K. Hovnanian Children’s Hospital is a Credentialed ImPACT Consultant (CIC) which utilizes ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) for baseline testing. ImPACT is the most widely accepted, systematically proven, computerized post-concussion evaluation program of neurocognitive function. With assistance of this assessment and various other non-cognitive brain function testing, analysis can be made on when the athlete can make a safe return to sports and physical activity following a concussion.
Beginning at 11 years old, if your child participates in contact sports, it is important that they participate in an ImPACT baseline test to establish a valid baseline measure of cognitive brain function. The test can be administered by physicians, athletic trainers, athletic directors, school nurses, team doctors, and physiologists who have completed the ImPACT training.
The ImPACT baseline provides an observation of the brain’s reaction time, processing speed, memory, and recognition prior to a concussion. The observation then can be reviewed if a concussion occurs to objectively evaluate the symptoms and assist the treatment and care process on a personalized basis.
Balance Testing – (BESS) – Balance Error Scoring System
The BESS test measures an individual’s ability to maintain posture in a variety of positions; with eyes open and closed as well as standing on the ground and on a soft pad. The three positions are:
standing with both feet together and hands on hips
standing on the non-dominant leg with hands on hips
standing with in tandem stance with the non-dominant foot in back with hands on hips
The number of errors (not maintaining posture) is counted over 20 seconds.
Vestibular Function – (VOMS) – Visual Ocular Motor System
With the head stationary, the individual is asked to follow with eyes only the movement of examiner’s finger through a variety of movements to assess smooth pursuit movement of the eyes without worsening symptoms for 20 to 30 seconds. Then the individual is asked to move eyes rapidly back and forth horizontally for 20 to 30 seconds, then vertically up and down rapidly for 20 to 30 seconds, and finally is asked to fix the gaze on a finger in front of their nose and to turn the head from side to side while continuing to focus on the finger. If any of these movements increase dizziness, headache or other issues, these indicate difficulties in the visual ocular motor system.
An object is held at arm’s length in front of the individual and gradually moved toward the nose. The point at which the object becomes blurry or two images are seen is measured to determine the quality of coordinated eye convergence – which should be less than 2 inches from the nose.
Cerebellar Position Sense/Coordination
The individual is tested with three common assessment tools for cerebellar function and coordination:
With eyes closed, and arms extended to form the letter T with the body, bend the right arm at the elbow and touch the index finger to one’s nose; then repeat with the left arm
With eyes open, perform rapid alternating movements with the index fingertip from one’s own nose to the fingertip of the examiner as the examiner moves his or her finger between movements
Perform rapid pronation and supination of the forearms (turning palms up and then down as quickly as possible)
King-Devick Test for Visual Scanning
The King-Devick Test entails reciting a series of numbers arrayed on several lines while being timed and checked for accuracy. There are three versions, each more challenging than the one before. The combination of the eyes scanning across the lines and the brain processing what is seen and then reciting it aloud incorporates a number of cognitive and visual brain functions. While there are norms for comparison among youths for each age group from 8 to 18, establishing a personal baseline is the most useful. It has been demonstrated that after concussion, the speed and accuracy are affected resulting in slower times and/or more errors.