Pocket CONCUSSION RECOGNITION TOOL

Transcription

1 Pocket CONCUSSION RECOGNITION TOOL Pocket To help identify CONCUSSION in children, RECOGNITION youth and adults TOOL To Pocket help identify CONCUSSION in children, RECOGNITION youth and adults TOOL. Memory function To help identify in children, youth and adults Failure to answer any se questions correctly may suggest a. What venue are we at today? Which half is it now? Who scored last in this game? RECOGNIZE What team did & you REMOVE play last week / game? RECOGNIZE Concussion Did your should team win & REMOVE suspected last game? if one or more following visible clues, Concussion RECOGNIZE signs, symptoms should & or REMOVE errors suspected in memory if one questions or more are present. Any athlete with a suspected should following IMMEDIATELY visible clues, REMOVED signs, Concussion FROM symptoms PLAY, should and or errors should suspected in memory not if one returned questions or more to are activity present. following until visible y are clues, assessed signs,. Visible symptoms clues or errors in suspected memory questions medically. Athletes with a suspected are present. should not left alone and Any one or more following visual clues can indicate a possible :. should Visible not clues drive a motor suspected vehicle. Any. Visible one or more clues following suspected visual clues can indicate a possible : Loss It is recommended consciousness that, or responsiveness in all cases suspected, player is referred to Any one or more following visual clues can indicate a possible : Loss Lying a medical motionless pressional consciousness on ground for diagnosis or responsiveness / Slow to and get up guidance as well as return to play decisions, Lying Loss Unsteady even if motionless consciousness symptoms feet / Balance resolve. ground or responsiveness / problems Slow to get or falling up over / Incoordination Unsteady Lying Grabbing motionless / Clutching on feet on / Balance ground head problems / Slow to get or falling up over / Incoordination Grabbing Unsteady Dazed, blank / on Clutching feet or vacant / Balance look RED FLAGS head problems or falling over / Incoordination Dazed, Grabbing Confused blank / Clutching / Not aware or vacant head plays or events If ANY following look are reported n player should safely and Confused Dazed, immediately blank / Not or aware vacant removed look plays from or events field. If no qualified medical pressional is Confused 2. available, Signs / Not and consider aware symptoms transporting plays events by suspected ambulance for urgent medical assessment: Presence any one or more following signs & symptoms may suggest a : 2. Signs and symptoms suspected Presence 2. - Signs Athlete any and complains one symptoms neck pain or more following suspected signs & symptoms -Deteriorating conscious state - Loss consciousness -Headache may suggest a : Presence -Increasing any one confusion or more or irritability following signs & symptoms may -Severe suggest or increasing a : headache - Seizure or convulsion -Dizziness - Loss -Repeated consciousness vomiting -Headache -Unusual haviour change - Loss -Balance consciousness problems -Headache -Confusion -Seizure or or convulsion -Dizziness - Double vision - -Seizure Nausea or or convulsion vomiting -Dizziness -Feeling slowed down -Balance - Weakness problems or tingling / burning in arms or -Confusion legs -Balance -Drowsiness problems -Confusion - Pressure in head - Nausea or vomiting -Feeling slowed down - Nausea -More emotional or vomiting -Feeling -Blurred slowed vision down -Drowsiness Rememr: - Pressure in head -Drowsiness -Irritability - Pressure -Sensitivity in to head light -More emotional -Blurred vision -More --Sadness In all emotional cases, basic principles first aid -Blurred -Amnesia vision -Irritability -Sensitivity to light --Irritability Fatigue (danger, or response, low energy airway, breathing, circulation) --Sensitivity Feeling like should to in light a fog followed. -Sadness - -Amnesia -Sadness -Nervous Do not attempt or anxious to move player (or -Amnesia -Neck than Pain required for airway support) Fatigue unless or trained low energy to so do - Feeling like in a fog - - Fatigue Don t or feel low right energy - Feeling -Sensitivity like in to noise a fog -Nervous - Do not or remove anxious helmet (if present) unless -Neck trained Pain to do so. -Nervous -Difficulty or rememring anxious -Neck -Difficulty Pain concentrating Don t feel right -Sensitivity to noise - Don t 20 Concussion feel right in Sport Group -Sensitivity to noise -Difficulty rememring -Difficulty concentrating -Difficulty rememring UTM, 9 -Difficulty Mississauga concentrating Rd., Miss Bristol Circle, Oakville from Concussion McCrory in Sport et. al, Group Consensus Statement on Concussion in Sport. Br J Sports Med 7 (), Concussion in Sport Group 20 Concussion in Sport Group

2 . Memory function Failure to answer any se questions correctly may suggest a.. What Memory venue are function we at today? Failure to answer any se questions correctly may suggest a. Which. Memory half is it function now? Failure to answer any se questions correctly may suggest a. What Who scored venue last are we in this at today? game? Which What What team half venue is did it are now? you we play at today? last week / game? Who Did Which your scored half team last is it win in now? this last game? game? What Who team scored did last you in play this game? last week / game? Any athlete with a suspected should IMMEDIATELY REMOVED Did What your team team did win you play last last game? week / game? FROM PLAY, and should not returned to activity until y are assessed medically. Did your Athletes team win with a last suspected game? should not left alone and Any should athlete not drive with a motor suspected vehicle. should IMMEDIATELY REMOVED FROM Any athlete PLAY, and with should a suspected not returned to should activity IMMEDIATELY until y are REMOVED assessed medically. It FROM is recommended PLAY, Athletes and that, should with in all a not suspected cases returned suspected to, activity should until not player y left is are referred alone assessed and to should a medically. medical not pressional drive Athletes a motor for with diagnosis vehicle. a suspected and guidance as well should as return not to play left decisions, alone and even It should if is recommended not symptoms drive that, a motor resolve. in all vehicle. cases suspected, player is referred to a It medical is recommended pressional that, for in diagnosis all cases and suspected guidance, as well as return player to play is decisions, referred to even RED a medical if FLAGS symptoms pressional resolve. for diagnosis and guidance as well as return to play decisions, If even ANY if symptoms following resolve. are reported n player should safely and immediately removed from field. If no qualified medical pressional is RED FLAGS available, consider transporting by ambulance for urgent medical assessment: If RED ANY FLAGS following are reported n player should safely and immediately - If Athlete ANY complains removed following neck from pain are reported field. If n no qualified -Deteriorating player medical should conscious pressional safely state and is available, immediately consider transporting by ambulance for urgent assessment: -Increasing confusion removed or irritability from field. If no qualified -Severe medical or increasing pressional headache is available, consider transporting by