Scott & White – Round Rock one of few in the area that is credentialed for Impact Testing
Every year, an estimated 3.8 million recreation and sport-related concussions occur in professional, collegiate and youth sports. Eighty-five percent of those concussions go undiagnosed meaning that many athletes go back to the field too soon, risking greater injuries, according to the American College of Sports Medicine. Scott & White Healthcare – Round Rock’s Orthopedics and Physical Therapy departments have joined together to offer local athletes comprehensive, integrated medical care that includes cognitive testing to help in the overall evaluation and treatment of a concussion.
Scott & White – Round Rock’s Concussion Center includes multiple medical specialties involved in the comprehensive care of athletes that include: sports medicine, neuropsychology, neurology, physical therapy, and athletic trainers.
“Signs of concussion can be subtle and can go unnoticed by medical staff or a coach, which means they generally go untreated, therefore athletes who return to sports too soon are putting themselves at risk for brain damage should another concussion occur,” explains Paul Hoover, director of physical therapy at Scott & White – Round Rock.
Natasha’s Law requires all athletes suspected of having a concussion to be seen by a physician. “Baseline testing should be done every other year for athletes and if they sustain a concussion during the year, they will need a baseline the following year,” said Heather Hammonds, MD, family medicine physician at Scott & White – Round Rock. “Our age range for concussion patients is 10 to 21 years of age. Our speech and physical therapists as well as myself are located all in one location and offer cognitive testing, complete concussion evaluation, cognitive rehab, and vestibular rehab for concussion patients.”
ImPACT is one of the diagnostic tools Scott & White uses to evaluate concussions. ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, is a computerized evaluation system that assesses the effects and severity of a concussion. The technology can also track injury recovery and help physicians, athletic trainers and other medical personnel determine when it’s safe for the athlete to return to sports, in addition to providing a pre-season baseline assessment. The test checks the neuro-cognitive state by measuring brain processing, speed, memory and motor skills. Conventional imaging technology, like CT scans or MRI, cannot detect a concussion.
“If your child does not have a baseline test they can still be seen by our concussion specialist because we can compare their post- concussion test with the millions of others that have taken the test that are the same age, same gender and same academic standing,” explains Hoover. “Therefore, if an athlete experiences a concussion, they get re-tested, and the baseline neuro-psychological data is compared to post-concussion data to help determine the athlete’s status and when it’s safe to return to sports.”
A concussion is an injury to the brain where it bumps up against the skull. The force of the hit can cause “tearing or twisting” of structures and blood vessels in the brain which causes a breakdown in the normal flow of messages within the brain. Symptoms can include chronic headaches, fatigue, sleep difficulties, increased irritability, sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory and problem solving.
ImPACT testing allows physicians to efficiently collect and store data. The program measures multiple aspects of cognition in athletes, including: attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving and reaction time. Testing is done through a computer using a keyboard and mouse to navigate/select responses on the screen.
Computer test modules for ImPACT include the following:
- Word Discrimination: evaluates attentional processes and verbal recognition memory. Twelve target words are presented on the computer screen. This word list is presented twice to facilitate learning of the list. At the end of the second presentation of the list, the subject is tested for recall. The subject responds by mouse-clicking the “yes” or “no” buttons on the screen.
- Design Memory: evaluates attentional processes and visual recognition memory. Twelve target designs are presented on the computer screen. This word list is presented twice to facilitate learning of the list. At the end of the second presentation of the list, the subject is tested for recall. The subject responds by mouse-clicking the “yes” or “no” buttons on the screen.
- X’s and O’s: measures visual working memory and visual processing speed. A distractor test measures reaction time as the subject is asked to click the correct mouse button for a blue square or red circle. The memory task requires the subject to remember which X’s and O’s are illuminated on a screen. The subject then takes the distractor test again and afterwards is asked to recall previously illuminated X’s and O’s. The subject completes four trials.
- Symbol Matching: evaluates visual processing speed, learning and memory. A screen displays 9 common symbols under which are a number of buttons 1 to 9. Below this grid, a symbol is presented. The subject must click the matching number as quickly as possible and remember the pairings.
- Color Match: represents a choice reaction time task and measures impulse control /response inhibition. The subject is required to click a red, blue or green button as they are presented on the screen to rule out color blindness. Next, a word is displayed on the screen in the same colored ink as the word (e.g. RED), or in a different colored ink (GREEN or BLUE). The subject is instructed to click in the box as quickly as possible only if the word is presented in the matching ink.
- Three letters: measures working memory and visual-motor response speed. Three letters are displayed on the screen. Immediately, a numbered grid re-appears and the subject must click as quickly as possible on numbered buttons in backward order as fast as possible. After 18 seconds, the numbered grid disappears and the subject is asked to recall the three letters by typing them from the keyboard. Five trials of this task are presented.
Texas House Bill 2038, “Tasha’s Law,” changed how concussions are treated for all athletes that compete under the UIL (University Interscholastic League) in the State. This bill went into effect September 1, 2011.
About Scott & White Healthcare – Round Rock
Scott & White Healthcare – Round Rock (roundrock.sw.org) serves the residents of Williamson and Travis counties, including the Austin/Round Rock metropolitan area. Our facilities include Scott & White Hospital – Round Rock, Scott & White Hospital – Taylor and 14 additional primary care and specialty clinic locations in Burnet, Cedar Park, Georgetown, Hutto, Pflugerville, Round Rock and Taylor.