Words in Italics throughout the Child SCAT3 are the instructions given to the child by the tester.
Sideline Assessment- child-Maddocks Score
To be completed on the sideline/in the playground, immediately following concussion. There is no requirement to repeat these questions at follow-up.
Symptom Scale 8
In situations where the symptom scale is being completed after exercise, it should still be done in a resting state, at least 1 0 minutes post exercise.
On the day of injury
- the child is to complete the Child Report, according to how he/she feels now.
On all subsequent days
- the child is to complete the Child Report, according to how he/she feels today,
- the parent/carer is to complete the Parent Report according to how the child has been over the previous 24 hours.
Standardized Assessment of Concussion - Child Version (SAC-C)4
Ask each question on the score sheet. A correct answer for each question scores 1 point. If the child does not understand the question, gives an incorrect answer, or no answer, then the score for that question is 0 points.
"I am going to rest your memory. I will read you a fist of words and when I am done, repeat back as many words as you can remember, in any order."
"I am going to repeat the same list again. Repeat back as many words as you can remember in any order. even if you said the word before. "
Complete all 3 trials regardless of score on trial 1 &2. Read the words at a rate of one per second. Score 1 pt. for each correct response. Total score equals sum across all 3 trials. Do not Inform the child that delayed recall will be tested.
"1 am going to rl!ad you a string of numbers and when I am done. you repeat them back to me backwards, in reverse order of how I read them to you. For example. if I say 7-1, you would say 1-7."
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 be read at the rate of one per second.
Days In Reverse Order:
"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" 1 pt. for entire sequence correct
The delayed recall should be performed after completion of the Balance and Coordination Examination.
"Do you remember that list of words I read a few times earlier? Tell me as many woods from the list as you can remember in any order.· Circle each word correctly recalled. Total score equals number of words recalled.
These instructions are to be read by the person administering the childSCAT3, and each balance task should be demonstrated to the child. The child should then be asked to copy what the examiner demonstrated.
Modified Balance EITDr Saring System (BESS) testing 3
This balance testing is based on a modified version of the Balance Error Scoring System (BESS)5• 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 off, roll up your pant legs above the ankle (if applicable), and remove any ankle taping (if applicable). This test will consist of two different parts"
(a) Double leg stance:
The first stance is standing wM the reet together with hands on hips and with eyes closed. The child should try to maintain stability in that position for 20 seconds. You should inform the child that you will be counting the number of times the child moW!! out of this position. You should start timing when the child is set and the eyes closed.
(b) Tandem stance:
Instruct the child to stand heel-to-toe with the non-dominant foot in the back. Weight should be evenly distributed across both feet Again, the child should try to maintain stability for 20 seconds with hands on hips and eyes dosed. You should inform the child that you will be counting the number of times the child moves out of this position. If the child stumbles out of this position, 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.
Balance testing- types of errors - Parts (a) and (b)
- Hands lifted off iliac crest
- Opening eyes
- Step, stumble, or fall
- Moving hip into> 30 degrees abduction
- Lifting forefoot or heel
- Remaining out of test position > 5 sec
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 only after the child has assumed the proper start position. The modified BESS is calculated by adding one error point for each error during the two 20-second tests. The maximum total number of errors for any single condition Is 10. If a child commits multiple errors simultaneously, only one error is recorded but the child should quickly return to the testing position, and counting should resume once the subject is set. Children who are unable to maintain the testing procedure for a minimum of five seconds at the start are assigned the highest possible score, ten, for that testing condition.
Tandem Galt 6-7
Use a clock (with a second hand) or stopwatch to measure the time taken to complete this task.
Instruction for the examiner- Demonstrate the following to the child:
The child is instructed to stand with their feet together behind a starting line (the test is best done with footwear removed). Then, they walk in a forward direction as quickly and as accurately as possible along with a 38mm wide (sports tape), 3-meter line with an alternate foot heel-to-toe galt ensuring that they approximate their heel and toe on each step. Once they cross the end of the 3m fine, they tum 180 degrees and return to the starting point using the same gait. A total of 4 trials are done and the best time is retained. Children fail the test if they step off the line, have a separation between their heel and toe, or if they touch or grab the examiner or an object. In this case, the time is not recorded and the trial repeated, if appropriate.
Explain to the child that you will time how long it takes them to walk to the end of the line and back.
Upper limb coordination
Finger-to-nose (FTN) task:
The tester should demonstrate It to the child.
"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 and elbow and fingers extended). When I give a start signal I would like you to perform five successive fingers to nose repetition using your index finger to touch the tip of the nose as quickly and as accurately as possible."
Scoring: 5 correct repetitions in < 4 seconds = 1
Note for testers: Children fail the test if they do not touch their nose, do not fully extend their elbow or do not perform five repetitions. Failure should be scored as 0.
References & Footnotes
- This tool has been developed by a group of international experts at the 4th International Consensus meeting on Concussion in Sport held in Zurich, Switzerland in November 2012. The full details of the conference outcomes and the authors of the tool are published in The BJSM Injury Prevention and Health Protection, 2013, Volume 47, Issue 5. The outcome paper will also be simultaneously co-published in other leading biomedical journals with the copyright held by the Concussion in Sport Group, to allow unrestricted distribution, providing no alterations are made.
- McCrory P et al., Consensus Statement on Concussion in Sport - the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine 2009; 43: i76-89.
- Maddocks, DL; Dicker, GD; Saling, MM. The assessment of orientation following concussion in athletes. Clinical Journal of Sport Medicine. 1995; 5(1): 32-3.
- McCrea M. Standardized mental status testing of acute concussion. Clinical Journal of Sport Medicine. 2001; 11: 176-181.
- Guskiewicz KM. Assessment of postural stability following sport-related concussion. Current Sports Medicine Reports. 2003; 2: 24-30.
- Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-Tooke, G.&McCrory, P. Normative values for 16-37 year old subjects for three clinical measures of motor performance used in the assessment of sports concussions. Journal of Science and Medicine in Sport. 2010; 13(2): 196-201.
- Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., Olsson, M., Yden. T.&Marshall, S.W. The effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and Medicine in Sport. 2010; 13(4): 382-386
- Ayr, L.K., Yeates, K.O., Taylor, H.G.,&Brown, M. Dimensions of post-concussive symptoms in children with mild traumatic brain injuries. Journal of the International Neuropsychological Society. 2009; 15:19-30.