Rethinking Concussion Diagnosis: Why One-Track Tests Are a Total Brain Fail

By Associate Professor James McLoughlin.

 

I have been asked recently my opinion about disappointing recent research with regard to the effectiveness of neurocognitive and VR eye-tracking tests in diagnosing concussion.

I could rant on about research methodology, types of tests, samples sizes and patient selection criteria. However, the answer to this complex question is simple – bad research questions!

Unidimensional Diagnostic Clinical Concussion Tests Are Doomed to Fail.

Picture this: you’re on the sidelines of a soccer game, and your friend—who just got bonked on the head by an overzealous defender—is getting asked a series of questions by a medical professional. The questions go something like, “What is your name?”, “What venue are we at today?” and “Who did we play last week?” Your friend squints at you, thinks for a second, and says, “Adelaide?” The medic gives them a thumbs-up, and suddenly they’re cleared to play again. Hooray?

Yeah, nah. Unidimensional tests, the one-trick ponies of concussion diagnosis, are hilariously doomed to fail. Let’s dive into why these outdated methods are less effective than using a paper umbrella in a rainstorm.

Concussions Are Like Bad Roommates: Complex and Unpredictable

Here’s the thing about concussions: they don’t fit neatly into one little box. They’re like that roommate who leaves dishes in the sink, hogs the bathroom, and sometimes mysteriously vanishes for days. They mess with your mood, memory, motor skills, and just about everything in between. So, expecting a single question like, “Do you know where you are?” to capture the full scope of this chaos is a bit like trying to catch some spilled soup with a strainer

Concussions mess with multiple dimensions of your brain. They affect your ability to think straight, your sense of balance, your visual processing, and—let’s not forget—your mood. If you try to diagnose that whole symphony of confusion with one simple test, you’re just going to miss the tune. And probably most of the instruments too.

The One-Test Wonder: Not So Wonderful

Imagine trying to determine if someone is drunk based solely on how well they can say the word “pineapple.” Sure, it might work for the extreme cases, but most people are going to skate by with a “pineapplish” that sounds about right. Concussion tests that focus on just one aspect—like memory recall or a basic visual task—are like this “Say pineapple” trick. They’re simplistic, easy to beat, and maybe not reflect the types of brian injury. I think sometimes sports are more concerned with convenience than accuracy.

The brain is far too crafty for these kinds of “gotcha” questions. A concussed person might nail the “What’s the score?” question but still struggle to walk in a straight line or remember why they went into the kitchen five minutes ago (and okay, to be fair, the latter could just be normal).

Multidimensional Problems Need Multidimensional Solutions

Here’s a radical idea: if concussions affect your brain in multiple ways, maybe—just maybe—we should assess them in multiple ways. Crazy, right? A strong concussion evaluation should involve balance tests, cognitive tests, eye tracking, and even mood assessments. It’s like forming a crack team of experts to tackle a complicated heist. Each one has their specialty, and together, they might just figure out what’s going on.

Plus, let’s be real: the stakes are high. A misdiagnosed concussion isn’t just a “fail” on the medical professional’s part—it could mean a person goes back out into a contact sport, takes another hit, and ends up with serious long-term damage. Concussions aren’t something we can afford to get wrong.

Let’s Leave Unidimensional Tests in the Past

The unidimensional test is the medical equivalent of trying to solve a Rubik’s cube by just staring at one side. Spoiler: it’s not going to end well. Concussions need a more nuanced approach—something that acknowledges the fact that the brain is not a simple machine but a symphony of electrical chaos, prone to occasional weird, delayed or subtle signs and symptoms. And all our brains are different before a concussion, with our own individual levels of eye movement control, skill, processing speed, headache symptoms, anxiety, sleep and memory. This is why multidimensional concussion baselines can be so useful.

Blood and saliva tests that confirm some brain damage are almost upon us, and symptoms and symptom provocation remain the cornerstone of the most sensitive tests following injury, with a mixed bag of physical, cognitive and psychological signs of injury. Currently symptoms carry the most weight in current concussion diagnostic tests and symptom resolution defines recovery! However multidimensional objective signs guide better decision making and gives everyone greater confidence moving forward.

If we’re serious about keeping athletes, children, and anyone else who takes an unfortunate knock to the head safe, we need to start treating concussion assessment like the complex issue it is. Please, no more research of these one-dimensional tests to confirm diagnosis. To be honest, the brain deserves more respect.