• Sport Concussion Assessment Tool

    This tool represents a standardized method of evaluating people after

    concussion in sport. This tool has been produced as part of the Summary and

    Agreement Statement of the Second International Symposium on Concussion

    in Sport, Prague 2004

    For more information see the .Summary and Agreement Statement of the

    Second International Symposium on Concussion in Sport. in the: Clinical

    Journal of Sport Medicine 2005; British Journal of Sports Medicine 2005;

    Neurosurgery 2005; Physician and Sportsmedicine 2005; this tool may be

    copied for distribution to teams, groups and organizations.

    Sports concussion is defined as a complex pathophysiological

    process affecting the brain, induced by traumatic

    biomechanical forces. Several common features that

    incorporate clinical, pathological and biomechanical injury

    constructs that may be utilized in defining the nature of a

    concussive head injury include:

    1. Concussion may be caused either by a direct blow to

    the head, face, neck or elsewhere on the body with an

    .impulsive. force transmitted to the head.

    2. Concussion typically results in the rapid onset of

    short-lived impairment or neurological function that

    resolves spontaneously.

    3. Concussion may result in neuropathological changes

    but the acute clinical symptoms largely reflect a

    functional disturbance rather than structural injury.

    4. Concussion results in a graded set of clinical

    syndromes that may or may not involve loss of

    consciousness. Resolution of the clinical and

    cognitive symptoms typically follows a sequential

    course.

    5. Concussion is typically associated with grossly

    normal structural neuroimaging studies.

    Post Concussion Symptoms

    Ask the athlete to score themselves based on how they feel

    now. It is recognized that a low score may be normal for

    some athletes, but clinical judgment should be exercised to

    determine if a change in symptoms has occurred following the

    suspected concussion event.

    It should be recognized that the reporting of symptoms may

    not be entirely reliable. This may be due to the effects of a

    concussion or because the athlete.s passionate desire to return

    to competition outweighs their natural inclination to give an

    honest response.

    If possible, ask someone who knows the athlete well about

    changes in affect, personality, behavior, etc.

    Remember, concussion should be suspected in the presence

    of ANY ONE or more of the following:

    Symptoms (such as headache), or

    Signs (such as loss of consciousness), or

    Memory problems

    Any athlete with a suspected concussion should be monitored

    for deterioration (i.e., should not be left alone) and should not

    drive a motor vehicle.

    The SCAT Card (Sport Concussion Assessment Tool)

    What is a concussion? A concussion is a disturbance in the function

    of the brain caused by a direct or indirect force to the head. It results

    in a variety of symptoms (like those listed below) and may, or may

    not, involve memory problems or loss of consciousness.

    How do you feel? You should score yourself on the

    following symptoms, based on how you feel now.

    Post Concussion Symptom Scale

    None Moderate Severe

    Headache 0 1 2 3 4 5 6

    .Pressure in head. 0 1 2 3 4 5 6

    Neck Pain 0 1 2 3 4 5 6

    Balance problems/dizzy 0 1 2 3 4 5 6

    Nausea or vomiting 0 1 2 3 4 5 6

    Vision problems 0 1 2 3 4 5 6

    Hearing problems/ringing 0 1 2 3 4 5 6

    .Don.t feel right. 0 1 2 3 4 5 6

    Feeling .dinged./.dazed. 0 1 2 3 4 5 6

    Confusion 0 1 2 3 4 5 6

    Feeling slowed down 0 1 2 3 4 5 6

    Feeling like .in a fog. 0 1 2 3 4 5 6

    Drowsiness 0 1 2 3 4 5 6

    Fatigue or low energy 0 1 2 3 4 5 6

    More than emotional 0 1 2 3 4 5 6

    Irritability 0 1 2 3 4 5 6

    Difficulty concentrating 0 1 2 3 4 5 6

    Difficulty remembering 0 1 2 3 4 5 6

    (follow up symptoms only)

    Sadness 0 1 2 3 4 5 6

    Nervous or anxious 0 1 2 3 4 5 6

    Trouble falling asleep 0 1 2 3 4 5 6

    Sleeping more than usual 0 1 2 3 4 5 6

    Sensitivity to light 0 1 2 3 4 5 6

    Sensitivity to noise 0 1 2 3 4 5 6

    Other: 0 1 2 3 4 5 6

    What should I do?

    Any athlete suspected of having a concussion should be

    removed from play, and told to seek medical evaluation.

    Signs to watch for:

    Problems could arise over the first 24-48 hours. You should

    not be left alone and must go to a hospital at once if you:

    Have a headache that gets worse

    Are very drowsy or can.t be awakened (woken up)

    Can.t recognize people or places

    Have repeated vomiting

    Behave unusually or seem confused; are very irritable

    Have seizures (arms and legs jerk uncontrollably)

    Have weak or numb arms or legs

    Are unsteady on your feet; have slurred speech

    Remember, it is better to be safe. Consult your doctor after

    a suspected concussion.

