ImPACT Quick Test Interpretation Doran Final · Speaker Biography • Pediatric neuropsychologist...

ImPACT Quick Test InterpretationPresenter: Anthony Doran, Psy.D.

NeuropsychologistHeadFirst Sports Injury and Concussion CareRighttime Medical Care

ConcussionManagement.com Copyright 2018. ImPACT Applications, Inc. All rights reserved.

• The statements and opinions contained in this program are solely those of the presenter.

• Treatment options and tools presented are some of many that are available.

• All individuals in control of content disclosed no relevant financial relationships.

• Other CE disclosures can be found in your course information document.

Disclosure Statements


Learn how to interpret ImPACT Quick Test, a screening tool to assist healthcare providers in making removal from activity decisions. This course overviews how to use the ImPACT Quick Test data with other tools to make return to activity decisions at a competition site, workplace, or point of care.

Course Objectives: At the end of the course, attendees will be able to:• Restate how to administer ImPACT Quick Test post-concussion• Identify how to use ImPACT Quick Test to help make removal from

activity decisions

Course Description


Speaker Biography

• Pediatric neuropsychologist

• Assessment approach utilizes concussion management software technology and developmental neuropsychological approach to head injury management

• Over 20 years of experience in psychological assessment

• Post-doctoral training in pediatric neuropsychology at Harvard Medical School

• Received doctorate or psychology from University of Hartford

• Taught multiply psychology classes at the US Naval Academy and Johns Hopkins University

• Served as subject matter expert and consultant for Military and Law Enforcement Commanders

Tony Doran, PsyDProgram DirectorRighttime’s HeadFirst Sports Injury and Concussion Care


Introduction

Overview• Administration and scoring of the ImPACT Quick Test

• Development and standardization• Statistical properties of ImPACT Quick Test

• Case Examples


What is ImPACT Quick Test?

• Clinically valid, reliable, useful• A tool• Rapid use and results


ImPACT Quick Test is Not:

• A stand-alone assessment

• Effective if the clinician is untrained

• A substitute for thorough medical evaluation

ConcussionManagement.com

ImPACT Quick Test


Evolving Definition of Concussion

A concussion (or mild traumatic brain injury) is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. Disturbance of brain function is related to neurometabolicdysfunction, rather than structural brain injury, and is typically associated with normal structural imaging findings (CT Scan, MRI). Concussion may or may not involve a loss of consciousness. Concussion results in a constellation of physical, cognitive, emotional, and sleep-related symptoms. Recovery is a sequential process and symptoms may last from several minutes to days, weeks, months, or even longer in some cases.”


Rationale for the Development of The ImPACT Quick Test

• Ease of administration

• Reliable and valid

• Provide information regarding neurocognitive functioning

• Brief computerized measure of• Memory• Attention• Reaction time


Appropriate Use

• After a suspected mTBI

• Ages 12 - 70

• Compared to normative data

• Doesn’t provide diagnosis

• Doesn’t provide status


Environment

• Disable inactivity lock

• Adjust screen brightness• Disable alerts and notifications• Sound should be turned on

• The testing environment should be quiet and free of noise• All cell phones, music players and other devices should be turned off

• The WI-FI connection for the device should be turned off


ImPACT Quick Test Login

Go to the login screen through the ImPACT Toolkit app on the iPad


Select Start a New Test


Select Desired Test


Demographic Information


Review Instructions

Review the “Basic Test Instructions”

Familiarize yourself with these instructions prior to administering any tests


Observed Signs


Reported Symptoms


ImPACT Quick Test Begins

• Read or paraphrase the instructions to the patient

• The ImPACT QT will go through 3 brief tests• Symbol/number matching; the patient’s task is to recall what numbers go with what symbols

• Letter recall and counting backwards from 25 for speed

• Tracking task – tapping a circle every time it turns green

• These tasks will take 5-8 mins depending on the speed of the patient


Symbol Match – Speed and Memory Test

• Test taker needs to quickly identify what number and symbol go together

• Reaction times are recorded

• The memory phase of the assessment involves recalling what numbers and symbols go together


Three Letter Memory – Memory Subtest

• Clients are shown 3 letters

• Count backwards from 25

• Then recall the 3 letter


Three Letter Memory – Speed Subtest

• Patient counts backward from 25

• Reaction time is recalled


Reaction Time and Sustained Attention Test


Additional Tests

ImPACT Quick Test now permits clinicians to enter the BESS and VOMS scores for patients.


Guiding Accommodations / Management• Brain Rest

• Diagnosis• mTBI• Head Trauma

• Return-to-Learn


Case Reviews:

Benefit of ImPACT Quick Test in Physician Offices and Urgent Cares


Case Example 1

Patient: 14 yr old male; right handed

MOI: fell playing basketball; legs knocked out from under him

LOI: mid- occipital region; no LOC; no amnesia

Symptoms: confused; disoriented; walked to the other bench and wrong side of the court; immediate pressure; throbbing HA


Case Example 1

Medical Hx: unremarkable; No Meds; NKDA

Developmental Hx: WNL; reached all developmental milestones on time; no other mTBI or significant head trauma identified during formative years; no history of complicating factors


Case Example 1

Seen 5 hours after injury in Urgent Care

ACE: 8

BESS: 1

VOMS: WNL/ convergence – 4cm


Case Example 1

ImPACT Quick Test• Attention tracking – 10th

• Motor speed – 1st

• Memory – 50th

Later that Week: ImPACT• Verbal - 100th

• Visual – 77th

• Visual-Motor – 68th


Case Example 2

Patient: 16 yr old female; right handed

MOI: thrown from horse at a gallop; estimated 25-30mph; head stuck ground

Patient taken by EMS to local hospital imaging of brain and cervical spine are WNL

LOI: mid- occipital region; LOC – 30 seconds; amnesia – about 5 mins

Symptoms: confused; disoriented; confused; memory problems; repeating same questions


Case Example 2

Medical Hx: unremarkable; No Meds; NKDA

Developmental Hx: WNL; reached all developmental milestones on time; no other mTBI or significant head trauma identified during formative years;

Complicating factors: History of motion sickness


Case Example 2

Seen next day

ACE: 10

BESS: 6

VOMS: +/convergence – 13cm


Case Example 2

ImPACT Quick Test• Attention tracking – 1st

• Motor speed – 1st

• Memory – 50th

Later That Week: ImPACT• Verbal - 58th

• Visual – 33rd

• Visual-Motor – 1st


Righttime Urgent Care/ HeadFirstConcussion Care

• Seen 75,000 mTBI visits since 2011

• Last 2 years looked at 14,500 consecutive mTBI patients

• Sent 947 for CT scans

• 6 positive scans

• Clinicians knew they were going to be positive

• History, Exam, and ImPACT help clinicians make good decisions and feel confident in their decision


Questions


Question

Have you used ImPACT Quick Test for patients with LD/ADHD? Any difference in average scores?


Question

How do you treat a patient who is underreporting their symptoms? Do you show them the ImPACT Quick Test data?


Question

Have you noticed a correlation between particular symptoms and any specific deficits on ImPACT Quick Test?


Question

How far apart would you generally conduct ImPACT Quick Test vs ImPACT?


Question

When do you refer out for vestibular and vision therapy?

ImPACT Quick Test Interpretation Doran Final · Speaker Biography • Pediatric neuropsychologist...

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