Kids and Sports-Related Concussions: The Role of Baseline Testing

By Gretchen Nuckles

If you’re an avid sports fan and a regular consumer of popular media, you’ve heard, seen, and read about sports-related concussions. Nearly four million young athletes–one in 10–will suffer concussions this year, according to the Centers for Disease Control. The actual number is likely much higher as concussions go unrecognized and under-reported.

Concussions are injuries that don’t play favorites–they can occur in any sport, at any level, at any age. And, whether they’re occurring more frequently or we’re getting better at recognizing them, data continues to underscore the seriousness and potential for long-term consequences. For example, recent research results from St. Michaels Hospital, Toronto, Ontario, indicate that repeated blows to the head, like those players in contact sports endure, can produce physical damage or changes to the brain. Other research results point to early dementia, depression, and other long-term symptoms.

What is a concussion?

A concussion is a brain injury. It is caused by traumatic force–either a direct hit to the head or an indirect blow to the body. While concussion reports may be a reoccurring topic, what is reported less often are the steps athletes, parents, coaches, and athletic trainers can take to help protect the health and safety of our young athletes.

A plan of action

First, learn to recognize concussion signs and symptoms. The CDC has an entire library of current materials for youth sports coaches and parents.  Plus, youth concussion laws are sweeping the country and interscholastic associations are tightening guidelines. Be aware of specific requirements in your state regarding education, informed consent, removal from play, and return to play.

Second, be sure to follow the fundamentals of the sport being played–wear proper fitting equipment in good condition, teach proper techniques, have water available at all times, follow the rules of the game, practice good sportsmanship, etc.

Third, in addition to getting a pre-sport physical exam, add a computerized cognitive “baseline” test to your pre-season check list.

How it works

Baseline testing is a term for any testing used before a treatment or activity. Cognitive baseline testing is one tool in an effective concussion plan because it measures what we can’t see – cognitive (brain) function. Baseline testing has been used for many years by professional and college-level sports programs. It is considered a best practice and recommended by both the National Collegiate Athletic Association (NCAA) and the American Academy of Pediatrics (AAP).

As part of their pre-season prep, an Athlete takes a baseline test before the sports season begins (or when uninjured). This establishes a “snapshot” of their brain’s speed and accuracy. If an athlete becomes concussed, they should seek appropriate medical attention. When physical symptoms have resolved, under the care of their qualified medical provider, an athlete can perform another test.  The tests look identical because repeating the same tasks after the injury identifies any cognitive changes from the baseline. This ability to compare results helps indicate whether the brain has fully recovered. It is an important, objective tool for qualified medical providers making decisions about when it is safe for athletes to return to the classroom, practice or play—whether that’s bike riding, snowboarding, cheerleading, or football.

Why computerized cognitive testing?

Concussion causes subtle changes in the speed and accuracy of cognition (thinking). These changes are usually the last symptoms to go away after a concussion and they can be very slight. While not diagnostic, computerized testing does help identify change in cognition. In fact, it is very difficult to detect these changes without a computerized test which compares an individual to themselves pre-injury.  This means that baseline testing in the pre-season, before any injury occurs, is essential.

There are many companies that offer computerized testing with differing approaches to the test, validity, and internal integrity checks.

For instance, at an Athlete can complete the baseline test in about eight to 10 minutes. The test features four tasks with playing cards and is designed to be easy to use and fair for athletes from very diverse backgrounds. “The brain likes making sense of new things,” said David Darby, M.D., CogState chief medical officer and co-creator of the Axon Sports test, “and kids are easily bored. Concealing and revealing cards allows for anticipation and curiosity–which both brains and kids thoroughly enjoy.

The test results are available immediately and stored in the Athlete’s secure account. This allows an athlete to confidently play for multiple schools, clubs and leagues throughout their childhood, all while having access to their account and their aggregated testing history. It allows parents to share test results at the click of a mouse with coaches, team managers, and medical providers.

Because the changes that occur in cognition with head injuries are often subtle and can occur within the normal ranges of population norms, evaluation of cognitive performance (i.e. how impaired is the individual) can benefit from the addition of sensitive tools like the Axon Sports Computerized Cognitive Assessment Tool,” said Darby.

Is it Valid?

For the past decade, validation studies have repeatedly proven the advantages of the Axon Sports CCAT for detecting cognitive change. The four tasks measure an Athlete’s processing speed, attention, learning and working memory. The validation efforts began in 2000 by establishing the properties necessary to detect change in cognitive function under a variety of comparisons and conditions. Several publications have reviewed the rationale behind using computerized cognitive testing by medical providers and have addressed validity issues. These studies showed the Axon Sports CCAT has minimal practice effects, good criterion, construct, test-retest and ecological validity.

So even though the Axon Sports test looks like a game and is motivating for the test-taker, the tasks are based on sound and well-established science. “The paradigms used are long-known psychological techniques regarding learning, memory, processing speed, and accuracy,” added Darby.

A winning sports team requires everyone to play a role. Play your part by educating yourself about concussions and the role baseline testing can play in the health and safety of young athletes.

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Gretchen is Axon Sports Vice President for Marketing and a Guest Contributor on  If you would like to be a guest contributor on please send your information to

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