Window 1: ImPACT Test – Brain Function and Concussion Management

Written By: David Burns

ImPACT Testing and Concussion Management 

 

The following is an adaptation from a presentation by Micky Collins, Ph.D., Management of Sports Concussion and The ImPACT Program. The following information is intended to help those who have taken the ImPACT test understand how the composite scores are derived. It is not intended to be used as a substitute for a medical evaluation or treatment.

This blog and the other blog “windows” into brain function are not intended for anybody to make any diagnosis or determine treatment for anybody. It is simply intended to help patients understand what a functional approach to neurology, brain function, concussion management, sports performance evaluation may entail. But most importantly, to help the patient or client communicate with the provider so that they or their children can achieve the best brain health possible. Achieving optimal brain health is an interdependent process, an active process that starts with communication. 

 

ACUTE MANAGEMENT:

  • Rule out more serious intracranial pathology: CT, MRI, neurologic examination primary diagnostic tests

POST INJURY MANAGEMENT:

  • Prevent against Second Impact Syndrome
  • Prevent against cumulative effects of injury
  • Prevent presence of Post-Concussion Syndrome

ImPACT neurocognitive testing is a great tool for concussion management. It is a tool that gives us a “window” to the level of function of various areas of brain. Like any test it assesses some areas of brain but not all. As a component of acomprehensive evaluation, it provides one great window to brain performance.


  1. IS a useful and reliable/valid concussion management program.
  2. IS a tool to help determine recovery from injury.
  3. IS a tool to help manage concussion (e.g. return to exertion, return to academics, return to play).
  4. IS a tool to help communicate post-concussion status to coaches, parents, clinicians.
  5. IS NOT a substitute for medical evaluation / treatment

 

Sensitivity and Specificity of ImPACT:

  • Positive Predictive Value (90%) – (Probability that that a concussion is present when test is positive)
  • Negative Predictive Value (82%) – (Probability that a concussion is not present when test is negative)

 

“Testing reveals cognitive deficits in asymptomatic

athletes within 4 days post-concussion.”

 

How Is Verbal Memory Composite Is Scored?

Average of:

Word Memory – Total Percent Correct = X

Symbol Match – Total correct (Hidden) / 9 * 100 = Y

Three Letters – Percent Total Letters Correct = Z

X + Y + Z / 3 = Verbal Memory Composite Score

 

How Is Visual Memory Calculated?

Average of:

Design Memory – Total Percent Correct = X

X’s and O’s – Total Correct (Memory) / 12 = Y

X + Y / 2 = Visual Memory Composite Score

How Is Visual-Motor Speed (Processing Speed) Calculated? 

Average of:

X’s and O’s- Total Correct / Interference) / 4  = X

Three Letters-Average Counted Correctly X 3 = Y

X + Y / 2 = Visual-Motor Composite Score 

 

How Is Reaction Time Calculated?

Average of:

X’s and O’s – Average Correct RT (Interference) = X

Symbol Match – Average Correct RT (Visible) / 3 = Y

Color Match – Average Correct Reaction Time = Z

X + Y + Z / 3 = Reaction Time Composite Score

 

How is Impulse Control Calculated?

Total of:

X’s and O’s – Total Incorrect (Interference) = X

Color Match – Total Commissions = Y

X + Y = Impulse Control Score

 

ImPACT Word Memory – Perfect and Optimal Score Sheet

Perfect

Optimal

Word Memory
Hits (immediate)

12

11-12

Correct Distracters  (immed.)

12

11-12

Learning Percent Correct

100%

90%

Hits (delay)

12

11-12

Correct Distracters  (delay)

12

11-12

Delayed Memory Pct Correct

100%

90%

Total Percent Correct

100%

90%

 

ImPACT Design Memory – Perfect and Optimal Score Sheet

 

Perfect

Optimal

Design Memory
Hits (immediate)

12

9-12

Correct Distracters (immed.)

12

9-12

Learning Percent Correct

100%

80%

Hits (delay)

12

9-12

Correct Distracters  (delay)

12

9-12

Delayed Memory Pct Correct

100%

80%

Total Percent Correct

100%

90%

ImPACT  X and O’s – Perfect and Optimal Score Sheet

Perfect

Optimal

X and O’s
Total Correct (memory)

12

9-12

Total Correct (interference)

NA

120+

Avg. Correct RT (interference)

NA

< 0.50

Total Incorrect (interference)

0

0-10

Avg. Incorrect RT (interference)

NA

< 0.50

ImPACT Color Match – Perfect and Optimal Score Sheet

Perfect

Optimal

Color Match
Total Correct

9

8-9

Avg. Correct RT

NA

< 0.75

Total Commissions

0

0-1

Avg. Commissions RT

NA

NA

ImPACT Three Letters – Perfect and Optimal Score Sheet

Perfect

Optimal

Three Letters
Total Sequence Correct

5

4-5

Total Letters Correct

15

14-15

Pct of Total Letters Correct

100%

95%

Avg Time to First Click

NA

NA

Avg Counted

25.0

> 15.0

Avg Counted Correctly

25.0

> 15.0

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