Painless, progressive weakness Could this be Motor Neurone Disease?
|
|
|
- Kerrie Wilkerson
- 5 years ago
- Views:
Transcription
1 Painless, progressive weakness Could this be Motor Neurone Disease?
2 The importance of early diagnosis removal of uncertainty for the person experiencing symptoms allowing for care and support to start as early as possible enabling the person with MND and their carer to consider and plan for their future increasing the window of opportunity to research into, and better understand, the condition
3 1. Does the patient have one or more of these symptoms?
4 Limb features
5 I m not in pain but don t have the strength I used to when doing everyday things carrying shopping, undoing jars that kind of thing.
6 I m not in pain but don t have the strength Limb features I used to when doing Focal weakness everyday things carrying shopping, undoing jars that kind of thing.
7 It is as if I can t control my fingers. I m having difficulty with simple things - unscrewing the petrol cap, doing up zips and buttons.
8 It is as if I can t control my fingers. I m having Limb features difficulty with simple Loss of dexterity things - unscrewing the petrol cap, doing up zips and buttons.
9 My foot and leg feel heavy and seem to drag when I walk sometimes I fall over because of it.
10 My foot and leg feel heavy and seem to Limb features drag when I walk Falls/trips from foot drop sometimes I fall over because of it.
11 I get cramps in my leg.
12 I get cramps in my leg. Limb features Cramps
13 70% of patients present with limb symptoms
14 Bulbar features
15 I am finding that I sometimes slur my words other people are noticing it too.
16 I am finding that I sometimes Bulbar features slur my words Dysarthria other - slurred people or quiet speech often when tired are noticing it too.
17 I have difficulty swallowing it feels like I cannot get my food to go down, almost a choking sensation.
18 I have difficulty swallowing Bulbar features it feels Swallowing difficulties like Liquids I cannot and/or solids get my food Excessive to go saliva down, Choking sensation especially almost when lying a choking flat sensation.
19 My tongue occasionally twitches and flickers.
20 My tongue occasionally Bulbar features twitches Tongue fasciculations and flickers.
21 25% of patients present with bulbar symptoms
22 Respiratory features
23 I feel tired during the day I ve not felt like that before. I don t seem to have any energy.
24 Respiratory features I Excessive feel tired daytime during sleepiness Fatigue the day I ve not felt like that before. I don t seem to have any energy.
25 When I wake up I am still tired and I feel a bit hung-over, my head is muzzy.
26 When I wake up I am still tired and I feel a bit hung-over, my Respiratory head is features muzzy. Early morning headache
27 I get quite breathless for example if I walk fast or run for the bus or train.
28 I get quite breathless for example if I walk fast or run for the bus or train. Respiratory features Shortness of breath on exertion
29 When I go to bed and lay down I find it harder to breathe it is better when I sit upright.
30 Respiratory features Orthopnoea When I go to bed and lay down I find it harder to breathe it is better when I sit upright.
31 Respiratory problems are often a late feature of MND and an unusual presenting feature. Patients present with features of neuromuscular respiratory failure.
32 Cognitive features
33 Frank dementia at presentation is rare
34 I find myself crying for no real reason sometimes.
35 I find myself crying for no real reason Cognitive features Emotional lability sometimes.
36 2. Is there progression?
37 Supporting factors Asymmetrical features Age MND can present at any age Positive family history of MND or other neurodegenerative disease Factors NOT supportive of MND diagnosis Bladder / bowel involvement Prominent sensory symptoms Double vision / Ptosis Improving symptoms If the patient has one or more symptoms and there is progression query MND and refer to Neurology. If you think it might be MND please state explicitly in the referral letter. Common causes of delay are initial referral to ENT or Orthopaedic services.
38 The Red Flags tool
39 Painless, progressive weakness Could this be Motor Neurone Disease? 1. Does the patient have one or more of these symptoms? 2. Is there progression? If yes to 1 and 2 query MND and refer to Neurology If you think it might be MND please state explicitly in the referral letter. Common causes of delay are initial referral to ENT or Orthopaedic services.
