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Form Structure: Caregiver Unintelligible Speech Rating Scale

This form structure is an organized set of data definitions for a copyrighted form
Title:
Caregiver Unintelligible Speech Rating Scale
Short Name:
CUSRS
Description:
This measure consists of 8 questions that assess a child’s speech intelligibility in spontaneous speech through parent/caregiver rating. References: Campbell, T. (1998). Measurement of Functional Outcome in Preschool. Children with Neurogenic Communication Disorder. Seminars in Speech and Language (19)3, 223- 233. Coplan, J., and Gleason, J. (1988). Unclear speech: recognition and significance of unintelligible speech in preschool children. Pediatrics 82, 447-452.
Disease:
General (For all diseases) Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-07
Owner:
Number of Data Elements:
33
eForms:
N
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 Optional 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 Optional 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 Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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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

CUS Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Respondent type  Respondent type, as part of Caregiver Unintelligible Speech CUSRespTyp Recommended CDE

Caregiver Unintelligible Speech Q1 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Attempts to say words scale  Attempts to say words scale , as part of Caregiver Unintelligible Speech CUSAttmptSayWrdsScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q2 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Understands what you say scale  Understands what you say scale , as part of Caregiver Unintelligible Speech CUSUndrstndWhtYouSayScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q3 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Successfully communicates needs by speaking scale  Successfully communicates needs by speaking scale , as part of Caregiver Unintelligible Speech CUSSuccCommNeedsSpkScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q4 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Successfully communicates without speaking scale  Successfully communicates without speaking scale , as part of Caregiver Unintelligible Speech CUSSuccCommWthoutSpkScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q5 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Successfully communicates with other children scale  Successfully communicates with other children scale , as part of Caregiver Unintelligible Speech CUSSuccCommOthrChildrnScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q6 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Able to talk without stuttering scale  Able to talk without stuttering scale , as part of Caregiver Unintelligible Speech CUSAbleTlkWthoutStuttScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 1 to 6 score  Question 1 to 6 score , as part of Caregiver Unintelligible Speech CUSQ1to6Score Recommended CDE

Caregiver Unintelligible Speech Q7 (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Question 6 situation type  Question 6 situation type , as part of Caregiver Unintelligible Speech CUSQ6SitnTyp Recommended CDE
2 Caregiver Unintelligible Speech -Unfamiliar listener understand scale  Unfamiliar listener understand scale , as part of Caregiver Unintelligible Speech CUSUnfmlrListnrUndstndScl Recommended CDE
3 Caregiver Unintelligible Speech -Question 7 score  Question 7 score , as part of Caregiver Unintelligible Speech CUSQ7Score Recommended CDE

Caregiver Unintelligible Speech Q8 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Caregiver Unintelligible Speech -Rate child's progress scale  Rate child's progress scale , as part of Caregiver Unintelligible Speech CUSRateChldPrgrssScl Recommended CDE
2 Caregiver Unintelligible Speech -Question 8 score  Question 8 score , as part of Caregiver Unintelligible Speech CUSQ8Score Recommended CDE
Keywords

Change History