HQ BaselineClinical principles
Your Baseline Is Only as Good as Your Worst Domain: Why Multi-Domain Testing Catches What Single Tests Miss
A baseline is a safety net — and a net with big holes still lets concussions through.
Imagine two athletes who both sustain concussions on the same day. Athlete A has impaired verbal memory and processing speed but normal balance and eye movements. Athlete B has perfect cognitive scores but severe vestibular dysfunction — dizziness with head turns, blurred vision during movement, and degraded postural stability.
What single-tool baselines miss
If both athletes only received a cognitive baseline (like ImPACT alone), Athlete A’s concussion would be detected through below-baseline cognitive scores. But Athlete B would pass the cognitive test and potentially be cleared — despite having significant functional impairment that places them at risk for falls, re-injury, and prolonged recovery. Research by Kontos et al. (2016) in the American Journal of Sports Medicine documented that vestibular-ocular deficits identified by VOMS are among the strongest predictors of prolonged recovery, yet they are entirely invisible to cognitive-only testing.
The six trajectories
The research consistently supports multi-domain baseline assessment. The UPMC Sports Medicine Concussion Program has identified six distinct clinical trajectories for concussion — cognitive/fatigue, vestibular, ocular, post-traumatic migraine, cervical, and anxiety/mood — each involving different functional domains. A comprehensive baseline that captures cognitive function, balance, vestibular-ocular performance, and symptom profile creates a safety net across all possible concussion presentations.
What NATA recommends
The National Athletic Trainers’ Association position statement (Broglio et al., 2014) recommends that baselines include assessment of symptoms, cognition, motor control, and ocular motor function. The 6th International Consensus Statement similarly emphasizes multimodal evaluation.
The minimum four-domain baseline
The minimum recommended four-domain baseline includes: symptom inventory (PCSS/SCAT6 checklist), cognitive testing (ImPACT, C3 Logix, or equivalent), balance assessment (mBESS, force plate, or smartphone-based), and vestibular-ocular screening (VOMS). Each takes 5–25 minutes. Together, they provide a comprehensive 30–45 minute assessment that maximizes detection sensitivity across all concussion subtypes. See also why multimodal batteries work.
At Headquarters, our standard baseline protocol covers all four domains. Because brain injuries don’t limit themselves to one functional system — and your assessment shouldn’t either.