40
41 Additional resources: MND Association downloads and publications at Copyright MND Association 2014
Painless, progressive weakness Could this be Motor Neurone Disease?
APPENDIX 1 Painless, progressive weakness Could this be Motor Neurone Disease? 1. Does the patient have one or more of these? Bulbar features Limb features Respiratory features Cognitive features (rare)
RESPIRATORY PROBLEMS IN MND RICHARD HARRISON MND RESPIRATORY ASSESSMENT SERVICE LUNG HEALTH UNIVERSITY HOSPITAL OF NORTH TEES
RESPIRATORY PROBLEMS IN MND RICHARD HARRISON MND RESPIRATORY ASSESSMENT SERVICE LUNG HEALTH UNIVERSITY HOSPITAL OF NORTH TEES A TYPICAL HISTORY: NON BULBAR ONSET Difficulty walking Weak hands and arms
2: Symptoms and management
2: Symptoms and management This section will help you to find out about the likely symptoms of motor neurone disease (MND) and how these can be managed. The following information is an extracted section
MOTOR NEURONE DISEASE
MOTOR NEURONE DISEASE Dr Arun Aggarwal Department of Rehabilitation Medicine, RPAH Department of Neurology, Concord Hospital. Motor Neurone Disease Umbrella term in UK and Australia (ALS in USA) Neurodegenerative
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Motor neurone disease: the use of non-invasive ventilation in the management of motor neurone disease 1.1 Short title Motor
SLEEP HISTORY QUESTIONNAIRE
Date of birth: Today s date: Dear Patient: SLEEP HISTORY QUESTIONNAIRE Thank you for taking the time to fill out a sleep history questionnaire. This will help our healthcare team to provide the best possible
PATIENT NAME: M.R. #: ACCT #: HOME TEL: WORK TEL: AGE: D.O.B.: OCCUPATION: HEIGHT: WEIGHT: NECK SIZE: GENDER EMERGENCY CONTACT: RELATIONSHIP: TEL:
SLEEP DISORDERS INSTITUTE HOSPITAL: DePaul Building Street Address City, State Zip Tel: (202) 555-1212 Fax: (202) 555-1212 SLEEP QUESTIONNAIRE PATIENT NAME: M.R. #: ACCT #: STREET ADDRESS: CITY: STATE:
For carers and relatives of people with frontotemporal dementia and semantic dementia. Newsletter
For carers and relatives of people with frontotemporal dementia and semantic dementia Newsletter AUGUST 2008 1 Welcome Welcome to the August edition of our CFU Support Group Newsletter. Thanks to all of
Assessment Instruments for Your Patients with Myasthenia Gravis (MG)
Assessment Instruments for Your Patients with Myasthenia Gravis (MG) Table of Contents Reported by patient Myasthenia Gravis Activities of Daily Living (MG-ADL): ~10 minutes 8-item outcome measure that
DEEP BRAIN STIMULATION SURGICAL CANDIDACY EVALUATION FORM
Name: MR#: Date: DEEP BRAIN STIMULATION SURGICAL CANDIDACY EVALUATION FORM Referring Physician s Name: Primary Care Provider s Name: 1. What was/were your first movement disorder symptoms? What did you
Course Handouts & Disclosure
ALS: DISEASE TRAJECTORY AND HOSPICE ELIGIBILITY Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources Inc Hospice Education Network Inc Course Handouts & Disclosure To download presentation
Two-point discrimination threshold of inhabitants in the methylmercury-polluted area.
