Patient-Formulated Lyme Disease Survey Draft

General or non-medical topics with information and discussion related to Lyme disease and other tick-borne diseases.
Camp Other
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Re: Patient-Formulated Lyme Disease Survey Draft

Post by Camp Other » Fri 8 Aug 2014 8:35

velvetmagnetta wrote:I just wanted to jump in here for a sec and thank Camp Other and Duncan and dif for bringing this subject up and for being so specific with it. I always had long hair, but had to cut it because I couldn't raise my arms over my head, let alone brush it! (Happily, I'm more able now, and my hair has grown back!)
I'm building this survey partly on my own experience, but also of other Lyme disease patients with whom I'm spoken. For me, I couldn't raise my arms above my head either when I first contracted Lyme disease and it disseminated. I couldn't wash my hair the normal way. I slowly stepped down into a bath tub and soaked my head in the water and hoped that did the job. If it didn't get shampooed - oh well. I was too sick to care.
velvetmagnetta wrote: Also the "stirring of thick foods" thing! Yes. Nobody realizes how hard that is for us. And trying to stay standing while doing it! Something that has really helped me with that particular problem is sitting right there on the floor and stirring. (Ever since Lyme, I have no shame!) I know some of you may not be able to do that, but it really took the load off of my arm - well, you can try it, at least!
Yes. Can openers are also a bitch. Early on, I bought pre-cut vegetables and fruit because repeatedly cutting and slicing stuff became impossible.

Yeah, the first cut ached. But try repeated cutting of anything and it was hell to pay. Pain - then muscle fatigue which forced me to stop right away. So I learned it was pointless to try cutting up anything and invested in microwave dinners and precut stuff, lunchmeat, nuts, and yogurt (especially for the probiotics around the antibiotics).
velvetmagnetta wrote: I know I should save it for the questionnaire, but it's just amazing how out of the many many symptoms of Lyme (and different ones in different stages and with different strains) that we all have some very specific symptoms in common. These are turning out to be not-so-non-specific after all!
Nods. I think someone has to start asking more questions and aim for greater specificity. It's helpful. And I think there is overlap, definitely.

Look forward to seeing your additions, velvetmagnetta. Go ahead, throw some questions into the the ring!

Camp Other
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Re: Patient-Formulated Lyme Disease Survey Draft

Post by Camp Other » Fri 8 Aug 2014 9:04

Concentration, Tracking, and Memory: Reading

Note below: Intended reading material is easy-to-read news articles, magazines, or fictional novels - and not technical manuals; highly technical reading such as scientific publications.

Reading, Concentration, & Recall

I can read alone in a quiet room. Yes___ No___ *This is a weed-out question.*

If yes, in real time:

I can read one sentence written on an otherwise blank piece of paper and understand it. Yes__ No___**
If yes:
I need to pause __min___sec to understand the sentence I just read.
I need to reread the sentence once___twice___a few times__ before it really makes sense.

** This is also a weed-out question, to which a "no" can be asked by having the reviewer write one sentence on an otherwise blank piece of paper and ask the subject to read it. If they cannot, then the remainder of this part of the survey can be skipped. Then the entire test should be given verbally and certain physical demonstrations exercised where needed.

I can read one sentence in a block of text, and remember what it said immediately before proceeding to the next sentence. Yes__ No___
If yes:
I need to pause __min___sec to understand the sentence I just read.
I need to reread the sentence once___ twice___ a few times___ before it really makes sense & continuing to read.

Text Format

Please check any of the following which apply:

I have trouble reading sentences in a large single-spaced paragraph.___
I have an easier time reading one sentence to a line with no wrapping, like this one.___
I have an easier time reading sentences if they are double spaced or have even more white space.___
I have an easier time reading text IN ALL CAPS.__

Reading Larger Blocks Of Text

I can read one paragraph and remember what it said immediately before proceeding to the next paragraph.
Yes___ No__
If yes: I need to pause __min___sec to understand the paragraph I just read.
I need to reread the paragraph once___ twice___ a few times___ before it really makes sense & continuing to read.

I can summarize the article which I have just read immediately after I have read it. Yes___No___
If yes: I need to pause __min___sec to think before summarizing the paragraph I just read.
I need to reread the entire article once___ twice___ a few times___ before it really makes sense & and I can summarize the major points.

