Form Structure: Benton Judgment of Line Orientation - Form V
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Benton Judgment of Line Orientation - Form V
Short Name:
JLO
Description:
"Judgment of Line Orientation (JLO) is a standardized test of visuospatial skills commonly associated with functioning of the parietal lobe in the right hemisphere. The test measures a person's ability to match the angle and orientation of lines in space. Subjects are asked to match two angled lines to a set of 11 lines that are arranged in a semicircle and separated 18 degrees from each other. The complete test has 30 items, but short forms have also been created. There is normative data available for ages 7-96. Copyright ? 1983 by PAR Benton AL, Hamsher K, Varney N, Spreen O. Contributions to Neuropsychological Assessment: A Clinical Manual. New York: Oxford; 1983."
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-08-31
Version:
1.0
Date Created:
2016-10-19
Owner:
Number of Data Elements:
54
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.
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 |
JOLO Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sex type | Self-reported sex of the participant/subject. | GenderTyp | Recommended | CDE |
| 2 | Education level USA type | Highest grade or level of school participant/subject has completed or the highest degree received | EduLvlUSATyp | Recommended | CDE |
| 3 | Laterality type | Laterality type relative to the anatomic site of the body examined or affected | LatTyp | Recommended | CDE |
Practice (Appears Up To 10 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
| 2 | Test item response text | The test (or assessment) item response text representing the answer for the items/questions of each test/assessment/questionnaire being asked. | TestItemRespTxt | Recommended | CDE |
Test Items (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Benton Judgment of Line Orientation (JLO) - Lines 5 to 10 MM correct Type | Indicates whether the response for lines 5 and 10 MM is correct as part of the Benton Judgment of Line Orientation (JLO) | JLOLine5To10MMCorrectTyp | Recommended | CDE |
| 2 | Benton Judgment of Line Orientation (JLO) - Lines 2 to 11 MM correct Type | Indicates whether the response for lines 2 and 11 MM is correct as part of the Benton Judgment of Line Orientation (JLO) | JLOLine2To11MMCorrectTyp | Recommended | CDE |
| 3 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 2 LL correct Type | Indicates whether the response for lines 1 and 2 LL is correct as part of the Benton Judgment of Line Orientation (JLO) | JLOLine1To2LLCorrectTyp | Recommended | CDE |
| 4 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 7 HH correct Type | Indicates whether the response for lines 1 and 7 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To7HHCorrectTyp | Recommended | CDE |
| 5 | Benton Judgment of Line Orientation (JLO) - Lines 6 to 7 HH correct Type | Indicates whether the response for lines 6 and 7 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine6To7HHCorrectTyp | Recommended | CDE |
| 6 | Benton Judgment of Line Orientation (JLO) - Lines 5 to 6 LL correct Type | Indicates whether the response for lines 5 and 6 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine5To6LLCorrectTyp | Recommended | CDE |
| 7 | Benton Judgment of Line Orientation (JLO) - Lines 4 to 5 HH correct Type | Indicates whether the response for lines 4 and 5 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine4To5HHCorrectTyp | Recommended | CDE |
| 8 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 3 MM correct Type | Indicates whether the response for lines 1 and 3 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To3MMCorrectTyp | Recommended | CDE |
| 9 | Benton Judgment of Line Orientation (JLO) - Lines 5 to 11 MM correct Type | Indicates whether the response for lines 5 and 11 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine5To11MMCorrectTyp | Recommended | CDE |
| 10 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 10 HH correct Type | Indicates whether the response for lines 1 and 10 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To10HHCorrectTyp | Recommended | CDE |
| 11 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 7 MM correct Type | Indicates whether the response for lines 1 and 7 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To7MMCorrectTyp | Recommended | CDE |
| 12 | Benton Judgment of Line Orientation (JLO) - Lines 2 to 6 HH correct Type | Indicates whether the response for lines 2 and 6 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine2To6HHCorrectTyp | Recommended | CDE |
| 13 | Benton Judgment of Line Orientation (JLO) - Lines 7 to 9 MM correct Type | Indicates whether the response for lines 7 and 9 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine7To9MMCorrectTyp | Recommended | CDE |
