Sport Concussion Assessment Tool for Gymnastics

Concussion picture

Concussion picture

Concussions and their Assessment


Download the SCAT Card for Gymnastics to keep available in the gym.

Download the Instructions for the SCAT Card for Gymnastics.

Concussions in Gymnastics

There is growing concern about the long-term effects of concussions on athletes, especially young athletes. Fortunately, male and female gymnasts are in the lowest category of risk for suffering a concussion.

While gymnastics is generally considered a high-risk sport for injuries, in general, the research reveals a low number of concussions in our sport. Gymnastics is an individual sport, so gymnasts don’t get hit by an opponent, but concussions can occur if gymnasts hit their head on the floor or equipment.

A concussion is a traumatic brain injury that can result in headaches, lowered levels of alertness or unconsciousness. Concussions temporarily interfere with the way the brain works. Concussions can affect balance, coordination, judgment, reflexes, memory, speech and sleep patterns.

Causes of Concussions

A concussion may result when the head hits the floor or a piece of gymnastics equipment. In gymnastics, a concussion most likely results from a fall off the equipment. Significant jarring of the brain in any direction can cause gymnasts to lose consciousness. The length of the period of unconsciousness can be a sign of how severe the concussion is. But milder concussions do not always involve loss of consciousness. The majority of athletes who have a concussion never black out. Gymnasts can have a concussion and not realize it.

Symptoms

The symptoms of a concussion can range from mild to severe.
Mild symptoms include:

  • Altered level of consciousness (drowsy, hard to arouse, or similar changes)
  • Confusion, feeling spacey, or not thinking straight
  • Headache
  • Loss of consciousness
  • Memory loss (amnesia) of what happened before or immediately after the injury
  • Nausea and vomiting
  • Gymnasts seeing flashing lights
  • Gymnasts feeling like they have “lost time”

Emergency symptoms of a concussion. Seek immediate medical care if there are:

  • Changes in alertness and consciousness
  • Convulsions (seizures)
  • Muscle weakness on one or both sides
  • Persistent confusion
  • Persistent unconsciousness (coma)
  • Repeated vomiting
  • Unequal pupils
  • Unusual eye movements
  • Problems walking

WARNING: Head injuries that result in concussion also often have related neck and back injuries. Anytime you have a gymnasts with a possible concussion, take particular care when moving them as they may also have a neck or back injury.

While recovering from a concussion, gymnasts may:

  • Be withdrawn, easily upset, or confused
  • Have a hard time with tasks that require remembering or concentrating
  • Have mild headaches
  • Be less tolerant of noise

Signs and Tests

The doctor will perform a physical exam and check your nervous system. There may be changes in your pupil size, thinking ability, coordination, and reflexes.

Tests that may be performed include:

  • EEG (brain wave test) may be needed if seizures continue
  • Head CT scan
  • MRI of the head

Treatment

A concussion with bleeding or brain damage must be treated in a hospital.

If the concussion occured during a meet and resulted in a headache, confusion, or change in alertness, a trained medical person must determine when that person can return to the competition.

Gymnasts with concussion symptoms should avoid all sports, especially contact sports, and from being overly active during recess, physical education classes and during other playtimes. Ask your doctor when your child can return to normal activities.

When can a gymnast safely return to normal activities?

It depends on the severity of the concussion. Some children may need to wait 1 to 3 months. Ask your gymnast’s doctor if it is okay before the gymnast participates in any activity where there is a risk of hitting or injuring the head. Specifically, ask when your gymnast can:

  • Participate in light gymnastics practice
  • Lift weights
  • Fully participate in gymnastics practice
  • Compete in gymnastics meets
  • Play contact sports, such as football, hockey, and soccer
  • Ride a bicycle, motorcycle, or off-road vehicle
  • Drive a car (if they are old enough and licensed)
  • Ski, snowboard, skate or do martial arts

Some organizations recommend that a child who had a concussion avoid all sports activities that could produce a similar head injury for the rest of the season. This is based on newly emerging, formerly unknown information about the long-term effects of concussions.  Ask your doctor.

Treatment for a concussion may include:

  • Acetaminophen (Tylenol) for a headache. Do NOT use aspirin, ibuprofen (Motrin or Advil), naproxen, or similar drugs.
  • Eat a light diet.
  • Avoid exercise, weight lifting, or heavy activities.
  • Light activity around the home is okay. You do not need to stay in bed.
  • Avoid alcohol until gymnast has completely recovered.
  • An adult should stay with the gymnast for the first 12 – 24 hours after the concussion. Going to sleep is okay. However, someone should wake the gymnast up every 2 or 3 hours for the at least the first 12 hours. They can ask a simple question, such as gymnast’s name, to look for any changes in the way the gymnast looks or acts.

