ImPACT Concussion Program

The ImPACT test is a computerized test to measure cognitive function of the brain primarily memory and reaction time. The ImPACT test is the most widely used computer concussion evaluation tool in the world. It is used by all the professional teams including the NFL, NHL, MLB, 7,400 high schools and 1,000 universities. ImPACT testing is 95% accurate in detecting deficits in brain function (measured from within hours to a few days) following a concussion.

Baseline testing is required for Bellevue School District athletes in ‘contact’ sports to establish a basis for comparison if a concussion is suspected. Your student-athlete had a baseline ImPACT test done prior to the competitive season by the Athletic Trainer. If and when a concussion is suspected the Athletic Trainer will repeat a post-concussion ImPACT test within 24-72 hours.

The Athletic Trainer will then contact the Bellevue School District’s ImPACT partner physician who will go online to review the results of the repeat ImPACT test and compare this to the baseline results. The doctor will then communicate with the school Certified Athletic Trainer as to whether there is or is not a concussion. If there is a concussion, there will need to be communication between the student-athlete and the Bellevue School District partner doctor (Dr. DePuydt) in his office to review the results of the ImPACT test and discuss the treatment program. Part of this discussion will cover academic accommodations if necessary for the athlete during recovery.

Before any athlete can return to full participation or competition, there is a mandatory 5-Step Return to Play Progression that each athlete must complete. The progression begins after:

  1. It is determined that the athlete is asymptomatic
  2. The repeat ImPACT test scores are as good or better than the baseline scores
  3. The patient’s neurologic exam needs to be normal

Once the criteria have been met, it is the role and responsibility of the Certified Athletic Trainer or Athletic Director to complete the 5-Step Progression with the athlete. Important information to remember during the implementation of the care plan includes:

  • Coaches, parents, team volunteers, teachers, and other students cannot administer or oversee the progression.
    • Information provided to the Athletic Trainer from these care team members are useful tools, but the Athletic Trainer and Athletic Director oversee the care plan.
  • If symptoms should occur during one of the five stages, the athlete is removed from that day’s activities, rested, and re-evaluated 24 hours later by the Athletic Trainer.
    • If the athlete presents symptom-free then the previous day’s step is repeated.
  • Once the athlete has successfully completed each stage, he/ she may resume full practice participation per the approval of the Athletic Trainer.
  • Competition participation may only be engaged in if the athlete has participated in at least one day of full practice prior to the match/ game/ meet, etc.; the actual competition cannot constitute the first full practice.

What is a concussion?

  • A concussion IS NOT a structural anatomic injury, therefore an MRI or CT scan are normal.
  • A concussion IS a mild traumatic brain injury.
  • Specifically, a concussion is a biomechanical and physiological alteration of the neurons in the brain which creates an energy crisis. There is a massive release of neurotransmitters that interferes with cognitive function, particularly memory and reaction time, which are measured by the ImPACT Program.

Symptoms may include one or more of the following:

Headaches Feeling sluggish or slowed down Sadness
“Pressure in head” Feeling foggy or groggy Nervousness or anxiety
Nausea or vomiting Drowsiness Irritability
Neck pain Change in sleep patterns More emotional
Balance problems or dizziness Amnesia Confusion
Blurred, double or fuzzy vision “Don’t feel right” Concentration or memory problems (forgetting game plays)
Sensitivity to light or noise Fatigue or low energy Repeating the same question/comment

Signs observed by teammates, parents and coaches include:

Appears dazed Slurred speech
Vacant facial expression Shows behavior or personality changes
Confused about assignment Can’t recall events prior to hit
Forgets plays Can’t recall events after hit
Is unsure of game, score or opponent Seizures or convulsions
Moves clumsily or displays loss of coordination Any change in typical behavior or personality
Answers questions slowly Loses consciousness

What can happen if my child keeps on playing with a concussion or returns to soon?

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student athlete’s safety.

If you think your child has suffered a concussion:

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The “Zackery Lystedt Law” in Washington requires the consistent and uniform implementation of long and well established return to play concussion guidelines that have been recommended for several years:

“A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time” AND “…may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”.

