What is Concussion Baseline Testing?

Baseline Concussion testing is a crucial pre-injury assessment tool for athletes, evaluating their cognitive abilities and other neurological functions. This assessment, conducted before any potential head trauma, establishes a benchmark for comparison in the event of a concussion. It assists medical professionals such as athletic trainers, physiotherapists, and chiropractors in accurately diagnosing concussions and helping with concussion management.

By tracking changes from the baseline, healthcare providers can make informed decisions regarding an athlete’s safe return to play, ensuring their overall well-being and reducing the risk of long-term consequences associated with repeated head injuries.

How Does Baseline Testing Work?

For a concussion baseline test to be reliable, it must include a comprehensive battery of tests. These tests typically encompass multiple aspects of brain function, such as cognitive testing (including memory, attention, and processing speed), balance assessment, reaction time, and self-reported symptoms, conducted when the athlete is healthy and before a concussion occurs.

These tests establish a baseline of an individual’s healthy brain function, serving as a comparison tool in case of a suspected concussion. If an individual sustains a head injury, these baseline test results provide a valuable benchmark for medical professionals to compare to post-injury testing results and aid in determining concussion recovery.

Baseline testing is typically conducted for athletes, especially those involved in high-impact or contact sports. It helps concussion experts make more accurate diagnoses and informed decisions about return-to-play protocols, ensuring a safer and more individualized approach to managing concussions and reducing the risk of further injury.

Why Athletes Should Have Baseline Concussion Testing.

Individualized Baseline Information:

Provides a personalized baseline for each athlete before any head injury occurs.

Aids in Concussion Diagnosis:

Offers a point of comparison to assess a concussion by comparing post-injury concussion test results with the baseline, helping in a more accurate diagnosis.

Objective Evaluation:

Offers objective data for medical professionals to measure the extent of impairment caused by a concussion, allowing for better treatment.

Safer Return to Play Decisions:

Guides the gradual return-to-play process by tracking recovery progress against the baseline, reducing the risk of premature return to activity.

Concussion Education and Awareness Tool:

Raises awareness about the seriousness of concussions and encourages proactive measures among athletes, coaches, parents, and sports organizations.

These benefits collectively contribute to a more comprehensive concussion care and management approach.

What To Expect During Concussion Baseline Testing.

Physician performing concussion baseline test on a patient

Medical History and Concussion History

It is critical to gather information about the patient’s general health and, specifically, any history of previous concussions during the baseline test. This information is significant as it allows healthcare professionals to understand the individual’s overall health status and prior history of concussions. We also want to know about a history of headaches (e.g., migraine), mental health diagnoses (e.g., anxiety/depression/PTSD), and learning disorder/disability (e.g., ADD/ADHD).

Concussion Symptoms Evaluation

The individual must fill out a 22-symptom scale (i.e., PCSS from the SCAT/SCOAT-6), listing any symptoms they may be experiencing and their severity. This can include headaches, dizziness, concentration difficulties, or other relevant symptoms. In the absence of a concussion, this would establish what is normal for the individual. Following a concussion, this information would help medical professionals to identify any changes or increases in symptoms.

Research suggests that many individuals exhibit certain symptoms without ever experiencing a concussion. A study published in the Journal of Neurotrauma reported that up to 40% of healthy, non-concussed athletes have one or more symptoms typically associated with a concussion, such as headache, dizziness, or difficulty concentrating. This is especially prevalent in adolescents. Therefore, the presence of symptoms post-injury does not necessarily confirm a concussion, underlining the importance of comparing post-injury symptoms with those recorded during a pre-injury baseline test. This comparison allows healthcare providers to determine whether the symptoms are a result of the concussion or were pre-existing, ensuring more accurate diagnosis and treatment plans.

Standard Assessment of Concussion (SAC)

This part of the testing primarily involves cognitive testing of orientation, immediate memory, and concentration. The SAC is particularly vital for sideline and immediate post-concussion assessment. It is a crucial tool for diagnosing a concussion shortly after an incident occurs. The results are then compared to the baseline values recorded pre-season. This comparative analysis aids in making an accurate and immediate diagnosis, which is critical in a sideline setting where quick decisions about an athlete’s ability to continue playing must be made. It’s important to note that while SAC is valuable in the diagnosis of a concussion, its usefulness becomes less significant in guiding return-to-play decisions.

