Baseline tests: Better understanding concussion

Imagine you have a crash, and you get concussion. How will your doctor know if your brain function is impaired, unless you’ve had a test when you were functioning normally, to compare it to?

The TCA, in partnership with HeadSmart Sports Concussion Programme, is now offering all rider members a free baseline brain functioning test. HeadSmart is a world leading program that focuses on baseline testing, concussion education and post-concussion management. 

In this article we explore concussion, through the experiences of Lauretta Hanson, Sabrina Stultiens, Ariane Luthi and Molly Weaver, and shine a light on why taking a baseline test before a crash is so vital.

By Lucy Cara

No concussion is the same. It is not always caused by a loss of consciousness, and all symptoms, no matter how mild, should be taken seriously. Dismissing them can have long lasting and devastating effects. 

Despite everyone’s experience of concussion being different, how athletes respond is unfortunately all too similar. 

Symptoms are ignored, and recovery can be prolonged for months. Riders often get back on their bike too quickly, carry on racing, and disregard how they are feeling. 

At best, concussion can result in mild, uncomfortable symptoms. At worst, it can be career ending and cause permanent damage. 

Sabrina Stultiens spent eight months recovering from her concussion. After a crash in September 2018, she didn’t ride a normal bike until March 2019, or a road bike until May that year. 

After initially feeling fine, and pushing through mild indicators of concussion, Sabrina developed severely debilitating symptoms. During this time, she couldn’t look at her phone, see friends, read a book, or go to the supermarket, let alone ride a bike. Everything became over-stimulating, leading to serious exhaustion. Even a ten-minute walk was too long. Sabrina had to be helped walk across the street, as looking for cars took too much energy. 

“My world became very small.” 

Sabrina Stultiens

It was a very isolating experience for Sabrina, who felt exceptionally lonely and struggled to stay positive. The worst symptoms lasted for around three months, after which she slowly recovered. The road to recovery was a day by day process, full of setbacks, despite her early diagnosis. In her case her initial recovery lasted longer than the 'usual two weeks'. That's when her team doctor referred her for a tailored concussion treatment programme.

Similarly, Lauretta Hanson had a seemingly innocuous crash which she routinely shrugged off. She wasn’t knocked out and just like Sabrina, didn’t experience symptoms of concussion straight away. 

Following the race, she tried to start riding, didn’t feel herself, but couldn’t quite explain it. People often trivialise the symptoms as the pain they experience during a race is much more sever, which gives them a false sense of security. 

Despite the unsettling feeling, Lauretta repeatedly tried to ride and didn’t see a specialist until two months after the crash. By this point she was experiencing issues with balance and movement, leading to another crash.

Her recovery process was long, with Lauretta not being cleared to ride properly again until five months after her accident. Even then, health professionals still struggled to distinguish between what was normal for her, or what were symptoms of the concussion. 

 “If I had taken a baseline test before the accident, I would have been able to realise that there was something wrong sooner. I had a delay in getting help and that’s what prolonged my recovery.” 

Lauretta Hanson

The challenge with brain injuries is they cannot be easily identified. They usually don’t have any obvious symptoms. 

 “People were always saying to me you look fine, but I couldn’t handle the noises or the light, and that was really hard to explain.” 

Sabrina Stultiens

It’s not like having a broken bone that you can see and know how to deal with. The brain only gives indirect warning signals. That’s why the baseline test is so important, because it gives you something to measure from, a clear-cut account of how your brain is functioning.

 “I have previously suffered from depression and know how difficult it is to tell whether the brain is functioning normally or not. I can’t look at my injured brain as I could do an injured leg. That’s what makes this test so incredibly valuable.”

Ariane Luthi

There needs to be a cultural shift in how we look at concussion. The pressure to keep riding, needs to stop. 

For many riders, concussion has simply never been on their radar.

“I was from an era when no one had a baseline test. I’ve never known anyone have one. Which is shocking.”

Molly Weaver

Molly Weaver recounts a time when she crashed, and despite being unconscious for a minute, the team didn’t ask any questions, and neither did she. Her teammate Alison Tetrick wanted Molly to stop racing, but Molly was dismissive, believing Alison was being over cautious.  

