Run Concussion Rehabilitation Assessment — Free

Assessment Details

Assessment type

Identify whether this is a baseline, acute, follow-up, or clearance-related assessment.

Days since injury

Enter the number of days since the suspected or confirmed concussion event.

Assessment setting

Document where the assessment was performed.

Baseline comparison available

Indicate whether pre-injury baseline testing or prior assessment results are available for comparison.

Yes No N/A

Relevant prior concussion history documented

Confirm whether prior concussion history and recovery pattern have been reviewed.

Yes No N/A

Symptom Burden

Overall symptom severity score critical (required)

Record the total symptom severity score using the clinic's chosen concussion symptom scale.

Note (optional)

Number of symptoms reported

Record the total number of symptoms currently reported by the patient.

Headache severity critical (required)

Rate headache severity during the assessment.

Dizziness or balance-related symptom severity critical (required)

Rate dizziness, vertigo, or imbalance symptoms.

Light sensitivity severity

Rate photophobia or light sensitivity symptoms.

Noise sensitivity severity

Rate phonophobia or noise sensitivity symptoms.

Balance and Vestibular Screening

Single-leg stance maintained without loss of balance critical (required)

Observe whether the patient can maintain single-leg stance for the clinic-defined duration without stepping, swaying excessively, or requiring support.

Yes No N/A

Tandem gait performed without deviation critical (required)

Assess whether tandem gait is completed without stepping off line, pausing, or needing assistance.

Yes No N/A

Romberg stance stability

Rate postural stability during Romberg stance or equivalent balance testing.

Vestibular symptom provocation during testing critical (required)

Indicate whether balance or head-movement testing provoked dizziness, nausea, blurred vision, or symptom worsening.

Yes No N/A

Gait observed as normal and safe

Confirm whether gait is steady, safe, and appropriate for the environment without assistive support.

Yes No N/A

Cognitive Screening

Orientation intact critical (required)

Confirm orientation to person, place, time, and situation.

Yes No N/A

Immediate recall performance

Record the number of words or items correctly recalled immediately, based on the selected screening tool.

Attention and concentration adequate for screening critical (required)

Indicate whether the patient could sustain attention and complete cognitive tasks without excessive prompting or distraction.

Yes No N/A

Delayed recall performance

Record delayed recall results using the clinic's chosen cognitive screening method.

Cognitive symptoms worsened during screening critical (required)

Document whether screening triggered headache, fogginess, slowed thinking, or other symptom worsening.

Yes No N/A

Return-to-Activity Readiness

Symptoms at rest are minimal or absent critical (required)

Confirm whether symptoms at rest are minimal enough to support progression in the return-to-activity plan.

Yes No N/A

Symptoms do not worsen with light activity critical (required)

Indicate whether the patient tolerated light physical or cognitive activity without symptom exacerbation.

Yes No N/A

Return-to-activity recommendation critical (required)

Select the current recommendation based on symptoms, balance, and cognitive findings.

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Run: Concussion Rehabilitation Assessment

Assessment Details

Symptom Burden

Balance and Vestibular Screening

Cognitive Screening

Return-to-Activity Readiness

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