Disability Questionnaire for Essential Tremor

Purpose: To evaluate the functional disability for a patient with essential tremor using the Columbia University Disability Questionnaire for Essential Tremor.

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Evaluation

Are you evaluating a patient with essential tremor?

Yes

Gender of the patient

Male

Female

Select the appropriate answer for each finding

Signing your name

Writing a letter, note or check

Typing

Placing a letter in an envelope

Drinking from a glass

Pouring mild or juice from a bottle

Carrying a cup of coffee

Using a spoon to drink soup

Carrying a tray of food

Eating in a restaurant

Inserting a coin in a pay telephone or a washing machine

Dialing a telephone

Holding a telephone to your ear

Buttoning your buttons

Tying your shoelaces

Zipping up a zipper

Putting on your eyeglasses

Putting on your contact lenses

Using eye drops

Cutting, trimming, or filing your nails

Putting on your watch

Brushing your teeth

Replacing a dollar bill in your wallet or purse

Reading a book, magazine or newspaper

Unlocking a door with a key

Threading a needle

Using a screwdriver

Screwing in a light bulb

Placing a plug in an electric socket

Tying your tie

Putting on lipstick

Shaving

Putting on eyeliner

Voice trembling when you talk

Head shaking

Embarrassed by tremor

Tremor in your legs

Tremor in your trunk

Results

Please fill out required fields.

Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Number of applicable items

Total score

Level of disability

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Risk Factors
Criteria For Diagnosis
- Impairment Associated with HIV-Associated Dementia Complex
Severity, Prognosis, Stage
Complications
Differential Diagnosis And Mimics, Red Flags
- Amyotrophic Lateral Sclerosis (ALS) Score

Therapy

Physical And Lifestyle
- Equations of Wade et al for Predicting the 6 Month Barthel Activities of Daily Living (ADL) Score in a Patient with a Recent Stroke
Surgery
- Response to Surgical Therapy for Pudendal Nerve Entrapment
- Disability Affecting Patients Following Complete Resection of an Ependymoma

Monitoring

Response To Therapy
Disease Progression
- The Oxford Handicap Scale
- Intracerebral Hemorrhage Functional Outcome Score (ICH-FOS)
Complication Detection
- Trunk Control Test for Motor Impairment After Stroke
- Motricity Index for Motor Impairment After Stroke
Comorbid Conditions
- Impairment Associated with HIV-Associated Dementia Complex

Patient Concerns

Disability And Performance
Quality Of Life
Social Activities, Family And Friends
- Stroke Recovery of Activities of Daily Living & Mobility (RAM) Index

Specialty

Sports Medicine & Rehabilitation
Neurology

Objective

disability and performance

ICD-10

G25.0 - Essential tremor

Info

Purpose: To evaluate the functional disability for a patient with essential tremor using the Columbia University Disability Questionnaire for Essential Tremor.

Specialty: Sports Medicine & Rehabilitation, Neurology

Objective: disability and performance

ICD-10: G25.0,

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