More Intensive Reading Under Various Conditions

I can read a few pages of a fictional novel and remember what it was about immediately after I have read it.
Yes___ No__
I can read a chapter of a fictional novel and remember what it was about immediately after I have read it.
Yes___ No___
I can read a fictional novel and remember what it was about when I have just finished it.
Yes___ No__

If yes for any of the above three statements:

I can read for___hrs ___min in a quiet room without distractions before I need a break.
I can read for ___hrs ___min in a room with someone repeatedly clicking a pen the entire time before I need a break.
I can read for ___hrs ___min in a room with a TV on in the background with a movie I know before I need a break.
I can read for ___hrs ___min in a room with music of my choosing in the background before I need a break.
I can read for ___hrs ___min in a room with two other people talking to each other (but not me) before I need a break.
I can read for ___hrs ___min in a crowded coffee shop with different people talking, chairs scraping on the floor, silverware clanking, etc. before I need a break.

Summary Memorization

I can summarize a news article or magazine article I read [check all that apply]:
__Within the hour after reading it.
__Several hours after reading it.
__A day after reading it.
__2-3 days later.
__A week later.
__Weeks later I will still recall the major point of what I'd read, e.g. Recall that $600K was being devoted towards federally funded research for a new direct detection test for Lyme disease; recall that low Vitamin D levels are associated with greater risk of developing dementia.

I can summarize a fictional novel I read [check all that apply]:
__Within the hour after finishing reading it (or reading a huge section up to that point).
__Several hours after reading it.
__A day after reading it.
__2-3 days later.
__A week later.
__Weeks later I will still recall the major point of what I'd read, e.g. The murderer was the butler in the pantry and the daughter was looking to cash in on the insurance plan.

Reading And Fatigue

Now that you have reached this part of the survey, how severe is your mental fatigue in response to reading the survey at this point in time [check one only]?

__I want to take a break for ___hours ___minutes right now.
__I can work on this a little longer, but feel like I need a break in ___minutes for ___hours ___minutes.
__I am fine with a short break of ___minutes then I can get right back to it within __minutes.
__I don't need a break at this point. But thanks for asking! :)

[If you genuinely need a break now or soon, please ask the reviewer now for a break and work out the details for later completion.]

----------------------------------------------

Comments:

I'm thinking after having worked on this section that anyone taking this survey is going to need to be questioned upfront about their capabilities for completing it in one format versus another.

Some people will need to be asked questions verbally, and they may not be able to read or read for very long. Some people will need to read the survey - at least for a section which is deliberately intended to be read and have it not be verbal, and those people are evaluated as being at least capable of reading to some degree. (If they fall into both categories, this is severe cognitive/neurological impairment. I seriously hope they've seen a doctor.)

The very act of administering the survey could present a challenge for collecting data because the same format may not suit everyone.

And the survey itself could be daunting, as it begins to take on greater length as it asks for more details - thus leading to the subject experiencing greater fatigue. Somehow, though, I think that fact can be worked into the very design of the survey as I've demonstrated above. That in and of itself is data.

Something to think about, anyway, in how to not only design the survey but also how best to administer it, and perhaps do some individual evaluations up front before "branching off" into specific sub-surveys.

duncan
Posts: 1370
Joined: Wed 5 Sep 2012 18:48

Re: Patient-Formulated Lyme Disease Survey Draft

Post by duncan » Fri 8 Aug 2014 13:04

This is excellent. Meticulous. Seriously good work.

Still, the length of the survey - unless we cut it back significantly - if it stood as is, typically would be problematic. It would scare off too many people.

I don't know, though. Each one of the individuals we would approach should have a vested interest in taking the time, and making the effort. And if they knew it was drafted with the insights and concerns of fellow patients...

Let's see what we end up with, content and format-wise. Certainly we would provide instructions that include recommendations to patients to treat the questionnaire almost as if it were a project, to take one's time, to reach out with questions etc.

What a treasure trove of data this COULD represent. Here's another thought: Do we ensure anonymity? Obviously within our Forum, but for those outside of our Forum who desire it? We can figure that out.

Camp Other, when I threw out the concept of intellectual/emotional/concentration triggers, I did not mean to imply you do all the work. I was just wondering if you would I agree that we should. I will put together some questions as well.

