Concussion Symptom Score Sheet Concussion Symptom Score Sheet Created Date 5 19 2015 1 55 03 PM
Please rate your symptoms as you have felt over the past 2 3 days according to the scale below 0 6 by circling the ONE number that represents your status best Post Concussion Symptom Scale Mild Moderate Severe Please use the following scale to rate each symptom
Concussion Symptom Score Sheet
Concussion Symptom Score Sheet
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Use of the Post Concussion Symptom Scale The athlete should fill out the form on his or her own in order to give a subjective value for each symptom This form can be used with each encounter to track the athlete s progress towards the resolution of symptoms Concussion results in a constellation of physical cognitive emotional and sleep related symptoms Symptoms may last from several minutes to days weeks months or even longer in some cases
Guidelines for Stage Progression Each stage is 24 hours in duration If symptoms return during a stage activity stop all activity and rest for the entire day The following day return to the last stage above where symptoms did not occur and progress accordingly Each stage should be performed symptom free before progression to the next stage Use of the Post Concussion Symptom Scale The athlete should fill out the form on his or her own in give a subjective value for each symptom This form can be used with each encounter to track the athlete s progress towards the resolution of symptoms Many athletes may have some of
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Individual item scores reflect the presence and severity of post concussive symptoms Post concussive symptoms as measured by the RPQ may arise for different reasons subsequent to although not necessarily directly because of a traumatic brain injury Do the symptoms get worse with mental activity Stanford Children s Health Christine R Boyd MD Pediatric Sports Medicine
The athlete should be given the symptom form and asked to read this instruction paragraph out loud then complete the symptom scale For the baseline assessment the athlete should rate his her symptoms based on how he she typically feels and for the post injury assessment the athlete should rate their symptoms at this point in time Do these symptoms worsen with Physical Activity Yes No Not applicable Thinking Cognitive Activity Yes No Not applicable Over the past 2 days my daily activity level has been of normal If YES to any visual problems further qualify with the Convergence Insufficiency Symptom Survey
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Concussion Symptom Score Sheet Created Date 5 19 2015 1 55 03 PM
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Please rate your symptoms as you have felt over the past 2 3 days according to the scale below 0 6 by circling the ONE number that represents your status best
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Concussion Symptom Score Sheet - The SCAT6 is a standardised tool for evaluating concussions designed for use by Health Care Professionals HCPs The SCAT6 cannot be performed correctly in less than 10 15 minutes Except for the symptoms scale the SCAT6 is intended to be used in the acute phase ideally within 72 hours 3 days and up to 7 days following injury If greater
