Research published by a group of Concussion Center faculty members shows that the Sport Concussion Assessment Tool-5th edition (SCAT-5) can be sorted into five groups to explain most concussion symptoms.

Led by Dr. Bara Alsalaheen, associate professor of Physical Therapy in the College of Health Sciences at University of Michigan-Flint, the team examined nearly 1,000 patient charts of adolescent boys and girls (ages 13-18) to come up with five groups of concussion symptoms, or “factors,” seen in the clinical setting following a sport-related concussion.

The findings, published in the Clinical Journal of Sports Medicine article “Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion,” define the factors as Energy, Mental Heath, Migrainous, Cognitive, and Vestibulo-Ocular. This five-factor structure model explained 61% of the variance in concussion symptoms. 

The factors were consistent between the sexes.

According to Matt Lorincz, a co-author of the article who also serves as the co-director of Michigan NeuroSport and co-associate director of the Concussion Center’s Clinical Core, the SCAT5 symptom scale contains 22 items that measure important concussion symptoms. “There are the items in it, like headache, dizziness, that have a tendency not to be specific to what’s going on with the patient,” he explained.

The group used factor analysis, a statistical method that clusters large quantities of data into similar groups, identifying five categories of common symptoms reported by concussed patients in a clinical setting.

He added this five-factor model validated their clinical thinking and that primary care physicians or general sport medicine offices could use this to help identify treatment areas.

“For instance, if someone was having problems with the vestibular-ocular factor, and we did the analysis and saw that those [vestibular-ocular factors] were scoring high, that would highlight the need for additional vestibular therapy to provide a more individualized treatment plan,” Lorincz said.

He also thinks the factor structure and concussion phenotypes can be used in aiding concussion recovery and help inform the patient about what to expect during their recovery.

“I think that’s important for people. The unknown has a tendency to drive symptoms. If we can tell people, ‘Hey, based on previous experience with this factor analysis, you’re likely to have a very normal recovery,’ I think that can be very reassuring and help recovery,” Lorincz said.  

According to Lorincz, this study was one of the first examples of research published using the University of Michigan Concussion Learning Health System (CLHS) data. The CLHS is concussion-specific electronic medical records that serve as standardized evaluation and treatment platforms. These records have the potential to offer real-time feedback and allow for individualized patient management. 

According to Lorincz, the study’s next step is to dig further into these five factors and see the degree to which patients are expressing them and how that relates to concussion recovery.