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com
BJSM Online First, published on April 28, 2017 as 10.1136/bjsports-2017-097492childscat5

Child SCAT5 ©
SPORT CONCUSSION ASSESSMENT TOOL
FOR CHILDREN AGES 5 TO 12 YEARS
FOR USE BY MEDICAL PROFESSIONALS ONLY

supported by

Patient details

Name:

DOB:

Address:

ID number:

Examiner:

Date of Injury: Time:

WHAT IS THE CHILD SCAT5? Key points

The Child SCAT5 is a standardized tool for evaluating • Any athlete with suspected concussion should be REMOVED
concussions designed for use by physicians and licensed FROM PLAY, medically assessed and monitored for
healthcare professionals1. deterioration. No athlete diagnosed with concussion
should be returned to play on the day of injury.
If you are not a physician or licensed healthcare professional,
• If the child is suspected of having a concussion and medical
please use the Concussion Recognition Tool 5 (CRT5). The
personnel are not immediately available, the child should
Child SCAT5 is to be used for evaluating Children aged 5 to
be referred to a medical facility for urgent assessment.
12 years. For athletes aged 13 years and older, please use
the SCAT5. • Concussion signs and symptoms evolve over time and it
is important to consider repeat evaluation in the assess-
Preseason Child SCAT5 baseline testing can be useful for ment of concussion.
interpreting post-injury test scores, but not required for that
purpose. Detailed instructions for use of the Child SCAT5 are • The diagnosis of a concussion is a clinical judgment,
provided on page 7. Please read through these instructions made by a medical professional. The Child SCAT5 should
carefully before testing the athlete. Brief verbal instructions NOT be used by itself to make, or exclude, the diagnosis
for each test are given in italics. The only equipment required of concussion. An athlete may have a a concussion even
for the tester is a watch or timer. if their Child SCAT5 is “normal”.

This tool may be freely copied in its current form for dis- Remember:
tribution to individuals, teams, groups and organizations.
It should not be altered in any way, re-branded or sold for • The basic principles of first aid (danger, response, airway,
commercial gain. Any revision, translation or reproduction breathing, circulation) should be followed.
in a digital form requires specific approval by the Concus- • Do not attempt to move the athlete (other than that required
sion in Sport Group. for airway management) unless trained to do so.
• Assessment for a spinal cord injury is a critical part of the
Recognise and Remove initial on-field assessment.
A head impact by either a direct blow or indirect transmission • Do not remove a helmet or any other equipment unless
of force can be associated with a serious and potentially fatal trained to do so safely.
brain injury. If there are significant concerns, including any
of the red flags listed in Box 1, then activation of emergency
procedures and urgent transport to the nearest hospital
should be arranged.

© Concussion in Sport Group 2017

Child SCAT5 © Concussion in Sport Group 2017 1
Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence.
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1
Name:

IMMEDIATE OR ON-FIELD ASSESSMENT DOB:

Address:
The following elements should be assessed for all athletes who
are suspected of having a concussion prior to proceeding to the ID number:
neurocognitive assessment and ideally should be done on-field after
Examiner:
the first first aid / emergency care priorities are completed.
Date:
If any of the “Red Flags“ or observable signs are noted after a direct
or indirect blow to the head, the athlete should be immediately and
safely removed from participation and evaluated by a physician or
licensed healthcare professional.
Incomprehensible sounds 2 2 2
Consideration of transportation to a medical facility should be at Inappropriate words 3 3 3
the discretion of the physician or licensed healthcare professional.
Confused 4 4 4
The GCS is important as a standard measure for all patients and can
Oriented 5 5 5
be done serially if necessary in the event of deterioration in conscious
state. The cervical spine exam is a critical step of the immediate Best motor response (M)
assessment, however, it does not need to be done serially.
No motor response 1 1 1

STEP 1: RED FLAGS

Extension to pain 2 2 2

Abnormal flexion to pain 3 3 3

Flexion / Withdrawal to pain 4 4 4

Localizes to pain 5 5 5
RED FLAGS:
Obeys commands 6 6 6
• Neck pain or • Seizure or convulsion Glasgow Coma score (E + V + M)
tenderness
• Loss of consciousness
• Double vision
• Deteriorating
• Weakness or tingling/ conscious state CERVICAL SPINE ASSESSMENT
burning in arms or legs
• Vomiting
Does the athlete report that their neck is pain free at rest? Y N
• Severe or increasing
• Increasingly restless,
headache
agitated or combative If there is NO neck pain at rest, does the athlete have a full
Y N
range of ACTIVE pain free movement?

