Physical functioning: 100 %

INSTRUCTIONS:

Please choose the one best answer to each question.

1. How much of a problem do I have in preparing my own meals?

2. How much of a problem do I have in dressing myself?

3. How much of a problem do I have in taking care of my personal hygiene?

4. How much of a problem do I have in washing the dishes?

5. How much of a problem do I have in doing the laundry?

6. How much of a problem do I have in taking care of my finances?

7. How much of a problem do I have in keeping appointments on time?

8. How much of a problem do I have in starting conversation in a group?

9. How much of a problem do I have in staying involved in work activities even when bored or tired?

10. How much of a problem do I have in remembering what I had for dinner last night?

11. How much of a problem do I have in remembering names of people I see often?

12. How much of a problem do I have in remembering my daily schedule?

13. How much of a problem do I have in remembering important things I must do?

14. How much of a problem would I have driving a car if I had to?

15. How much of a problem do I have in getting help when I’m confused?

16. How much of a problem do I have in adjusting to unexpected changes?

17. How much of a problem do I have in handling arguments with people I know well?

18. How much of a problem do I have in accepting criticism from other people?

19. How much of a problem do I have in controlling crying?.

20. How much of a problem do I have in acting appropriately when I’m around friends?

21. How much of a problem do I have in showing affection to people?

22. How much of a problem do I have in participating in group activities?

23. How much of a problem do I have in recognizing when something I say or do has upset someone else?

24. How much of a problem do I have in scheduling daily activities?

25. How much of a problem do I have in understanding new instructions?

26. How much of a problem do I have in consistently meeting my daily responsibilities?

27. How much of a problem do I have in controlling my temper when something upsets me?

28. How much of a problem do I have in keeping from being depressed?

29. How much of a problem do I have in keeping my emotions from affecting my ability to go about the day’s activities?

30. How much of a problem do I have in controlling my laughter?


Bibliographic References (copyright belongs to the author/s of this instrument):

  1. Fleming, J. M., Strong, J., et al. (1998). "Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationshipto outcome." J Head Trauma Rehabil 13(5): 39-51.
  2. Fordyce, D. J. and Roueche, J. R. (1986). "Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury." Rehabil Psychol 31(4): 217-229.
  3. Prigatano, G. P., Fordyce, D. J., et al. (1986). Neuropsychological rehabilitation after brain injury, Johns Hopkins University Press Baltimore.
  4. Fordyce, David J. Leathem, J. J. M., Murphy, L. L. J., et al. (1998). "Self- and Informant-Ratings on the Patient Competency Rating Scalein Patients with Traumatic Brain Injury." Journal of Clinical & Experimental Neuropsychology 20(5): 694.
  5. Prigatano, G. P., Bruna, O., et al. (1998). "Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury." J Head Trauma Rehabil 13(5): 29-38.