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By: AAST Associate Editor on November 30th, 2021

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What You Need to Know About Baseline Testing for Concussion

sports-related concussions | baseline testing

While more research and testing are needed to show the correlation between lack of sleep and sports-related concussions (SRCs), as noted in part one of the Sleep and Sports-Related Concussion series, baseline concussion tests on athletes can help identify the effects of post-concussion syndrome and sleep disturbances.

To learn more about baseline testing for SRCs, we spoke with Laura Beck, vice president of rehabilitation at St. Charles Hospital in Port Jefferson, New York. In 2010, St. Charles Hospital started the ThinkSmart! Concussion Management Program to help bring awareness to concussions, baseline testing and treatment. The program now provides baseline testing to athletes at 42 school districts across Long Island, New York, and cares for more than 1,200 athletes each year following the incidence of a concussion. Here is what we learned about baseline testing for concussions.

Tell me a bit about the concussion baseline test. What is it, what it is used for and how should it be utilized? 

A baseline test would simply be any test or measure taken on a healthy, uninjured individual that can be compared to their performance on the same measure following a concussion to assess for any changes. Baseline testing may include balance assessments, vestibular assessments, ocular assessments and neurocognitive testing. ImPACT baseline testing is a test we utilize in our ThinkSmart! Concussion Management Program. It is a commonly-used, computerized neurocognitive test. 

Walk me through the test’s process. Where is the test performed and what does it entail? 

It depends on the type of baseline test being administered. For ImPACT, the process is simple. The proctor for the test will assist the test takers to log into the web-based test. It is important to ensure the testing environment is distraction free and quiet, phones turned off, etc. Once the test takers are logged in, the directions for each portion of the test are provided by the test. Once started, the test takes approximately 20 minutes.

Who interprets the data from the test? What specifics are they looking for?

This depends on the test. For ImPACT, which is the baseline test we use in our program, the physician would be comparing baseline performance to post-injury performance to see if there are any significant changes. ImPACT tests for attention, memory/recall, processing speed and reaction time so the interpreting physician would be analyzing their performance in these areas as well as overall performance. Ideally, individuals will have a baseline test available for comparison. For individuals that may not have a baseline test, there is normative data that physicians can utilize for comparison.

Which athletes should undergo baseline testing, and when should they do this? 

Baseline testing could be of benefit to any athlete, but certainly any athlete participating in contact sports. It is recommended that baseline testing be completed prior to the start of season and repeated at least every two years.

Are you seeing an increase in interest for this test? Why do you think that is?

In the last 10–12 years there has been a significant increase in interest in baseline testing with many states instituting regulations around concussion management as well as the ongoing media attention placed on concussion.

Who interprets the data from the test? 

Baseline data is typically not interpreted as long as the results are valid; however, following injury, if a test is re-administered it is considered a post-injury test, and those tests should be administered and interpreted by a physician with experience in concussion management.

What should coaches, parents and athletes know about baseline testing? What should sleep technologists know?

Baseline testing is just one component of a comprehensive concussion management system. While baseline testing can provide valuable information to physicians providing medical management of an individual following concussion, it does not replace a thorough physical exam and assessment — and, alone, should not be used for treatment plan and return to play decisions. It is only one piece of the larger puzzle.

Poor performance on baseline testing could also be attributed to poor sleep. Sleep is often affected following concussion and education regarding sleep is a key component to concussion management.

How should an athlete prepare for baseline testing?

Get a good night’s sleep, hydrate and eat well. Do not take a baseline test following rigorous exercise. For neurocognitive baseline testing, it is important to be in a quiet space with minimal distractions.

Takeaways

Baseline testing for concussion at the beginning of the season can be a valuable tool for athletes, parents and coaches — in the case of the sport-related concussion — to evaluate the impact of a concussion and can aid in concussion management. It is important to keep in mind, that an athlete’s poor sleep prior to testing may affect the results of the baseline concussion test.