(12) Baseline testing on concussion assessment measures is recommended to establish the individual athlete's “normal” pre‐injury performance and to provide the most reliable benchmark against which to measure recovery. Baseline testing also controls for extraneous variables (attention deficit disorder, learning disabilities, age, education, etc) and for the effects of previous concussion, while also evaluating the possible cumulative effects of recurrent concussions.
(13) The use of objective concussion assessment tools will help ATCs in more accurately identifying deficits caused by injury and recovery from injury and protect players from the potential risks associated with prematurely returning to competition and sustaining a repeat concussion. The concussion assessment battery should include a combination of tests for cognition, postural stability, and self reported symptoms known to be affected by concussion.
(14) A combination of brief screening tools appropriate for use on the sideline—for example, standardised assessment of concussion (SAC), balance error scoring system (BESS), symptom checklist—and more extensive measures—for example, neuropsychological testing, computerised balance testing—to evaluate more precisely recovery later after injury is recommended.
(15) Before instituting a concussion neuropsychological testing battery, the ATC should understand the test's user requirements, copyright restrictions, and standardised instructions for administration and scoring. All evaluators should be appropriately trained in the standardised instructions for test administration and scoring before embarking on testing or adopting an instrument for clinical use. Ideally, the sports medicine team should include a neuropsychologist, but in reality, many ATCs may not have access to a neuropsychologist for interpretation and consultation, nor the financial resources to support a neuropsychological testing program. In this case, it is recommended that the ATC use screening instruments (SAC, BESS, symptom checklist) that have been developed specifically for use by sports medicine clinicians without extensive training in psychometric or standardised testing and that do not require a special license to administer or interpret.
(16) ATCs should adopt for clinical use only, those neuropsychological and postural stability measures with population specific normative data, test‐retest reliability, clinical validity, and sufficient sensitivity and specificity established in the peer reviewed literature. These standards provide the basis for how well the test can distinguish between those with and without cerebral dysfunction in order to reduce the possibility of making false positive and false negative errors, which could lead to clinical decision‐making errors.
(17) As is the case with all clinical instruments, results from assessment measures to evaluate concussion should be integrated with all aspects of the injury evaluation—for example, physical examination, neurological evaluation, neuroimaging, player's history, etc—for the most effective approach to injury management and return to play decision making. Decisions about an athlete's return to play should never be based solely on the use of any one test.