Questionnaire Text

Questionnaire form view entire document:  text  image
For all individuals in the household

[Questions 1 - 9 were asked of all individuals.]


5. What type of physical or mental impediment do you have?

(Mark the most severe)

[] 1 Blindness
[] 2 Deafness
[] 3 Mental retardation
[] 4 Cerebral Paralysis
[] 5 Permanent physical disability
[] 6 Other
[] 7 None

Questionnaire instructions view entire document:  text  image

Question No. 5: What type of physical or mental impediment do you have? (Mark the most serious)

This question is asked with the object of understanding the population that suffers from some type of physical or mental impediment.
Carry out this question if in the list of occupants the name of a person has been marked in the circle from question 4, or was not marked in circle 7 "none".

[p. 71]

Consider as
Blindness: a person who has no vision or sees very little (visual weaknesses) an impediment that cannot be normalized with the use of glasses, treatments or other optical aids. Include persons who are blind from birth, blind by sickness like glaucoma, "toxoplasmosis", and diverse infections, and those blind by accident (hit in the eye, diverse injuries, etc.).

[To the right of the text is a picture of an eye doctor and patient.]

Deafness: a person who does not hear or talk and communicates through signs but with normal intelligence.

Mental Retardation: a person who has a below normal intellectual capacity. The characteristics are shown through a low performance in school, problems with adaptation and behavior, and retardation in mental and social development. A typical case is a "mongoloid" [Down's syndrome] person.

Cerebral Paralysis: a person who when being born or during the first three years of life suffered a cerebral lesion or injury that does not permit them to move in a normal form and having stiff muscles and uncoordinated movements. Generally, they have aural, visual, and mental problems with language and suffer convulsions.

Physical disability: a person who because of an accident, disease, cerebral brain hemorrhage, or amputation has difficulty doing with skill activities of daily life or moving independently. Also those who have malformations that limit them physically or those who were born lacking any extremity.

Other: Mark this box in the case of a person who is autistic, suffers from dementia or presents irregularities in development (its is applied also to children in which when their age is considered, do not crawl, walk or speak when it is expected that they do it and do not have a definite diagnosis that would permit them to be put in any of the other categories listed above). Or that is, include a person who does not have any type of impediment described in the categories listed above. (Circles 1 to 5).

None: Mark this circle when the person declared in the list of occupants to not have a physical or mental impediment.