How do you know if you have a concussion?
Keeping Your Head in the Game: Concussion Awareness and the SCAT Evaluation
(A reminder this is only for informative purposes and is not medical advice, please seek medical attention if you suspect you have had a concusssion.)
Whether it is on TV or in person, you may have seen an athlete take a hard hit to the head. The
athlete is surrounded by medical professionals within seconds assessing their condition before
they are taken off the field for in-depth analysis. But what are they looking for and how do they
decide what to do next? Before the season even begins, many athletes undergo a comprehensive medical evaluation. Part of this includes the Sport Concussion Assessment Tool (SCAT) to assess concussion symptoms with things like memory, balance and symptoms evaluation. This gives the professionals a
snapshot of the athlete’s normal condition. When no concussion is suspected, it is used as a
baseline for comparison in the event that the athlete experiences one in the future. In the scenario
above, the athlete is assessed for a concussion and the SCAT is used and compared to their
“baseline.” This helps medical professionals not only assess the severity of the concussion, but
can also be used to track progression as the athlete recovers.
What is a concussion?
Concussions are more common than many people realize. It has been estimated that around 3.8
million concussions occur in the U.S. each year due to sports and activities. Of those, around
50% go unreported, especially from high school and college athletes.1 But what qualifies as a
concussion, and what symptoms should you look for? A concussion is a mild traumatic injury to
the brain that affects its function. This is usually caused by a blow to the head or body, often after
a fall or during contact sports.2 One common misconception is that a person must lose
consciousness to be diagnosed with a concussion but in most cases, people do not pass out.
Common symptoms of a concussion include (2):
● A headache
● Ringing in the ears
● Nausea
● Vomiting
● Increased tiredness
● Blurry vision
● Confusion/Brain Fog
● Dizziness or “seeing stars”.
Additionally, a witness who saw the concussion occur may notice that the affected person:
● Appears dazed or stunned
● Has slurred speech
● Is confused or forgetful
● May briefly lose consciousness (but not always)
Sometimes, the symptoms of a concussion do not appear right away, or they linger for days,
weeks, or months. These often include the common symptoms mentioned above as well asdifficulty concentrating, irritability, sensitivity to light, issues sleeping, feeling depressed or changes in their taste and smell2. If you believe you or someone you know may be experiencing concussion symptoms, please seek
medical attention for evaluation and management as soon as possible.
So what is SCAT?
The Sports Concussion Assessment Tool is a helpful, multi-part tool used for the assessment of a
concussion by health care professionals. It is ideally used within 72 hours and up to 7 days after
a possible concussion has occurred. This tool is used for athletes 13 years and older and a Child
SCAT can be completed for those 12 years old and younger. General guidelines include taking
the athlete with a suspected concussion out of play and if they are diagnosed with a concussion,
they are not allowed to return to play the same day. The assessment starts by making sure the
injured person does not have “red flags”, which are signs and symptoms that raise concern for a medical emergency.
These symptoms include (3):
● Neck pain or tenderness
● Seizure
● Double vision
● Loss of consciousness
● Weakness, tingling or burning in more than one arm or leg
● Being conscious and becoming unconscious
● Vomiting
● Severe or progressively worsening headache
● Restless, agitated or combative
● A visible difference in head shape
If these are found on examination, the athlete is rushed via ambulance for further workup. If
these findings are not present, the medical professional can continue with the SCAT assessment.
The SCAT is broken down into 2 parts, the on field neurological evaluation, and the off field
symptom, mental status, and coordination/balance evaluation.
On-Field Neurological Examination
The purpose of this analysis is to determine how severe the brain may have been injured by the
injury. During this section of the evaluation the medical professional documents the event that
led to the injury. They then assess the patient for the red flags mentioned above, followed by
consciousness evaluation through eye, verbal and movement responses. Afterwards, the neck,
coordination, and memory are checked. Once completed, the person is either taken to the
hospital for further work up in severe cases or taken off field to continue the SCAT evaluation.
