Friedreich's Ataxia Experience 1 Survey

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1. Please give the age and sex of the person with Friedreich's Ataxia in your household? What year were they diagnosed with this condition? (Please complete a separate survey for other members of your household that have Freidreich's Ataxia)

Please give the age and sex of the person with Friedreich's Ataxia in your household? What year were they diagnosed with this condition? (Please complete a separate survey for other members of your household that have Freidreich's Ataxia) Age
Sex
Year of diagnosis

2. Which of the following best describes the mobility of the person with Friedreich's Ataxia.

Which of the following best describes the mobility of the person with Friedreich's Ataxia. Mobile

Unsteady at times

Very unsteady

Uses a walking frame/walking aid

Uses a wheelchair/scooter regularly

Uses a wheelchair/scooter now and then

Uses a wheelchair/scooter where a lot of walking/standing is involved

Wheelchair dependant

3. How often does the person with Friedreich's Ataxia receive Physiotherapy from the HSE?

How often does the person with Friedreich's Ataxia receive Physiotherapy from the HSE? Twice weekly

Weekly

Every second week

Monthly

In a batch of several sessions

Very seldom

Never

In your opinion is this sufficient?

4. Where does the person receive their Physiotherapy?

Where does the person receive their Physiotherapy?

5. Do you pay for private Physiotherapy sessions?

Do you pay for private Physiotherapy sessions? Yes

6. In the past twelve months, how many times have you / the person with Friedreich's Ataxia met with an Occupational Therapist?

In the past twelve months, how many times have you / the person with Friedreich's Ataxia met with an Occupational Therapist? Never

Once

Several times

What circumstance necessitated the appointment? (eg school, building work, etc)

7. In the past twelve months has the person with Friedreich's Ataxia had an Assistive Technology appointment or review?

In the past twelve months has the person with Friedreich's Ataxia had an Assistive Technology appointment or review? Yes

Do you feel that such an appointment was necessary?

8. How many sessions of Hydrotherapy has the person with Friedreich's Ataxia received in the past 12 months?

How many sessions of Hydrotherapy has the person with Friedreich's Ataxia received in the past 12 months? Weekly

Every second week

Monthly

Batch of several sessions

None

If hydrotherapy was available would you avail of the service?

9. Say how satisfied you are with the services that are being provided to the person that suffers from Friedreich's Ataxia in your house.

Say how satisfied you are with the services that are being provided to the person that suffers from Friedreich's Ataxia in your house. Very satisfied

Satisfied

Dissatisfied

Most dissatisfied

Please comment

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10. To update you on the results of our survey, please enter you details below.This information will not shared with third parties.

To update you on the results of our survey, please enter you details below.This information will not shared with third parties. Name:
City/Town:
Email Address:

Friedreich's Ataxia Experience 1Exit this survey

*1. Please give the age and sex of the person with Friedreich's Ataxia in your household? What year were they diagnosed with this condition? (Please complete a separate survey for other members of your household that have Freidreich's Ataxia)