Neurocognitive Assessment and ICAP for Concussions

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What is a Neurocognitive Assessment/Test?

A neurocognitive assessment or test provides information about how a child or teens brain is working by objectively evaluating thinking skills, memory, cognition, and reaction time. Unlike a CT or MRI, which evaluates brain structure, neurocognitive testing evaluates brain function, which is the source of symptoms in concussions.  After a concussion, this information is used to answer questions about specific areas of functional impairment, whether the brain is fully healed, why difficulties might be seen, whether a return to sports is sensible, and how best to treat any school, thinking, or behavioral problems. SPARCC is staffed by the only dual board-certified pediatric sports medicine physician in Tucson credentialed in imPACT neurocognitive testing with particular expertise in how to evaluate and manage concussions in children, teenagers, and adults.

What is involved in a neurocognitive assessment after a concussion?

After a concussion, a neurocognitive assessment typically involves five parts:

  1. Reviewing information about the injury, current problems, and relevant medical/educational background.
  2. Administering a 30-45 min computerized neurocognitive test called imPACT to evaluate memory (verbal, sequential, and visual), attention, processing speed, reaction time, and other thinking areas
  3. Review of test and interpretation of the results
  4. Formulation of an Individualized Cognitive Action Plan (ICAP) based on test interpretation
  5. Providing feedback to patient, parents, school/work, and professionals about the test results and the ICAP.

What is ImPACT testing?

ImPACT is the computerized neurocognitive test we utilize for all our patients.  It is a 30-45 minute test on the computer that assesses memory, processing, attention, reaction time utilizing 6 different interactive modules (see example). ImPACT is a well validated and reliable tool with high sensitivity for objectively identifying subtle cognitive deficits.   ImPACT offers the richest research background and normative database of all computerized tests available (see references).  Dr. Mortazavi is a Credentialed Impact Consultant “CIC” and is involved in regular continuing education with ImPACT.

What is an ICAP and what does it entail?

The Individualized Cognitive Action Plan (ICAP) is a 1-2 page individualized report produced by Dr. Mortazavi to cover specific return to learn academic supports after a concussion. This includes recommendations on daily school attendance, workload, testing, homework, extracurricular activities, etc.  Specific accommodations will be suggested based on physical and cognitive impairments noted on the physical exam and neurocognitive testing.  Repeat testing and a revised ICAP may be necessary every few weeks as the student recovers. (See example ICAP)

How much time do assessments take?

After a concussion, the computerized neurocognitive testing typically lasts 25-45 minutes, which does not include any review or interpretation of the test.  Review, interpretation, and formulation of an ICAP typically will require 24-48 hours at which time reports will be available in your patient portal.  In some situations, assessments can take more time, such as when concussions have occurred many months prior to the evaluation, after more severe injuries, or when baseline testing needs to be retrieved from an outside facility.

Who should be present at the session?

In addition to the child or teen, at least one caregiver should be present for the appointment. Computerized testing does need to be done in a distraction free environment, so caregivers will be asked to wait in the lobby for the duration of the test.  Cell phones or any other distracting items should be left with the caregiver.

How will I find out about the results?

In all cases, an ICAP report is written summarizing the results and recommendations. The report is sent directly to your patient portal as soon as it is completed and signed off and typically copies are faxed to primary healthcare providers and other involved professionals (with parental consent).

How do I get the results to my child’s school/teachers?

We recommend that you deliver the ICAP to your child’s school request a meeting counselors/teachers to inform everyone of the plan.  It is critical that everyone is advocating for your child, as concussed students often cannot self-advocate.  It is recommended to appoint a team leader or point person at school for regular check-ins with the student and to make sure that the plan is being implemented.

By Mo Mortazavi, MD