Form Structure: NIH Toolbox Sensation Domain Dynamic Visual Acuity Test
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Sensation Domain Dynamic Visual Acuity Test
Short Name:
NIHTBDynamicVisualAcutyTst
Description:
Sensation Domain : The NIH Toolbox Dynamic Visual Acuity Test (DVA) is a measure of gaze stability during head movement, which helps identify individuals who may have a deficit of the vestibular system (which regulates internal balance). First, the NIH Toolbox Visual Acuity Test must be administered, followed by the DVA Test. As with the Visual Acuity Test, only the letters H, O, T, and V are used for ages 3-7, while ages 8+ use the entire letter set. Smaller optotypes are displayed as the participant correctly identifies letters, and larger ones are displayed if the participant cannot correctly identify the letter shown, until the computer has calculated the smallest size that the participant can see with the head moving. The DVA Test takes approximately six minutes to administer and is recommended for ages 3-85. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases)
Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-03
Owner:
Number of Data Elements:
53
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 |
NIH Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox - Test domain battery type | Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox | NIHTBTestDomainBattryTyp | Recommended | CDE |
| 2 | NIH Toolbox - Test domain battery type other | The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox | NIHTBTestDomainBatteryTypOTH | Recommended | CDE |
| 3 | NIH Toolbox - Test name type | Type of NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestNameTyp | Recommended | CDE |
| 4 | NIH Toolbox - Test name type other | The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox | NIHTBAdminTestNameTypOTH | Recommended | CDE |
| 5 | NIH Toolbox - Test administration language type | Type of language for test being administrated, as part of the NIH Toolbox | NIHTBTestAdminLanguageTyp | Recommended | CDE |
| 6 | NIH Toolbox - Test administration language type other | Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox | NIHTBTestAdminLanguageTypOTH | Recommended | CDE |
| 7 | NIH Toolbox - Form administered type | Type of NIH Toolbox form being administered, as part of the NIH Toolbox | NIHTBFormAdminTyp | Recommended | CDE |
| 8 | NIH Toolbox - Test administration flag type | Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagTyp | Recommended | CDE |
| 9 | NIH Toolbox - Test administration flag indicator | Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagInd | Recommended | CDE |
NIH Toolbox Visual Acuity Test 1 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Has progressive lenses indicator | Indicator of whether participant has progressive lenses or not, as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVAHasPrgrssveLensInd | Recommended | CDE |
| 2 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Visual Acuity Test - Trial result type | Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Visual Acuity Test | NIHTBVATrialResultType | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Log minimum angle of resolution (MAR) score | Score for log of minimum angle of resolution (MAR), as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test | NIHTBVALogMARScore | Recommended | CDE |
| 5 | NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Static visual acuity Snellen score | Snellen score for static visual acuity, as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test | NIHTBVAStaticSnellenScore | Recommended | CDE |
NIH Toolbox Visual Acuity Test 2 (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Has progressive lenses indicator | Indicator of whether participant has progressive lenses or not, as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVAHasPrgrssveLensInd | Recommended | CDE |
| 2 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Visual Acuity Test - Trial result type | Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Visual Acuity Test | NIHTBVATrialResultType | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Log minimum angle of resolution (MAR) score | Score for log of minimum angle of resolution (MAR), as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test | NIHTBVALogMARScore | Recommended | CDE |
| 5 | NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Static visual acuity Snellen score | Snellen score for static visual acuity, as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test | NIHTBVAStaticSnellenScore | Recommended | CDE |
NIH Toolbox Dynamic Visual Acuity Test: Practice Test (Appears Up To 10 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Dynamic Visual Acuity Test - Trial result type | Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Dynamic Visual Acuity Test | NIHTBDVATrialResultType | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Dynamic Visual Acuity Test - Practice test completed successfully indicator | Indicator of whether participant has successfully completed the practice test, as a part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVAPracticeCmpltSuccssInd | Recommended | CDE |
Dynamic Visual Acuity Test: Part 1 (Right) Test (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Test 1 indicator | Indicator of Test 1 (with glasses or contact lenses if usually worn for distance vision), as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBVATest1Ind | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Test 2 indicator | Indicator of Test 2 (only for those participants with glasses that are multifocal or who have progressive lenses), as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBVATest2Ind | Recommended | CDE |
| 3 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Dynamic Visual Acuity Test - Trial result type | Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Dynamic Visual Acuity Test | NIHTBDVATrialResultType | Recommended | CDE |
Dynamic Visual Acuity Test: Part 2 (Left) Test (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Test 1 indicator | Indicator of Test 1 (with glasses or contact lenses if usually worn for distance vision), as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBVATest1Ind | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Test 2 indicator | Indicator of Test 2 (only for those participants with glasses that are multifocal or who have progressive lenses), as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBVATest2Ind | Recommended | CDE |
| 3 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Dynamic Visual Acuity Test - Trial result type | Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Dynamic Visual Acuity Test | NIHTBDVATrialResultType | Recommended | CDE |
NIH Toolbox Dynamic Acuity Test Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Rightward rotation difference logMAR score | Score for rightward rotation difference logMAR, as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVARRotatDifflogMARScore | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Leftward rotation difference logMAR score | Score for leftward rotation difference logMAR, as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVALRotatDifflogMARScore | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test - Overall logMAR score | Score for overall logMAR, as part of the NIH Toolbox Sensation Domain Vestibular Measure Dynamic Visual Acuity Test | NIHTBDVAOveralllogMARScore | Recommended | CDE |
| 4 | NIH Toolbox Performance Measures (web and CAT) - Age-adjusted scale score | Age-adjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) | NIHTBPMAgeAdjSclScore | Recommended | CDE |
| 5 | NIH Toolbox Performance Measures - Age-adjusted national percentile value | Value of age-adjusted national percentile, as part of the NIH Toolbox Performance Measures | NIHTBPMAgeAdjNationalPctVal | Recommended | CDE |
| 6 | NIH Toolbox Performance Measures - Fully-adjusted scale score | Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures | NIHTBPMFullyAdjSclScore | Recommended | CDE |
| 7 | NIH Toolbox Performance Measures (web and CAT) - Unadjusted scale score | Unadjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) | NIHTBPMUnadjSclScore | Recommended | CDE |
| 8 | NIH Toolbox - Standard error | Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. | NIHTBStandardError | Optional | CDE |
Keywords
