Sub-Domain: Additional Proposed Instruments
CRF:
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 | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
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C18944 | Reflex exam global assessment other text | RflxExmGlobAssmtOTH | The free-text field related to 'Reflex exam global assessment result' specifying other text. The global assessment of the ability and condition of reflexes | The free-text field related to 'Reflex exam global assessment result' specifying other text. The global assessment of the ability and condition of reflexes | Other, specify | Alphanumeric |
Choose one. If abnormal answer questions A and B. |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C11061 | Gait assessment result | GaitAssmtReslt | Result of the gait assessment | Result of the gait assessment | Gait - global assessment | Normal;Abnormal;Cannot Assess;Other, specify | Normal;Abnormal;Cannot Assess;Other, specify | Alphanumeric |
Choose one. Indicate type if abnormal |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-22 16:57:17.79 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | ||||||||||||||||||||||||||||
C18510 | Reflex left leg assessment status | RflxLftLegAssmtStatus | The status of the relfex assessment for the left leg. | The status of the relfex assessment for the left leg. | Left Leg | Increased with clonus;Increased without clonus;Hypoactive;Absent | Increased with clonus;Increased without clonus;Hypoactive;Absent | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-30 14:29:49.047 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14440 | Muscle bulk assessment anatomic site | MuscBulkAssmtAntmicSite | Anatomic location of the muscle bulk exam as part of the motor examination. | Anatomic location of the muscle bulk exam as part of the motor examination. | Muscle Bulk - global assessment | Right upper extremity;Left upper extremity;Right lower extremity;Left lower extremity | Right upper extremity (RUE);Left upper extremity (LUE);Right lower extremity (RLE);Left lower extremity (LLE) | Alphanumeric |
Evaluate all extremities |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14452 | Tremor assessment status | TremAssessStatus | The status indicating whether tremors could be detected during the exam | Whether tremors are detected during the exam | Tremor | Yes;No;Cannot Assess;Other, specify | Yes;No;Cannot Assess;Other, specify | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18934 | Motor exam global assessment abnormality other text | MotorExamGloblAbnrmlyAssmtOTH | The free-text field related to 'Motor exam global assessment abnormality type' specifying other text. Global assessment abnormality type found during the motor exam | The free-text field related to 'Motor exam global assessment abnormality type' specifying other text. Global assessment abnormality type found during the motor exam | Other, specify | Alphanumeric |
If the global assessment found an abnormality, then record the abnormality type |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14466 | Sensory system global assessment result | SensySytGlobAssmtReslt | The condition and ability of sensory system | The condition and ability of sensory system | Sensory System - global assessment | Abnormal;Normal;Cannot Assess;Other, specify;Abnormal;Normal;Cannot Assess;Other, specify | Abnormal;Normal;Cannot Assess;Other, specify;Abnormal;Normal;Cannot Assess;Other, specify | Alphanumeric |
Choose one. If abnormal answer questions A-D. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18945 | Reflex plantar right response other text | RflxPlntrRtRespnsOTH | The free-text field related to 'Reflex plantar right response result' specifying other text. The results from reflex plantar response on the right side | The free-text field related to 'Reflex plantar right response result' specifying other text. The results from reflex plantar response on the right side | Other, specify | Alphanumeric |
Choose all that apply. If other, explain. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14429 | Global change since prior examination result | GlobalChangeSincPriorExamReslt | Global assessment of the difference between the prior and follow-up examinations | Global assessment of the difference between the prior and follow-up examinations | If follow-up exam, change from prior exam | No change;Improved;Worse;Unknown;Other, specify | No change;Improved;Worse;Unknown;Other, specify | Alphanumeric |
Record change from prior exam if follow-up exam |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18511 | Reflex right arm assessment status | RflxRtArmAssmtStatus | The status of the relfex assessment for the right arm. | The status of the relfex assessment for the right arm. | Right Arm | Increased with clonus;Increased without clonus;Hypoactive;Absent | Increased with clonus;Increased without clonus;Hypoactive;Absent | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-30 14:29:49.047 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14441 | Muscle bulk assessment abnormality indicator | MuscBulkAbnrmlyAssmtInd | Whether the muscle bulk assessment found any abnormalities | Whether the muscle bulk assessment found any abnormalities | Abnormality present? | Yes;No;Cannot Assess | Yes;No;Cannot Assess | Alphanumeric |
Choose one for each anatomic site |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14453 | Tremor type | TremTyp | The type of tremor detected during the exam | The type of tremor detected during the exam | Type of tremor | Postural;Rest;Intention;Other, specify | Postural;Rest;Intention;Other, specify | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18935 | Muscle bulk assessment abnormality other text | MuscBulkAbnrmlyAssmtOTH | The free-text field related to 'Muscle bulk assessment abnormality type' specifying other text. The muscle bulk abnormality type | The free-text field related to 'Muscle bulk assessment abnormality type' specifying other text. The muscle bulk abnormality type | Other, specify | Alphanumeric |