ambulance for urgent medical assessment: -Repeated vomiting -Unusual haviour change - Athlete complains neck pain -Deteriorating conscious state -Seizure or convulsion - Double vision -Increasing Athlete complains confusion or neck irritability pain -Severe -Deteriorating increasing conscious headache state - Weakness or tingling / burning in arms or legs -Repeated -Increasing vomiting confusion or irritability -Unusual -Severe or haviour increasing change headache -Seizure -Repeated or convulsion vomiting - -Unusual Double haviour vision change Rememr: - Weakness -Seizure or or convulsion tingling / burning in arms or legs - Double vision - -In Weakness all cases, or tingling basic principles / burning in first arms aid or legs Rememr: (danger, response, airway, breathing, circulation) should followed. - Do not attempt to move player (or than required for airway support) - Rememr: unless In all cases, trained to basic so do principles first aid - -(danger, Do In not all cases, remove response, helmet basic airway, principles (if present) breathing, unless first circulation) aid trained to should do so. followed. - Do (danger, not attempt response, to move airway, breathing, player (or circulation) than required should for airway followed. support) -unless Do not trained attempt to so to do move player (or than required for airway support) - Do unless not remove trained helmet to so do(if present) unless trained to do so. - Do not remove helmet (if present) unless trained to do so. from McCrory et. al, Consensus Statement on Concussion in Sport. Br J Sports Med 7 (), Concussion in Sport Group from McCrory et. al, Consensus Statement UTM, 9 on Concussion Mississauga in Sport. Rd., Br J Miss. Sports Med (), 20 from McCrory et. al, Consensus Statement 2 Bristol on Concussion Circle, Oakville in Sport. Br J Sports Concussion Med 7 in Sport (), Group Concussion in Sport Group

3 Downloaded from from bjsm.bmj.com on on March March 2, 2, Published - Published by by group.bmj.com Child-SCAT Sport Concussion Assessment Tool Tool for for children children ages ages to2 to2 years years For For use use by by medical medical pressionals pressionals only only What What is is childscat? childscat? The ChildSCAT is a standardized tool for evaluating injured children for and can The ChildSCAT is a standardized tool for evaluating injured children for and can used in children aged from to 2 years. It supersedes original SCAT and SCAT2 used in children aged from to 2 years. It supersedes original SCAT and SCAT2 published in 200 and 2009, respectively published in 200 and 2009, respectively 2. For older persons, ages years and over, please 2. For older persons, ages years and over, please use SCAT. The ChildSCAT is designed for use by medical pressionals. If you are not use SCAT. The ChildSCAT is designed for use by medical pressionals. If you are not qualified, please use Sport Concussion Recognition Tool qualified, please use Sport Concussion Recognition Tool.Preseason baseline testing with.preseason baseline testing with ChildSCAT can helpful for interpreting post-injury test scores. ChildSCAT can helpful for interpreting post-injury test scores. Specific instructions for use ChildSCAT are provided on page. If you are not familiar with Specific ChildSCAT, instructions please for read use through ChildSCAT se instructions are provided carefully. on This page tool. If may you are freely not familiar copied in with its current ChildSCAT, form for please distribution read through to individuals, se instructions teams, groups carefully. and organizations. This tool may Any revision freely copied and in any its reproduction current form in for a digital distribution form require to individuals, approval teams, by groups Concussion and organizations. in Sport Group. Any revision and NOTE: any reproduction The diagnosis in a a digital form require is a clinical approval judgment, by ideally Concussion made by in a Sport medical Group. pressional. The NOTE: ChildSCAT The diagnosis should not a used solely is to a make, clinical or judgment, exclude, ideally diagnosis made by a medical pressional. in absence The ChildSCAT clinical judgement. should not An athlete used solely may have to make, a or exclude, even if diagnosis ir ChildSCAT is normal. in absence clinical judgement. An athlete may have a even if ir ChildSCAT is normal. What is a? What is a? A is a disturbance in brain function caused by a direct or indirect force to head. It results A in a variety is a disturbance non-specific in brain signs function and/or caused symptoms by a (like direct those or indirect listed low) force and to most head. ten It results does not in a involve variety loss non-specific consciousness. signs and/or Concussion symptoms should (like those suspected listed in low) presence and most ten any one does or not more involve loss following: consciousness. Concussion should suspected in presence any one or more following: -Symptoms (e.g., headache), or -Physical -Symptoms signs (e.g., (e.g., headache), unsteadiness), or or -Impaired -Physical brain signs function (e.g., unsteadiness), (e.g. confusion) or or -Abnormal -Impaired haviour brain function (e.g., (e.g. change confusion) in personality). or -Abnormal haviour (e.g., change in personality). SIDeLIne SIDeLIne ASSeSSmenT ASSeSSmenT Indications for emergency management Indications for emergency management note: A hit to head can sometimes associated with a more severe brain injury. note: if A hit concussed to head child can displays sometimes any associated following, with n a do more not severe proceed brain with injury. if ChildSCAt; concussed instead child activate displays emergency any procedures following, n and urgent do not transportation with to ChildSCAt; nearest hospital: instead activate emergency procedures and urgent trans- proceed portation to nearest hospital: - Glasgow Coma score less than -Deteriorating - Glasgow Coma mental score status less than -potential -Deteriorating spinal injury mental status - progressive, -potential spinal worsening injurysymptoms or new neurologic signs -persistent - progressive, vomiting worsening or new neurologic signs - evidence -persistent skull vomiting fracture -post - evidence traumatic skull seizures fracture -Coagulopathy -post traumatic seizures - History -Coagulopathy neurosurgery (eg Shunt) -multiple - History injuries neurosurgery (eg Shunt) -multiple injuries glasgow coma scale (gcs) glasgow coma scale (gcs) Best eye response (e) no Best eye eye opening response (e) eye no opening eye opening response to pain 2 eye eye opening opening to in speech response to pain 2 eyes eye opening opening spontaneously to speech eyes opening spontaneously Best verbal response (v) no Best verbal verbal response response (v) incomprehensible no verbal response sounds 2 inappropriate incomprehensible words sounds 2 Confused inappropriate words oriented Confused oriented Best motor response (m) no Best motor motor response response (m) extension no motor to response pain 2 Abnormal extension flexion to pain to pain 2 Flexion Abnormal / Withdrawal flexion to pain localizes Flexion / to Withdrawal pain to pain oys localizes commands to pain 6 oys commands glasgow Coma score (e + v + m) 6 GCS glasgow should Coma recorded score for all athletes (e + v in + case m) subsequent deterioration. GCS should recorded for all athletes in case subsequent deterioration. Potential Potential signs signs?? if any following signs are observed after a direct or indirect blow to if any following signs are observed after a direct or indirect blow to head, child should stop participation, evaluated by a medical pressional head, child should stop participation, evaluated by a medical pressional and should not permitted to return to sport same day if a and should not permitted to return to sport same day if a is suspected. is suspected. Any loss consciousness? Any loss consciousness? Y n Balance or motor incoordination (stumbles, slow / laboured movements, etc.)? Balance or motor incoordination (stumbles, slow / laboured movements, etc.)? Y Disorientation or confusion n (inability to respond appropriately to questions)? Y Disorientation or confusion (inability to respond appropriately to questions)? loss memory: loss memory: n Before or after injury?" Before or after injury?" Blank or vacant look: Y Blank or vacant look: Visible facial injury in combination with any above: n Visible facial injury in combination with any above: Y n 2 2 Sideline Assessment child-maddocks Score Sideline Assessment child-maddocks Score I am going to ask you a few questions, please listen carefully and give your st effort. I am going to ask you a few questions, please listen carefully and give your st effort. Modified Maddocks questions ( point for each correct answer) Modified Maddocks questions ( point for each correct answer) Where are we at now? 0 Where are we at now? 0 is it fore or after lunch? 0 is it fore or after lunch? 0 What did you have last lesson / class? 0 What did you have last lesson / class? 0 What is your teacher s name? 0 What is your teacher s name? 0 child-maddocks score child-maddocks score Child-Maddocks score is for sideline diagnosis only and is not used for serial testing. Child-Maddocks score is for sideline diagnosis only and is not used for serial testing. Any child with a suspected should RemoveD FRom Any PLAy, child medically with a suspected assessed and monitored should for deterioration RemoveD (i.e., FRom should PLAy, not medically left alone). assessed No child and diagnosed monitored with for deterioration should (i.e., should returned not to left sports alone). participation No child diagnosed on day with Injury. should returned to sports participation on day Injury. BACKgRounD BACKgRounD name: Date / time injury: examiner: name: Date Date Assessment: / time injury: Sport examiner: / team / school: Date Assessment: Age: Sport / team / school: Gender: m F Current Age: school year / grade: Gender: m F Dominant Current hand: school year / grade: right left neir mechanism Dominant hand: injury ( tell me what happened?): right left neir mechanism injury ( tell me what happened?): For Parent / carer to complete: How For many Parent s / carer to has complete: child had in past? When How was many s most recent has? child had in past? How When long was was most recovery recent from? most recent? Has How child long was ever en recovery hospitalized from or had most medical recent imaging? done Has (Ct or child mri) ever for a en head hospitalized injury? or had medical imaging Has done child (Ct or ever mri) en for diagnosed a head injury? with headaches or migraines? Does Has child child have ever a en learning diagnosed disability, with dyslexia, headaches or migraines? Y ADD/ADHD, Does child seizure have disorder? a learning disability, dyslexia, Has ADD/ADHD, child ever seizure en disorder? diagnosed with depression, anxiety Has or or child psychiatric ever en diagnosed disorder? with depression, Has anxiety anyone or in or family psychiatric ever en disorder? diagnosed with any Has se anyone problems? in family ever en diagnosed with is any child se on any problems? medications? if yes, please list: is child on any medications? if yes, please list: CHILD-SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group University Toronto Mississauga, RAWC 9 Mississauga Rd., Miss., ON LL C CHILD-SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport 26 Group 2 Bristol Circle, Suite 02, Oakville, ON L6H 6P

4 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com SymPTom evaluation Child report name: never rarely sometimes ten i have trouble paying attention 0 2 i get distracted easily 0 2 i have a hard time concentrating 0 2 i have problems rememring what people tell me 0 2 i have problems following directions 0 2 i daydream too much 0 2 i get confused 0 2 i forget things 0 2 I have problems finishing things 0 2 I have trouble figuring things out 0 2 it s hard for me to learn new things 0 2 i have headaches 0 2 i feel dizzy 0 2 i feel like room is spinning 0 2 i feel like i m going to faint 0 2 things are blurry when i look at m 0 2 i see double 0 2 i feel sick to my stomach 0 2 i get tired a lot 0 2 i get tired easily 0 2 Total numr symptoms (Maximum possible 20) Symptom severity score (Maximum possible 20 x = 60) self rated clinician interview self rated and clinician monitored Parent report CognITIve & PHySICAL evaluation Cognitive assessment Standardized Assessment Concussion Child version (SAC-C) orientation ( point for each correct answer) What month is it? 0 What is date today? 0 What is day week? 0 What year is it? 0 orientation score Immediate memory List Trial Trial 2 Trial Alternative word list elbow candle baby finger apple paper monkey penny carpet sugar perfume blanket saddle sandwich sunset lemon bubble wagon iron insect Total Immediate memory score total Concentration: Digits Backward List Trial Alternative digit list Total The child never rarely sometimes ten has trouble sustaining attention 0 2 is easily distracted 0 2 has difficulty concentrating 0 2 has problems rememring what he / she is told 0 2 has difficulty following directions 0 2 tends to daydream 0 2 gets confused 0 2 is forgetful 0 2 has difficulty completeing tasks 0 2 has poor problem solving skills 0 2 has problems learning 0 2 has headaches 0 2 feels dizzy 0 2 has a feeling that room is spinning 0 2 feels faint 0 2 has blurred vision 0 2 has double vision 0 2 experiences nausea 0 2 gets tired a lot 0 2 gets tired easily 0 2 Total numr symptoms (Maximum possible 20) Symptom severity score (Maximum possible 20 x = 60) Do symptoms get worse with physical activity? Do symptoms get worse with mental activity? parent self rated clinician interview parent self rated and clinician monitored overall rating for parent / teacher / coach / carer to answer. How different is child acting compared to his / her usual self? Please circle one response: no different very different unsure n/a Concentration: Days in Reverse Order ( pt. for entire sequence correct) Sunday-Saturday-Friday-thursday-Wednesdaytuesday-monday 0 Concentration score 6 neck examination: range motion tenderness upper and lower limb sensation & strength Findings: Balance examination Do one or both following tests. Footwear (shoes, barefoot, braces, tape, etc.) Modified Balance Error Scoring System (BESS) testing Which foot was tested (i.e. which is non-dominant foot) left right Testing surface (hard floor, field, etc.) Condition Double leg stance: errors tandem stance (non-dominant foot at back): errors Tandem gait 6,7 time taken to complete (st trials): seconds if child attempted, but unable to complete tandem gait, mark here Coordination examination upper limb coordination Which arm was tested: left right Coordination score name person completing parent-report: relationship to child person completing parent-report: Scoring on ChildSCAT should not used as a stand-alone method to diagnose, measure recovery or make decisions about an athlete s readiness to return to competition after. 9 SAC Delayed Recall Delayed recall score Since signs and symptoms may evolve over time, it is important to consider repeat evaluation in acute assessment. CHILD-SCAT Sport ConCuSSion ASSeSment tool PAge 2 20 Concussion in Sport Group 26 Copies available for reproduction on CHILD SCAT Sport Concussion Assessment Tool PAGE 2