| 14 | Benton Judgment of Line Orientation (JLO) - Lines 2 and 5 HL correct Type | Indicates whether the response for lines 2 and 5 HL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine2To5HLCorrectTyp | Recommended | CDE |
| 15 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 9 LL correct Type | Indicates whether the response for lines 1 and 9 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To9LLCorrectTyp | Recommended | CDE |
| 16 | Benton Judgment of Line Orientation (JLO) - Lines 7 to 8 MM correct Type | Indicates whether the response for lines 7 and 8 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine7To8MMCorrectTyp | Recommended | CDE |
| 17 | Benton Judgment of Line Orientation (JLO) - Lines 3 to 5 HH correct Type | Indicates whether the response for lines 3 and 5 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine3To5HHCorrectTyp | Recommended | CDE |
| 18 | Benton Judgment of Line Orientation (JLO) - Lines 10 to 11 MH correct Type | Indicates whether the response for lines 10 and 11 MH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine10To11MHCorrectTyp | Recommended | CDE |
| 19 | Benton Judgment of Line Orientation (JLO) - Lines 1 to 4 MM correct Type | Indicates whether the response for lines 1 and 4 MM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine1To4MMCorrectTyp | Recommended | CDE |
| 20 | Benton Judgment of Line Orientation (JLO) - Lines 3 to 11 LL correct Type | Indicates whether the response for lines 3 and 11 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine3To11LLCorrectTyp | Recommended | CDE |
| 21 | Benton Judgment of Line Orientation (JLO) - Lines 6 to 10 LL correct Type | Indicates whether the response for lines 6 and 10 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine6To10LLCorrectTyp | Recommended | CDE |
| 22 | Benton Judgment of Line Orientation (JLO) - Lines 2 to 9 LL correct Type | Indicates whether the response for lines 2-9 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine2To9LLCorrectTyp | Recommended | CDE |
| 23 | Benton Judgment of Line Orientation (JLO) - Lines 3 to 8 HH correct Type | Indicates whether the response for lines 3-8 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine3To8HHCorrectTyp | Recommended | CDE |
| 24 | Benton Judgment of Line Orientation (JLO) - Lines 9 to 11 HH correct Type | Indicates whether the response for lines 9-11 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine9To11HHCorrectTyp | Recommended | CDE |
| 25 | Benton Judgment of Line Orientation (JLO) - Lines 3 to 4 LM correct Type | Indicates whether the response for lines 3-4 LM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine3To4LMCorrectTyp | Recommended | CDE |
| 26 | Benton Judgment of Line Orientation (JLO) - Lines 8 to 9 LL correct Type | Indicates whether the response for lines 8-9 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine8To9LLCorrectTyp | Recommended | CDE |
| 27 | Benton Judgment of Line Orientation (JLO) - Lines 8 to 11 HH correct Type | Indicates whether the response for lines 8-11 HH is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine8To11HHCorrectTyp | Recommended | CDE |
| 28 | Benton Judgment of Line Orientation (JLO) - Lines 7 to 10 LL correct Type | Indicates whether the response for lines 7-10 LL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine7To10LLCorrectTyp | Recommended | CDE |
| 29 | Benton Judgment of Line Orientation (JLO) - Lines 3 to 10 HL correct Type | Indicates whether the response for lines 3-10 HL is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine3To10HLCorrectTyp | Recommended | CDE |
| 30 | Benton Judgment of Line Orientation (JLO) - Lines 5 to 8 HM correct Type | Indicates whether the response for lines 5-8 HM is correct as part of theBenton Judgment of Line Orientation (JLO) | JLOLine5To8HMCorrectTyp | Recommended | CDE |
Summary (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Benton Judgment of Line Orientation (JLO) - Total correct count | The number of questions the participant/subject got correct as part of the Benton Judgment of Line Orientation (JLO) | JLOTotalCorrectCt | Recommended | CDE |
| 2 | Benton Judgment of Line Orientation (JLO) - Examiner impression text | The free-text field to describe the examiner's impressions of the participant/subject as part of the Benton Judgment of Line Orientation (JLO) | JLOExaminerImpressTxt | Recommended | CDE |
| 3 | Benton Judgment of Line Orientation (JLO) - Examiner observations text | The free-text field to describe the examiner's observations of the participant/subject as part of the Benton Judgment of Line Orientation (JLO). | JLOExaminerObsvTxt | Recommended | CDE |
| 4 | Benton Judgment of Line Orientation (JLO) - Lesion summary text | The free-text field to summarize lesion information on the participant/subject as part of the Benton Judgment of Line Orientation (JLO) | JLOLesionSummTxt | Recommended | CDE |
Keywords
