ImPACT Administration and Interpretation Guidelines for Baseline Testing Melissa N. Womble, M.S....

ImPACT Administration and Interpretation

Guidelines for Baseline Testing

Melissa N. Womble, M.S.Psychology Intern HFHS

University of South Alabama

Brad Merker, Ph.D.Co-Director Sports Concussion Clinic

Sr. Staff Neuropsychologist HFHS

ImPACT Administration WHO CAN ADMINISTER THE TEST?

• Athletic Trainers• Physicians• Nurses• Neuropsychologists• Sports Medicine Clinicians• Psychologists• Coaches• Athletic Directors

ImPACT Administration

WHAT DO TEST ADMINISTRATORS NEED TO KNOW/DO TO PREPARE?

• Take the test

• Be familiar with the testing protocol

• Take the free “Getting Started with ImPACT” webinar

• No home based testing

• Although many people can administer the tests, a medical professional who is legally allowed to make the return to play decision must be the one who interprets the post injury test results.


WHO IS LEGALLY ALLOWED TO MAKE RETURN TO PLAY DECISIONS IN MICHIGAN?

• A health professional who is licensed or otherwise authorized to engage in a health profession and whose scope of practice within that health profession includes the recognition, treatment, and management of concussions. – Example: Neuropsychologists, Physicians with a MD degree

Michigan Sports Concussion Law – Michigan Department of Community Health Website


HOW OFTEN IS BASELINE TESTING NEEDED?

• ImPACT suggests that: – Athletes should be tested every two years from 6th to 12th grade. – Collegiate athletes should only be tested once. – Professional athletes should only be tested once.

WHO CAN TAKE IMPACT?

• Anyone between the ages of 10 to 59.


SIGNING ON TO IMPACT


SIGNING ON TO IMPACT

For first time test takers you would select Launch Baseline Test

For previously tested individuals you will type the first part of their last name in the box, select their name and then press launch Baseline Test.


COMPUTER REQUIREMENTS


COMPUTER LAB TESTING


RECOMMENDATIONS FOR TESTING SESSIONS


WHAT ARE SOME IMPORTANT CONSIDERATIONS DURING TESTING?

If possible…– Sit athletes at every other computer (not directly next to or across from one another)

– Randomly assign athletes to a computer

– Have athletes wear headphones to reduce extraneous noise

– Have multiple administrators in the room

– Reduce and control distractions in the testing environment

– Give clear group instructions and rules

– Ensure athletes are not fatigued while testing

– Identify and remove any athletes who are disruptive

– Encourage good effort

Moser, Schatz, Neidzwski, & Ott (2011)


WHY ARE THESE TYPE OF CONSIDERATIONS IMPORTANT?

• Administering baseline neurocognitive testing to athletes in a group setting may introduce extraneous error, negatively affecting test performance.

• The type of tests being administered are affected by distractions while testing.– Consequently can impact the validity and reliability of the test.

• Neurocognitive testing, historically, is meant to take place in a quiet, standardized, individualized setting.

• Post-Injury testing is likely to occur in an individual setting.Moser, Schatz, Neidzwski, & Ott (2011)


TAKE HOME MESSAGE

Since the purpose of baseline testing is for comparison with postconcussion results, we must ensure we are capturing the athlete’s best and most consistent testing performance both

before and after a concussion.

Moser, Schatz, Neidzwski, & Ott (2011)

Standardization and control of the test environment is extremely important during baseline testing to ensure the data is as reliable

(and useful) as possible.

PURPOSE OF BASELINE TESTING


COMMON ERRORS/FIXES

ImPACT Interpretation

WHAT DOES IT MEAN IF A TEST IS “INVALID”?Invalid Testing• The examinee did not put

forth appropriate effort on the test administered

• The examinee may have mislead the examiner through inaccurate responses or effort

• Examinee may have intentionally or unintentionally produced false scores/reported false symptoms

Invalid Tests are Marked with ** on the Organization Report Page


WHAT COULD BE THE CAUSE OF “INVALID” TEST SCORES?

• Failure to properly read directions due to a reading disability or carelessness

• Attention deficit disorder and/or hyperactivity (ADD or ADHD)

• Excessive fatigue (e.g. completion of testing after vigorous exercise)

• “Horseplay”– Often occurs when athletes are not

properly supervised/are placed too close together in a room.

• Left-right confusion.– Often is evidenced by scores of apx. 20 on

the Impulse Control composite and is usually the result of the reversal of left and right on the X’s and O’s distracter task

• “Sandbagging” or poor performance to attempt to set a low baseline standard.


WHAT IS “SANDBAGGING”?• When an athlete intentionally performs poorly to establish a low baseline-

thus making it easier to exceed this level of performance following a concussion.

HOW CAN I IDENTIFY POTENTIAL “SANDBAGGING”?

