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14 AFL MEDICAL OFFICERS ASSOCIATION
Notes
THE MANAGEMENT OF CONCUSSION IN
AUSTRALIAN FOOTBALLAFL ReseARch boARd
AFL MedIcAL oFFIceRs AssocIATIoN
THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 3
summary■ Concussion refers to a disturbance in brain function caused by trauma.
■ Complications can occur if the player is returned to play before having fully recovered from injury.
■ The key components of management include:
a) suspecting the diagnosis in any player with symptoms such as confusion or headache after a knock to the head;
b) Referring the player for medical evaluation; and
c) ensuring that the player has received medical clearance before allowing a return to play or a graded training program.
■ The cornerstones of medical management include rest until symptoms have resolved; cognitive testing to ensure recovery of brain function, and then a graded return to sport program with monitoring for recurrence of symptoms.
■ In general, a more conservative approach (i.e. longer time to return to sport) is used in cases where there is any uncertainty about the player’s recovery (“if in doubt sit them out”).
■ Difficult cases, such as those involving prolonged symptoms or deficits in brain function, require a more detailed, multi-disciplinary approach to management.
A player with suspected concussion must be withdrawn from playing or training until medically evaluated and cleared.
THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL
AFL Medical Officers Association Position Statement
This document has been produced by the AFL following an AFL Research board project, carried out by dr Michael Makdissi, and endorsed by the AFL Medical officers’ Association as a Position
statement on the Management of concussion in Australian Football.
The guidelines should be adhered to at all times. decisions regarding return to play after concussive injuries should only be made by a medical doctor with experience in concussive injuries.
August, 2008
THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL
4 AFL MEDICAL OFFICERS ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 5
BackgroundConcussion is a relatively common injury in Australian Football. It reflects a disturbance in brain function caused by trauma, rather than a structural injury. Resulting symptoms and changes in brain function are temporary and recover spontaneously. The recovery process however, is variable from person to person and injury to injury and may take from just a few minutes through to several weeks.
Symptoms of concussion typically include headache, blurred vision, dizziness and nausea. Brain function is also affected. Changes include confusion, memory loss and reduced ability to think clearly, concentrate and process information. These deficits can impair the way a player reacts during competition, which may put player at risk of further head or musculoskeletal injury. Repeated head injury, particularly when the player has not yet fully recovered from a previous head injury, has been linked with a number of potential complications, such as prolonged symptoms and long-term deterioration of brain function. Therefore, it is important to make the diagnosis and manage the condition appropriately. This means keeping the player out of training and competition until fully recovered.
This document approved by the AFL Medical Officers’ Association summarises the specific management guidelines developed for care of Australian Football players following a concussive injury.
Overall, these guidelines should serve only as a general guide for the management of concussive injuries sustained in Australian Football based on the most up-to-date evidence available. Treatment of individual players will be determined by the experience of the examining practitioner, the specific clinical circumstances presented and the resources available for assessment and testing.
6 AFL MEDICAL OFFICERS ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 7
Management guidelines
Game-day evaluation and treatmentThe key components of initial management involve making an accurate diagnosis and careful monitoring of the injured player.
1. on-field
■ Loss of consciousness (LOC), confusion, and memory disturbance are classic features of concussive injuries, but these are not present in every case of concussion.
■ Other symptoms that should raise suspicion of a concussive injury include: headache, blurred vision, balance problems, dizziness, feeling “dinged” or “dazed”, a player saying “I don’t feel right”, drowsiness, fatigue, difficulty concentrating or difficulty remembering.
■ Any player with a suspected concussive injury must be removed from the field of play for further evaluation.
■ The diagnosis can be confirmed using sideline mental status assessment tools, such as the Sideline Concussion Assessment Tool (SCAT).
■ Basic first-aid principles apply when dealing with any unconscious player (i.e. airways, breathing, circulation). Care must be taken with the player’s cervical spine, which may have also been injured in the collision.
2. sideline evaluation
■ Regular reassessment of symptoms and brain function in the hours following injury is essential to monitor for deterioration. This helps differentiate concussion (improvement) from structural head injuries (deterioration).
