Words in quotations throughout the SCAT3 are the instructions given to the athlete by the tester.
"You should score yourself on the following symptoms. based on how you feel now"
To be completed by the athlete. 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.
For a total number of symptoms, the maximum possible is 22. For Symptom severity score, add all scores in the table, the maximum possible is 22 x6 = 132.
"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"
"I am going to repeat the same list again. Repeat back as many words as you can remember in any order, even if you u 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 athlete that delayed recall will be tested.
"I am going to read you a string of numbers and when I am done, you repeat them back to me backward, in reverse order of how I read them to you. For example, if I say 7-1-9, you would say 9-1-7"
If correct, go to next string length. If incorrect, read trial 2. One point is possible for each string length. Stop after Incorrect on both trials. The digits should be read at the rate of one per second.
Months In reverse order
"Now tell me the months of the year in reverse order. Start with the last month and go backward. So you'll say December, November... Go Ahead"
1pt. for entire sequence correct
The delayed recall should be performed after completion of the Balance and Coordination
"Do you remember that list of words read an fl!w times earlier? Tell me as many ones from the lists you can member in any order."
Score 1 pt. for each correct response
Modified Balance Error Scoring System (BESS) testing'
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 balancr!. Please take your shoes off, roll up your pant legs above ankle (if applicable), and remove any ankle taping (if applicable). This test will consist of three twenty second 1ests with different stances."
"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. I will be counting the number of times you move out of this pasition. I will start timing when you are set and have dosed your eyes."
(b) Tandem stance:
"If you were to kick a bail, which would you use? This will be dominant foot. Now stand on your non-dominant foot. the dominant leg should be held in apprximately 30 degress of hip flexion and 45 degrees of knee flexion. Again, you should try to maintain stability 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 position. If you stumble out of this position, open your eyes and retum to the start position and continue balancing. I will start timing when you are set and hall!! dosed your eyes."
(c) Tandem stance:
Now stand heel-to-toe with your non-dominant foot in back. Your weight should be evenly distributed aaoss both feet. Again, you should try to maintain stability 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 position. If you stumble out of this position. open your eyes and retum to the start position and continue balandng. I will start timing when you are set and have closed your eyes.
Balance testing- types of errors
- 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.
OPTION: For further assessment, the same 3 stances can be performed on a surface of medium density foam (e.g., approximately 50cm x 40cm x 6cm).
Participants are 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 gait ensuring that they approximate their heel and toe on each step. Once they cross the end of the 3m line, they turn 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. Athletes should complete the test in 14 seconds. Athletes 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.
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.