• “Sandbagging” is usually evident in:– Reaction Time Composite scores that are in the .80 to 1.5 second range.

• Baseline scores in this range produced by an otherwise healthy athlete with no history of learning disabilities are very rare and generally fall below the fifth percentile.

• If a score in this range is produced, the athlete should be asked whether he/she had any difficulty in taking the test (e.g. sticking mouse, failure to understand directions).

– Verbal Memory Composite scores that fall below 70% correct.

– Visual Memory Composite scores that fall below 60% correct.

• Scores in this range following a concussion are not unusual and should be taken seriously.


HOW CAN I HELP REDUCE “INVALID” TEST SCORES?

• Each athlete should be cautioned that he or she may be asked to repeat the baseline evaluation if they are felt to not be extending maximum effort.

• Following the completion of each season’s baseline evaluation, the test administrator should review all scores in an attempt to identify athletes who did not extend good effort or who performed idiosyncratically on testing.

• Since ImPACT is highly sensitive to neurocognitive processes such as attention, memory and processing speed, athletes with a history of learning disabilities and/or attention disabilities should be evaluated using normative data gathered on these specific groups.


WHAT ARE THE IMPACT INVALIDITY INDICATORS?

ImPACT provides a validity index designed to aid in identifying invalid baseline examinations. This index is based on the following algorithm:

If any of these criteriaare reached, the

ImPACT report will automatically print a

sentence that identifies the test results as being

of questionable validity.

Impulse Control Composite > 30


WHAT ARE THE IMPACT INVALIDITY INDICATORS?

• ImPACT was designed specifically to simultaneously measure both speed and accuracy of responding. – Some athletes may attempt to increase accuracy by taking a slower and

more deliberate approach to the test. – Other athletes may attempt to increase their speed without regard for

accuracy.

• CEI is an index of the “tradeoff” between speed and accuracy on the Symbol Match subtest.

Extremely low scores (0 to .20) may in some cases suggest a very poor performance on this subtest.


WHAT SHOULD YOU DO IF A TEST IS “INVALID”?

• Discuss the test results with the athlete privately.– Identify possible

reasons– Examples: Difficulty

understanding one or more of the modules, not taking the test seriously, etc.

• Repeat the baseline exam.


ACCESSING TEST RESULTS


FROM TEST LOOK UP…


FROM ORGANIZATION REPORT…

Reviewing Baseline Performance

• Each administration is located in a different column.

• Raw composite scores are located on the left side of the column.

• Percentile score for the composite measures are located on the right side of the column.

• Explanation of CEI

• Can only have RCI issues when you have multiple assessments being compared

• Shows hours slept last night and medication information


• Probably most helpful to look at the percentiles to determine if the baseline performance is where you might expect it to be.


WHAT ARE PERCENTILES AND PERCENTILE RANGES?

Percentile Scores• The raw score is converted to a number

indicating the percentage of the norm group who scored below you. – Example: A score at the 60th percentile

means that the individual's score is the same as or higher than the scores of 60% of those who took the test.

• Percentiles have the disadvantage that they are not equal units of measurement. – Example: A difference of 5 percentile points

between two individual’s scores will have a different meaning depending on its position on the percentile scale, as the scale tends to exaggerate differences near the mean and collapse differences at the extremes.

ImPACT Interpretation FURTHER UNDERSTANDING OF PERCENTILES AND

INTERPRETATION

Impaired Poor L. Avg H. Avg Superior Very Superior

Average


CASE AN:• Notice all the red in the Post-

Injury administrations?

• This means at Post-Injury Time 1 and Time 2 her scores were significantly different than we would have expected based on her baseline scores.

• Reliable Change Index: Statistic used to understand whether a change in an individual’s score (e.g. after a concussion, between baseline assessments) is statistically significant or not (based on how reliable the measure is).


CASE AN:You can consult the

interpretation guide to see which scores may be leading to composite scores exceeding the

RCI

• Memory Composite (Visual)– Total % Correct (Design Memory)– Total Correct (X’s/O’s)

• Visual Motor Speed Composite– Total # Correct (X’s/O’s)– Average Counted Correctly (3

Letters)

• Reaction Time Composite– Average Correct RT (X’s/O’s)– Average Correct RT (Sym. Match)– Average Correct RT (Color Match)


CASE TW:Tells you that the test may

be invalid


CASE TW:TIME TO IDENTIFY WHICH SCORES MAY BE INVALID…

CHEAT SHEET



CASE MT:Another example of possible

invalidity

CHEAT SHEET



CASE MT:TIME TO IDENTIFY WHICH SCORES

MAY BE INVALID…

CHEAT SHEET

c


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ImPACT Administration and Interpretation Guidelines for Baseline Testing Melissa N. Womble, M.S....

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