Ask a Doctor with Dr. Mark Lovell

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Q: What if an athlete scores normally on ImPACT but is still having symptoms, could this athlete be cleared to return to play?

A: No. Consistent with international return to play guidelines, all athletes should be symptom free at rest and following physical exertion before returning to play REGARDLESS of whether or not their ImPACT scores are within normal limits. Many athletes can have persistent symptoms such as headache, dizziness and balance dysfunction, despite being normal in terms of memory and cognitive speed. Conversely, the athlete may have ongoing cognitive issues but not have other symptoms.

Q: How does ImPACT determine which composite scores are normal, compared to baseline test results?

A: ImPACT uses reliable change index or RCI scores. These scores take into account the expected change from taking the test more than one time. If a score fits outside of the RCI boundary, it will appear in bold lettering in the report.

Q: One of my athletes is having difficulty reading following her concussion? Is this expected after a concussion and how can I help her?

A: Concussed athletes often have difficulties reading after an injury. This can occur for several reasons. First of all, the athlete may have cognitive problems with focus or concentration that make it difficult to retain what they read. In addition, it is quite common for an athlete to have difficulty with visual tracking after a concussion. In other words, the eyes may not move in a coordinated fashion or they may have jerky movements of the eyes called nystagmus. Vision may also be blurry. Attempting to read under these conditions often results in a worsening of headaches and an increase in nausea and other symptoms. In many athletes, this goes away in one to two weeks but can be persistent in some athletes. If your athlete has persistent difficulties with vision, a visit to a visual specialist is often warranted. In some situations, visual therapy may be helpful.

Q: How often should an athlete be evaluated after a concussion?

A: This may vary based on the symptoms reported by the individual athlete but a general rule of thumb is every 5 to 10 days. We DO NOT recommend testing an athlete on a daily basis. This often results in an increase in symptoms and is not necessary. Another good rule of thumb is not to test the athlete more than twice within a 7 day period.

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