Off-Field Examination
The off field section of the evaluation is more comprehensive and used to confirm a concussion
diagnosis as well as check the injured person’s mental and physical function after the injury. To
assess the patient’s mental function, the medical professional asks the patient to rate their current
symptoms on a pain scale, orient themselves to the date, day of the week, their ability to recall
words immediately after hearing them and their ability to concentrate. They then assess the
physical function by checking their coordination and balance through a walking analysis, similar
to that of a sobriety test. After the coordination portion is complete the athlete is asked to recall
words they were asked to remember earlier, which checks their long-term memory.
Once all parts of the SCAT are completed the medical professional calculates a total score which
helps determine and support the diagnosis of a concussion.
The Recovery Process
What should a person with a concussion do to recover? You may recall people being told to lie
down in a dark room and rest for the first 1-2 days, but this is now outdated. The newest
concussion guidelines recommend something called “relative rest”. This includes normal daily
activities like cooking a meal or visiting with friends and family and reduced screen time.
Additionally, they can go on a light walk as long as it doesn’t worsen their symptoms.
In order to progress back to normal daily routines, those with a concussion must follow a return
to life/sports protocol. The person must have no concussion symptoms prior to starting each
progression. Each step in the protocol lasts a minimum of 24 hours and they cannot advance to
the next step unless they continue to experience no concussion symptoms. If their symptoms
return or they develop new symptoms, the body is telling them they are pushing recovery too
hard. The person then stops the aggravating activities, rests and begins the process again.
6 Steps to Return to Sport (4):
Step 1: Return to Regular Activities
During this step the athlete returns to regular activities like school or work
Step 2: Light Exercise
The goal of this step is to only increase the athlete’s heart rate for about 5-10 minutes.
Examples include walking, light jogging and riding an exercise bike, there is no weight
lifting at this time.
Step 3: Medium Exercise
The athlete continues to increase their heart rate with body or head movement. Examples
include jogging, increased intensity stationary biking or moderate intensity weight lifting
(less time and/or weight than normal for the athlete)
Step 4: Heavy Non-Contact Activity
The athlete may return to heavy non-contact activity. Examples include running/sprinting,
regular weightlifting, and non-contact sport specific drills
Step 5: Practice and Full Contact
The athlete returns to normal practice and full contact in a controlled practice
environment
Step 6: Return to Play
At this step the athlete is officially cleared by a medical professional and is able to return
to play with no limitations. For non-athletes, recovery follows a similar progression. It begins the same with rest, limited screen time, and gradual return to normal activities. Once symptoms are improving or they are
symptom-free most individuals can return to school/work, often within 1–2 days after a
concussion 5. During this time they may need more breaks to rest throughout the day and extra
time to complete assignments due to the increased stress on the brain. Each day as the person
recovers, they tend to feel better, and their symptoms reduce or resolve completely. But, keep in
mind for non-athletes and athletes alike, the recovery process is different for everyone. It may
take a few days to weeks to months to recover from a concussion, but consistency and support is
the key.
Concussions can be frustrating as we want to return to “normal” as soon as possible, but the
injury prevents us from doing so. If you know someone who is recovering from a concussion,
offering support, understanding, and reassurance can make a meaningful difference in their
recovery. When it comes to concussions, recognizing the signs and symptoms and understanding the
evaluation and recovery is essential in protecting long term brain health and returning safely to
everyday life.
Do this next!
Share this Article with a Friend or Family member who might be interested in the topic!
Call our office TODAY at (773) 296-2766 to book a New Patient appointment or schedule a free chat (discovery call) with us to see if we can help you out or if you have other questions about care or costs. You can book either by clicking here!
Keep an eye out for our next article!
References:
1. Hallock H, Mantwill M, Vajkoczy P, et al. Sport-Related Concussion: A Cognitive
Perspective. Neurol Clin Pract. 2023;13(2):e200123.
doi:10.1212/CPJ.0000000000200123
2. Mayo Clinic Staff. Concussion - Symptoms and Causes. Mayo Clinic. Published
February 17, 2022.
https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355
594
3. Sport Concussion Assessment Tool for Adolescents (13 Years +) & Adults.
https://cisgstg.wpengine.com/wp-content/uploads/2023/07/SCAT6-v7.pdf
4. CDC. Returning to Sports. HEADS UP. Published May 16, 2024.
https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html
5. CDC. Recovery from Concussion. HEADS UP. Published May 16, 2024.
https://www.cdc.gov/heads-up/guidelines/recovery-from-concussion.html