F2878-C17733
C17733
Person completing form name
Name of person completing the form
NeuroRehab Supplemental-Highly Recommended
Stroop Test
True
NeuroRehab
NeuroRehab Comprehensive
F2865-C14835
C14835
Activities specific Balance Confidence Scale (ABC-Scale) - walk stairs scale
Using the Activities-specific Balance Confidence (ABC) Scale, the level of confidence that the participant/subject reports for being able to maintain balance and remain steady when walking up or down stairs
NeuroRehab Supplemental-Highly Recommended
Activities Specific Balance Confidence Scale (ABC-Scale)
True
NeuroRehab
NeuroRehab Comprehensive
F2861-C54465
C54465
Functional Gait Assessment (FGA) - Gait task stair score
Score for the subject/participant's performance walking up stairs for the Steps task, as part of the Functional Gait Assessment (FGA)
NeuroRehab Supplemental-Highly Recommended
Functional Gait Assessment
False
NeuroRehab
NeuroRehab Sport Related Concussion Comprehensive
F2863-C52376
C52376
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) - Fatigue scale
Scale that rates the severity of how the subject now suffers from fatigue and/or tiring more easily as compared with before the accident, as part of The Rivermead Post-Concussion Symptoms Questionnaire (RPQ)
NeuroRehab Supplemental-Highly Recommended
Rivermead Post-Concussive Symptoms Questionnaire (RPQ)
False
NeuroRehab
NeuroRehab Comprehensive
F2903-C20581
C20581
TBI Quality of Life (TBI-QOL) - Resilience T-score
The T-Score related to subjective experience of the process and outcome of successfully adapting to difficult or challenging life experiences, especially highly stressful or traumatic events, as part of the TBI Quality of Life (TBI-QOL)
NeuroRehab Supplemental-Highly Recommended
Traumatic Brain Injury - Quality of Life (TBI-QOL)
False
NeuroRehab
NeuroRehab Concussion/Mild TBI
F2902-C17371
C17371
Parkinson's Disease Quality of Life (PDQUALIF) - trouble stay asleep scale
Rating scale for trouble staying asleep as part of Parkinson's Disease Quality of Life (PDQUALIF) form
NeuroRehab Supplemental-Highly Recommended
Parkinson's Disease Quality of Life Scale (PDQUALIF)
True
NeuroRehab
NeuroRehab Comprehensive
F2861-C54449
C54449
Dynamic Gait Index (DGI) - Gait speed change task score
Score for the change in gait speed task, as part of the Dynamic Gait Index (DGI)
NeuroRehab Supplemental-Highly Recommended
Functional Gait Assessment
False
NeuroRehab
NeuroRehab Comprehensive
F2899-C09310
C09310
Apathy Scale (AS) - Energy scale
The scale related to the subject's energy levels, as part of the Apathy Scale (AS) form
NeuroRehab Supplemental-Highly Recommended
Apathy Scale (AS)
True
NeuroRehab
NeuroRehab Comprehensive
F2903-C20551
C20551
TBI Quality of Life (TBI-QOL) - Ability participate social role activity T-score
The T-Score related to degree of involvement in one's usual social roles, activities, and responsibilities, including work, family, friends, and leisure, as part of the TBI Quality of Life (TBI-QOL)
NeuroRehab Supplemental-Highly Recommended
Traumatic Brain Injury - Quality of Life (TBI-QOL)
False
NeuroRehab
NeuroRehab TBI Epidemiology
F2942-C58875
C58875
Therapy or rehabilitation received status other text
The free-text field related to 'Therapy or rehabilitation received status' specifying other text. Status of therapy or rehabilitation services received by the participant/subject
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab General
F2898-C07006
C07006
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill indicator
Indicator for whether the participant/subject has ever used any sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST)
NeuroRehab Supplemental-Highly Recommended
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
False
NeuroRehab
NeuroRehab Comprehensive
F2901-C09956
C09956
World Health Organization Quality of Life (WHOQOL-BREF) - form assistance indicator
Indicator of whether someone helped the participant filled out the questionnaire, as part of the World Health Organization Quality of Life (WHQOL-BREF) questionnaire
