Being Mindful: Cleveland Clinic Concussion iPad App

Mar 12

By Amanda Schuller, DPT, Bedford Center


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A concussion can result from a blow or hit to the head that causes damage and chemical changes inside the brain. A concussion may present differently in patients depending on the cause and severity of the injury.


Signs and symptoms, which can last days to months, include headache, dizziness, nausea, visual changes, feeling off balance, sensitivity to light or noise, not feeling like yourself, fatigue and difficulty concentrating.

 Concussion assessments can take a variety of forms. One of the latest assessments is the Cleveland Clinic Concussion (C3) iPad app for evaluating concussion-like symptoms. Within a 30-minute testing session, the C3 app assesses balance, reaction time, cognition, vision and memory within seven subsections. It can be used readily in the clinic or for on-field assessments at sporting events.


The seven subsections within the application are:

1) Scat 2 assesses symptoms on a scale of 0 (best) to 6 (worst), including the ability to say numbers and months in the reverse order in which they are given.

2) Bess evaluates balance in three different scenarios on even and uneven surfaces with eyes closed. The examiner scores all errors during each testing position and records for retesting.

3) Trail Making A&B assesses your attention by connecting dots in numerical order on the iPad. The second part of the test includes connecting dots in numerical/alphabetical order (example: 1A2B3C)

4) Simple Reaction Time assesses quickness in the ability to touch a light above the hold button on the iPad when it turns from yellow to green.

5) Choice Reaction Time assesses the ability to process information by keeping index fingers on the left and right hold buttons under the blue light on the iPad. The objective is to touch the green light with the index finger below and keep the opposite index finger on the hold button.

6) Cognitive Assessment Profile assesses brain function when using a key to match symbols with their respective numbers on the key.

7) Static and Dynamic Acuity assesses visual deficits with and without head movement; specifically, recognizing five letters in a single row while moving head from side to side.

The C3 app combines assessments for systems that may be affected after a head injury. While assessing all components, a healthcare professional is able to make a better decision regarding severity of injury or return to activity.


C3 Application Instruction Manual. Cleveland, Ohio.