0	1	2	3	4
Never true for me	Rarely true for me	Sometimes true for me	Often true for me	Very true for me
Over the PAST WEEK, my spasticity:
Answer
11. Made grooming (hair, teeth) difficult for me or my attendant/caregiver
12. Made dressing difficult for me or my attendant/caregiver
13. Made personal hygiene (e.g. toileting, cleaning) difficult for me or my attendant/caregiver
14. Made eating or feeding difficult for me or my attendant/caregiver
15. Interfered with my ability to exercise
16. Made transfers hard for me or my attendant/caregiver