7     Complete Independence (timely, safely)
6     Modified Independence (device)
5     Supervision (cuing, setup, coaxing)
*4     Minimal Assist (Patient participation= 75% or more)
*3     Moderate Assist (Patient participation= 50% – 74%)
*2     Maximal Assist (Patient participation= 25% – 49%)
*1     Dependent (Patient participation= less than 25%)
0     Activity did not occur/ Not Tested
*See Categories of Scoring for Objective Score to Determine these Levels of Assist

Categories of Scoring:

Eating/ Feeding (__/7)

• Picking up a utensil
• Using suitable utensils
• Scooping food onto a utensil
• Bringing food to the mouth
• Drinking from a cup or glass
• Chewing and swallowing
• Managing a variety of food consistencies

Grooming (__/5)

• Oral care
• Hair grooming (combing or brushing),
• Washing hands
• Washing the face
• Shaving the face or applying make-up

Bathing (& drying) (__/10)

• Left arm
• Chest
• Right arm
• Abdomen
• Front perineal area
• Back perineal area (buttocks)
• Left upper leg
• Right upper leg
• Left lower leg, including the foot
• Right lower leg, including the foot

Upper Body Dressing (__/15)

• Shirt
• Right Arm
• Left Arm
• Overhead
• Arranging in the back
• Fasteners
• Bra
• Right Arm
• Left Arm
• Overhead
• Arranging in the back
• Fasteners
• Sweater/ Jacket
• Right Arm
• Left Arm
• Overhead
• Arranging in the back
• Fasteners

Lower Body Dressing (__/14)

• Pants
• Right Leg
• Left Leg
• Arranging over hips
• Fasteners
• Socks
• Right Foot
• Left Foot
• Shoes
• Right Foot
• Left Foot
• Fastener
• Underwear/ Brief
• Right Leg
• Left Leg
• Arranging over hips
• Compression Stockings
• Right foot
• Left foot

Toileting (__/3)

• Transfer
• Clothing Management
• Hygiene

Cognition

• Communication
  • Complex Abstract Information
  • Current events
  • Humor
  • Religion
  • Finances
  • Discharge Planning
  • Participating in and understanding information during group conversation/ relationships
  • Basic Information
  • Nutrition
  • Fluids
  • Hygiene
  • Sleep
• Comprehension
  • Auditory
  • In patient’s usual language
  • Visual
  • Writing
  • Sign language
  • Gestures
• Expression (ability to express needs & desires)
  • Verbal
  • Nonverbal
  • Social Interactions
• Problem Solving
  • Initiating, sequencing and self-correcting tasks and activities to solve problems.
  • Making reasonable, safe and timely decisions regarding financial, social and personal affairs.
  • Recognizing a problem
  • Making appropriate decisions
  • Initiating steps and readjusting to changing circumstances
  • Carrying out a sequence of steps
  • Evaluating the results
  • Complex problems:
  • Managing a checking account
  • Participating in discharge plans
  • Self-administration of medications
  • Confronting personal problems
  • Making employment decisions
  • Routine problems:
  • The completion of daily tasks
  • Dealing with unplanned events or hazards that occur during daily activities
• Memory
  • Recognizing people frequently encountered
  • Remembering daily routines
  • Executing requests without being reminded