Date of Pulmonary Function Testing: Not Done Reason not done: Fatigue Low oral motor tone/unable to hold mouthpiece URI/LRI/ severe coughing Unable to get subject into supine Behavioral issues position due to scloiosis, contractures, Equipment failure cannot move to bed (for supine only) Unable to follow directions Other, specify: What type of pulmonary function testing is being performed? (Check all that apply. Record results in appropriate tables below): Slow Vital Capacity (sVC) Maximum Expiratory Pressure (MEP) Maximum Inspiratory Pressure (MIP) Unassisted Peak Cough Flow (PCF) Helium lung volumes Forced Vital Capacity (FVC) Sniff Nasal Inspiratory Pressure (SNIP) Inspiratory Capacity (IC) Maximal Voluntary Ventilation (MVV) Other, specify Note: Position should remain consistent for all trials. Position for the assessment: Sitting Both (sitting and supine) Supine (FVC only) If assessment performed sitting, what was the subject’s seated position? Semi-erect Leaning forward Erect N/A assessment done supine – What type of mouthpiece was used?: Scuba Mask Cardboard Type of Pulmonary Function Testing Equipment Used: Manufacturer: Software program: Model: Additional Pediatric-specific Elements These elements are recommended for pediatric studies. Ulna length: [pre-populated field] cm Ulna length measured with: Harpenden Anthropometer Other, Specify Rosscraft segmometer Was patient taking brochodilator at time of testing? Yes No
Date of Pulmonary Function Testing: Not Done Reason not done: Fatigue URI/LRI/ severe coughing Behavioral issues Equipment failure Unable to follow directions Low oral motor tone/unable to hold mouthpiece Unable to get subject into supine position due to scloiosis, contractures, cannot move to bed (for supine only) Other, specify: What type of pulmonary function testing is being performed? (Check all that apply. Record results in appropriate tables below): Slow Vital Capacity (sVC) Maximum Inspiratory Pressure (MIP) Helium lung volumes Sniff Nasal Inspiratory Pressure (SNIP) Maximal Voluntary Ventilation (MVV) Maximum Expiratory Pressure (MEP) Unassisted Peak Cough Flow (PCF) Forced Vital Capacity (FVC) Inspiratory Capacity (IC) Other, specify Note: Position should remain consistent for all trials. Position for the assessment: Sitting Supine (FVC only) Both (sitting and supine) If assessment performed sitting, what was the subject’s seated position? Semi-erect Erect Leaning forward N/A – assessment done supine What type of mouthpiece was used?: Scuba Cardboard Mask Type of Pulmonary Function Testing Equipment Used: Manufacturer: Model: Software program: Additional Pediatric-specific Elements These elements are recommended for pediatric studies. Ulna length: [pre-populated field] cm Ulna length measured with: Harpenden Anthropometer Rosscraft segmometer Other, Specify Was patient taking brochodilator at time of testing? Yes No