Aa
MS Symptom Inventory
I tried twice to put this as a new health page and each time couldn't get it to format correctly so I have deleted it there and figure you can read it here. I printed a copy of this when I was initially diagnosed and have lost the web address where I found it. if you know the source, please let me know so I can give credit........... Lulu
The original version had a 0-4 scale to rate each symptom.
0 = not at all, 1= a little bit, 2=moderately, 3=quite a bit, and 4=a great deal
Carefully read each symptom and circle the appropriate response as to whether you have experienced this symptom in the past month.
Visual Symptoms
1. I find it hard to read unless the print is large, even with glasses.
2. Driving is difficult because I cannot read road signs or see stop lights clearly, even with glasses.
3. I cannot see some colors well, even with glasses.
4. My vision is worse when lights are dim, even with glasses.
5. My vision is blurred or seems hazy in my right eye.
6. My vision is blurred or seems hazy in my left eye.
7. My vision becomes worse when I am hot or after exercise.
8. I am able to read for only a short period of time.
Left Hemisphere Symptoms
9. My speech is more difficult than it used to be.
10. People tell me I repeat myself.
11. I have difficulty thinking of words I want to use.
12. When I have something to do that takes a long time, I have trouble deciding where to start.
13. I have trouble fixing mechanical things at home.
14. I cannot understand what somebody is saying if other people are talking around me.
15. I need to read something more than once to understand it.
16. I easily forget things just told to me.
17. I find it difficult to keep track of the characters and plots in TV programs or movies or books.
18. I lose things around the house more now than I used to.
19. I often find myself laughing or crying at TV commercials or other minor things when I really don't feel that happy or sad.
20. I have difficulty buttoning buttons.
21. I drop things easily from my right hand.
22. I have trouble picking up small objects like coins from a flat surface with my right hand.
23. My handwriting is not as neat as it used to be.
24. I do not spell as well as I used to.
25. I often recognize someone's face, but cannot remember the name.
26. I have difficulty organizing what I want to say.
27. I have difficulty saying exactly what I mean.
28. I sometimes say a different word than the one I mean to say.
29. Of my arms and legs, my right hand is the weakest.
30. I definitely have less sensation on the right side of my body than on the left.
31. The right side of my body does not work as well as the left.
Right Hemisphere Symptoms
32. Balancing my checkbook is difficult for me because of problems with addition and subtraction.
33. I drop things easily from my left hand.
34. I have trouble picking up small objects like coins from a flat surface with my left hand.
35. Of my arms and legs, my left hand is the weakest.
36. Reading maps is more difficult for me than it used to be.
37. I definitely have less sensation on the left side of my body than on the right.
38. When I read, I need to use a ruler or straigth edge to keep track of which line I am on.
39. The left side of my body does not work as well as it used to.
Brain Stem and Cerebellar Symptoms
40. I slur my words.
41. My hands tremble.
42. I stagger as if I were drunk when I first get up after sitting or lying for some time.
43. I stagger as is I were drunk most of the time.
44. I would lose my balance if I had to run.
45. My handwriting is larger than it used to be.
46. I am more clumsy now than I used to be.
47. My legs are hard to control
48. Even though I can walk, I can no longer dance.
49. I have double vision.
50. I have double vision when I look at objects for a while.
51. I feel like I am moving when I am not.
52. My face is numb on one side.
53.1 stagger as if I were drunk when I am tired or hot.
54. My speech gets worse when I am fatigued.
55. My hands tremble when I am fatigued.
56.1 have numbness or tingling in my arms or hands.
57. My hands often feel cold.
58. It is hard for me to accurately feel the temperature in the bth or shower with my hands or feet.
59.1 have a dull pain in my arms.
60. Occasionally 1 feel an electric-like shock go up or down my spine.
61.1 have a band of abnormal sensation around my chest or abdomen.
62. My hands often feel cold.
63. I have numbness or tingling in my legs or feet.
64.1 have a burning sensation even in my best leg.
65.1 have a dull pain in my legs.
66.1 have a cramping pain in my legs.
67.1 would have trouble walking on uneven ground.
68.1 have trouble walking in the dark.
69.1 trip over carpet edges, small stones, etc.
70.1 have more difficulty walking than I used to.
71. Both my legs feel heavy.
72.1 use a wheelchair around the house.
73.1 use a wheelchair when I go out of my home.
74.1 use a wheelchair most of the time.
75.1 have difficulty going up or down stairs.
