F2896-C21039
C21039
Frontal Systems Behavior Scale (FrSBE) - Appearance grooming interest frequency scale
Frequency of caring about his/her appearance (for example, daily grooming) as part of Frontal Systems Behavior Scale (FrSBE) - Apathy subscale
NeuroRehab Supplemental-Highly Recommended
Frontal Systems Behavioral Scale (FrSBe)
True
NeuroRehab
NeuroRehab General
F2863-C52362
C52362
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) - Poor concentration scale
Scale that rates the severity of how the subject now suffers from poor concentration 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 Acute Sport Related Concussion
F2900-C08504
C08504
36-item Short Form Health Survey (SF-36) - Health limited moderate activities score
Score of surveyee-reported limited moderate activities due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36)
NeuroRehab Supplemental-Highly Recommended
Short Form 36-Item Health Survey (SF-36)
True
NeuroRehab
NeuroRehab General
F2942-C58495
C58495
Toilet device type
Type for all toileting devices currently used by the participant/subject
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab General
F2869-C53774
C53774
Wide Range Achievement Test 4 (WRAT-4) - Word reading item 12 text
The word used for Word Reading item 12, as part of Wide Range Achievement Test 4 (WRAT-4)
NeuroRehab Supplemental-Highly Recommended
Word Reading Subtest of the Wide Range Achievement Test (WRAT-4)
True
NeuroRehab
NeuroRehab Comprehensive
F2903-C20584
C20584
TBI Quality of Life (TBI-QOL) - Stigma T-score
The T-Score related to others' perceptions of oneself and publically enacted negativity, prejudice, and discrimination as a result of injury-related manifestations, 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 Moderate/Severe TBI: Rehabilitation
F2894-C09361
C09361
Hamilton Depression Rating Scale (HDRS) - somatic symptoms indicator
Score for the intensity of the participant/subject's somatic gastrointestinal symptoms, as part of the Hamilton Depression Rating Scale (HDRS)
NeuroRehab Supplemental-Highly Recommended
Hamilton Depression Rating Scale (HDRS)
False
NeuroRehab
NeuroRehab General
F2917-C55618
C55618
PROMIS - Emotional Distress depression no reason for living scale
Scale related to the individual feeling he/she had no reason for living, as part of the PROMIS Emotional Distress Depression
NeuroRehab Supplemental-Highly Recommended
PROMIS Item Bank v1.0 - Emotional Distress - Depression (Calibrated Items)
False
NeuroRehab
NeuroRehab Comprehensive
F2898-C07072
C07072
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total c score
Score for the total sum of all the question C scores (cannabis), 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
F2942-C56952
C56952
Crutch use type
Type of crutches which the participant/subject uses, if applicable
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab Comprehensive
F2863-C52362
C52362
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) - Poor concentration scale
Scale that rates the severity of how the subject now suffers from poor concentration 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 Concussion/Mild TBI
F2902-C17364
C17364
Parkinson's Disease Quality of Life (PDQUALIF) - communication ability scale
Rating scale for ability of communication with people affected by illness 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 Parkinson's Disease
F2861-C54460
C54460
Functional Gait Assessment (FGA) - Gait task eye closed score
Score for the subject/particpant's performance on the Gait With Eyes Closed task, as part of the Functional Gait Assessment (FGA)
NeuroRehab Supplemental-Highly Recommended
Functional Gait Assessment
False
NeuroRehab
NeuroRehab Comprehensive
F2889-C07440
C07440
Patient Health Questionnaire - (PHQ) - Depression questionnaire total score
Total score of the questionnaire, as the part of Patient Health Questionnaire Depression (PHQ)
NeuroRehab Supplemental-Highly Recommended
Patient Health Questionnaire - 9 (PHQ-9) Depression Scale
True
NeuroRehab
NeuroRehab Comprehensive
F2914-C20819
C20819
Patient-Reported Outcome Measurement Information System (PROMIS) - Physical tense bedtime assessment past week scale
The scale which represents how often the participant felt physically tense at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS)
NeuroRehab Supplemental-Highly Recommended
PROMIS Item Bank v1.0 - Sleep Disturbance
True
NeuroRehab
NeuroRehab Congenital Muscular Dystrophy (CMD)
F2896-C21092
C21092
Frontal Systems Behavior Scale (FrSBE) - Missing answer total count
Total count of unanswered or missing questions as part of Frontal Systems Behavior Scale (FrSBE) form
NeuroRehab Supplemental-Highly Recommended
Frontal Systems Behavioral Scale (FrSBe)
True
NeuroRehab
NeuroRehab Comprehensive
F2939-C18667
C18667
Data source other text
The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form
NeuroRehab Supplemental-Highly Recommended
Assessments and Examinations Demographic and Clinical Conditions
False
NeuroRehab
NeuroRehab Comprehensive
F2899-C17769
C17769
Rater name
Name of rater
NeuroRehab Supplemental-Highly Recommended
Apathy Scale (AS)
True
NeuroRehab
NeuroRehab General
F2942-C21652
C21652
Elbow wrist orthosis type
Type of elbow or wrist orthosis the participant/subject uses
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab General
F2886-C10311
C10311
Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem changed activities indicator
Scale assessing how true the following statement has been for the participant during the last month: My usual work or leisure activities have changed because of my swallowing problem. 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 Comprehensive
F2910-C55333
C55333
PROMIS - Negative consequences trouble trusting people when drink scale
Scale related to an individual having trouble trusting other people when he/she drank, as part of the PROMIS Negative Consequences
NeuroRehab Supplemental-Highly Recommended
PROMIS Item Bank v1.0 - Alcohol: Negative Consequences
False
NeuroRehab
NeuroRehab Stroke
F2893-C09354
C09354
Hamilton Anxiety Rating Scale (HAM-A) - gastrointestinal symptom score
The score of the participant's/subject's gastrointestinal symptoms, as part of the Hamilton Anxiety Rating Scale (HAM-A) form.
NeuroRehab Supplemental-Highly Recommended
Hamilton Anxiety Rating Scale (HAM-A)
False
NeuroRehab
NeuroRehab Comprehensive
F2916-C20774
C20774
Patient-Reported Outcome Measurement Information System (PROMIS) - Alter normal routine anxiety assessment past week scale
The scale which represents how often the participant was anxious if his normal routine was disturbed in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS)
NeuroRehab Supplemental-Highly Recommended
PROMIS Item Bank v1.0 - Emotional Distress - Anxiety
True
NeuroRehab
NeuroRehab General
F2942-C18183
C18183
Wheelchair driven subject indicator
Indicator for whether the power wheelchair is driven by the participant/subject
NeuroRehab Supplemental-Highly Recommended
Devices: Mobility and Manipulation
False
NeuroRehab
NeuroRehab Comprehensive
F2880-C52957
C52957
Hopkins Verbal Learning Test Revised (HVLT-R) - Delayed recall raw score
The raw score for Delayed Recall, as part of the Hopkins Verbal Learning Test Revised (HVLT-R)
NeuroRehab Supplemental-Highly Recommended
Hopkins Verbal Learning Test - Revised (HVLT-R)
True
NeuroRehab
NeuroRehab General