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Some are concerned with you and some are general. There are two options for every single question, Yes and No. Please tick ( ) mark only to the answer to which you feel to. Tick ( ) mark to only one answer of each question. I am simply interested in knowing your interest and perception of your life. Please complete all the questions carefully as possible. All your answers in the questionnaire will be treated in strict con fidence. May I thank you very much for your co-operation.
3.Are you tense about your family? Yes NO 4.Do you suddenly feel unilateral extreme weakness? Yes NO 5. Do you feel loss of function one side of the body? Yes NO 6. Do you ever have a pain in neck? Yes NO 7. Do you ever feel pain in bones? Yes NO 8. Are you trembling, while facing a panic situation? Yes NO
10. Do you ever feel weakness in one side of the body? Yes NO
12. Is your blood pressure always high? Yes NO 13. Are you suffering from diabetes? Yes NO 14. Do you have a problem of insomnia? Yes NO 15.Do you have you a problem of motor speech impairment? Yes NO 16.Do you have a problem in writing? Yes NO
18. Does your perception loss due to sudden brain stroke? Yes NO
20. Have aggression often become a problem in your day to day life? Yes NO 21. Do you ever feel headache? Yes NO 22. Do you have a problem of vertigo, nausea and vomiting? Yes NO
24. Do you feel dizziness? Yes NO 25. Are you often very aware of impairments happening in you? Yes NO 26. Are you anxious about your poor performance? Yes NO 27. Do you ever feel seizures? Yes NO 28. Do you have inability to move your limbs normally? Yes NO
29. Are you feeling loss of sensation in one side of the body? Yes NO
31. In which side of the body you feel more weakness? Yes NO
32. Do you lose your balance if you use your affected side more? Yes NO