You should also inform your child’s coach if you think that your child may have a concussion Remember it’s better to miss one game than miss the whole season. And when in doubt, the athlete sits out.

Return to Play Following a Concussion or Mild Traumatic Brain Injury

According to the Washington State House Bill (1999) concussions are one of the most commonly reported injuries among children and adolescents who participate in sports and recreational activities. The Centers for Disease Control and Prevention estimate that as many as three million nine hundred thousand sports-related and recreation-related concussions occur in the United States each year. The risk of catastrophic injury, or death, resulting from a concussion or brain injury is significantly increased if not properly evaluated and managed. Therefore the Bellevue School District complies with Washington State House Bill 1824, more commonly referred to as the Lystedt Law, which states that any youth athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussions or head injuries.

The law holds that each athlete withheld must have written medical clearance releasing them back to full activity before any physical activity is resumed. The Bellevue School District, in accordance with Board Policy and Procedure 3422 partners with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) which is “the most-widely used and most scientifically validated computerized concussion evaluation system.  ImPACT provides trained clinicians with neurocognitive assessment tools and services that have been medically accepted as state-of-the-art best practices — as part of determining safe return to play decisions.” (

Licensed healthcare providers currently allowed return-to-play authorization include:

  • Medical Doctors (MD)
  • Doctor of Osteopathy (DO)
  • Advanced Registered Nurse Practitioners (ARNP)
  • Physician’s Assistants (PA)
  • Licensed Certified Athletic Trainers (ATC, AT/L)*

Licensed healthcare providers that cannot provide return to play authorizations include:

  • Physical Therapists (DPT, PT, FAAOMPT)
  • Physical Therapist Aides
  • Chiropractors (DC)
  • Dentists (DDS)

Healthcare Providers

The Bellevue School District, through its partnership with ImPACT, will include information from healthcare providers when an athlete is examined post-concussion. However, final approval for the return to play protocol must include a recommendation from a Credentialed ImPACT Consultant. There are a number of Credentialed ImPACT Consultants from which families can choose to visit. As always, a family can choose to see their primary care physician to seek information regarding care as well. Physicians/clinics on the list of Credentialed ImPACT Consultants include:

Swedish Spine, Sports & Musculoskeletal Medicine

Renee Low, PhD, CIC

1600 East Jefferson St Suite 300
Seattle , WA 98122
PHONE: (425) 498-2272
View Details | Get Directions

Washington Institute Of Sports Medicine

Thomas Depuydt, MD, CIC

12707 120th Ave NE Ste 100
Kirkland, WA 98034
PHONE: (425) 820-2110
View Details | Get Directions


Harborview Medical Center

Stan Herring, MD, CIC
David Coppel, PhD, CIC

908 Jefferson Street
Seattle, WA 98104
PHONE: 206-744-8000
Get Directions


Seattle Sports Concussion Program

Stan Herring, MD, CIC
David Coppel, PhD, CIC
David Breiger, PhD

4800 Sandpoint Way NE
Seattle, WA 98105
PHONE: (206) 987-2109
View Details | Get Directions

This clinic is associated with Children’s Hospital

Brain Centers NW

David Burns, DACNB

2115 NW Poplar Way
Issaquah, WA 98027
PHONE: (800) 688-1183
Get Directions

Harborview Medical Center – Pediatric Clinics

Kyle Yasuda, MD

325 9th Ave
Seattle, WA 98124
PHONE: (206)744-9511
Get Directions

5- Step Return to Play Progression

Step 0 Rest until 24h symptom free Rest and relaxation
Step 1 Light Aerobic Activity Walking, stationary bike without resistance
Step 2 Sports- Specific Activity Running/ Jogging – No contact activity
Step 3 Non- Contact Training Drills Drills without possibility for contact/ may begin lt. resistance tr.
Step 4 Full Practice Normal practice activity (full pads/ full gear)
Step 5 Full Participation Normal game/ meet/ competition activity