Is the limb strength and sensation normal? Y N

STEP 2: OBSERVABLE SIGNS In a patient who is not lucid or fully conscious, a cervical
spine injury should be assumed until proven otherwise.
Witnessed  Observed on Video 
Lying motionless on the playing surface Y N OFFICE OR OFF-FIELD ASSESSMENT
STEP 1: ATHLETE BACKGROUND
Balance / gait difficulties / motor incoordination: stumbling, slow /
Y N
laboured movements Please note that the neurocognitive assessment should be done in a distraction-free
environment with the athlete in a resting state.
Disorientation or confusion, or an inability to respond appropriately
Y N
to questions Sport / team / school:

Blank or vacant look Y N Date / time of injury:

Years of education completed:

Facial injury after head trauma Y N
Age:

Gender: M / F / Other
STEP 3: EXAMINATION Dominant hand: left / neither / right

GLASGOW COMA SCALE (GCS)2 How many diagnosed concussions has the
athlete had in the past?:
Time of assessment When was the most recent concussion?:
Date of assessment How long was the recovery (time to being cleared to play)

from the most recent concussion?: (days)

Best eye response (E)
Has the athlete ever been:
No eye opening 1 1 1
Hospitalized for a head injury? Yes No
Eye opening in response to pain 2 2 2

Eye opening to speech 3 3 3 Diagnosed / treated for headache disorder or migraines? Yes No

Eyes opening spontaneously 4 4 4 Diagnosed with a learning disability / dyslexia? Yes No

Best verbal response (V) Diagnosed with ADD / ADHD? Yes No

No verbal response 1 1 1 Diagnosed with depression, anxiety or other psychiatric disorder? Yes No

Current medications? If yes, please list:

© Concussion in Sport Group 2017

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STEP 2: SYMPTOM EVALUATION

Name:
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
DOB:
should rate their symptoms at this point in time.
Address:
To be done in a resting state
ID number:
Please Check:  Baseline  Post-Injury
Examiner:
Date:
2

Child Report3 Not at all/

Never
A little/
Rarely
Somewhat/
Sometimes
A lot/ Often

I have headaches 0 1 2 3 Parent Report

I feel dizzy 0 1 2 3 The child: Not at all/
Never
A little/
Rarely
Somewhat/
Sometimes
A lot/ Often

I feel like the room is spinning 0 1 2 3 has headaches 0 1 2 3

I feel like I’m going to faint 0 1 2 3 feels dizzy 0 1 2 3

Things are blurry when has a feeling that the

0 1 2 3 0 1 2 3
I look at them room is spinning

I see double 0 1 2 3 feels faint 0 1 2 3

I feel sick to my stomach 0 1 2 3 has blurred vision 0 1 2 3

My neck hurts 0 1 2 3
has double vision 0 1 2 3

I get tired a lot 0 1 2 3

experiences nausea 0 1 2 3

I get tired easily 0 1 2 3

has a sore neck 0 1 2 3

I have trouble paying attention 0 1 2 3

gets tired a lot 0 1 2 3

I get distracted easily 0 1 2 3

gets tired easily 0 1 2 3

I have a hard time concentrating 0 1 2 3

has trouble sustaining attention 0 1 2 3

I have problems remember-

0 1 2 3 is easily distracted 0 1 2 3
ing what people tell me

has difficulty concentrating 0 1 2 3

I have problems
0 1 2 3
following directions
has problems remember-
0 1 2 3
ing what he/she is told
I daydream too much 0 1 2 3

has difficulty following

I get confused 0 1 2 3 0 1 2 3
directions

I forget things 0 1 2 3
tends to daydream 0 1 2 3

I have problems finishing things 0 1 2 3

gets confused 0 1 2 3

I have trouble figuring things out 0 1 2 3

is forgetful 0 1 2 3

It’s hard for me to

0 1 2 3 has difficulty completing tasks 0 1 2 3
learn new things

Total number of symptoms: of 21 has poor problem solving skills 0 1 2 3

Symptom severity score: of 63 has problems learning 0 1 2 3

Do the symptoms get worse with physical activity? Y N

Total number of symptoms: of 21

Do the symptoms get worse with trying to think? Y N

Symptom severity score: of 63

Do the symptoms get worse with physical activity? Y N

Overall rating for child to answer:
Do the symptoms get worse with mental activity? Y N
Very bad Very good

On a scale of 0 to 10 (where 10 is
Overall rating for parent/teacher/
0 1 2 3 4 5 6 7 8 9 10
normal), how do you feel now? coach/carer to answer
If not 10, in what way do you feel different?: On a scale of 0 to 100% (where 100% is normal), how would you rate the child now?

