Activity

• Feeding:
  • 0 = unable
  • 5 = needs help cutting, spreading butter etc, or requires modified diet
  • 10 = independent
• Bathing:
  • 0 = dependent
  • 5 = independent (or in shower)
• Grooming:
  • 0 = needs help with personal care
  • 5 = independent face/hair/teeth/shaving
• Dressing:
  • 0 = dependent
  • 5 = needs help but can do about half unaided
  • 10 = independent (including buttons, zips, laces)
• Bowels:
  • 0 = incontinent (or needs to be given enemas)
  • 5 = occasional accident
  • 10 = continent
• Bladder:
  • 0 = incontinent, or catheterized and unable to manage alone
  • 5 = occasional accident
  • 10 = continent
• Toilet Use:
  • 0 = dependent
  • 5 = needs some help
  • 10 = independent (on and off, dressing, wiping)
• Transfers: (bed to chair and back)
  • 0 = unable, no sitting balance
  • 5 = major help (one or two people, physical) can sit
  • 10 = minor help (verbal or physical)
  • 15 = independent
• Mobility: (on level surfaces)
  • 0 = immobile or less than 50 yards
  • 5 = wheelchair independent, including corners, more than 50 yards
  • 10 = walks with help of one person (verbal or physical) more than 50 yards
  • 15 = independent
• Stairs:
  • 0 = unable
  • 5 = needs help (verbal, physical, carrying aid)
  • 10 = independent

0-100 Points

Record what patient actually does; need for supervision > not independent; usually last 24-48 hrs