5 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com InSTRuCTIonS Words in Italics throughout ChildSCAt are instructions given to child by tester. Sideline Assessment child-maddocks Score to completed on sideline / in playground, immediately following. re is no requirement to repeat se questions at follow-up. Symptom Scale 8 in situations where symptom scale is ing completed after exercise, it should still done in a resting state, at least 0 minutes post exercise. on day injury - child is to complete Child report, according to how he / she feels now. on all subsequent days - child is to complete Child report, according to how he / she feels today, and - parent/carer is to complete parent report according to how child has en over previous 2 hours. Standardized Assessment Concussion Child version (SAC-C) Orientation Ask each question on score sheet. A correct answer for each question scores point. If child does not understand question, gives an incorrect answer, or no answer, n score for that question is 0 points. Immediate memory I am going to test your memory. I will read you a list words and when I am done, repeat back as many words as you can rememr, in any order. Trials 2 & : I am going to repeat same list again. Repeat back as many words as you can rememr in any order, even if you said word fore. Complete all trials regardless score on trial & 2. Read words at a rate one per second. Score pt. for each correct response. Total score equals sum across all trials. Do not inform child that delayed recall will tested. Concentration Digits Backward: I am going to read you a string numrs and when I am done, you repeat m back to me backwards, in reverse order how I read m to you. For example, if I say 7-, you would say -7. If correct, go to next string length. If incorrect, read trial 2. One point possible for each string length. Stop after incorrect on both trials. The digits should read at rate one per second. Days in Reverse order: Now tell me days week in reverse order. Start with Sunday and go backward. So you ll say Sunday, Saturday Go ahead pt. for entire sequence correct Delayed recall delayed recall should performed after completion Balance and Coordination examination. Do you rememr that list words I read a few times earlier? Tell me as many words from list as you can rememr in any order. Circle each word correctly recalled. Total score equals numr words recalled. Balance examination These instructions are to read by person administering childscat, and each balance task should demonstrated to child. The child should n asked to copy what examiner demonstrated. Modified Balance Error Scoring System (BESS) testing This balance testing is based on a modified version Balance Error Scoring System (BeSS). A stopwatch or watch with a second hand is required for this testing. I am now going to test your balance. Please take your shoes f, roll up your pant legs above ankle (if applicable), and remove any ankle taping (if applicable). This test will consist two different parts. (a) Double leg stance: The first stance is standing with feet toger with hands on hips and with eyes closed. The child should try to maintain stability in that position for 20 seconds. You should inform child that you will counting numr times child moves out this position. You should start timing when child is set and eyes are closed. (b) Tandem stance: Instruct child to stand heel-to-toe with non-dominant foot in back. Weight should evenly distributed across both feet. Again, child should try to maintain stability for 20 seconds with hands on hips and eyes closed. You should inform child that you will counting numr times child moves out this position. If child stumbles out this position, instruct him/her to open eyes and return to start position and continue balancing. You should start timing when child is set and eyes are closed. Balance testing types errors - Parts (a) and (b). Hands lifted f iliac crest 2. opening eyes. Step, stumble, or fall. moving hip into > 0 degrees abduction. lifting forefoot or heel 6. remaining out test position > sec each 20-second trials is scored by counting errors, or deviations from proper stance, accumulated by child. examiner will gin counting errors only after child has assumed proper start position. The modified BESS is calculated by adding one error point for each error during two 20-second tests. The maximum total numr errors for any single condition is 0. if a child commits multiple errors simultaneously, only one error is recorded but child should quickly return to testing position, and counting should resume once subject is set. Children who are unable to maintain testing procedure for a minimum five seconds at start are assigned highest possible score, ten, for that testing condition. option: For furr assessment, same 2 stances can performed on a surface medium density foam (e.g., approximately 0cm x 0cm x 6cm). Tandem gait 6,7 Use a clock (with a second hand) or stopwatch to measure time taken to complete this task. Instruction for examiner Demonstrate following to child: The child is instructed to stand with ir feet toger hind a starting line ( test is st done with footwear removed). Then, y walk in a forward direction as quickly and as accurately as possible along a 8mm wide (sports tape), meter line with an alternate foot heel-totoe gait ensuring that y approximate ir heel and toe on each step. Once y cross end m line, y turn 80 degrees and return to starting point using same gait. A total trials are done and st time is retained. Children fail test if y step f line, have a separation tween ir heel and toe, or if y touch or grab examiner or an object. In this case, time is not recorded and trial repeated, if appropriate. Explain to child that you will time how long it takes m to walk to end line and back. Coordination examination upper limb coordination Finger-to-nose (Ftn) task: The tester should demonstrate it to child. I am going to test your coordination now. Please sit comfortably on chair with your eyes open and your arm (eir right or left) outstretched (shoulder flexed to 90 degrees and elbow and fingers extended). When I give a start signal, I would like you to perform five successive finger to nose repetitions using your index finger to touch tip nose as quickly and as accurately as possible. Scoring: correct repetitions in < seconds = Note for testers: Children fail test if y do not touch ir nose, do not fully extend ir elbow or do not perform five repetitions. Failure should scored as 0. References & Footnotes. this tool has en developed by a group international experts at th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland in novemr 202. full details conference outcomes and authors tool are published in BJSm injury prevention and Health protection, 20, Volume 7, issue. outcome paper will also simultaneously co-published in or leading biomedical journals with copyright held by Concussion in Sport Group, to allow unrestricted distribution, providing no alterations are made. 2. mccrory p et al., Consensus Statement on Concussion in Sport rd international Conference on Concussion in Sport held in Zurich, novemr British Journal Sports medicine 2009; : i maddocks, Dl; Dicker, GD; Saling, mm. assessment orientation following in athletes. Clinical Journal Sport medicine. 