If not 100%, in what way does the child seem different?

© Concussion in Sport Group 2017

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3
Name:

STEP 3: COGNITIVE SCREENING DOB:

Standardized Assessment of Concussion - Child Version (SAC-C)4 Address:

IMMEDIATE MEMORY ID number:

The Immediate Memory component can be completed using the Examiner:

traditional 5-word per trial list or optionally using 10-words per trial Date:
to minimise any ceiling effect. All 3 trials must be administered irre-
spective of the number correct on the first trial. Administer at the rate
of one word per second.
Please choose EITHER the 5 or 10 word list groups and circle the specific word list chosen
for this test. CONCENTRATION
I am going to test your memory. I will read you a list of words and when I am done, repeat
back as many words as you can remember, in any order. For Trials 2 & 3: I am going to repeat DIGITS BACKWARDS
the same list again. Repeat back as many words as you can remember in any order, even if
you said the word before. Please circle the Digit list chosen (A, B, C, D, E, F). Administer at the
rate of one digit per second reading DOWN the selected column.

Score (of 5) I am going to read a string of numbers and when I am done, you repeat them back to me
List Alternate 5 word lists in reverse order of how I read them to you. For example, if I say 7-1-9, you would say 9-1-7.
Trial 1 Trial 2 Trial 3

Concentration Number Lists (circle one)

A Finger Penny Blanket Lemon Insect

List A List B List C

B Candle Paper Sugar Sandwich Wagon

5-2 4-1 4-9 Y N 0

C Baby Monkey Perfume Sunset Iron
4-1 9-4 6-2 Y N 1
D Elbow Apple Carpet Saddle Bubble
4-9-3 5-2-6 1-4-2 Y N 0

E Jacket Arrow Pepper Cotton Movie

6-2-9 4-1-5 6-5-8 Y N 1

F Dollar Honey Mirror Saddle Anchor 3-8-1-4 1-7-9-5 6-8-3-1 Y N 0

3-2-7-9 4-9-6-8 3-4-8-1 Y N 1

Immediate Memory Score of 15
6-2-9-7-1 4-8-5-2-7 4-9-1-5-3 Y N 0
Time that last trial was completed
1-5-2-8-6 6-1-8-4-3 6-8-2-5-1 Y N 1

7-1-8-4-6-2 8-3-1-9-6-4 3-7-6-5-1-9 Y N 0

Score (of 10)
5-3-9-1-4-8 7-2-4-8-5-6 9-2-6-5-1-4 Y N 1
List Alternate 10 word lists
Trial 1 Trial 2 Trial 3 List D List E List F

Finger Penny Blanket Lemon Insect 2-7 9-2 7-8 Y N 0

G
Candle Paper Sugar Sandwich Wagon 5-9 6-1 5-1 Y N 1

7-8-2 3-8-2 2-7-1 Y N 0

Baby Monkey Perfume Sunset Iron
H 9-2-6 5-1-8 4-7-9 Y N 1
Elbow Apple Carpet Saddle Bubble
4-1-8-3 2-7-9-3 1-6-8-3 Y N 0

Jacket Arrow Pepper Cotton Movie 9-7-2-3 2-1-6-9- 3-9-2-4 Y N 1

I
Dollar Honey Mirror Saddle Anchor 1-7-9-2-6 4-1-8-6-9 2-4-7-5-8 Y N 0

Immediate Memory Score of 30 4-1-7-5-2 9-4-1-7-5 8-3-9-6-4 Y N 1

2-6-4-8-1-7 6-9-7-3-8-2 5-8-6-2-4-9 Y N 0

Time that last trial was completed
8-4-1-9-3-5 4-2-7-3-9-8 3-1-7-8-2-6 Y N 1

Digits Score: of 5

DAYS IN REVERSE ORDER

Now tell me the days of the week in reverse order. Start with the last day and go backward.
So you’ll say Sunday, Saturday. Go ahead.