    What can I expect?

    Concussion typically results in the rapid onset of short-lived

    impairment that resolves spontaneously over time. You can

    expect that you will be told to rest until you are fully

    recovered (that means resting your body and your mind).

    Then, your doctor will likely advise that you go through a

    gradual increase in exercise over several days (or longer)

    before returning to sport.

    The SCAT Card (Sport Concussion Assessment Tool)

    Medical Evaluation

    Name: _______________________ Date: ________

    Sport/Team: __________________ Mouth guard? Y N

    1) SIGNS

    Was there loss of consciousness/unresponsiveness? Y N

    Was there seizure or convulsive activity? Y N

    Was there a balance problem / unsteadiness? Y N

    2) MEMORY

    Modified Maddocks questions (check if athlete answers correctly)

    At what venue are we? ____ Which half is it? ____

    Who scored last? ____

    What team did we play last? ____: Did we win last

    game? ____

    3) SYMPTOM SCORE

    Total number of positive symptoms (from reverse side of the card) = _____

    4) COGNITIVE ASSESSMENT (5 word recall)

    (Examples) Immediate Delayed

    Word 1 _____ cat ________ ________

    Word 2 _____ pen ________ ________

    Word 3 _____ shoe ________ ________

    Word 4 _____ book ________ ________

    Word 5 _____ car ________ ________

    Months in reverse order:

    Jun-May-Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sep-Aug-Jul

    Digits Backwards (check correct)

    5-2-8 3-9-1 _____

    6-2-9-4 4-3-7-1 _____

    8-3-2-7-9 1-4-9-3-6 _____

    7-3-9-1-4-2 5-1-8-4-6-8 _____

    Ask delayed 5-word recall now

    5) NEUROLOGIC SCREENING

    Pass Fail

    Speech ____ ____

    Eye Motion and Pupils ____ ____

    Pronator Drift ____ ____

    Gait Assessment ____ ____

    Any neurologic screen abnormality necessitates formal

    neurologic or hospital assessment

    RETURN TO PLAY

    Athletes should not be returned to play the same day of injury.

    When returning athletes to play they should follow a stepwise

    symptom-limited program, with stages of progression. For example:

    1. rest until asymptomatic (physical and mental rest)

    2. light aerobic exercise (e.g stationary cycle)

    3. sport-specific training

    4. non-contact training drills (start light resistance training)

    5. full contact training after medical clearance

    6. return to competition (game play)

    There should be approximately 24 hours (or longer) for each stage

    and the athlete should return to stage 1 if symptoms recur.

    Resistance training should only be added in the later stages.

    Medical clearance should be given before return to play.

    Instructions:

    The side of the card is for the use of medical doctors, physical

    therapists, or athletic therapists. In order to maximize the

    information gathered from the card, it is strongly suggested that all

    athletes participating in contact sports complete a baseline evaluation

    prior to the beginning of their competitive season. This card is a

    suggested guide only for sports concussion and is not meant to assess

    more severe forms of brain injury. Please give a COPY of this card

    to the athlete for their information and to guide follow up

    assessment.

    Signs:

    Assess for each of these items and circle Y (yes) or N (no).

    Memory:

    Select any 5 words (an example is given). Avoid choosing

    related words such as .dark. and .moon. which can be

    recalled by means of word association. Read each word at a

    rate of one word per second. The athlete should not be

    informed of the delayed testing of memory (to be done after

    the reverse months and/or digits). Choose a different set of

    words each time you perform a follow-up exam with the same

    candidate.

    Concentration / Attention:

    Ask the athlete to recite the months of the year in reverse

    order, starting with a random month. Do not start with

    December or January. Circle any months not recited in the

    correct sequence. For digits backwards, if correct, go to the

    next string length. If correct, read trial 2. Stop after incorrect

    on both trials.

    Neurologic Screening:

    Trained medical personnel must administer this examination.

    These individuals might include medical doctors,

    physiotherapists or athletic therapists. Speech should be

    assessed for fluency and lack slurring. Eye motion should

    reveal no diplopia in any of the 4 planes of movement

    (vertical, horizontal and both diagonal planes). The pronator

    drift is performed by asking the patient to hold both arms in

    front of them, palms up, with eyes closed. A positive test is

    pronating the forearm, dropping the arm, or drift away from

    midline. For gait assessment ask the patient to walk away

    from you, turn and walk back.

    Return to Play:

    A structured, graded exertion protocol should be developed,

    individualized on the basis of sport, age, and the concussion

    history of the athlete. Exercise or training should be

    commenced only after the athlete is clearly asymptomatic with

    physical and cognitive rest. Final decision for clearance to

    return to competition should ideally be made by a medical

    doctor.

    Notes:

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