■ Indications for referral to hospital are listed in Table 1.
■ Overall, if there is any doubt, the patient should be referred to hospital.
■ If the player is being discharged home, clear and practical instructions, particularly regarding abstinence from alcohol and driving, medication use, physical exertion and medical follow up, should be given to the player and relevant caregivers (e.g. parents, partner, etc).
■ Tools such as the SCAT facilitate regular re-assessment of concussed players and provide simple and practical advice for patient education (see attachment). It is important to note that abbreviated sideline evaluation tools are designed for rapid concussion evaluation. They are not meant to replace a more comprehensive cognitive assessment and should not be used as a stand-alone tool for the ongoing management of concussive injuries.
3. Follow-up
■ Any player who has suffered from a concussive injury must be referred for medical evaluation and clearance before being allowed to return to training.
Table 1. Indications for referral to hospital
➤ Deterioration of conscious state post-injury (e.g. increased drowsiness).
➤ Focal neurological signs (e.g. numbness or weakness in the arms or legs).
➤ Prolonged confusion (for more than 30 minutes) or loss of consciousness for more than one minute.
➤ Persistent vomiting or increasing headache post-injury.
➤ Where there is difficulty with assessment or uncertain follow-up
➤ Children (under 18) with head injuries.
➤ High-risk patients (e.g. haemophilia, use of blood thinners).
8 AFL MEDICAL OFFICERS ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 9
Return-to-play decisionsThe basic principle of return-to-play decisions following concussive injury is to ensure that the player has fully recovered before being allowed to return to competition. In practical terms, this means resting the player until symptoms have resolved, then performing an objective test to assess recovery of brain function, followed by a graded return to play with monitoring for recurrence of symptoms (“concussion rehabilitation”).
■ In every case, decisions regarding the timing of return to training should be made by a medical doctor with experience in concussive injuries. Do not be swayed by the opinion of players, coaching staff or others suggesting premature return to play.
■ Cognitive tests can be used to assess recovery of brain function. These tests should be performed after symptoms have resolved. The important aspects of this testing involve comparing the post-concussion results to the players’ own pre-injury baseline and using a test that is sensitive to the effects of concussion. Ideally, computerised test platforms should be used, however, paper-and-pencil tests such as the Digit Symbol Substitution Test (with a more conservative return-to-play approach) are useful in cases where costs and time restrictions limit the use of computerised testing. Overall, it is important to remember that cognitive testing is only one component of assessment, and therefore should not be the sole basis of management decisions.
■ In general, a more conservative approach (i.e. longer time to return to sport) is used in cases where there is any uncertainty about the player’s recovery (“if in doubt sit them out” ).
Return to play on the day of injury■ In general, the safest course of action is that the player not be allowed
to return to play in the game or training session.
concussion rehabilitation■ Following a concussive injury players should be returned to play in a
graded fashion (see Table 2).
■ If symptoms recur at any stage of the “concussion rehab”, the player
should be re-evaluated by their treating doctor.
complex concussions■ “Complex concussions” are cases in which symptoms or changes
in brain function persist for more than 10 days, where the player has suffered multiple concussions over time or where the player has sustained a significant injury in response to a minor blow.
■ These cases are best managed in a multi-disciplinary manner by doctors with specific expertise in concussive injuries.
Table 2. concussion rehabilitation
Early rest (do nothing!).
Graduated return to activity (to commence 24-48 hours after resolution of symptoms).
1. Light aerobic exercise e.g. stationary bike.
2. Running.
3. Non-contact training drills.
4. Full contact training.
5. Game play.
10 AFL MEDICAL OFFICERS ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 11
The
Scat
Car
d
Spor
t Con
cuss
ion
Asse
ssm
ent T
ool
Spor
t Co
ncus
sion
Ass
essm
ent
Tool
(SC
AT)
Th
e SC
AT
Car
d (S
port
Con
cuss
ion
Ass
essm
ent T
ool)
Ath
lete
Info
rmat
ion
Wha
t is
a co
ncus
sion
? A
con
cuss
ion
is a
dis
turb
ance
in th
e fu
nctio
n of
the
brai
n ca
used
by
a di
rect
or i
ndire
ct fo
rce
to th
e he
ad.
