How easy, or difficult, is it for you to:

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* 1. Name and/or ID

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* 2. Get into and out of the tub or shower

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* 3. Dress your lower body

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* 4. Get on and off the toilet

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* 5. Get up from the floor

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* 6. Balance while standing

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* 7. Stand for one-half hour

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* 8. Pick up an object from floor while standing

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* 9. Get up from a chair

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* 10. Get into and out of a car

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* 11. Walk around indoors

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* 12. Walk outside on uneven ground

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* 13. Walk in bad weather (e.g., rain, snow, wind)

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* 14. Walk up to two hours

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* 15. Walk up a steep ramp

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* 16. Get on and off an escalator

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* 17. Climb one flight of stairs with a rail

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* 18. Climb one flight of stairs without a rail

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* 19. Run one block

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* 20. Carry a plate of food while walking

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* 21. Put on and take off orthosis or prosthesis

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