Baseline concussion testing is invaluable to concussion management, treatment, and return to play decision-making. Concussions, especially in sports and activities with head injury risks, require meticulous management. Baseline concussion testing, which involves pre-injury assessments of cognitive, neurological, and physical functions, is a critical component of this process.
This article explores the various types of baseline concussion tests, including IMPACT, King-Devick, SCAT 5, and VOMS assessments, and the use of Videonystagmography to quantify eye movements, highlighting their significance and practical applications.
Understanding Baseline Concussion Testing
Baseline concussion testing involves a series of assessments designed to measure an individual’s standard cognitive, neurological, and physical capabilities. These tests provide a critical reference point for evaluating changes or impairments resulting from a concussion.
They’re also a great way to understand the differences between concussions in individuals and how they present with various symptoms. It’s an invaluable way to help coaches, parents, and trainers realize how different symptoms will present with different athletes, giving them the tools, education, and understanding to recognize concussion symptoms when they present themselves.
Importance of Baseline Testing
The main advantage of baseline concussion testing is the collection of objective data on an individual’s normal brain function before they sustain a concussion. This information is crucial for accurately diagnosing concussions, monitoring recovery, and making safe return-to-play decisions. It also helps differentiate between pre-existing conditions and new injuries, ensuring a tailored treatment approach.
Baseline concussion testing has become a standard for many youth sports programs due to the growing interest in brain injuries and long-term developmental and neurodegenerative conditions. And while the research has yet to find a causal pattern, it’s best to prepare and find ways to prevent and treat concussions as quickly as possible.
How Baseline Concussion Testing Works
Baseline concussion tests include neurocognitive evaluations, balance tests, and visual assessments. These components are standardized and performed under controlled conditions to ensure reliable and accurate data collection.
It’s important to note that these tests are administered before an individual starts a season or job to establish baseline metrics. They are also used during a sports season or after a head injury to assess changes in testing data and to determine the impact of an injury.
There is also a growing interest in establishing baseline norms for autonomic outcomes such as heart rate, heart rate variability (HRV), blood pressure, pulse oxygenation, respiration rate, and even sleep metrics from wearable devices.
While we’re still in the early stages of validating wearable devices such as smartwatches and rings, these devices can provide insights into functional changes and characteristics that can give us more conviction as to whether or not someone has sustained a concussion.
Types of Baseline Concussion Tests
Neurocognitive Tests (Including IMPACT)
Neurocognitive tests evaluate memory, attention, reaction time, and problem-solving abilities. The Immediate Post-Concussion Assessment and Cognitive Testing (IMPACT) test is a widely used computerized assessment that provides comprehensive data on cognitive functions. Its accessibility and detailed reporting make it a preferred choice in sports settings.
It’s also one of the most accessible tests to administer due to its simplicity, scalability, and accessibility to individuals via a computer program.
Balance Tests
Balance tests are essential in detecting visual and vestibular dysfunction, a common consequence of concussions. These baseline concussion tests can include standing on one leg, tandem walking, and maintaining balance with one foot in front of the other. Most of the time, they involve tests on hard and foam surfaces in Romberg’s position (feet together), which allows providers and trainers to assess which specific systems have been affected by the injury.
Balance tests help assess an individual’s ability to maintain stability and coordination, which is vital for athletic performance and everyday life. Objective balance platforms and hardware devices can also quantify sway patterns for pre-and post-testing, but they aren’t always available or widely used.
Visual Tests (Including King-Devick, VOMS, and Videonystagmography)
Visual tests are crucial for detecting visual and potential vestibular disturbances, a frequent symptom of concussions. Here’s a list of a few of the most popular ones out there:
The King-Devick Test
The King-Devick Test assesses saccadic eye movements by having individuals read numbers quickly, providing insights into visual processing speed and accuracy. It can be a quick and helpful tool to perform for concussion testing and an on-the-field assessment in an acute evaluation of a concussion.
The Vestibular/Ocular Motor Screening (VOMS)
The VOMS assessment evaluates the vestibular and ocular motor systems, testing functions such as smooth pursuits, saccades, convergence, rotational vestibular-ocular reflexes (VOR), and visual motion sensitivities. VOMS is instrumental in identifying issues related to balance and vision that may not be apparent through other tests.
Videonystagmography (VNG) Testing
A VNG Test is an objective visual test that uses video technology to record eye movements using standardized testing measurements. VNG is particularly valuable in assessing the extraocular and vestibular system and detecting involuntary eye movements (nystagmus). These findings have a very high efficacy for indicating visual and vestibular dysfunction, helping providers and rehabilitation specialists diagnose concussion and track progress over time.
