Tests for Assessing Concussion

SYMPTOMS OF CONCUSSION

• Headache   
• Any vision change   
• Ringing in one or both ears   
• Nausea or vomiting   
• Confusion   
• Unsteadiness   
• Altered emotional state for that athlete -- e.g., anxiety, crying, being excessively angry, refusing or unwilling to cooperate with tests.

Grade 1, “Ding” or “Having Your Bell Rung”:
Conscious at all times but dazed, foggy, or fuzzy.

1. Administer confusion/orientation, memory, and concentration tests. He or she may miss one to two items. If more than that, no return to play even if normal later on in the contest/practice.   
2. Administer the neurologic tests. Athlete must pass all components of the neurologic tests. If not, there is no return to play even if normal later in the contest/practice. If pupils are unequal in size, send to an emergency room immediately.

Grade 2, Out to Lunch:
Conscious at all times but dazed, blank stares, “clueless,” or amnesia of any kind. If the athlete gives wrong answers to more than two questions on the confusion/orientation or memory tests the first time tested, immediately remove him or her from play and seek emergency medical attention. The athlete should not return to play for at least five to seven days and should be cleared by his or her doctor first.

Grade 3, Knocked Out -- Blacked Out:
Any loss of consciousness, no matter how brief, is a grade 3 concussion requiring immediate medical attention. No need for you to perform any exams, but you must do the following:

• If the athlete wakes up within one minute and does not have any neck pain, you may move the athlete to the sideline, where you should keep him or her calm and quiet. Call an ambulance or ask a responsible adult to take the player directly to an emergency room.   
• If the athlete is unconscious longer than one minute, does not wake up, or complains of neck pain after returning to consciousness, assume the athlete has a neck/spine injury. Do not move the athlete. Make sure that he or she is breathing. Do not allow others to move the athlete. Call an ambulance. While waiting for the ambulance to arrive, keep the athlete’s head from being moved.

In either case, expect the athlete to be prohibited from taking part in the activity for a minimum of two weeks to one month.

Resist well-meaning adults who unknowingly want their child returned to athletic activity.

TESTS FOR CONCUSSION

Remember to tailor your questions to the age of your athletes.

 Confusion/Orientation:

• What’s your name?    
• Where are you?    
• What month or year is it?    
• Who are we playing?    
• What sport are we playing?    
• Who’s winning?

 Memory: 

• Who was our last opponent?    
• Who won that game?    
• When was the last major holiday?    
• What is the next one?    
• What has happened so far in this game?    
• Who is the president of the United States?    
• Give the athlete three objects (cat, book, tree) to remember, then ask him or her to tell you what they are after three minutes.

 Concentration:

• Repeat these numbers backward (4-3-6, 8-2-7-1, 9-4-5-2-0).    
• Beginning with December, say the months of the year backwards.    
• Tell me a multiplication table forwards.

 Neurologic Tests (for balance and hand/eye coordination):

• Pupils should be of equal size. If not, call an ambulance.   
• Have the athlete touch finger to nose with eyes closed. Fails test if misses nose.   
• Have the athlete stand on both feet with arms out, first with eyes open and then with eyes closed -- fails test if sways (for hockey: skate blue line forward on one foot).   
• Have the athlete walk heel-toe in straight line, forward and backward -- fails test if wavers or line is not straight (for hockey: skate backwards without looking).

Download Tests for Assessing Concussion (.pdf, 46 kb)

© 1999, 2003 Massachusetts Medical Society