Need coffee. Better feed my Stupid Big dog before she devours another bear. And shower.

With those three things behind me, who knows, maybe I can turn my mind in on my mind.

duncan
Posts: 1370
Joined: Wed 5 Sep 2012 18:48

Re: Patient-Formulated Lyme Disease Survey Draft

Post by duncan » Fri 8 Aug 2014 14:36

I attribute most of the cognitive symptoms I have to NB, but I'm not sure that needs to be the case.

Do acts of prolonged intellectual exercises cause fatigue or cognitive difficulties? __No__Yes. If yes, please indicate where appropriate, and please identify the appropriate time frame that pertains to when the symptoms begin:
___Writing: Please explain______________________________________ __30 minutes or less. __30-60 minutes, __1 to 2 hours__ more than 2 hours.
___Reading (CO, this and the next are redundant with yours, so maybe I should delete reading and studying) Please explain:________________________________________________________
___Studying. Please explain:_________________________________________________________________
___Math problems (e.g, paying bills, estimating tips, etc). Please explain:___________________________________
___Non-passive Listening, when a response is expected (considering). Please explain:_________________________
___Other. Please explain_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Do excessive (wrong word choice) emotions cause fatigue or cognitive difficulties? __No__Yes, If yes, please indicate where appropriate:
__Anger. Please explain________________________________________________
__Sadness. Please explain:_____________________________________________
__Laughter. Please explain: _________________________________________
__Joy. Please explain:_________________________________________________
__Other. Please explain: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do prolonged bouts of concentration or focus cause fatigue or cognitive issues? __No__Yes. If yes, please indicate where appropriate, and please identify the appropriate time frame that pertains to when symptoms begin :
___Driving. Please explain:________________________________________________
___Watching TV. Please explain:_____________________________________________
___Watching a loved one in a school sport.Please explain:____________________________________________
___Precision-required processes such as knitting or gardening or measuring. Please explain:______________
___Other. Please explain:_________________________________________________________________________________________________________________________________________________________________________________________________

Aach. I'm having trouble differentiating concentration from intellectual, and coming up with general categories of concentration. Also, as Camp Other did, I need to introduce some sort of degree factor here. For instance, Does the length of time contribute to the degree of suffering? Phyfe, maybe you can put this in some sort of tabular format? Do something in increments of time? Less than 30 minutes. 30 - 60 minutes? One hour to two hours. More than Two Hours?I'm not trying to shrug this tabular thing onto your shoulders, Phyfe, but I cannot figure out how to do that in this thing without making it indecipherable.

I just looked at what Camp Other did. Maybe we do that? How do you tally all those open ended time fields? Might be problematic.

I think we need to have the defined time qualifiers here, i.e. in these three questions I've added, and for now, I think the increments I have will do, but we might want to change later. I do NOT think we should have the time qualifiers for the Emotion category, because I don't think the increments are identifiable. Phyfe, PM me if you want and I will explain.

phyfe
Posts: 167
Joined: Sat 15 Sep 2012 19:28

Re: Patient-Formulated Lyme Disease Survey Draft

Post by phyfe » Fri 8 Aug 2014 17:02

Camp Other wrote:I'm working on this on a piecemeal fashion... This may be the best way for now because fatigue has been dogging me lately...

------------------------------------------

Cognitive Symptoms Panel - Part N

Time sense distortion - For Reviewer Use ONLY

Have the subject work on a puzzle* that takes, on average, 10 minutes to solve.
At the end of one minute, ask the subject how many minutes have passed.
___min

Have the subject continue to work on the same puzzle*. At the end of 10 minutes,
ask the subject how many minutes have passed.
___min

As the reviewer administering this survey was asked to mark the start time of the survey, the reviewer should also return to this question as the very last question on the survey and ask the subject: How long did it take to complete this survey?
Approximately ___hours ____min

*The puzzle may or may not be used to measure other cognitive and/or neurological abnormalities. For the purpose of this section of the survey, it does not have to be used for any reason other than to make a note of how much time subject thinks has passed.

