In 2008, the ISCN was formed to reduce the number of concussions that went undetected, untreated, or improperly handled in athletes. The Network is an initiative of the Forté Orthopedic Research Institute, which is a separately incorporated not-for-profit 501(c) 3 organization.

The ISCN is composed of members from a variety of disciplines at each level of contact with the athlete. Those who make up the front line of concussion recognition and evaluation include certified athletic trainers, athletic directors, school nurses, coaches, and parents. These people are vital to identifying an athlete who may be concussed, as well as monitoring the athlete and seeking emergency care if needed. Physicians, psychologists, neurologists, neurosurgeons, and neuropsychologists guide the management of concussions and return to play. Resolution of signs and symptoms, a normal neurological exam, and a graded activity progression program help to determine when the brain has recovered. In certain cases, neurological testing may be necessary and is left to the discretion of the physician.

ISCN Administrative Team

Terry Horner, MD
Terry Horner, MDCo-Director
Daniel Kraft, MD
Daniel Kraft, MDCo-Director
Amanda Smith, MS, LAT, ATC
Amanda Smith, MS, LAT, ATCProgram Coordinator

Keys to Concussion Management

Treat the Athlete


Why is the computerized neurocognitive baseline testing discontinued in athletes?
Answer: Recent research on computerized neurocognitive baseline testing shows that it barely meets the sensitivity and specificity to be a reliable test. Also, it is done in a group setting often causing the athlete to be distracted. Also the motivation to take the baseline test is not the same as taking the post-injury test when the athletes know they have to pass as part of the return to play protocol.

Will the post-injury computerized neurocognitive tests still be done?
Answer: There may be times that the post-injury test will be done in certain circumstances which will be left up to the discretion of the treating MD.

Is neurocognitive testing necessary when evaluating an athlete after a concussion?
Answer: Almost all athletes recover from a concussion without any side effects. However, in some instances where recovery is delayed or pre-existing conditions complicate the post injury course a more specific form of neurocognitive testing may be required. There is presently ongoing research to develop the best and most valid neurocognitive testing for concussions.

Are there any instances where a computerized neurocognitive baseline test would be done?
Answer: Pre-existing conditions such as a learning disability and sometimes ADD/ADHD might be necessary to have a baseline to compare to a post-injury test, again that would be at the discretion of the physician.

If the NFL and college athletics are still using the computerized neurocognitive baseline testing, why aren’t middle school and high school athletes being tested?
Answer: The governing body for the NFL and college athletics (NCAA) establish their own practices. In the NFL a hybrid baseline test which is not computerized is being compared to the ImPACT to decide which is the better test. The NCAA is still using computerized cognitive testing but we suspect that will change when data is reported from a very large concussion study funded by NCAA and DOD.

As an athletic director, what should I do next in regards to computerized baseline neurocognitive testing?
Answer: The letter from the ISCA is only a recommendation. We suggest that you speak directly with your sports medicine team (AT & Physician) to determine if your school will make any changes to your current concussion management protocols.

Post-Concussion Syndrome

A very large percentage of athletes who sustain a concussion recover completely, usually in a relatively short period of time. However, some athletes may experience prolonged symptoms and rarely permanent injury. However, some athletes have persistent symptoms after the concussion has resolved. Resolution of these symptoms may require specialty consultation. These symptoms may be related to an underlying condition that has been exacerbated by the concussion. These may include a pre-existing psychological condition with anxiety and depression or others that often mimic the symptoms common to concussion. Treatment often requires neuropsychological consultation and/or medication as well and as neurocognitive therapy. Early recognition and treatment of concussion may lessen the likelihood of developing Postconcussion Syndrome.

Determine Return to Play

There are necessary steps that are to be followed before an athlete should be allowed to return to full competition. To ensure full recovery of the brain, an integral progression of both physical and cognitive activity should be initiated in the first few days when symptoms begin to resolve symptoms as a guide to continue the activity. These steps should be followed by a healthcare professional trained in the treatment and management of concussions.

  • Athlete must be asymptomatic at rest.
  • A normal neurologic examination.
  • Athlete must be asymptomatic physically and cognitively with increased activity and pass an activity progression protocol.

Must have a written clearance from a healthcare provider trained in the management of concussion.
Unlike some other sports injuries where the athlete can return to play when they attain 75% or greater recovery without a significant risk of recurrent injury, a brain injury should be 100% recovered before returning to full activity.

Establish A Concussion Protocol For Each Organization

Each organization should establish its own concussion protocol outlining how concussions will be managed within their organization. The directors have created a set of guidelines on the state-of-the-art concussion management of student-athletes that can help create a policy for the organization as discussed in the Keys To Concussion Management.

Rules and Laws

Some athletic governing bodies have created mandates on concussion management for athletes who play in their organization. Listed is a sampling of the mandates that have been initiated to protect the athletes.

Need More Information?

Please feel free to contact us with any questions or concerns related to concussions, implementing ImPACT, or the ISCN. Contact us if you have attended a training session and have not received your log-in information.