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Preventing & Mitigating Traumatic Brain Injuries
Arising from Sports & Recreational Activities
Sports and recreational participation is an integral part
of the lives of most children and young adults. An estimated 30 million children are involved in youth sports in
the U.S., under the direction of 4.5 million coaches and
1.5 million administrators. Sports and recreational activities offer many physical and social benefits, including
skills development, coordination, exercise, competitive
play, team spirit, sacrifice and self-discipline.
However, there is also the risk of injury, which can range
from minor cuts and bruises to more serious fractures
and sprains. Permanent, debilitating injuries such as
paraplegia and brain damage can also occur.
One of the most alarming statistics in amateur sports is
the growing number of traumatic brain injuries among
children. The incidence of these injuries has nearly doubled in the last decade and now represents approximately 21 % of all traumatic brain injuries among U.S.
children and adolescents.
A traumatic brain injury (TBI) is defined as a blow or jolt to the head, or a penetrating head injury,
that disrupts the normal function of the brain. TBI can result when the head suddenly and violently
hits an object or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can
be mild, moderate or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in mental state or consciousness, while severe cases may result in extended
periods of unconsciousness, coma or even death.
MAGNITUDE
According to the Center for Disease Control :
 Each year, U.S. hospital emergency departments (ED) treat an estimated 173,285 sports- and
recreation-related TBIs among children and adolescents, 19 years of age or younger.
 During the last decade, ED visits for sports- and recreation-related TBIs increased by 60%.
 Bicycling, football, playground activities, basketball, and soccer are associated with the greatest number of TBI-related ED visits.
 Children from birth to age 9 commonly sustained injuries during playground activities or while
bicycling.
 70.5% of sports- and recreation-related TBI ED visits were among persons aged 10-19 years.
 For males aged 10-19, sports- and recreation-related TBIs occurred most often while playing
football or bicycling.
 Females aged 10-19 sustained sports- and recreation-related TBIs most often while playing
soccer, basketball or while bicycling.
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Injury data collected by the Consumer Product Safety Commission (CPSC) from 2001 to 2009
show that each year, an average of 173,278 sports-related head injuries are treated at hospital
emergency departments. In 2009, 248,418 TBI injuries were treated, a 29% increase over the
prior year.
While these numbers may seem to be staggering, many believe they are much higher as many less
severe head injuries are treated at physician's offices or immediate care centers, or are selftreated and not captured in the CPSC database.
The following list is the top 20 TBI producing sports / recreational activities incurred by persons 19
years of age or younger as per the CPSC:
Activity
TBIs
All sports / recreational
% of total
related injuries
injuries resulting in
Number
Percent of
Number
Percent of
TBI
Total
Total
Bicycling
26,212
15.1%
323,571
12.2%
8.1
Football
25,376
14.6%
351,562
13.3%
7.2
Playground
16,706
9.6%
210,979
8.0%
7.9
Basketball
13,987
8.1%
375,601
14.2%
3.7
Soccer
10,436
6.0%
135,988
5.1%
7.7
Baseball
9,634
5.6%
121,309
4.6%
7.9
All-terrain vehicle riding
6,337
3.7%
59,533
2.2%
10.6
Skateboarding
Swimming
Hockey1
Miscellaneous ball
Horseback riding
Moped/Dirt bike riding3
Scooter riding
Gymnastics4
Combative sports5
Softball
Exercising
Tobogganing/Sledding
Trampoline Use
6,004
4,557
4,427
4,065
3,638
3,370
3,336
3,319
2,981
3.5%
2.6%
2.6%
2.3%
2.1%
1.9%
1.9%
1.9%
1.7%
101,577
62,745
45,450
66,543
23,842
39,363
54,561
71,248
50,639
3.8%
2.4%
1.7%
2.5%
0.9%
1.5%
2.1%
2.7%
1.9%
5.9
7.3
9.7
6.1
15.3
8.6
6.1
4.7
5.9
2,735
2,406
2,377
2,323
1.6%
1.4%
1.4%
1.3%
49,345
77,069
23,306
86,584
1.9%
2.9%
0.9%
3.3%
5.5
3.1
10.2
2.7
1Includes
ice hockey, field hockey, roller hockey, and street hockey.
lacrosse, rugby, handball, and tetherball.
