Why Normative (Baseline) Testing?

Dr. Lowell Greib MSc ND CISSN

While normative (baseline) testing is recognized as an optional element for concussion management, The SportLab recommends normative testing for ALL athletes. The value of pre-injury normative testing (in neurocognitive, postural control, symptomology and clinical assessment) allows a clinician to delineate whether there is individual variability from a pre-injury state to an injured state.  Not only is the individual data taken into consideration, but also sex-specific normative means for the athlete are evaluated.  In essence, it allows a health care professional to compare data captured after injury with that of the individual AND a sex matched group in an uninjured state. Collectively, all of this information is used to help identify concussive injury.  It is important to note that they are not diagnostic tools on their own, but rather assessment tools that are used by medical practitioners to assist in evaluation of an injured athlete.  Their utility extends into the recovery of each athlete as well.

The SportLab has adopted the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) as a means of neurocognitive assessment.  Neuropsychologial testing is considered a ‘cornerstone’ of concussion management by the subject matter experts in the Concussion in Sport group. The validated test is done in an online platform and measures memory, attention span, visual and verbal problem solving. It is the first concussion specific medical device to receive FDA clearance. The suggested frequency of retesting ImPACT is every two years.

Postural stability testing uses sophisticated computerized posturography to identify postural stability deficits when injured.  By using this research grade technology, The SportLab can accurately decipher postural change in very accurate manner. This adjunct to normative testing allows medical professionals to assess the motor control of a potentially injured athlete.  Since each individual has slightly different balance and innate sway in their stance, it is important to get normative measurement for comparative purposes.

A symptom evaluation is part of normative testing.  We all have different functioning on a day to day basis, and thus it can be valuable to know what that normal is for each athlete. Symptom evaluation is done using part of the Sport Concussion Assessment Tool (5th Ed.) As some athletes can express some of the common symptoms of concussion and NOT have a head injury, it is important to clearly understand what is ‘normal’ for that particular individual. For example, we all know a teenager who experiences fatigue on a daily basis.

The final component of the comprehensive normative testing completed by The SportLab is specific to the vestibular and ocular motor systems. The vestibular system is responsible for balance and spacial orientation. The ocular motor system is responsible for the coordination of the six muscles that move your eyes. Literature suggests that both of these systems may be affected in concussive injury.  Further, it has been suggested that normative data is important to measure and document normal variations in these two systems.

To summarize, individual normative testing and sex-matched comparative values are only to be used to assist in the evaluation of an athlete and collectively used to aid in diagnosis.  Because post-concussive return to play goals include symptom resolution and a return to neurocognitive baseline levels, clinical decisions rest in part on understanding modifiers of this baseline.  The true value of normative testing is to provide clinical data and an inventory of information that can then be effectively utilized by a medical professional should an injury occur.  Consider it a physical exam for an athletes brain…

1 Clin J Sport Med. 2002;12(1)

2 J Clin Exper Neuropsychology. 2005;27(6)

3 Clin J Sports Med. 2001;11(3)

4 BJSM. 2017;51(11)

5 Am J Sports Med. 2014.

6 Am J Sports Med. 2016.

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