Expectations and Prognosis

Healing and recovering from a concussion takes time. It may take days, weeks, or even months. Gymnasts may be irritable, have trouble concentrating, be unable to remember things, have headaches, dizziness and blurry vision. These problems will probably go away slowly. Gymnasts may want to get help from family or friends before making important decisions.

Complications

Complications from a concussion can include:

  • Bleeding in the brain
  • Brain injury that results in physical, emotional, or intellectual changes
  • Second impact syndrome (SIS) is when a person gets a second concussion while still having symptoms from a first one. This raises the risk for brain swelling, which can be deadly.

Call the doctor if:

  • A head injury causes changes in alertness or produces any other worrisome symptoms.
  • Symptoms do not go away or are not improving after 2 or 3 weeks, talk to your doctor.
  • Changes in behavior or unusual behavior
  • Changes in speech (slurred, difficult to understand, does not make sense)
  • Confusion
  • Difficulty waking up or becoming more sleepy
  • Double vision or blurred vision
  • Fever
  • Fluid or blood leaking from the nose or ears
  • Headache that is getting worse, lasts a long time, or does not get better with over-the-counter pain relievers
  • Problems walking or talking
  • Seizures
  • Vomiting more than three times

Prevention

Attention to safety, including the use of proper skill progression and proper equipment progresson reduces the risk of head injury.

SCAT for Gymnastics
The SCAT (Sport Concussion Assessment Tool) tool represents a standardized method of evaluating athletes after a possible concussion in gymnastics.

Signs of a concussive head injury include:

  1. Concussions can be caused by either a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.
  2. Concussion typically results in the rapid onset of short-lived impairment or neurological function that resolves spontaneously.
  3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
  4. Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  5. Concussion is typically associated with grossly normal structural neuroimaging studies.

Post Concussion Symptoms

Ask the athlete to score themselves based on how they feel now. It is recognized that a low score may be normal for some athletes, but clinical judgment should be exercised to determine if a change in symptoms has occurred following the suspected concussion event.

It should be recognized that the reporting of symptoms may not be entirely reliable. This may be due to the effects of a concussion or because the athlete’s passionate desire to return to competition outweighs their natural inclination to give an honest response.

If possible, ask someone who knows the athlete well about changes in affect, personality, behavior, etc.

Remember, concussion should be suspected in the presence of ANY ONE or more of the following:

  • Loss of consciousness
  • Headache
  • Memory loss (amnesia) of what happened before or immediately after the injury
  • Other memory problems
  • Nausea or vomiting
  • Altered level of consciousness (drowsy, hard to arouse, or similar changes)
  • Confusion, feeling spacey, or not thinking straight
  • Gymnasts seeing flashing lights
  • Gymnasts feeling like they have “lost time”

Any athlete with a suspected concussion should should not be left alone, should not drive a motor vehicle and be monitored for deterioration or other symptoms.

The SCAT Card (Sport Concussion Assessment Tool)

What is a concussion? A concussion is a disturbance in the function of the brain caused by a direct or indirect force to the head. It results in a variety of symptoms (like those listed below) and may, or may not, involve memory problems or loss of consciousness.

How do you feel? You should score yourself on the following symptoms, based on how you feel now.

Post Concussion Symptom Scale

Rate on a Scale
0-None 1 2 3-Moderate 4 5 6-Severe 6

  • Headache
  • “Pressure in head”
  • Neck Pain
  • Balance problems/dizzy
  • Nausea or vomiting
  • Vision problems
  • Hearing problems/ringing
  • “Don’’t feel right”
  • Feeling “dazed”
  • Confusion
  • Feeling slowed down
  • Feeling like “in a fog”
  • Drowsiness
  • Fatigue or low energy
  • More than emotional
  • Irritability
  • Difficulty concentrating
  • Difficulty remembering (follow up symptoms only)
  • Sadness
  • Nervous or anxious
  • Trouble falling asleep
  • Sleeping more than usual
  • Sensitivity to light
  • Sensitivity to noise
  • Other: ______________

What Should I Do?

Any athlete suspected of having a concussion should be removed from play, and told to seek medical evaluation.

Signs to Watch For:

Problems could arise over the first 24-48 hours. You should not be left alone and must go to a hospital at once if you:

  • Have a headache that gets worse
  • Are very drowsy or can’’t be awakened (woken up)
  • Can’’t recognize people or places
  • Have repeated vomiting
  • Behave unusually or seem confused; are very irritable
  • Have seizures (arms and legs jerk uncontrollably)
  • Have weak or numb arms or legs
  • Are unsteady on your feet; have slurred speech

Remember, it is better to be safe. Consult your doctor after a suspected concussion.

