Form Structure: Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design
This form structure is an organized set of data definitions for a copyrighted form
Title:
Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design
Short Name:
WASI_IBlockDesgn
Description:
The Wechsler Abbreviated Scale of Intelligence - First Edition (WASI-I) - Block Design subtest is used as part of assessment of human intelligence. It is thought to tap spatial visualization ability and motor skill. The test-taker uses hand movements to rearrange blocks that have various color patterns on different sides to match a pattern. The items in a block design test can be scored both by accuracy in matching the pattern and by speed in completing each item. http://www.pearsonassess.ca/en/programs/00/28/88/p002888.html
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-06-10
Version:
1.0
Date Created:
2016-04-12
Owner:
Number of Data Elements:
30
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 Group (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 2 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 3 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 4 | 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 |
Design 1 to 4 (Appears Up To 4 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number | Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnNum | Recommended | CDE |
| 2 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator | Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCorrInd | Recommended | CDE |
| 3 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 1-4 score | Score for Designs 1-4, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgn1to4Score | Recommended | CDE |
| 4 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time | Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCompltTime | Recommended | CDE |
Design 5 to 9 (Appears Up To 5 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number | Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnNum | Recommended | CDE |
| 2 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator | Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCorrInd | Recommended | CDE |
| 3 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 5-9 score | Score for Designs 5-9, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgn5to9Score | Recommended | CDE |
| 4 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time | Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCompltTime | Recommended | CDE |
Design 10 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number | Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnNum | Recommended | CDE |
| 2 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator | Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCorrInd | Recommended | CDE |
| 3 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design 10 score | Score for Design 10, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgn10Score | Recommended | CDE |
| 4 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time | Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCompltTime | Recommended | CDE |
Design 11 to 13 (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design number | Design number, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnNum | Recommended | CDE |
| 2 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Correct Design indicator | Indicator of correct Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCorrInd | Recommended | CDE |
| 3 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Designs 11-13 score | Score for Designs 11-13, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgn11to13Score | Recommended | CDE |
| 4 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Design completion time | Time to complete Design, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnCompltTime | Recommended | CDE |
Total score (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section - Total score | Total score, as part of the Wechsler Abbreviated Scale of Intelligence I (WASI-I) Block Design Section | WASI_IBlockDesgnTotalScore | Recommended | CDE |
Keywords
