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Form Structure: Western Aphasia Battery Revised (WABR) Bedside Record Form

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Western Aphasia Battery Revised (WABR) Bedside Record Form
Short Name:
WABRB
Description:
Western Aphasia Battery Revised (WABR) Bedside Record Form is designed to evaluate a patient's language function following stroke, dementia, or other acquired neurological disorder.Kertesz, A. (2007). Western Aphasia Battery-Revised;www.pearsonassessments.com
Disease:
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:
2016-12-01
Owner:
Number of Data Elements:
64
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.

Collapse All   Expand All

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

Spontaneous Speech: Content (Appears Up To 4 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside (WABR)-Content Item 1 score  Content item 1 score, as part of the Western Aphasia Battery Revised Bedside (WABR). WABBDContentItem1Score Recommended CDE
5 Western Aphasia Battery Revised Bedside (WABR)-Content Item 2 score  Content item 2 score, as part of the Western Aphasia Battery Revised Bedside (WABR). WABBDContentItem2Score Recommended CDE
6 Western Aphasia Battery Revised Bedside (WABR)-Content Item 3 score  Content item 3 score, as part of the Western Aphasia Battery Revised Bedside (WABR). WABBDContentItem3Score Recommended CDE
7 Western Aphasia Battery Revised Bedside (WABR)-Content Item 4 score  Content item 4 score, as part of the Western Aphasia Battery Revised Bedside (WABR). WABBDContentItem4Score Recommended CDE

Spontaneous Speech: Content Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Content score  Content score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDContentScore Recommended CDE

Spontaneous Speech:Fluency (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Beside (WABR)-Fluency value statement type  Fluency value statement type , as part of Western Aphasia Battery Revised Beside (WABR) WABBDFluencyValueStatementTyp Recommended CDE
2 Westen Aphasia Battery Revised Bedside (WABR)-Fluency score  Fluency score , as part of Westen Aphasia Battery Revised Bedside (WABR) WABBDFluencyScore Recommended CDE

Auditory Verbal Comprehension: Yes/No Questions (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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside(WABR)-Auditory verbal comprehension item score  Auditory verbal comprehension item score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDAudVerbCompItemScore Recommended CDE

Auditory Verbal Comprehension:Yes/No Questions Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside(WABR)-Auditory verbal comprehension score  Auditory verbal comprehension item score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDAudVerbCompScore Recommended CDE

Sequential Command (Appears Up To 4 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Beside(WABR)- Sequential commands item score  Sequential commands item score , as part of Western Aphasia Battery Revised Beside(WABR) WABBDSeqComItemScore Recommended CDE

Sequential Command Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside(WABR)-Sequential commands score  Sequential commands score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDSeqComScore Recommended CDE

Repetition (Appears Up To 6 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside(WABR)-Repetition item score  Repetition item score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDRepItemScore Recommended CDE

Repetition Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Repetition score  Repetition score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDRepScore Recommended CDE

Object Naming (Appears Up To 20 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside(WABR)-Object naming item score  Object naming item score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDObjNamItemScore Recommended CDE

Object Naming Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Object naming score  Object naming score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDObjNamScore Recommended CDE

Bedside Aphasia Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Bedside sum of scores  Bedside sum of scores , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDBDSumOfScore Recommended CDE
2 Western Aphasia Battery Revised Bedside(WABR)-Beside aphasia score  Beside aphasia score , as part of Western Aphasia Battery Revised Bedside(WABR) WABBDBDAphasiaScore Recommended CDE

Reading (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Reading score  Reading score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDReadingScore Recommended CDE

Writing (Appears Up To 4 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside (WABR)-Writing item score  Writing item score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDWritingItemScore Recommended CDE

Writing Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Writing score  Writing score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDWritingScore Recommended CDE

Bedside Language Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Westen Aphasia Battery Revised Bedside(WABR)-Bedside language sum of scores  Beside language sum of scores, as part of Western Aphasia Battery Revised Bedside (WABR). WABBDBDLangSumOfScore Recommended CDE
2 Western Aphasia Battery Revised Bedside (WABR)-Bedside language score  Bedside language score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDBDLangScore Recommended CDE

Apraxia (Optional) (Appears Up To 5 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 Western Aphasia Battery Revised (WABR)-Item text 

(Draft)

 		Item text , as part of Western Aphasia Battery Revised (WABR) WABItemTxt Recommended UDE
3 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
4 Western Aphasia Battery Revised Bedside (WABR)-Apraxia item score  Apraxia item score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDApraxiaItemScore Recommended CDE

Apraxia Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised Bedside (WABR)-Apraxia score  Apraxia score , as part of Western Aphasia Battery Revised Bedside (WABR) WABBDApraxiaScore Recommended CDE

Bedside Aphasia Classification Criteria (Appears Up To 8 Times)

# Title Short Description Variable Name Required? Type
1 Western Aphasia Battery Revised (WABR)-Bedside phasia type  Bedside phasia type , as part of Western Aphasia Battery Revised (WABR) WABBDAphTyp Recommended CDE
2 Western Aphasia Battery Revised (WABR)-Bedside fluency number type  Bedside fluency number type , as part of Western Aphasia Battery Revised (WABR) WABBDFluencyNumTyp Recommended CDE
3 Western Aphasia Battery Revised (WABR)-Bedside auditory verbal comprehension score type  Bedside auditory verbal comprehension score type , as part of Western Aphasia Battery Revised (WABR) WABBDAudVerbComNumTyp Recommended CDE
4 Western Aphasia Battery Revised (WABR)-Bedside repetition number type  Bedside repetition number type , as part of Western Aphasia Battery Revised (WABR) WABBDRepNumTyp Recommended CDE
Keywords