[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 |