Two-point discrimination threshold of inhabitants in the methylmercury-polluted area. Shigeru Takaoka Kyoritsu Neurology and Rehabilitation Clinic Yoshinobu Kawakami, Shin-ichi Shigeoka, Tadashi Fujino
The Fresco Institute for Parkinson's and Movement Disorders
The Fresco Institute for Parkinson's and Movement Disorders Follow Up Patient Questionnaire Name: Date: Accompanied by: Do you smoke? CURRENT PAST NEVER Which neurological symptom bothers you most right
130 Preston Executive Drive Cary, NC Ph(919) Fax(919) Page 1 of 6. Patient History
130 Preston Executive Drive Cary, NC 27513 Ph(919)462-8081 Fax(919)462-8082 www.parkwaysleep.com Page 1 of 6 Patient History *Please fill out in dark BLACK INK only. General Information Name Sex: Male
BRAIN STEM CASE HISTORIES CASE HISTORY VII
463 Brain stem Case history BRAIN STEM CASE HISTORIES CASE HISTORY VII A 60 year old man with hypertension wakes one morning with trouble walking. He is feeling dizzy and is sick to his stomach. His wife
Sleep Symptoms & History
Sleep Symptoms & History In your own words, please tell us what brings you to the sleep clinic today? How long have you been experiencing your sleep problems? yrs. mos. To give us a precise understanding
Patient History & Sleep Questionnaire
Patient History & Sleep Questionnaire Patient Full Name: Nick Name: Birth date: Age: Sex: Height: Current Weight: Weight Five Years Ago: Peak Lifetime Weight: Marital Status: Single Married Divorced Widowed
LIST CHANGES IN YOUR MEDICATION OR SUPPLEMENTS INTAKE (add new meds, changes in old meds or meds you stopped taking) Are you taking it?
Date Patient name: LIST YOUR THREE MAIN COMPLAINTS FOR THIS VISIT - - - New med Old med LIST CHANGES IN YOUR MEDICATION OR SUPPLEMENTS INTAKE (add new meds, changes in old meds or meds you stopped taking)
End of Life Care in Dementia. Sue Atkins Dignity in Care/Dementia/Learning Disabilities Clinical Nurse Specialist
End of Life Care in Dementia Sue Atkins Dignity in Care/Dementia/Learning Disabilities Clinical Nurse Specialist Objectives Understanding the decline in people with dementia To recognise when patients
Non-Motor Symptoms of Parkinson s Disease
Non-Motor Symptoms of Parkinson s Disease Samantha Holden, MD University of Colorado Movement Disorders MOTOR SYMPTOMS Rigidity Bradykinesia Tremor Gait Imbalance NON-MOTOR SYMPTOMS Dementia Urinary frequency
Rehabilitation after colorectal surgery
Rehabilitation after colorectal surgery Advice for your recovery Information for patients Recovering after your operation The recovery period following your operation starts as soon as you get back to
Height: Weight: Neck Size: Does your work involve shift work? Yes No. Where did you hear about us: Physician Media Friend Other
Personal Information Name: Date of birth: Sex: Male Female Marital Status: Nationality: MRN(for KAUH Patients): Height: Weight: Neck Size: Address: Occupation: Length of work day: Does your work involve
Relief from. Snoring and Sleep Apnoea. Workbook. Tess Graham
Relief from Snoring and Sleep Apnoea Workbook Tess Graham Copyright Tess Graham, Breathing Training Pty Ltd 2012 The moral right of the author has been asserted. All rights reserved. Without limiting the
Assessment of Sleep Disorders DR HUGH SELSICK
Assessment of Sleep Disorders DR HUGH SELSICK Goals Understand the importance of history taking Be able to take a basic sleep history Be aware the technology used to assess sleep disorders. Understand
MOTOR NEURONE DISEASE RESPIRATORY ISSUES
MOTOR NEURONE DISEASE RESPIRATORY ISSUES Dr Peter Allcroft Southern Adelaide Palliative Services Daw Park Repatriation General Hospital South Australia MOTOR NEURONE DISEASE Progressive weakness muscles
Sleep Questionnaire. Today s Date: DOB: Age: Marital Status: S M W D Gender: Occupation: Phone: Height: Current Weight: Weight 1 year ago:
Sleep Questionnaire Patient's Name: Referring Dr.: Today s Date: DOB: Age: Marital Status: S M W D Gender: Occupation: Phone: Height: Current Weight: Weight 1 year ago: Weight 5 years ago: 5 yrs ago: 10
Polio Overview. Bulbar Polio
Polio Overview with an emphasis on Bulbar Polio Prepared by: Richard Daggett President, Polio Survivors Association Member, American Academy of Home Care Medicine Poliomyelitis, often called polio or infantile
Disclosures. This speaker has indicated there are no relevant financial relationships to be disclosed.
