Nearly 50% of people worldwide will experience a mild traumatic brain injury in their lifetime, according to a study in Lancet Neurology. Many people will experience a concussion without knowing it, or experience long-term effects.
Self-report questionnaires are available for patients to describe their symptoms, but there's a pressing need for objective cognitive measures to get a clear and immediate picture of brain function so providers can make timely and appropriate referrals as needed.
There are a number of tools available for concussion testing to help clinicians accurately and confidently assess their patients for a concussion. In this article, we’ll walk through the different kinds, as well as how and when to use them.
Whether you’re an occupational therapist, sports neurologist, a primary care provider wanting to screen a patient before referral, or other medical professional, this article will help to understand and evaluate concussion assessment tools.
What is Concussion Testing?
Concussion testing is used to assess whether a patient has sustained a mild traumatic brain injury, and can also be used to track the severity and progression of concussion symptoms. Concussion testing can assess and track various brain functions relevant to post-concussion syndrome, such as: sustained attention, focus, verbal and spatial reasoning, immediate memory, and more.
What is a Concussion?
A concussion is a mild traumatic brain injury that occurs when the brain has been bruised by an impact with the skull. This can be caused by a hit to the head, or any violent movement that causes the head to jerk suddenly, and can affect both adults and children. The patient doesn’t necessarily need to have lost consciousness, and many people with concussions didn’t.
Symptoms of a Concussion
Symptoms of a concussion can vary greatly from person to person, as well as over time. The most common symptoms—headache, dizziness, and nausea—usually present very early after a brain injury event, and will often be what brings the patient in to see a doctor.
However, concussions are incredibly varied, and there are many other symptoms that can come with a concussion (Theadom et al., 2016, Haarbauer-Krupa et al., 2021). Other symptoms of concussions include:
- Confusion
- Memory dysfunction
- Light sensitivity
- Sound sensitivity
- Trouble concentrating
- Issues sleeping
- Fatigue
- Depression
- Irritability
- Decreased ability to solve problems
- Trouble thinking
When to Test for a Concussion
Concussions can be caused by a variety of things, such as “falls, motor vehicle or other types of road injuries, sports-related injuries, and interpersonal physical violence or violence by other means” (Haarbauer-Krupa et al., 2021). With multiple mechanisms of injury, it’s important to know when to test for a concussion.
- Before a concussion happens: Getting a baseline of a patient's cognitive performance provides better data in the event they get a concussion.
- Immediately after a concussion: It’s often a good idea to test for a concussion after any kind of head injury. Clinicians should talk to their patients about their cognitive health as early as possible. It’s helpful for a patient to be aware of their concussion early, as symptoms can worsen if ignored. The earlier a patient can get assessed, the earlier they can start a treatment plan to mitigate symptoms.
- Upon repeat impacts: Repeated head injuries can worsen the symptoms of a concussion over time.
- Periodically after a concussion occurs: Routine assessments are a key part of tracking treatment efficacy and symptom progression. Many people experience concussion symptoms for 3-6 months after an injury, and studies have found that some concussion symptoms can persist up to a year post-injury (Machamer et al., 2022).
What Does a Concussion Assessment Tool Measure?
Concussion assessment tools are designed to measure a variety of things, such as a patient’s self-reported symptoms, functional abilities such as their balance and coordination, mental health, and their cognitive abilities (e.g. memory, problem solving, and attention).
- Self-reported symptoms: Symptoms can be assessed with a self-report questionnaire, like the RPQ.
- Functional abilities: Balance and coordination are often assessed immediately post-injury with simple tasks, such as having the patient touch a moving point then their nose and back again.
- Mental health: Mental health can be assessed using a variety of tools and questionnaires, such as the PHQ-9 which can be used to assess depressive symptoms.
- Cognitive abilities: These can be tested with cognitive tasks that the patient can complete, with many available online. Using an objective cognitive test, like our Double Trouble task, allows healthcare professionals and their patients to see quantitative data on cognitive function.
Objective cognitive tests are particularly useful to integrate into concussion assessment, as it can be difficult for a patient to say how good their memory and reasoning abilities are without putting them to the test. Using cognitive tests can indicate more objectively how a patient’s symptoms are affecting them in their daily life.
How To Assess A Concussion
Following a Sports Injury
Sporting matches are one of the highest risk factors for concussions. The field of sports medicine has grown significantly in recent years, as has understanding of sports related concussions. There are a number of special considerations when it comes to sports related concussions, and studies are coming out frequently on the lasting impact of concussions on the brain function of athletes.
One important consideration when it comes to athletes is baseline data. Assessment tools can be done before a concussion or the start of the season. These baseline results are used to get a better idea of normal brain function in an athlete. Then, in the case of a brain injury, it’s possible to compare new results to a baseline.
Another important consideration in sports related concussions is on-site assessment. Unlike other environments, an athlete can be assessed immediately following an injury. This has led to the invention of short, on-site assessments, like the Standardized Assessment of Concussion. These kinds of assessments are designed to be simple and don’t require a specialist to administer. They typically include balance, memory, and other cognition tasks.
After initial screening, a variety of tests are useful to more confidently diagnose, treat, and track changes for patients. Patient assessment can be performed by sports neurologists, team physiotherapists, or other medical professionals. Symptom checklists and questionnaires are common, as are objective cognitive tests to measure brain function and affected skills.
Assessments can be administered regularly, in order to monitor the development of symptoms. When taken over time, these data can be visualized with graphs to show trends and progress.
