What is a Concussion?
A disturbance in brain function that occurs following either
a blow to the head or as a result of the violent shaking of the
It is a chemical change that cannot be detected on MRI or
In a survey of football players, when asked if they’d
sustained a concussion during the season, 15% said yes.
When removing the word “concussion” and just supplying a
description of the symptoms, 50% said yes.
More on concussions…
Most of what we know about concussions, we’ve learned in the last 5
The CDC just called sports related concussions an “epidemic”
There are 7.5 million high school athlete in the US and an estimated
1.6-3.8 million sports related concussions each year. (CDC Toolkit for
Physicians, In Press)
Athletes in a contact sport have a 19% chance of sustaining a
concussion in one season (impacttest.com)
Athletes who sustain a first concussion are more susceptible to
sustaining a second concussion.
Signs & Symptoms of a Concussion
• Balance Problems
• Visual Problems
• Sensitivity to light
• Sensitivity to noise
• Feeling mentally "foggy"
• Feeling slowed down
• Difficulty concentrating
• Difficulty remembering
• More emotional
• Sleeping less than usual
• Sleeping more than usual
• Trouble falling asleep
SECOND IMPACT SYNDROME
“Occurs when an athlete sustains a second impact before being
completely healed from a first concussion”
Causes increased pressure in the skull
50% OF ALL SIS CASES ARE FATAL
If not fatal, permanent deficits occur (reports of coma from 3 days to
Only occur in the adolescent brain because it is not fully developed
In 2008, 5 football players died from SIS
Please take a minute to watch
Why some athlete don’t tell of their symptoms
They don’t want to let their team down
They don’t want to let their parents down
They don’t want to appear weak
They want more than anything to be playing
ImPACT Test Background
Designed by Director of Neuropsychology, Mark Lovell,
PhD , Chief Clinical Officer of University of Pittsburgh
Medical Center, Michael Collins, PhD, and Chief Medical
Officer of University of Pittsburgh Medical Center, Joseph
A user-friendly computer based test designed for the
management of sports-related concussion.
The test has been designed after 10-years of University-
based, grant-supported research.
ImPACT is currently the most widely used computerized
program in the world.
ImPACT is used effectively across high school, collegiate,
and professional levels of sport participation.
Computerized test which takes about 20 minutes
Subject Profile and Health History
Current Symptoms and Conditions
• Word Discrimination
• Design Memory
• X’s and O’s
• Symbol Matching
• Color Match
• 3 letters
Graphic Display of Data
What do these tests measure?
Sustained and selective attention time
Non-verbal Problem Solving
What ImPACT testing is NOT
Not a substitute for medical evaluation/treatment
Not a substitute for comprehensive
neuropsychological testing when needed
Tips for Recovery
REST, REST, and REST!!!
No TV, No video games, may need to stay home from
school/work (concentration makes symptoms worse)
Avoid activities that could result in a second concussion
Gym class, roughhousing at home, participation in any sports
Do not operate heavy machinery
Take only the drugs your doctor has approved
Timeline for Recovery
Since every athlete and every concussion are
different, there is no set time for expected return to
The protocol at SESD is as follows:
Athlete must be completely symptom-free for 24 hours
Athlete then takes the post-concussion test through
If they pass and there are no return of symptoms, they begin a
5 day gradual progression to return-to-play. Athlete must
remain symptom-free through each day. (progression on next
If they DO NOT pass the test, they are given approximately 3
to 4 more days of healing time and are then re-tested.
5 Day Gradual Return to Play
aerobic exercise (.e.g., stationary bicycle, jog 1 mile)
sport specific training (e.g., running, skating)
non-contact drills (includes cutting and other lateral
full-contact controlled training
full-contact game play
Without ImPACT it’s very difficult for any doctor to make an educated
decision on whether the athlete is safe to return to play.
Family doctors do not SPECALIZE in concussion management. Many
feel if the athlete is symptom free, they are healed. All of the old
concussions scales are no longer used. Scientific studies have disproved
Athletes that report being symptom free are still not scoring as well as a
A study by the Nationwide Children’s Hospital showed that 41% of
athletes with a concussion returned to play too early.
Risks Associated with NOT taking ImPACT
No Baseline to determine “normal” cognitive
No post-concussion test determining the extent of
Clinician has no data to make informed decision on
Premature return-to-play leading to second impact
Professionals that ImPACT test
MAJOR LEAGUE BASEBALL
NATIONAL HOCKEY LEAGUE
CIRQUE DU SOLEIL
ALL MAJOR LEAGUE SOCCER
A few Colleges in PA that use ImPACT
Lebanon Valley College
Lock Haven University
Penn State University
Robert Morris College
Slippery Rock University
University of Pittsburgh
West Chester University
York College of PA
East Stroudsburg State University
Indiana University of PA
Frequently Asked Questions
Q: When will my child be able to return to sports?
A: Athletes return to play after being symptom-free for 24 hours, passing the
ImPACT test, and gradually progressing through a 5 day regimen.
Q: Do I need to take my child to the doctor?
A: Not every concussion requires physican referral. However, physician visits
are never discouraged. There are some cases in which they are encouraged.
When dealing with a head injury, a neurologist is the most trained in dealing
with concussions and neurological issues stemming from them.
Q: Does age matter for recovery time?
A: Doctors at UPMC have researched and found that the adolescent brain does
not heal as quickly as the adult brain. Therefore, high school athletes take
longer to recover than college athletes.
Q: How close to the baseline scores do my child’s post-concussion
scores have to be before returning to play?
A: Reliable change indices (RCI) are used for determining when an athlete's
post-injury test has satisfactorily approached baseline levels. If the scores are
outside of the RCI, they are considered atypical and show the athlete’s brain
has not completely healed from the injury. RCI is not be the only criteria in
determining when an athlete's test scores are back to baseline. Symptoms and
exertional testing are a part of the process.
Q: What if my child has a learning disability?
A: They can still take the test and the results will be specific to them. There is a
specific box to “check” notifying the examiner of their condition. The test also
wants to know of any current medications the athlete may be taking so they can
type in any special medications at the appropriate place.
Q: How often can my child take the ImPACT test after a
A: If the athlete does not pass the ImPACT test, they are given 3 days to
heal and are then allowed to retake the test. If the concussion is severe,
they will be permitted to take it once a week.
Q: What is the frequency of baseline testing?
A: All athletes will be tested at least once in high school. It is our goal at SESD
that they be tested twice so we have the most accurate baseline information on
Feel free to view a sample of clinical results at
“Knocking Heads” Dan Rather Reports
Presentation by Dr. Mark Lovell, UPMC