Disclosures This speaker has indicated there are no relevant financial relationships to be disclosed. Parkinson s Disease, Huntington s Disease and ALS: A brief overview of three diagnoses Leo G. Rafail,
1960 FP CENTER FOR SLEEP DISORDERS
1960 FP CENTER FOR SLEEP DISORDERS Sleep Questionnaire Name: Date: Date of Birth: / / Age: Gender: Height: Weight: lbs. Referring Physician: Occupation: Please give a brief description of your sleep problem
20/11/2013. Dr. Sinead Maguire Neurology Registrar 22 nd November 2013
Dr. Sinead Maguire Neurology Registrar 22 nd November 2013 The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and psychological,
HEALTHY LIFESTYLE, HEALTHY SLEEP. There are many different sleep disorders, and almost all of them can be improved with lifestyle changes.
HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep disorders, and almost all of them can be improved with lifestyle changes. HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep
PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID (208)
PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID 83704 (208)884-2922 ***Questionnaire MUST be completed PRIOR to arrival for appointment*** Today s Date / / / / Last First MI DOB Referring
WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS
WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS Prior to your office visit, we request that you complete this questionnaire. It asks questions not only about your sleeping habits and behavior
FOR SECURITY REASONS, WE DO NOT ALLOW OCCUPIED VEHICLES IN OUR PARKING LOT.
Pain & Wellness of Centers of Georgia FOR SECURITY REASONS, WE DO NOT ALLOW OCCUPIED VEHICLES IN OUR PARKING LOT. I understand that if I receive a ride here, the people that accompany me MAY NOT wait in
Pain Drawing. Name: Today s Date: How were you referred to the office: Visual Analog Scale
Pain Drawing Name: Today s Date: How were you referred to the office: Please be sure to fill this out as accurately as possible. This will become part of your permanent medical record and will be used
Sleep History Questionnaire B/P / Pulse: Neck Circum Wgt: Pulse Ox
2700 Campus Drive, Ste 100 2412 E 117 th Street Plymouth, MN 55441 Burnsville, MN 55337 P 763.519.0634 F 763.519.0636 P 952.431.5011 F 952.431.5013 www.whitneysleepcenter.com Sleep History Questionnaire
SLEEP QUESTIONNAIRE. Name: Home Telephone. Address: Work Telephone: Marital Status: Date of Birth: Age: Sex: Height: Weight: Pharmacy & Phone #:
q JHMCE q JHS q SMEH SLEEP QUESTIONNAIRE 1. DEMOGRAPHIC DATA Name: Home Telephone Address: Work Telephone: Marital Status: Date of Birth: Age: Sex: Height: Weight: 2. PHYSICIAN INFORMATION Name of Primary
The PSP Association. Presentation on the symptoms, care and support of patients with PSP.
