A Parent’s Guide to Concussion Baseline Testing
As you cheer your child on from the stands, the last thing you may be thinking about is whether he or she will have a concussion this year. To be honest, it’s one of the last thoughts you might want to entertain, but unfortunately it’s a very real risk in many sports, even those which are non-contact.
In the past, physicians were only able to treat the symptoms of a concussion based on tests performed at the time, but today, health professionals can administer a test beforehand to track normal brain function, making it potentially easier to identify any unusual activity. It’s appropriately referred to as concussion baseline testing, and many schools and club organizations are beginning to require it before your child even starts practice.
A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that causes the brain to move back and forth rapidly. Symptoms can include headache, blurred vision, nausea or vomiting, dizziness, slurred speech, appearing dazed, or feeling groggy or sleepy.
Baseline testing is performed prior to an athlete starting their season in order to establish “normal” brain activity for that particular person, including learning and memory skills, the ability to pay attention or concentrate, and problem-solving skills, as well as the presence of any current concussion symptoms.
“Establishing a baseline makes it much easier for a physician to interpret a patient’s post-injury testing. Every kid is unique but they all use the same test, so it’s important for us to know how a post-injury test result compares to the individual patient’s ‘normal,’” says Sarah Gill, an athletic trainer on the staff at Texas Health Sports Medicine Concussion Center – Plano. “For example, a score in the 50th percentile may seem okay, but if a patient’s baseline is in the 90th percentile that score actually reflects a significant deficit that is likely caused by an unhealed head injury.”
Post-injury test scores are compared to a patient’s baseline results and any significant decrease may be interpreted as a deficit caused by a traumatic head injury, such as a patient’s symptoms making it too difficult for them to complete the assigned tasks or an actual impairment in the brain’s ability to function normally. Because of this, Kester adds that baseline testing can also be especially important for athletes with learning differences who may struggle with the specific tasks included in the test, which may come up as a false red flag during concussion testing after an injury.
So what goes on during a concussion baseline test? Gill explains that the most popular form of testing is through the use of a computerized neurocognitive test. The athlete is most commonly in a private room, free from distractions, and usually on their own because Gill says it is common for young patients to have trouble focusing while a parent is in the room. An athletic trainer or medical assistant will then get them started on the computerized test with some basic instructions and will also be available to answer any questions they may have before and during the test, which can take anywhere from 20 to 45 minutes.
After the computerized test, the parent is brought back, and a test of the athlete’s balance is performed. When all testing is complete, the physician will meet with the athlete and his or her parent to interpret and explain the results.
The standard recommendation is to take a new baseline test every two years, starting at age 10, but Katherine Kester, M.D., a primary care sports medicine physician on the medical staff at Texas Health Allen and at Allen Orthopedics and Sports Medicine, a Texas Health Physicians Group practice, adds that some clinics (including Allen Orthopedics and Sports Medicine) offer pediatric baseline testing for children as young as five years old.
“I would encourage every athlete to take a baseline test,” Kester says. “Texas law states that any student-athlete in any sport suspected of having a concussion must be cleared by a physician to return to activity, and baseline testing can be very helpful with that process.
“Also, it’s not just contact-sport athletes that get concussions. In our clinic, we’ve treated patients who have been injured playing literally every sport, including tennis, swimming and track.”
Sports are a leading cause of concussion, with a 52 percent increase in traumatic brain injury visits from 2001 to 2009, most of which were related to sports injuries, according to the Centers for Disease Control and Prevention. A national study conducted by Blue Cross Blue Shield also revealed a 71 percent spike in youth concussions between 2010 and 2015, making baseline testing even more important.
“EVERY concussion sustained by a child needs to be evaluated and managed by a physician,” Kester stresses. “We do not recommend that parents wait to see if the child feels better after a few days, or if the symptoms are ‘serious enough’ to need a doctor. Children’s brains are still developing, and this makes them especially vulnerable to significant injury if they are not properly protected after a concussion. Research also shows that patients who get into a proper concussion management protocol early recover more quickly from their injuries than those who wait.”
Kester adds that while many pediatricians and primary care physicians offer concussion baseline testing, she strongly encourages parents to have their children tested at a clinic that specializes in sports medicine and concussion management.
“They use these tests every day and are best trained to instruct and supervise the testing properly and interpret the results,” she says.