99; (): 2.. mccrea m. Standardized mental status testing acute. Clinical Journal Sport medicine. 200; : Guskiewicz Km. Assessment postural stability following sport-related. Current Sports medicine reports. 200; 2: Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G. & mccrory, p. normative values for 6-7 year old subjects for three clinical measures motor performance used in assessment sports s. Journal Science and medicine in Sport. 200; (2): Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t. & marshall, S.W. effect footwear and sports-surface on dynamic neurological screening in sport-related. Journal Science and medicine in Sport. 200; (): Ayr, l.k., Yeates, K.o., taylor, H.G., & Brown, m. Dimensions post-concussive symptoms in children with mild traumatic brain injuries. Journal international neuropsychological Society. 2009; :9 0. Copies available for reproduction on CHILD SCAT Sport Concussion Assessment Tool PAGE CHILD-SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group 26

6 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com CHILD ATHLeTe InFoRmATIon Any child suspected having a should removed from play, and n seek medical evaluation. The child must not return to play or sport on same day as suspected. Signs to watch for Problems could arise over first 2 8 hours. The child should not left alone and must go to a hospital at once if y develop any following: - new Headache, or Headache gets worse - persistent or increasing neck pain - Becomes drowsy or can t woken up - Can not recognise people or places - Has nausea or Vomiting - Behaves unusually, seems confused, or is irritable - Has any seizures (arms and / or legs jerk uncontrollably) - Has weakness, numbness or tingling (arms, legs or face) - is unsteady walking or standing - Has slurred speech - Has difficulty understanding speech or directions Rememr, it is tter to safe. Always consult your doctor after a suspected. Return to school Concussion may impact on child s cognitive ability to learn at school. this must considered, and medical clearance is required fore child may return to school. It is reasonable for a child to miss a day or two school after, but extended absence is uncommon. in some children, a graduated return to school program will need to developed for child. child will progress through return to school program provided that re is no worsening symptoms. if any particular activity worsens symptoms, child will abstain from that activity until it no longer causes symptom worsening. use computers and internet should follow a similar graduated program, provided that it does not worsen symptoms. this program should include communication tween parents, teachers, and health pressionals and will vary from child to child. return to school program should consider: - extra time to complete assignments / tests - Quiet room to complete assignments / tests - Avoidance noisy areas such as cafeterias, assembly halls, sporting events, music class, shop class, etc - Frequent breaks during class, homework, tests - no more than one exam / day - Shorter assignments - repetition / memory cues - use peer helper / tutor - reassurance from teachers that student will supported through recovery through accommodations, workload reduction, alternate forms testing - later start times, half days, only certain classes The child is not to return to play or sport until he / she has successfully returned to school / learning, without worsening symptoms. medical clearance should given fore return to play. If re are any doubts, management should referred to a qualified health practitioner, expert in management in children. Return to sport re should no return to play until child has successfully returned to school / learning, without worsening symptoms. Children must not returned to play same day injury. When returning children to play, y should medically cleared and n follow a stepwise supervised program, with stages progression. For example: rehabilitation stage Functional exercise at each stage rehabilitation objective each stage no activity physical and cognitive rest recovery light aerobic exercise Sport-specific exercise non-contact training drills Full contact practice return to play Walking, swimming or stationary cycling keeping intensity, 70 % maximum predicted heart rate. no resistance training Skating drills in ice hockey, running drills in soccer. no head impact activities progression to more complex training drills, eg passing drills in football and ice hockey. may start progressive resistance training Following medical clearance participate in normal training activities normal game play increase heart rate Add movement exercise, coordination, and cognitive load Restore confidence and assess functional skills by coaching staff re should approximately 2 hours (or longer) for each stage and child should drop back to previous asymptomatic level if any post-concussive symptoms recur. resistance training should only added in later stages. if child is symptomatic for more than 0 days, n review by a health practitioner, expert in management, is recommended. medical clearance should given fore return to play. notes: ConCuSSIon InjuRy ADvICe FoR THe CHILD AnD PARenTS / CAReRS (to given to person monitoring concussed child) this child has received an injury to head. A careful medical examination has en carried out and no sign any serious complications has en found. it is expected that recovery will rapid, but child will need monitoring for next 2 hours by a responsible adult. If you notice any change in havior, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, please call an ambulance to transport child to hospital immediately. patient s name Date / time injury Date / time medical review treating physician or important points: - Following, child should rest for at least 2 hours. - child should avoid any computer, internet or electronic gaming activity if se activities make symptoms worse. - child should not given any medications, including pain killers, unless prescrid by a medical practitioner. - child must not return to school until medically cleared. - child must not return to sport or play until medically cleared. Clinic phone numr 266 MISSISSAUGA LOCATION: University Toronto Mississauga RAWC 9 Mississauga Rd., Miss., ON LL C Contact details or stamp OAKVILLE LOCATION: 2 Bristol Circle, Suite 02, Oakville, ON L6H 6P CHILD-SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group Copies available for reproduction on CHILD SCAT Sport Concussion Assessment Tool PAGE

