Public concern for concussions has grown in recent years, as has the field of sports medicine. Between 2010–2016, there were approximately 283,000 annual emergency department visits among children for sports-related traumatic brain injuries. About 45% of those visits were associated with contact sports. Fortunately, through concerted efforts, these numbers began to decrease in 2018 (Waltzman et al., 2020).
Baseline tests measure normal cognitive function and physical abilities, and they play an important role in concussion treatment and recovery, especially for sports-related concussions. Having an individual’s baseline measurement allows healthcare professionals to compare back to it in the event of a head injury.
Computerized cognitive assessments is particularly useful for capturing baseline data and assessing the effects of a concussion as soon as it happens. This article will describe the benefits of baseline testing and how cognitive testing can be used to establish baseline cognitive performance data.
Sports, especially contact sports, carry a high risk of concussion. Concussion baseline tests are mainly used for athletes, typically before the sports season starts. They measure cognitive and physical function—such as coordination and balance—of an individual when not impaired or injured.
Baseline testing is essential to detecting differences when screening a patient for a concussion immediately after an injury. It’s relatively quick to retest an athlete to see if their scores are meaningfully different from baseline in the case of a possible concussion.
Baseline testing is also an important part of a concussion treatment plan. Patients can perform the same assessments as they did for their baseline throughout treatment and recovery. These results can then be consistently compared back to their baseline results, in order to see if their results are approaching baseline or are still differing significantly from their expected level of healthy brain function.
The CDC estimates that between 1.6 and 3.8 million concussions occur annually in the U.S. However, these numbers might underestimate the prevalence, as many people with concussions do not know or seek medical attention (Maas et al., 2017).
While concussions in sports are a major concern, concussions can come from a number of places. Any hit to the head or sudden jolt can lead to a traumatic brain injury or concussion, regardless of whether the individual loses consciousness or not. Motor vehicle accidents, workplace injuries, and falls are all common causes of concussion (Maas et al., 2008 & 2017).
Baseline testing provides more—and more accurate—data for understanding changes to a patient’s cognitive performance post-injury, and offers a personalized benchmark to measure recovery against. With baseline test results, a patient can immediately be screened for a concussion after a head injury. Baseline tests are also an accurate way to track recovery compared to an individual standard, and to determine when a patient is approaching their pre-injury levels of function.
Consistent baseline testing can also help get athletes used to the importance of cognitive health care and reduce stigma around concussion diagnosis and treatment.
There are many benefits to using baseline testing throughout the concussion diagnosis, treatment, and recovery process. UCLA Health defines three major benefits of using baseline concussion testing: early detection of concussions, objective assessment, and benefits to return-to-play decision making.
Patients may have a hard time determining whether they’re experiencing concussion symptoms immediately after an impact. However, if they can immediately perform the same test as their baseline and performance has declined significantly, a concussion can be confirmed quickly.
It’s important for patients to get diagnosed and start a treatment plan as soon as possible, so as not to exacerbate symptoms and lengthen recovery time. An early treatment plan supports symptom and pain management for patients. The sooner a patient knows they have a concussion and can take steps towards recovery, the better. High levels of either cognitive or physical exertion after a concussion have been shown to worsen symptoms and lengthen concussion recovery time (Majerske et al., 2008; Brown et al., 2014).
While interviews and questionnaires are important for understanding a patient’s experience of their symptoms, objective tests are also important for concussion treatment. Objective assessments offer cognitive performance data to create a complete picture of the patient’s brain health alongside their self-reported symptoms. These tests are easy to do repeatedly and easy to compare back to, especially when available digitally.
Dr. Williams, medical director of the Kerlan-Jobe Center for Sports Neurology explains that a “brain injury is not always visible,” which can lead to difficulties for patients.
Having an objective test that’s able to measure how far patients are from their function at baseline, and whether it’s improving, is invaluable for treatment and the delivery of patient-centered care. Dr. Williams found that by using the computerized cognitive tests through Creyos, he was able to “demonstrate where impairment and improvement is happening.”
Additionally, a patient doesn’t need to be an athlete or have sustained a traumatic brain injury to be interested in and benefit from improving brain health. Routine cognitive assessment can help enhance patient experience.
Returning to regular activities too early can be dangerous and lead to a risk of further injury. If a patient is injured again before the last concussion has healed, this can lead to worse symptoms that last longer (Maas et al., 2017)
Baseline concussion tests can assist medical professionals in making return to play decisions. It can be difficult for a concussion patient to accurately recall if symptoms have changed since before the injury. Patients may also minimize or underreport their symptoms, wanting to return to play, work, or other activities quicker (McCrea et al., 2004).
Baseline testing and sideline testing work in tandem to support each other in concussion screening and diagnosis. While baseline testing is done before an injury, sideline testing is immediate assessment performed after a head injury.
Sideline assessment can lead to a decision of whether or not to pull the athlete from play. If there is a suspected concussion, the athlete should not return to play or physical activity until they’ve been thoroughly assessed by a healthcare professional. While exercise can be good for the brain, the risk of reinjury or overexertion can negatively affect the cognitive health of a concussed individual.
