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AGE: _56______

NUMBER OF YEARS SINCE YOU WERE DIAGNOSED WITH PD:
_3_______

DO YOU HAVE PROBLEMS WITH TREMOR? ___very little______

DO YOU HAVE ANY PROBLEMS WITH WALKING? _yes________

FREEZING IN DOORWAYS? _no     _______

SHUFFLING GAIT? _a little___

PROBLEMS STARTING TO WALK? __no_______

PROBLEMS SUSTAINING WALKING? _____yes____

DO EVER FEEL AS THOUGH YOUR FEET ARE "GLUED TO THE
FLOOR"? ____no______

DO YOU FIND THAT STEPPING OVER OBJECTS ON THE FLOOR IS
HELPFUL FOR WALKING? ___no______

DO YOU FIND THAT YOU DON'T FREEZE WHILE WALKING UP OR
DOWN STAIRS?  __n/a_______

ARE SOME FLOOR PATTERNS EASIER FOR YOU TO WALK
ACROSS (for example, cracks in the sidewalk)? ____no_______

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