7 SCAT Sport Concussion Assessment Tool rd edition For Sport use by medical Concussion pressionals only Assessment Tool rd edition For use by medical pressionals only Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com name name Date / Time Injury: Date Assessment: Date / Time Injury: Date Assessment: examiner: examiner: What is SCAT? What is SCAT? SCAt is a standardized tool for evaluating injured athletes for and can used in athletes aged from years and older. it supersedes original SCAt and SCAt2 published in 200 and 2009, respectively SCAt is a standardized tool for evaluating injured athletes for and can used in athletes aged from years and older. it supersedes 2. For younger original SCAt and SCAt2 published in 200 and 2009, respectively 2. For younger persons, ages 2 and under, please use Child SCAt. SCAt is designed for use by medical pressionals. If you are not qualified, please use Sport persons, ages 2 and under, please use Child SCAt. SCAt is designed Concussion recognition tool. preseason baseline testing with SCAt can for use by medical pressionals. If you are not qualified, please use Sport helpful for interpreting post-injury test scores. Concussion recognition tool. preseason baseline testing with SCAt can helpful for interpreting post-injury test scores. Specific instructions for use SCAT are provided on page. If you are not familiar with SCAt, please read through se instructions carefully. this Specific instructions for use SCAT are provided on page. If you are not tool may freely copied in its current form for distribution to individuals, teams, familiar with SCAt, please read through se instructions carefully. this groups and organizations. Any revision or any reproduction in a digital form requires tool may approval freely by copied Concussion in its current in Sport form Group. for distribution to individuals, teams, groups and organizations. Any revision or any reproduction in a digital form requires NOTE: diagnosis a is a clinical judgment, ideally made by a medical pressional. approval by Concussion SCAt should in Sport not Group. used solely to make, or exclude, NOTE: diagnosis diagnosis a in absence is a clinical clinical judgement. judgment, ideally An athlete made may by a have medical a pressional. even if ir SCAt SCAt should is normal. not used solely to make, or exclude, diagnosis in absence clinical judgement. An athlete may have a even if ir SCAt is normal. What is a? A is a disturbance in brain function caused by a direct or indirect force to What head. is It a results? in a variety non-specific signs and / or symptoms (some examples A listed is low) a disturbance and most in brain ten function does not caused involve by loss a direct consciousness. or indirect force Concussion to head. should It results suspected in a variety in non-specific presence signs any and one / or or symptoms more (some following: examples listed low) and most ten does not involve loss consciousness. Concussion should suspected in presence any one or more -Symptoms (e.g., headache), or following: -Physical signs (e.g., unsteadiness), or -Impaired -Symptoms brain (e.g., function headache), (e.g. confusion) or or -Abnormal -Physical signs haviour (e.g., (e.g., unsteadiness), change in or personality). -Impaired brain function (e.g. confusion) or -Abnormal haviour (e.g., change in personality). Sideline ASSeSSmenT Sideline ASSeSSmenT glasgow coma scale (gcs) glasgow coma scale (gcs) Best eye response (e) no Best eye opening eye response (e) eye no opening eye opening response to pain 2 eye eye opening opening to speech in response to pain 2 eyes eye opening opening spontaneously to speech Best eyes verbal opening response spontaneously (v) no Best verbal verbal response response (v) incomprehensible no verbal response sounds 2 inappropriate incomprehensible words sounds 2 Confused inappropriate words oriented Confused Best oriented motor response (m) no motor response Best motor response (m) extension to pain no motor response 2 Abnormal flexion to pain extension to pain 2 Flexion / Withdrawal to pain Abnormal flexion to pain localizes to pain Flexion / Withdrawal to pain oys commands localizes to pain 6 glasgow oys commands Coma score (e + v + m) 6 GCS glasgow should recorded Coma score for all athletes (e + v in + case m) subsequent deterioration. GCS should recorded for all athletes in case subsequent deterioration. 2 maddocks Score 2 maddocks Score I am going to ask you a few questions, please listen carefully and give your st effort. Modified Maddocks questions ( point for each correct answer) indications for emergency management I am going to ask you a few questions, please listen carefully and give your st effort. What Modified venue Maddocks are we questions at today? ( point for each correct answer) 0 note: A hit to head can sometimes associated with a more serious brain indications for emergency management injury. Any following warrants consideration activating emergency procedures note: and A hit urgent to transportation head can sometimes to nearest associated hospital: with a more serious brain Who scored last in this match? 0 Which half is it now? 0 What venue are we at today? 0 injury. Any following warrants consideration activating emergency procedures and urgent transportation to nearest hospital: Who scored last in this match? 0 Which half is it now? 0 - Glasgow Coma score less than What team did you play last week / game? 0 -Deteriorating mental status Did your team win last game? 0 -potential - Glasgow spinal Coma injury score less than What team did you play last week / game? 0 - progressive, -Deteriorating worsening mental status symptoms or new neurologic signs maddocks Did your score team win last game? 0 -potential spinal injury Maddocks - progressive, worsening symptoms or new neurologic signs maddocks score is score validated for sideline diagnosis only and is not used for serial testing. Potential signs? if any following signs are observed after a direct or indirect blow to Maddocks score is validated for sideline diagnosis only and is not used for serial testing. head, Potential athlete signs should stop? participation, evaluated by a medical pressional if any and should following not signs permitted are observed to return after to a direct sport or indirect same blow day to if a notes: mechanism injury ( tell me what happened?): head, is athlete suspected. should stop participation, evaluated by a medical pressional and should not permitted to return to sport same day if a notes: mechanism injury ( tell me what happened?): Any loss consciousness? is suspected. Any loss consciousness? Balance or motor incoordination (stumbles, slow / laboured movements, etc.)? Y n Disorientation or confusion (inability to respond appropriately to questions)? Balance or motor incoordination (stumbles, slow / laboured movements, etc.)? loss memory: Y n Disorientation or confusion (inability to respond appropriately to questions)? Y n loss memory: Y Before or after injury?" n Any athlete with a suspected should removed Blank if so, or how vacant long? look: From PlAy, medically assessed, monitored for deterioration Visible Before facial or injury after in combination injury?" with any above: (i.e., Any should athlete not with left a alone) suspected and should not drive should a motor removed vehicle Blank or vacant look: until From cleared PlAy, to do medically so by a medical assessed, pressional. monitored no for athlete deterioration diagnosed (i.e., with should not left should alone) and returned should to not sports drive participation a motor vehicle Visible facial injury in combination with any above: on until day cleared injury. to do so by a medical pressional. no athlete diagnosed with should returned to sports participation on day injury. University Toronto Mississauga, RAWC 9 Mississauga Rd., Miss., ON LL C SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion Sport Group 2 Bristol Circle, Suite 02, Oakville, ON L6H 6P SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group 29

