Learning Ability? Need assistance (list/describe) Yes No Is falling a concern for you? If yes, how often do you fall? Describe how you fall (like a tree, etc.), what commonly causes you to fall, and how you recover. Please rate with one number for each limb below. Left Side Right Side No Use Full Use Rating Rating 1 2 3 4 5 6 7 8 9 10 Hand Strength Dexterity Arm Strength Arm Reach/Extension Upper-Body Strength Leg Strength Leg Control How do you handle the following?
Learning Ability? Need assistance (list/describe) Is falling a concern for you? Yes No If yes, how often do you fall? Describe how you fall (like a tree, etc.), what commonly causes you to fall, and how you recover. Please rate with one number for each limb below. No Use Full Use 1 2 3 4 5 6 7 8 9 10 Left Side Rating Right Side Rating Hand Strength Dexterity Arm Strength Arm Reach/Extension Upper-Body Strength Leg Strength Leg Control How do you handle the following?
SDI-Client-App-Rev-9-2015.docx