A baseline test is a test that is taken before any concussion, activity or treatment have occurred. Baseline testing data is valuable in determining the athletes’ pre-injury (normal) level of cognitive functioning. It is a tool in our toolbox in which we feel is an effective concussion management program because it measures what we can’t see – cognitive (brain) function. Baseline information can also be gathered after an athlete has completely recovered from the symptoms of a concussion.
Stopconcussions.com and Shift Concussion Management provides an advanced approach to concussion awareness and management. Formed in partnership by Stopconcussions.com, an organization founded by former Philadelphia Flyers captain, Keith Primeau, and the Shift Concussion Management Program, SCC is a leader in Concussion Care.
Concussions can produce a wide array of symptoms which poses a challenge for coaches, trainers, parents, and health professionals involved in the care of an injured athlete. The time-course for recovery also varies widely from athlete to athlete, making it impossible to employ a “cookie-cutter” approach to concussion rehabilitation and return-to-play timelines.
For this reason, a growing emphasis has been placed on objective baseline testing protocols that can be used to track an athlete’s recovery and serve as a tangible “measurement” for return-to-play. The SCC Team believes this requires a multifaceted approach that moves beyond an isolated cognitive test.
That is why SCC offers a comprehensive baseline test designed to assess:
- Cognitive function (learning, memory, processing speed, accuracy)
- Balance, Coordination, and Neurological function
- Strength and Endurance Testing
How a Baseline Test Works
Baseline or pre-season evaluation is an essential part of the concussion management process. An athlete takes a baseline test pre-season or when uninjured. Most baseline tests are designed for use by non-specialists and may be administered by people with minimal training. They may be supervised by adults; including parents, athletic trainers and coaches to ensure the athlete is free from distractions. Please note: Reports should be interpreted by a physician.
Important Benefits of Baseline Testing
Medical staff evaluating a concussion can prepare a more specific treatment plan for recovery and can use the data for research purposes.
Testing provides a meaningful comparison against which a post-concussion assessment can be compared.
Allows the athlete to safely return to play sooner; in giving, parents, coaches, trainers, and the athlete themselves comfort that they have returned to the previous level of performance and symptom level before returning to play.
If you think an athlete or person has become concussed, they should seek medical attention immediately.
Under the guidance of a medical professional that the athlete is symptom free, the athlete will then perform a further baseline test. This test is identical to the initial test because repeating the same tasks after the injury identifies any cognitive changes from the initial test performance. This ability to compare results helps indicate whether the brain has fully recovered.
Concussions can cause subtle changes in the speed and accuracy of thinking (cognition). These changes are usually the last symptoms to go away after a concussion and they can be very slight. In fact, it is very difficult to detect them without a computerized test which compares an individual to themselves when they were “normal.”
This means that a baseline test in the pre-season, before any injury occurs is essential. Additional specific information on a particular baseline can be found under this tab.
Computerized Neurocognitive Testing: Important Role in Concussion Evaluation, Return To Play Decision
Computerized neuropsycognitive testing for concussions has become increasingly popular in recent years and have been shown to have value in making the all-important return to play decision.
Because they can detect subtle signs of cognitive impairment indicating that an athlete’s brain has not fully healed, even where the athlete claims his symptoms have cleared, the tests helps to protect young athletes against the risk of suffering a second concussion by returning too soon, which can lead to short- and long-term cognitive problems, even death from second impact syndrome.
The current international consensus of experts (Zurich consensus statement), views computerized neuropsychological or neurocognitive (NP) testing as an “important component” in determining when it is safe for an athlete to return to play after a concussion, and recommends formal baseline NP screening of athletes in all organized sports in which there is a high risk of concussion (e.g. football, hockey, lacrosse, soccer, basketball), regardless of the age or level of performance.
In the absence of NP and other testing (e.g. formal balance assessment), the international consensus of concussion experts is to take a more conservative approach to return to play, especially for children and adolescents.
For years the only way to test cognitive function was with so-called pencil and paper tests.
More recently, computer generated neuropsychological test programs have been developed and are currently being validated in the sports setting. They include:
- Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) developed at the University of Pittsburgh Medical Center;
- Computerized Cognitive Assessment Tool (CCAT) marketed in North America by Axon Sports and developed by CogState of Victoria, Australia;
- Concussion Resolution Index (CRI) developed by HeadMinder, Inc. of New York, NY; and
- Automated Neuropsychological Assessment Metrics (ANAM) system: a PC Windows-based test protocol developed by the National Rehabilitation Hospital Assistive Technology and Neuroscience Center in Washington, DC(Editor’s note: a joint investigation by National Public Radio and Pro Publica, which aired on NPR’s “All Things Considered” on November 28, 2011, severely questioned the reliability of this program, which was developed and is primarily used by the military).
Computerized tests have four significant advantages over traditional pencil and paper neuropsychological tests:
- Rapid scoring: tests take less time (more traditional pencil and paper neuropsychological tests usually take an hour or more to administer)
- Ease of administration: the tests do not need to be administered by a neuropsychologist.
- Increased test-retest reliability. Some tests allow for infinite variety in the test questions that reduce the practice or learning effects seen with more traditional neuropsychological test batteries.
- Greater accessibility: The computerized test batteries are accessible to a wide range of clinicians, including athletic trainers and, even to parents of athletes (although experts strongly caution against use by untrained or undertrained personnel in “cookbook fashion.”
One recent study suggests that the tests may also help clinicians predict, when combined with an athlete’s scores on the Post-Concussion Symptom Scale in the first 2 to 3 days post-injury, whether a concussion will require protracted recovery (more than 14 days), although the study have been criticized for using only post-injury test results without comparison to pre-injury baseline test results, and as lacking in practical value in the care of individual athletes which, current concussion management guidelines say, requires individualized assessment and treatment.
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