Concussion Test

What is concussion testing?

Healthcare providers, athletic trainers and coaches use concussion tests to evaluate brain function before and after a head injury.

What is a concussion?

A concussion is a mild traumatic brain injury that results from a bump, violent jolt or blow to your head. The injury disrupts normal brain function. You can also get a concussion after a strong body hit causes you to jerk your head forward, backward or to the side.

How do I know if I have a concussion?

One commonly held myth is that a concussion happens only if you lose consciousness. In fact, most people who have a concussion never lose consciousness. It’s also possible that you, your child or another loved one may have had a concussion and not even know it. That’s why it’s important to get checked even if you think the knock to your head isn’t serious.

What are the symptoms of a concussion?

The most common symptoms of concussion include:

• Headache. This is the most common symptom.
• Nausea or vomiting.
• Confusion.
• Temporary loss of consciousness.
• Balance problems/dizziness/lightheadedness.
• Double vision or blurry vision.
• Ringing in the ears.
• Sensitivity to light and noise.
• Feeling tired or drowsy.
• Changes in sleep patterns, like sleeping much more or less than usual or can’t sleep.
• Trouble understanding and/or concentrating.
• Depression or sadness.
• Being irritable, nervous and anxious.
• Feelings of being “just not right” or in a "fog."
• Difficulty paying attention, forgetful and/or memory loss.

When should you get tested for a concussion?

Anyone who experiences a hit on their head or a whiplash-like head movement should be checked for a concussion. Concussion testing checks your cognition — your brain’s ability to think and process information — after a head injury.

Concussion testing is a useful tool for helping your healthcare provider diagnose a concussion. Early diagnosis allows for earlier planning and management of a concussion. Repeat concussion testing is also helpful to evaluate how well your brain recovers after a head injury.

What brain functions are checked in a concussion test?

There are many concussion tests. They range from the very simple (usually performed by non-healthcare professionals) to very detailed (performed by healthcare professionals). These tests all use a combination of verbal, written or computerized methods to check various brain functions.

Brain functions that are evaluated in concussion tests include:

• Alertness.
• Memory.
• Attention and concentration.
• Speed of thinking and solving problems.
• Ability to recall information.
• Vision.
• Balance and coordination.
• Reflexes.
• Hearing.

What are some examples of concussion tests?

There are many “named” concussion tests. Most concussion tests are a series of questionnaires or symptom checklists. All have their own scoring system.

Some concussion tests are administered by athletic trainers, coaches or sports medicine physicians. Other tests are self-reported tests you can fill in on your own. Still, others are one of the tools used by healthcare providers, such as neurologists.

Some of the named concussion tests include:

Concussion assessment tools

Warning: Assessment tools for concussions are not a substitute for medical evaluation. No youth athlete (under the age of 18 years) who has taken a blow to their head or has a suspected concussion should ever return to sport the same day. They should be removed immediately until a medical provider feels it's safe for them to resume their sport. In all 50 states, it goes against state law for an athlete to return to a practice/game without first being assessed by a medical professional for clearance.

SAC test

People use the standardized assessment of concussion (SAC) test on the sidelines and at the emergency room test to assess the immediate mental status of athletes. This test checks the athlete’s orientation, immediate memory, concentration and delayed memory. SAC takes about five minutes to complete. Test questions include:

• Stating the date, month, year, day of the week and current time.
• Memorizing a list of words then recalling them.
• Repeating a sequence of numbers backward.
• Saying the months of the year in reverse order.

SCAT 5

SCAT stands for Sports Concussion Assessment Tool 5. It's a concussion evaluation tool used for people 13 years and older. It includes the SAC test and much more — a neck evaluation and balance assessment, yes/no symptom checklist and other information on injury and conditions associated with concussion. The SCAT5 takes about 15 to 20 minutes to complete. There's also a pediatric version for children ages 6 to 12.

MACE

MACE stands for Military Acute Concussion Evaluation. This test collects information about the event, concussion signs and symptoms and includes a version of the SAC test information.

King-Devick test

• This athlete concussion test begins with a coach or trainer asking each athlete to read numbers on three index cards. Each card has a series of random numbers spaced unequally apart across eight lines. This test is done before the athletic season and is timed. If the athlete takes a blow to their head, the athlete goes to the sideline and retakes the test. If the athlete completes the test five seconds slower than the first time they took the test, they may have a concussion. This test has also been called the 1-minute concussion test or the 2-minute concussion test.

Balance tests

BESS

BESS stands for Balance Error Scoring System. This test measures your balance. It consists of six stances:

• Three on a firm surface.
• The same three on an unstable surface like medium-density foam.

Your eyes are closed and your hands are on your hips during this test. The stance is with your feet shoulder-width apart, one foot in front of the other and single leg stand on your non-dominant leg. All stances need to be held for 20 seconds.

Symptom scales

ACE

Healthcare providers use the acute concussion evaluation (ACE) tool. It includes questions about the presence of concussion characteristics, a checklist of 22 concussion symptoms and risk factors that might lengthen recovery. The form collects specific information, including:

• Concussion cause.
• Early signs of concussion.
• Memory issues.
• Loss of consciousness
• Concussion history.
• Headache history.
• Development history (including any learning disabilities, attention-deficit hyperactivity disorder).
• Psychiatric history (anxiety, depression, sleep disorder).
• Emergency symptoms (seizures, worsening headache, slurred speech, weakness/numbness).
• Diagnosis and follow-up plan.

PCSS test

The post-concussion symptom scale (PCSS) is a self-reported test in which you rank 21 symptoms by severity (none to severe) at baseline and at various time points. Symptoms cover physical, thinking, sleep and emotional functioning.

