A baseline concussion test is a pre-injury assessment of brain function, balance, and symptoms taken before an athletic season begins. It creates a snapshot of how your brain normally performs, so if you later suffer a concussion, a doctor can compare your post-injury results against that personal benchmark. This comparison helps determine how severely the concussion affected you and when you’ve recovered enough to return to school or sport.
What the Test Actually Measures
A full baseline assessment covers several areas of brain and body function. The goal is to capture a wide picture of your normal abilities so that even subtle changes after a head injury become visible. The main domains include:
- Memory: Both verbal memory (recalling words or lists) and visual memory (recognizing images or patterns you saw earlier).
- Processing speed: How quickly you can take in information and respond to it.
- Attention and concentration: Tasks like reciting digits backward or listing months in reverse order.
- Balance: Standing still in different stances with your eyes closed, on both firm and foam surfaces.
- Symptom inventory: A checklist of 22 possible symptoms, each rated from 0 (none) to 6 (severe), producing a total severity score out of 132. This records whether you already experience headaches, dizziness, or trouble sleeping before any injury occurs.
Some programs also test eye movement. The King-Devick test, for example, measures how quickly and accurately you can read rows of numbers aloud from left to right. Your total reading time, plus any uncorrected errors, gives a score that reflects the speed and precision of the rapid eye movements your brain uses to track objects.
How the Testing Works
The most widely used computerized tool is called ImPACT. It takes about 20 minutes and runs on a standard computer. You’ll work through a series of tasks involving reaction time, memory recall, and attention. A typical out-of-pocket cost is around $30 per athlete, though many school athletic programs cover it or offer group testing days.
The test should be done in a quiet, distraction-free environment while you’re well rested and healthy. Testing while tired, sick, or distracted can produce artificially low scores, which defeats the purpose.
Balance testing often follows the Balance Error Scoring System (BESS). You stand in three positions: both feet together, on one leg, and in a heel-to-toe tandem stance. Each position is held for 20 seconds with your eyes closed and hands on your hips. An evaluator counts errors like stumbling, opening your eyes, or lifting your hands. The maximum error score per stance is 10.
The current gold-standard sideline tool is the Sport Concussion Assessment Tool, version 6 (SCAT6), designed for athletes aged 13 and older. Its off-field portion includes orientation questions, immediate and delayed word recall, concentration tasks, balance testing, and a timed tandem gait (walking heel-to-toe in a straight line). All of these sections produce numerical scores that become your baseline reference.
When and How Often to Test
Baseline testing should happen during the preseason, ideally before the first practice. This ensures the snapshot reflects your brain at its healthiest, not after early-season contact or fatigue.
For adolescents, a new baseline should be established every year. The developing brain improves measurably between ages 9 and 15, meaning a two-year-old baseline may no longer reflect your true abilities. Some experts recommend testing every six months for athletes under 15. Adults in stable health can go longer between tests, but annual retesting is still recommended when resources allow, especially for anyone who has had a concussion since their last baseline.
For children under 13, baseline cognitive testing has limited reliability. The rapid developmental changes in younger kids make scores unstable from one session to the next. The American Academy of Pediatrics notes that routine mandatory baseline testing is not recommended for children, though it can be considered for older adolescents and competitive athletes when resources permit. A separate child version of the concussion assessment tool (Child SCOAT6) exists for ages 8 to 12, but its clinical utility is still limited compared to the adult version.
How Baseline Scores Are Used After a Concussion
If you take a hit and a concussion is suspected, a clinician will re-administer the same tests, typically within 72 hours of injury. Your post-injury scores are then laid alongside your baseline. A drop in memory recall, slower processing speed, worse balance, or a jump in symptom severity all signal that the brain hasn’t recovered yet.
This comparison is repeated at intervals throughout recovery. Returning to your personal baseline scores is one piece of evidence (alongside symptom resolution and a graduated exercise protocol) that helps guide the decision on when it’s safe to return to play. No single test score makes that decision on its own. The SCAT6 explicitly states that its scoring should not be used as a standalone method to diagnose concussion or clear an athlete.
Why Your Effort on the Test Matters
One well-known problem with baseline testing is sandbagging: deliberately performing below your true ability so that post-injury scores look normal by comparison. If you tank your memory score on purpose, a concussed brain might still match that artificially low number, making it look like nothing is wrong.
Clinicians watch for this using built-in validity indicators that flag performances too slow or inconsistent to reflect genuine effort. The reasons for poor baselines aren’t always intentional. Younger athletes are more likely to produce invalid results simply because they weren’t paying attention, didn’t understand the instructions, or didn’t appreciate why the test mattered. Adults, on the other hand, are more likely to be influenced by external incentives to underperform.
If your baseline is flagged as invalid, it becomes essentially useless. You may be asked to retest, and in the meantime a clinician would have to rely on normative data (average scores for your age and sex) rather than your personal benchmark, which is a less precise comparison.
What Baseline Testing Cannot Do
A baseline test does not predict who will get a concussion or how severe it will be. It also cannot diagnose a concussion on its own. It is one tool in a larger clinical picture that includes symptom tracking, neurological examination, and a healthcare professional’s judgment. Athletes without a baseline can still be evaluated after a concussion using population averages, though having your own data makes the comparison more sensitive to subtle changes that fall within the “normal” range for the general population but are abnormal for you.