“I was young and felt indestructible.”

 Molly Weaver

We all readily accept that crashing is part of cycling.We accept injuries too quickly, often without acknowledging the repercussions. We don’t think about the long-term effects, and what happens after we stop racing. Everyone needs to start taking responsibility for their health and ultimately value it above and beyond performance. 

“It wasn’t until after I retired, partly due to a bad crash, that I realised how much it was just accepted, and almost celebrated that we crash so much. It’s seen as a badge of honour and you get kudos if you get back up.”  

Molly Weaver

Imagine a paradigm shift where athletes put the decision about their health in the hands of a neutral outsider. Not a DS, coach, family member, or even themselves, as there are too many flaws in that system. Professional cyclists need an objective person who doesn’t have a vested interest in whether they race, making a decision about their health. 

 “The danger with teams and athletes is if it’s not a clear-cut thing, people’s priorities and motives get in the way, whereas your health should be the only thing that matters.” 

Molly Weaver

As no concussion is the same, no recovery is the same. The most important thing is to be attentive to how you are feeling and give yourself time to recover. Getting advice from a professional doctor is essential, as they will be able to guide you correctly. 

At the time, you may think you can’t miss training because you’re focused on an upcoming race, but you must think of the bigger picture. Time invested early in the recovery process makes a real difference. Like any illness, if you catch it early, then you cure it early. You must ask yourself; do you want to have these symptoms for your whole life? Or do you want to take them seriously for two weeks and speed up the recovery process?

“You have to see the bigger picture, and trust in the process of recovery. Stay positive.” 

Sabrina Stultiens

The two weeks after the concussion are the most important. Being strict with your recovery, and not getting over stimulated is vital. Building up cognitive functions slowly by finding a balance between rest and doing small things will help. 

Take care of your food intake. There is a danger of feeling like you don’t have to eat because you’re not doing much, but the brain takes a lot of energy so ensuring you maintain a good diet is essential during healing. 

Pay attention to your sleep cycle. Try to keep a regular schedule, not sleeping lots in the day so you maintain your normal circadian rhythm. 

Surround yourself with good people that understand your limitations and can do the small, everyday tasks, like going to the shops.

Perhaps most importantly, find peace in your head, accept that it will take time to recover, and give your body the time and attention it needs.  

“Listen to your body.” 

Sabrina Stultiens

Do you know what a baseline test is?Do you know the symptoms of concussion?
“I didn’t realise the importance of a baseline test and how valuable it could be in my recovery.”
Lauretta Hanson
“It’s easy to take your mind for granted, it’s only when you break it, you realise you should have valued it more.”
Molly Weaver 
• Establishes a baseline of current brain function performance

• The assessment features simple playing cards, which are universally understood, regardless of language or age 

• It is easy to administer under supervision, or remotely by health care providers

• The assessment takes about 8 minutes and covers four areas;
1. Processing speed
2. Attention
3. Visual learning
4. Working memory

• The objective results are available immediately and can be repeatable without concern for practice effects 
• Headaches or neck pain 
• Difficulty concentrating
• Memory loss 
• Slurred speech
• Weakness, numbness, or decreased coordination
• Getting lost or easily confused
• Tiredness
• No energy or motivation
• Mood changes 
• Unusual behaviour
• Changes in sleep patterns 
• Light-headedness, dizziness, or loss of balance
• Urge to vomit 
• Repeated vomiting, convulsions or seizures 
• Increased sensitivity to lights, sounds, or distractions
• Blurred vision or eyes that tire easily 
• Loss of sense of smell or taste
Tinnitus (ringing in the ears)
What’s next checklist
☐ Contact Carmen Small for a test voucher at; 
☐ Take the test before racing starts again! 
☐ Know the symptoms of concussion 
☐ Take the test again after any crash 
☐ Listen to your body 
☐ Stay up to date with the current thinking on concussion, knowledge is always developing 


Written by: Lucy Cara

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