impact clinical report...impact clinical report sample sam the cognitive efficiency index measures...
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ConcussionManagement.comPage 1
Wrestling
130lbs
Moderate
2
Current sportPrimary position/event/classCurrent level of participationYears of experience at this level
13
No
No
No
No
No
Years of education completed (excluding kindergarden)Received speech therapyAttended special education classes
Repeated one or more years of schoolDiagnosed learning disabilityDiagnosed with ADD/ADHD
US
English
SpanishNative Country/RegionNative Language
Second Language
Date of birthOrganization
Jan 01, 1990
School 123
MaleGender
Name ImPACT Passport ID K9LH-BPBZ-L9E3Sample Sally
ImPACT Clinical ReportSample Sam
CONCUSSION HISTORY
02
01
01
00
00
10
Number of times diagnosed with a concussion (excluding current injury)
Number of concussions resulting in:- Loss of consciousness- Confusion- Difficulty remembering events thatpocurred immediately after injury- Difficulty remembering events thatpocurred
Total games missed as a result of all concussions combined
Yes
Yes
No
No
No
Yes
No
No
No
No
Treatment for:- Headaches by physician- Migraine headaches by physician- Epilepsy/seizures- Brain surgery- Meningites- Substance or alcohol abuse- Psychiatric condition (depression/panxiety)
Diagnosed with dyslexiaDiagnosed with autism
Strenuous exercise in the last 3 hours
Copyright, ImPACT Applications, Inc., 2019. All Rights Reserved.
Page 2
ImPACT Clinical ReportSample Sam
The Cognitive Efficiency Index measures the interaction between accuracy (percentage correct) and speed (reaction time) in seconds on the Symbol Match test. This score was not developed to make return to activity decisions but can be helpful in determining the extent to which the test taker tried to work very fast on symbol match (decreasing accuracy) or attempted to improve their accuracy by taking a more deliberate and slow approach (jeopardizing speed). Low scores (0 to .20) may in some cases suggest a very poor performance on this subtest.
Scores in bold RED type exceed the Reliable Change Index (RCI) when compared to the baseline score. However, scores that do not exceed to RCI index may still be clinically significant. Percentile scores if available are listed in small type.
ImPACT Applications clinical reports are not intended to provide a diagnosis or decision about the test taker. Testing results should be interpreted only by qualified healthcare professionals.
Exam Type
Age When Tested
Date Tested
Concussion In Last 6 Months
Exam Language
Test Version
Hours slept last night
Medication
Memory composite (verbal)
Memory composite (visual)
Visual motor speed composite
Reaction time composite
Impulse control composite
Total Symptom Score
Cognitive Efficiency Index
COMPOSITE SCORE
ConcussionManagement.comCopyright, ImPACT Applications, Inc., 2019. All Rights Reserved.
Page 3
ImPACT Clinical ReportSample Sam
WORD MEMORYHits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory % correct
Total percent correct
DESIGN MEMORYHits (immediate)
Correct distractors (immed.)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory % correct
Total percent correct
X’s AND O’sTotal correct (memory)
Total correct (interference)
Average correct RT (interference)
Total incorrect (interference)
Average incorrect RT (interference)
SYMBOL MATCHTotal correct (visible)
Average correct RT (visible)
Total correct (hidden)
Average correct RT (hidden)
COLOR MATCHTotal correct (visible)
Average correct RT (visible)
Total correct (hidden)
Average correct RT (hidden)
THREE LETTERSTotal sequence correct
Total letters correct
% of total letters correct
Average time to first click
Average counted
Average counted correctly
ConcussionManagement.comCopyright, ImPACT Applications, Inc., 2019. All Rights Reserved.
Page 4
ImPACT Clinical ReportSample Sam
First column displays symptoms immediately before test.
The ImPACT Symptom Increase Score
SYMPTOM SCOREHeadache
Nausea
Vomiting
Balance Problems
Dizziness
Fatigue
Trouble falling asleep
Sleeping more than usual
Sleeping less than usual
Drowsiness
Sensitivity to light
Sensitivity to noise
Irritability
Sadness
Nervousness
Feeling more emotional
Numbness or tingling
Feeling slowed down
Feeling mentally foggy
Difficulty concentrating
Difficulty remembering
Visual problems
Total Symptom Score
ConcussionManagement.comCopyright, ImPACT Applications, Inc., 2019. All Rights Reserved.
Page 5
SYMPTOM SCOREIMPULSE CONTROL COMPOSITE
REACTION TIME COMPOSITEVISUAL MOTOR COMPOSITE
MEMORY COMPOSITE (VISUAL)MEMORY COMPOSITE (VERBAL)
ImPACT Clinical ReportSample Sam
ConcussionManagement.comCopyright, ImPACT Applications, Inc., 2019. All Rights Reserved.