3Includes other two-wheeled, powered, off-road vehicles and dune buggies.
4Includes cheerleading and dancing.
5Includes boxing, wrestling, martial arts, and fencing.
2Includes
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With respect to boxing, studies show that amateur boxers can suffer permanent brain damage
even if they don’t move on to the professional ranks. TBI occurs in approximately 20% of professional boxers. The force of a boxer's fist can be equivalent to being hit with a 13-pound bowling
ball traveling 20 miles per hour, or about 52 times the force of gravity. Since 1960 to date, 480
boxing-related deaths were recorded, of which 66 % resulted from head, brain or neck injuries.
Additionally, competition has increased the TBI risk factors for many sporting and recreational activities. One key example is cheerleading. Cheerleading has changed drastically in the last 20
years, with increasingly difficult acrobatic stunts. According to the CPSC, head and neck injuries
accounted for 15.1 % of total cheerleading injuries, of which 1,070, or 20% were concussions
each year.
For children age 14 and younger, the 10 sports/recreational activities with the greatest number of
TBIs are:





Cycling
Football
Baseball and Softball
Basketball
Skateboards/Scooters





Water Sports
Soccer
Powered Recreational Vehicles
Winter Sports
Trampolines
STATE LAWS
Between 2009 and 2012, 43 states, and
the District of Columbia, passed laws on
concussions in sports for youth and/or
high school athletes (often called Return
to Play laws). Some organizations, such
as the National Conference of State Legislatures created online maps to track
and update concussion in sports laws by
state. Law Atlas provides another state
by state summary of TBI laws.
Most of these laws require three action steps:
1. Educate Coaches, Parents, and Athletes: Inform and educate coaches, athletes and their
parents/legal guardian about concussions through training and/or a concussion information
sheet.
2. Remove Athlete from Play: An athlete who is believed to have a concussion is to be removed
from play immediately.
3. Obtain Permission to Return to Play: An athlete can only return to play or practice after at
least 24 hours and with permission from a health care professional.
Organizations must know all applicable laws in their jurisdiction and follow them.
PREVENTING AND MITIGATING TRAUMATIC BRAIN INJURIES
Preventing TBIs may require cultural and behavioral changes in sporting/recreational organizations, especially among the coaching staff. During the heat of play, decision-making may be
swayed by the drive to win, out-weighing the risk of injury to those participating in the sport. While
winning is important, the organization needs to foster a fundamental attitude that the safety of all
participants must never be sacrificed in achieving this goal.
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An effective brain injury prevention program will help to protect the health of all participants. This
program should incorporate a policy statement and action plan addressing prevention, mitigation,
education and training. Required participation in the program by all appropriate staff and mandatory use of all available helmets or other protective head equipment are also essential in preventing traumatic brain injuries and mitigating their severity.
POLICY STATEMENT
Sporting and recreational organizations should adopt a formal policy that clearly states their commitment to preventing TBI. Adopting a TBI policy is the first step in reducing these injuries and fostering a more protective attitude throughout the organization, including the first line of defense –
the coaching staff. These staff members can help to modify the behaviors and attitudes of those
individuals who view winning as the sole purpose of any sport.
An effective policy should include a commitment to safety, information on concussions and an outline of the responsibilities and accountabilities of all affected individuals. The organization’s leaders should be responsible for establishing & enforcing the safety policies, rules and practices. The
responsibilities and accountabilities of each staff member, and the participant’s parents or legal
guardian, in identifying, preventing, mitigating, educating and reporting head injuries should be
well-defined. The consequences of not adhering to the requirements of the policy should also be
set forth.