It re
sults
in a
var
iety
of s
ympt
oms
(like
thos
e lis
ted
belo
w) a
nd m
ay,
or m
ay n
ot, i
nvol
ve m
emor
y pr
oble
ms
or lo
ss o
f con
scio
usne
ss.
H
ow d
o yo
u fe
el?
You
sho
uld
scor
e yo
urse
lf on
the
follo
win
g sy
mpt
oms,
bas
ed o
n ho
w y
ou fe
el n
ow.
Wha
t sho
uld
I do?
A
ny a
thle
te s
uspe
cted
of h
avin
g a
conc
ussi
on s
houl
d be
re
mov
ed fr
om p
lay,
and
then
see
k m
edic
al e
valu
atio
n.
Sign
s to
wat
ch fo
r: P
robl
ems
coul
d ar
ise
over
the
first
24-
48 h
ours
. Y
ou s
houl
d no
t be
left
alon
e an
d m
ust g
o to
a h
ospi
tal a
t onc
e if
you:
H
ave
a he
adac
he th
at g
ets
wor
se
Are
ver
y dr
owsy
or c
an’t
be a
wak
ened
(wok
en u
p)
Can
’t re
cogn
ize
peop
le o
r pla
ces
Hav
e re
peat
ed v
omiti
ng
Beh
ave
unus
ually
or s
eem
con
fuse
d; a
re v
ery
irrita
ble
Hav
e se
izur
es (a
rms
and
legs
jerk
unc
ontro
llabl
y)
Hav
e w
eak
or n
umb
arm
s or
legs
A
re u
nste
ady
on y
our f
eet;
have
slu
rred
spe
ech
Rem
embe
r, it
is b
ette
r to
be s
afe.
Con
sult
your
doc
tor a
fter a
su
spec
ted
conc
ussi
on.
Wha
t can
I ex
pect
? C
oncu
ssio
n ty
pica
lly re
sults
in th
e ra
pid
onse
t of s
hort-
lived
im
pairm
ent t
hat r
esol
ves
spon
tane
ousl
y ov
er ti
me.
You
can
exp
ect
that
you
will
be
told
to re
st u
ntil
you
are
fully
reco
vere
d (th
at m
eans
re
stin
g yo
ur b
ody
and
your
min
d).
Then
, you
r doc
tor w
ill li
kely
ad
vise
that
you
go
thro
ugh
a gr
adua
l inc
reas
e in
exe
rcis
e ov
er
seve
ral d
ays
(or l
onge
r) b
efor
e re
turn
i ng
to s
port.
Spor
ts c
oncu
ssio
n is
def
ined
as
a co
mpl
ex
path
ophy
siol
ogic
al p
roce
ss a
ffect
ing
the
brai
n,
indu
ced
by tr
aum
atic
bio
mec
hani
cal f
orce
s. S
ever
al
com
mon
feat
ures
that
inco
rpor
ate
clin
ical
, pa
thol
ogic
al a
nd b
iom
echa
nica
l inj
ury
cons
truct
s th
at
may
be
utili
zed
in d
efin
ing
the
natu
re o
f a c
oncu
ssiv
e he
ad in
jury
incl
ude:
1.
Con
cuss
ion
may
be
caus
ed e
ither
by
a di
rect
blo
w
to th
e he
ad, f
ace,
nec
k or
els
ewhe
re o
n th
e bo
dy
with
an
'impu
lsiv
e' fo
rce
trans
mitt
ed to
the
head
. 2.
Con
cuss
ion
typi
cally
resu
lts in
the
rapi
d on
set o
f sh
ort-l
ived
impa
irmen
t of n
euro
logi
cal f
unct
ion
that
re
solv
es s
pont
aneo
usly
. 3.
Con
cuss
ion
may
resu
lt in
neu
ropa
thol
ogic
al
chan
ges
but t
he a
cute
clin
ical
sym
ptom
s la
rgel
y re
flect
a fu
nctio
nal d
istu
rban
ce ra
ther
than
st
ruct
ural
inju
ry.
