Did you have problems standing or walking because of difficulty feeling the ground under your feet?
Did you have difficulty manipulating small objects with your fingers (for example, fastening small buttons)?
Did you have difficulty climbing stairs or getting up out of a chair because of weakness in your legs?
Please answer the following question only if you drive a car: Did you have difficulty using the pedals?
Please answer the following question only if you are a man: Did you have difficulty getting or maintaining an erection?
How much have your symptoms interfered with your work (including work around the house) in the last week?
How much have your symptoms interfered with your relations with other people in the last week?