The written policy should be distributed throughout the organization and to all participants and
their parents/legal guardian. Requiring a signed acknowledgement and understanding of the policy from all recipients will help to foster their support.
The policy statement should emphasize the following four key areas:
 Prevention and mitigation practices
 Education and training
 Handling injured or potentially injured participants including their immediate removal from play
 Protocol to safely return participants to play
PREVENTION
Assessing rules of play, eligibility and the need for helmets or other protective head protection:
Organizations should periodically examine and, if necessary, modify their rules of play to limit contact or contact forces (e.g., prohibiting helmet-to-helmet contact), as well as participant eligibility
requirements. Additionally, the mandatory use of helmets or other protective head gear (e.g. protective caps for baseball pitchers) should be periodically reviewed, since this equipment will help
prevent or minimize head injuries. Reviewing the causes of previous
head injuries or potential injuries and researching the efforts of other organizations and available injury causation and prevention studies such as those published by the Center for Disease Control, Consumer Product Safety Commission or the Brain Trauma Foundation
will also be helpful. In addition, organizations should review any
new or amended state or local regulations.
Baseline pre-season screening:
All participants should receive a baseline pre-season medical
screening by a healthcare professional that is trained and experienced in evaluating head injuries and concussions. This process will
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help identify at-risk individuals, particularly those who have had prior head injuries or concussions.
A similar screening should be performed following an injury to assess the individual’s health by
comparing the post-injury findings to this baseline.
The result of these findings should be referred to the participant’s personal physician and parents/ legal guardian for further evaluation. A determination will then be made on whether or not
these at-risk individuals can safely participate. Written authorization to return to the sport should
be obtained from the physician and parents/legal guardian, and should include any playing or
practicing restrictions.
MITIGATION
The use of head protection should be required during play and practice. Injured or potentially injured participants should be immediately removed from practice or play. A healthcare professional trained and experienced in evaluating concussions should assess the participant’s condition.
The participant should only be allowed to return when clearance is provided. The healthcare professional should prohibit the participant’s return to play and refer symptomatic participants to
their physician for further evaluation and treatment.
Trained healthcare staff and coaches should have immediate access to first aid and the ability to
contact available emergency medical services for assistance. Guidelines in treating head injuries
and suspected concussions should be available for reference.
EDUCATION & TRAINING
Coaches, trainers and other affected staff should be
notified of the organization’s policies, rule changes
and their role in preventing and minimizing head injuries. The participant’s parents/legal guardian
should be informed of the organization’s TBI policies
and practices, including their role in mitigating these
injuries. All affected staff, parents/legal guardian
and participants should be trained in recognizing the
symptoms of a head injury and what to do if an injury
is suspected. Training should be provided prior to
the start of each season and participation mandated
for coaches, trainers, medical staff and other affected individuals of the organization.
Training should include:
 Symptom recognition, risk of secondary injury,
including the risk of second impact syndrome
 Criteria outlining when to remove an injured or potentially injured participant
 Reporting injuries, suspected injuries and actions to be taken
 Protocol to return participants to play or practice
 Prevention and mitigation practices
 Protection requirements
Use signed acknowledgements, scored examinations as well as short “fact sheets”, such as those
offered by the CDC to distribute throughout the season to reinforce training. Retain evidence of
training completion for all affected staff of the organization.
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PARTICIPATION
The organization’s leaders are responsible for enforcing their safety policies, rules and practices.
Each member should be held accountable for their injury prevention role. Participants should be
responsible for following the rules of play, wearing protective equipment and reporting any equipment defects. They should be encouraged to report all injuries and symptoms indicating potential
TBI. Parents/legal guardian should be encouraged to notify the organization when they feel that
the coaches or other staff may not be adhering to the safety policy.
