CDE Detailed Report
Disease: content
Subdomain Name: Adaptive and Daily Living Skills
CRF: welcome
Displaying 1 - 48 of 48
Subdomain Name: Adaptive and Daily Living Skills
CRF: welcome
Displaying 1 - 48 of 48
| CDE ID | CDE Name | Variable Name | Definition | Short Description | 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 / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C07321 | Mayo-Portland Adaptability Inventory (MPAI-4) - participation subscale score | MPAI4PrtpSubscaleScore | MPAI-4 Participation Subscale raw score (items 22-29) | MPAI-4 Participation Subscale raw score (items 22-29), as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Participation Subscale | Numeric Values |
Rescore item 27. Original score = ___. If original score = 0 or 1, new score = 0. If original score = 2 or 3, new score = 1. If original score = 4, new score = 3. Rescore item 28A or 28B. Original score = ___. If original score = 0, new score = 0. If original score = 1 or 2, new score = 1. If original score = 3 or 4, new score = 3. E. New score for item 27 = ___ F. New score for item 28A or 28B = ___ G. Sum of scores for items 22–24 = ___ H. Sum of scores for items 25, 26, 29 ___ Sum of E through H = Raw Score for Participation Subscale |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Free-Form Entry |
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| C07289 | Mayo-Portland Adaptability Inventory (MPAI-4) - depression scale | MPAI4DeprsnScale | Description of level at which the patient/subject experiences depression problems including being sad, blue, hopeless, having poor appetite, poor sleep, worry, self-criticism | Description of level at which the patient/subject experiences depression problems including being sad, blue, hopeless, having poor appetite, poor sleep, worry, self-criticism as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Depression: Sad, blue, hopeless, poor appetite, poor sleep, worry, self-criticism | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07300 | Mayo-Portland Adaptability Inventory (MPAI-4) - self care scale | MPAI4SelfcareScale | Description of level at which the participant/subject experiences problems with self-care including eating, dressing, bathing, hygiene | Description of level at which the participant/subject experiences problems with self-care including eating, dressing, bathing, hygiene, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Self-care: Eating, dressing, bathing, hygiene | 0;1;2;3;4 | Independent completion of self-care activities;Mild difficulty, occasional omissions or mildly slowed completion of self-care| may use assistive device or require occasional prompting;Requires a little assistance or supervision from others (5-24% of the time) including frequent prompting;Requires moderate assistance or supervision from others (25-75% of the time);Requires extensive assistance or supervision from others (more than 75% of the time) | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07279 | Mayo-Portland Adaptability Inventory (MPAI-4) - dizziness scale | MPAI4DizScale | Description of level at which the patient/subject experiences dizziness problems including feeling unsteady, dizzy, light-headed | Description of level at which the patient/subject experiences dizziness problems including feeling unsteady, dizzy, light-headed, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Dizziness Feeling unsteady dizzy light headed | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07311 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre psychotic symptom scale | MPAI4PrePyschSymptmScale | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject before the injury | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Psychotic Symptoms Hallucinations delusions other persisten severely distorted perceptions of reality | 0;1;2;3;4 | None;Current problem under treatment or in remissions, symptoms do not interfere with everyday functioning;Symptoms occasionally interfere with everyday functioning but no additional evaluation or treatment recommended;Symptoms interfere with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07322 | Mayo-Portland Adaptability Inventory (MPAI-4) - total raw score | MPAI4TotlRawScore | MPAI-4 Total raw score | MPAI-4 Total raw score, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Raw Scores | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Free-Form Entry |
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| C07290 | Mayo-Portland Adaptability Inventory (MPAI-4) - irritability anger aggression scale | MPAI4IrritAngAgrsnScale | Description of level at which the patient/subject experiences irritability, anger, aggression problems including verbal or physical expressions of anger | Description of level at which the patient/subject experiences irritability, anger, aggression problems including verbal or physical expressions of anger, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Irritability: Verbal or physical expressions of anger | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07301 | Mayo-Portland Adaptability Inventory (MPAI-4) - residence scale | MPAI4ResdnceScale | Description of level at which the participant/subject experiences problems with residence including responsibilities of independent living and homemaking | Description of level at which the participant/subject experiences problems with residence including responsibilities of independent living and homemaking as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Residence: Responsibilities of independent living and homemaking (such as, meal preparation, home repairs and maintenance, personal health maintenance beyond Core hygiene including medical management) but not including managing money | 0;1;2;3;4 | Independent| living without supervision or concern from others;Living without supervisions but others have concerns about safety or managing responsibilities;Requires a little assistance or supervision from others (5-24% of the time);Requires moderate assistance or supervision from others (25-75% of the time);Requires extensive assistance or supervision from others (more than 75% of the time) | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07312 | Mayo-Portland Adaptability Inventory (MPAI-4) - post psychotic symptom scale | MPAI4PstPyschSymptmScale | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject after the injury | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject after the injury as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Psychotic Symptoms Hallucinations delusions other persisten severely distorted perceptions of reality | 0;1;2;3;4 | None;Current problem under treatment or in remissions, symptoms do not interfere with everyday functioning;Symptoms occasionally interfere with everyday functioning but no additional evaluation or treatment recommended;Symptoms interfere with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07280 | Mayo-Portland Adaptability Inventory (MPAI-4) - motor speech scale | MPAI4MotSpeechScale | Description of level at which the patient/subject experiences motor speech problems including abnormal clearness or rate of speech; stuttering | Description of level at which the patient/subject experiences motor speech problems including abnormal clearness or rate of speech; stuttering, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Motor speech Abnormal clearness or rate of speech stuttering | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07291 | Mayo-Portland Adaptability Inventory (MPAI-4) - pain headache scale | MPAI4PainHeadachScale | Description of level at which the patient/subject experiences pain and headache problems including verbal and nonverbal expressions of pain; activities limited by pain | Description of level at which the patient/subject experiences pain and headache problems including verbal and nonverbal expressions of pain; activities limited by pain, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Pain and headache: Verbal and nonverbal expressions of pain; activities limited by pain | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07302 | Mayo-Portland Adaptability Inventory (MPAI-4) - transportation scale | MPAI4TrsptScale | Description of level at which the participant/subject experiences problems with transportation | Description of level at which the participant/subject experiences problems with transportation, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | 0;1;2;3;4 | Independent in all modes of transportation including independent ability to operate a personal motor vehicle;Independent in all modes of transportation, but others have concerns about safety;Requires a little assistance or supervision from others (5-24% of the time), cannot drive;Requires moderate assistance or supervision from others (25-75% of the time), cannot drive;Requires extensive assistance or supervision from others (more than 75% of the time), cannot drive | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07313 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre law violation scale | MPAI4PreLawViolScale | History of law violations of participant/subject before the injury | History of law violations of participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Law violations History before and after injury | 0;1;2;3;4 | None or minor traffic violations only;Conviction on one or two misdemeanors other than minor traffic violations;History of more than two misdemeanors other than minor traffic violations;Single felony conviction;Repeat felony convictions | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07281 | Mayo-Portland Adaptability Inventory (MPAI-4) - verbal communication scale | MPAI4VerbCommunScale | Description of level at which the patient/subject experiences verbal communication problems including problems expressing or understanding language | Description of level at which the patient/subject experiences verbal communication problems including problems expressing or understanding language, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Verbal communication Problems expressing or understanding langauge | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07292 | Mayo-Portland Adaptability Inventory (MPAI-4) - fatigue scale | MPAI4FatgeScale | Description of level at which the patient/subject experiences fatigue problems including feeling tired; lack of energy; tiring easily | Description of level at which the patient/subject experiences fatigue problems including feeling tired; lack of energy; tiring easily as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Fatigue: Feeling tired; lack of energy; tiring easily | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07303 | Mayo-Portland Adaptability Inventory (MPAI-4) - paid employment scale | MPAI4PaidEmplmtScale | Description of level at which the participant/subject experiences problems with paid employment | Description of level at which the participant/subject experiences problems with paid employment, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Paid Employment Rate either item 28A or 28B to refelct the primary desired social role. Do not rate both. Rate 28A if the primary social role is paid employment. If another social role is primary rate only 28B. For both 28A and 28B support means speci | 0;1;2;3;4 | Full-time (more than 30 hrs/wk) without support;Part-time (3 to 30 hrs/wk) without support;Full-time or part-time with support;Sheltered work;Unemployed| employed less than 3 hours per week | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07314 | Mayo-Portland Adaptability Inventory (MPAI-4) - post law violation scale | MPAI4PstLawViolScale | History of law violations of participant/subject after the injury | History of law violations of participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Law violations History before and after injury | 0;1;2;3;4 | None or minor traffic violations only;Conviction on one or two misdemeanors other than minor traffic violations;History of more than two misdemeanors other than minor traffic violations;Single felony conviction;Repeat felony convictions | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07282 | Mayo-Portland Adaptability Inventory (MPAI-4) - nonverbal communication scale | MPAI4NonverbCommunScale | Description of level at which the patient/subject experiences nonverbal communication problems including restricted or unusual gestures or facial expressions; talking to much or not enough; missing nonverbal cues from others | Description of level at which the patient/subject experiences nonverbal communication problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Nonverbal communication Restricted or unusual gestures or facial expressions talking too much or not enough missing nonverbal cues from others | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07293 | Mayo-Portland Adaptability Inventory (MPAI-4) - mild symptom sensitivity scale | MPAI4MldSymptmSensScale | Description of level at which the patient/subject experiences sensitivity to mild symptoms problems including focusing on thinking, physical or emotional problems attributed to brain injury | Description of level at which the patient/subject experiences sensitivity to mild symptoms problems including focusing on thinking, physical or emotional problems attributed to brain injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Sensitivity to mild symptoms: Focusing on thinking, physical, or emotional problems attributed to brain injury; rate only how concern or worry about these symptoms affects current functioning over and above the effects of the symptoms themselves | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07304 | Mayo-Portland Adaptability Inventory (MPAI-4) - other employment scale | MPAI4OthrEmplmtScale | Description of level at which the participant/subject experiences problems with other employment for example involved in constructive, role-appropriate activity other than paid employment | Description of level at which the participant/subject experiences problems with other employment for example involved in constructive, role-appropriate activity other than paid employment, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Other employment: Involved in constructive, role-appropriate activity other than paid employment. | 0;1;2;3;4 | Full-time (more than 30 hrs/wk) without support, full time course load for students;Part-time (3 to 30 hrs/wk) without support;Full-time or part-time with support;Activities in a supervised environment other than a sheltered workshop;Inactive, involved in role-appropriate activities less than 3 hours per week | Numeric Values |
Check only one to indicate primary desired social role: Childrearing/care-giving; Homemaker, no childrearing or care-giving; Student; Volunteer; Retired (check retired onlyif over age 60; if unemployed, retired as disabled and under age 60, indicate "Unemployed" for item 28A) |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07315 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre other physical impairment scale | MPAI4PreOthrPhysImpairScale | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury before the injury | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Other condition causing physical impairment Physical disability due to medical conditions other than brain injury such as spinal cord injury amputation. | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07283 | Mayo-Portland Adaptability Inventory (MPAI-4) - attention concentration scale | MPAI4AttenConcenScale | Description of level at which the patient/subject experiences attention/concentration problems including problems ignoring distractions, shifting attention, keeping more than one thing in mind at a time | Description of level at which the patient/subject experiences attention/concentration problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Attention Concentration Problems ignoring distractions shifting attention keeping more than one thing in mind at a time | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07294 | Mayo-Portland Adaptability Inventory (MPAI-4) - inappropriate social scale | MPAI4InApprSocInterScale | Description of level at which the patient/subject experiences inappropriate social interaction problems including acting childish, silly, rude, behavior not fitting for time and place | Description of level at which the patient/subject experiences inappropriate social interaction problems including acting childish, silly, rude, behavior not fitting for time and place, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Inappropriate social interaction: Acting childish, silly, rude, behavior not fitting for time and place | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07305 | Mayo-Portland Adaptability Inventory (MPAI-4) - primary social role name | MPAI4PrimrySoclRoleName | Primary desired social role for other employment of participant/subject | Primary desired social role for other employment of participant/subject, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Check only one to indicate primary desired social role | Childrearing/care-giving;Homemaker, no childrearing or care-giving;Student;Volunteer;Retired | Childrearing/care-giving;Homemaker, no childrearing or care-giving;Student;Volunteer;Retired | Alphanumeric |