4. C
oncu
ssio
n re
sults
in a
gra
ded
set o
f clin
ical
sy
ndro
mes
that
may
or m
ay n
ot in
volv
e lo
ss o
f co
nsci
ousn
ess.
Res
olut
ion
of th
e cl
inic
al a
nd
cogn
itive
sym
ptom
s ty
pica
lly fo
llow
s a
sequ
entia
l co
urse
. 5.
Con
cuss
ion
is ty
pica
lly a
ssoc
iate
d w
ith g
ross
ly
norm
al s
truct
ural
neu
roim
agin
g st
udie
s.
Rem
embe
r, co
ncus
sion
sho
uld
be s
uspe
cted
in th
e pr
esen
ce o
f AN
Y O
NE
or m
ore
of th
e fo
llow
ing:
S
ympt
oms
(suc
h as
hea
dach
e), o
r S
igns
(suc
h as
loss
of c
onsc
ious
ness
), or
M
emor
y pr
oble
ms
Any
ath
lete
with
a s
uspe
cted
con
cuss
ion
shou
ld
be m
onito
red
for d
eter
iora
tion
(i.e.
, sho
uld
not b
e le
ft al
one )
and
sho
uld
not d
rive
a m
otor
veh
icle
.
Post
Con
cuss
ion
Sym
ptom
s A
sk th
e at
hlet
e to
sco
re th
emse
lves
bas
ed o
n ho
w
they
feel
now
. It
is re
cogn
ized
that
a lo
w s
core
may
be
nor
mal
for s
ome
athl
etes
, but
clin
ical
judg
men
t sh
ould
be
exer
cise
d to
det
erm
ine
if a
chan
ge in
sy
mpt
oms
has
occu
rred
follo
win
g th
e su
spec
ted
conc
ussi
on e
vent
. It
shou
ld b
e re
cogn
ized
that
the
repo
rting
of
sym
ptom
s m
ay n
ot b
e en
tirel
y re
liabl
e. T
his
may
be
due
to th
e ef
fect
s of
a c
oncu
ssio
n or
bec
ause
the
athl
ete’
s pa
ssio
nate
des
ire to
retu
rn to
com
petit
ion
outw
eigh
s th
eir n
atur
al in
clin
atio
n to
giv
e an
hon
est
resp
onse
. If
poss
ible
, ask
som
eone
who
kno
ws
the
athl
ete
wel
l ab
out c
hang
es in
affe
ct, p
erso
nalit
y, b
ehav
ior,
etc.
Post
Con
cuss
ion
Sym
ptom
Sca
le
N
one
Mod
erat
e
Sev
ere
Hea
dach
e 0
1 2
3 4
5 6
“Pre
ssur
e in
hea
d”
0 1
2 3
4 5
6 N
eck
Pai
n 0
1 2
3 4
5 6
Bal
ance
pro
blem
s or
diz
zy 0
1
2 3
4 5
6 N
ause
a or
vom
iting
0
1 2
3 4
5 6
Vis
ion
prob
lem
s 0
1 2
3 4
5 6
Hea
ring
prob
lem
s / r
ingi
ng 0
1
2 3
4 5
6 “D
on’t
feel
righ
t” 0
1 2
3 4
5 6
Feel
ing
“din
ged”
or “
daze
d” 0
1
2 3
4 5
6 C
onfu
sion
0
1 2
3 4
5 6
Feel
ing
slow
ed d
own
0 1
2 3
4 5
6 Fe
elin
g lik
e "in
a fo
g"
0 1
2 3
4 5
6 D
row
sine
ss
0 1
2 3
4 5
6 Fa
tigue
or l
ow e
nerg
y 0
