CDE Detailed Report

Disease: Friedreich's Ataxia
Sub-Domain: Activities of Daily Living/Performance
CRF: Activities of Daily Living and Gait

Displaying 1 - 35 of 35
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C10714 Walker use indicator WalkerUseInd Indicator whether the participant/subject uses a walker Indicator whether the participant/subject uses a walker Indicate if participant/subject uses a walker. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Canine assistance use indicator"

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10693 Swallowing level status SwallowingLvlStatus Status that reflects the participant's/subject's current level of swallowing ability Status that reflects the participant's/subject's current level of swallowing ability Indicate the description that reflects the participant's/ subject's current level of swallowing. Normal;Rare choking;Frequent choking;Requires modified food or chokes multiple times a week or avoids certain foods;Requires NG tube or gastrostomy feedings Normal;Rare choking (less than once a month);Frequent choking (less than once a week, greater than once a month);Requires modified food or chokes multiple times a week or avoids certain foods;Requires NG tube or gastrostomy feedings Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C17517 Wheelchair bound age indicator WheelchairBoundAgeInd Indicator used related to age of participant/subject permanently bound to a wheelchair Indicator used related to age of participant/subject permanently bound to a wheelchair If participant/subject is permanently bound to the wheelchair, indicate age of participant when first permanently bound to wheelchair. Unknown Unknown Alphanumeric

Check Unknown if age is not known.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10704 Walking difficulty age others noticed value WalkDfficltyAgeOthersNoticeVal Age when other people first noticed the participant's/subject's gait disturbances Value of the participant/subject's age at which other people first noticed her or his gait disturbances If participant/subject walks with some difficulties or with difficulty, indicate age when other people noticed gait disturbances. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10715 Walker use age started value WalkerUseStrtAgeVal Age of the participant/subject when he/she began using a walker Value of participant/subject's age at which he/she began using a walker If yes to walking, indicate age participant/subject began using a walker. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10694 Cutting food or use of items functioning level status CutUseFunctionLvlStatus Status that reflects the participant's/subject's current level of functioning for cutting food or use of items Status that reflects the participant's/subject's current level of functioning for cutting food or use of items Indicate the description that reflects the participant's/ subject's current level of functioning for cutting food/use of items. Normal;Somewhat slow and clumsy, but no help needed;Clumsy and slow, but can cut most foods with some help needed or needs assistance when in a hurry;Food must still be cut by someone, but can still feed self slowly;Needs to be fed Normal;Somewhat slow and clumsy, but no help needed;Clumsy and slow, but can cut most foods with some help needed or needs assistance when in a hurry;Food must still be cut by someone, but can still feed self slowly;Needs to be fed Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C18153 Data unknown text DataUnknwnTxt The free-text field to Mark an "X" in to record if data are unknown or not available. The free-text field to Mark an "X" in to record if data are unknown or not available. Or data. Unknown Alphanumeric

If age unknown, leave age blank and check Unknown.

No references available Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points 20

Free-Form Entry

C10705 Walking difficulty age interfered with activities value WalkDffcltyAgeIntrfereActivVal Age of participant/subject when difficulty with walking interfered with activities Value of the participant/subject's age when difficulty with walking first interfered with activities If participant/subject walks with difficulty, indicate age when difficulty with walking interfered with activities. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10716 Canine assistance use indicator CanineAssistanceUseInd Indicator whether the participant/subject uses canine assistance for walking Indicator whether the participant/subject uses canine assistance for walking Indicate if participant/subject uses canine assistance. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Wheelchair use indicator"

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10695 Dressing level status DressingLvlStatus Status that reflects the participant's/subject's current level of dressing ability Status that reflects the participant's/subject's current level of dressing ability Indicate the description that reflects the participant's/subject's current level of dressing. Normal;Somewhat slow, but no help needed;Occasional assistance with buttoning, getting arms in sleeves, etc. or has to modify activity in some way;Considerable help required but can do some things alone;Helpless Normal;Somewhat slow, but no help needed;Occasional assistance with buttoning, getting arms in sleeves, etc. or has to modify activity in some way (e.g. having to sit to get dressed, use Velcro for shoes, stop wearing ties, etc.);Considerable help required but can do some things alone;Helpless Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10706 Walking difficulty age support first needed value WlkDffcltyAgeNdIntrmitSuprtVal Age of participant/subject when intermittent support first needed for walking Value of participant/subject's age at which she or he first needed intermittent support for walking If participant/subject needs intermittent support for walking, indicate age of participant when support first needed. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10717 Canine assistance use age started value CanineAssistanceUseStrtAgeVal Age of the participant/subject when he/she began using canine assistance Value of the participant/subject's age at which he/she began using canine assistance for walking If yes to canine assistance, indicate age participant/subject began using canine assistance. Numeric Values

Answer should be recorded in years.