HELMETS / HEAD PROTECTION
From bicycling to boxing, skateboarding to soccer, each sport requires its own safety equipment to
prevent sports injuries. Depending on the sport, this could mean special shoes that grip the
ground, pads that protect the wrists, shins and knees or mouth guards. For many sports, a helmet
is the most common and critical piece of protective equipment. For example, cycling accounts for
about 600 deaths a year, with two-thirds being attributed to TBI. It is estimated that up to 85% of
head injuries can be prevented through proper usage of helmets.
The use of helmets has been a long standing accepted practice for many sports. Sports and recreational organization need to decide when helmet use is required for those activities that normally do not require it. Helmets should be required for all contact sports. It should also be required
for sports/recreational activities where participants move by mechanical and animal means (e.g.,
cycling, skate boarding, skiing, ice skating or horseback riding), when participants can fall any distance or be struck by a ball or other projectile with enough force to cause a TBI.
When helmets are required, they must be worn. Helmets should meet requirements of the applicable specifications-setting organizations or trade association. The most common standardsetting organizations for helmets are the National Operating Committee on Standards for Athletic
Equipment (NOCSAE), The Snell Memorial Foundation, American National Standards Institute
(ANSI) or American Society for Testing and Materials (ASTM).
Organizations should provide the proper head gear to participants and should inspect them to ensure effective protection is provided. Since helmet fit is critical, a range of sizes should be available. Participants should be trained in donning, adjusting, cleaning and caring for their helmets
and reporting damaged units.
Organizations should require that helmets be regularly inspected and damaged units destroyed or repaired according to the manufacturer’s instructions. The manufacturers of some helmets may require that they be removed and destroyed after any impact,
even if there is no sign of damage.
Coaches and trainers need to be
aware of the manufacture’s use and
care guidelines and be required to follow them. Modifying helmets in any
manner should be prohibited.
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WAIVERS OF LIABILITY
In addition to a brain injury prevention program, organizations should implement liability waivers
with all participants and their parents / legal guardians to minimize claims and legal proceedings.
Waiver requirements can vary extensively by state and jurisdiction and case law on the subject is
constantly evolving, therefore, competent legal advice is always recommended. Waivers of Liability showing that participants are clearly aware of the risks of injury from the sport or recreational
activity, are freely accepting those risks, and agree to abide by all safety rules, and instructions
are an important part of the an organization’s risk management practices. Waivers notify potential participants and their guardians of the possibility of serious injury. They may also deter at risk
individuals from participating. Waivers for minors must also be signed by their parent or legal
guardian to be valid. Many organizations require that forms submitted by minors, be notarized to
affirm the signature of the parent or guardian.
CONCLUSION
Preventing and mitigating traumatic brain injuries requires a coordinated effort throughout an organization, with involvement by the participant, their parents/legal guardian and healthcare providers.
APPENDIX I: Model Policy and Protocol for the Prevention and Treatment of Sports & Recreational Related Concussions
 APPENDIX II: Brain Injury Prevention and Mitigation Program Checklist
 APPENDIX III: FAQ: Baseline Testing
 APPENDIX IV: Free Training and other Resources

Remember, Everest Loss Control offers services to help you in your loss prevention efforts. If you
would like more information about these services, visit our web site at www.everestregroup.com.
Loss Control is a daily responsibility of your individual management. This publication is not a substitute for your own loss control
program. The information that is provided in this Alert should not be considered as all encompassing, or suitable for all situations,
conditions, or environments. Each organization is responsible for implementing their safety/injury/illness prevention program and
should consult with legal, medical, technical, or other advisors as to the suitability of using the information contained in this
Alert. The information contained in this publication is intended for general informational purposes only and is not intended to constitute legal advice or opinions. You should contact an attorney if you need legal advice and/or you have any questions concerning
your obligations under any law, statute and/or code identified in this publication. ©Everest National Insurance Company 2014
CONTACT US
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Preventing & Mitigating Traumatic Brain Injuries
Loss Control Department
Phone: 908-604-3000
Fax: 908-604-3526
E-mail: [email protected]
April 2014
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APPENDIX I
Model Policy and Protocol for the Prevention and Treatment
of Sports & Recreational Related Concussions
Prevention
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
Pre-season baseline testing.
