better) Symbol Match Instructions Scoring Visible vs. Hidden Visible is when the key (symbols included) is still on the screen, hidden is when it is not

14 Color Match Instructions Scoring Color Blindness? Only affected if true achromatic color blindness Three Letters Instructions Scoring Average counted is how far into counting backwards from 25 Average counted correctly indicates accuracy

15 Composite Scores Clinical scales that determine if an athlete is neurocognitively intact Useful even if baseline scores are not available, especially when you know what kind of grades a student is getting PERCENTILE RANGES of Composite Scores Superior/Very Superior High Average Average Low Average Borderline Impaired 92 nd -99th 76 th 91st 25 th 75th 9 th 24th 2 nd 8th <1 st 2nd

16 With no baseline, each athlete must be compared to pre-injury estimates of functioning using educational/academic history: SAT/ACT score (percentile rank) GPA/Grades Learning Disability/Special Education? ESTIMATED percentile ranges of composite scores: A/B Student, High SAT score 65 th -75 th percentile or higher B/C Student, Average SAT score 35 th -40 th percentile or higher D/F student, low SAT score, LD 20 th percentile or higher IMPORTANT to understand symptoms & cognitive data in combination

17 Verbal Memory Composite Average of the following scores: Word Memory: Total Percent Correct Symbol Match: (Total Correct Hidden/9)*100 Three Letters: Percent Total Letters Correct Webinar Sample Visual Memory Composite Average of the following scores: Design Memory: Total Percent Correct X s & O s: (Total Correct Memory/12)*100 Webinar Sample

18 Visual Motor Speed Composite (Processing Speed) Average of the following scores: X s & O s: (Total Correct Interference)/4 Three Letters : (Average Counted Correctly)*3 Webinar Sample Reaction Time Composite Average of the following scores: X s & O s: Average Correct RT Interference Symbol Match: Average Correct RT Visible/3 Color Match: Average Correct RT Webinar Sample

19 Impulse Control Composite SUM of the following scores: X s & O s: Total Incorrect Interference Color Match: Total Commissions Functions as an invalidity check at baseline if score is 30 or greater Not a clinical scale Webinar Sample Cognitive Efficiency Index Not a clinical scale Provides insight vs. speed and accuracy in symbol match subtest ONLY

20 Page 4 Symptom Score Are symptoms consistent with what the athlete is telling you during your clinical evaluation? Good visual of how symptoms are improving, worsening, or staying consistent ImPACT Symptom Increase Score Page 5 Bars graphs of composite scores & symptom score No New Info Good visual demonstration of improvement or decline in scores

21 Reliable Change Index Scores Scores that appear in RED or BOLD on Page 2 Statistically calculated & based on a standard error of measurement Allow for wiggle room in the normal range of scores In the normal, non-concussed population, you would not exceed these levels of change 90% of the time Verbal Memory Composite Change greater than 8 points Visual Memory Composite Change greater than 13.5 points Visual Motor Speed Composite Change greater than 5.5 points Reaction Time Composite Change greater than 0.06 seconds

22 Common Error X s and O s Mixing up P & Q will result in switched scores between Total Correct & Total Incorrect Interference (INCORRECT will be very high) Contributes to decrease in Visual Motor Speed Composite Example Common Error Three Letters Counting forward from 1-25 (instead of backward) will result in abnormally low Average Counted Correctly (numbers should be pretty close, and average is 13-18). Contributes to decreased Visual Motor Speed Composite Example

23 Color Match Error Reaction Time Composite will look TOO GOOD 0.00 seconds for Average Correct Reaction Time in Color Match will result in abnormally low RT composite (less than 0.40 seconds) Throw out 0.00 and average the other two scores for a corrected Reaction Time Composite score Resources Coaches Parents Physicians Athletes

24 Questions? Thank you! The ImPACT Applications, Inc. software is a tool that provides basic data related to neurocognitive functioning. The software does not provide treatment recommendations or a specific medical diagnosis with respect to any particular end user. Training provided or facilitated by ImPACT Applications, Inc. on the use of its software is intended to provide users with the ability to properly administer the tests embedded in the software and to become familiar with the types of data generated by the software. Treatment decisions that you and/or your organization make based on the data generated by the software is in you and/or your organization s sole and absolute discretion. By participating in the training, you and your organization acknowledge and agree that ImPACT Applications, Inc., its officers, directors, employees, or agents and affiliates and their respective successors and assigns will not be held liable for claims of medical malpractice, practicing medicine without a license or similar claims made by you, your organization or any third party. To the fullest extent permitted by applicable law, you and your organization agree to hold ImPACT Applications, Inc., its officers, directors, employees, agents, and affiliates and their respective successors and assigns harmless and to indemnify ImPACT Applications Inc. and its officers, directors, employees, agents, and affiliates and their respective successors and assigns against any and all such claims.

25 All rights reserved. No part of this publication maybe reproduced in whole or in part or transmitted in any form or by any means without the prior written permission of ImPACT Applications, Inc. For information regarding permission, please write to ImPACT Applications, Inc., ImPACT and associated logos are trademarks of ImPACT Applications, Inc. ImPACT and the ImPACT Logo are trademarks of ImPACT Applications, Inc. and are used herein with the express written permission of ImPACT Applications, Inc. and may not be duplicated, removed or altered without ImPACT Applications, Inc. s written consent.