The PSP Association Presentation on the symptoms, care and support of patients with PSP. 1 Presented by: Kathy Miller-Hunt Development Officer Southwest Other names Steele Richardson Olszewski Syndrome
Iowa Sleep Disturbances Inventory (ISDI)
Department of Psychological & Brain Sciences Publications 1-1-2010 Iowa Sleep Disturbances Inventory (ISDI) Erin Koffel University of Iowa Copyright 2010 Erin Koffel Comments For more information on the
YOUR NAME AGE DATE. Comments. Describe your sleep problem and how long you ve had it
YOUR NAME AGE DATE Describe your sleep problem and how long you ve had it Have you ever been at a sleep center before? YES NO When? Where? Ever been on CPAP? YES NO WORK SCHEDULE When does your usual work
Emergency Contact Information Name: Phone: Address: Employer Information Employer Name: Address/Street: City: Zip: Phone: Fax:
SUNSET SLEEP LABS PATIENT INFORMATION FORM Patient Information Name: Sex: M F Date of Birth: Address/Street: City: Zip: Phone: Alt Phone: Parent/Guardian: Phone: Social Security Number: Drivers License:
Baptist Health Floyd 1850 State Street New Albany, IN Sleep Disorders Center Lung & Sleep Specialists. Date of Birth: Age:
Page 1 of 7 GENERAL INFORMATION Name: Date of Birth: Age: Social Security #: Sex: Height: Weight: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Employer s Name: Marital Status: Married
PATIENT SLEEP QUESTIONNAIRE
PATIENT SLEEP QUESTIONNAIRE Name: Date of Birth: Today s Date Primary Care Physician Telephone # Physician ordering test (Other than PCP): Physician s Tel. #: _ Age: Years Height: Feet Inches Weight: Lb
Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address
Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading
Muscular System. Disorders & Conditions
Muscular System Disorders & Conditions Fibromyalgia Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Often is described
Amarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
Re-Exam Questionnaire
Re-Exam Questionnaire Patient Name: Date: The following hi-lighted symptoms are what brought you into our office originally. DIRECTIONS: Please rate ALL hi-lighted symptoms: S = same; B = better; W = worse
Kennedy s Disease. Information for people with or affected by Kennedy s Disease
2B Kennedy s Disease Information for people with or affected by Kennedy s Disease If you have been diagnosed with Kennedy s disease, also known as spinal bulbar muscular atrophy or SBMA, you may be looking
Northern Ireland Chest Heart & Stroke. What are Chest, Heart and Stroke conditions?
Northern Ireland Chest Heart & Stroke What are Chest, Heart and Stroke conditions? Everyone in Northern Ireland knows someone who has suffered from a chest, heart or stroke condition. 40% of adult deaths
Name: DOB: Age: Phone: Phone: Is this an injury related to a : (circle one) Other? Yes / No (Please Explain)
Family/Primary Doctor: Emergency Contact: Name Phone: Phone: Who referred you to our office? Who else have you seen for this condition? INSTRUCTIONS: Please provide the following information, in detail.
*521634* Sleep History Questionnaire. Name of primary care doctor:
*521634* Today s Date: Sleep History Questionnaire Appointment Date: Please answer the following questions before coming to your appointment. Please arrive 15 minutes early with this packet filled out.
Obstructive Sleep Apnea
Obstructive Sleep Apnea Introduction Obstructive sleep apnea is an interruption in breathing during sleep. It is caused by throat and tongue muscles collapsing and relaxing. This blocks, or obstructs,
Please complete ALL 6 pages of the form in blue/black ink. Patient Acct # Provider # BMI # Height Weight
Please complete ALL 6 pages of the form in blue/black ink. Patient Acct # Provider # BMI # Height Weight f-25-n (08-07-13) ( 11-02-12) 0 10 Spine Questionnaire (continued) OFFICE USE ONLY Patient Acct
Home Sleep Testing Questionnaire
Home Sleep Testing Questionnaire Patient Name: DOB: / / Gender: Male Female Study Date: / / Marital Status: Married Cohabitate Single Divorced Widow/Widower Email: Phone: Height: Weight: Neck Size: What
Therapy following a neck of femur fracture
INFORMATION FOR PATIENTS Therapy following a neck of femur fracture Name of patient: ffffffffffffffffffffffffffffffffffffffffffff Procedure: ffffffffffffffffffffffffffffffffffffffffffffffffffff Consultant:
ROLE OF THE DIETITIAN. Aims of Dietetic Treatment NUTRITIONAL ISSUES WHY? MALNUTRITION NUTRITONAL MANAGEMENT OF MOTOR NEURONE DISEASE.