NeuroRehab Supplemental-Highly Recommended
World Health Organization Quality of Life Assessment (WHOQOL-BREF)
True
NeuroRehab
NeuroRehab Comprehensive
F2942-C58498
C58498
Transfer transportation device type other text
Text describing the presence of any other transfer/transportation device used
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab Comprehensive
F2895-C11860
C11860
Frontal Behavioral Inventory (FBI) - excessive jocularity score
The score the caregiver gives for the participant's/subject's excessive jocularity, as part of the Frontal Behavioral Inventory (FBI) form
NeuroRehab Supplemental-Highly Recommended
Frontal Behavioral Inventory (FBI)
True
NeuroRehab
NeuroRehab General
F2898-C07051
C07051
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis concern indicator
Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST)
NeuroRehab Supplemental-Highly Recommended
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
False
NeuroRehab
NeuroRehab General
F2939-C06060
C06060
Pain location indicator
Indicates if the participant experienced pain in the particular location described jointly by the laterality and anatomic site
NeuroRehab Supplemental-Highly Recommended
Assessments and Examinations Demographic and Clinical Conditions
False
NeuroRehab
NeuroRehab General
F2877-C56282
C56282
NIH Toolbox Cognitive Cognition crystallized composite fully adjusted scale score
The fully adjusted scale score for the Cognition Crystallized Composite field of the NIH Toolbox Cognitive Battery
NeuroRehab Supplemental-Highly Recommended
NIH Toolbox Cognitive Battery
False
NeuroRehab
NeuroRehab General
F2942-C58484
C58484
Dynamic lower extremity stretch orthosis splint use frequency type
Frequency type with which the participant/subject uses their dynamic lower extremity stretching orthosis/splints, if applicable
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab General
F2891-C20429
C20429
Beck Depression Inventory II (BDI-II) - Suicidal thought wish scale
Scale identifying level of suicidal thoughts or wishes, as part of the Beck Depression Inventory II (BDI-II)
NeuroRehab Supplemental-Highly Recommended
Beck Depression Inventory II (BDI-II)
True
NeuroRehab
NeuroRehab General
F2896-C21080
C21080
Frontal Systems Behavior Scale (FrSBE) - Disinhibition subscale T score
T score for Disinhibition subscale as part of Frontal Systems Behavior Scale (FrSBE)
NeuroRehab Supplemental-Highly Recommended
Frontal Systems Behavioral Scale (FrSBe)
True
NeuroRehab
NeuroRehab General
F2873-C54251
C54251
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) - Semantic fluency total score
Total score, as part of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Semantic Fluency Subtest
NeuroRehab Supplemental-Highly Recommended
Repeatable Battery for Assessment of Neuropsychological Status (RBANS)
True
NeuroRehab
NeuroRehab Comprehensive
F2879-C20465
C20465
Brief Visuospatial Memory Test - Revised (BVMT-R) - Delayed recall T-score
T-score for Delayed Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R)
NeuroRehab Supplemental-Highly Recommended
Brief Visuospatial Memory Test Revised (BVMT-R)
True
NeuroRehab
NeuroRehab Comprehensive
F2942-C21655
C21655
Back brace frequency type
Describes how long the participant/subject wears the body jacket/back brace/TSLO
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab Comprehensive
F2886-C10304
C10304
Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem depress indicator
Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem depresses me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL)
NeuroRehab Supplemental-Highly Recommended
Quality of Life in Swallowing Disorders (SWAL-QOL)
True
NeuroRehab
NeuroRehab General
F2895-C11847
C11847
Frontal Behavioral Inventory (FBI) - inflexibility score
The score the caregiver gives for the participant's/subject's inflexibility, as part of the Frontal Behavioral Inventory (FBI) form
NeuroRehab Supplemental-Highly Recommended
Frontal Behavioral Inventory (FBI)
True
NeuroRehab
NeuroRehab Comprehensive