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Pre Session Questions
Post Session Questions
NexNeuro Care Post-Session Details and Evaluation
Date
09-05-2010
Name
Week # of patient recieving sessions
Speech
0 = Not understandable 10 = very verbal
0
1
2
3
4
5
6
7
8
9
10
Facial Expression:
0 = no expression 10 = no effect of PD
0
1
2
3
4
5
6
7
8
9
10
Gait (Walking):
0 = immobile/wheelchair 10 = normal/no effect of PD
0
1
2
3
4
5
6
7
8
9
10
Posture:
0 = walks bend over 10 = totally upright
0
1
2
3
4
5
6
7
8
9
10
Tremor:
0 = always 10 = none
0
1
2
3
4
5
6
7
8
9
10
Numbness &/or Tingling:
0 = always 10 = none
0
1
2
3
4
5
6
7
8
9
10
Stability/ Falls
0 = always 10 = none
0
1
2
3
4
5
6
7
8
9
10
Range of motion (arms):
0 = no mobility 10 = full range of motion
0
1
2
3
4
5
6
7
8
9
10
Range of motion (legs):
0 = no mobility 10 = full range of motion
0
1
2
3
4
5
6
7
8
9
10
Depression:
0 = depressed state 10 = none
0
1
2
3
4
5
6
7
8
9
10
Anxiety:
0 = anxious/nervous state 10 = none
0
1
2
3
4
5
6
7
8
9
10
Pain:
0 = anxious/nervous state 10 = none
0
1
2
3
4
5
6
7
8
9
10
How many sessions (on average) per day did you have this week?
( 1 )
( 2 )
( 3 )
( Over 3 )
Has family, friends or doctor observed changes in you since you began the sessions?
No
Yes
Would you recommend the NexNeuro Therapy to others including your doctor?
No
Yes
Would you like to have NexNeuro therapy available to you on the continual basis?
No
Yes
Overall comments regarding changes since beginning sessions