An injury like no other: Baseline testing a valuable tool in treating concussions
by Heather Baggett
Editor’s note: This is the second article in a two-part series on the dangers of concussions in high school athletics. The first article was published in the Jan. 27 edition of The Daily Home.

After an athlete has sustained a concussion, coaches, parents and medical professionals are then tasked with the duty to determine when that person has recovered and able to return to play.

Unlike some injuries, such as broken bones where an X-ray can provide proof of healing, it’s not as easy to determine when a person who sustained a concussion is healthy enough to return to play.

In the past few years, baseline testing has become a tool used by more and more professional and amateur athletic organizations.

Baseline testing is defined by the Centers for Disease Control and Prevention as “a pre-season exam conducted by a trained health care professional. Baseline tests are used to assess an athlete’s balance and brain function (including learning and memory skills, ability to pay attention or concentrate, and how quickly he or she thinks and solves problems), as well as for the presence of any concussion symptoms.”

Results from these tests, which are generally performed before the season begins, or in the summer for high school teams, are kept on file and are then used as a reference point should the athlete sustain a concussion.

Shaun Duhe, an athletic trainer at Coosa Valley Medical Center in Sylacauga, said the four schools he currently works with (Sylacauga, Childersburg, Winterboro and Fayetteville high schools) do not use baseline testing. He said the cost of performing baseline testing has been an issue, but he is hopeful they will be able to offer it soon.

“To do the computer test, I think it’s $500 per school, per year, and you have to renew that every year,” Duhe said. “For a high school, that can be quite cost prohibitive. I’m looking into some things where you can get those assessments for free, at least the baseline assessments. If we can do that, I would like to do that maybe this summer, so that we can use that and have maybe a little better estimate of how they are now and compare that to if they get a concussion.”

ImPACT, Immediate Post-Concussion Assessment and Cognitive Testing, is one of the most popular brands of baseline testing being used today.

“It’s basically a computer test – a neuropsychological test,” Duhe said. “You basically see a picture on a screen and it kind of times your reaction to it, having you match shapes and sizes and colors and things like that. In a way, it shows your reaction speed, processing it in the brain to your hands on the mouse and seeing your speed. When you have a concussion, you do it again. If you’re still showing symptoms, your reaction is going to be slower.”

Medical professionals at Southern Bone and Joint Specialists, which has offices in Dothan, Enterprise and Geneva, conduct ImPACT testing for sports teams at 30 schools in the area.

“We go to the schools every other year and do the testing, and the groups that we’re concentrating on is football, basketball, soccer and cheerleading,” said Marshall Smith, a credentialed ImPACT consultant and athletic trainer at Southern Bone and Joint. “We try to go to a school and stay there all day and test as many as can get tested.”

Smith said the program has been in place for about three years. In that time, Southern Bone and Joint has baseline tested about 3,000 athletes. In the same period of time, about 200 athletes have been treated for concussions, he said. The baseline testing takes about 40 minutes per athlete, including filling out the demographic information.

“It works out better for the athlete and better for us if the athlete does have a baseline assessment,” Smith said.

Once an athlete has a concussion, Smith said they could test the person again and compare the cognitive results with the results from the baseline assessment. Without a baseline test, Smith said medical professionals would have to compare results with data from a group of people the same age.

“It works out better if you have a baseline to compare them to themselves,” Smith said.

Smith said he began looking into baseline testing after his son sustained a concussion in 2004. It took a few years of research into the process and procuring certification, but he said coaches have been receptive to the program.

Adam Fossett, head football coach and athletic director at Childersburg High School, said he heard about baseline testing during All-Star Sports week, which is held in the summer.

“It’s something I haven’t talked to the other coaches in the county about, but I think it would be beneficial,” Fossett said. “The biggest problem we have is resources, getting it done in the county. It’s one of those things where, in my opinion, we might as well start doing it because it’s a matter of time before it’s mandatory. The precautions are going to become more and more as time progresses, from the AHSAA and from the national level as well. I thought it was pretty interesting.”

Duhe said baseline testing could be a valuable tool to help assess when an athlete is ready to return to play.

“I do think they’re beneficial because they give you hard data to look at and compare to before and after,” he said. “If you don’t have a baseline, a lot of it is subjective. A lot of it is symptom checklists.”

Both Duhe and Smith recommend using other tests, such as balance tests and eyes and ears coordination tests, in conjunction with baseline testing.

“If a clinic is considering doing baseline testing, they do not need to use only the test to determine if the athlete is ready to return to play,” Smith said.

Duhe described a balance test as doing “balancing drills in different positions with your feet on a hard surface and then on an unstable surface. You might give them 20 seconds and tell them to stay on it as long as you can and then count how many times they touch down or wobble or something like that. Then you compare that to post concussion tests.”

Both trainers believe eliminating the subjectivity related to concussions would be beneficial to the athlete’s health.

“It’s very subjective; a lot of emphasis is put on the kid or parent telling you how they are doing this day,” Duhe said, referring to relying on symptom checklists for concussion evaluations. “If they’re not telling the truth, it can throw it off a little, or quite a bit.”

According to Smith, the ImPACT Test, and other tests like it, can go a long way to reducing that subjectivity by relying on before and after test results instead of an athlete’s answers to questions on a checklist.

“It takes all of the subjective things out of it and makes it very objective,” he said.

Contact Heather Baggett at

© 2013