CDE Detailed Report

Disease: Chiari I Malformation
Subdomain Name: General and Motor
CRF: Imbalance

Displaying 1 - 10 of 10
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
C11061 Gait assessment result GaitAssmtReslt Result of the gait assessment Result of the gait assessment Tandem Gait Normal;Abnormal Normal;Abnormal Alphanumeric

5 paces unaided

 Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C17277 Modified Romberg test result ModRombergTestReslt The result of the Modified Romberg test The result of the Modified Romberg test Tandem Romberg Normal;Abnormal Normal;Abnormal Alphanumeric

Able for 5 sec

 Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21923 Balance unsteady stand walk indicator BalanceUnsteadyStandWalkInd The indicator related to feelings of unsteadiness when standing or walking The indicator related to feelings of unsteadiness when standing or walking Feelings of unsteadiness when standing or walking? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 13:27:41.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21925 Balance falls frequency BalanceFallsFreq The frequency as related to falls The frequency as related to fall Falls Daily;Weekly;Occasionally;Rarely Daily;Weekly;Occasionally;Rarely Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 14:17:52.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21926 Mobility assistive device use type MobilityAssistiveDeviceUseTyp The type as related to use of a mobility assistance device The type as related to use of a mobility assistance devic Use of assist device? Cane;Wheelchair;N/A Cane;Wheelchair;N/A Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 14:28:05.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21931 Dizziness motion related indicator DizzinessMotionRelatedInd The indicator related to motion related dizziness The indicator related to motion related dizziness Motion related dizziness No;Yes No;Yes Alphanumeric

Dizziness with turning or in motion in a vehicle

 Adult;Pediatric Supplemental 1.00 2016-06-06 15:23:36.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21944 Dizziness motion related duration type DizzinessMotionRelatedDurTyp The duration as related to the motion related dizziness The duration as related to the motion related dizzines Duration – How long have you had motion-related dizziness? Weeks;Months;years Weeks;Months;years Alphanumeric

Select single duration

 Adult;Pediatric Supplemental 1.00 2016-06-06 15:40:55.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C21966 Ataxia upper extremity indicator AtaxiaUpperExtremityInd The indicator related to upper extremities having ataxia The indicator related to upper extremities having ataxi Limb Ataxia: Upper extremities No;Yes No;Yes Alphanumeric

By physician exam

 Adult;Pediatric Supplemental 1.00 2016-06-06 16:08:42.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C22013 Ataxia lower extremity indicator AtaxiaLowerExtremityInd The indicator related to lower extremities having ataxia The indicator related to lower extremities having ataxi Limb Ataxia: Lower extremities No;Yes No;Yes Alphanumeric

By physician exam

 Adult;Pediatric Supplemental 1.00 2016-06-07 08:41:33.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
C22015 Ocular movement disorder type OcularMovementDisorderTyp The type as related to ocular movement disorder The type as related to ocular movement disorde Ocular movement disorder Jittery movements;Saccadic pursuit;Downbeat nystagmus Jittery movements;Saccadic pursuit;Downbeat nystagmus Alphanumeric

By physician exam; Indicate those that apply

 Adult;Pediatric Supplemental 1.00 2016-06-07 08:51:02.0 Imbalance General and Motor Assessments and Examinations

Single Pre-Defined Value Selected
CSV