Computerized neurocognitive tests

ImPACT

The immediate post-concussion assessment and cognitive test is a computerized test for athletes 12 years and up. The test has three sections.

1. The athlete fills out their history (of sports participation, drug and alcohol use, learning disabilities and ADHD, other neurologic disorders and previous concession)
2. They complete a checklist of 22 symptoms.
3. They complete modules that test visual and verbal memory, reaction time, number sequencing ability, ability to learn and their brain’s visual processing speed.

This testing platform now has a pediatric version as well as a quick test for diagnostic testing within an emergency room or urgent care setting.

C3 Logix (proprietary test)

Cleveland Clinic has developed its own concussion mobile application for medical professionals who assess and manage concussions. After baseline data is collected, the C3 app is used to:

• Document the injury.
• Perform an initial assessment on the field.
• Measure the individual’s impairments.
• Assist in managing symptom recovery.
• Help determine when they've recovered and can return to participation.

The C3 app compares assessments after injury to athlete baseline and normative data of balance, information processing, reaction time, sequencing, coordination and vision.

Although these tests are useful to identify a possible concussion, you should still see your healthcare provider (if the test wasn’t administered by a medical professional). Your healthcare provider or neurology team will also do a complete exam including balance and vision checks. They may also order imaging tests, including MRI or CT scans, to check for bruising or bleeding in your brain. There’s also a blood test called the brain trauma indicator. This blood test measures specific proteins in blood released after mild traumatic brain injury. The presence of these proteins may indicate a brain bleed.

What are baseline concussion tests and sideline concussion tests?

These types of concussion tests are mostly performed on student athletes. Student athletes who play in contact sports usually undergo a baseline concussion test before the start of their season. This questionnaire measures normal brain function in areas including memory, speed of thinking and attention. Computerized testing is often similar to playing a video game. If the athlete experiences a head injury any time during the season, they are removed from play and retested. The results of the current concussion test are compared to the preseason results.

Another simple tool is a sideline concussion evaluation. This test checks brain function in concussion-suspected athletes. Typical questions include:

• Naming the opponent and stating the score (short-term memory).
• Saying your name and date of birth (long-term memory).
• Naming the months of the year in reverse order (a complex task).

Remember, no player who has taken a blow to their head or has a suspected concussion should ever return to the game. These tests provide some information. If a physician or sports medicine specialist is not on staff at school, players should be referred to their healthcare provider for further follow-up. Your healthcare provider will perform a complete physical exam and some tests or may refer you to a sports medicine specialist or neurologist for additional tests and imaging tests if needed.

Is there a quick concussion test that can be done at home?

First, know that only medical professionals can examine you or your loved one and order any needed tests to diagnose a concussion. However, in some instances, you can ask a few simple questions and gather some information to share with the healthcare provider.

For example, you might be with your parent when they fall and bump their head or with your child when they fall off their bike and hit their head. Collecting information immediately after a fall will not only be helpful when you first see your provider, but also while you’re caring for your loved one after they return home from their examination. If there are any changes in the information, call your loved one’s healthcare provider right away.

Questions to ask and notes to share with your healthcare provider include:

• Ask your loved one to state their name, where they are, the time and date, and what just happened.
• Ask your loved one to spell the word “world” backward.
• Ask your loved one if they have a headache, feel dizzy or nauseous.
• Ask your loved one to follow your finger movements with both of their eyes. Draw a large “x” in front of their eyes. Are both of their eyes following your finger motion?
• Ask your loved one if they’re experiencing weakness or numbness and tingling anywhere in their body.
• Notice if your loved one’s speech is normal or slurred.
• Notice if your loved one’s pupils are the same size or if one is larger than the other.
• Notice if your loved one is sensitive to sound or light.
• Notice any changes in your loved one’s behavior. Are they getting more restless, agitated or confused?

Again, never try to diagnose a concussion on your own. No head injury is too small. All head injuries should be checked by a medical professional. Your loved one’s healthcare provider will want to conduct their own tests — possibly including brain imaging studies — before making a diagnosis.

What do the results of concussion tests mean?

Each concussion test has its own scoring system. You may take one or more types of concussion tests. If the concussion test(s) plus any other findings show you've had a concussion, your healthcare provider will discuss a recovery plan.

The recovery plan will include:

• Getting more rest and sleep than normal but not too much. Too much mental rest can lengthen the recovery period.
• Learning the triggers that bring on concussion symptoms and, when they occur, back off and rest.
• Adding more activities back into your day as your symptoms improve.
• Developing a return-to-school plan to share with teachers, school nurses, counselors or psychologists (if the concussed person is a student).
• Working with athletic trainers and all others involved in the organization’s (usually school) concussion protocol. This is an organization’s set of policies and procedures for caring for someone (usually a student-athlete) who has had a head injury.

What is a concussion eye test?

Normal pupil diameter (the black part of your eyes) should be about equal in both eyes. Your pupils react to direct light. One simple concussion assessment test is to shine a low-beam flashlight from the outer edge of each eye inward. Pupils should quickly get smaller (constrict) in response to the light. A slow pupil response to light may be a sign of brain injury (increased intracranial pressure or ICP). Pupils that don’t react at all to the light may mean a severe increase in ICP or severe brain damage.

Pupil shape can also reveal important information. Normally, your pupils should be round in shape. An oval pupil may also be a sign of a brain injury (increased intracranial pressure).

A note from Cleveland Clinic

A concussion is a mild traumatic brain injury. Concussion tests are a relatively simple, quick tool to evaluate possible concussions. Concussion tests are not the only method used by healthcare providers to diagnose concussions. Your healthcare provider will conduct a complete exam, order imaging scans (if needed) and other tests. The results of concussion tests and other tests allow for early diagnosis and management of concussion, which will help you recover faster and may prevent further injury.