SCAT (Sport Concussion Assessment Tool)
SCAT is a standardized tool for evaluating suspected concussions. It includes symptom checklists, cognitive, visual, and physical evaluations, and balance tests. SCAT is widely used in sports settings for its comprehensive approach, which provides immediate post-injury assessments and monitors recovery.
It covers an array of aspects, such as symptom severity, orientation, memory, and physical signs, offering a broad overview of an individual’s condition post-injury. With its widely available implementation and ability to provide insights into return-to-play decision-making, it has quickly become one of the widely used tests for assessing concussions.
Who Should Undergo Baseline Testing?
Baseline concussion testing is advisable for anyone at risk of head injuries, including athletes, military personnel, and individuals in high-risk professions. It’s particularly important for young athletes, as their developing brains are more vulnerable to injury, and recovery can differ significantly from adults.
Sadly, baseline concussion testing doesn’t happen nearly as often as it should due to personal decisions not to take assessments and a lack of resources for a given organization. As awareness continues to grow around concussions and the impact they have on the brain, people are beginning to realize the importance of prevention, assessments, and their utility in making decisions for return to play and work.
When to Perform Baseline Concussion Testing?
Ideally, baseline concussion testing is administered before the start of a sports season or any high-risk activity. Regular re-testing, especially in growing children and adolescents, ensures that any cognitive or physical status changes are considered.
And since concussion testing has become widely available to implement, track, and record, there are very few excuses for an organization or company to have regarding their use.
Benefits of Baseline Concussion Testing
The benefits of baseline concussion testing include:
Accurate Concussion Assessment
By comparing post-injury performance to baseline data, clinicians can accurately assess the extent of a concussion. They also allow providers, coaches, and managers objective information to make decisions about returning an individual to play or work.
Customized Recovery Plans
Individual baseline data enables healthcare providers to tailor treatment and recovery plans to the patient’s specific needs. It also allows medical practitioners to track progress and show quantifiable changes in their documentation.
Informed Return-to-Play Decisions
Ensures athletes fully recover before returning to play, reducing the risk of subsequent injuries. Second impact syndrome is a significant issue with youth and high school sports. Having baseline concussion testing is crucial for protecting the developing brains of these athletes.
Limitations of Standardized Concussion Testing
While beneficial, baseline concussion testing has its limitations. It cannot prevent concussions and is not solely sufficient for diagnosing concussions. A concussion diagnosis has to be made by a trained medical provider via thorough orthopedic and neurological examination.
Variations in an individual’s effort, testing environment, and individual baseline fluctuations can affect test outcomes, highlighting the need for careful administration and interpretation by professionals. Athletes have also subjectively reported “gamifying” their baseline concussion testing scores so if they suffer a head injury, their scores won’t change, allowing them to return to play without flagging an investigation.
Baseline Concussion Testing in Youth Sports
Youth sports organizations are increasingly adopting baseline concussion testing to protect young athletes. These tests help make informed decisions about participation and ensure players’ safety, particularly after suspected concussions.
There is a growing number of organizations and institutions becoming aware of the impact concussions can have on the brain. As a result, youth sports programs are quickly moving to protect their athletes by implementing baseline concussion testing programs.
Although many major sports teams still deny the impact of concussions and the onset of neurodegenerative disorders, research is starting to show a correlation between early head injuries and later-stage neurological changes in the brain.
Implementing Baseline Testing in Schools and Sports Programs
Schools and sports programs play a crucial role in promoting baseline concussion testing. Schools can also safeguard student-athletes and foster a better understanding of brain health by integrating these programs.
The Role of Healthcare Professionals
Healthcare professionals, including neurologists, functional neurologists, sports medicine specialists, and athletic trainers, are essential in conducting baseline concussion tests and interpreting their results. Their expertise ensures accurate testing and appropriate management of concussions.
A properly trained healthcare provider is required to create a formal diagnosis of a concussion. Integration of care is essential for ensuring proper follow-up, treatment, and setting a personalized care plan.
At The Neural Connection, we’ve spent the last decade working with complex neurological cases like concussions, brain injuries, headaches, and chronic dizziness. If you’re dealing with post-concussion symptoms and still looking for answers, click the link below to schedule a consultation!
Technology in Baseline Concussion Testing
Computerized Testing
Computerized testing, exemplified by the IMPACT test, offers precise and efficient cognitive assessments. These tests facilitate detailed tracking of cognitive performance over time and allow for quick, reliable data collection.
