For each item, please check the box next to the statement that best reflects your current situation. Please read the text carefully and only check one box in each section. 70.Moving around moderate distances (10 to 100 meters) I use a wheelchair. To move around, ... ... I need total assistance ... I need an electric wheelchair or partial assistance to operate a manual wheelchair ... I am independent in a manual wheelchair I walk moderate distances and ... ... I need supervision while walking (with or without walking aids) ... I walk with a walking frame or crutches, swinging forward with both feet at a time ... I walk with crutches or two canes, setting one foot before the other ... I walk with one cane ... I walk with a leg orthosis(es) only e.g., leg splint ... I walk without walking aids 70/126