Sunday - Saturday - Friday - Thursday - Wednesday - Tuesday - Monday 0 1

Days Score of 1

Concentration Total Score (Digits + Days) of 6

© Concussion in Sport Group 2017

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4
Name:

STEP 4: NEUROLOGICAL SCREEN DOB:

See the instruction sheet (page 7) for details of Address:

test administration and scoring of the tests. ID number:
Can the patient read aloud (e.g. symptom check- Examiner:
Y N
list) and follow instructions without difficulty?

Does the patient have a full range of pain- Date:

Y N
free PASSIVE cervical spine movement?

Without moving their head or neck, can the patient look

Y N
side-to-side and up-and-down without double vision?

Can the patient perform the finger nose

coordination test normally?
Y N
5
Can the patient perform tandem gait normally? Y N
STEP 5: DELAYED RECALL:
BALANCE EXAMINATION The delayed recall should be performed after 5 minutes have
elapsed since the end of the Immediate Recall section. Score 1
Modified Balance Error Scoring System (BESS) testing5 pt. for each correct response.
Which foot was tested  Left  Do you remember that list of words I read a few times earlier? Tell me as many words
(i.e. which is the non-dominant foot)  Right from the list as you can remember in any order.

Testing surface (hard floor, field, etc.)

Time Started
Footwear (shoes, barefoot, braces, tape, etc.)

Condition Errors Please record each word correctly recalled. Total score equals number of words recalled.

Double leg stance of 10

Single leg stance (non-dominant foot, 10-12 y/o only) of 10

Tandem stance (non-dominant foot at back) of 10

Total Errors 5-9 y/o of 20 10-12 y/o of 30 Total number of words recalled accurately: of 5 or of 10

STEP 6: DECISION
Date and time of injury:
Date & time of assessment:
If the athlete is known to you prior to their injury, are they different from their usual self?
Domain  Yes  No  Unsure  Not Applicable
(If different, describe why in the clinical notes section)
Symptom number
Child report (of 21)
Parent report (of 21) Concussion Diagnosed?
 Yes  No  Unsure  Not Applicable
Symptom severity score
Child report (of 63) If re-testing, has the athlete improved?
Parent report (of 63)
 Yes  No  Unsure  Not Applicable
of 15 of 15 of 15
Immediate memory
of 30 of 30 of 30 I am a physician or licensed healthcare professional and I have personally
administered or supervised the administration of this Child SCAT5.
Concentration (of 6)

Normal Normal Normal Signature:

Neuro exam
Abnormal Abnormal Abnormal
Name:
Balance errors
(5-9 y/o of 20) Title:
(10-12 y/o of 30)

of 5 of 5 of 5 Registration number (if applicable):

Delayed Recall
of 10 of 10 of 10
Date:

SCORING ON THE CHILD SCAT5 SHOULD NOT BE USED AS A STAND-

ALONE METHOD TO DIAGNOSE CONCUSSION, MEASURE RECOVERY OR
MAKE DECISIONS ABOUT AN ATHLETE’S READINESS TO RETURN TO
COMPETITION AFTER CONCUSSION.

© Concussion in Sport Group 2017

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Name:
DOB:
Address:
ID number:
Examiner:
Date:

For the Neurological Screen (page 5), if the child cannot read, ask
him/her to describe what they see in this picture.

CLINICAL NOTES:

Concussion injury advice for the Clinic phone number:

child and parents/carergivers Patient’s name:
(To be given to the person monitoring the concussed child)
Date / time of injury:
This child has had an injury to the head and needs to be carefully
watched for the next 24 hours by a responsible adult. Date / time of medical review:
If you notice any change in behavior, vomiting, dizziness, worsening
Healthcare Provider:
headache, double vision or excessive drowsiness, please call an
ambulance to take the child to hospital immediately.

Other important points:

Following concussion, the child should rest for at least 24 hours.

• The child should not use a computer, internet or play video

games if these activities make symptoms worse.

• The child should not be given any medications, including

pain killers, unless prescribed by a medical doctor.