Review of concussion prevention educational
information throughout the organization, with
participants and their parents / legal guardians.
Reinforce the importance of early identification and treatment of concussions to improve
recovery.
Reinforce the organization’s policy that participants who are exhibiting the signs or symptoms of a concussion or other head injuries
during practice or competition shall be immediately removed from play and may not return
to play until cleared by a designated medical
provider, trained in the evaluation and management of TBIs.
Mitigation
1) All affected persons must be trained and educated in identifying and responding to potential
concussions. Examples of observable / reportable symptoms include:
Possible Signs of Concussion which could be observed by Coaches, Licensed Athletic Trainers,
Physicians, or Other trained healthcare providers.
 Appears dazed, stunned, or disoriented
 Forgets plays, or demonstrates short term memory difficulty
 Exhibits difficulties with balance or coordination
 Answers questions slowly or inaccurately
 Loses consciousness
Possible Symptoms of Concussion which could be reported by the participant.
 Headache
 Nausea/Vomiting
 Balance problems or dizziness
 Double vision or changes in vision
 Sensitivity to light or sound/noise
 Feeling sluggish or foggy
 Difficulty with concentration and short term memory
 Sleep disturbance
 Irritability
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2) Participants suspected of incurring a concussion must be immediately removed from play or
practice and evaluated by a physician or licensed health care provider trained in the evaluation
and management of concussion to determine the presence or absence of a concussion or other head injury.
3) For symptomatic participants:
 Coaches and trainers must call emergency responders if there is a deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury.
 The participant must be evaluated by their licensed healthcare provider who is trained in
the evaluation and management of concussions.
 A designated individual such as the coach or trainer should contact the participant’s
parent/guardian and inform him/her of the suspected sports-related concussion or head
injury and provide the participant, their legal guardian and their treating physician with organization approved concussion assessment and management checklist. See CDC for examples.
 The participant must provide written clearance from a physician, trained in the evaluation
and management of concussions that states the participant is asymptomatic and may
begin the organization’s return-to-play protocol. The organization must also receive written
authorization from the participant’s parent or legal guardian before proceeding to return
the individual to play.
Return to Competition and Practice Protocol
After written medical clearance and parental authorization is received the participant may begin a
graduated individualized return-to-play protocol developed and supervised by the organization’s
licensed athletic trainer or other licensed health care provider trained in the evaluation and management of sports-related concussions.
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APPENDIX II
Brain Injury Prevention and Mitigation Program Checklist
Policy Statement
Policy is in writing
Policy states the organization’s commitment to protecting participants and preventing / mitigating
traumatic brain injuries
Outlines the responsibilities and accountabilities of affected individuals:
 Organization’s leaders are responsible for establishing & enforcing the safety policies, rules and
practices
 Coaches, trainers and other affected members are responsible for implementing the
organization’s program
 Participants and their parents / legal guardians are responsible for adhering to the
organizations rules and educating themselves to identify symptoms of suspected brain injuries
and to take appropriate action when symptoms are observed
 Policy includes consequences of not adhering to the program such as warnings, suspensions
and terminations
Policy is distributed throughout the organization and to all participants and their parents/legal
guardian
Requires a signed acknowledgement of understanding from recipients
Emphasizes:
 Prevention and mitigation practices
 Education and training
 Handling injured or potentially injured participants, including their immediate removal from play
 Protocol to safely return participants to play
Prevention
Annual assessment to determine:
 Need to modify rules of play such as prohibiting helmet to helmet contact
 Changes to participant eligibility such as minimum / maximum age & weight requirements, or
at-risk participants such as those having a previous head injury
 Changes to helmet requirements and other head protection (e.g. protective caps for baseball
pitchers)
Annual review incorporates:
 Causes of previous head injuries & potential injuries
 Changes being made by other organizations
 Review of available injury causation and prevention studies such as those published by the
CDC, Brain Trauma Foundation, CPSC, or trade associations
 Changes to jurisdictional regulations
Pre-Season TBI Baseline Screening:
 Required for all participants
 Completed by healthcare professionals trained and experienced in evaluating concussions
 At risk individuals are referred for further assessment to determine eligibility to participate
 Written authorization from a physician trained and experienced in concussions and parent /
legal guardian obtained for at risk participants
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Mitigation
Handling injured or potentially injured participants
 Immediate removal from play / practice
 Assessed by the organization’s healthcare professional trained and experienced in evaluating
concussions
Healthcare professional determines
 Clearance to return to play or
 Need for further assessment or
 Need for immediate medical attention
Note: the coaching staff cannot overrule the healthcare professional’s decision to remove a
participant from play/practice.