1 2
3 4
5 6
Mor
e em
otio
nal t
han
usua
l 0
1 2
3 4
5 6
Irrita
bilit
y 0
1 2
3 4
5 6
Diff
icul
ty c
once
ntra
ting
0 1
2 3
4 5
6 D
iffic
ulty
rem
embe
ring
0 1
2 3
4 5
6 (fo
llow
up
sym
ptom
s on
ly)
Sad
ness
0
1 2
3 4
5 6
Ner
vous
or A
nxio
us
0 1
2 3
4 5
6 Tr
oubl
e fa
lling
asl
eep
0 1
2 3
4 5
6 S
leep
ing
mor
e th
an u
sual
0
1 2
3 4
5 6
Sen
sitiv
ity to
ligh
t 0
1 2
3 4
5 6
Sen
sitiv
ity to
noi
se
0 1
2 3
4 5
6 O
ther
: ___
____
____
____
0
1 2
3 4
5 6
For m
ore
info
rmat
ion
see
the
“Sum
mar
y an
d A
gree
men
t Sta
tem
ent o
f the
Sec
ond
Inte
rnat
iona
l S
ympo
sium
on
Con
cuss
ion
in S
port”
in th
e A
pril,
200
5 ed
ition
of t
he C
linic
al J
ourn
al o
f Spo
rt M
edic
ine
(vol
15
), B
ritis
h Jo
urna
l of S
ports
Med
icin
e (v
ol 3
9),
Neu
rosu
rger
y (v
ol 5
9) a
nd th
e P
hysi
cian
and
S
ports
med
icin
e (v
ol 3
3).
This
tool
may
be
copi
ed fo
r di
strib
utio
n to
team
s, g
roup
s an
d or
gani
zatio
ns.
©20
05 C
oncu
ssio
n in
Spo
rt G
roup
This
tool
repr
esen
ts a
sta
ndar
dize
d m
etho
d of
ev
alua
ting
peop
le a
fter c
oncu
ssio
n in
spo
rt. T
his
Tool
ha
s be
en p
rodu
ced
as p
art o
f the
Sum
mar
y an
d A
gree
men
t Sta
tem
ent o
f the
Sec
ond
Inte
rnat
iona
l S
ympo
sium
on
Con
cuss
ion
in S
port,
Pra
gue
2004
ww
w.c
jspo
rtm
ed.c
om
12 AFL MEDICAL OFFICERS ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 13
McC
rory
, Joh
nsto
n, M
eeuw
isse,
et a
l
Spor
t Co
ncus
sion
Ass
essm
ent
Tool
(SC
AT)
Th
e SC
AT
Car
d (S
port
Con
cuss
ion
Ass
essm
ent T
ool)
Med
ical
Eva
luat
ion
Nam
e: _
____
____
____
____
____
____
__
Dat
e __
____
____
S
port/
Team
: ___
____
____
____
____
____
M
outh
gua
rd?
Y N
1)
SIG
NS
Was
ther
e lo
ss o
f con
scio
usne
ss o
r unr
espo
nsiv
enes
s?
Y
N
Was
ther
e se
izur
e or
con
vuls
ive
activ
ity?
Y
N
W
as th
ere
a ba
lanc
e pr
oble
m /
unst
eadi
ness
? Y
N
2)
MEM
OR
Y
Mod
ified
Mad
dock
s qu
estio
ns (c
heck
cor
rect
) A
t wha
t ven
ue a
re w
e? _
_; W
hich
hal
f is
it? _
_; W
ho s
core
d la
st?_
_ W
hat t
eam
did
we
play
last
? __
; Did
we
win
last
gam
e? _
_?
