Clinical Domains

The 5th International Consensus (Berlin 2016) states that a suspected diagnosis of SRC can include one or more of the following clinical domains:

a. Symptoms:

somatic (e.g,, headache),

cognitive (eg, feeling like in a fog),

sleep, and/or

emotional symptoms (e.g., lability)

c. Balance impairment (e.g., gait unsteadiness)

d. Behavioral changes (e.g., irritability)

e. Cognitive changes (e.g., slowed reaction times, difficulty learning)

f. Sleep/wake disturbance (e.g., somnolence, drowsiness)

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	Clinical Domains
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Symptom Clusters

young athlete talking to medical professional: "I’m so edgy. If I could just sleep, or my headache would lay off . . . I canâ€™t think."

A young person probably won't tell you, "I've had a concussion!" But the symptoms he or she reports just might.

When a youth has suffered a concussion, he or she can experience clusters of symptoms from any or all of the categories identified in the Berlin statement. Your patient may report symptoms from any of these symptom clusters:

Somatic / Physical (such as headache).

Cognitive (such as feeling in a fog).

Emotional (such as being irritable over nothing, unusually unemotional or non-reactive).

Sleep-related (such as being unable to sleep).

Physical Signs

Physical signs of a concussion may or may not be present. Whether a youth mentions them or not, you or others may observe signs such as:

Loss of consciousness (LOC).

Amnesia.

Balance issues.

young athlete being examined by medical professional who thinks, "He can’t tell me how he got from the playing field to here."

Behavior Changes

young athlete being examined by medical professional who thinks, "Wow, this child goes ballistic over nothing!"

Even in a young person you have not met before, you may observe behavioral signs of concussion, such as extreme irritability. Questioning the youth and the family or coaching staff will help confirm a change in temperament with a sudden onset, which may signal a concussion.

Speech tone or pattern changes
Doesn’t seem “like self”
Atypical reactions

Cognitive Impairment

It’s important to watch for cognitive signs of a concussion, especially since the young person may be unaware he or she is having trouble. For example, as you spend time with the young person, you may notice slowed reaction time or difficulty concentrating. These problems may signal cognitive impairment resulting from a concussion.

Post traumatic amnesia: anterograde, retrograde.
Unusually distractible or forgetful.
Does not recognize familiar people.

young athlete being examined by medical professional who thinks, "He is cooperative, but there"s a lag of seconds before he complies."

Sleep Disturbance

young athlete being examined by medical professional who thinks, "The parent says this child is usually really active, but now she can’t keep her eyes open, even at meals."

Sleep-related signs of a concussion, such as drowsiness, may be observable. Any disruption of the normal sleep pattern can indicate a concussion has occurred.

Sleeps more
Increased latency
Frequent wakings
Fatigue