No references available Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10696 Personal hygiene level status PrsnalHygieneLvlStatus Status that reflects the participant's/subject's current level of personal hygiene Status that reflects the participant's/subject's current level of personal hygiene Indicate the description that reflects the participant's/subject's current level of personal hygiene. Normal;Somewhat slow, but no help needed;Very slow hygiene care or has need for devices such as special grab bars, tub bench, shower chair, etc.;Requires personal help with washing, brushing teeth, combing hair or using toilet;Fully dependent Normal;Somewhat slow, but no help needed;Very slow hygiene care or has need for devices such as special grab bars, tub bench, shower chair, etc.;Requires personal help with washing, brushing teeth, combing hair or using toilet;Fully dependent (bed-bound) Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10707 Walking difficulty age permanent support started value WlkDffcltyAgeNeedPermSuportVal Age of participant/subject when permanent support first needed walking Value of participant/subject's age at which she or he first needed permanent support for walking If participant/subject needs permanent support for walking, indicate age of participant when support first needed. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10718 Wheelchair use indicator WheelchairUseInd Indicator whether the participant/subject uses a wheelchair Indicator whether the participant/subject uses a wheelchair Indicate if the participant/subject uses a wheelchair. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Walking other assistive device use indicator"

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10697 Fall rate FallRate Rate that reflects the participant's/subject's current frequency of falling Rate that reflects the participant's/subject's current frequency of falling Indicate the description that reflects the participant's/subject's current rate of falls. Normal;Rare falling;Occasional falls;Falls multiple times a week or requires device to prevent falls;Unable to stand Normal;Rare falling (less than once a month);Occasional falls (once a week to once a month);Falls multiple times a week or requires device to prevent falls;Unable to stand Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10708 Wheelchair bound age value WheelchairBoundAgeVal Age of participant/subject when first permanently bound to wheelchair Value of participant/subject's age at which she or he was permanently bound to a wheelchair If participant/subject is permanently bound to the wheelchair, indicate age of participant when first permanently bound to wheelchair. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10719 Wheelchair use age started value WheelchairUseStrtAgeVal Age of the participant/subject when he/she began using a wheelchair Value of the participant/subject's age at which he/she began using a wheelchair If yes to wheelchair, indicate age participant/subject began using wheelchair. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 4.00 2013-07-11 15:03:49.0 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10698 Walking ability status WalkingAbilityStatus Status that reflects the participant's/subject's current ability to walk Status that reflects the participant's/subject's current ability to walk Indicate the description that reflects the participant's/subject's current ability to walk. Normal;Mild difficulty, perception of imbalance;Moderate difficulty, but requires little or no assistance;Severe disturbance of walking, requires assistance or walking aids;Cannot walk at all even with assistance Normal;Mild difficulty, perception of imbalance;Moderate difficulty, but requires little or no assistance;Severe disturbance of walking, requires assistance or walking aids;Cannot walk at all even with assistance (wheelchair bound) Alphanumeric

Choose only one.

No references available. Adult;Pediatric Core 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10709 Walking assistive device indicator WalkAssistiveDeviceInd Indicator of whether the participant/subject uses an assistive device for walking Indicator of whether the participant/subject uses an assistive device for walking Indicate if the participant/subject uses an assistive device. Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one. History can also be obtained from a family member, friend, or chart/ medical record. If the informant is unable to answer the question or is deemed unreliable (e.g., the participant/ subject has dementia) the history should be obtained from the medical record. Unknown includes the scenario where information is not documented in the medical record. Choose one. If answer is "No" or "Unknown" stop here and do not complete the rest of the form.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10720 Walking other assistive device use indicator WalkOthrAssistiveDevUseInd Indicator whether the participant/subject uses any other assistive device for walking Indicator whether the participant/subject uses any other assistive device for walking Indicate if the participant/subject uses any other assistive device. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Walking primary assistive device daily use duration"

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10699 Sitting ability status SittingAbilityStatus Status that reflects the participant's/subject's current ability to sit Status that reflects the participant's/subject's current ability to sit Indicate the description that reflects the participant's/subject's current ability to sit. Normal;Slight imbalance of the trunk, but needs no back support;Unable to sit without back support;Can sit only with extensive support;Unable to sit Normal;Slight imbalance of the trunk, but needs no back support;Unable to sit without back support;Can sit only with extensive support (geriatric chair, posy, etc.);Unable to sit Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10710 Walking 1 cane use indicator Walk1CaneUseInd Indicator whether the participant/subject uses one cane for walking Indicator whether the participant/subject uses one cane for walking Indicate if the participant/subject uses a cane. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Walking cane or crutches pair use indicator."

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10721 Walking other assistive device use age started value WalkOthrAssistDevUseStrtAgeVal Age of the participant/subject when he/she began using the other assistive device for walking Value of the participant/subject's age at which he/she began using the other assistive device for walking If yes to other assistive device, indicate age participant/subject began using other assistive device. Numeric Values

Answer should be recorded in years.