NUTRITONAL MANAGEMENT OF MOTOR NEURONE DISEASE. ROLE OF THE DIETITIAN SALLY DARBY NEUROLOGY DIETITIAN Not just tube feeding Referral soon after diagnosis Advise on healthy eating for MND Monitor nutritional
Acute Neurology. Charlotte Lawthom
Acute Neurology Charlotte Lawthom Or Neurology isn t just for Neurologists 2 Where are the neurologists? Despite Neurology conditions making up 10% to 20% of acute medical admissions.. Many DGH only have
PRE-VISIT QUESTIONNAIRE FOR NEW PATIENTS
UF Health Senior Care PO Box 100383 Gainesville, FL 32608 352-265-0615 Fax 352-294-5803 PRE-VISIT QUESTIONNAIRE FOR NEW PATIENTS Please complete this questionnaire at home and bring it with you to the
PEDIATRIC SLEEP EVALUATION
PEDIATRIC SLEEP EVALUATION Directions: Please answer each of the following questions by writing in or choosing the best answer. This will help us know more about your family and your child. CHILD S INFORMATION
Pediatric Sleep History
Fax 423-431-2983 Pediatric Sleep History Patient/ Child s Name: Date of Birth: Parent Name: Last 4 of Social Security No: Gender: Male Female Height: Weight: Age: Race: Street Address: City: State: Zip:
Sleep Disorders Diagnostic Center 9733 Healthway Drive, Berlin, MD , ext. 5118
Sleep Questionnaire *Please complete the following as accurate as possible. Please bring your completed questionnaire, insurance card, photo ID, Pre-Authorization and/or Insurance referral form, and all
The Language of Stroke
The Language of Stroke Examination / Imaging / Diagnosis / Treatment Dr Suzanne Busch A lot of letters! CBF CVA ICH CVD CBV DWI US MRI/MRA CAA CTA CTP ICA MCA SAH WMD TIA MCA Agnosia A lot of big words!
Questionnaire for Lipedema Patients
Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees
Case 1 A 65 year old college professor came to the neurology clinic referred by her family physician because of frequent falling. She had a history of
Peripheral Nervous System Case 1 A 65 year old college professor came to the neurology clinic referred by her family physician because of frequent falling. She had a history of non-insulin dependent diabetes
Narendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine
Narendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine PATIENT DEMOGRAPHICS Who is the Physician that referred you to us? Who is the primary care Physician? Date: Do you want this report
1. a. Please state in your own words why you (or your physician) asked for a sleep evaluation.
Jupiter Medical Center Sleep Center 1230 S. Old Dixie Highway Jupiter, FL 33458 (561) 744-4478 Fax (561) 748-4114 Email: Sleep@jupitermed.com S L E E P C E N T E R An ACHC Accredited Sleep Facility Sleep
Are you skimping on sleep, or could you have a sleep disorder?
Are you skimping on sleep, or could you have a sleep disorder? Look around you: the guy nodding off on the bus, the co-worker snoozing during a dull presentation, the people with heavy eyelids lined up
Fibromyalgia summary. Patient leaflets from the BMJ Group. What is fibromyalgia? What are the symptoms?
