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Mild Head Injury Evaluation & Assessment

Lehigh University Sports Medicine

Mild Head Injury Evaluation and Assessment

NATA Position Statement: Management of Sport-Related Concussions

  • Baseline testing on assessment measures is recommended, but not necessary for reliability of tests.
    • Provides reliable pre-injury performance scores
    • Controls for extraneous variables
  • The use of objective assessment tools will assist in more accurately identifying deficits caused by injury and tracking post-injury recovery.
  • Return to participation must be an objective decision.  No one test or assessment tool should be used solely to determine recovery orreturn to participation.  Treat all student-athletes the same.
  • Brief Screening Tools
    • Graded Symptom Checklist (GSC) – Self Reported Symptoms
    • Standardized Assessment of Concussion (SAC) – Cognitive Function
    • Balance Error Scoring System (BESS) – Postural Instability
  • Neuropsychological Testing (ImPACT)
    • Neuropsychological testing should be used as an adjunct to the brief screening tools in providing more extensive and precise measures to evaluate recovery.
    • The ImPACT computerized test is often used as the sole assessment tool by Certified Athletic Trainers and Physicians to evaluate mild head injuries.  However, ImPACT should not be the only measure utilized for tracking and making return to participation decisions.
    • Individuals that administer the ImPACT test must be appropriately trained in standardized testing procedures.
    • Ideally, a Neuropsychologist or a Physician trained in interpreting results from ImPACT testing should be consulted.
    • Many Certified Athletic Trainers do not have the financial means of supporting the ImPACT system and/or do not have access to a Neuropsychologist or Physician trained in interpreting testing results.  In these cases, using only the brief screening tests is recommended.
  • Diagnostic Testing
    • CT and MRI are appropriate for ruling out hemorrhage, but have little significance with regard to mild head injuries.

Other Sources

  • A panel of experts, including Dr. Mark Lovell (developer of ImPACT), has recently recommended “neuropsychological testing should not be performed while the athlete is symptomatic because it adds nothing to return to play decisions, and it may contaminate the testing process by allowing practice effects to confound the results.”  (from NATA News, June 2006)
    • We deduct this statement was offered to address anecdotal reports that some student-athletes “pass” the ImPACT test while they are still symptomatic and other anecdotal reports that there is appears to be learning curve the more the test is taken.  (from LU Sports Medicine)
  • There have been no peer-reviewed papers reporting reliability or validity data on the ImPACT system.  (from “Is Neuropsychological Testing Useful in the Management of Sport-Related Concussion?”, Journal of Athletic Training. 2005;40(3):138-154)
    • No existing conventional or computerized neuropsychological test used for sport-related concussions have me all the criteria necessary to warrant routine clinical application.
    • Test-retest data from any of these instruments are difficult to interpret.  Any interpretation made must rely more heavily on clinical judgment rather than statistical/computerized algorithms.
    • Further research is necessary before neuropsychological testing is routinely used as a standard assessment tool in the management of sport-related concussions.

Anecdotal Reports from Colleagues at Other Institutions

  • There has been a learning curve observed with the ImPACT testing.
  • There have been symptomatic student-athletes who “pass” the ImPACT test.
  • There have been student-athletes who claim to be asymptomatic.  Only after “failing” the ImPACT test do they admit they were not being honest.
  • ImPACT test is computerized.  Anyone with visual problems tend to struggle more when taking the test.