King Devick Testing

The King-Devick Test is a timed rapid number naming assessment where the individual reads aloud single-digit numbers displayed on test cards. It evaluates an individual’s eye movements, attention, and concentration — all key areas a concussion could impact. Post-injury, the same test is administered, and if the time needed to complete the test increases from the baseline or if more errors are made, it’s a strong indication of a possible concussion.

The King-Devick test is highly effective due to its ability to capture the impairment of several different brain functions, including those controlling eye movement, language, attention, and other cognition aspects often affected by concussions. The King-Devick test has been extensively validated in research studies as an effective diagnostic tool for immediate post-concussion assessment on the sidelines during sporting events.

Balance Testing

Man performing the Balance Error Scoring System (BESS) test as a part of their baseline concussion test

Balance Error Scoring System (BESS)

The Balance Error Scoring System (BESS) test is an effective tool for assessing postural stability, an essential aspect of neurologic function that can be affected by concussions. The athlete is asked to stand in three different stances (double leg, single leg, and tandem stance). Each stance is held for 20 seconds with eyes closed. The healthcare provider observes the individual for any errors. The total number of errors made in all stances constitutes the final BESS score. A higher score indicates worse balance, which can be a sign of a concussion if compared to the baseline test results.

The BESS test is highly effective in diagnosing a concussion because it objectively measures balance and stability. However, it’s essential to note that BESS is only reliable immediately after a concussion and may not be the most reliable tool for guiding return-to-play decisions. This is primarily because BESS scores have been shown to improve within a few days post-concussion. Therefore, passing the BESS test post-injury does not necessarily mean full recovery from a concussion, and return-to-play decisions should be made considering a more sensitive test like the Postural Sway tool on the Concussion Tracker App and the Dual Task Tandem Gait Test. Complete Concussions has recently made the BESS test an optional test, since research shows our other two tests are more sensitive and reliable. 

Wheelchair Error Scoring System (WESS)

While Complete Concussions is phasing out the use of the BESS test, the Wheelchair Error Scoring System (WESS) test is still encouraged for wheelchair athletes. The WESS is specially designed for wheelchair athletes, enabling effective evaluation of balance in this group of individuals. Much like the BESS test, the WESS has been specifically adapted for athletes who utilize wheelchairs. Rather than standing, the athlete maintains a seated position in their own wheelchair and performs a series of balance tasks, such as leaning in various directions without arm support, maintaining stability during head turns and eye closures, and performing functional reaching tasks. Errors are counted each time the athlete needs to use their arms or feet to regain balance or prevent a fall, or if they fail to maintain the required posture. The total number of errors made across all tasks is the final WESS score, with a higher score indicating worse balance. The WESS test is highly effective in identifying potential balance impairments following a concussion in wheelchair athletes. It provides a valuable comparison point for post-injury assessments and contributes to comprehensive concussion management in wheelchair athletes.

Concussion Tracker App POSTURAL SWAY TOOL

The Concussion Tracker App Postural Sway Tool provides an objective, quantifiable measure of balance control and postural sway, both of which can be altered following a concussion.  The app evaluates the individual’s postural control and sway in 5 different test positions. The advantage of using the Concussion Tracker App is its ability to discern subtle changes in balance that may not be apparent through observation alone in the BESS. Studies have shown that postural sway can take as long as 30 days to improve post concussion. This sensitivity makes it a superior tool for guiding return-to-play decisions.

Dual Task Tandem Gait

The Dual Task Tandem Gait test is a crucial component of concussion baseline testing. It is a dynamic balance test that assesses both cognitive and motor abilities. The test involves the individual walking heel-to-toe in a straight line, while simultaneously performing a cognitive task, such as counting backwards by 7. The time taken to complete the task is measured.

The Dual Task Tandem Gait test is particularly advantageous in concussion assessment as it evaluates the ability to perform simultaneous cognitive and motor tasks, a skill set often compromised following a concussion. Researchers have found that individuals with a concussion take significantly longer to complete the Dual Task Tandem Gait test than healthy controls, making it a sensitive tool for identifying potential concussions.