No references available Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10700 Bladder control status BladderControlStatus Status that reflects the participant's/subject's current level of bladder control Status that reflects the participant's/subject's current level of bladder control Indicate the description that reflects the participant's/subject's current level of bladder control. Normal;Mild urinary hesitance, urgency or retention;Moderate hesitance, urgency, rate retention/incontinence;Frequent urinary incontinence;Loss of bladder function requiring intermittent catheterization/indwelling catheter Normal;Mild urinary hesitance, urgency or retention (less than once a month);Moderate hesitance, urgency, rate retention/incontinence (greater than once a month, but less than once a week);Frequent urinary incontinence (greater than once a week);Loss of bladder function requiring intermittent catheterization/indwelling catheter Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10711 Walking cane use age started value WalkCaneUseStrtAgeVal Age of the participant/subject when he/she began using a cane for walking Value of the participant/subject's age at which he/she began using a cane for walking If yes to cane, indicate age participant/subject began using a cane. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10722 Walking primary assistive device daily use duration WalkPrimryAssistvDevDlyUseDur Duration for which the participant/subject uses her or his primary assistive walking device on a daily basis Duration for which the participant/subject uses her or his primary assistive walking device on a daily basis Indicate the amount of time the participant/subject uses the primary assistive walking device. Numeric Values

Answer should be recorded in hours:minutes format (HH:MM) and should be less than 24 hours. If subject/participant does not use an assistive walking device, leave blank and check Unknown.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10701 Walking difficulty level status WalkingDifficultyLvlStatus Status that reflects the participant's/subject's current level of walking difficulty Status that reflects the participant's/subject's current level of walking difficulty Indicate the description that reflects the participant's/subject's current level of difficulty walking. Without any difficulty;With some difficulties walking or getting around;With difficulty, difficulty walking interfered with activities of daily living;Participant unable to walk on their own Without any difficulty;With some difficulties walking or getting around;With difficulty, difficulty walking interfered with activities of daily living;Participant unable to walk on their own Alphanumeric

If answer is "Without any difficulty" stop here and do not complete the rest of the form. If answer is "With some difficulties walking or getting around" or "With difficulty, difficulty walking interfered with activities of daily living" skip to "Walking difficulty age started value" question.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10712 Walking use 2 cane crutch indicator WalkUse2CaneCrutchInd Indicator whether the participant/subject uses two canes or crutches for walking Indicator whether the participant/subject uses two canes or crutches for walking Indicate if the participant/subject uses two canes/crutches. Yes;No;Unknown Yes;No;Unknown Alphanumeric

If "No" or "Unknown" skip to "Walker use indicator."

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C17511 Walking difficulty age need intermittent support indicator WlkDfcltyAgeNdIntrmtSuprtInd Indicator used when participant/subject age when needing intermittent support for walking Indicator used when participant/subject age when needing intermittent support for walking If participant/subject needs intermittent support for walking, indicate age of participant when support first needed. Unknown Unknown Alphanumeric

Leave age blank is unknown and check Unknown.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10702 Walking own unable reason WalkingOwnUnableRsn Reason why the participant/subject is unable to walk on his/her own Reason why the participant/subject is unable to walk on his/her own If participant/subject is unable to walk on their own, indicate reason why. Alphanumeric

After answering this question skip to "Wheelchair bound age value", "if participant is permanently bound to the wheelchair, indicate age of participant when first permanently bound to wheelchair."

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points 255

Free-Form Entry

C10713 Walking cane or crutches pair use age started value WalkUse2CaneCrutchStrtAgeVal Age of the participant/subject when he/she began using two canes or crutches for walking Value of the participant/subject's age at which he/she began using two canes or crutches for walking If yes to canes/ crutches, indicate age participant/subject began using two canes/crutches. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 4.00 2013-07-11 15:03:49.0 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

C10692 Speech level status SpeechLvlStatus Status that reflects the participant's/subject's current level of speech ability Status that reflects the participant's/subject's current level of speech ability Indicate the description that reflects the participant's/ subject's current level of speech. Normal;Mildly affected, no difficulty being understood;Moderately affected, sometimes asked to repeat statements;Severely affected, frequently asked to repeat statements;Unintelligible most of the time Normal;Mildly affected, no difficulty being understood;Moderately affected, sometimes asked to repeat statements;Severely affected, frequently asked to repeat statements;Unintelligible most of the time Alphanumeric

Choose only one.

No references available. Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C17512 Walking difficulty age need permanent support indicator WlkDffcltyAgeNeedPrmSuprtInd Indicator related to age of participant/subject needing permanent support for walking Indicator related to age of participant/subject needing permanent support for walking If participant/subject needs permanent support for walking, indicate age of participant when support first needed. Unknown Unknown Alphanumeric

Leave age blank and check Unknown.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Single Pre-Defined Value Selected

C10703 Walking difficulty age started value WalkingDifficultyStrtAgeVal Age when participant/subject first noticed problems with walking Value of the age at which participant/subject first noticed problems with walking If participant/subject walks with some difficulties or with difficulty, indicate age when participant first noticed problems with walking. Numeric Values

Answer should be recorded in years.

No references available. Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Activities of Daily Living and Gait Activities of Daily Living/Performance Outcomes and End Points

Free-Form Entry

CSV