Baseline concussion tests are a set of brain and body assessments taken before a sports season starts, designed to capture how your brain normally functions when healthy. If you later get a concussion, a doctor can repeat the same tests and compare your post-injury scores to your pre-injury scores, looking for measurable drops in memory, reaction time, balance, or other areas. The idea is straightforward: knowing your personal “normal” makes it easier to detect when something is off and to track your recovery.
What a Baseline Test Actually Measures
A full baseline evaluation isn’t a single test. It’s a combination of assessments that together create a snapshot of your cognitive and physical function across several categories.
The cognitive portion is typically done on a computer. The most widely used platform, ImPACT, runs six subtests that produce four composite scores: verbal memory (how well you recall words and information), visual memory (how well you recall images and patterns), processing speed (how quickly you can match visual information), and reaction time. The computerized portion usually takes about 20 to 25 minutes on its own, though a full supervised session that includes all components can run around 45 minutes.
Balance testing adds a physical dimension. The most common protocol, the Balance Error Scoring System (BESS), asks you to stand in three positions: feet together, on one leg, and heel-to-toe (tandem stance). You do each position twice, once on a firm surface and once on a foam pad, with your eyes closed and hands on your hips for 20 seconds per trial. An evaluator counts errors like stumbling, opening your eyes, or lifting your hands. The maximum error score for each stance is 10.
A vestibular and eye-movement screening called VOMS (Vestibular/Ocular Motor Screening) tests five areas: smooth pursuit (tracking an object with your eyes), saccades (quick eye movements side to side and up and down), convergence (focusing on an object as it moves toward your nose), vestibular-ocular reflex (keeping your vision stable while turning your head), and visual motion sensitivity (how you tolerate busy visual environments). After each task, you report whether your symptoms changed. This screening captures problems that balance testing alone would miss, since balance tests only assess one part of the vestibular system.
Finally, a symptom inventory records your starting point for common concussion-related complaints. The CDC’s evaluation form tracks 22 symptoms across four categories: physical symptoms like headache, dizziness, nausea, light sensitivity, and noise sensitivity; cognitive symptoms like feeling foggy or having trouble concentrating; emotional symptoms including irritability, sadness, and nervousness; and sleep-related symptoms such as drowsiness and trouble falling asleep. Most healthy people report a few of these at baseline, which is exactly why having those numbers on file matters. If you normally report mild headaches and some trouble sleeping, those symptoms after a hit to the head carry different weight than they would for someone who reported zero symptoms at baseline.
How Results Are Used After a Concussion
When you sustain a concussion, a clinician repeats the same battery of tests and compares your new scores to your baseline. A meaningful decline in any area, say a noticeable drop in verbal memory or a slower reaction time, helps confirm the diagnosis and gives the medical team a concrete target for recovery. Rather than relying only on how you feel, they can see objective evidence of impairment.
The comparison also guides return-to-play decisions. You generally need to return to your baseline levels (or close to them) on cognitive testing, balance, and symptom reporting before being cleared for full contact. This prevents you from going back too early, when your brain may still be recovering even though you feel fine.
The Standardized Assessment Tools
The Sport Concussion Assessment Tool, now in its sixth version (SCAT6), is the standardized framework most widely recommended for athletes ages 13 and older. A separate Child SCAT6 exists for children ages 8 through 12. These tools bundle symptom scales, cognitive screening, and balance testing into one structured evaluation. A newer companion tool, the SCOAT6, was developed for follow-up assessments in an office setting after the initial sideline evaluation.
The SCAT6 symptom scales show the strongest ability to distinguish concussed athletes from healthy ones within the first 72 hours after injury. The cognitive and balance components are useful but have more variability, particularly in children, which is one reason baseline testing is considered especially helpful for young athletes whose developing brains make population averages less reliable.
Who Should Get Baseline Testing
Baseline testing is most common among organized athletes in contact and collision sports: football, soccer, hockey, lacrosse, basketball, and similar activities. Many high schools, colleges, and professional leagues build it into preseason protocols. Military personnel also undergo baseline testing in some branches.
For children, the picture is more nuanced. The latest international consensus guidelines from 2022 did not recommend routine, mandatory baseline testing for all children, largely because rapid developmental changes during childhood and adolescence mean a baseline taken one year may not accurately reflect a child’s abilities the next. However, the guidelines note that baseline testing can be considered for older adolescents and competitive athletes when trained personnel and proper resources are available. Computer-based tools designed for younger children exist and are FDA-cleared for ages as young as five, using simplified iPad-based tasks that assess memory and processing speed in about 20 minutes.
How Often to Repeat Baseline Tests
Because your brain changes over time, a baseline from three years ago may not represent your current function. Most sports medicine programs recommend repeating baseline testing annually, especially for younger athletes whose brains are still developing. College programs commonly retest every year or every other year. Adults in stable age ranges can sometimes stretch to every two to three years, though annual testing remains the standard recommendation in organized sports.
Limitations Worth Knowing
Baseline testing has real value, but it’s not as precise as many people assume. A large study of collegiate athletes from the NCAA-DoD CARE Consortium found that individualized baseline scores added limited diagnostic benefit over simply comparing post-injury results to population-wide averages. In other words, for many athletes, using a general reference table of “normal” scores worked nearly as well as using their own personal baseline.
This doesn’t mean baseline testing is useless. It matters most for people whose normal performance falls well outside the average, whether unusually high or unusually low. If your healthy reaction time is significantly slower than the population norm, a post-concussion test might look “normal” compared to average scores but actually represent a meaningful decline for you. That’s where individual baselines earn their keep.
Another concern is “sandbagging,” where athletes intentionally perform poorly on their baseline tests so that post-injury scores look comparatively better and they get cleared to return sooner. The latest consensus guidelines specifically recommend implementing checks for performance validity during baseline testing to catch this. Some computerized platforms have built-in validity indicators that flag suspiciously slow or inconsistent responses.
The balance portion of baseline testing also has known variability. Scores on the BESS can shift based on fatigue, the testing environment, and how well the evaluator was trained to count errors. More systematic training methods for evaluators have shown promise in improving reliability, but it remains one of the less precise components of the battery. These limitations are why baseline testing is treated as one piece of a larger clinical picture, not a standalone diagnostic tool.