Concussion testing is a set of evaluations that measure brain function before and after a head injury. These tests check memory, reaction time, balance, vision, and symptoms to determine whether a concussion has occurred and how recovery is progressing. They range from quick sideline screenings done in minutes to detailed computerized assessments that take 20 to 30 minutes, and they’re used across sports, emergency rooms, and doctors’ offices.
Baseline Testing: The “Before” Snapshot
The most useful concussion testing starts before any injury happens. A baseline test records how your brain normally performs on measures like memory, processing speed, reaction time, and balance. If you later take a hit to the head, a provider can compare your post-injury results to your personal baseline rather than relying on population averages. This comparison makes it much easier to spot subtle deficits that might otherwise go unnoticed.
Baseline testing is most common among athletes in contact sports, often required by schools or leagues. Most components should be repeated annually to stay accurate, though computerized cognitive tests can be updated every two years. More frequent retesting may be needed if an athlete has a history of concussions or a condition like ADHD that could shift their baseline scores over time.
Sideline Screening Tools
When a possible concussion happens during a game or practice, the first evaluation typically occurs on the sideline. The most widely used tool is the Sport Concussion Assessment Tool, now in its sixth version (SCAT6). It takes at least 10 to 15 minutes to administer correctly and is designed for use within the first 72 hours after injury.
The SCAT6 starts with an immediate neurological screen that can be done on the field. An evaluator watches for observable red flags: lying motionless after impact, falling without bracing, a blank or vacant look, visible confusion, balance problems, or a seizure. They then check neck pain and range of motion, test coordination by having the athlete touch their finger to their nose, and assess memory with a set of questions like “What venue are we at today?” and “Who scored last in this match?”
If the athlete moves to a more thorough off-field assessment, the SCAT6 adds a 22-item symptom checklist covering headache, pressure in the head, nausea, dizziness, blurred vision, feeling “in a fog,” difficulty concentrating, fatigue, irritability, and trouble falling asleep, among others. Each symptom is rated from 1 (very mild) to 6 (severe), producing a maximum severity score of 132. Higher scores indicate more significant symptoms. The off-field portion also includes cognitive screening (recalling a word list, reciting digits backward, saying the months in reverse order) and balance testing through stance challenges and timed walking tasks.
A separate sideline tool, the King-Devick Test, takes a different approach. It asks the athlete to read rows of numbers as quickly as possible, which requires rapid eye movements, attention, and language processing. Any slowdown compared to a baseline time suggests a problem.
Pediatric Versions
Children under 13 receive modified assessments. The Child SCAT uses simpler language, different symptom items, and adjusted scoring scales appropriate for younger athletes. Kids aged 8 to 12 are evaluated with this child-specific version, while those 13 and older receive the standard adult tool.
Computerized Neurocognitive Testing
Beyond the sideline, computerized tests provide a more detailed picture of brain function. The most widely known is ImPACT, approved for athletes aged 12 and up. These programs measure verbal and visual memory, processing speed, and reaction time through a series of timed tasks on a computer or tablet. Results are scored automatically and compared against the athlete’s baseline or age-matched norms.
Computerized testing is particularly useful for tracking recovery over days or weeks, because the same test can be repeated and compared objectively. A player might feel fine subjectively but still show slower reaction times or weaker memory recall than their pre-injury performance. That gap matters for making safe return-to-play decisions.
Vestibular and Eye Movement Screening
Concussions frequently disrupt the connection between your eyes, inner ear, and brain. The Vestibular/Ocular Motor Screening, or VOMS, specifically targets these systems. Before each exercise, you rate your headache, dizziness, nausea, and fogginess on a 0-to-10 scale. Then the evaluator walks you through a series of tasks.
Smooth pursuits have you follow a fingertip moving slowly left, right, up, and down. Saccades test how quickly your eyes can jump between two points. Near-point convergence measures how close you can bring an object toward your nose before you see double. A convergence point of 5 centimeters or more from your nose is considered abnormal. The VOR (vestibular-ocular reflex) portion asks you to focus on a stationary target while turning or nodding your head at a set pace. A visual motion sensitivity test has you stand and rotate your head and trunk while focusing on your thumb. After each task, you re-rate your symptoms. Any significant increase in headache, dizziness, nausea, or fogginess points to vestibular or ocular involvement, which can guide treatment.
Blood Tests and Brain Imaging
A relatively new option is a blood test that detects two proteins released by injured brain cells. When brain tissue is damaged, these proteins leak into the bloodstream and can be measured within hours. The test has FDA clearance and is primarily used in emergency settings to help determine whether a CT scan is necessary. If the blood test comes back negative, it can help rule out bleeding or bruising in the brain, potentially sparing the patient from radiation exposure.
Standard imaging like CT scans and MRIs do not diagnose concussions themselves. Most concussions produce no visible changes on a scan. Imaging is reserved for more serious warning signs: severe headaches, seizures, repeated vomiting, or symptoms that keep getting worse. A CT scan is the standard first choice for adults when imaging is needed. For children, CT scans are used only when specific criteria are met, such as signs of a skull fracture or a particularly dangerous mechanism of injury. MRI may be ordered later if complications are suspected or symptoms persist.
What Happens After Testing
Test results don’t just confirm or rule out a concussion. They also guide recovery. If testing reveals deficits in balance, you may be referred for vestibular therapy. If cognitive scores are low, your provider may recommend academic accommodations like reduced screen time or lighter workloads before gradually returning to normal activity.
For athletes, return to sport follows a structured six-step progression set by CDC guidelines. Each step requires a minimum of 24 hours, and you only advance if no new symptoms appear. The steps move from normal daily activities, to light aerobic exercise (5 to 10 minutes of walking or stationary biking), to moderate activity with head movement, to heavy non-contact drills like sprinting and full weightlifting, to full-contact practice, and finally back to competition. Testing results at various points along this timeline help confirm the brain has recovered enough to handle each increase in demand.
The entire process, from initial screening to clearance for full activity, typically takes at least a week and often longer. Concussion testing isn’t a single pass-fail exam. It’s a series of checkpoints designed to protect the brain while it heals.