8 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com BACkground CogniTive & PhySiCAl evaluation name: examiner: Sport / team / school: Date: Date / time injury: Age: Gender: m F Years education completed: Dominant hand: right left neir How many s do you think you have had in past? When was most recent? How long was your recovery from most recent? Have you ever en hospitalized or had medical imaging done for a head injury? Have you ever en diagnosed with headaches or migraines? Do you have a learning disability, dyslexia, ADD / ADHD? Have you ever en diagnosed with depression, anxiety or or psychiatric disorder? Has anyone in your family ever en diagnosed with any se problems? Are you on any medications? if yes, please list: SCAT to done in resting state. Best done 0 or more minutes post excercise. SymPTom evaluation how do you feel? You should score yourself on following symptoms, based on how you feel now. none mild moderate severe Headache pressure in head neck pain nausea or vomiting Dizziness Blurred vision Balance problems Sensitivity to light Sensitivity to noise Feeling slowed down Feeling like in a fog Don t feel right Difficulty concentrating Difficulty rememring Fatigue or low energy Confusion Drowsiness trouble falling asleep more emotional irritability Sadness nervous or Anxious Total numr symptoms (Maximum possible 22) Symptom severity score (Maximum possible 2) Do symptoms get worse with physical activity? Do symptoms get worse with mental activity? self rated clinician interview self rated and clinician monitored self rated with parent input overall rating: if you know athlete well prior to injury, how different is athlete acting compared to his / her usual self? Please circle one response: no different very different unsure N/A Cognitive assessment Standardized Assessment Concussion (SAC) 6 7 orientation ( point for each correct answer) What month is it? 0 What is date today? 0 What is day week? 0 What year is it? 0 What time is it right now? (within hour) 0 orientation score immediate memory List Trial Trial 2 Trial Alternative word list elbow candle baby finger apple paper monkey penny carpet sugar perfume blanket saddle sandwich sunset lemon bubble wagon iron insect Total immediate memory score total Concentration: digits Backward List Trial Alternative digit list Total Concentration: month in reverse order ( pt. for entire sequence correct) Dec-nov-oct-Sept-Aug-Jul-Jun-may-Apr-mar-Feb-Jan 0 Concentration score neck examination: range motion tenderness upper and lower limb sensation & strength Findings: Balance examination Do one or both following tests. Footwear (shoes, barefoot, braces, tape, etc.) Modified Balance Error Scoring System (BESS) testing Which foot was tested (i.e. which is non-dominant foot) left right Testing surface (hard floor, field, etc.) Condition Double leg stance: Single leg stance (non-dominant foot): tandem stance (non-dominant foot at back): And / or Tandem gait 6,7 time (st trials): seconds Coordination examination upper limb coordination Which arm was tested: left right errors errors errors Coordination score Scoring on SCAT should not used as a stand-alone method to diagnose, measure recovery or make decisions about an athlete s readiness to return to competition after. Since signs and symptoms may evolve over time, it is important to consider repeat evaluation in acute assessment. 8 SAC delayed recall delayed recall score Copies available for reproduction on SCAT Sport ConCuSSion ASSeSment tool PAge 2 SCAT Sport Concussion 20 Assessment Concussion in Sport Tool Group PAGE 2 260

9 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com instructions Words in Italics throughout SCAt are instructions given to athlete by tester. Symptom Scale You should score yourself on following symptoms, based on how you feel now. to completed by athlete. in situations where symptom scale is ing completed after exercise, it should still done in a resting state, at least 0 minutes post exercise. For total numr symptoms, maximum possible is 22. For Symptom severity score, add all scores in table, maximum possible is 22 x 6 = 2. SAC immediate memory I am going to test your memory. I will read you a list words and when I am done, repeat back as many words as you can rememr, in any order. Trials 2 & : I am going to repeat same list again. Repeat back as many words as you can rememr in any order, even if you said word fore. Complete all trials regardless score on trial & 2. Read words at a rate one per second. Score pt. for each correct response. Total score equals sum across all trials. Do not inform athlete that delayed recall will tested. Concentration digits backward I am going to read you a string numrs and when I am done, you repeat m back to me backwards, in reverse order how I read m to you. For example, if I say 7--9, you would say If correct, go to next string length. If incorrect, read trial 2. One point possible for each string length. Stop after incorrect on both trials. The digits should read at rate one per second. months in reverse order Now tell me months year in reverse order. Start with last month and go backward. So you ll say Decemr, Novemr Go ahead pt. for entire sequence correct delayed recall delayed recall should performed after completion Balance and Coordination examination. Do you rememr that list words I read a few times earlier? Tell me as many words from list as you can rememr in any order. Score pt. for each correct response Balance examination Modified Balance Error Scoring System (BESS) testing This balance testing is based on a modified version Balance Error Scoring System (BESS). A stopwatch or watch with a second hand is required for this testing. I am now going to test your balance. Please take your shoes f, roll up your pant legs above ankle (if applicable), and remove any ankle taping (if applicable). This test will consist three twenty second tests with different stances. (a) double leg stance: The first stance is standing with your feet toger with your hands on your hips and with your eyes closed. You should try to maintain stability in that position for 20 seconds. I will counting numr times you move out this position. I will start timing when you are set and have closed your eyes. (b) Single leg stance: If you were to kick a ball, which foot would you use? [This will dominant foot] Now stand on your non-dominant foot. The dominant leg should held in approximately 0 degrees hip flexion and degrees knee flexion. Again, you should try to maintain stability for 20 seconds with your hands on your hips and your eyes closed. I will counting numr times you move out this position. If you stumble out this position, open your eyes and return to start position and continue balancing. I will start timing when you are set and have closed your eyes. (c) Tandem stance: Now stand heel-to-toe with your non-dominant foot in back. Your weight should evenly distributed across both feet. Again, you should try to maintain stability for 20 seconds with your hands on your hips and your eyes closed. I will counting numr times you move out this position. If you stumble out this position, open your eyes and return to start position and continue balancing. I will start timing when you are set and have closed your eyes. Balance testing types errors. Hands lifted f iliac crest 2. opening eyes. Step, stumble, or fall. moving hip into > 0 degrees abduction. lifting forefoot or heel 6. remaining out test position > sec each 20-second trials is scored by counting errors, or