76. I hold onto walls to walk.
77. I use a cane to walk.
78.1 need to use a walker to get around.
79. My legs are stiff in the morning or at the end of the day.
80.1 have muscle cramps during the day.
81.1 have muscle cramps at night.
82.1 have a tendency to fall easily.
83. Both of my legs are weak.
84. Sometimes my legs suddenly give way.
85. I have to get to a bathroom faster than I used to.
86. I go to the bathroom more often now than I used to.
87. Occasionally I have accidents with my bladder.
88. I wear absorbent pads.
89. Occasionally I have accidents with my bowels.
90. My legs are stiff when I am fatigued or on hot days.
91. I have more difficulty walking when 1 am tired.
92. I fall more often when I am tired.
93. My legs feel heavy when I am fatigued.
Non-Localizing Symptoms
94. I avoid becoming hot or taking a hot shower or bath because it would make my symptoms worse.
95. I develop muscle weakness when I am hot.
96. My fatigue is worse when I am hot.
97. I am not able to do what I used to do because of fatigue.
98. I can only do things for a short period of time because I fatigue easily.
99. Fatigue substatially interferes with my daily activity.
The original version had a 0-4 scale to rate each symptom.
0 = not at all, 1= a little bit, 2=moderately, 3=quite a bit, and 4=a great deal
Carefully read each symptom and circle the appropriate response as to whether you have experienced this symptom in the past month.
Visual Symptoms
1. I find it hard to read unless the print is large, even with glasses.
2. Driving is difficult because I cannot read road signs or see stop lights clearly, even with glasses.
3. I cannot see some colors well, even with glasses.
4. My vision is worse when lights are dim, even with glasses.
5. My vision is blurred or seems hazy in my right eye.
6. My vision is blurred or seems hazy in my left eye.
7. My vision becomes worse when I am hot or after exercise.
8. I am able to read for only a short period of time.
Left Hemisphere Symptoms
9. My speech is more difficult than it used to be.
10. People tell me I repeat myself.
11. I have difficulty thinking of words I want to use.
12. When I have something to do that takes a long time, I have trouble deciding where to start.
13. I have trouble fixing mechanical things at home.
14. I cannot understand what somebody is saying if other people are talking around me.
15. I need to read something more than once to understand it.
16. I easily forget things just told to me.
17. I find it difficult to keep track of the characters and plots in TV programs or movies or books.
18. I lose things around the house more now than I used to.
19. I often find myself laughing or crying at TV commercials or other minor things when I really don't feel that happy or sad.
20. I have difficulty buttoning buttons.
21. I drop things easily from my right hand.
22. I have trouble picking up small objects like coins from a flat surface with my right hand.
23. My handwriting is not as neat as it used to be.
24. I do not spell as well as I used to.
25. I often recognize someone's face, but cannot remember the name.
26. I have difficulty organizing what I want to say.
27. I have difficulty saying exactly what I mean.
28. I sometimes say a different word than the one I mean to say.
29. Of my arms and legs, my right hand is the weakest.
30. I definitely have less sensation on the right side of my body than on the left.
31. The right side of my body does not work as well as the left.
Right Hemisphere Symptoms
32. Balancing my checkbook is difficult for me because of problems with addition and subtraction.
33. I drop things easily from my left hand.
34. I have trouble picking up small objects like coins from a flat surface with my left hand.
35. Of my arms and legs, my left hand is the weakest.
36. Reading maps is more difficult for me than it used to be.
37. I definitely have less sensation on the left side of my body than on the right.
38. When I read, I need to use a ruler or straigth edge to keep track of which line I am on.
39. The left side of my body does not work as well as it used to.
Brain Stem and Cerebellar Symptoms
40. I slur my words.
41. My hands tremble.
42. I stagger as if I were drunk when I first get up after sitting or lying for some time.
43. I stagger as is I were drunk most of the time.
44. I would lose my balance if I had to run.
45. My handwriting is larger than it used to be.
46. I am more clumsy now than I used to be.
47. My legs are hard to control
48. Even though I can walk, I can no longer dance.
49. I have double vision.
50. I have double vision when I look at objects for a while.
51. I feel like I am moving when I am not.
52. My face is numb on one side.
53.1 stagger as if I were drunk when I am tired or hot.
54. My speech gets worse when I am fatigued.
55. My hands tremble when I am fatigued.
56.1 have numbness or tingling in my arms or hands.
57. My hands often feel cold.
58. It is hard for me to accurately feel the temperature in the bth or shower with my hands or feet.
59.1 have a dull pain in my arms.
