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untitled
Given these issues, more sensitive neu-
rodiagnostic assessment strategies have
proven critical to the safe management of
the concussed athlete. Further, such tech-
niques have provided a valuable research
paradigm from which to gain a better under-
standing of this elusive injury. At the fore-
front of these approaches is the advent of
computerized neurocognitive testing. The
Directors of the University of Pittsburgh
Medical Center (UPMC) Center for Sports
Medicine and Department of Neurosurgery
Mark Lovell Ph.D, Michael Collins Ph.D
and Joseph Maroon, M.D. have recently developed a
computerized battery of neurocognitive tests called
ImPACT (Immediate Post-concussion Assessment and
Cognitive Testing) that is becoming widely used, both
nationally and internationally, to better diagnose and
manage sports-related concussion.
ImPACT is a sophisticated, though easy-to-use, soft-
ware program that has been specifically developed to help
clinicians evaluate recovery following concussion. The
program is a 20-minute computerized test battery that can
be administered in the preseason for a baseline and post-
injury to track a concussion. ImPACT allows for proper
determination that the athlete has fully recovered from
concussion, thus ensuring for safe return to play and more
sophisticated management of the injury.
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VOL
. XXVII
NO
. II
WWW.CIFSTATE.ORG
The management of sports-related concussion is cur-
rently one of the most intensely debated topics in sports
medicine. Much of this debate centers on determining
safe return to play once concussion has been diagnosed.
Until recovery from concussion is complete, the athlete is
much more vul-
nerable to another
blow to the head.
If a second con-
cussion occurs
prior to full recov-
ery from a first
concussion, the
athlete may expe-
rience long-term symptoms in the form of chronic
headaches, sleep difficulties, dizziness, and personality
changes or thinking problems that can negatively affect
academics and simple everyday functions. In rare cases, a
second concussion may even result in death in the form of
second impact syndrome.
As such, proper assessment of injury and determina-
tion of existing symptoms that may indicate incomplete
recovery prove critical to the safe management of the con-
cussed athlete. In short, no athlete should return to play
until all signs and symptoms of concussion have been
completely resolved.
The determination of lingering difficulties associated
with concussion has traditionally proven problematic for
a variety of reasons. These may include: Mainstream techniques such as CT scan and MRI,
though invaluable in discerning more serious injury
(e.g., skull fracture, hematoma), are normal and unre-
markable following concussion. Athletes who have experienced a concussion present
with a wide variety of symptoms. Although the classic
symptoms of loss of consciousness, confusion, memory
loss and/or balance problems may be present in some
athletes with mild concussion, there may or may not be
obvious signs that a concussion has occurred.
Symptoms indicative of concussion can be quite subtle
and may go unnoticed by the athlete, parents, team
medical staff or coaches. Many coaches and other team personnel may have lim-
ited training in recognizing signs and symptoms of con-
cussion and, therefore, may not accurately diagnose the
injury when it occurs. Additionally, athletes may not
be aware of the symptoms of concussion or may simply
underreport them for fear that they will be removed
from play. Many sports medicine practitioners are not satisfied
with the current concussion return-to-play and man-
agement guidelines (at least 19 current versions) that
are not based on data-driven or scientific principles. In
fact, there is tremendous variability in recommenda-
tions given by physicians pertaining to management of
concussion and return-to-play recommendations.
The ImPACT program uses a battery of scientifically
validated computerized neurocognitive tests to evaluate
and document multiple aspects of brain functioning
including memory, processing speed, reaction time and
post-concussive symptoms. The test consists of a Self-
Report Symptom Questionnaire, a Concussion History
Form, and seven tests of neurocognitive functioning. In
Continued on page 6
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By Labiba Russo, Director of Sales & Marketing, ImPACT Applications 2
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President: Bob Wallace, Superintendent, Escalon U.S.D.
President-Elect: Kathy Wheeler, Superintendent, Red Bluff J.U.H.S.D.
Past-President: Cheryl Ernst, Retired Superintendent, Carlsbad U.S.D.
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Bob Wallace, Superintendent, Escalon U.S.D.
Lynn Dodd, Principal, McClymonds High School
Cheryl Ernst, Retired Superintendent, Carlsbad U.S.D.
Mike Henson, Principal, Strathmore High School
George Hinds, Superintendent, Le Grand School District
Camille Maben, California Department of Education
Sister Cheryl Milner, Principal, Bellarmine-Jefferson High School
Brad Syth, Principal, Santa Clara High School
Kathy Wheeler, Superintendent, Red Bluff J.U.H.S.D.
F
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Rich Alderson, Association of California School Administrators
Ray Alvarado, Athletic Administrator, Calexico High School
Susana Arce, Assistant Principal, Nordhoff High School
Paul Breit, Principal-At-Large, Pomona U.S.D.
Marci Cranford, Coach, Kingsburg High School
John Dahlem, Principal, Western High School
Heather Daims, Principal, Fairfax High School
Lynn Dodd, Principal, McClymonds High School
Cheryl Ernst, Retired Superintendent, Carlsbad U.S.D.
Nancy Evangelho, Principal, International Studies Academy
Dick Fukuda, Athletic Director, Locke High School
Earl Haugen, Director on Assignment, Downey U.S.D.
Arleen Hammerschmidt, California Association for Health,
Physical Education, Recreation and Dance
Mike Henson, Principal, Strathmore High School
George Hinds, Superintendent, Le Grand School District
Andrew Ishibashi, Principal, George Washington High School
Patrick Koop, Assistant Superintendent, Riverdale U.S.D.
Elizabeth Kyle, Principal, Fall River High School
Camille Maben, California Department of Education
Mike Mackey, California Association for Health,
Physical Education, Recreation and Dance
Catherine Manthey, California Association of Private School Organizations
Kim McEwen, Athletic Director, Los Angeles Polytechnic High School
Brian McKibben, Administrator on Special Assignment, Santa Fe Annex
Sister Cheryl Milner, Principal, Bellarmine-Jefferson High School
Anthony Monreal, Superintendent, Selma U.S.D.
Richard Morris, California School Boards Association
Nelson Noriega, Principal, Berean Christian High School
Ray Odom, Superintendent, Hamilton U.H.S.D.
Tony Ortega, California Association of Directors of Activities
Jennifer Owen, California School Boards Association
Keith Parkhurst, Superintendents Liaison Committee
Jim Rear, California Coaches Association
Dennis Regalado, Director of Alternative Education, Acalanes U.H.S.D.
Dave Reid, California State Athletic Directors Association
Jose Reyes, Principal, La Entrada High School
Anne Rosser, California Coaches Association
Greg Sanchez, Athletic Director, Live Oak High School
Susan Saunders, California State Athletic Directors Association
Sherry Segalas, Principal, Terra Nova High School
Gary Smidderks, California Association of Private School Organizations
Rebecca Smith, Principal, Monte Vista High School
Jan Smith Billing, Vice Principal, Montgomery High School
Rick Spears, Principal, Colfax High School
Brad Syth, Principal, Santa Clara High School
Nancy Veilleux, Vice Principal, Roseville High School
Bob Wallace, Superintendent, Escalon U.S.D.
Doug Walker, Vice Principal, Palo Alto High School
Bruce Ward, Director, San Diego U.S.D.
Kathy Wheeler, Superintendent, Red Bluff J.U.H.S.D.
Marilyn Wheeler, Superintendent, Coronado U.S.D.
S
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CIIFF S
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Marie M. Ishida, Executive Director
Diane Marshall-Freeman, General Counsel
Roger Blake, Assistant Executive