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  • RTL Symptom Log Progress Monitoring

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    This document is a concussion symptom log used to monitor symptoms over time on a scale of 0-6. It tracks cognitive, physical, emotional, and sleep symptoms related to a concussion over multiple dates following the injury. The log allows patients and medical professionals to track the presence and severity of common concussion symptoms to monitor recovery progress.

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    This document is a concussion symptom log used to monitor symptoms over time on a scale of 0-6. It tracks cognitive, physical, emotional, and sleep symptoms related to a concussion over multiple dates following the injury. The log allows patients and medical professionals to track the presence and severity of common concussion symptoms to monitor recovery progress.

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    © All Rights Reserved
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    69 views1 page

    RTL Symptom Log Progress Monitoring

    Uploaded by

    api-651653241
    This document is a concussion symptom log used to monitor symptoms over time on a scale of 0-6. It tracks cognitive, physical, emotional, and sleep symptoms related to a concussion over multiple dates following the injury. The log allows patients and medical professionals to track the presence and severity of common concussion symptoms to monitor recovery progress.

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    © All Rights Reserved
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    of 1

    Concussion Symptom Log—Progress Monitoring

    Rate on 0-6 intensity scale


    0=not present, 1-2=mild, 3-4=moderate, 5=moderately severe, 6=severe

    DATE DATE DATE DATE DATE DATE DATE DATE DATE


    Symptoms Day of
    Injury
    Cognitive
    Difficulty thinking
    clearly
    Difficulty
    concentrating
    Difficulty
    remembering
    Feeling slowed
    down
    Feeling sluggish
    or hazy

    Physical
    Headache
    Nausea
    Vomiting
    Balance Problems
    Dizziness
    Fatigue
    Vison changes
    Sensitive to noise
    Sensitive to light
    Numbness or
    tingling
    Weakness in
    extremities
    Neck pain

    Emotional
    Irritability
    Sadness
    More emotional
    than usual
    Nervous

    Sleep
    Sleeping more
    than usual
    Sleeping less than
    usual
    Drowsiness

    Adapted from: Nationwide Children’s Hospital. A School Adminitrator’s Guide to Academic Concussion Management

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