Would you recommend baseline testing?
Answer: I have found that baseline testing can be a very valuable tool, in the right setting. I don't think there is any question that having objective data that provides a snapshot of a patient's cognitive function prior to their injury is a good thing. The first problem comes when one considers whether or not a physician can trust that the recorded "baseline" values are a true measure of that person's abilities. There are many things that can effect performance on a computerized test. Environmental distractions, internal distractions, fatigue, poor sleep, pain, and illness are just a few. The most prevalent issue, however, is motivation. How hard somebody is trying during computerized testing in critical. If you stop and think about the difference in motivation between the pre-season and post-injury testing environments, it's not hard to imagine why this is a major problem with baseline testing. Secondly, while computerized cognitive tests have been shown to be sensitive to picking up the cognitive changes seen in concussion, they have not been shown to be very specific at all. In essence, they should never be used to make a diagnosis.
It's also extremely important to realize that not all baseline tests are created equal. I prefer to use tests that are shorter, simpler, and intrinsically motivating. For the purposes of managing sports concussion, we really don't need to measure complex brain functions. The simpler a test is, the less noise I see in the data, and the more useful it is clinically.
Bottom line, I definitely encourage baseline testing, and doing so on an annual basis. I can't stress enough, however, the importance of understanding the limitations of these tests and what factors effect the results. If you're thinking about using a particular test, look into the science behind it, try to understand what it's actually measuring, and be sure that it's used as part of a physician guided concussion management program, and not as a stand-alone device.
Dr. Jeffrey Kutcher is the Director of Michigan NeuroSport and Chair, Sports Neurology Committee, American Academy of Neurology. He is a member of the SportsConcussions.org Advisory Board.