Pre-Season Management Baseline Testing
A Baseline Concussion Test is a preventative measure typically taken prior to a sport season (when an athlete has not yet had exposure to training and/or competition). Should an athlete become concussed during the season, the same test is taken again by the athlete, yielding comparative scores from before (pre-season) and after the injury. These baseline tests and post-injury tests are computerized assessments that measure Reaction Time, Memory Capacity, Speed of Mental Processing, and Executive Functioning of the brain. They also record baseline concussion symptoms and provide extensive information about the athlete’s history with concussions.
Why is it Important to Implement Baseline Testing?
A Baseline Concussion Test is an important component of concussion management. Each concussion is unique, so it is important to treat individuals on a case-by-case basis. Comparing post-injury test scores of an individual to their own baseline test scores from before the concussion is considered best practice and is why Cappino continues to include baseline testing in the management of concussions. Without a baseline test to use for comparison, an individual’s post-injury test scores can only be compared to the general population. Whenever possible, we want to compare apples to apples, and Baseline Concussion Tests allow us to do just that. Also, because baseline testing usually occurs early in the season, the very act of getting tested will raise concussion awareness for athletes, parents, and coaches.
Different Baseline Tests
1 – SCAT3 Baseline (most popular) – The Sport Concussion Assessment Tool 3 (SCAT3) is a concussion evaluation tool designed for individuals 13 years and older. It takes about 12- 15 mins to complete and helps in making return-to-play decisions on the sidelines or in a healthcare provider’s office. The Child SCAT3 is a newly developed concussion evaluation tool designed for children ages 5 to 12 years (Graham et al., 2014 ). It is similar to the SCAT3 except that tests such as the SAC and Maddocks questions are age appropriate for younger children. The SCAT3 has a symptom evaluation form, cognitive assessment, and a neck coordination and balance examination.
*The Inter-tester Reliability of the SCAT3: The BESS section (Balance Error Scoring System) of the SCAT3 lends itself to a very subjective evaluation system which may implicate issues with inter-tester reliability when the test is being performed clinically. If there is a significant difference in the perception of this portion of the exam, it may make it difficult to rely on this portion of the SCAT 3 when making return to play criteria, especially if the pre and post- concussion exams are performed by different evaluators. (Graham et al., 2014).
2 – Cappino’s Concussion Baseline: This baseline combines the SCAT3’s symptom evaluation and neck examination with the cognitive assessment of the NeuroTracker to potentially record a better baseline test than other tests individually.
3 – Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT): ImPACT is an online computerized neuropsychological test battery composed of three general sections. First, athletes input their demographic and descriptive information by following instructions on a series of screens. The demographic section includes sport participation history, history of alcohol and drug use, learning disabilities, attention deficit hyperactive disorders, major neurological disorders, and history of previous concussion. Next, the athletes self-report any of 22 listed concussion symptoms, which they rate using a 7-point Likert scale. The third section consists of six neuropsychological test modules that evaluate the subject’s attention processes, verbal recognition memory, visual working memory, visual processing speed, reaction time, numerical sequencing ability, and learning.
Schatz and colleagues examined the diagnostic utility of the composite scores and the PCSS of the ImPACT in a group of 72 concussed athletes and 66 non-concussed athletes (Graham et al., 2014). All athletes were administered a baseline test and all concussed athletes were tested within 72 hours of incurring a concussion. Approximately 82 percent of the participants in the concussion group and 89 percent of the participants in the control group were correctly classified. This indicates that the sensitivity of ImPACT was 81.9 percent and the specificity was 89.4 percent (Graham et al., 2014).
Other tests include: the King-Devick, CogSport/Axon and Clinical Reaction Time Test. For more information regarding these tests, please contact our Sports Coordinator.