They’re also great at providing quantifiable data for pre- and post-testing purposes, evaluating progress over time, and showcasing historical data for an individual. Organizations and schools can implement these evaluations as standardized testing sites. They can also scale their testing protocols by utilizing computerized data tracking for baseline concussion testing.
Mobile App Solutions
The development of mobile app solutions has made baseline concussion testing more accessible and convenient. These apps can conduct various tests, providing flexibility for assessments outside traditional clinical settings.
Although these applications are easier to administer, their reliability and accuracy scores are still questionable without adequate supervision and training by the user.
Common Myths About Baseline Concussion Testing
A common misconception is that baseline concussion testing can prevent concussions, which it cannot. No form of testing or diagnostic evaluation can prevent concussions. We thought helmets and mouth guards could prevent concussions, but that is no longer true.
Another evasive myth is that these tests are only necessary for professional athletes; in reality, they are beneficial for anyone at risk of head injuries, including casual athletes and non-athletes.
We would argue that baseline concussion testing is even more important for young individuals and student-athletes, as only a tiny percentage of them will play sports professionally. Chronic post-concussion symptoms could severely limit someone’s quality of life. This becomes a big issue, especially once they get to higher levels of education and into the workforce.
The Future of Concussion Testing
The future of baseline concussion testing is promising, with ongoing advancements in technology and a growing awareness of concussion management. Innovations like more sophisticated testing methods and broader implementation will enhance the accuracy and effectiveness of concussion care.
We believe that the future of concussion testing will involve greater data collection using wearable technologies, periodic objective tests for balance, vision, and psychological analysis, and potentially even blood chemistry panels.
Although the research is still early, we’re seeing a growing trend in the private sector of concussion testing. Companies are actively trying to find faster and more effective ways to evaluate concussion and head injuries.
Best Practices for Baseline Testing
It’s best to conduct baseline concussion testing in a controlled environment using standardized and validated tools to ensure reliable results. The focus is to evaluate the individual’s physical, emotional, and mental state, ensuring they are well-rested and able to focus during the assessment.
We also suggest repeating the baseline concussion testing within a 24-hour period to ensure the reliability and validity of the testing outcomes. Some people may do better than others on the initial assessment versus a repeated test. If this is feasible, we support it, but it’s not always possible due to financial resources.
FAQs
What is baseline concussion testing?
Baseline concussion testing involves a series of tests performed in a specific pattern or order. They measure an individual’s cognitive, psychological, and physical functions before any potential head injury. The goal of the testing is to provide a benchmark for post-injury comparisons.
How long does baseline concussion testing take?
The timing of testing typically ranges from 30 to 60 minutes, depending on the specific assessments administered.
Can baseline concussion tests diagnose a concussion?
Baseline tests alone cannot diagnose a concussion. They merely provide critical data for looking at post-injury symptoms compared to the individual’s baseline.
How often should baseline testing be done?
We suggest to administer these tests annually. This is particularly relevant for individuals active in activities with a high risk of head injuries. Baseline concussion tests yield the highest benefits before any sporting or high-risk event.
Is baseline concussion testing mandatory for athletes?
While not universally required, many sports organizations and schools highly recommend or require baseline concussion testing for athletes.
How reliable are baseline tests?
These tests are reliable when performed under standardized conditions. It should be noted that factors like effort, testing environment, and individual variations can influence the results.
Baseline Concussion Testing Makes Sense
Baseline concussion testing plays a vital role in concussion management and evaluation. By providing objective data on pre-injury cognitive, psychological, and physical functions, these tests help healthcare professionals make informed decisions about diagnosis, treatment, and safe return to play.
As technology evolves, the accuracy of these assessments will continue to improve. These improvements will help in enhancing the safety and well-being of those at risk of concussions. People are becoming more aware of the impacts that concussions can have on their brain development. As a result of that, we see baseline concussion testing becoming far more used than it is today.
Concussions are treatable, regardless of how long someone has had symptoms. Here’s a great success story and testimonial from one of our patients who was dealing with chronic post-concussion issues:
“Dr. Reis is an incredible practitioner who helped me so much in my recovery from a mild traumatic brain injury sustained three years ago. Not only did he provide therapies that improved my symptoms in a remarkable way, he gave me hope that I would get my life back and that my future was bright! I highly recommend Dr. Reis for TBI recovery and chiropractic care.” – Kim B.
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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.
