This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Beery-Buktenica Developmental Test
Short Name:
BBDT
Description:
The Beery-Buktenica Developmental Test (of Visual-Motor Integration, Visual Perception, and/or Motor Coordinatio) is a developmental sequence of geometric forms to be copied with paper and pencil. The BBDT is designed to assess the extent to which individuals can integrate their visual and motor abilities (eye-hand coordination). Copyright 1967, 1982, 1989, 1997, 2004, 2006 (Adults), 2010 Keith E. Beery and Natasha A. Beery. All rights reserved. Published and distributed exclusively by NCS Pearson, Inc.
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:
2016-12-21
Owner:
Number of Data Elements:
69
eForms:
N

 Documentation


 Groups & Attached Data Elements

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

BBDTVMI Chronological Age (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Age derived value  The calculation of age based on the equation of Date of Event-Date of Birth. AgeDerivedVal Recommended UDE

BBDTVMI Items 1-3 (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 Beery-Buktenica Developmental Test-Task or form text  Task or form text , as part of Beery-Buktenica Developmental Test BBDTTaskOrFormTxt Recommended CDE
3 Image response file  The image used to obtain the subject response. ImageResponse Recommended CDE
4 Beery-Buktenica Developmental Test-Item score 

(Draft)

Item score , as part of Beery-Buktenica Developmental Test BBDTItmScore Recommended UDE
5 Beery-Buktenica Developmental Test-Marked box type  Marked box type , as part of Beery-Buktenica Developmental Test BBDTMarkedBoxTyp Recommended CDE
6 Beery-Buktenica Developmental Test-Mark spontaneity type 

(Draft)

Mark spontaneity type , as part of Beery-Buktenica Developmental Test BBDTMarkSponTyp Recommended UDE
7 Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value  Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration BBDTVMIAgeNormVal Recommended CDE
8 Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text 

(Draft)

Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMIObsTxt Recommended UDE
9 Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMITotalRawScore Recommended CDE

BBDTVMI Items 1-6 (Appears Up To 7 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 Beery-Buktenica Developmental Test-Task or form text  Task or form text , as part of Beery-Buktenica Developmental Test BBDTTaskOrFormTxt Recommended CDE
3 Beery-Buktenica Developmental Test-Item score 

(Draft)

Item score , as part of Beery-Buktenica Developmental Test BBDTItmScore Recommended UDE
4 Image response file  The image used to obtain the subject response. ImageResponse Recommended CDE
5 Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value  Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration BBDTVMIAgeNormVal Recommended CDE
6 Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text 

(Draft)

Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMIObsTxt Recommended UDE
7 Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMITotalRawScore Recommended CDE

BBDTVMI Items 7-30 (Appears Up To 24 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 Beery-Buktenica Developmental Test-Task or form text  Task or form text , as part of Beery-Buktenica Developmental Test BBDTTaskOrFormTxt Recommended CDE
3 Beery-Buktenica Developmental Test-Item score 

(Draft)

Item score , as part of Beery-Buktenica Developmental Test BBDTItmScore Recommended UDE
4 Image response file  The image used to obtain the subject response. ImageResponse Recommended CDE
5 Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value  Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration BBDTVMIAgeNormVal Recommended CDE
6 Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text 

(Draft)

Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMIObsTxt Recommended UDE
7 Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration BBDTVMITotalRawScore Recommended CDE

BBDTVP (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test of Visual Perception-Item 1 type 

(Draft)

Item 1 type , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPItm1Typ Recommended UDE
2 Beery-Buktenica Developmental Test of Visual Perception-Item 2 type 

(Draft)

Item 2 type , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPItm2Typ Recommended UDE
3 Beery-Buktenica Developmental Test of Visual Perception-Item 3 type 

(Draft)

Item 3 type , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPItm3Typ Recommended UDE
4 Beery-Buktenica Developmental Test of Visual Perception-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPTotalRawScore Recommended CDE

