Version June 2024
| [SCAT-listed symptoms in bold] Instructions: Please rate each symptom from 0 (none) to 6 (severe). If how you feel today is different from how you felt prior to your injury, place a check mark ✓ next to your score. | |||||
| Domain
| Symptom | Date of assessment: | Date of assessment: | Date of assessment: | Date of assessment: |
| Cognitive | Memory problems/ forgetfulness | ||||
| Confusion | |||||
| Feeling in a fog | |||||
| Feeling slowed down | |||||
| Don't feel right | |||||
| Poor concentration/ distracted | |||||
| Difficulty staying on task | |||||
| Speech problems | |||||
| Headache/migraine | Headaches | ||||
| Pressure in head | |||||
| Photophobia/light sensitivity | |||||
| Nausea/vomiting | |||||
| Ocular/oculomotor | Blurred vision | ||||
| Difficulty with visual activities | |||||
| Difficulty judging distances | |||||
| Double vision | |||||
| Eye pain/fatigue | |||||
| Vestibular | Dizziness or vertigo | ||||
| Balance problems | |||||
| Motion sensitivity | |||||
| Nausea/vomiting | |||||
| Fogginess | |||||
| Mood/anxiety | Sadness | ||||
| Anxiety or nervousness | |||||
| Tearfulness/ emotionality | |||||
| Irritability | |||||
| Mood swings | |||||
| Shakiness/tremors | |||||
| Panic | |||||
| Explosive anger/aggression | |||||
| Impulsive behavior | |||||
| Sleep disturbance/ fatigue | Trouble falling asleep | ||||
| Drowsiness | |||||
| Fatigue | |||||
| Waking up in middle of night | |||||
| Restless sleep | |||||
| Excessive sleep | |||||
| Cervical/ cervicogenic | Neck pain or pressure | ||||
| Stiff neck/restricted movement | |||||
| Occipital/suboccipital headache | |||||
| Other symptoms | Fainting/near fainting | ||||
| Lack of sweating/night sweats | |||||
| Increased heart rate triggers symptoms | |||||
| Exercise intolerance | |||||
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