3) S
YMPT
OM
SC
OR
E
Tota
l num
ber o
f pos
itive
sym
ptom
s (fr
om re
vers
e si
de o
f the
car
d) =
___
___
4) C
OG
NIT
IVE
ASS
ESSM
ENT
5 w
ord
(E
xam
ples
) (a
fter c
once
ntra
tion
task
s)re
call
Imm
edia
te
Del
ayed
W
ord
1 __
____
____
___
cat
___
___
W
ord
2___
____
____
__
pen
___
___
W
ord
3 __
____
____
___
shoe
__
_ __
_
Wor
d 4
____
____
____
_ bo
ok
___
___
W
ord
5 __
____
____
___
car
___
___
Mon
ths
in re
vers
e or
der:
Jun-
May
-Apr
-Mar
-Feb
-Jan
-Dec
-Nov
-Oct
-Sep
-Aug
-Jul
(c
ircle
inco
rrec
t) or
D
igits
bac
kwar
ds (c
heck
cor
rect
) 5-
2-8
3-9-
1 __
____
6-
2-9-
4 4-
3-7-
1 __
____
8-
3-2-
7-9
1-4-
9-3-
6 __
____
7-
3-9-
1-4-
2 5-
1-8-
4-6-
8 __
____
Ask
dela
yed
5-w
ord
reca
ll no
w
5) N
EUR
OLO
GIC
SC
REE
NIN
G
P
ass
Fail
Spe
ech
___
___
Eye
Mot
ion
and
Pup
ils
___
___
Pro
nato
r Drif
t __
_ __
_ G
ait A
sses
smen
t __
_ __
_
Any
neur
olog
ic s
cree
ning
abn
orm
ality
nec
essi
tate
s fo
rmal
ol
ogic
or h
ospi
tal a
sses
smne
uren
t 6)
RET
UR
N T
O P
LAY
Ath
lete
s sh
ould
not
be
retu
rned
to p
lay
the
sam
e da
y of
inju
ry.
Whe
n re
turn
ing
athl
etes
to p
lay,
they
sho
uld
follo
w a
ste
pwis
e sy
mpt
om-li
mite
d pr
ogra
m, w
ith s
tage
s of
pro
gres
sion
. Fo
r exa
mpl
e:1.
re
st u
ntil
asym
ptom
atic
(phy
sica
l and
men
tal r
est)
2.
light
aer
obic
exe
rcis
e (e
.g. s
tatio
nary
cyc
le)
3.
spor
t-spe
cific
exe
rcis
e
4.
non-
cont
act t
rain
ing
drill
s (s
tart
light
resi
stan
ce tr
aini
ng)
5.
full
cont
act t
rain
ing
afte
r med
ical
cle
aran
ce
6.
retu
rn to
com
petit
ion
(gam
e pl
ay)
Ther
e sh
ould
be
appr
oxim
atel
y 24
hou
rs (o
r lon
ger)
for e
ach
stag
e an
d th
e at
hlet
e sh
ould
retu
rn to
sta
ge 1
if s
ympt
oms
recu
r.
Res
ista
nce
train
ing
shou
ld o
nly
be a
dded
in th
e la
ter s
tage
s.
Med
ical
cle
aran
ce s
houl
d be
giv
en b
efor
e re
turn
to p
lay.
Ret
urn
to P
lay:
A
stru
ctur
ed, g
rade
d ex
ertio
n pr
otoc
ol s
houl
d be
de
velo
ped;
indi
vidu
aliz
ed o
n th
e ba
sis
of s
port,
age
an
d th
e co
ncus
sion
his
tory
of t
he a
thle
te.
Exe
rcis
e or
tra
inin
g sh
ould
be
com
men
ced
only
afte
r the
ath
lete
is
clea
rly a
sym
ptom
atic
with
phy
sica
l and
cog
nitiv
e re
st.
Fina
l dec
isio
n fo
r cle
aran
ce to
retu
rn to
com
petit
ion
shou
ld id
eall y
be
mad
e by
a m
edic
al d
octo
r.
Neu
rolo
gic
Scre
enin
g:
Trai
ned
med
ical
per
sonn
el m
ust a
dmin
iste
r thi
s ex
amin
atio
n. T
hese
indi
vidu
als
mig
ht in
clud
e m
edic
al
doct
ors,
phy
siot
hera
pist
s or
ath
letic
ther
apis
ts.
Spe
ech
shou
ld b
e as
sess
ed fo
r flu
ency
and
lack
of
slur
ring.
Eye
mot
ion
shou
ld re
veal
no
dipl
opia
in a
ny
of th
e 4
plan
es o
f mov
emen
t (ve
rtica
l, ho
rizon
tal a
nd
both
dia
gona
l pla
nes)
. Th
e pr
onat
or d
rift i
s pe
rform
ed
by a
skin
g th
e pa
tient
to h
old
both
arm
s in
fron
t of
them
, pal
ms
up, w
ith e
yes
clos
ed.