• The child should not go back to school

until symptoms are improving.
© Concussion in Sport Group 2017
• The child should not go back to sport or play
until a doctor gives permission.

Contact details or stamp

6 Child SCAT5 © Concussion in Sport Group 2017 6

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INSTRUCTIONS
Words in Italics throughout the Child SCAT5 are the instructions given to the athlete by the clinician
A stopwatch or watch with a second hand is required for this testing.
Symptom Scale
“I am now going to test your balance. Please take your shoes off, roll
In situations where the symptom scale is being completed after exercise, it should still
up your pants above your ankle (if applicable), and remove any ankle
be done in a resting state, at least 10 minutes post exercise.
taping (if applicable). This test will consist of two different parts.“
At Baseline On the day of injury On all subsequent days
OPTION: For further assessment, the same 3 stances can be performed on a
• The child is to complete • The child is to complete • The child is to complete surface of medium density foam (e.g., approximately 50cm x 40cm x 6cm).
the Child Report, the Child Report, the Child Report,
(a) Double leg stance:
according to how he/ according to how he/ according to how he/
she feels today, and she feels now. she feels today, and The first stance is standing with the feet together with hands on hips and with eyes
closed. The child should try to maintain stability in that position for 20 seconds. You
• The parent/carer is to • If the parent is present, • The parent/carer is to
should inform the child that you will be counting the number of times the child moves out
complete the Parent and has had time to complete the Parent
of this position. You should start timing when the child is set and the eyes are closed.
Report according to assess the child on the Report according to how
how the child has been day of injury, the parent the child has been over (b) Tandem stance:
over the previous week. completes the Parent the previous 24 hours.
Instruct or show the child how to stand heel-to-toe with the non-dominant foot
Report according to how in the back. Weight should be evenly distributed across both feet. Again, the
the child appears now. child should try to maintain stability for 20 seconds with hands on hips and eyes
closed. You should inform the child that you will be counting the number of times
For Total number of symptoms, maximum possible is 21
the child moves out of this position. If the child stumbles out of this position,
For Symptom severity score, add all scores in table, maximum possible is 21 x 3 = 63 instruct him/her to open the eyes and return to the start position and continue
balancing. You should start timing when the child is set and the eyes are closed.
Standardized Assessment of Concussion Child Version (SAC-C) (c) Single leg stance (10-12 year olds only):
Immediate Memory “If you were to kick a ball, which foot would you use? [This will be the dominant foot]
Now stand on your other foot. You should bend your other leg and hold it up (show
Choose one of the 5-word lists. Then perform 3 trials of immediate memory using this list. the child). Again, try to stay in that position for 20 seconds with your hands on your
hips and your eyes closed. I will be counting the number of times you move out of this
Complete all 3 trials regardless of score on previous trials.
position. If you move out of this position, open your eyes and return to the start position
“I am going to test your memory. I will read you a list of words and when I am done, repeat and keep balancing. I will start timing when you are set and have closed your eyes.“
back as many words as you can remember, in any order.” The words must be read at a
rate of one word per second.
Balance testing – types of errors
OPTION: The literature suggests that the Immediate Memory has a notable ceiling effect
1. Hands lifted off 3. Step, stumble, or fall 5. Lifting forefoot or heel
when a 5-word list is used. (In younger children, use the 5-word list). In settings where this
iliac crest
ceiling is prominent the examiner may wish to make the task more difficult by incorporating
4. Moving hip into > 30 6. Remaining out of test
two 5–word groups for a total of 10 words per trial. In this case the maximum score per
2. Opening eyes degrees abduction position > 5 sec
trial is 10 with a total trial maximum of 30.

Trials 2 & 3 MUST be completed regardless of score on trial 1 & 2. Each of the 20-second trials is scored by counting the errors, or deviations from the
proper stance, accumulated by the child. The examiner will begin counting errors
Trials 2 & 3: “I am going to repeat the same list again. Repeat back as many words as you only after the child has assumed the proper start position. The modified BESS is
can remember in any order, even if you said the word before.“ calculated by adding one error point for each error during the 20-second tests. The
maximum total number of errors for any single condition is 10. If a child commits
Score 1 pt. for each correct response. Total score equals sum across all 3 trials. Do NOT
multiple errors simultaneously, only one error is recorded but the child should quickly
inform the athlete that delayed recall will be tested.
return to the testing position, and counting should resume once subject is set. Children
who are unable to maintain the testing procedure for a minimum of five seconds at
Concentration the start are assigned the highest possible score, ten, for that testing condition.