In the event of a suspected concussion, the test results should be compared to the baseline data obtained pre-season to identify any significant changes. Studies have emphasized the importance of the Dual Task Tandem Gait test in the return-to-play decision-making process, highlighting its sensitivity in identifying persistent deficits in dual-task performance even after other symptoms have resolved. This makes it a reliable tool in concussion management, ensuring a safer return to play.

Reaction Time Testing

Reaction time is often impaired after a concussion, which is why it’s essential to include a reaction time test in the battery of concussion baseline tests. During a post-concussion assessment, the same test is administered, and if the reaction time has significantly increased, it is an indication of a possible concussion.

Reaction time is especially important in sports where quick reactions are crucial, as a slower reaction time can impact performance and increase the risk of further injury. Reaction time can be impaired for 21-59 days, making this a durable metric in the return-to-play process. This test effectively complements the other tests in the concussion baseline testing protocol, contributing to a comprehensive evaluation of the individual’s cognitive and neurological state.

Neurocognitive Testing

The DANA (Defense Automated Neurobehavioral Assessment) Neurocognitive Test is a powerful computerized neurocognitive test, similar to the ImPACT test. It’s designed to assess cognitive efficiency and function. It involves a series of short, game-like tests that measure aspects such as memory, reaction time, and processing speed – cognitive abilities that can be impacted by a concussion. This test is particularly effective as it provides real-time, objective data about cognitive performance.

The DANA test is portable and can be administered on any smartphone or tablet, making it an ideal tool for baseline testing in the field or on the sidelines. The results are instantly compared to the baseline values, helping medical providers to make immediate and informed decisions about an individual’s possible concussion and the appropriate next steps.

Download Our Concussion Tracker App Guide!

Factors to Consider During Baseline Testing.

While baseline testing, it’s crucial to consider several factors that may influence the test results. These include the individual’s age, gender, history of concussions, and current physical and mental health. Any recent illnesses or fatigue may affect the baseline, so it’s important to ensure the individual is in a normal state of health when testing. Additionally, consider the individual’s comprehension of the testing instructions – they must understand each task fully to ensure accurate results. Lastly, the environment in which the test is administered should be quiet and comfortable to minimize distractions, further enhancing the accuracy of the results.

When Should You Get Concussion Baseline Testing?

A group of girl soccer players learning about the importance of concussion baseline testing

It is essential to regularly re-test the baseline concussion test to maintain its accuracy and relevance. Typically, it is recommended to repeat the test annually before the sports season starts, particularly for young athletes whose cognitive abilities may significantly change as they grow and mature.

Why Choose Complete Concussions for Baseline Testing?

At Complete Concussions, we offer the most comprehensive baseline concussion testing due to several distinguishing factors. Firstly, our testing protocol incorporates a comprehensive range of assessments covering balance, reaction time, and neurocognitive function, ensuring a holistic evaluation of an individual’s pre-injury state. Secondly, we utilize cutting-edge tools such as the Computerized Balance Assessment (Postural Sway Tool on the Concussion Tracker App) and the DANA Neurocognitive Test, which provide objective, quantifiable data, significantly enhancing the accuracy of our assessments. Lastly, at Complete Concussions, we are committed to staying abreast of the latest research in concussion management. We regularly update our testing protocol based on the most current scientific findings. This commitment to continual improvement and evidence-based practice ensures that our baseline concussion test remains relevant, accurate, and reliable, offering the highest level of care for those at risk of concussions.

Learn more about us at: https://clinics.completeconcussions.com/ 


The importance of concussion baseline testing in the realm of contact sports cannot be overstated. It provides a pre-injury overview of an individual’s normal cognitive and physical functions, acting as a reference point in the event of a concussion. It aids in accurately assessing post-injury changes, ensuring a personalized and effective management strategy for recovery. Whether it’s evaluating changes in memory, attention, balance, or reaction time, these tests play an essential role in safeguarding the health of athletes, ensuring they return to sport when fully recovered.


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