Patient leaflets from the BMJ Group Fibromyalgia summary We all get aches and pains from time to time. But if you have long-term widespread pain across your whole body, you may have a condition called
Patient Information. Name: Date of Birth: Address: Number & Street City State Zip Code. Home Number: ( ) Cell Number: ( )
Patient Information Name: Date of Birth: Age: Address: Number & Street City State Zip Code Home Number: ( ) Cell Number: ( ) Social Security Number: Marital Status: Religion: Race: Height: Weight: Sex:
Stroke Impact Scale VERSION 3.0
Stroke Impact Scale VERSION 3.0 The purpose of this questionnaire is to evaluate how stroke has impacted your health and life. We want to know from YOUR POINT OF VIEW how stroke has affected you. We will
Original Sleep Hygiene Rules*
Original Sleep Hygiene Rules* 1. Sleep as much as needed to feel refreshed and healthy during the following day, but not more. Curtailing time in bed a bit seems to solidify sleep; excessively long times
The road to recovery. The support available to help you with your recovery after stroke
The road to recovery The road to recovery The support available to help you with your recovery after stroke We re for life after stroke Need to talk? Call our confidential Stroke Helpline on 0303 3033
Seizures explained. What is a seizure? Triggers for seizures
Seizures explained What is a seizure? A seizure is a sign of a temporary disruption in the brain s electrical activity. Billions of brain cells pass messages to each other and these affect what we say
Patient Questionnaire
Name: DOB: Date of Visit: Patient Questionnaire Social History Yes No Do you eat a healthy balanced diet with minimal salt and bad fats? For Example: Balanced Diet = Combination of fruits, vegetables,
Kelowna Sleep Clinic Dr. Ronald Cridland Inc Sleep Questionnaire
Dr. Ronald Cridland Inc Sleep Questionnaire Name: Date: d/m/yr Date of Birth: d/m/yr Age: Marital Status: Sex: M F Address: City: Province: Postal Code: Health Care #: Home Phone #: Work Phone #: _ Cell
Occupation: Leisure Activities: ALLERGIES Are you latex-sensitive? Y N List any medication(s) you are allergic to:
Hello and thank you for choosing Fusion Physical Therapy as the provider for your current healthcare need(s)! We look forward to working with you to help make your day a little easier! To ensure you receive
Dr Seeta Durvasula. 30 th October 2012
Dr Seeta Durvasula seeta.durvasula@sydney.edu.au 30 th October 2012 1 How old is old? What happens with ageing? Ageing and health in people with intellectual disability How does ageing affect people with
PATIENT INFORMATION. Name: Date of Birth: Home Phone: Cell Phone: Work Phone: Address: Home Address: City: State ZIP: Emergency Contact: Phone:
PATIENT INFORMATION Name: Date of Birth: Home Phone: Cell Phone: Work Phone: Email Address: Home Address: City: State ZIP: Social Security #: Marital Status: Single Married Divorced Widowed Emergency Contact:
SLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem:
SLEEP QUESTIONNAIRE Your answers to the following questions will help us to obtain a better understanding of your sleep problems. Please answer every question to the best of your ability. It is helpful
There are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
Patient Adult Information History
Patient Adult Information History Patient name: Age: Date: What is the main reason for today s evaluation? Infant History Birth delivery: Normal C-section Delayed Epidural Premature: No Yes If yes, how
ALLIANCE COMMUNITY HOSPITAL SLEEP DISORDERS CENTER PATIENT QUESTIONNAIRE/HISTORY PLEASE COMPLETE AND BRING WITH YOU ON THE NIGHT OF YOUR TEST.
ALLIANCE COMMUNITY HOSPITAL SLEEP DISORDERS CENTER PATIENT QUESTIONNAIRE/HISTORY PLEASE COMPLETE AND BRING WITH YOU ON THE NIGHT OF YOUR TEST. NAME DATE: HEIGHT: WEIGHT: DOB: SEX: HOME PHONE #: REFERRING
Patient Sleep History and Physical
Dear Patient, We appreciate your selection of this office to serve your medical and health needs and we will do all we can to provide you with the very best care. You must bring the following items with
ANNUAL FOLLOW-UP QUESTIONNAIRE
SLEEP HEART HEALTH STUDY - TUCSON ANNUAL FOLLOW-UP QUESTIONNAIRE - 2004 Dear Sleep Heart Health Study participant: Today s Date: / / Month Day Year Please take the time to complete and return this short
A Hypothesis Driven Approach to the Neurological Exam
A Hypothesis Driven Approach to the Neurological Exam Vanja Douglas, MD Assistant Clinical Professor UCSF Department of Neurology Disclosures None 1 Purpose of Neuro Exam Screen asymptomatic patients Screen
Information & Health History Form
Information & Health History Form Name Date Address City/State/Zip Code Home Phone Cell Phone Email Address (Please Print Clearly) Employment (Company, Position) Date of birth Age Gender M / F Emergency
New Patient Sleep Intake
New Patient Sleep Intake Name: Date of Birth: Primary Care Physician: Date of Visit: Referring Physician and/or Other Physicians: Retail Pharmacy: Mail Order Pharmacy: Address: Mail Order Phone #: Phone
Please fill out the following form in as much detail as possible. Please Print. Name. Address. City State Zip. Home Phone Office Phone.