Check retired only if over age 60; if unemployed, retired as disabled and under age 60, indicate "Unemployed" for item C07303. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07316 | Mayo-Portland Adaptability Inventory (MPAI-4) - post other physical impairment scale | MPAI4PstOthrPhysImpairScale | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury after the injury | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Other condition causing physical impairment Physical disability due to medical conditions other than brain injury such as spinal cord injury amputation. | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07284 | Mayo-Portland Adaptability Inventory (MPAI-4) - memory scale | MPAI4MemryScale | Description of level at which the patient/subject experiences memory problems including problems learning and recalling new information | Description of level at which the patient/subject experiences memory problems including problems learning and recalling new information, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Memory Problems learning and recalling new information | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07295 | Mayo-Portland Adaptability Inventory (MPAI-4) - impaired self awareness scale | MPAI4ImprdSelfawrnesScale | Description of level at which the patient/subject experiences impaired self-awareness problems including lack of recognition of personal limitations and disabilities and how they interfere with everyday activities and work or school | Description of level at which the patient/subject experiences impaired self-awareness problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Impaired self-awareness: Lack of recognition of personal limitations and disabilities and how they interfere with everyday activities and work or school | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07306 | Mayo-Portland Adaptability Inventory (MPAI-4) - manage money scale | MPAI4MngMnyScale | Description of level at which the participant/subject experiences problems with managing money and finances including problems with shopping, keeping a check book or other bank account, managing personal income and investments | Description of level at which the participant/subject experiences problems with managing money and finances, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Managing money and finances: Shopping, keeping a check book or other bank account, managing personal income and investments | 0;1;2;3;4 | Independent, manages small purchases and personal finances without supervision or concern from others;Manages money independently but others have concerns about larger financial decisions;Requires a little help or supervision (5-24% of the time) with large finances, independent with small purchases;Requires moderate help or supervision (25-75% of the time) with large finances, some help with small purchases;Requires extensive help or supervision (more than 75% of the time) with large finances, frequent help with small purchases | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07317 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre other cognitive impairment scale | MPAI4PreOthrCogImpair | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Other condition causing cognitive impairment Cognitive disability due to nonpsychiatric medical conditions other than brain injury such as dementia stroke developmental disability | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07285 | Mayo-Portland Adaptability Inventory (MPAI-4) - information fund scale | MPAI4InfoFundScale | Description of level at which the patient/subject experiences fund of information problems including problems remembering information learned in school or on the job; difficulty remembering information about self and family from years ago | Description of level at which the patient/subject experiences fund of information problems including problems remembering information learned in school or on the job; difficulty remembering information about self and family from years ag | Fund of Information Problems remembering information learned in school or on the job difficulty remembering information about self and family from years ago | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07296 | Mayo-Portland Adaptability Inventory (MPAI-4) - family relationship scale | MPAI4FmlyRelateScale | Description of the stress level at which the patient/subject experiences family/significant relationship issues including interactions with close others | Description of the stress level at which the patient/subject experiences family/significant relationship issues including interactions with close others, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Family/significant relationships: Interactions with close others; describe stress within the family of those closest to the person with brain injury; "family functioning" means cooperating to accomplish those tasks that need to be done to keep the househo | 0;1;2;3;4 | Normal stress within family or other close network of relationships;Mild stress that does not interfere with family functioning;Mild stress that interferes with family functioning 5-24% of the time;Moderate stress that interferes with family functioning 25-75% of the time;Severe stress that interferes with family functioning more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07275 | Mayo-Portland Adaptability Inventory (MPAI-4) -mobility scale | MPAI4MobilityScale | Mobility: Problems walking or moving; balance problems that interfere with moving about | Mobility: Problems walking or moving; balance problems that interfere with moving about | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values | Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07307 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre alcohol use scale | MPAI4PreAlcUseScale | Use of alcoholic beverages by the participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of alcoholic beverages by the participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of alcoholic beverages pre-injury | 0;1;2;3;4 | No or socially acceptable use;Occasionally exceeds socially acceptable use but does not interfere with everyday functioning, current problem under treatment or in remission;Frequent excessive use that occasionally interferes with everyday functioning, possible dependence;Use or dependence that interferes with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07318 | Mayo-Portland Adaptability Inventory (MPAI-4) - post other cognitive impairment scale | MPAI4PstOthrCogImpair | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions other than brain injury, such as, dementia, stroke, developmental disability after the injury | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions other than brain injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Other condition causing cognitive impairment Cognitive disability due to nonpsychiatric medical conditions other than brain injury such as dementia stroke developmental disability | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07286 | Mayo-Portland Adaptability Inventory (MPAI-4) - novel problem solve scale | MPAI4NovProbSlvScale | Description of level at which the patient/subject experiences novel problem solving problems including problems thinking up solutions or picking the best solution to new problems | Description of level at which the patient/subject experiences novel problem solving problems including problems thinking up solutions or picking the best solution to new problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Novel problem solving Problems thinking up solutions or picking the best solution to new problems | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07297 | Mayo-Portland Adaptability Inventory (MPAI-4) - initiation scale | MPAI4InitScale | Description of level at which the participant/subject experiences problems with initiation including problems getting started on activities without prompting | Description of level at which the participant/subject experiences problems with initiation including problems getting started on activities without prompting, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Initiation: Problems getting started on activities without prompting | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07276 | Mayo-Portland Adaptability Inventory (MPAI-4) - use hand scale | MPAI4UseHandScale | Use of hands: Impaired strength or coordination in one or both hands | Use of hands: Impaired strength or coordination in one or both hands, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values | Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07308 | Mayo-Portland Adaptability Inventory (MPAI-4) - post alcohol use scale | MPAI4PostAlcUseScale | Use of alcoholic beverages by the participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of alcoholic beverages by the participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of alcoholic beverages post-injury | 0;1;2;3;4 | No or socially acceptable use;Occasionally exceeds socially acceptable use but does not interfere with everyday functioning, current problem under treatment or in remission;Frequent excessive use that occasionally interferes with everyday functioning, possible dependence;Use or dependence that interferes with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07319 | Mayo-Portland Adaptability Inventory (MPAI-4) - ability subscale score | MPAI4AblSubscaleScore | MPAI-4 Ability Subscale raw score (items 1-12) | MPAI-4 Ability Subscale raw score (items 1-12), as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Abilities Subscale | Numeric Values |
Resocre item 4. If original score = 0, new score = 0. If original score = 1, 2, or 3, new score = 1. If original score = 4, new score = 3. New score for item 4 = ____ Sume of scores for items 1-3 and 5-12 (use highest score for 7A or 7B) = ___ Sum of A and B = Raw Score for Abilities Subscale = |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Free-Form Entry |
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| C07287 | Mayo-Portland Adaptability Inventory (MPAI-4) - visuospatial ability scale | MPAI4VisspatAblScale | Description of level at which the patient/subject experiences visuospatial ability problems including problems drawing, assembling things, route-finding, being visually aware on both the left and right sides | Description of level at which the patient/subject experiences visuospatial ability problems including problems drawing, assembling things, route-finding, being visually aware on both the left and right side | Visuospatial abilities Problems drawing assembling things route finding being visually aware on both the left and right sides | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07298 | Mayo-Portland Adaptability Inventory (MPAI-4) - social contact scale | MPAI4SoclContScale | Description of level at which the participant/subject experiences problems with social contact with friends, work associates, and other people who are not family, significant others or professionals | Description of level at which the participant/subject experiences problems with social contact with friends, work associates, and other people who are not family, significant others or professional | Social contact with friends, work associates, and other people | 0;1;2;3;4 | Normal involvement with others;Mild difficulty in social situations but maintains normal involvement