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Evaluation

Are you evaluating a patient with a motor neuron disease for dyspnea?

Name of first activity associated with shortness of breath

Name of second activity associated with shortness of breath

Name of third activity associated with shortness of breath

Name of fourth activity associated with shortness of breath

Name of fifth activity associated with shortness of breath

Select appropriate answer for the difficulty breathing during each activity

Shortness of breath during running

Shortness of breath during walking

Shortness of breath during dancing

Shortness of breath during bending

Shortness of breath during dressing

Select appropriate answer for how often you felt about your shortness of breath during the past 2 weeks

Frustrated or impatient

Fear or panic

Confidence in ability to deal with illness

Upset, worried or depressed

In control of breathing

Relaxed and free of tension

Low in energy

Discouraged or down in the dumps

Satisfied and pleased with life

Upset or scared

Restless, tense or upset

Results

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