What is a Concussion Baseline Test?
A Concussion Baseline Test is an assessment conducted before any concussion occurs, often administered prior to the start of a sporting season. This test provides a snapshot of an athlete’s current cognitive and physical abilities, giving healthcare providers an objective reference point for comparison after an injury. If a concussion occurs during the season, the baseline test can be repeated, and the results compared to the pre-season test to better inform rehabilitation needs and ensure a safe and informed return-to-play process.
Why Obtain a Concussion Baseline Test?
Unfortunately, there is no single clinical test that definitively diagnoses a concussion. While blood biomarker research is progressing, widespread access to this type of medical testing is not yet available. Additionally, standard neuroimaging techniques like CT and MRI do not reliably detect concussions.
Healthcare providers rely on various functional evaluation measures, such as cognitive screening, balance testing, visual function tests, and exercise tolerance testing, to inform their clinical impression and provide tailored treatment strategies. Having a baseline test—that is, knowing how an athlete typically performs without a concussion—allows for a more personalized approach to clinical care and adds an additional layer of objectivity to the decision-making process.
It’s important to note that concussion assessment and treatment is a nuanced process, and your healthcare provider will consider more than just your baseline testing when determining your treatment and return-to-play plan.
Who Should Get a Concussion Baseline Test?
Obtaining a concussion baseline is generally not necessary or recommended for every athlete. Those who should consider a baseline test include athletes participating in contact-heavy sports (such as hockey, football, and rugby) or sports that pose a high risk of collision and contact. Athletes in competitive or representative streams of these sports, who have higher play volumes and greater contact exposure, may be at a greater risk of concussion. Additionally, athletes who have previously sustained concussions should consider obtaining a baseline test before further sport participation.
What’s Involved in Concussion Baseline Testing?
The components of a baseline test may vary based on the healthcare provider’s training and expertise, testing location, available equipment, and the preferences of the athlete, family, or team. Generally, it is recommended that a baseline test includes age-appropriate and validated cognitive assessment tools. One widely used computer test in sport concussion assessment is ImPACT (Immediate Post-Concussion and Cognitive Testing) (1).
What is the ImPACT Test?
The ImPACT test is a computerized neurocognitive assessment that evaluates several cognitive functions, such as memory, attention, reaction time, and information processing. By measuring these key cognitive areas before a concussion occurs, the ImPACT test provides a valuable baseline that can be compared to post-injury results, aiding healthcare providers in detecting any cognitive changes following a head injury.
The ImPACT test has been scientifically validated and is widely used in the management of concussions, especially in athletes. It’s part of a larger concussion management strategy and is often one component of a more comprehensive assessment process.
What Does the ImPACT Test Measure?
The ImPACT test assesses a range of cognitive functions commonly impacted by concussion. These include:
– Verbal Memory: This evaluates the ability to recall words and language-based information. This is particularly important, as memory issues are common after a concussion.
– Visual Memory: This measures the ability to recall shapes, patterns, and visual stimuli. Visual memory is often tested using image recognition tasks.
– Reaction Time: The test measures how quickly an individual can respond to stimuli, which is crucial in many sports where quick decision-making and responses are necessary.
– Processing Speed: This refers to how efficiently the brain can process information. A concussion can slow down processing speed, impacting how athletes react and perform.
The ImPACT test is structured in such a way that it can be administered quickly, usually in about 20 to 30 minutes. The data from this test provides a snapshot view of an athlete’s cognitive function and can highlight any clinically significant changes that may result from a concussion.
Limitations of the ImPACT Test
While the ImPACT test is a powerful tool, it’s important to recognize its limitations. The test does not diagnose concussions on its own and should not be used in isolation. Concussion assessment and management require a multi-faceted approach, which includes physical examinations, balance tests, symptom checklists, and medical history reviews.
Additional Baseline Test Components
Physical assessment screens are also often recommended as part of the baseline test. These include a variety of standardized tests designed to measure balance and postural stability, visual performance, and coordination—tests that are typically part of a standard concussion workup.
For example, a baseline assessor may ask an athlete to perform a balance task under several conditions (eyes open, closed, standing on firm ground or on a foam surface) – to evaluate the athlete’s overall stability. A standardized scoring system allows the healthcare provider to compare post injury balance performance to baseline values to better understand how the concussion may have impacted the athlete’s functional performance.
Alternative Baseline Testing Tools
Alternative tests may be selected by your healthcare provider in some circumstances, especially if they are involved with sideline support. The Sport Concussion Assessment Tool 6 (SCAT6) is a popular sideline assessment tool that may be used in some baseline testing scenarios (2).
For athletes under the age of 12, consult your healthcare provider about whether baseline testing is appropriate. Due to wide developmental variability in younger athletes, it is important to consider cases individually and use age-appropriate test applications, such as the Paediatric ImPACT test, which must be completed in person under clinical supervision.
Final Thoughts
By prioritizing awareness and proactive measures, we can better protect athletes and individuals from the potential risks associated with concussions. Remember, early detection and proper management are crucial for ensuring optimal recovery and long-term health.
- ImPACT Applications. Accessed Sep 11, 2024. https://impacttest.com/.
- Echemendia RJ, Brett BL, Broglio S, et al. Sport concussion assessment tool™ – 6 (SCAT6). Br J Sports Med. 2023 Jun;57(11):622-631.
