In the following questionnaire, I am going to ask you a variety of questions.

Some are concerned with you and some are general. There are two options for every single question, µYes´ and µNo¶. 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.

GulRukhsaar PGDRP Student

Name: ««««««««««««Age ««««. Sex: «««. Family Status:

Occupation: «««««««««««««««««««««... Education:

Monthly Income: «««««««««««««««««««« Address: «««««««««««««««««««««««. Rural/Urban: «««««««««««««««««««««.


1. Are you always in stress? Yes NO

2.Are you facing economic problems? Yes NO

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

9.Does your heart beats more fast in fearful situations? Yes NO

10. Do you ever feel weakness in one side of the body? Yes NO

11. Do you walk with any support? 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

17.Do you feel loss of perception? Yes NO

18. Does your perception loss due to sudden brain stroke? Yes NO

19. Do you ever feel loss of memory? 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

23. Were you ever in coma? 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

30. Are you unable to hold a limb in any position? 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