BBDTVP Items 4 to 6 (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test-Task or form text  Task or form text , as part of Beery-Buktenica Developmental Test BBDTTaskOrFormTxt Recommended CDE
2 Beery-Buktenica Developmental Test of Visual Perception-Correct indicator 

(Draft)

Correct indicator , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPCrrctInd Recommended UDE
3 Beery-Buktenica Developmental Test of Visual Perception-Item figure score 

(Draft)

Item figure score , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPItmFigScore Recommended UDE

BBDTVP Items 7 to 30 (Appears Up To 24 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test-Task or form text  Task or form text , as part of Beery-Buktenica Developmental Test BBDTTaskOrFormTxt Recommended CDE
2 Beery-Buktenica Developmental Test of Visual Perception-Correct indicator 

(Draft)

Correct indicator , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPCrrctInd Recommended UDE
3 Beery-Buktenica Developmental Test of Visual Perception-Item figure score 

(Draft)

Item figure score , as part of Beery-Buktenica Developmental Test of Visual Perception BBDTVPItmFigScore Recommended UDE

BBDTMC Items 1-3 (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test of Motor Coordination-Item text  Item text , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCItmTxt Recommended CDE
2 Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator  Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCCrrctInd Recommended CDE
3 Beery-Buktenica Developmental Test of Motor Coordination-Item score  Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCItmScore Recommended CDE
4 Beery-Buktenica Developmental Test of Motor Coordination-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCTotalRawScore Recommended CDE

BBDTMC Items 4A-6B (Appears Up To 6 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator  Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCCrrctInd Recommended CDE
2 Beery-Buktenica Developmental Test of Motor Coordination-Item score  Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCItmScore Recommended CDE
3 Beery-Buktenica Developmental Test of Motor Coordination-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCTotalRawScore Recommended CDE

BBDTMC Items 7-30 (Appears Up To 24 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator  Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCCrrctInd Recommended CDE
2 Beery-Buktenica Developmental Test of Motor Coordination-Item score  Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCItmScore Recommended CDE
3 Beery-Buktenica Developmental Test of Motor Coordination-Total raw score  Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination BBDTMCTotalRawScore Recommended CDE

BBDT Summary Comments and Recommendations (Appears Up To 5 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test-Abilities type  Abilities type , as part of Beery-Buktenica Developmental Test BBDTAbilitiesTyp Recommended CDE
2 Beery-Buktenica Developmental Test-Summary comments and recommendations text 

(Draft)

Summary comments and recommendations text , as part of Beery-Buktenica Developmental Test BBDTSummCommentsAndRecTxt Recommended UDE

BBDT Actions Taken and Progress Text (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test-Actions taken text  Actions taken text , as part of Beery-Buktenica Developmental Test BBDTActionsTakenTxt Recommended CDE
2 Beery-Buktenica Developmental Test-Progress text  Progress text , as part of Beery-Buktenica Developmental Test BBDTProgressTxt Recommended CDE

BBDT Summary Scoring (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Beery-Buktenica Developmental Test-Summary score type  Summary score type , as part of Beery-Buktenica Developmental Test BBDTSummScoreTyp Recommended CDE
2 Beery-Buktenica Developmental Test-Standard score 

(Draft)

Standard score , as part of Beery-Buktenica Developmental Test BBDTStandardScore Recommended UDE
3 Beery-Buktenica Developmental Test-Scaled score 

(Draft)

Scaled score , as part of Beery-Buktenica Developmental Test BBDTScaledScore Recommended UDE
4 Beery-Buktenica Developmental Test-Percentiles value  Percentiles value , as part of Beery-Buktenica Developmental Test BBDTPercentilesVal Recommended CDE
5 Beery-Buktenica Developmental Test-Other scaling score  Other scaling score , as part of Beery-Buktenica Developmental Test BBDTOTHScalingScore Recommended CDE
6 Beery-Buktenica Developmental Test-Comments and recommendations text 

(Draft)

Comments and recommendations text , as part of Beery-Buktenica Developmental Test BBDTCommentsAndRecTxt Recommended UDE

 Change History

 Administrative Change History