420 Final C-3 Keys to Interpretation Special Focus Sandbagging Handouts 87728

7/29/2019 420 Final C-3 Keys to Interpretation Special Focus Sandbagging Handouts 87728

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Webinar: C-3 (Advanced)Title: Keys to Interpretation: Special

Focus on Sand Bagging

Speaker: Mark Lovell, Ph.D., FACPN, D. Sci. (Hon)

Description:

This 45 minute course will review the role of

neurocognitive assessment in concussion management,

brief review of interpretation strategy and review atimely issue while focusing if the someone can Sandbag

the test.. This course is 45 minutes of presentation and

followed by 30 minutes of Q & A.

Table of Contents for Handouts

Section 1: Speaker Biography

Section 2: Slides (Presentation Handouts)

Section 3: Other Helpful HandoutsSection 4: FAQ from Workshop Attendees

Certificate of Completion Issued to All Registered.

BOC Credits available for Athletic Trainers

C-3 Keys to InterpretaSpecial Focus on Sand B

Info

Table of Contents


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Keys to Interpretation: Special Focus on Sand Bagging

Speaker: Mark Lovell, Ph.D., FACPN, D. Sci. (Hon.)

Biography

Mark R. Lovell, Ph.D., is internationally recognized as a concussion

expert for his development of innovative neurocognitive testing

programs and ground breaking research. Currently Dr. Lovell

serves as the chairman and chief executive officer of ImPACTApplications. In the early 1990s he developed the ImPACT test

which is the first, most-widely used and most scientifically validated

computerized concussion evaluation system. The ImPACT test has

become an internationally tool used in the comprehensive clinical

management of concussions. Dr. Lovells expertise led to his

development and direction of the first league wide

neuropsychological testing programs for the National Football

League (NFL) and National Hockey League (NHL). Dr. Lovell

remains a neuropsychological consultant for several organizations

throughout the world including, but not limited to, the NFL, NHL,Irish Rugby, USA Womens Olympic Hockey team, World Wrestling

Entertainment (WWE) and the US Ski and Snowboard team.

In 2000 Dr. Lovell became the founding director of the University ofPittsburgh Medical Centers (UPMC) Sports Medicine Concussion

Program. Dr. Lovells pioneering approach to concussion

management attracted professional athletes from around the world

to the UPMC Concussion Program. Until his retirement from clinical

practice in 2011 Dr. Lovell directed the UPMC program, which has

been regarded as the first and largest program of its kind.

C-3 Keys to InterpretSpecial Focus on Sa

Bagging

1: Bio


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Dr. Lovell is a leader in concussion research, publishing over 100peer-reviewed articles, authoring or co-authoring nine textbooks

and writing over 40 book chapters. He is an instrumental force in

spreading concussion education and awareness among the public

and medical community. Dr. Lovell served as a panel member for

the Center for Disease Controls Coaches Toolkitand has trained

thousands of medical professionals on neurocognitive testing and

concussion management.

Dr. Lovells contributions to the neuropsychological community

have allowed him to be a frequent presenter at professionalmeetings internationally and serve as a member of the Vienna and

Prague International Consensus Conference on Sports-Related

Concussion.

His vast accomplishments have been recognized by the Council of

Brain Injury award for excellence in research, National Concussion

Summit Excellence in Safety Award, USA Hockey Excellence in

Safety Award,American Board of Professional Neuropsychology

Distinguished Clinical Neuropsychologist Award and most recently

his alma mater, Northern Michigan University, awarded him with anHonorary Doctor of Science degree for his pioneering work in

managing sports concussions.

Dr. Lovell is a member of various professional and scientific

organizations including the International Neuropsychological

Society, American Psychological Association and North American

Brain Injury Association. In addition to being a member of several

prestigious organizations Dr. Lovell has been a reviewer for over 15

professional journals and is currently serving as an editorial board

member for several different journals.


