Breakin' It Down: ImPACT Testing

Here on Injury Island, we have a whole mess of NHLers suffering from concussions.

Intern Jeff Skinner, Sidney Crosby, Claude Giroux, Chris Pronger, Mike Richards, Milan Michalek, Marc Staal, Joni Pitkanen, just to name a few.

(We’re really upset about Jeffy thought. Our office is a mess and we just ran out of Mexicola.)

We miss you. Come back soon. We're thirsty.

With all talk about concussions, hockey coaches, writers and pundits you might have heard the term “ImPACT Test.”

So what exactly is the ImPACT test?  What does it test?  Why should we care?

Apologies ahead of time because this post is long and chock full of information, but as true hockey fans, I feel strongly that it is something that we should all be educated about.

Knowledge is power, people.

What the heck is this “ImPACT Test”?

  • ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing.
  • It  is a computerized concussion evaluation system developed in the early 1990s.
  • It is the most widely used computer-based testing program in the world, and is utilized by high schools, collegiate, and professional sports to assess players who may have a concussion.
  • It is a 20-minute test that measures the cognitive functioning in athletes including attention span, working memory, attention time, response variability, non-verbal problem solving, and reaction time.
  • The test is administered by an athletic trainer, team doctor, or team psychologist who has completed training in how to administer the test.
  • The test should be taken before any injury has occurred, say at the beginning of the season to determine the player’s “baseline” score.  The test should be re-administered 24 to 72 AFTER injury/concussion has occurred.
  • The team trainer or doctor is able to use this test as part of a more broad process to objectively evaluate a player’s post-injury condition.  It helps them to track a player’s recovery with a set of measurable scores and hard data.
The Test Itself
The test has a total of 5 sections.
  • Section 1 requires the athlete to input basic demographic information and descriptive information through a series of easy-to-follow instructional screens.
  • Section 2  asks questions about the athlete’s most recent concussion date, hours slept last night, and current medications. Then the athlete is to rate the current severity of 22 concussion symptoms via a 7-point Likert scale (0 being “none” , and 6 being “severe).
    • Concussion symptoms evaluated are:
      • Headache
      • Nausea
      • Vomiting
      • Drowsiness
      • Numbness 0r tingling
      • Dizziness
      • Balance problems
      • Sleeping more than usual
      • Sensitivity to light
      • Sensitivity to noise
      • Feeling slowed down
      • Feeling as if ‘in a fog’
      • Difficulty concentrating
      • Difficulty remembering
      • Trouble falling asleep
      • More emotional than usual
      • Irritability
      • Sadness
      • Nervousness
      • Other
  • Section 3 involves the Neuropsychological tests, and is broken up into 5 modules:
    • Word Memory – evaluation of attention and verbal memory
    • Design Memory – evaluation of attention and visual recognition memory
    • Xs and O’s – measures visual working memory and how fast the player can visually process images
      • for those of you who watched HBO’s 24/7 last night, you might have seen Claude Giroux doing this test after his knock to the head from Wayne Simmons.
    • Symbol Matching – evaluates visual processing speed, learning and memory
    • Color Match – measures impulse control and response inhibition.
    • Three Letter Memory – measures working memory and visual-motor response speed
  • Section 4 allows the player to input details about their concussion like point of contact, symptoms, description of injury, even info about the type of helmet and mouth guard they were wearing.
  • Section 5 is the actually test scores themselves.   There are 5 ImPACT test scores that are displayed graphically.  Trainers and/or Team doctors can then use this data to determine what additional steps need to be taken with the player.

So all of this is all well and good, but the larger question remains….

Why should we, as hockey fans, care about any of this?

Aside from the obvious reason which is making ourselves more educated and knowledgeable hockey fans, we should care because this test strives to protect players.   To protect them from returning to play too soon. To protect their health, their well-being, and most importantly, their quality of life.   Guess you could say that the test also protects teams who have made substantial investments in their athletes in the hopes of attaining the penultimate prize.  But when it comes down to it, I’d like to believe that no NHL team, owner, or coach with jeopardize a player’s quality of life to win a trophy.

They may be gruff and rough on the outside but on the inside, hockey people are just as warm and fuzzy as the rest of us.

They care about each other and we should care about them.

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  1. As an athletic trainer who uses this test almost daily, I just want to say thanks for this post. This test has improved the care of my athletes (and thousands all over) dramatically and prevented some serious and potential life long effects. And in the end…that is all that matters, yanno?

    Not that I don’t wish these guys a speedy recovery and all…I’m just saying I get the conservative treatment plans. And it’s not terrible to see them in suits.

    • You’re welcome, Li Li. Thanks for the kind words.

      It makes us sad that so many players are going down with concussions this year, but we’re happy that the league and teams are taking it all so seriously.

  2. Oy the third section makes me so scared. Imagine looking right at that stuff and not being able to process it? THREE LETTERS? Precisely why players should take all the time they need and more to recover, because there’s no way you live any part of a normal life outside the game if you can’t perform those tasks.

    PS: Jeff. My heart is breaking. Please be okay.

  3. I used to give these when I studied AT in college….We had two versions and one of my athletes had so many he memorized the first one and we had to create a new one just for him…

    honestly, I can’t even do them without an injury!

  4. Cassy Reply

    I think they did a version of this with me when I had my concussion nearly 20 years ago!

    Those of you who know me will know that I’m totally in favour of the cautious approach to head injuries – and it’s not because of my mad love for Savard. Being a nurse and my own experience of it has taught me this.

    Concussion is dangerous. It can be life altering. Better to be safe than sorry and here’s hoping all the boys are back fighting fit soon.

  5. raedanda Reply

    Thank you for taking the time to post and share this with us, Chuck! Concussions are not to be taken lightly, and this post just emphasizes that even more for us who aren’t/weren’t aware of how simple things like recognizing shapes, words and letters can be taken for granted.

    ‘Hoping and praying that all the players who’ve been diagnosed recover, not even quickly, but well and up to their 100% best. 🙂

  6. Pingback: Yeah, Mom, I hit my head. Can I go back out and play now? : Who’s REALLY deciding when a play gets back on the ice? « Phace Off