CASE NO. Please fill out the following form in as much detail as possible. Please Print Date Name Address City State Zip Home Phone Office Phone E-mail Address Age Date of Birth Occupation Sex (M) (F)
1/28/2019. OSF HealthCare INI Care Center Team. Neuromuscular Disease: Muscular Dystrophy. OSF HealthCare INI Care Center Team: Who are we?
Neuromuscular Disease: Muscular Dystrophy Muscular Dystrophy Association (MDA) and OSF HealthCare Illinois Neurological Institute (INI) Care Center Team The Neuromuscular clinic is a designated MDA Care
Depression & Anxiety. What can I do? What are other possible treatments? What is this? Why does this happen? KEY POINTS
Depression & Anxiety One set of important protectors from depression is friends and family as much as you can, keep yourself active and engaged with others. Exercise, particularly while outside, may help.
Epilepsy 101. Recognition and Care of Seizures and Emergencies Patricia Osborne Shafer RN, MN. American Epilepsy Society
Epilepsy 101 Recognition and Care of Seizures and Emergencies Patricia Osborne Shafer RN, MN American Epilepsy Society Objectives Recognize generalized and partial seizures. Demonstrate basic first aid
Getting Comfortable with Managing Pain and Pressure Care in individuals with Motor Neuron Disease Stephanie Williams Occupational Therapist
Getting Comfortable with Managing Pain and Pressure Care in individuals with Motor Neuron Disease Stephanie Williams Occupational Therapist State-wide Progressive Neurological Diseases Service Calvary
Sleep Health Center. You have been scheduled for an Insomnia Treatment Program consultation to further discuss your
Sleep Health Center You have been scheduled for an Insomnia Treatment Program consultation to further discuss your sleep. In the week preceding your appointment, please take the time to complete the enclosed
Exercise and Your Heart
Northwestern Memorial Hospital Patient Education CARE AND TREATMENT Physical inactivity is a recognized risk factor for coronary artery disease. Exercise and Your Heart Why Exercise? Exercise can improve
Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire
Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire First Name: M.I. Last Name: Date of Birth: Phone: Marital Status: Married Divorced Separated Widowed Single Work Status: Employed
What to expect following spinal cord injury. Information for patients Therapy Services
What to expect following spinal cord injury Information for patients Therapy Services Introduction This leaflet aims to explain what spinal cord injury is and what to expect over the next few months. What
The Medical Center Sleep Center
The Medical Center Sleep Center Date: / / Name: Age: (First) (M.I.) (Last) Address: (Street / P.O. Box) (City) (State) (Zip) (County) Phone: Home ( ) Work ( ) Date of Birth: / / Education: Marital Status:
U n i f i e d P a r k i n s o n s D i s e a s e R a t i n g S c a l e ( U P D R S )
Patient last name:................................. Date of birth:.... /.... /........ Patient first name:................................. Date:.... /.... /........ U n i f i e d P a r k i n s o n s D
MS Ireland s Opinion On The Introduction of Sativex
MS Ireland s Opinion On The Introduction of Sativex Introduction Multiple Sclerosis Ireland is the national organization providing information, support and advocacy services to the MS community people