The Practice Parameter of the American Academy of Neurology for Concussion in Sports describe a sideline evaluation protocol for athletes who have had a head injury. If findings persist for more than 1 hour or if any loss of consciousness occurs, then medical observation and repeat monitoring are indicated.



(1) review of signs and symptoms

(2) mental status testing for orientation, concentration and memory

(3) external provocative tests

(4) neurologic examination of pupils, coordination and sensation


Frequently encountered findings in athletes with concussion:

(1) vacant stare, befuddled facial expression

(2) delayed verbal and motor responses, slow to answer questions, slow to follow instructions

(3) confusion and inability to focus attention, easily distracted, unable to complete normal activities

(4) disoriented, walking in wrong direction, unaware of place or time

(5) slurred or incoherent speech

(6) gross observable incoordination, unsteadiness

(7) emotions out of proportion to circumstances, emotional lability

(8) memory deficit, repeating questions already asked

(9) loss of consciousness


Early symptoms (minutes and hours)

(1) headache

(2) dizziness or vertigo

(3) lack of awareness for surroundings

(4) nausea or vomiting

(5) photophobia

(6) blurred or double vision


Mental status testing for orientation:

(1) time

(2) place

(3) person

(4) circumstances of the injury


Mental status testing for concentration:

(1) ability to repeat a string of 3 numbers backwards

(2) ability to repeat a string of 4 numbers backwards

(3) ability to repeat a string of 5 numbers backwards

(4) ability to repeat the months of the year in reverse order


Mental status testing for memory:

(1) names of teams in prior contests

(2) recall of 3 words at 0 and 5 minutes

(3) recall of 3 objects at 0 and 5 minutes

(4) recent newsworthy events

(5) details of the current contest (plays, moves, strategies, scores, etc.)


External provocative tests: abnormal if the test induces any of the signs or symptoms associated with concussion (see list above):

(1) 40 yard sprint

(2) 5 push ups

(3) 5 sit ups

(4) 5 knee bends


Neurologic examination:

(1) pupils: symmetry and reactivity

(2) coordination: finger-nose-finger, tandem gait

(3) sensation: finger-nose with eyes closed, Romberg (unsteadiness of gait with eyes open or closed)


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