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Keys to Interpretation Advanced: Sandbaggin

pyright 2013 by ImPACT Applications, Inc.rights reserved. No part of this publication maybe reproduced in whole or in part or transmitted in any form or by any mean s

hout the prior written permission of ImPACT Applications, Inc. For information regarding permission, please write to ImPACT

Mark Lovell PhD, FACPN, D.Sci.

Chairman and CEO

ImPACT Applications, Inc.

Keys to InterpretationAdvanced Workshop Q and A

Special Focus-Sandbagging

Copyright 2013 by ImPACT

Applications, Inc.

All rights reserved. No part of this publication maybe

reproduced in whole or in part or transmitted in any form

or by any means without the prior written permission of

ImPACT Applications, Inc. For information regarding

permission, please write to ImPACT Applications, Inc.,

[email protected]

ImPACT and associated logos are trademarks

of ImPACT Applications, Inc.
mailto:[email protected]:[email protected]


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ImPACT and the ImPACT logos are

trademarks of ImPACT Applications,Inc. and are used herein with the

express written permission of ImPACT

Applications, Inc. and may not be

duplicated, removed or altered

without ImPACT Applications, Inc.s

written consent.

The ImPACT Applications, Inc. software is a tool that provides

basic data related to neurocognitive functioning. The software

does not provide treatment recommendations or a specific

medical diagnosis with respect to any particular end user.

Training provided or facilitated by ImPACT Applications, Inc. on the use of its software

is intended to provide users with the ability to properly administer the tests

embedded in the software and to become familiar with the types of data generated by

the software. Treatment decisions that you and/or your organization make based on

the data generated by the software is in you and/or your organizations sole and

absolute discretion. By participating in the training, you and your organization

acknowledge and agree that ImPACT Applications, Inc., its officers, directors,

employees, or agents and affiliates and their respective successors and assigns will notbe held liable for claims of medical malpractice, practicing medicine without a license

or similar claims made by you, your organization or any third party. To the fullest

extent permitted by applicable law, you and your organization agree to hold ImPACT

Applications, Inc., its officers, directors, employees, agents, and affiliates and their

respective successors and assigns harmless and to indemnify ImPACT Applications Inc.

and its officers, directors, employees, agents, and affiliates and their respective

successors and assigns against any and all such claims.


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1. Review of role of neurocognitive assessment

in concussion management

2. Brief review of interpretation strategy

3. Review a timely issue

Todays topic: Sandbagging

4. Q and A

GOALS OF WEBINAR

Neurocognitive Testing: What it is and IsntIS a tool to help determine recovery frominjury.

IS a tool to help manage concussion (e.g.return to academics, return to exertion returnto play).

ISa tool to help communicate post-concussion status to coaches, parents,clinicians.

IS NOT a substitute for medical evaluation/treatment or more formal NP assessment


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Interpretation Guidelines

STEP 1

Pre Season BaselineTesting & Education

Educate Athletes,Parents, Coaches,

Teachers onConcussions

Take an ImPACTTraining Webinar orWorkshop to Learnabout Baseline Test

Administration

Have a ConcussionManagement Protocol

On-hand and HaveYour Team of Key

Professionals (listedbelow) Ready to TreatAthlete - Roles/DutiesShould be Established

for:

- ATC

-Concussion Specialist(MD/DO/PhD)

-Rehabilitaion

Have Parents SignHigh School Permission

Slip

Schedule SupervisedBaselines in School's

Computer Lab

Test AdministratorConfirms All Baselines

are Valid

(if Invalid retest Athlete)

STEP 2

Concussion isSuspected

SidelineAssessment

If Concussion isSuspected Immediate

Removal fromPlay/Activity

ATC Sets Up Referral forConcussion Specialist

(MD/DO/PhD)

Vestibular Screening

At the discretion oftrained medical

personnel...