The participant cannot return until clearance is provided
Trained healthcare staff and coaches have
 Immediate access to first aid
 Ability to contact available emergency medical services for assistance
 Guidelines in treating head injuries and suspected concussions
Returning participants to play
 Begins after written medical clearance and parental authorization is received
 Graduated individualized return-to-play protocol developed
 Protocol supervised by the organization’s licensed healthcare provider trained in the evaluation
and management of sports-related concussions
 Clearance to return provided by healthcare provider with signed authorization by parents/legal
guardian
Education & Training
 Coaches, trainers and other affected staff notified of the organization’s policies, rule changes
and their role in preventing and minimizing head injuries
 The participant and his/her parents/legal guardian informed of the organization’s TBI policies
and practices, including their role in mitigating these injuries
 Affected staff, participants and their parents/legal guardians are trained in recognizing the
symptoms of a head injury and what to do if an injury is suspected
 Training is provided before the start of each season
 Mandatory participation for all coaches, trainers, and other affected individuals of the
organization
Training covers:
 Symptom recognition, risk of secondary injury, including the risk of second impact syndrome
 Criteria outlining when to remove an injured or potentially injured participants
 Reporting injuries, suspected injuries and actions to be taken
 Protocol to return participants to play or practice
 Prevention and mitigation practices
 Protection requirements
 Scored examinations used for training of organizational staff
 Fact sheets used to inform and reinforce participant and their parents/legal guardians
Fact sheets distributed throughout the season to reinforce training
Signed acknowledgements or other evidence of training retained for all affected staff of the
organization
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Participation
The organization’s leaders periodically monitors practices and play to assure safety policies, rules
and practices are being followed
Infractions handled according to the organizations policy
Participants encouraged to report equipment defects, injuries and symptoms indicating potential
TBI
Parents/legal guardians are encouraged to notify the organization when they feel that the coaches
or other staff may not be adhering to the safety policy
Protection
The need to introduce head protection for those sporting / recreational activities that normally do
not require head protection has been reviewed periodically
Helmet use is required for all sports / recreational activities when:
 Any contact sports are performed / practiced
 Participants move by mechanical or animal (e.g. motorized racing or horseback riding)
 Participants can fall any distance or be struck by a ball or other projectile with enough force to
cause a TBI
 An organization has otherwise determined a need
Helmet use is mandatory when they are required
Helmets must meet requirements of the applicable specifications-setting organizations or trade
association such as:
 National Operating Committee on Standards for Athletic Equipment (NOCSAE)or
 The Snell Memorial Foundation, or
 American National Standards Institute (ANSI) or
 American Society for Testing and Materials (ASTM)
Head protection:
 Is available in a range of sizes
 Periodically inspected
 Damaged units immediately removed & destroyed/repaired according to the mfr. instructions
 All modifications prohibited
Participants trained in:
 Wearing, adjusting, caring for and cleaning head protection
 Reporting damages
Coaches and trainers are aware of the manufacture’s use and care guidelines
Waivers of Liability
Are used for all participants
Crafted by local attorney knowledgeable of jurisdictional waiver laws
Waivers of Liability:
 State that participants are clearly aware of the risks of injury from the sport or recreational
activity
 Are freely accepting those risks, and
 Agree to abide by all safety rules, and instructions
Waivers for minors are signed by their parent or legal guardian
Waivers for minors are notarized to affirm the signature of the parent or guardian
Signed waivers retained for a time frame recommended by attorney
State Laws
Organization has reviewed and complies with applicable laws and regulations
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APPENDIX III
FAQ: Baseline Testing
Baseline testing is a pre-season exam conducted by a trained health care professional. Baseline tests are used
to assess an athlete’s balance and brain function (including learning and memory skills, ability to pay attention
or concentrate, and how quickly he or she thinks and solve problems), as well as for the presence of any concussion symptoms. Results from baseline tests (or pre-injury tests) can be used and compared to a similar exam conducted by a health care professional during or at the end of the season if an athlete has a suspected
concussion.