Choose one |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14467 | Sensory system abnormality symmetry type | SensySysAbnrmlySymmTyp | Symmetry of abnormality for sensory system results | Symmetry of abnormality for sensory system results | Symmetry of Abnormality | Symmetric;Asymmetric | Symmetric;Asymmetric | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18946 | Reflex plantar left response other text | RflxPlntrLftRespnsOTH | The free-text field related to 'Reflex plantar left response result' specifying other text. The results from reflex plantar response on the left side | The free-text field related to 'Reflex plantar left response result' specifying other text. The results from reflex plantar response on the left side | Other, specify | Alphanumeric |
Choose all that apply. If other, explain. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14431 | Mental status examined type | MentlStatExamTyp | Type of mental status assessment performed | Type of mental status assessment performed | Mental assessments | Attention;Working Memory;Recent Memory;Remote Memory;Spontaneous speech;Comprehension;Naming;Repetition;Reading;Affect | Attention;Working Memory;Recent Memory;Remote Memory;Spontaneous speech;Language Comprehension;Language Naming;Language Repetition;Language Reading;Affect | Alphanumeric |
Answer where applicable Recommended tests are: Attention-forward digit span (6 is normal for adults), Working Memory-reverse digit span (4 is normal for adults), Recent (Episodic) Memory-immediate recall of 3 objects and then recall again after 3-5 minute delay, Remote (Semantic) Memory-either recall of verifiable personal information from the patient's past (i.e. previous addresses or schools) or well-known current events (i.e. naming the Presidents backwards) |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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C18512 | Reflex right leg assessment status | RflxRtLegAssmtStatus | The status of the relfex assessment for the right leg. | The status of the relfex assessment for the right leg. | Right Leg | Increased with clonus;Increased without clonus;Hypoactive;Absent | Increased with clonus;Increased without clonus;Hypoactive;Absent | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-30 14:29:49.047 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14442 | Muscle bulk assessment abnormality type | MuscBulkAbnrmlyAssmtTyp | The muscle bulk abnormality type | The muscle bulk abnormality type | If abnormal, indicate type: | Abnormal - Increased;Abnormal - Decreased;Other, specify | Abnormal - Increased;Abnormal - Decreased;Other, specify | Alphanumeric |
Choose one |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C14454 | Cerebellar or coordination assessment type | CerbllrCoordinationAssmtTyp | Type of cerebellar/coordination assessment performed | Type of cerebellar/coordination assessment performed | Cerebellar/Coordination assessments | Finger-to-Nose;Rapid Alternating Movements;Heel-to-Shin | Finger-to-Nose;Rapid Alternating Movements;Heel-to-Shin | Alphanumeric |
For each assessment type record whether an abnormality is present and if so the type of abnormality |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18936 | Muscle tone assessment abnormality other text | MuscToneAbnrmlyAssmtOTH | The free-text field related to 'Muscle tone assessment abnormality type' specifying other text. The muscle tone abnormality type | The free-text field related to 'Muscle tone assessment abnormality type' specifying other text. The muscle tone abnormality type | Other, specify | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14468 | Sensory system abnormality anatomic site | SensySysAbnrmlySymmAntmicSite | The location of abnormality for sensory system | The location of abnormality for sensory system | Location of Abnormality | Stocking;Stocking/Glove;Dermatome;Sensory Nerve;Other, specify | Stocking;Stocking/Glove;Dermatome;Sensory Nerve;Other, specify | Alphanumeric |
Choose all that apply. If other, explain. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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C18947 | Sensory system global assessment other text | SensySysGlobAssmtOTH | The free-text field related to 'Sensory system global assessment result' specifying other text. The condition and ability of sensory system | The free-text field related to 'Sensory system global assessment result' specifying other text. The condition and ability of sensory system | Other, specify | Alphanumeric |
Choose one. If abnormal answer questions A-D. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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C14432 | Mental status exam abnormality indicator | MentlStatExamAbnrmlyInd | Whether the mental assessment showed abnormal results | Whether the mental assessment showed abnormal results | Abnormality present? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose only one |
No references available | Adult;Pediatric | Proposed | 1.00 | 2012-10-05 00:00:00.0 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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C18513 | Sensory system abnormality dermatome present text | SensySysAbnrmlyDermtPresTxt | The free-text field to describe the dermatome sensory abnormality, the area of skin supplied with afferent nerve fibers by a single posterior spinal root. | The free-text field to describe the dermatome sensory abnormality, the area of skin supplied with afferent nerve fibers by a single posterior spinal root. | Dermatome, explain | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-07-30 14:29:49.047 | Neurological Exam | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
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C14443 | Muscle tone assessment anatomic site | MuscToneAssmtAntmicSite | Anatomic location of the muscle tone as part of the motor examination. | Anatomic location of the muscle tone as part of the motor examination. | Muscle Tone - global assessment | Right upper extremity;Left upper extremity;Right lower extremity;Left lower extremity;Truncal tone | Right upper extremity (RUE);Left upper extremity (LUE);Right lower extremity (RLE);Left lower extremity (LLE);Truncal tone | Alphanumeric |
Evaluate all extremities. Truncal tone - is recommended for pediatric studies only |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-08-28 16:08:00.453 | Neurological Exam | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms |