Originally Posted by Mark in Idaho

The ImPACT test is a computerized version of a limited neuropsych assessment. The software and testing licenses are purchased and installed on a computer. It is best when the athlete does a start of season baseline. Then, after a head impact, they can tests the athlete to see if there are cognitive problems. If so, the athlete is held out from play. Once the IMPACT test returns to a higher percentage of normal, the athlete is allowed to return to play.

I studied the system after it was featured on a news report here in the Boise area. It appears to be used primarily to support a coach or trainer's decision to hold a athlete out from play. It gives objective evidence of cognitive dysfunction that can convince athletes and their parents that continued play is a risk. It allows return to play too early by my understanding. It also helps with insurance claims by having an 'objective' way to decide return to play issues.

The primary weakness of the ImPact Test is its inability to predict second impact risks. It only measures limited neuro-psychological performance. The developers even state that it should be used along with other data such as location and intensity of the impact.

It primary value is to determine if an athlete has a cognitive dysfunction that puts the athlete at additional risk of another head injury due to poor reaction times, poor judgment skills, or poor motor coordination.

These neuropsych parameters can appear normal but the brain can still be very susceptible to a second impact risk. After a concussion, the brain will ALWAYS be more susceptipble to a second impact, even decades later.

Second or multiple impact risks are the important issue to be considered before returning an athlete to play. The research shows that concussions received subsequent to a first concussion to far more damage relative to the impact force. This damage can increase at an exponential rate for some brains.

Some researchers have even started using a term of "sub-concussion impact" to define a less than concussion force that still causes brain damage. These sub-concussion impacts can be very damaging, especially under two circumstances: closely following a previous concussion and when the sub-concussion forces are repetitive as in a ball heading drill in soccer or helmet to helmet contact in football.

So, the ImPACT test is to be used to determine a minimum level of recovery, not a safe level of recovery.

I believe it creates a false sense of security about return to play decisions.