This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Short Name:
This CRF Module contains data elements that are collected to further assess the level of balance.
Traumatic Brain Injury
Required Program Form:
Standard NINDS CDE
Form Type:
Clinical Assessment
Date Created:
Number of Data Elements:


 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 Recommended CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Recommended 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 Recommended 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 Recommended CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Recommended CDE
9 General notes text   General notes GeneralNotesTxt Recommended 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

Balance (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Electronystagmography result  Global result of electronystagmography testing ElectronystagmographReslt Optional CDE
2 Rotational chair testing result  The result of rotational chair testing RotatnlChairTestReslt Optional CDE
3 Posturography testing result  Global result of posturography testing PosturographyTestReslt Optional CDE
4 Modified Romberg test result  The result of the Modified Romberg test ModRombergTestReslt Optional CDE
5 Vestibular evoked myogenic potential test result  The result of the vestibular evoked myogenic potential (VEMP) test VestibEvokMyogenPotentlTstRslt Optional CDE

 Change History

 Administrative Change History