deviations from proper stance, accumulated by athlete. examiner will gin counting errors only after individual has assumed proper start position. The modified BeSS is calculated by adding one error point for each error during three 20-second tests. The maximum total numr errors for any single condition is 0. if a athlete commits multiple errors simultaneously, only one error is recorded but athlete should quickly return to testing position, and counting should resume once subject is set. Subjects that are unable to maintain testing procedure for a minimum five seconds at start are assigned highest possible score, ten, for that testing condition. option: For furr assessment, same stances can performed on a surface medium density foam (e.g., approximately 0 cm x 0 cm x 6 cm). Tandem gait 6,7 Participants are instructed to stand with ir feet toger hind a starting line ( test is st done with footwear removed). Then, y walk in a forward direction as quickly and as accurately as possible along a 8mm wide (sports tape), meter line with an alternate foot heel-to-toe gait ensuring that y approximate ir heel and toe on each step. Once y cross end m line, y turn 80 degrees and return to starting point using same gait. A total trials are done and st time is retained. Athletes should complete test in seconds. Athletes fail test if y step f line, have a separation tween ir heel and toe, or if y touch or grab examiner or an object. In this case, time is not recorded and trial repeated, if appropriate. Coordination examination upper limb coordination Finger-to-nose (FTN) task: I am going to test your coordination now. Please sit comfortably on chair with your eyes open and your arm (eir right or left) outstretched (shoulder flexed to 90 degrees and elbow and fingers extended), pointing in front you. When I give a start signal, I would like you to perform five successive finger to nose repetitions using your index finger to touch tip nose, and n return to starting position, as quickly and as accurately as possible. Scoring: correct repetitions in < seconds = Note for testers: Athletes fail test if y do not touch ir nose, do not fully extend ir elbow or do not perform five repetitions. Failure should scored as 0. references & Footnotes. this tool has en developed by a group international experts at th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland in novemr 202. full details conference outcomes and authors tool are published in BJSm injury prevention and Health protection, 20, Volume 7, issue. outcome paper will also simultaneously co-published in or leading biomedical journals with copyright held by Concussion in Sport Group, to allow unrestricted distribution, providing no alterations are made. 2. mccrory p et al., Consensus Statement on Concussion in Sport rd international Conference on Concussion in Sport held in Zurich, novemr British Journal Sports medicine 2009; : i maddocks, Dl; Dicker, GD; Saling, mm. assessment orientation following in athletes. Clinical Journal Sport Medicine. 99; (): 2.. mccrea m. Standardized mental status testing acute. Clinical Journal Sport medicine. 200; : Guskiewicz Km. Assessment postural stability following sport-related. Current Sports medicine reports. 200; 2: Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G. & mccrory, p. normative values for 6-7 year old subjects for three clinical measures motor performance used in assessment sports s. Journal Science and Medicine in Sport. 200; (2): Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t. & marshall, S.W. The effect footwear and sports-surface on dynamic neurological screening in sport-related. Journal Science and medicine in Sport. 200; (): Copies available for reproduction on SCAT Sport Concussion Assessment Tool PAGE SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group 26

10 Downloaded from bjsm.bmj.com on March 2, 20 - Published by group.bmj.com AThleTe information Any athlete suspected having a should removed from play, and n seek medical evaluation. Signs to watch for Problems could arise over first 2 8 hours. The athlete should not left alone and must go to a hospital at once if y: - Have a headache that gets worse - Are very drowsy or can t awakened - 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 ir feet; have slurred speech rememr, it is tter to safe. Consult your doctor after a suspected. return to play Athletes should not returned to play same day injury. When returning athletes to play, y should medically cleared and n follow a stepwise supervised program, with stages progression. For example: Scoring Summary: test Domain numr Symptoms 22 Symptom Severity Score 2 orientation immediate memory Concentration Delayed recall SAC Total BESS (total errors) Tandem Gait (seconds) Coordination notes: Score Date: Date: Date: rehabilitation stage Functional exercise at each stage rehabilitation objective each stage no activity physical and cognitive rest recovery light aerobic exercise Sport-specific exercise non-contact training drills Full contact practice return to play Walking, swimming or stationary cycling keeping intensity, 70 % maximum predicted heart rate. no resistance training Skating drills in ice hockey, running drills in soccer. no head impact activities progression to more complex training drills, eg passing drills in football and ice hockey. may start progressive resistance training Following medical clearance participate in normal training activities normal game play increase heart rate Add movement exercise, coordination, and cognitive load Restore confidence and assess functional skills by coaching staff There should at least 2 hours (or longer) for each stage and if symptoms recur athlete should rest until y resolve once again and n resume program at previous asymptomatic stage. resistance training should only added in later stages. if athlete is symptomatic for more than 0 days, n consultation by a medical practitioner who is expert in management, is recommended. medical clearance should given fore return to play. ConCuSSion injury AdviCe (To given to person monitoring concussed athlete) this patient has received an injury to head. A careful medical examination has en carried out and no sign any serious complications has en found. recovery time is variable across individuals and patient will need monitoring for a furr period by a responsible adult. Your treating physician will provide guidance as to this timeframe. if you notice any change in haviour, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, please contact your doctor or nearest hospital emergency department immediately. or important points: - Rest (physically and mentally), including training or playing sports until symptoms resolve and you are medically cleared - no alcohol - no prescription or non-prescription drugs without medical supervision. Specifically: no sleeping tablets Do not use aspirin, anti-inflammatory medication or sedating pain killers - Do not drive until medically cleared - Do not train or play sport until medically cleared Clinic phone numr patient s name Date / time injury Date / time medical review treating physician MISSISSAUGA LOCATION: University Toronto Mississauga RAWC 9 Mississauga Rd., Miss., ON LL C OAKVILLE LOCATION: 2 Bristol Circle, Suite 02, Oakville, ON L6H 6P Contact details or stamp 262 SCAT Sport ConCuSSion ASSeSment tool PAge 20 Concussion in Sport Group Copies available for reproduction on SCAT Sport Concussion Assessment Tool PAGE