B) Would you like to receive rehabilitation that could help you get back to work?

• Yes
• No

Check No and write in: Vocational Rehabilitation is not helpful when you have Huntingtons Disease because ability to learn new tasks is poor and because I am more slow and disorganized than before. My poor motor coordination, balance, and constant chorea prevents safe employment in manual labor.

Section IX Remarks

Huntingtons Disease is an incurable, degenerative brain disorder that affects every part of an individuals life. Characteristic features of HD include involuntary movements, dementia, and behavioral changes. Family members may first notice that the individual experiences mood swings or becomes uncharac-teristically irritable, apathetic, passive, depressed, or angry. These symptoms may lessen as the disease progresses or, in some individuals, may continue and include hostile outbursts or deep bouts of depression.

HD may affect the individual's judgment, memory, and other cognitive functions. Early signs might include having trouble driving, learning new things, remember-ing a fact, answering a question, or making a decision. Some may even display changes in handwriting. As the disease progresses, concentration on intel-lectual tasks becomes increasingly difficult.

In some individuals, the disease may begin with uncontrolled movements in the fingers, feet, face, or trunk. These movementswhich are signs of chorea often intensify when the person is anxious. HD can also begin with mild clumsiness or problems with balance. Some people develop choreic movements later, after the disease has progressed. They may stumble or appear uncoordinated. Chorea often creates serious problems with walking, increasing the likelihood of falls.

The disease can reach the point where speech is slurred and vital functions, such as swallowing, eating, speaking, and especially walking, continue to decline. Some individuals cannot recognize other family members. Many, however, remain aware of their environment and are able to express emotions.

8-Do your symptoms affect your ability to do these things YES or NO? continued

speaking: already experiencing problems remembering words, no slurring yet, vulgar when I loose temper
traveling to are from work: Have begun running red lights and will have to quit driving very soon.

reading the newspaper: can't do any more because of loss of attention span
watching TV: can't remember who is who or what's happening so isn't enjoyable any more
driving the car: will stop driving soon as I'm afraid of killing others or family when running red lights
using the telephone: takes long time to recognize voices and to recall numbers to dial. If people leave me messages I don't remember them later.

9-Your height:

Input YOUR height here.

10 -Names of 2 people we can call who know of your condition?

Would include your family doctor, neurologist, psychologist, psychiatrist or other friends.

11-Do you have any significant mental problems or emotional? If yes explain.

Those normally associated with HD, personality changes, drastic mood swings, loss of social inhibitions, cognitive decline, etc.

12-Do your mental emotional problems affect your day to day living or working? If yes explain.

Don't want to get up in morning, medication helps a little but makes sleepy and slower and dulls emotions

13-Have you ever received any mental or emotional treatment tell why if yes.

If you've seen a psychologist or psychiatrist, put their name and information here.  Otherwise put "not yet".

14-Do you think you need a mental or emotional evaluation in regard to YOUR disability benefits? If yes tell why.

Possibly, since cognitive and emotional symptoms are all part of HD

15- Do you have a counselor?

Put in the name of your psychologist or psychiatrist if you've seen one regarding HD, or HD related symtpoms.

16-Do you need another person help or need reminders or supervision in performing/completing the following activities? If yes, explain. Yes or No

bathing: Not yet
brushing your teeth: No
fixing your hair shaving: Yes, Because of movements must use electric shaver because have cut myself before using razor
selecting appropriate clothing: Yes, can't decide which clothes to wear
cooking: Yes, keep forgetting to turn off burners and stove
paying bills: Yes, have problems remembering when they're due or where I put them to be paid
visiting: Don't visit because I'm afraid to drive more than absolutely necessary
shopping/making change: Not yet
riding the bus: Maybe, get confused often and may loose directions. Have gotten lost before in familiar surroundings and own neighborhood.
taking care of children: No, all children are grown up

17-Do you have difficulty keeping your mind or attention on a task/activity? If yes explain.

Yes, get distracted easily now, can't focus or remember well.

18-Do you have difficulty completing task? If yes, explain.

Same as 17 above.

19-Do you have problems making decisions? If yes, explain.

Yes, can't make up my mind or I act impulsively and do things I would have never done before.

20-What upsets you?

Change. Noise. Multiple instructions. Become frustrated not being able to perform as well as I did before. Can't control my emotions anymore

21-When your daily routine changes how do you react?

I can't cope well and find myself unable to figure out what to do next.

22-When you have stress /or pressure how do you react?

My chorea movements increase and I become more animated and begin to slur my words and not think logically. I also loose my temper easier.

How often does it happen?

Depends on what "triggers" it during the day. Sometimes something small and sometimes something big. I try to avoid anything that would be stressful now like never using the freeway and never driving during rush hour, keeping radio off so there are no distractions, etc.

23-How do you get along with other people?

I have a very short fuse now and say exactly what's on my mind. Before I know I've done it I've told someone off. I am very aggressive now and don't care what others think or if I've hurt them with what I've said.