- ICCONS,Shoranur, Palakkad (0466)2224869; 6238440945
- ICCONS, Pulayanarkotta,Trivandrum-11 (0471)2440232, 2447729
- icconssrr@gmail.com
- icconstvpm2018@gmail.com
Non-Communicable Neurological Disorder
Name*
Age and Sex
District
Country and State
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Telephone Number*
Email id*
Conduct Survey
Has anybody in your family is a diagnosed case of Non-Communicable Neurological Disorder?
Has anybody in your family developed sudden weakness of any part of the body?
Has anybody in your family developed sudden loss of Consciousness, Language : Understanding/Expressing/Both, Reading, Writing, Balance, Sensations : Touch/ Smell, Ability to walking?
Has anybody in your family experienced difficulty in any of the following in his/her later life? (Swallowing, Retaining and or naming persons, places or situations, Finding the correct way to home or office)
Has anybody in your family experienced any of the following in his/her later life? (Change in normal walking pattern, Difficulty in changing from one posture to another, Tremor of hands, Slowness of movement, Decreased speed of activity, Stiffness or pain of joints)
Has anybody in your family developed any of the following problems? (Progressive weakness of body, Frequent twitching movements, Thinning of any body parts, Unclear speech, Abnormal tongue movements)