Time sense distortion - Subject/Patient Questions

I find myself underestimating the amount of time that has passed. For example, someone will ask me to be ready to leave in 20 minutes and I only think 5 has passed if I am not watching the clock:
Most of the time___ Often ___ Sometimes ___ Rarely___ Never___

If any choice but "Never":

When discussing events which occured months to years in the past, I often think they occurred:
Within a third of the time they actually occurred, i.e. 3 mos ago when it was 9 months: ___
Within half the time they actually occurred, i.e. 2 years ago when it was 4 years ago.___
Other underestimation: _________________________________________________________

I have trouble estimating the amount of time I need to complete a task:
Most of the time___ Often___ Sometimes___ Rarely___ Never___

If any choice but "Never":

I have trouble estimating the amount of time I need to complete a task because
[check all which apply]:

I often need to stop and rest partway through a task before starting it again.___
I often "space out" during a task and don't remember what I was doing.___
When I am interrupted by an external event, it is harder to refocus on the task.___
I cannot tell how much time has passed and at which speed it passes.___

--------------------------------------------

Again, feedback welcome - as well as ideas as how to build upon this.

I may just do a small series of these clips over time.
I've added these to my list. Thanks Camp Other!

phyfe
Posts: 167
Joined: Sat 15 Sep 2012 19:28

Re: Patient-Formulated Lyme Disease Survey Draft

Post by phyfe » Fri 8 Aug 2014 17:10

Camp Other wrote:Concentration, Tracking, and Memory: Reading

Note below: Intended reading material is easy-to-read news articles, magazines, or fictional novels - and not technical manuals; highly technical reading such as scientific publications.

Reading, Concentration, & Recall

I can read alone in a quiet room. Yes___ No___ *This is a weed-out question.*

If yes, in real time:

I can read one sentence written on an otherwise blank piece of paper and understand it. Yes__ No___**
If yes:
I need to pause __min___sec to understand the sentence I just read.
I need to reread the sentence once___twice___a few times__ before it really makes sense.

** This is also a weed-out question, to which a "no" can be asked by having the reviewer write one sentence on an otherwise blank piece of paper and ask the subject to read it. If they cannot, then the remainder of this part of the survey can be skipped. Then the entire test should be given verbally and certain physical demonstrations exercised where needed.

I can read one sentence in a block of text, and remember what it said immediately before proceeding to the next sentence. Yes__ No___
If yes:
I need to pause __min___sec to understand the sentence I just read.
I need to reread the sentence once___ twice___ a few times___ before it really makes sense & continuing to read.

Text Format

Please check any of the following which apply:

I have trouble reading sentences in a large single-spaced paragraph.___
I have an easier time reading one sentence to a line with no wrapping, like this one.___
I have an easier time reading sentences if they are double spaced or have even more white space.___
I have an easier time reading text IN ALL CAPS.__

Reading Larger Blocks Of Text

I can read one paragraph and remember what it said immediately before proceeding to the next paragraph.
Yes___ No__
If yes: I need to pause __min___sec to understand the paragraph I just read.
I need to reread the paragraph once___ twice___ a few times___ before it really makes sense & continuing to read.

I can summarize the article which I have just read immediately after I have read it. Yes___No___
If yes: I need to pause __min___sec to think before summarizing the paragraph I just read.
I need to reread the entire article once___ twice___ a few times___ before it really makes sense & and I can summarize the major points.

More Intensive Reading Under Various Conditions

I can read a few pages of a fictional novel and remember what it was about immediately after I have read it.
Yes___ No__
I can read a chapter of a fictional novel and remember what it was about immediately after I have read it.
Yes___ No___
I can read a fictional novel and remember what it was about when I have just finished it.
Yes___ No__

If yes for any of the above three statements:

I can read for___hrs ___min in a quiet room without distractions before I need a break.
I can read for ___hrs ___min in a room with someone repeatedly clicking a pen the entire time before I need a break.
I can read for ___hrs ___min in a room with a TV on in the background with a movie I know before I need a break.
I can read for ___hrs ___min in a room with music of my choosing in the background before I need a break.
I can read for ___hrs ___min in a room with two other people talking to each other (but not me) before I need a break.
I can read for ___hrs ___min in a crowded coffee shop with different people talking, chairs scraping on the floor, silverware clanking, etc. before I need a break.

