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This form structure is an organized set of data definitions for a form that has not been copyrighted
Short Name:
This CRF Module contains data elements that are collected to further assess the level of balance.
Traumatic Brain Injury
Required Program Form:
Standard NINDS CDE
Form Type:
Clinical Assessment
Publication Date:
Date Created:
Number of Data Elements:
Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Recommended CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Recommended CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Recommended CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Recommended CDE
9 General notes text   General notes GeneralNotesTxt Recommended CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE
7 Assessment completion status  Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. AssessmentCompletionStat Recommended UDE
8 Assessment completion status text  A free text related to Assessment completion status specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion AssessmentCompletionStatTxt Recommended UDE

Balance (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Electronystagmography result  Global result of electronystagmography testing ElectronystagmographReslt Optional CDE
2 Rotational chair testing result  The result of rotational chair testing RotatnlChairTestReslt Optional CDE
3 Posturography testing result  Global result of posturography testing PosturographyTestReslt Optional CDE
4 Modified Romberg test result  The result of the Modified Romberg test ModRombergTestReslt Optional CDE
5 Vestibular evoked myogenic potential test result  The result of the vestibular evoked myogenic potential (VEMP) test VestibEvokMyogenPotentlTstRslt Optional CDE

Change History