Nearly 50% of people worldwide will experience a mild traumatic brain injury (TBI) in their lifetime. Some may even experience a TBI, like a concussion, without knowing it, which can come with long-term effects.
Concussion assessment tools are the questionnaires, checklists, and cognitive tests clinicians use to evaluate a patient after a suspected head injury. These can include subjective tools, where patients self-report their symptoms, and objective tools, such as computerized neurocognitive tests, which measure brain function directly.
Self-report questionnaires are available for patients to describe their symptoms after a head injury, but there's a pressing need for objective cognitive measures to get a clear and immediate picture of brain function so that providers can make timely and appropriate referrals as needed. This need is especially critical in concussion diagnosis, to ensure patients receive the right care at the right time.
Providers screening patients want to know which tools to use and when. No single test is sufficient on its own. This article covers the subjective and objective tools available, what each one measures, and how to fit them into screening, diagnosis, and follow-up.
Article Highlights
- Nearly 50% of people worldwide will experience a mild traumatic brain injury in their lifetime, and some concussions go unrecognized.
- Concussion assessment tools include subjective self-report questionnaires like the RPQ and SCAT, and objective cognitive performance tests.
- No single tool is sufficient. Combining objective and subjective tests with physiological testing and clinician assessment gives the most complete picture.
- Symptoms commonly persist 3–6 months and can last up to a year, so assessment should be repeated across recovery, not run once.
When should you test for a concussion?
Concussions may result from a variety of injury mechanisms, like car accidents, sports injuries, falls, and anything else that causes a hit to the head or a sudden jolt. With multiple mechanisms of potential injury, it's important to know when to test for a concussion.
- Before a concussion happens: Where possible, conducting baseline testing of a patient's cognitive performance provides baseline data that can be used to measure improvement or decline in the event of a concussion, which is especially useful in the case of sport related concussion in athletes.
- Immediately after a concussion: Clinicians will likely want to assess patients for a concussion after any kind of head injury. It may also be beneficial for them to talk with patients about their cognitive health as early as possible, since symptoms of an untreated concussion can worsen. The earlier a patient is assessed, the earlier they can start a treatment plan to mitigate symptoms.
- Upon repeat impacts: Repeated head traumas have cumulative symptom effects that can worsen a concussion over time.
- Periodically after a concussion: Routine assessments are a key part of tracking treatment efficacy and symptom progression. Many people experience concussion symptoms for 3–6 months after a head injury, and symptoms can even persist up to a year post-injury.
What does a concussion assessment tool measure?
Concussion assessment tools are designed to measure a variety of symptoms, including:
- Self-reported symptoms: Patient symptoms can be assessed with a self-report questionnaire, like the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).
- Functional abilities: Balance and coordination are often assessed immediately post-injury, through brief tasks like having the patient touch a moving point, then their nose, and back again.
- Mental health: Mental health is often impacted by concussion and can be assessed using a variety of tools and questionnaires, like the Patient Health Questionnaire (PHQ-9), which can be used to assess depressive symptoms.
- Cognitive abilities: Cognitive assessment is an important part of concussion assessment, as research has demonstrated that certain cognitive abilities are impaired after a brain injury. The Creyos platform delivers cognitive tasks online with automatic scoring, so healthcare professionals and their patients can see quantitative data on cognitive function.
Objective cognitive tests are particularly useful here, because it is difficult for patients to accurately evaluate their own memory and reasoning skills using self-report alone. Digital cognitive tests can objectively measure how a patient's concussion symptoms affect them and their ability to function in daily life.
How to test for a concussion
Broadly, there are two main types of concussion assessments used in a clinical consultation: subjective and objective. This section describes a number of examples for each.
With so many options, clinicians might be asking: What is the best concussion assessment tool? The answer is: A combination of objective and subjective cognitive performance tests is ideal, along with physiological tests and clinician assessment. An absence of one or the other could result in incomplete information, so it's a good idea to use a range of tests that assess multiple facets of cognitive, mental, psychological, and physical health to inform a whole-person care approach to healthcare.
Subjective tests
Subjective concussion evaluation tools typically involve a questionnaire or a symptom checklist for patients to self-report their symptoms. These symptoms can vary from person to person, so it's important to interpret results in the context of each individual patient. Having a personalized approach to a patient and healthcare is especially important when it comes to brain health.
- The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is a self-report questionnaire designed to assess and quantify the severity of patient symptoms. This questionnaire asks patients to rate the severity of specific symptoms over the last 24 hours.
- The Sport Concussion Assessment Tool, or SCAT-5, is designed for healthcare professionals to use with patients after a sports-related head injury. In addition to symptom self-reporting, this concussion evaluation tool has tasks designed to test concentration and balance.