Summary Memorization

I can summarize a news article or magazine article I read [check all that apply]:
__Within the hour after reading it.
__Several hours after reading it.
__A day after reading it.
__2-3 days later.
__A week later.
__Weeks later I will still recall the major point of what I'd read, e.g. Recall that $600K was being devoted towards federally funded research for a new direct detection test for Lyme disease; recall that low Vitamin D levels are associated with greater risk of developing dementia.

I can summarize a fictional novel I read [check all that apply]:
__Within the hour after finishing reading it (or reading a huge section up to that point).
__Several hours after reading it.
__A day after reading it.
__2-3 days later.
__A week later.
__Weeks later I will still recall the major point of what I'd read, e.g. The murderer was the butler in the pantry and the daughter was looking to cash in on the insurance plan.

Reading And Fatigue

Now that you have reached this part of the survey, how severe is your mental fatigue in response to reading the survey at this point in time [check one only]?

__I want to take a break for ___hours ___minutes right now.
__I can work on this a little longer, but feel like I need a break in ___minutes for ___hours ___minutes.
__I am fine with a short break of ___minutes then I can get right back to it within __minutes.
__I don't need a break at this point. But thanks for asking! :)

[If you genuinely need a break now or soon, please ask the reviewer now for a break and work out the details for later completion.]

----------------------------------------------

Comments:

I'm thinking after having worked on this section that anyone taking this survey is going to need to be questioned upfront about their capabilities for completing it in one format versus another.

Some people will need to be asked questions verbally, and they may not be able to read or read for very long. Some people will need to read the survey - at least for a section which is deliberately intended to be read and have it not be verbal, and those people are evaluated as being at least capable of reading to some degree. (If they fall into both categories, this is severe cognitive/neurological impairment. I seriously hope they've seen a doctor.)

The very act of administering the survey could present a challenge for collecting data because the same format may not suit everyone.

And the survey itself could be daunting, as it begins to take on greater length as it asks for more details - thus leading to the subject experiencing greater fatigue. Somehow, though, I think that fact can be worked into the very design of the survey as I've demonstrated above. That in and of itself is data.

Something to think about, anyway, in how to not only design the survey but also how best to administer it, and perhaps do some individual evaluations up front before "branching off" into specific sub-surveys.
I've added these too, Camp Other. Thanks so much!!

phyfe
Posts: 167
Joined: Sat 15 Sep 2012 19:28

Re: Patient-Formulated Lyme Disease Survey Draft

Post by phyfe » Fri 8 Aug 2014 17:13

duncan wrote:I attribute most of the cognitive symptoms I have to NB, but I'm not sure that needs to be the case.

Do acts of prolonged intellectual exercises cause fatigue or cognitive difficulties? __No__Yes. If yes, please indicate where appropriate, and please identify the appropriate time frame that pertains to when the symptoms begin:
___Writing: Please explain______________________________________ __30 minutes or less. __30-60 minutes, __1 to 2 hours__ more than 2 hours.
___Reading (CO, this and the next are redundant with yours, so maybe I should delete reading and studying) Please explain:________________________________________________________
___Studying. Please explain:_________________________________________________________________
___Math problems (e.g, paying bills, estimating tips, etc). Please explain:___________________________________
___Non-passive Listening, when a response is expected (considering). Please explain:_________________________
___Other. Please explain_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Do excessive (wrong word choice) emotions cause fatigue or cognitive difficulties? __No__Yes, If yes, please indicate where appropriate:
__Anger. Please explain________________________________________________
__Sadness. Please explain:_____________________________________________
__Laughter. Please explain: _________________________________________
__Joy. Please explain:_________________________________________________
__Other. Please explain: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do prolonged bouts of concentration or focus cause fatigue or cognitive issues? __No__Yes. If yes, please indicate where appropriate, and please identify the appropriate time frame that pertains to when symptoms begin :
___Driving. Please explain:________________________________________________
___Watching TV. Please explain:_____________________________________________
___Watching a loved one in a school sport.Please explain:____________________________________________
___Precision-required processes such as knitting or gardening or measuring. Please explain:______________
___Other. Please explain:_________________________________________________________________________________________________________________________________________________________________________________________________

Aach. I'm having trouble differentiating concentration from intellectual, and coming up with general categories of concentration. Also, as Camp Other did, I need to introduce some sort of degree factor here. For instance, Does the length of time contribute to the degree of suffering? Phyfe, maybe you can put this in some sort of tabular format? Do something in increments of time? Less than 30 minutes. 30 - 60 minutes? One hour to two hours. More than Two Hours?I'm not trying to shrug this tabular thing onto your shoulders, Phyfe, but I cannot figure out how to do that in this thing without making it indecipherable.

