Concussion is a functional injury. Scans, such as brain MRIs, are unable to diagnose or confirm recovery from concussion. It is similar to being hungry or sleepy – a scan won’t be able to pick it up but you know it is there. A multimodal battery of functional tests are currently the best insight to the brain to accurately determine its recovery.
What is Concussion baseline testing?
Baseline testing is a series of physical and cognitive (mental) tests that measure healthy brain function before a sports season starts. This means that if a concussion were to happen, the results of these tests can help determine when full brain recovery has taken place and can help the athlete’s healthcare provider make safer return-to-sport decisions.
Baseline testing measures many different functions of the brain and can detect deficits within the brain, long after even symptoms have resolved. Any deficit in the brain compared to an athlete’s pre-injury is considered significant and will not be able to return to sport until the brain has fully recovered. This will ensure that the brain is fully recovered going back to sport and an athlete won’t be put into undue risk.
Why does my team really need baseline testing?
Symptom recovery does not equal brain recovery! Resolution of symptoms, following concussion, is known to be a poor indicator of recovery and this puts healthcare providers in a very precarious position when making return to play decisions. Studies show that full brain recovery can occur two to four times longer than symptom resolution in athletes. Numerous studies also show that returning prior to this full brain recovery can but the brain in an extremely vulnerable position. A second hit, in this state, can lead to prolonged symptoms of months and potentially permanent brain damage or death.
Healthcare providers can often face pressure from athletes or parents to provide clearance especially when the athlete is in a symptom-free state. Having data on the athlete and seeing discrepancies in brain health compared to baseline can justify the healthcare practitioner to delay an athletes return to sport due to the lack of full brain recovery. You will also be confident that an athlete’s brain has fully recovered and there is no increased risk on the athlete in returning.
Many healthcare practitioners just rely on symptom resolution or a SCAT5 test to clear the athlete. A SCAT5 is a series of memory/orientation questions and, in isolation, is not recommended to return athletes to sport. Unfortunately, there is no formal concussion training in any university in Australia for healthcare or medical students, so the idea of baseline testing in Australia is not well-practiced in the medical community.
What happens in a baseline test?
Sydney Concussion Centre uses a comprehensive battery of multi-modal tests which has been shown to have high validity and reliability in measuring brain recovery. The more tests the better as is it more likely to pick up any brain deficits. Tests in isolation are inadequate. Experts continue to agree that no one test in isolation is sufficient to pick up the full spectrum of concussion.
For each athlete we will test:
- Medical history and current symptom score
- Orientation
- Auditory memory
- Concentration
- Visual tracking and processing speed
- Balance and postural sway
- Reaction time
- Grip strength
- Delayed recall
- imPACT (computerized testing), if athlete is 13 years or older
Should every team get a baseline test?
No. There are two things to consider when deciding if a baseline test is appropriate for your child or team.
Baseline tests are only validated in those over 10 years old. The speed of the personal development of children under this age was so huge that their baselines became invalid very quickly!
Even though baselines can happen anywhere, we have to consider the value that baselines will give to athletes engaged in low risk sports (such as swimming, tennis, cross country and golf) compared to athletes involved in high risk sports where they are more likely to sustain a concussion (soccer, AFL, rugby, MMA)
Generally speaking, if an athlete or team is older than 10 years old and engages in high risk or collision sports – then a baseline is recommended.
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