What is ImPACT™ Concussion Baseline Testing?

ImPACT™ stands for Immediate Postconcussion Assessment Cognitive Testing. The ImPACT™ baseline concussion test is a computer-based program designed for the management of sports-related concussions. It records an athlete’s health history and current symptoms, and measures cognitive functions. ImPACT™, tests children prior to a head injury to establish a baseline in cognitive functioning. Should he or she have a head injury later, the baseline can be compared to post-concussion testing and determine the severity of the injury. The program measure's multiple aspects of cognitive functioning in athletes including:

  • verbal memory
  • visual memory
  • visual motor (processing) speed
  • reaction time
  • impulse control
  • cognitive efficiency

Should an athlete have a head injury later, the concussion baseline can be compared to post-concussion testing and determine the severity of the injury. The ImPACT™ baseline concussion test takes approximately 30 minutes to complete.

Pros and cons of baseline testing

teenage girls playing soccer

There are many controversies and myths surrounding concussion and baseline testing, especially in children. One of the controversies is whether baseline testing should be performed at all for any youth athlete. There are many reputable pediatric concussion programs that do not use baseline testing. In cases of non-sports related concussion, which comprises the vast majority of concussions in kids younger than 18, children rarely have a baseline available, yet their concussions can be managed effectively without it.

The other argument against testing is that the younger the child the less capable they are of producing reliable test results because they are easily distracted or fail to read and follow the instructions. To combat the latter problem and improve the likelihood of a valid baseline, Nicklaus Children's Hospital has trained proctors who are present for the test in order to make sure the child takes the test properly and that testing conditions are optimal.

What does the test involve?

ImPACT™ testing takes about 30 minutes to complete. The athlete fills out a number of questions related to personal characteristics and medical history, assigns a severity grade to 22 symptoms of concussion, then completes the timed neurocognitive testing. The software then processes the athlete’s answers into performance raw scores and percentiles that compare the athlete’s scores to approximately 5,000 healthy, non-concussed age-matched controls.

Is any special preparation needed?

No special preparation is needed for this test. Baseline tests are likely to be invalid or inaccurate if the athlete does not get at least 8 hours of sleep the preceding night, if the test is given at the end of a grueling physical work out, if they have ADD, ADHD, autism or dyslexia, if they are still recovering from a previous concussion, or if they are even slightly distracted during the test, e.g., by cell phones or other noise or commotion during the test.

ImPACT™ Baseline Pre-Concussion Testing Cost:
$15 per athlete

Who should NOT come in for baseline testing?

Most high school sports programs have well-established baseline and post-injury testing programs that are part of their concussion management protocol. These athletes should continue to get tested by their trainers. However, athletes who are in sports or activities and do not have access to baseline testing are invited to be tested and receive educational materials on concussion recognition and management.

Who is most likely to benefit from baseline testing?

Any child in middle school or higher who participates in sports and activities that places them at high risk for a head injury. Children who have had a prior concussion are at increased risk of subsequent concussions and would also benefit as long as they have fully recovered from the first.

Nicklaus Children's Hospital has chosen middle school children as the main target population due to the lack of athletic trainers and available baseline testing in this age group. One of the myths about pediatric concussion is that younger athletes don’t run fast enough, or hit or get hit hard enough to get concussions. A recent study of middle school girl soccer players reported an incidence of concussion which was higher than both high school and college soccer players, and 30% of concussions were sustained while heading the ball. Over half of these girls continued to play with symptoms and only 44% sought medical attention of any kind.

2 boys playing footbal and a boy skateboarding

Clearly, greater awareness and education about concussion is needed, which is why, Nicklaus Children's Hospital provides children and parents with educational materials and recommendations if a concussion is suspected.

Why limit testing to middle school children and older?

The main reason for not testing very young children is the lack of a valid, reliable and developmentally appropriate computerized test for this age group. An exciting new test for children age 5-12 has recently completed beta testing and appears very promising. We hope to offer that test in the near future when it becomes available.

About the Concussion and Brain Injury Clinic

The Concussion and Brain Injury Clinic is a trusted resource for the prevention and treatment of brain injuries that provides:

cheerleader in red and white uniform mid jump
  • baseline and post-injury ImPACT™ testing
  • neurologic evaluation and assessment of brain imaging needs (CAT Scan, MRI)
  • care plan for return-to-school with accommodations
  • guidance and supervision of return to physical activity
  • rehab therapy for physical, visual/ocular, vestibular and cognitive sequelae
  • clearance for return to contact sports
  • long-term management of post-concussion syndrome