Concussion signs (those noticed by coaches, parents and teammates) and symptoms (feelings or problems experienced by the athlete) fall into five "clusters":
a. somatic (headache, nausea, vomiting, dizziness, visual problems, sensitivity to light/noise, balance problems);
b. cognitive (feeling mentally "foggy," feeling slowed down, difficulty concentrating and remembering);
c. emotional (involuntary crying or uncontrollable episodes of crying and/or laughing)
2. Physical signs (loss of consciousness (LOC), amnesia, unsteadiness, vacant or blank stare)
3. Behavioral changes (irritability, sadness, nervousness, more emotional, depression)
4. Cognitive impairments (slowed reaction time)
5. Sleep disturbance (insomnia, drowsiness, sleeping less than usual, sleeping more than usual)
Despite widespread concerns about chronic under-reporting by athletes, assessing their symptoms remains a critical component of concussion diagnosis and management.
1. Headache (reported as symptom by 94.2% of high school athletes)
2. Dizziness (75.6%)
3. Difficulty concentrating (54.8%)
4. Light sensitivity (36%)
5. Nausea and vomiting (31.4%)
6. Balance problems
8. Trouble falling asleep
9. Sleeping more than usual
10. Sleeping less than usual
12. Noise sensitivity
16. Feeling more emotional
17. Numbness or tingling
18. Feeling slowed down
19. Feeling mentally "foggy"
21. Difficulty remembering
22. Visual problems
In diagnosing concussion, the treating doctor will consider both the number of symptoms the athlete reports and their severity on a 6-point scale, in which 0 means the symptom is not present and 6 being unbearably bad.
Because the list includes symptoms that are not specific to concussion, some non-injured athletes may report symptoms. Student-athletes with pre-injury depression, sleep disturbances, and/or attention-deficit/hyperactivity disorder should not be expected to have a total score of 0 on the symptom scale before they are medically cleared for a return to play because of their elevated baselines. As a result, the generally accepted threshold total symptom score for return to play is 7.
Remembering this list of symptoms is difficult for any parent, coach or player. As Dr. Joseph Congeni says in The Smartest Team, after he and Dr. Rosemarie Moser tick off most of the 22 symptoms from this list, “There' so many different ways concussion can present that it’s very hard to tell a kid, a coach or parent … this is the one symptom to look for because there’s all these symptoms. Are you kidding me?”
Fortunately, there are a number of helpful smartphone apps which list the symptoms so that they are at a parent, coach's or player's fingertips. In addition, concussion experts have developed a Pocket Concussion Recognition Tool to help identify concussion, which is freely available for download and printing from the Internet.