Digits backward Tandem Gait

Choose one column only, from List A, B, C, D, E or F, and administer those digits as follows: Instruction for the examiner - Demonstrate the following to the child:
“I am going to read you some numbers and when I am done, you say them back to me The child is instructed to stand with their feet together behind a starting line (the test
backwards, in reverse order of how I read them to you. For example, if I say 7-1, you would is best done with footwear removed). Then, they walk in a forward direction as quickly
say 1-7.” and as accurately as possible along a 38mm wide (sports tape), 3 metre line with an
alternate foot heel-to-toe gait ensuring that they approximate their heel and toe on each
If correct, circle “Y” for correct and go to next string length. If incorrect, circle “N” for the
step. Once they cross the end of the 3m line, they turn 180 degrees and return to the
first string length and read trial 2 in the same string length. One point possible for each
starting point using the same gait. Children fail the test if they step off the line, have a
string length. Stop after incorrect on both trials (2 N’s) in a string length. The digits should
separation between their heel and toe, or if they touch or grab the examiner or an object.
be read at the rate of one per second.

Days of the week in reverse order Finger to Nose

The tester should demonstrate it to the child.
“Now tell me the days of the week in reverse order. Start with Sunday and go backward. So
you’ll say Sunday, Saturday ... Go ahead” “I am going to test your coordination now. Please sit comfortably on the chair with your
eyes open and your arm (either right or left) outstretched (shoulder flexed to 90 degrees
1 pt. for entire sequence correct 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 the tip of the nose as
Delayed Recall quickly and as accurately as possible.”

Scoring: 5 correct repetitions in < 4 seconds = 1

The delayed recall should be performed after at least 5 minutes have elapsed since the
end of the Immediate Recall section. Note for testers: Children fail the test if they do not touch their nose, do not fully extend
“Do you remember that list of words I read a few times earlier? Tell me as many words from their elbow or do not perform five repetitions.
the list as you can remember in any order.“

Circle each word correctly recalled. Total score equals number of words recalled. References
1. McCrory et al. Consensus Statement On Concussion In Sport – The 5th International
Neurological Screen Conference On Concussion In Sport Held In Berlin, October 2016. British Journal
of Sports Medicine 2017 (available at www.bjsm.bmj.com)
Reading
2. Jennett, B., Bond, M. Assessment of outcome after severe brain damage: a practical
The child is asked to read a paragraph of text from the instructions in the Child SCAT5.
scale. Lancet 1975; i: 480-484
For children who can not read, they are asked to describe what they see in a photograph
or picture, such as that on page 6 of the Child SCAT5.
3. Ayr, L.K., Yeates, K.O., Taylor, H.G., Brown, M. Dimensions of postconcussive
symptoms in children with mild traumatic brain injuries. Journal of the International
Modified Balance Error Scoring System (mBESS)5 testing Neuropsychological Society. 2009; 15:19–30
These instructions are to be read by the person administering the Child SCAT5, and each
balance task should be demonstrated to the child. The child should then be asked to copy 4. McCrea M. Standardized mental status testing of acute concussion. Clinical Journal
what the examiner demonstrated. of Sports Medicine. 2001; 11: 176-181