Optional Brain imagingif needed

STEP 3

Post Injury Testing &Treatment Plan

Athlete to TakeSupervised Post Injury

Test 24 -48 Hours AfterInjury Supervised

ATC Continues toCoordinate Concussion

Specialist(MD/DO/PhD)

Referral

Team Coordinates Carebetween Athlete,

Parent, MD/DO/PhD,ATC, Teachers, Coaches

Does the athlete needadditional and more

extensiveneuropsychological

Testing ?If so, Refer to

Neuropsychologist

STEP 4

Is Athlete Ready for NonContact Activity?

CRITERIA:

A: Symptom Free @Rest & With Cognitive

Exertion

B. Post ImPACT Test:Within Normal Range

of Baseline

C: Written Clearancefor Progression to

Activity by SupervisingDoctor (non-ER Doctor)

NormalVestibularEvaluation

IF NOT:Return to STEP 3

IF YES: StepwiseReturn-to-Play

Progression Beginningwith Light Non-ContactActivity Progressing to

Full Non-ContactExertion

STEP 5

Determining SafeReturn-to-Play

Return-to-PlayDecisions Should

Always be Made by aConcussion Specialist

(MD/DO/PhD)

No Recurring Symptomsat Rest or FollowingPhysical or Cognitive

Exertion

ImPACT Test ScoresBack to Baseline

After Return to Play

Athlete's Final ImPACTScore is Set as theirNew Baseline

ImPACTs Best Practices for Concussion Management for Schools and Teams


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Speed vs. Memory

Look for low scores and variability Be mindful of role of exertion with post-injury variability

Different areas of deficit with different

biomechanics and affected systems

1. Was baseline valid (Check Validity Index)

2. Comparison to baseline and RCIS?

3. Percentile score analysis

Interpretation Guidelines:

Analysis of Composite Scores

Sandbagging


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We have recently heard a great deal in the media

about athletes sandbagging the baseline test

(trying to set a low baseline to make it easier to

return to play).

How can you detect this using ImPACT?

Common question from clients

Answer:

Athletes routinely try to hide concussion symptoms

Athletes are always looking for ways to get back on field

Studies suggest that 53 percent of FB players had symptoms

but didnt report them (McCrea et al., 2004).

Some athletes may attempt to fool ImPACT but it is difficult to do

Validity Index is set up to catch them

Best way to prevent is to tell them up front that they

will most likely be caught and need to take test again!

Always Check validity index!!


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Research

Two Recent study with college athletes caught between89 and 95 percent of athletes trying to sandbag.

(see Erdal,Archives of Clinical Neuropsychology, 2012

and Schatz et al., Archives of Clinical Neuropsychology,

in Press).

Schatz and Glatts, 2013, Archives of Clinical NeuropsychologySandbagging Baseline Test Performance on ImPACT, Without

Detection is More Difficult than it Appears.

Tested 60 college students assigned to three groups:

Do Best, Nave Malinger, Coached Malinger 95% if nave and 100% of coached sandbaggers were detected

The Balance Error Scoring System (BESS) did not detect sandbaggers

Why do athletes sometimes attempt tosandbag their Baseline test?

(estimated rate is under 5 percent in HS students)

People in general are often more focused on

Short term gain rather than long-term risk

(other example: weight loss and dieting)

Examples: recent ESPN survey, survey of

Olympic Athletes

Athletes are highly motivated to play

Athletes are well-known to deny symptoms

of concussion when they occur

Recent Quote from NFL Player: You need to protect us from ourselves


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ImPACT Invalidity Criteria (Current)

Not all invalid scores indicate sandbagging(failure to understand directions, LD, ADD,

other factors)

Word memory below 69

Design Memory below 50

Xs and Os incorrect interference >30

Color Match total correct


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Case 1

First Hint.

Uniformly poor performance

Across all composite scores


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Word Memory below 69%

Design memory close

to below 50%

Three letter total correct


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Case 2

All composite scores very poor


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Poor performance but does not

exceed criterion (


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Summary:

Athletes are strongly motivated to

compete

Hiding symptoms has been linked to

the death of a number of kids

A minority may attempt to sandbag

A proactive approach is best

Always check validity index after

baseline

Open Q and A


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What is your post

exertional time frame

for giving the ImPACT,

baseline or post injury?

