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Appendix EXAMINATION BOOKLET The examiner was furnished with a booklet in which he entered the re- sults of his examination. The booklet was designed on the basis of a draft code, so that his entries might have the desired specificity and he might have the responsibility for making the proper choice of alternative classifications. At the right of each page the examiner was given a generous blank space in which to write explanatory notes clarifying his entries, etc. Only after all the booklets had been received and edited by both authors could the booklet be amended to constitute a technically adequate code for punch- card use. Such amendments may be exemplified as follows: (/) a single- choice classification is changed to a multiple-choice one; (2) an additional combination of findings is recognized in the classification; (3) a central review (e.g., EEG) requires a new classification of its own; (4) a classifica- tion is extended to include findings not originally recognized, and (5) a center makes some additional type of observation that requires its own classification. As used, the booklet for the follow-up examination extended to 47 pages and has seemed too detailed for reproduction here except in outline form. As in appendix 2, therefore, the outline specifies every item of information obtained but provides none of the detail of the classification of information applied to each item. However, many of the more important classifications appear in the tables throughout the text. Outline of Booklet for Follow-up Examination I. Identification A. Center and type of roster B. Study number within center, and race XII. Time from injury to follow-up examination XIII. Personal history A. Birth history B. Birth number in family C. Development D. Previous head injuries E. Previous illnesses F. Immediate family 1. Number in family 2. Number of epileptics in family G. Relatives 1. Number of aunts, uncles, and first cousins 2. Number of aunts, uncles, and first cousins that were epileptics 173

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H. Other nervous disorders in immediate family, excluding epileptics and self I. Alcohol habits of patient J. Constipation XIV. Rehabilitation A. Work status at time of report B. General work progress C. Marital status during period from injury D. Children E. Mode of patient's living F. Home adjustment G. Social adjustment H. Economic adjustment XV. Clinical symptomatology A. General B. Speech C. Visual D. Auditory E. Somatosensory F. Motor G. Olfactory H. Sexual I. Abnormalities of other systems XVI. Neurological examination A. General summary B. Mental status C. Memory D. Serial 7 test E. Aphasia F. Apraxia XVII. Cranial nerves A. General B. Olfaction C. Vision 1. General 2. Funduscopic 3. Extraocular movements 4. Pupils D. Face 1. Facial sensation 2. Facial movement E. Hearing F. Swallowing 174

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XVIII. Motor status A. Power B. Tone 1. Contralateral side 2. Ipsilateral side C. Atrophy D. Coordination E. Alternating movements and general status F. Grip dynamometer 1. Right 2. Left XIX. Sensory status A. Superficial: pain or touch or temperature B. Deep: position or vibratory or 2 point C. Stereognosis XX. Reflex status A. Tendon reflexes B. Abdominal reflexes C. Plantar reflexes XXI. Miscellaneous A. Station and gait B. Handedness and side wounded C. Scalp and skull D. Summary of neurological examination E. Summary of physical examination XXII. Epilepsy since injury A. Incidence of attacks B. Type of attacks C. Aura D. Post-ictal phenomena E. Number of minor or focal attacks in each 12-month period after injury F. Number of grand mal attacks in each 12-month period after injury G. Anti-convulsive medication in each 12-month period after injury XXIII. Summary of electroencephalogram A. Hospital EEG number B. Time from injury C. Type D. General characteristics E. Generalized abnormalities F. Focal abnormalities 1. Location 2. Type 175

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G. Activated EEC H. Focal activated changes 1. Location 2. Side XXIV. Wechsler-Bellevue Intelligence Scale A. Time B. General IQ C. Percentage deterioration D. General information E. Comprehension F. Arithmetic G. Digit span H. Similarities I. Vocabulary J. Picture arrangement K. Picture completion L. Object assembly M. Block design N. Digit symbols XXV. Minnesota Multiphasic Personality Inventory A. Time required B. Query score C. Lie score D. K score E. F (validity) score F. Profile chart 1. Hs scale 2. D scale 3. Hy scale 4. Pd scale 5. Mf scale 6. Pa scale 7. Pt scale 8. Sc scale 9. Ma scale XXVI. Fluoroscopy of skull XXVII. Visual fields, results XXVIII. Goddard Tactual Performance Test A. Time in minutes for test B. Dominant hand, time C. Recessive hand, time D. Both hands, time E. Memory score (drawing) F. Location score 176