Quality of Life Assistant
Restricted Activity Chart
PPND home page || QLA home page
Unusual exertion may trigger attacks of paralysis or weakness but it man take from moments to 72 hours for weakness to develop after exertion Some patients report that minor episodes may be aborted with mild exercise. It is hoped that by keeping a log you might determine your level of exercise tolerance.
Please use this chart to help you determine activity triggers to attacks. Additional spaces have been left for you to individualize the chart to your particular exercise/activity schedule.
| Activity | Details | Date | Duration | Frequency | Positive and/or Negative Effects |
|---|---|---|---|---|---|
| Walking | |||||
| Climbing Stairs (specify no. of steps) | |||||
| Food Shopping | |||||
| Shopping - Other (specify) | |||||
| Gardening (specify) | |||||
| Housework (specify) | |||||
| Lifting (specify) | |||||
| Showering, Bathing (specify) | |||||
The space below allows for special notations to your activities of daily life (ADL)