What Can I Expect?

Concussion typically results in the rapid onset of short-lived impairment that resolves spontaneously over time. You can expect that you will be told to rest until you are fully recovered (that means resting your body and your mind).

Then, your doctor will likely advise that you go through a gradual increase in exercise over several days (or longer) before returning to sport.

The SCAT Card (Sport Concussion Assessment Tool)

Medical Evaluation

Name: _______________________
Date: ________
Team: __________________

1) SIGNS

Was there loss of consciousness/unresponsiveness? Yes No
Was there seizure or convulsive activity? Yes No
Was there a balance problem / unsteadiness? Yes No
2) MEMORY
Questions (check if athlete answers correctly)
What gym are we at? ____
Which event are we on? ____
What did you score on the last event? ____
What skill did you fall on? ____:
Did you win a medal on this event at your last meet? ____
3) SYMPTOM SCORE
Total number of positive symptoms (from reverse side of the card) = _____
4) COGNITIVE ASSESSMENT (5 word recall)
(Examples) Immediate Delayed
Word 1 _____ cat ________ ________
Word 2 _____ pen ________ ________
Word 3 _____ shoe ________ ________
Word 4 _____ book ________ ________
Word 5 _____ car ________ ________
Months in reverse order:
Jun-May-Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sep-Aug-Jul
Digits Backwards (check correct)
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 delayed 5-word recall now
5) NEUROLOGIC SCREENING
Pass Fail Scoring
Speech  ____
Eye Motion and Pupils  ____
Pronator Drift  ____
Gait Assessment  ____
Any abnormalities in this neurological screen requires formal assessment at the hospital.

Instructions:

The side of the card is for the use of medical doctors, physical therapists, or athletic therapists. In order to maximize the information gathered from the card, it is strongly suggested that all athletes participating in contact sports complete a baseline evaluation prior to the beginning of their competitive season. This card is a suggested guide only for sports concussion and is not meant to assess more severe forms of brain injury.

Please give a COPY of this information to the gymnast and their parents for their information and for the follow-up assessment.

Signs:

Assess for each of these items and circle Yes or No.
Memory:
Select any 5 words (an example is given). Avoid choosing related words which can be recalled by means of word association. Read each word at a rate of one word per second. The gymnast should not be informed of the delayed testing of memory (to be done after the reverse months and/or digits). Choose a different set of words each time you perform another test with the same gymnast.

Concentration / Attention:

Ask the gymnast to recite the months of the year in reverse order, starting with a random month. Don’t start with December or January. Circle any months not recited in the correct sequence. For the backwards digits test, if correct, go to the next string length. If correct, go on and read trial 2. After incorrect responses on both trials, stop, the test is over.

Neurologic Screening:

Trained medical personnel must administer this portion of the examination.
These individuals might include medical doctors, physiotherapists or athletic therapists. Speech should be assessed for fluency and lack slurring. Eye motion should reveal no diplopia in any of the 4 planes of movement
(vertical, horizontal and both diagonal planes).

The pronator drift is performed by asking the patient to hold both arms in front of them, palms up, with eyes closed. A positive test is pronating the forearm, dropping the arm, or drift away from midline. For gait assessment ask the patient to walk away from you, turn and walk back.

RETURN TO PRACTICE AND COMPETITION

Gymnasts should not return to practice or competition the same day of the injury.

When returning athletes to play they should follow a step-by-step symptom-limited rehab program, with slow stages of progression. For example:

  1. Total rest (physical and mental rest) until symptoms disappear
  2. Light aerobic exercise (e.g stationary bicycle)
  3. Light gymnastics training where there is little-to-no risk of falls
  4. Can resume conditioning and light weight training)
  5. Full gymnastics training after medical clearance
  6. Return to competing in competitions

There should be approximately 24 hours (or longer) for each stage and the gymnast should return to stage 1 if symptoms recur.

Weight training should only be added in the later stages of recovery.

Medical clearance must be given before returning to practice and competition.

A structured progression for returning to full participation in gymnastics should be developed, individualized on the gymnast’s level in the sport, their age and their concussion history. Exercise or training should be begun only after the gymnast clearly demonstrates no further symptoms and after taking both physical and mental rest. The final decision for clearance to return to a competition should ideally be made by a medical doctor.

Notes:

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Download the SCAT Card for Gymnastics to keep available in the gym.

Download the Instructions for the SCAT Card for Gymnastics.

 

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