Updates to sports concussion assessment tool now addresses children under 12

2014-12-16 09:47:09 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Football helmet of the late Owen Thomas, a former University of Pennsylvania football player, brought to a hearing on H.R 6172, the Protecting Student Athletes from Concussions Act by his mother, Rev. Katherine E. Brearley, Ph.D. Creative Commons/Flickr Football helmet of the late Owen Thomas, a former University of Pennsylvania football player, brought to a hearing on H.R 6172, the Protecting Student Athletes from Concussions Act, by his mother, Rev. Katherine E. Brearley, Ph.D. Creative Commons/Flickr

Concussions are always a hot topic around here, and parents are constantly asking me how to evaluate kids on the sidelines for concussions.

So, I want to share with our readers the most updated concussion assessment tool, the SCAT3.

In March of this year, the Consensus Statement on Concussion in Sport updated and released the SCAT3. Itís an international standardized tool for evaluating athletes, ages 13 and up, for concussions.

And for the first time, they also released a C-SCAT for evaluating concussions in children 12 and under.

Today, I had the chance to speak with WAKR host Ray Horner about the specifics of this test and what parents and coaches need to know about it.

Below is an audio file and transcript of our discussion.

Horner: Our good friend, Dr. Joe Congeni, onboard with us right now. Joe, do you remember where you were when Lenny Barker (former starting pitcher) threw his perfect game this date in 1981?

Dr. Congeni: Oh I do, so much. I had a ticket for the game.

Horner: You did?

Dr. Congeni: And I couldnít go. I went up to graduation at Notre Dame and I missed that game. Wow.

Dr. Joe Congeni Dr. Joe Congeni

Horner: Ahhh, okay. We just talked to one of our listeners who was there. I mean, he knew the whole lineup, all the key plays. He definitely knew what was going on in that game. Well, what do you have for us today, Joe?

Dr. Congeni: Well, Ray, new international guidelines came out. Iíve been talking about this every two years now.

met in Zurich, Switzerland, (at the Consensus Conference on Concussion in Sport) and they came out in March of 2013 with some new guidelines on treatment, management of concussions. You know, a hot topic for us, of course.

A lot of people are surprised on the sideline , ďHow do we assess these things?Ē Itís like, is there an X-ray test? You know, how is it done? Is there some instantaneous test that we can tell ? Sometimes itís obvious, but a lot of times itís not all together clear.

There is a tool that was updated again this year. Itís called the Sport Concussion Assessment Tool. Itís known by people on the sidelines as the SCAT test, and this is called SCAT3.

For the first time, they have a C-SCAT, itís being called, a child version for 12 and under. So, the questions are a little bit easier for a C-SCAT, Child SCAT.

It takes about 15 minutes and itís very detailed and itís a lot of questions looking at the function of the brain. And so when we do this test, you canít do it on the sidelines.

Itís very hard to do it in a loud place. A lot of times you want to go back in the locker room or the training room to go over this test. I was going to give you a little bit of an idea.

Again, this year, they added some other components that make it longer and longer, but it takes the trainer a good 15 minutes to go through this test with people.

The first part is whatís called the Maddock Score, and itís just orientation stuff, like what half is it now? Who scored last in the game? What team did you play last week?

The second part is what are your symptoms now? And itís not like the old days, Ray, of just ďHey, do you feel okay?Ē

There are 22 symptoms that athletes have to rate right now from a score of zero to six, starting with headache, pressure in the head, dizziness, blurred vision, sensitivity to light, sensitivity to noise, and on and on.

Itís a lot of questions, 22 questions about what are the symptoms that you feel.

Then, we get into some of the memory questions. They start with pretty easy ones: What month is it? What day is it today? What day of the week?

Then, we ask 5 words immediately, and then we ask it again in 10 minutes.

There are different lists of these 5 things that we ask you to remember, like the first list: elbow, apple, carpet, saddle, bubble. And, we ask the athlete to repeat those back Ö again in 10 minutes when weíre done testing.

The one for concentration is stating the months in reverse order. When I give talks, I have people do it. So, for instance, Ray, would you like to try that starting with May?

Horner: May, April, March, February, January.

Congeni: And keep going.

Horner: Oh. December, November, October, September, August, July, June.

Congeni: Alright, so, not too bad and you got through that very quickly. The one for the kids, the C-SCAT, is just days in reverse order, starting with Wednesday, Tuesday, Monday. So, itís going through that to see if kids can concentrate.

Thereís a part digits backward, where Iíll read off 4 or 5 digits and then you give them to me backwards. So, 5, 3, 9, 1, 4, 8.

Horner: ...†I pass.

Congeni: Then, we check the neck, and then we do a balance exam. So, you stand with your feet together and close your eyes. Then, you stand on one leg, your non-dominate leg, close your eyes and we have them hold that for 5 seconds.

Then, we have them stand in tandem stance, one foot in front of the other.

Then, the coordination exam is a finger-to-nose test. Then, we go back and ask you those 5 words that we gave you earlier.

This sideline assessment, Sport Concussion Assessment Tool, SCAT3, was updated this year. Right now, thatís the gold standard thatís being used to test athletes, and thereís a scoring system at the end to see if they have a concussion.

, we go over with them how to treat a concussion initially. Make sure that overnight somebodyís with you in case it worsens. Make sure that youíre followed up. You cannot return to play until youíve been assessed medically now ó thatís the new law as of a month ago.

So, people ask, ďWhat kind of questions do you guys ask?Ē I just wanted to review today the Sport Concussion Assessment Tool.

Horner: Sounds pretty thorough and sounds pretty good, as well. Joe, thanks for the time. Good stuff this morning. Weíll catch up with you again next week.

Congeni: Alright, Ray, have a great week.

Horner: You too. Dr. Joe Congeni from Sports Medicine Center at Akron Childrenís Hospital.

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