The simplest definition of a concussion baseline test is a series of physical and cognitive tests that measure healthy brain function before a sports season starts – and prior to an injury. In the event of a concussion, the results of these tests can be used as a comparison to help your healthcare provider make return-to-sport decisions.
Relying on symptoms to determine recovery is risky
Symptoms disappearing or going away after a concussion is considered a poor indication of brain recovery. If a concussed athlete shows no more symptoms, this does not mean that they have fully recovered from their concussion.
A concussion causes disturbances in brain cells, changes in blood flow to the brain, and a number of other functional issues.[1,2] Research shows that before full recovery from a concussion, the brain is very vulnerable. Even smaller impacts could cause another concussion, which could result in severe brain injury or, in rare cases, death.[3,4]
The safest thing that a concussed athlete can do is avoid returning to high-risk sports until after they have fully recovered from their concussion; not just from their symptoms, but also from a brain function standpoint.[5,6,7]
How can a concussion baseline test help?
When properly used and interpreted, a concussion baseline test can add useful information to the management of concussions by giving healthcare practitioners insight into an athlete’s individualized pre-injury function and abilities. Simply, we have a better understanding of an athlete’s healthy state and what type of results they should get when fully recovered.
Having access to these test scores after a concussion injury can provide healthcare practitioners with a set of personalized, objective data that could be used to make more informed and safer return to play decisions for an injured athlete.
What to look for in a concussion baseline test?
Baseline testing is more than just a computerized neurocognitive test. These are proven to be insufficient on their own, and can have reliability and validity issues. [5,6,7,8,9,10]
A multi-modal, comprehensive baseline test has many tests, which has shown to have better reliability and utility.
This is why Complete Concussion Management has built our baseline test battery around a comprehensive series of tests, which includes concussion and medical history, symptom score, orientation, auditory memory, concentration, visual tracking and processing speed, balance, postural sway, reaction time, delayed recall, neurocognitive testing and more. A similar protocol is endorsed in the new National Concussion Guidelines for Athletes released by the Canadian Olympic and Paralympic Committee.
The more tests, the better. Experts continue to agree that no one test is sufficient to detect the full spectrum of concussion. In fact, multimodal baseline testing is now recommended or considered to be a helpful tool by the following medical groups:
- Ontario Neurotrauma Foundation Pediatric Concussion Guidelines (link)
- The International Consensus Statement on Concussion in Sport (link)
- The Centers for Disease Control & Prevention (link)
- The NCAA Best-Practices Handbook (link)
- The National Athletic Trainers’ Association Concussion Position Statement (link)
- The International Ice Hockey Summit – Action on Concussion (link)
Is Baseline Testing Right for Everyone?
No. We don’t yet recommend baseline testing for athletes younger than 10 years old as they tend to change quite rapidly over time and most of the concussion tests available have only been validated in athletes over 10. Furthermore, although concussions can happen anywhere, athletes who play sports with a low risk of concussion (swimming, golf, tennis, etc.) would have to consider whether baseline testing adds enough value given their relatively low risk of concussion injury.
The rule of thumb to consider whether baseline concussion testing is right for you is:
Are you over the age of 10 and do you participate in a collision or high-speed sport?
- Yes – consider annual comprehensive baseline testing
- No – baseline testing won’t hurt, but should not be a requirement for participation
 Giza CC, Hovda DA. The New Neurometabolic Cascade of Concussion. Neurosurgery. 2014;75:S24–S33.
 Signoretti S, Lazzarino G, Tavazzi B, Vagnozzi R. The Pathophysiology of Concussion. PM&R. 2011;3(10):S359–68.
 Vagnozzi R, Tavazzi B, Signoretti S, Amorini AM, Belli A, Cimatti M, et al. Temporal window of metabolic brain vulnerability to concussions. Neurosurgery. 2007;61(2):379–89.
 Vagnozzi R, Signoretti S, Tavazzi B, Cimatti M, Amorini AM, Donzelli S, et al. Hypothesis of the Postconcussive Vulnerable Brain: Experimental Evidence of Its Metabolic Occurrence. Neurosurgery. 2005;57(1):164–71.
 McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250–8.
 Broglio SP, Ferrara MS, Macciocchi SN, Baumgartner TA, Elliott R. Test-retest reliability of computerized concussion assessment programs. J Athl Train. 2007 Oct;42(4):509–14.
 Resch J, Driscoll A, McCaffrey N, Brown C, Ferrara MS, Macciocchi S, et al. ImPact Test-Retest Reliability: Reliably Unreliable? J Athl Train. 2013 Jul;48(4):506–11.
 Kontos AP, Braithwaite R, Dakan S, Elbin RJ. Computerized Neurocognitive Testing within 1 Week of Sport-Related Concussion: Meta-analytic Review and Analysis of Moderating Factors. J Int Neuropsychol Soc. 2014 Feb 13;20(03):324–32.
 Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, et al. American Medical Society for Sports Medicine position statement: concussion in sport. British Journal of Sports Medicine. 2012 Dec 13;47(1):15–26.
 Mayers LB, Redick TS. Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues. Journal of Clinical and Experimental Neuropsychology. 2012 Mar;34(3):235–42.