• FACIAL DISABILITY INDEX (FDI)

  • Please choose the most appropriate response to the following questions related to problems associated with the function of your facial muscles.


    For each question, consider your function during the past month.

    5 = No difficulty 

    4 = A little difficulty

    3 = Some difficulty 

    2 = Much difficulty

    1 = Usually did not eat because of health

    0 = Usually did not eat because of other reasons

  • 1. How much difficulty did you have keeping food in your mouth, moving food around your mouth, or getting food stuck in your cheek?
  • 2. How much difficulty did you have drinking from a cup?
  • 3. How much difficulty did you have saying specific sounds while speaking?
  • 4. How much difficulty did you have with your eye tearing excessively or becoming dry?
  • 5. How much difficulty did you have with brushing your teeth or rinsing your mouth?

  • Please choose the most appropriate response to the following questions related to problems associated with the function of your facial muscles.

    For each question, consider your function during the past month.

    6 = All of the time 

    5 = Most of the time 

    4 = A good bit of the time

    3 = Some of the time

    2 = A little bit of the time

    1 = None of the time

     

  • 6. How much time have you felt calm and peaceful?
  • 7. How much of the time did you isolate yourself from people around you?
  • 8. How much of the time did you get irritable toward those around you?
  • 9. How often did you wake up early or wake up several times during your nighttime sleep?
  • 10. How often has your facial function kept you from going out to eat, shop, or participate in family or social activities?
  • Date*
     - -
  •  p. 443.979.7171 AAA Physical Therapy, LLC
    admin@AAAPhysicalTherapy.com
    8975 Guilford Rd Ste 170 Columbia, MD 21046    		  f. 667.200.5908

     

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