Baseline testing should take place during the pre-season—ideally prior to the first practice. It is important to
note that some baseline and concussion assessment tools are only suggested for use among athletes ages 10
years and older.
How is baseline testing information used if an athlete has a suspected concussion?
Results from baseline testing can be used if an athlete has a suspected concussion. Comparing post-injury test
results to baseline test results can assist health care professionals in identifying the effects of the injury and
making more informed return to school and play decisions.
Education should always be provided to athletes and parents if an athlete has a suspected concussion. This
should include information on safely returning to school and play, tips to aid in recovery (such as rest), dangers
signs and when to seek immediate care, and how to help reduce an athlete’s risk for a future concussion.
What should be included as part of baseline testing?
Baseline testing should include a check for concussion symptoms, as well as balance and cognitive (such as
concentration and memory) assessments. Computerized or paper-pencil neuropsychological tests may be included as a piece of an overall baseline test to assess an athlete’s concentration, memory, and reaction time.
During the baseline pre-season test, health care professionals should also assess for a prior history of concussion (including symptoms experienced and length of recovery from the injury). It is also important to record other medical conditions that could impact recovery after concussion, such as a history of migraines, depression,
mood disorders, or anxiety, as well as learning disabilities and Attention Deficit/Hyperactivity Disorder.
Baseline testing also provides an important opportunity to educate athletes and others about concussion and
return to school and play protocols.
Who should administer baseline tests?
Baseline tests should only be conducted by a trained health care professional.
Who should interpret baseline tests?
Only a trained health care professional with experience in concussion management should interpret the results
of baseline exam. When possible, ideally a neuropsychologist should interpret the computerized or paperpencil neuropsychological test components of a baseline exam. Results of neuropsychological tests should not
be used as a stand-alone diagnostic tool, but should serve as one component used by health care professionals to make return to school and play decisions.
How often should an athlete undergo baseline testing?
It is recommended that most components of baseline testing be repeated annually to establish a valid test result for comparison. Baseline computerized or paper-pencil neuropsychological tests may be repeated every 2
years. However, more frequent neuropsychological testing may be needed if an athlete has sustained a concussion or if the athlete has a medical condition that could affect results of the test.
Preventing & Mitigating Traumatic Brain Injuries
April 2014
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APPENDIX IV
Free Training and other Resources
Free educational material is available from the CDC Heads Up program to help organizations meet many of the requirements in their brain injury prevention policies
and programs.
Resources include online courses for:
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Youth coaches and parents
High school coaches (developed in partnership with the National Federation of
State High School Associations)
Health care professionals (developed with support from the NFL and CDC Foundation)
Other Resources:
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Center For Disease Control
Consumer Product Safety Commission
Brain Trauma Foundation
Preventing & Mitigating Traumatic Brain Injuries
April 2014