TheRivermead

Postoncussion
SymptomsQuestion
naire*
Aftera headinjuryor accident
somepeopleexperience
symptoms
whichcancauseworryor
nuisance.Wewouldliketo knowif younowsufferfromanyof the symptoms
givenbelow.
Asmanyof thesesymptoms
occurnormally,
wewouldlikeyouto compare
yourself
nowwith
beforethe accident.Foreachone,pleasecirclethe numberclosest
to youranswer.
0
1,
2
3
4

=
=
=
=
=

Notexperienced
at all
Nomoreof a problem
Am i l dprobl em
Amoderateproblem
Asevereproblem

Compared
withbeforetheaccident,
doyounow(i.e.,overthe last24 hours)sufferfrom:
01,234
F e g l i n gosf D i zzi n e ss
.................................
0L234
Na u s e aa n d /o r V o mi ti
n g.....,......,...........,..
0L234
NoiseSensitivity,
e a s il yu p se tb y l o u dn o i se ......,.........
L
0
Sl e e pD i s tu rbnace .r...............
r....................
L
0
F a t i g u et i,ri n gmo ree a si l y...........,.............
L
0
Be i n gl r r i ta b l ee,a si l ya n g e re d
..................
T
0
F e e l i nD
g e p rg sseodr T e a rfu....................
l
L
0
Feeling
Frustrated
................0
or lmpatient
L
poormemory.................!...
Forgetfulngss,
L
0
P o o rC o n cg n tra
....................
o ti
n.....
.......
r ... 0
L
T ak i n gL o ng eto
r T h i n k...,.......,.........
r........0
L
Blurrgd Vision ...........r..............,.....t.......
rr... 0
L
LightSensitivity,
Easilyupsetby brigftt1ight...............,
L
0
D ou b leVi sion........................r
..... . . . . . . r.0. .
L
R estl gSSneS
S
............................
. . . . . . . .0. . . . . . . . L
..
He ad aCh eS.. . . . . r . . . . . . . . . . . . . . . . . . . . . . r . . . . . . . . r . .. . . . . . . r .

2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3

2
2
2

34
34
34

4
4
4
4
4
4
4
4
4
4

Are you experiencingany other difficulties?

L.

2.

1.

*King N.,Crawford,
S.,Wenden,F.,Moss,N.,and Wade,D. (1995)J.Neurologr
242:587-592

06/23/08