Is it 24 hours or longer?

ImPACT Training Questions:

What about multi-

sport players? When

do you test them?



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What are your

thoughts on ImPACT

testing with athletes

that are

symptomatic?


How many of the

invalidity criteria must

be met?

Is it just 1 or 2 or should

all?



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Where is the score of

18 on the

Word Memory test?


How would you interpret an athlete

with a normal baseline score but high

symptoms and 2 post injury scores

which are significantly diminished?

Also the last scores decreased in 3

areas but pt reporting no symptoms,normal saccades, gaze, no

convergence, and normal physical

exam/balance? she also was tested

too much (4 times in 4 days)?



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Does ImPACT send me anote if one of my

baseline tests is

potentially invalid?

(group testing of

athletes)


How many times would you

administer ImPACT, when

they are assymptomatic,

but they continue to fail

before you would have

them undergo more

thorough NP testing?



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Do you find that with an

"invalid" baseline in 1

composite area, that the

baseline can still be useful

with the other scores?


In a patient with dyslexia, he received normal

scores in his reaction time and his visual motor

speed composites.

His verbal and visual memory were below the

1st% both times we had him test.

(there was 10 days in between the test).

He was asymptomatic and no history of injury. We

accepted this second one as a baseline.

If he is injured I assume we would need to refer

him to a NP(I am a nurse practitioner and MD team)



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A low design memory score53% with all other areas of

the baseline being great

IMPACT flagged this test as

possible invalid.

How would we handle thisbaseline?


Is there one area, in the

post-injury test, that

consistently reveals a

low score?



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An athlete is symptom

free and able to handle

light exertion. How

frequently can he/she

be tested?


Is it possible for an

athlete to take the

baseline test athome?



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An athletes baseline test

showed a composite score

in the


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What are the guidelinesfor making return-to-

play decisions?

Are there official

numbers used for

making this decision?


Is it possible for a

student with any color-

vision deficiency to

complete theColor Match Module of

the test?



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Will using a touch

screen effect the

reaction time in

the ImPACT test?


For kids with learning

disabilities, how do I use

the normative data?



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Thank You


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Helpful Links

Peer Reference Articles

http://impacttest.com/uploads/resources/ImPACT_References_5-11-12.pdf

ImPACTs Client Resource Center

The resource center contains a wealth of information that is available to

you. In the center you will find fact sheets for parents, coaches andathletes. In addition there are training videos available as well as forms that

you are able to use and adopt and many other types of useful information

and forms.

http://impacttest.com/resources

password: ImClient2011

Free Apps

ImCATImPACT Concussion Awareness Tool was developed to educate

athletes, parents, teachers and coaches about common signs and symptoms

of concussions. For more information please click on the link below.

http://impacttest.com/imcat

ImPACTs Mobile Customer Center app for iPhone and iPad, ImPACTs

customers can access their Customer account from an iOS device. To

download your free ImPACT Mobile Customer Center please visit the app

store.

Centers for Disease Control and Prevention is a great resource to gatheradditional information regarding concussions.

http://www.cdc.gov/concussion/headsup/
http://impacttest.com/uploads/resources/ImPACT_References_5-11-12.pdfhttp://impacttest.com/uploads/resources/ImPACT_References_5-11-12.pdfhttp://impacttest.com/resourceshttp://impacttest.com/resourceshttp://impacttest.com/imcathttp://impacttest.com/imcathttp://www.cdc.gov/concussion/headsup/http://www.cdc.gov/concussion/headsup/http://www.cdc.gov/concussion/headsup/http://impacttest.com/imcathttp://impacttest.com/resourceshttp://impacttest.com/uploads/resources/ImPACT_References_5-11-12.pdf

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420 Final C-3 Keys to Interpretation Special Focus Sandbagging Handouts 87728