Baseline concussion testing is a series of brain and body assessments taken before a sports season or activity begins, designed to capture how well your brain works when you’re healthy. If you later get a concussion, a doctor compares your post-injury scores to your baseline to gauge the severity and track your recovery. The tests typically measure memory, reaction time, balance, concentration, and visual tracking, and the whole process takes roughly 20 to 30 minutes.
What the Tests Actually Measure
A baseline evaluation isn’t a single test. It’s a collection of assessments that together create a snapshot of your normal cognitive and physical function. The main areas covered are:
- Memory: You’ll be asked to memorize a list of words, then recall them immediately and again after a delay of at least five minutes.
- Concentration and attention: Tasks like repeating number strings backward or listing the months of the year in reverse order.
- Reaction time: How quickly you respond to visual or auditory cues, usually measured by computer.
- Balance: Standing in specific positions with your eyes closed while an examiner counts how many times you wobble, step, or lose your stance.
- Symptom inventory: A checklist of 22 symptoms, from headaches and dizziness to fogginess and trouble sleeping, each rated on a 0 to 6 severity scale. Your pre-injury scores on this checklist matter because some people normally report mild versions of these symptoms even without a concussion.
Some programs also screen eye movement and vestibular function, checking whether tracking a moving object, shifting your gaze quickly between two points, or turning your head while focusing on a target provokes any headache, dizziness, nausea, or fogginess. These visual-motor screenings are especially useful because the eye movement system is one of the first things disrupted by a concussion.
Computerized vs. Sideline Tools
The two most common formats are computerized tests done on a laptop and paper-based sideline tools administered by a trained clinician.
ImPACT is the most widely used computerized version. It runs about 20 to 30 minutes and generates scores for attention span, working memory, nonverbal problem solving, reaction time, and response variability. Many high schools and colleges use it because it’s easy to administer to large groups and stores results in a database for later comparison. A baseline ImPACT test typically costs around $30 out of pocket.
The SCAT6 (Sport Concussion Assessment Tool, now in its sixth edition) is the standard clinical tool endorsed by the international concussion consensus group. It combines a symptom checklist, cognitive screening, balance testing, and a timed heel-to-toe walking task. It also includes an optional dual-task test where you walk heel-to-toe while counting backward, which stresses the brain’s ability to do two things at once. The SCAT6 is designed to be administered by a healthcare professional, while a simplified version called the CRT6 (Concussion Recognition Tool) can be used by coaches and parents on the sideline.
How Balance Testing Works
The balance portion uses a protocol called the Balance Error Scoring System, or BESS. You stand in three positions with your eyes closed and hands on your hips: feet together, heel-to-toe (tandem), and on one leg. Each stance lasts 20 seconds. An examiner watches for errors like opening your eyes, moving your hands off your hips, stumbling, or lifting part of your foot off the ground. The maximum error count for any single stance is 10. If you can’t hold a position for even five seconds, you receive that maximum score automatically.
One important detail: if multiple errors happen at the same instant (you stumble, open your eyes, and drop your hands simultaneously), only one error is counted. Your baseline error total gives clinicians a reference point, since balance naturally varies from person to person. Some people are just wobblier than others, and that’s useful information after an injury.
Who Should Get Tested
Baseline testing is most common among athletes in contact sports like football, soccer, hockey, lacrosse, and rugby. Many youth leagues, high schools, and colleges now require it at the start of each season. But the testing has value beyond organized sports.
The 2022 Amsterdam Consensus Statement on concussion, the most current set of international guidelines, notes that athletes with disabilities may particularly benefit from baseline testing because the variable nature of their conditions can make post-injury assessment tricky without a personal reference point. For younger children (ages 8 to 12), the consensus group is more cautious: baseline testing has limited usefulness in this age range because children’s brains are still developing rapidly, meaning their “normal” scores shift from year to year in ways unrelated to injury.
How Results Are Used After an Injury
When a concussion is suspected, the same tests are repeated. Clinicians compare the new scores against your baseline using a method called a reliable change index, which calculates whether the drop in performance is large enough to be meaningful rather than just normal day-to-day variation. For example, post-injury cutoffs for clinically significant change on different symptom profiles range from a 2-point to a 4-point shift depending on the category being measured.
This comparison helps in two ways. First, it can confirm a concussion diagnosis when symptoms are subtle or the athlete is downplaying them. Second, and often more importantly, it helps guide return-to-play decisions. An athlete might feel fine and want to get back on the field, but if their memory scores or reaction times haven’t returned to their personal baseline, they’re likely still recovering.
Limitations Worth Knowing About
Baseline testing is a useful tool, but it’s not perfect. The reliability of different components varies considerably. Symptom scores are the most stable: when the same healthy person takes the SCAT5 twice, two weeks apart, symptom ratings correlate strongly (a reliability coefficient of 0.85). The cognitive screening portion is much less consistent, with a reliability of only 0.58, and balance scores are lower still at 0.40. In practical terms, this means a healthy, uninjured person can score noticeably differently on cognitive and balance tests from one session to the next.
The cognitive variability comes largely from the memory subtests. In one study, total cognitive scores on the SCAT5 ranged from 28 to 45 among healthy athletes, and individual change scores between two testing sessions ranged from minus 7 to plus 11 points. Clinicians need to account for this natural fluctuation when interpreting post-injury results, which is why baseline scores are just one piece of the diagnostic puzzle alongside clinical examination and symptom monitoring.
There’s also the issue of effort. Some athletes intentionally perform poorly on baseline tests, sandbagging their scores so that a post-concussion test looks normal by comparison. The latest SCAT6 includes built-in checks designed to flag when baseline performance seems suspiciously low. If you’re tempted to do this, understand that it only hurts you: a falsely low baseline makes it harder for your medical team to detect a real brain injury when it matters.
How Often to Retest
Baseline scores don’t last forever. Most programs recommend retesting annually, especially for younger athletes whose cognitive abilities are still maturing. Even for adults, factors like fitness level, sleep quality, and general health can shift baseline performance over time. If your baseline is more than a year or two old, it may not accurately represent your current normal, which reduces its usefulness after an injury.