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Post-Concussion Symptom Scale Guide

This document is a post-concussion symptom scale used to rate the severity of common concussion symptoms such as headache, nausea, dizziness, sensitivity to light and noise, sleep issues, and cognitive problems like difficulty concentrating and remembering. Patients are asked to rate each symptom on a scale from 0 to 6 for none to severe over multiple dates to track recovery progress. The scale totals the severity ratings to assess overall symptom burden.

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Phoenix
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130 views1 page

Post-Concussion Symptom Scale Guide

This document is a post-concussion symptom scale used to rate the severity of common concussion symptoms such as headache, nausea, dizziness, sensitivity to light and noise, sleep issues, and cognitive problems like difficulty concentrating and remembering. Patients are asked to rate each symptom on a scale from 0 to 6 for none to severe over multiple dates to track recovery progress. The scale totals the severity ratings to assess overall symptom burden.

Uploaded by

Phoenix
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ConcussionManagement.

com

Post-Concussion Symptom Scale


Patient's Name: _________________________________________
Date of Birth: __________________

Please use the following scale to rate each symptom:

None Mild Moderate Severe


0 1 2 3 4 5 6
SYMPTOMS SEVERITY RATING
Date: Date: Date: Date: Date: Date: Date:

Headache
Nausea
Vomiting
Balance Problems
Dizziness (spinning or movement sensation)
Lightheadedness
Fatigue
Trouble falling asleep
Sleeping more than usual
Sleeping less than usual
Drowsiness
Sensitivity to light
Sensitivity to noise
Irritability
Sadness
Nervous/ Anxious
Feeling more emotional
Numbness or tingling
Feeling slowed down
Feeling like "in a fog"
Difficulty concentrating
Difficulty remembering
Visual problems
Other

Total

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