ARDS Cognitive Questionnaire

On Tuesday, May 4, 1999, Sue Peterson spoke with Dr. William H. Shull, Jr., who is an Assistant Professor of Rehabilitative Medicine and Director of Trauma Rehabilitation specializing in brain injury. Dr. Shull is with the University of Pennsylvania School of Medicine. The ARDS Advisory Council has heard from many ARDS survivors and their families about some of the cognitive changes noted after surviving ARDS, such as short term memory loss, difficulty in concentration, depression, anxiety and trouble with executive functions. We have received many questions from you regarding this. We have learned that many of your doctors do not address these issues and do not offer a great deal of assistance in this area. This is probably because no research has been done, to our knowledge, in the area of pulmonary injury causing chemical changes/injury to the brain. This is your opportunity as ARDS survivors and as families of loved ones who have survived ARDS to start the ball rolling in getting more attention and research into this very important area. We have written an informal survey and would greatly appreciate your responses. They are important as we move forward and attempt to understand more about ARDS. We ask you to answer these questions as fully as you can and also at the bottom of the survey to write about any other problems/questions that you have experienced in your recovery process. Your responses will be forwarded to Dr. Shull. Dr. Shull believes "this will definitely lead to research and more importantly, to improved awareness of the importance of rehab doctors in helping the pulmonary physician treat the ARDS survivor, and most importantly, to improved quality of life for patients and families".

INSTRUCTIONS FOR ANSWERING AND SENDING RESPONSES:

Please read all the instructions before proceeding. We suggest you print out this page after it has fully loaded so that you will have the instructions easily available to you. There are two methods you may use to answer the questions below and then forward your responses on for compilation into the database.

First Method: To download this questionnaire as a text file so that you may answer the questions and forward your responses later, please click HERE. If the text file opens in your browser window instead of the download window opening up automatically, then click File in your Menu bar and click "Save" or "Save As". Then save it to a directory or place on your hard drive where you may easily retrieve it using your word processor and then answer each question below the question where the A: appears. When done, re-save the file with the answers. Then open your e-mail program, prepare an e-mail with e-mail address of ards@iname.com, attach the saved file to the e-mail, type in body of message "Attention council member Donna Hild", and send the e-mail.

Second Method (not all browsers support or permit this method, use only if your browser is capable of on-line page editing and sending edited pages; if you are unsure, please go back and use the text method):

Open File in your Menu bar at the top of the screen and then click "Edit Page" or something similar (depending on your browser). This will put the questionnaire in a format that will accept your answers. Proceed with answering each question. When you are ready to send the questionnaire with your answers, open File in your browser Menu bar again and click "Send Page" or "Send To" (or similar) in the File list. When message form appears, enter (type) ards@iname.com in the "To" box, in "Subject" line type "Attention council member Donna Hild", and then click "Send". If you wish to keep your typed questionnaire and answers, again open File on the Menu bar, click on "Save As" or "Save To" (or similar) and save it to a place of your choice on your harddrive.

THANK YOU. You will be helping many others.

1. Do you have problems with loss of memory? If so, please describe the problems.

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2. Do you have trouble concentrating?

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3. Do you have trouble organizing your day?

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4. Is it difficult to pay close attention to TV?

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5. Are you able to comprehend what you read?

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6. Do you find yourself having to go back and re-read paragraphs that you just read?

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7. Do you lose your place while reading?

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8. Do you have problems with basic self-care?

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9. Do you have trouble driving?

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10. Do you have problems with community based mobility skills, i.e. walking, attending meetings and understanding what was said, etc.?

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11. Do you have difficulty with fine motor skills?

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12. Do you feel that your judgment is impaired?

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13. Do you feel that you have poor safety awareness?

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14. Do you find your self suddenly being impulsive?

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15. Are you having problems with sleep/wake cycles? If so, please describe.

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16. Have you noticed any changes in your personality?

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17. Please tell us about any other areas in your mental thinking/anxiety/emotions that you are having problems with.

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