Baseline Concussion Testing

If you have a child that plays contact sports, you may have already heard about “baseline concussion testing” — a cognitive evaluation tool designed to assess an athlete’s normal state of brain function prior to the start of the sports season.

Though not intended as a sole diagnostic tool, baseline testing provides a comparison starting point against which doctors and trained clinicians can measure pre-injury scores against post-injury scores to help them better identify and manage a brain injury. 

According to the Centers for Disease Control and Prevention (CDC), ideally, baseline testing should be conducted annually — before any contact drills or game play. There are two main types of baseline tests currently being used: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Sport Concussion Assessment Tool 2 (SCAT2). ImPACT consists of a group of in-depth computerized tests, while SCAT2 is administered face to face. 

Certified athletic therapist Al Ezaki and his team at Morgan Crossing Sports Medicine Clinic in Surrey, British Columbia, Canada use the SCAT2 tool, which includes a cognitive assessment (memory, concentration and orientation), as well as a balance and coordination examination.  

The Battle Sports Science Impact IndicatorThough he admits the 15-minute SCAT2 test has its limitations, he says it enables him to personally interact with the patient and visually assess how he or she looks, feels and acts while taking the test. Comparing pre-injury test scores to post-injury scores — along with other forms of evaluation — can be very helpful, says Ezaki, in determining a change in brain function. 

“The number itself doesn’t necessarily mean a lot, but it gives you something to compare to if they come in again after they’re concussed,” he said. “The other thing is that it gives me a chance to provide a little bit of education about concussions. The age group that we’re looking at is very susceptible to this kind of injury because their brains are still developing. They can take a long time to heal.”

Many believe that the comparative figures are a critical piece in helping health care providers determine when it is safe for athletes to return to play. However, some question the validity of the tests due to the variables that can affect scores. These can include how well the test is explained to the patient, the level of experience of the person giving and interpreting the test, environmental distractions and patient effort.

“There is probably just as much evidence to support that it works than it doesn’t work, but I think it’s about having the right professionals interpreting it and having the network of professionals who can send the patient in the right direction, if they do suspect a problem. The biggest variable would be patient honesty. A lot of professional athletes have admitted they will go in the room and do the baseline test [but] they just won’t try very hard because they know that the post-injury results will show that they are concussed and they won’t get to play.”

Despite the potential for inexactness, Ezaki says there is no doubt the testing leads to improved athlete safety and better concussion education — including knowing what to do if something does happen.

“Sure it’s a little more time consuming to have everyone tested, but at least you know that no one is going to really slip through the cracks.”

Any athlete showing signs of a concussion should be immediately removed from play and assessed medically. For more information on hockey related concussion and prevention, visit

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