Sometimes, trained professionals are available on the sidelines to assess athletes after any injury. But this isn’t always the case. The responsibility of sideline assessment can often fall to untrained coaches or sports officials (Committee on Sports-Related Concussions in Youth, 2014). As such, standard automated tests that can easily and quickly compare symptoms to baseline information are incredibly helpful. This way it’s much easier to determine whether an individual differs significantly from their usual function.
Both baseline testing and sideline testing contribute to concussion diagnosis and recovery. They work together, with baseline assessment being compared to sideline assessment.
When performing a baseline concussion assessment, a variety of tests can be helpful, since patients will all be affected by concussions in different ways. For example, one patient may struggle with memory but have no issues with balance, while another patient may have an opposite set of symptoms. Patients can be assessed in as many areas as possible to facilitate whole person care.
Cognitive tests can assess neurocognitive functions that are known to be affected by concussions, such as short term memory, concentration, and reasoning. This is an important part of concussion testing, as cognitive symptoms can have an effect for a prolonged period of time, even longer than other symptoms (Stafford et al., 2020). They can also continue showing effects in the brain under imaging scans, even when athletes had otherwise been cleared to return to play (Manning et al., 2017).
To gather baseline scores and for those scores to be usable, sports neurologists and concussion specialists need to be equipped with the right tools. Computerized cognitive tests are one way to help concussion specialists gather the required information.
Computerized cognitive tests can shorten the time it takes to access testing and makes retesting highly accessible. Many computerized cognitive tests can be done in the clinic or at the patient’s home without any need for specialized referrals, meaning that healthcare professionals can retain patients in their care and establish continuity of care.
In addition, digital cognitive tests and more in depth neuropsychological testing can offer a detailed look at various cognitive domains that may be affected by a mild traumatic brain injury, such as memory, concentration, and reasoning.
Computerized cognitive tests administered online can help make the overall baseline testing process more convenient for patients and healthcare practitioners alike. The Kerlan-Jobe Center for Sports Neurology found an increase in patient retention and 10% fewer referrals when switching to Creyos computerized cognitive tests. Patients can complete assessments in the clinic, on the same day, or from their home. This can help make for a more accessible patient experience.
When it comes to balance, it’s important to have an individual’s personalized baseline. Having a baseline provides information about a patient’s normal stability, rather than comparing each patient to a population standard that may not be relevant to their abilities.
There are many simple tasks designed to assess balance, such as asking patients to balance with their eyes closed or to walk along a straight line. These tasks are fairly common for assessing balance and can be given by anyone. However, there are also standardized assessments designed to be used by healthcare providers in concussion screening and diagnosis.
For example, the Sports Concussion Assessment Tool (SCAT-5) outlines a balance assessment task to be administered as part of concussion screening. The SCAT-5 website and guide encourage baseline testing to be done with this assessment tool, and that having a baseline is important for accurately interpreting results.
Once a baseline has been established pre-concussion, healthcare professionals will need testing tools post-concussion to further track and measure symptoms and recovery. There are a number of concussion assessment tools available to support. In this section, we’ll outline some common concussion assessment tools and their different uses throughout concussion care.
Rivermead Post-Concussion Symptoms Questionnaire (RPQ): This task is a self-report questionnaire that asks patients to rate the severity of concussion symptoms over the last 24 hours. This questionnaire is designed to be taken repeatedly, so patients and their healthcare provider can see how their symptoms are changing over time.
This questionnaire is available in the Creyos Health platform in digital format and can be completed alongside cognitive performance tasks for a comprehensive view of both subjective and objective concussion symptoms.
Creyos cognitive tasks: Creyos assessments provide objective measurements of brain function through various computerized tasks. They assess cognitive functions that are often affected by a traumatic brain injury, such as short-term memory, reasoning, and concentration.
Standard Assessment of Concussion (SAC): This test is designed to measure mental status and to be used immediately post-injury. It doesn’t require a trained specialist to interpret the results and takes about five minutes to complete.
Sports Concussion Assessment Tool (SCAT-5): This test is designed to be used by athletes 13 years old and above. It takes longer to complete than the SAC and is designed to be administered by a trained professional. This assessment tool has different sections for immediate on-field assessment, as well as for office or off-field assessment.
The child SCAT-5 is a similar test which is designed for athletes 12-years-old and under.
Recently, in 2025, the SCAT-6 has been released. This is an updated version of the SCAT-5, but both are still in use.
Baseline testing is particularly important for athletes, and has many benefits for concussion assessment and treatment. It can help with clearer interpretation of post-injury testing, provides a more objective assessment, and supports return to play decisions. We also discussed how to perform a baseline test and the types of concussion assessment tools that are available.
Baseline concussion testing is invaluable when it comes to supporting patients with sports-related concussions. Cognitive assessments are an essential part of concussion baseline testing, and can lead to a more complete treatment plan and understanding of patient health.
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.