A p
ositi
ve te
st is
pr
onat
ing
the
fore
arm
, dro
ppin
g th
e ar
m, o
r drif
t aw
ay
from
mid
line.
For
gai
t ass
essm
ent,
ask
the
patie
nt to
w
alk
away
from
you
, tur
n an
d w
alk
back
.
Cog
nitiv
e A
sses
smen
t: S
elec
t any
5 w
ords
(an
exam
ple
is g
iven
). A
void
ch
oosi
ng re
late
d w
ords
suc
h as
"dar
k" a
nd "m
oon"
w
hich
can
be
reca
lled
by m
eans
of w
ord
asso
ciat
ion.
R
ead
each
wor
d at
a ra
te o
f one
wor
d pe
r sec
ond.
Th
e at
hlet
e sh
ould
not
be
info
rmed
of t
he d
elay
ed
test
ing
of m
emor
y (to
be
done
afte
r the
reve
rse
mon
ths
and/
or d
igits
). C
hoos
e a
diffe
rent
set
of
wor
ds e
ach
time
you
perfo
rm a
follo
w-u
p ex
am w
ith
e sa
me
cand
ida
th
te.
uenc
e.
Ask
the
athl
ete
to re
cite
the
mon
ths
of th
e ye
ar
in re
vers
e or
der,
star
ting
with
a ra
ndom
mon
th.
Do
not s
tart
with
Dec
embe
r or J
anua
ry.
Circ
le a
ny
mon
ths
not r
ecite
d in
the
corr
ect s
eqFo
r dig
its b
ackw
ards
, if c
orre
ct, g
o to
the
next
st
ring
leng
th.
If in
corr
ect,
read
tria
l 2.
Sto
p af
ter
inco
rrec
t on
both
tria
ls.
Mem
ory:
If n
eede
d, q
uest
ions
can
be
mod
ified
to
mak
e th
em s
peci
fic to
the
spor
t (e.
g. “
perio
d” v
ersu
s “ha
lf”)
For m
ore
info
rmat
ion
see
the
“Sum
mar
y an
d A
gree
men
t Sta
tem
ent o
f the
Sec
ond
Inte
rnat
iona
l S
ympo
sium
on
Con
cuss
ion
in S
port”
in th
e A
pril,
200
5 C
linic
al J
ourn
al o
f Spo
rt M
edic
ine
(vol
15)
, Brit
ish
Jour
nal o
fSpo
rts M
edic
ine
(vol
39)
, Neu
rosu
rger
y (v
ol
59) a
nd th
e P
hysi
cian
and
Spo
rtsm
edic
ine
(vol
33)
. ©
2005
Con
cuss
ion
in S
port
Gro
up
Inst
ruct
ions
: Th
is s
ide
of th
e ca
rd is
for t
he u
se o
f med
ical
doc
tors
, ph
ysio
ther
apis
ts o
r ath
letic
ther
apis
ts.
In o
rder
to
max
imiz
e th
e in
form
atio
n ga
ther
ed fr
om th
e ca
rd, i
t is
stro
ngly
sug
gest
ed th
at a
ll at
hlet
es p
artic
ipat
ing
in
cont
act s
ports
com
plet
e a
base
line
eval
uatio
n pr
ior t
o th
e be
ginn
ing
of th
eir c
ompe
titiv
e se
ason
. Th
is c
ard
is a
sug
gest
ed g
uide
onl
y fo
r spo
rts c
oncu
ssio
n an
d is
no
t mea
nt to
ass
ess
mor
e se
vere
form
s of
bra
in
inju
ry.
Plea
se g
ive
a C
OPY
of t
his
card
to th
e at
hlet
e fo
r the
ir in
form
atio
n an
d to
gui
de fo
llow
-u p
ass
essm
ent.
Sign
s:
Ass
ess
for e
ach
of th
ese
item
s an
d ci
rcle
Y
(yes
) or N
(no)
.
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