- There's also a Child SCAT-5 available, designed to assess children aged 12 and under.
- The sixth edition, SCAT-6, became available in 2025.
These tools are invaluable for screening, but are not always substantial enough for a full concussion diagnosis on their own, and may leave clinicians wondering: When do they need to refer to a specialist for a concussion?
Using only subjective self-report evaluations often requires clinicians to refer to a specialist in order to fully evaluate the needs and treatment care plan of a patient who has experienced a head trauma. However, using subjective tests together with objective tests can lead to a more complete and accurate picture of brain health, post-injury.
Objective tests
Objective concussion assessments include cognitive performance tools that test brain function. These tasks are designed to quantitatively assess various cognitive skills related to post-concussion syndrome, like memory, attention, processing speed, executive function, and language skills.
Creyos offers a variety of online cognitive tasks that are scientifically validated and backed by 30 years of research. These tasks can be performed by patients in a clinic or at home and do not require the presence of a healthcare professional or trained administrator. For example:
- Double Trouble: Measures a patient's response inhibition, attention, and concentration ability in the presence of distracting information.
- Number Ladder: Assesses a patient's spatial short-term memory and their ability to update it as information changes.
- Paired Associates: Examines a patient's episodic memory: their ability to recall information and its context.
- Odd One Out: Measures a patient's deductive reasoning skills.
- Spatial Planning: Is a reasoning task that assesses the patient's ability to plan, which is an important component of executive function.
Cognitive deficits related to a brain injury can depend on the nature, severity, location, and time passed since the injury, as well as other factors. A comprehensive assessment of several domains of cognition allows for greater test sensitivity and an increased likelihood that the assessment can effectively detect impairment when it is present after a concussion. Long-term effects tend to be more subtle, but can persist. For example, research on concussion history and cognition found that people who report a history of at least one concussion tend to score lower on Double Trouble.
How do concussion assessments fit into a clinical workflow?
- Screening: There are some tests designed specifically for on-site assessment or emergency room use. Perhaps one of the most common is the Standardized Assessment of Concussion (SAC) screening tool. It takes about 5 minutes to complete and is designed to be used immediately after a suspected concussion. This brief assessment doesn't require a specialist to interpret the test scores, but it has inadequate sensitivity and therefore isn't a good stand-alone test.
- Diagnosis: Neurologists or other trained medical professionals will likely perform a variety of tests and assessments in order to diagnose a concussion. Such assessment may include testing and evaluating a patient's symptoms, balance, cognitive ability, etc., before beginning a treatment plan.
- Regular testing: Assessment tools can be used regularly to monitor symptoms over time and to assess the effectiveness of a treatment plan. Cognitive tasks are particularly useful for repeated testing at regular follow-up. A Kerlan-Jobe case study found that using Creyos cognitive assessments in the clinic led to 10% fewer referrals and an increase in patient retention.
- Return to regular activities: For sports injuries in particular, while exercise and brain health are positively linked, it may be recommended for athletes to delay return to play until they are no longer experiencing concussion symptoms and have been cleared by their healthcare team. Similarly, a patient's healthcare team will determine when and how it's best for them to return to work, school, or certain leisure activities like video gaming.
What do concussion test results mean?
A concussion test can measure the:
- Number of symptoms
- Severity of symptoms
- Duration of symptoms
Each test is scored differently, so it's important to have an understanding of what to look for when interpreting the results of each assessment. For example, the Rivermead Post-Concussion Symptoms Questionnaire, or RPQ, is a self-report questionnaire that includes a series of questions related to post-concussion symptoms experienced in the last 24 hours, such as physical, cognitive, emotional, sensory, and sleep-related impairments. The RPQ can be paired with additional questionnaires and cognitive tasks to get a more objective picture of brain health.
The RPQ and other concussion evaluation tools may indicate a suspected concussion, but should never be interpreted in isolation. Results should be taken together along with the findings of other tests, assessments, and interviews. Working with other members of the patient's healthcare team for continuity of care has been shown to have a positive impact on the patient's overall health.
Advancing concussion care with robust testing
No single concussion assessment tool is sufficient on its own. Subjective questionnaires capture what the patient experiences, and objective cognitive tests measure what the injury has actually affected. Together they support a decision neither can support alone.
Patients can present with a variety of symptoms and effects after a concussion. Because of this, it's important to consider a range of tests when evaluating a patient. Multiple assessments paired together provide a more comprehensive picture of patient health.
Assessments should also be repeated across the course of recovery from a TBI. This can help the healthcare provider determine how the patient's symptoms are changing and how effective a given treatment plan is.
Reviewed by Mike Battista, Director of Science & Research at Creyos
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.