60. Occasionally 1 feel an electric-like shock go up or down my spine.
61.1 have a band of abnormal sensation around my chest or abdomen.
62. My hands often feel cold.
63. I have numbness or tingling in my legs or feet.
64.1 have a burning sensation even in my best leg.
65.1 have a dull pain in my legs.
66.1 have a cramping pain in my legs.
67.1 would have trouble walking on uneven ground.
68.1 have trouble walking in the dark.
69.1 trip over carpet edges, small stones, etc.
70.1 have more difficulty walking than I used to.
71. Both my legs feel heavy.
72.1 use a wheelchair around the house.
73.1 use a wheelchair when I go out of my home.
74.1 use a wheelchair most of the time.
75.1 have difficulty going up or down stairs.
76. I hold onto walls to walk.
77. I use a cane to walk.
78.1 need to use a walker to get around.
79. My legs are stiff in the morning or at the end of the day.
80.1 have muscle cramps during the day.
81.1 have muscle cramps at night.
82.1 have a tendency to fall easily.
83. Both of my legs are weak.
84. Sometimes my legs suddenly give way.
85. I have to get to a bathroom faster than I used to.
86. I go to the bathroom more often now than I used to.
87. Occasionally I have accidents with my bladder.
88. I wear absorbent pads.
89. Occasionally I have accidents with my bowels.
90. My legs are stiff when I am fatigued or on hot days.
91. I have more difficulty walking when 1 am tired.
92. I fall more often when I am tired.
93. My legs feel heavy when I am fatigued.
Non-Localizing Symptoms
94. I avoid becoming hot or taking a hot shower or bath because it would make my symptoms worse.
95. I develop muscle weakness when I am hot.
96. My fatigue is worse when I am hot.
97. I am not able to do what I used to do because of fatigue.
98. I can only do things for a short period of time because I fatigue easily.
99. Fatigue substatially interferes with my daily activity.
You're welcome - I thought this was so specific to brain areas and symptoms that it would be useful to someone. Shell is going to turn it into an HP since I failed miserably at that task. -Lulu
Wow, Lulu, this is great! Thank you so much for posting this!
Thanks saveone, I will check this out today.
doni
Thanks saveone, I will check this out today.
doni
Thanks for the addresses - I think the 1st one, the Kings County Washington site might be where I originally found this. Their website says they are merging with another chapter and perhaps that is why we can't retrieve this file. I believe this one is meant to be completed and taken to a doctor's appointment.
The second address from Saveone will take you to the MS society's Quality of Life assessment tool which is another good resource, but substantially meatier than the one I have listed here.
The one above breaks out the symptoms as they relate to the sections of our brains - that's part of what I really liked about this ..... the brain section is the heading on each grouping of questions.
Be well, Lulu
The second address from Saveone will take you to the MS society's Quality of Life assessment tool which is another good resource, but substantially meatier than the one I have listed here.
The one above breaks out the symptoms as they relate to the sections of our brains - that's part of what I really liked about this ..... the brain section is the heading on each grouping of questions.
Be well, Lulu
I have the PDF file but when I try to load the page it says error page unavailable. This is the html address. I put in spaces.
http: //74.125.45.132 /search?q=cache: EulqjOrwUFYJ: www. msakc.org/questionnaires/SymptLong.pdf+symptom+inventory:
+long+form&hl=en&ct =clnk&cd=1&gl=us &client=firefox-a
Quality of Life Inventory asks questions regarding symptoms etc to calculate your quality of life. The scoring guide is on the last 2 pages. This address takes you to the page where you can find the survey. It is the first one listed. Since it is the National MS Society there is so much more info there.
http://www. nationalmssociety.org /search-results/index.aspx? pageindex=0&pagesize=20&keywords= symptom+inventory&x=0&y=0
http: //74.125.45.132 /search?q=cache: EulqjOrwUFYJ: www. msakc.org/questionnaires/SymptLong.pdf+symptom+inventory:
+long+form&hl=en&ct =clnk&cd=1&gl=us &client=firefox-a
Quality of Life Inventory asks questions regarding symptoms etc to calculate your quality of life. The scoring guide is on the last 2 pages. This address takes you to the page where you can find the survey. It is the first one listed. Since it is the National MS Society there is so much more info there.
http://www. nationalmssociety.org /search-results/index.aspx? pageindex=0&pagesize=20&keywords= symptom+inventory&x=0&y=0
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