Understanding baseline concussion testing

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Deciding when an athlete may return to sport is not always easy. The availability of computerized neuropsychological testing (NPT) has created the possibility of being able to assess aspects of brain function like reaction time, memory, and concentration in addition to what can be tested with traditional medical examination. Having a baseline assessment, that is, knowing how the athlete’s brain was functioning before the concussion would be an ideal way to assess whether their NPT testing after injury is normal. However, getting accurate “baseline” information can be difficult.

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Several studies of computer-based NPTs with teens and younger children have shown that a large percentage (up to 40%) of these tests are considered invalid, meaning, not an accurate assessment of the athlete’s normal function. This can be for several reasons. Often these baseline tests on young athletes are done in group settings using the school’s computer classroom. The group setting may create distractions that prevent the athlete from performing their best. In group settings, instructions for performing the tests may not be effectively communicated to all the athletes. Furthermore, some athletes, knowing that these tests might determine whether they will return to play after a concussion, will do poorly on purpose (“sandbagging”).

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On the other hand, the developers of these computer-based NPTs have thousands of tests results on normal (not concussed) athletes. Athletes with concussions can therefore be compared to athletes of their same age to see if their results fall within the ranges of normal. Studies have shown that comparing a young athlete’s NPT results to their peers is just as accurate as comparing to their own baseline for determining whether their NPT results are normal or not.

The Sports Concussion Program at Texas Children’s Hospital does not routinely perform group baseline testing because of the problems associated with getting accurate baseline data. Doing baseline testing involves a separate visit to the doctor and additional cost. Studies currently show that baseline testing is not necessary for evaluating NPT after concussion.