ACUTE CONCUSSION ASSESSMENT

Step	Rehabilitation stage	Objective of Stage
1A	Acute Management	·       Notify coach & medical staff if not present. ·       If a Doctor has performed the assessment, please send any reports or imaging.
		·
1B	Acute Assessment	1. If unconscious - assume neck fracture or brain damage and immobilise neck in rigid collar and carry out routine ABC’s. If unconscious, direct doctor or hospital consult is needed. Further management will be by hospital or doctor. 2. If conscious – determine level of alertness (ie “Glascow Coma Scale”-see below), orientation (place, time, person), extent of amnesia( antrograde vs. retrograde), memory recall(repeat 3 objects 2 mins after assessment) and neurological symptoms with ‘concussion symptom scale’.

   

• When athlete is send to hospital, initial protocol from the hospital should be followed.

Update staff as soon as possible in that case.

• Athlete could be advised to stay in the hospital for some days.

 

• Further management can start when athlete is out of hospital and clearens from the hospital or doctor is given.
• Diagnosis is either Simple or Complex concussion, and further management is the same by both, but duration is different.

      SUBACUTE CONCUSSION GUIDELINE           

Step	Rehabilitation stage	Objective of Stage
2A	Subacute Management	·       Rest: avoid watching TV, using your computer, driving and reading. ·       Nutrition: optimal liquid, vitamins and protein intake. ·       If there is any deterioration in symptoms, seek medical assessment immediately.
2B	Subacute Assessment	·       While symptomatic – fill in the ‘SCAT3 Symptom Evaluation’ scale twice/day and test balance with the ‘BESS’ score. Start this as soon as possible/practical following the concussion. (NB. Can also use SCAT2 app for iPhone, which has the ability to email the results directly and covers both SCAT2 and BESS). Patients that are recovering need scores of 0-1 on the “post concussion symptom scale” before progressing rehabilitation.

 

Post Concussion Symptom Scale

The Post Concussion Symptom Scale is a questionnaire subtracted from the SCAT5. The scale has been shown to have high sensitivity, reliability and validity with monitoring concussion.

Symptom	None	Mild		Moderate		Severe
Headache	0	1	2	3	4	5	6
Nausea	0	1	2	3	4	5	6
Vomitting	0	1	2	3	4	5	6
Balance Problems/ Dizziness	0	1	2	3	4	5	6
Fatigue	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
Drowsiness	0	1	2	3	4	5	6
Sensitivity to Light/ Noise	0	1	2	3	4	5	6
Sadness	0	1	2	3	4	5	6
Nervousness	0	1	2	3	4	5	6
Numbness/Tingling	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
Difficulty Concentrating	0	1	2	3	4	5	6
Difficulty Remembering	0	1	2	3	4	5	6
More Emotional than Usual	0	1	2	3	4	5	6
Irritability	0	1	2	3	4	5	6
Other	0	1	2	3	4	5	6

   

• SCAT 5: http://www.sportphysio.ca/wp-content/uploads/SCAT-5.pdf