with others;Mildly limited involvement with others (75-95% of normal interaction for age);Moderately limited involvement with others (25-74% of normal interaction for age);No or rare involvement with others (less than 25% of normal interaction for age) | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07277 | Mayo-Portland Adaptability Inventory (MPAI-4) - vision scale | MPAI4VisScale | Description of level at which the patient/subject experiences vision problems including problems seeing, double vision, eye, brain or nerve injuries that interfere with seeing | Description of level at which the patient/subject experiences vision problems including problems seeing, double vision, eye, brain or nerve injuries that interfere with seeing, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Vision Problems seeing double vision eye brain or nerve injuries that interfere with seeing | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07309 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre drug use scale | MPAI4PreDrugUseScale | Use of illegal drugs or abuse of prescription drugs by the participant/subject pre-injury | Use of illegal drugs or abuse of prescription drugs by the participant/subject pre-injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of illegal drugs or abuse of prescription drugs pre-injury | 0;1;2;3;4 | No or occasional use;Occasional use does not interfere with everyday functioning, current problem under treatment or in remission;Frequent use that occasionally interferes with everyday functioning, possible dependence;Use or dependence interferes with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07320 | Mayo-Portland Adaptability Inventory (MPAI-4) - adjustment subscale score | MPAI4AdjSubscaleScore | MPAI-4 Adjustment Subscale raw score (items 13-24) | MPAI-4 Adjustment Subscale raw score (items 13-24) as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Adjustment Subscale | Numeric Values |
Rescore item 16. If original score = 0, new score = 0. If original score = 1, or 2, new score = 1. If original score = 3 or 4, new score = 2. New score for item 16 = ____ Sum of scores for items 13–15 and 17–24 = ___ Sum of C and D = Raw Score for Adjustment Subscale |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Free-Form Entry |
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| C07288 | Mayo-Portland Adaptability Inventory (MPAI-4) - anxiety scale | MPAI4AnxtylScale | Description of level at which the patient/subject experiences anxiety problems including being tense nervous, fearful or having phobias, nightmares, flashbacks of stressful events | Description of level at which the patient/subject experiences anxiety problems including being tense nervous, fearful or having phobias, nightmares, flashbacks of stressful events as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Anxiety Tense nervous fearful phobias nightmares flashbacks of stressful events | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07299 | Mayo-Portland Adaptability Inventory (MPAI-4) - leisure scale | MPAI4LeisScale | Description of level at which the participant/subject experiences problems with leisure and recreational activities | Description of level at which the participant/subject experiences problems with leisure and recreational activities, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Leisure and recreational activities participation | 0;1;2;3;4 | Normal participation in leisure activities for age;Mild difficulty in these activities by maintains normal participation;Mildly limited participation (75-95% of normal participation for age);Moderately limited participation (25-74% of normal participation for age);No or rare participation (less than 25% of normal participation for age) | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07278 | Mayo-Portland Adaptability Inventory (MPAI-4) - audition scale | MPAI4AudScale | Description of level at which the patient/subject experiences audition problems including problems hearing; ringing in the ears | Description of level at which the patient/subject experiences audition problems including problems hearing; ringing in the ears, as [art pf the Mayo-Portland Adaptability Inventory (MPAI-4) | Audition Problems hearing ringing in the ears | 0;1;2;3;4 | None;Mild problem but does not interfere with activities, may use assistive device or medication;Mild problem, interferes with activities 5-24% of the time;Moderate problem, interferes with activities 25-75% of the time;Severe problem, interferes with activities more than 75% of the time | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07310 | Mayo-Portland Adaptability Inventory (MPAI-4) - post drug use scale | MPAI4PostDrugUseScale | Use of illegal drugs or abuse of prescription drugs by the participant/subject post-injury | Use of illegal drugs or abuse of prescription drugs by the participant/subject post-injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | Use of illegal drugs or abuse of prescription drugs post-injury | 0;1;2;3;4 | No or occasional use;Occasional use does not interfere with everyday functioning, current problem under treatment or in remission;Frequent use that occasionally interferes with everyday functioning, possible dependence;Use or dependence interferes with everyday functioning, additional treatment recommended;Inpatient or residential treatment required | Numeric Values |
Refer to instructions on form. |
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Available in the public domain. URL: http://www.tbims.org/combi/mpai | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Mayo-Portland Adaptability Inventory-4 (MPAI-4) | Adaptive and Daily Living Skills | Outcomes and End Points |
Single Pre-Defined Value Selected |