I just looked at what Camp Other did. Maybe we do that? How do you tally all those open ended time fields? Might be problematic.

I think we need to have the defined time qualifiers here, i.e. in these three questions I've added, and for now, I think the increments I have will do, but we might want to change later. I do NOT think we should have the time qualifiers for the Emotion category, because I don't think the increments are identifiable. Phyfe, PM me if you want and I will explain.
I've got these too Duncan. ;) You guys are amazing!

phyfe
Posts: 167
Joined: Sat 15 Sep 2012 19:28

Re: Patient-Formulated Lyme Disease Survey Draft

Post by phyfe » Fri 8 Aug 2014 17:23

duncan wrote:This is excellent. Meticulous. Seriously good work.

Still, the length of the survey - unless we cut it back significantly - if it stood as is, typically would be problematic. It would scare off too many people.

I don't know, though. Each one of the individuals we would approach should have a vested interest in taking the time, and making the effort. And if they knew it was drafted with the insights and concerns of fellow patients...

Let's see what we end up with, content and format-wise. Certainly we would provide instructions that include recommendations to patients to treat the questionnaire almost as if it were a project, to take one's time, to reach out with questions etc.

What a treasure trove of data this COULD represent. Here's another thought: Do we ensure anonymity? Obviously within our Forum, but for those outside of our Forum who desire it? We can figure that out.

Camp Other, when I threw out the concept of intellectual/emotional/concentration triggers, I did not mean to imply you do all the work. I was just wondering if you would I agree that we should. I will put together some questions as well.

Need coffee. Better feed my Stupid Big dog before she devours another bear. And shower.

With those three things behind me, who knows, maybe I can turn my mind in on my mind.
We could always do this in sections. Sections one could be computer generated for anyone to take and other sections could be given to research participants in person. We can discuss those things later.

The time it takes a person to complete a computer generated survey can be clocked by the computer so that shouldn't be an issue, as long as participants are told to log out of the survey when they are resting. The ability to log out and back in is critical, in my mind, because most patients know how long they can "work" on something before becoming ill and crashing. We don't want to force that to happen.

Anonymity could also be assured through a computer system so that's not a problem either.

I have other thoughts too, that I can write down and discuss with all of you when we get to that point.

This is great work you are all doing...please keep up the input.

phyfe
Posts: 167
Joined: Sat 15 Sep 2012 19:28

Re: Patient-Formulated Lyme Disease Survey Draft

Post by phyfe » Fri 8 Aug 2014 17:26

duncan wrote:Aach. I'm having trouble differentiating concentration from intellectual, and coming up with general categories of concentration. Also, as Camp Other did, I need to introduce some sort of degree factor here. For instance, Does the length of time contribute to the degree of suffering? Phyfe, maybe you can put this in some sort of tabular format? Do something in increments of time? Less than 30 minutes. 30 - 60 minutes? One hour to two hours. More than Two Hours?I'm not trying to shrug this tabular thing onto your shoulders, Phyfe, but I cannot figure out how to do that in this thing without making it indecipherable.
Duncan, do you see this time factor as being different for each answer or for the overall category? (in other words, three times or for each individual answer?)

Am I making sense here or do I need to clarify more? :bonk:

By the way, I've changed it to read: __less than 30 minutes __30-59 minutes, __1 to 2 hours__ more than 2 hours.

duncan
Posts: 1370
Joined: Wed 5 Sep 2012 18:48

Re: Patient-Formulated Lyme Disease Survey Draft

Post by duncan » Fri 8 Aug 2014 17:34

I proposed three distinct but related questions: Intellectual, Concentration, Emotional. Under each of those three questions, running DOWN, wouuld be the respective examples for each question, e.g.Writing, Reading, Studying, Math, etc..

Running ACROSS the page, for two of those questions, Intellectual and Concentration, would be Time Frames. The Time Frames would not need to be addressed for Emotions.

Does that help?

I MISS CLARITY!!! Sometimes I feel like the Scarecrow in the Wizard of Oz. :)

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