Welcome to your Post-Course Assessment VVR

Thank you for taking Phoenix Concussion Recovery's Visuo-Vestibular Rehabilitation for Concussion / mTBI Course!

Page 1 contains 17 questions from Parts 1-3.
Page 2 contains 14 questions from Parts 4-6.
A passing grade of 80% or greater is required for CEU reporting, please keep your completion email for your reporting records.

Thank you for working with us and helping to improve patient care for concussions nationwide!

-Phoenix Team

This quiz is for logged in users only.


Welcome to your Complete Questionnaires

On Page 1 you will fill out the Post-Concussion Symptom Scale.
On Page 2 you will fill out your activity score from the Post-Concussion Symptom Scale.
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I will ask you to complete this questionnaire before each physical therapy visit to track progress.
These scales were adapted from Lovell and Collins, Journal of Head Trauma and Rehabilitation. 1998;13-9-26.
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On Page 3 you will fill out the Brain Injury Vision Symptom Survey.
I will only ask you to do this survey on your first and final physical therapy visit to track overall progress.
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On Page 4 you will fill out the Dizziness Handicap Inventory (DHI) - please fill this out only for symptoms of dizziness!
I will only ask you to do this survey on your first and final physical therapy visit to track overall progress.
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I know it is a lot of paperwork and so appreciate your taking the time to complete these outcome measures!

Welcome to your PCSS All Visits
On Page 1 you will fill out the Post-Concussion Symptom Scale.
On Page 2 you will fill out your activity score from the Post-Concussion Symptom Scale.
-----------------
I will ask you to complete this questionnaire before each physical therapy visit to track progress.
These scales were adapted from Lovell and Collins, Journal of Head Trauma and Rehabilitation. 1998;13-9-26.
-----------------
This questionnaire will take approximately 2-4minutes and is important for measuring your progress!

Welcome to your BIVSS Initial and Final Visit

Below you will fill out the Brain Injury Vision Symptom Survey.
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I will only ask you to do this survey on your first and final physical therapy visit to track overall progress.
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This questionnaire will take approximately 3-5minutes and is important for measuring your progress!
Please remember to go back to your email with the links and complete ALL 3 QUESTIONNAIRES

1. 
Distance vision blurred and not clear - even with lenses

2. 
Near vision blurred and not clear - even with lenses

3. 
Clarity of vision changes or fluctuates during the day

4. 
Poor night vision / can't see well to drive at night

5. 
Eye discomfort / sore eyes / eye strain

6. 
Headaches or dizziness after using eyes

7. 
Eye fatigue / very tired after using eyes all day

8. 
Feel "pulling" around the eyes

9. 
Double vision - especially when tired

10. 
Have to close or cover one eye to see clearly

11. 
Print moves in and out of focus when reading

12. 
Normal indoor lighting is uncomfortable - too much glare

13. 
Outdoor light too bright - have to use sunglasses

14. 
Indoors fluorescent lighting is bothersome or annoying

15. 
Eyes feel "dry" and sting

16. 
"Stare" into space without blinking

17. 
Have to rub the eyes a lot

18. 
Clumsiness / misjudge where objects really are

19. 
Lack of confidence walking / missing steps / stumbling

20. 
Poor handwriting (spacing, size, legibility)

21. 
Side vision (peripheral vision) distorted / objects move or change position

22. 
What looks straight ahead isn't always straight ahead

23. 
Avoid crowds / can't tolerate "visually-busy" places

24. 
Short attention span / easily distracted when reading

25. 
Difficulty / slowness with reading and writing

26. 
Poor reading comprehension / can't remember what was read

27. 
Confusion of words / skip words during reading

28. 
Lose place / have to use finger not to lose place when reading

Welcome to your DHI Initial and Final Visit

Below you will fill out the Dizziness Handicap Inventory.
I will only ask you to do this survey on your first and final physical therapy visit to track overall progress.
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Please fill out this questionnaire only for your dizziness!
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This questionnaire will take approximately 3-5minutes and is important for measuring your progress!
Please remember to go back to your email with the links and complete ALL 3 QUESTIONNAIRES

1. 
Does looking up increase your problem?

2. 
Because of your problem, do you feel frustrated?

3. 
Because of your problem, do you restrict your travel for business or recreation?

4. 
Does walking down the aisle of a supermarket increase your problem?

5. 
Because of your problem, do you have difficulty getting into or out of bed?

6. 
Does your problem significantly restrict your participation in social activities such as going out to dinner, going to the movies, dancing, or to parties?

7. 
Because of your problem, do you have difficulty reading?

8. 
Does performing more ambitious activities such as sports, dancing, household chores (sweeping or putting dishes away) increase your problems?

9. 
Because of your problem, are you afraid to leave your home without someone accompanying you?

10. 
Because of your problem, have you been embarrassed in front of others?

11. 
Do quick movements of your head increase your problem?

12. 
Because of your problem, do you avoid heights?

13. 
Does turning over in bed increase your problem?

14. 
Because of your problem, is it difficult for you to do strenuous housework or yard work?

15. 
Because of your problem, are you afraid people may think you are intoxicated?

16. 
Because of your problem, is it difficult for you to walk by yourself?

17. 
Does walking down a sidewalk increase your problem?

18. 
Because of your problem, is it difficult for you to concentrate?

19. 
Because of your problem, is it difficult for you to walk around your house in the dark?

20. 
Because of your problem, are you afraid to stay home alone?

21. 
Because of your problem, do you feel handicapped?

22. 
Has your problem placed stress on your relationships with members of your family or friends?

23. 
Because of your problem, are you depressed?

24. 
Does your problem interfere with your job or household responsibilities?

25. 
Does bending over increase your problem?

Welcome to your Post-Course Assessment Final

Thank you for taking Phoenix Concussion Recovery's Integrative Concussion Management Course!

Page 1 contains 10 questions from Part 1.
Page 2 contains 15 questions from Part 2.
A passing grade of 80% or greater is required for CEU reporting, please keep your completion email for your reporting records.

Thank you for working with us and helping to improve patient care for concussions nationwide!

-Phoenix Team