The Concussion Management Process Using ImPACT
A. Baseline ImPACT testing
1. This should be done at the onset of each season
B. Acute Management Steps
1. Immediate Medical Triage / Record time of initial incident
2. Sideline evaluation of athlete – ATC/PT/Coach/onsite medical personnel
- Medical Evaluation – additional triage as necessary
- Basic Neurological Screen
- Sideline or on field cognitive screen (SCAT)
- Post concussive symptom survey (PCSS) – completed by athlete
3. If symptomatic or Sideline evaluation is abnormal > athlete out for the day
4. Athlete out and home for rest – Home Care Instructions.
5. If NO symptoms and sideline evaluation is Normal > Athlete may return to
training/competition that day. No f/u ImPACT test required.
IF THERE ARE SIGNS/SYMPTOMS > DO NOT RETURN TO SPORT ON THIS DAY
C. If Athlete is Believed to be Concussed (did not return to play on injury day)
1. Athlete/Parent/Coach given these home care Instructions
- Athlete monitored over 24-48 hrs by responsible individual for worsening symptoms or delayed responses. follow-up evaluation consisting of above steps and ImPACT screen within 24-48 hrs.
- Any worsening signs/symptoms seek immediate emergent medical care
- Follow-up evaluation in 24-48 hrs – when symptoms clear – consisting of PCSS, SCAT, medical/neurological evaluation, and ImPACT
2. Coach / Parent / Trainer contact Think Head First to notify for post injury ImPACT testing when symptom free & athlete is medically cleared.
D. Post Concussion Medical Personnel Follow-up Recommendations:
- Medical Personnel will evaluate athlete clinically, any additional testing as indicated
- SCAT/SAC/ImPACT Sideline evaluation will be completed and Athlete will fill out the
Post Concussive Symptom Survey.
- If the Medical Personnel clears athlete medically > post injury ImPACT
- Think Head First CIC notified to arrange online ImPACT post injury screen. This
testing is possible to accomplish online from anywhere with an internet connection.
Instructions will be given on how to access the post injury testing.
- Once test completed, Think Head First CIC will review ImPACT result and will
subsequently and advise athlete, parent, coach and trainer if cleared by ImPACT post injury results to begin Return to Sport Progression
Recommendations for Returning to Sport
Three Basic Requirements Necessary to BEGIN Return to Sport Progression:
- Asymptomatic at Rest – REST from all activity and cognitive stress until all symptoms resolved. Never return to sport if there are any symptoms.
- Normal medical exam – Normal Neurological screen – Normal sideline evaluation
- ImPACT Normal – post injury ImPACT test returned to baseline levels
Return to Sport Progression – General Guidelines:
The following represents a generalized progression in activities that can be scheduled once the athlete is symptom free at rest. Generally, 1-2 levels can be completed daily before progressing to the next level. If ANY signs/symptoms return with any level of activity, stop and rest until symptoms clear and then begin at level where symptoms occurred.
- Activities of Daily Living – rest with light walking around home, etc
- Light Cognitive activity – reading, limited school work or computer work (short duration/15-20 minutes at a time with plenty of recovery between work intervals
- Low levels of physical activity such as light jogging, stationary bike, etc for 20-30 min. with no return of symptoms.
- Light resistance training – lower weight, higher repetition weightlifting – No multi joint,high valsalva type exercises (Bench Press, Squats, Cleans)
- Moderate levels of physical activity – Increase intensity of aerobic activity with use of short 15-30 sec intervals interspersed within 20-30 mins of aerobic activity
- Moderate intensity resistance training – multi joint, higher resistance weight training but still below normal typical routine.
- Sport specific training drills in controlled setting with supervision
- Actual Sport training progression; begin with reduced volume/intensity with supervision and gradually increase volume first then intensity to work toward full loads
- Full training load