Each of 20-second trial/stance is scored by counting the number of errors. The This 5. Guskiewicz KM. Assessment of postural stability following sport-related concussion.
balance testing is based on a modified version of the Balance Error Scoring System (BESS)5. Current Sports Medicine Reports. 2003; 2: 24-30
© Concussion in Sport Group 2017
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CONCUSSION INFORMATION
If you think you or a teammate has a concussion, tell your coach/trainer/ Graduated Return to School Strategy
parent right away so that you can be taken out of the game. You or your
teammate should be seen by a doctor as soon as possible. YOU OR Concussion may affect the ability to learn at school. The child may need
YOUR TEAMMATE SHOULD NOT GO BACK TO PLAY/SPORT THAT DAY. to miss a few days of school after a concussion, but the child’s doctor
should help them get back to school after a few days. When going back
to school, some children may need to go back gradually and may need to
Signs to watch for
have some changes made to their schedule so that concussion symptoms
Problems can happen over the first 24-48 hours. You or your teammate should not don’t get a lot worse. If a particular activity makes symptoms a lot worse,
be left alone and must go to a hospital right away if any of the following happens: then the child should stop that activity and rest until symptoms get better.
To make sure that the child can get back to school without problems, it is
• New headache, or • Feeling sick to your • Has weakness, important that the health care provider, parents/caregivers and teachers
headache gets worse stomach or vomiting numbness or tingling talk to each other so that everyone knows what the plan is for the child
(arms, legs or face)
to go back to school.
• Neck pain that • Acting weird/strange,
gets worse seems/feels confused, • Is unsteady walking
or is irritable or standing Note: If mental activity does not cause any symptoms, the child may
• Becomes sleepy/ be able to return to school part-time without doing school activities at
drowsy or can’t • Has any seizures • Talking is slurred home first.
be woken up (arms and/or legs
jerk uncontrollably) • Cannot understand
• Cannot recognise what someone is Goal of
Mental Activity Activity at each step
people or places saying or directions each step

1. Daily activities Typical activities that the child Gradual

Consult your physician or licensed healthcare professional after a
that do not does during the day as long as return to
suspected concussion. Remember, it is better to be safe. give the child they do not increase symptoms typical
symptoms (e.g. reading, texting, screen activities.
Graduated Return to Sport Strategy time). Start with 5-15 minutes at
a time and gradually build up.
After a concussion, the child should rest physically and mentally for a
few days to allow symptoms to get better. In most cases, after a few 2. School Homework, reading or other Increase
activities cognitive activities outside of tolerance
days of rest, they can gradually increase their daily activity level as long the classroom. to cognitive
as symptoms don’t get worse. Once they are able to do their usual daily work.
activities without symptoms, the child should gradually increase exercise
in steps, guided by the healthcare professional (see below). 3. Return to Gradual introduction of school- Increase
school work. May need to start with academic
The athlete should not return to play/sport the day of injury. part-time a partial school day or with activities.
increased breaks during the day.
NOTE: An initial period of a few days of both cognitive (“thinking”) and
4. Return to Gradually progress school Return to full
physical rest is recommended before beginning the Return to Sport
school activities until a full day can be academic
progression. full-time tolerated. activities and
catch up on
Functional exercise missed work.
Exercise step Goal of each step
at each step
If the child continues to have symptoms with mental activity, some other
1. Symptom- Daily activities that do Gradual reintroduc- things that can be done to help with return to school may include:
limited activity not provoke symptoms. tion of work/school
activities. • Starting school later, only • Taking lots of breaks during
going for half days, or going class, homework, tests
2. Light aerobic Walking or stationary Increase heart rate.
exercise cycling at slow to medium only to certain classes
pace. No resistance • No more than one exam/day
training. • More time to finish
assignments/tests • Shorter assignments
3. Sport-specific Running or skating drills. Add movement.
exercise No head impact activities.
• Quiet room to finish • Repetition/memory cues
4. Non-contact Harder training drills, e.g., Exercise, coor- assignments/tests
training drills passing drills. May start dination, and
• Use of a student helper/tutor
progressive resistance increased thinking. • Not going to noisy areas
training.
like the cafeteria, assembly • Reassurance from teachers
5. Full contact Following medical clear- Restore confi- halls, sporting events, music that the child will be supported
practice ance, participate in normal dence and assess class, shop class, etc.
while getting better
training activities. functional skills by
coaching staff.
The child should not go back to sports until they are back to school/
6. Return to Normal game play. learning, without symptoms getting significantly worse and no longer
play/sport needing any changes to their schedule.

There should be at least 24 hours (or longer) for each step of the progression.
If any symptoms worsen while exercising, the athlete should go back to
the previous step. Resistance training should be added only in the later
stages (Stage 3 or 4 at the earliest). The athlete should not return to
sport until the concussion symptoms have gone, they have successfully
returned to full school/learning activities, and the healthcare professional
has given the child written permission to return to sport.

If the child has symptoms for more than a month, they should ask to be
referred to a healthcare professional who is an expert in the management
of concussion.

© Concussion in Sport Group 2017

8 Child SCAT5 © Concussion in Sport Group 2017 8
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Sport concussion assessment tool for

childrens ages 5 to 12 years

Br J Sports Med published online April 26, 2017

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