Following a Workplace or Vehicle Accident
Sports concussions are common, but sports injuries aren’t the only thing that can lead to a concussion. Individuals involved in a car accident often walk away with a concussion. Concussions can also occur at home or in the workplace.
When a brain injury occurs in a situation without an on-site medical professional, it’s typically emergency room staff or primary care providers that assess these suspected concussions. In the emergency room or doctor’s office, the same questionnaires, balance tests, and cognitive assessments are common.
Once diagnosed with a mild traumatic brain injury, patients can be referred to a specialist to design a treatment plan for symptom management and monitor progression of post-concussion syndrome. In the case of ongoing treatment, it’s important to have a consistent healthcare team monitoring the patient, for continuity of care.
There are a variety of concussion evaluation tools available. We offer a variety of assessments for healthcare professionals online, to more confidently diagnose, treat, and track changes for patients.
Types of Concussion Assessments
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 this 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, along with physiological tests. An absence of one or the other could result in incomplete information, so it’s a good idea to use a range of tests, leading to a whole person care approach to health care.
Subjective Tests
Subjective concussion assessments typically involve patients using a questionnaire or a symptom checklist to self-report their symptoms. These symptoms can vary from person to person, so it’s important to look at the results as a whole for that individual patient. Having a personalized approach to a patient 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 Sports Concussion Assessment Tool, or SCAT-5, is designed for healthcare professionals to use with patients after a sports injury. In addition to symptom self-reporting, this assessment 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, or SCAT-6, became available in 2025.
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.
We offer a variety of online cognitive tasks. These tasks can be performed by patients in a clinic or at home, and do not require the presence of a healthcare professional. Some of these are listed below.
- Double Trouble: This task measures a patient’s concentration when distracting information is present.
- Number Ladder: This task assesses a patient’s spatial short term memory, and their ability to update it as information changes.
- Paired Associate: This task examines a patient’s ability to recall information and the context it appeared in.
- Odd One Out: This task measures a patient’s deductive reasoning.
- Spatial Planning: This is a reasoning task that assesses the patient’s ability to plan ahead.
Objective cognitive deficits due to a brain injury can depend on the nature, severity, location, and time passed since the injury, as well as other factors. A broad assessment of several areas of cognition can maximize the chances of catching any significant deficits the patient may be experiencing in the days after a concussion. Long-term effects tend to be more subtle, but can persist—for example, people who report a history of at least one concussion tend to score lower in Double Trouble (Stafford et al., 2020).
Fitting Concussion Assessment and Screening Into a Clinical Workflow
Screening: There are some tests designed specifically for on-site or emergency room assessment. The most common is the Standardized Assessment of Concussion (SAC). This standardized tool takes about 5 minutes to complete and is designed to be done immediately after a suspected concussion. This task doesn’t require a specialist to interpret the test scores.
Diagnosis: Neurologists or other trained professionals should perform a variety of tests and assessments in order to diagnose a concussion. Healthcare professionals should assess 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. Cognitive tasks are great to use at regular intervals to see how a patient’s ability is changing. Patients should also have regular checkups to assess the effectiveness of a treatment plan. A case study on the Kerlan-Jobe Center for Sports Neurology found that using Creyos cognitive assessments in clinic led to 10% fewer referrals and an increase in patient retention.
Return to regular activities: For sports injuries, while exercise can have a positive effect on brain health, athletes should not 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 to return to work, school, or certain activities like video games.
What is the Gold Standard Concussion Assessment?
There is no single gold standard concussion assessment. So what should be used? Well, studies have shown that the best way to assess concussion symptoms is to use a variety of tests (Feddermann-Demont, 2017). Long-term effects, though usually subtle, can be detected using objective cognitive tasks. These results can be complemented with subjective, self-report data from patients.
What Do Concussion Test Results Mean?
A concussion test can measure:
- Number of symptoms
- Severity of symptoms
- Change in body and brain function compared to baseline
- How long symptoms have lasted
Each test is scored differently, so it’s important to have an understanding of what to look for in 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. Questions are scored on a scale of 0 (“not experienced at all”) to 4 (“a severe problem”).
An overall score between 16 and 35 may be indicative of post-concussion syndrome, and greater than 35 may also be predictive of moderate to severe limitations in abilities. The RPQ can be paired with additional questionnaires and cognitive tasks to get a more objective picture of brain health.
The RPQ and other assessments may indicate a suspected concussion, but should never be interpreted in isolation. Results should be taken in tandem with other tasks, assessments, and interviews, and considered as a whole. Working with other members of the patient’s healthcare team for whole person care have been shown to have a positive impact on the patient’s overall health.
Everyone will react differently to a concussion, based on area of injury, age, sex, and a variety of other factors (Haarbauer-Krupa et al., 2021). It’s necessary to consider the individual and their needs, in order to make brain health care as accessible as possible.
Advancing Concussion Care with Robust Testing
In this article, we’ve given an overview of concussions, and the purpose of concussion assessments. We’ve described a variety of concussion assessments available, with a focus on subjective and objective measurements.
Patients can present with a variety of symptoms and effects after a concussion. Because of this, it’s important to look at a range of tests when evaluating a patient. Ideally, multiple assessments should be performed in order to complement each other.
These assessments should also be taken by the patient multiple times. This will help the healthcare provider determine how the patient’s symptoms are changing, and how effective a given treatment plan is.