Patient performs task safely, with no modifications, assistive devices, or aids, 100% of the time
Patient requires adaptive equipment, takes more than reasonable time, or has safety concerns, but NO helper needed
Patient requires standby assistance, cueing, coaxing, or setup, but NO physical contact from helper
Patient performs 75%+ of effort, helper provides <25% (touching/contact required)
Patient performs 50-74% of effort, helper provides 26-50%
Patient performs 25-49% of effort, helper provides 51-75%
Patient performs <25% of effort, or activity not performed
Levels 7-6: NO HELPER required (patient independent with or without equipment)
Level 5: Helper required for supervision/setup but NO PHYSICAL CONTACT
Levels 4-1: Helper required with PHYSICAL CONTACT/ASSISTANCE
Key: Level 6 uses adaptive equipment (walker, grab bars, etc.)
Key: Level 6 = modified methods (writing, gestures, extra time) but NO helper
❌ Scoring 7 when adaptive equipment is used
✅ If patient uses ANY equipment (walker, grab bars, etc.) = Level 6, not 7
❌ Confusing supervision (5) with minimal assistance (4)
✅ Level 5 = NO physical contact. ANY touching = Level 4 or lower
❌ Not considering safety in scoring
✅ If patient is unsafe even when independent = Level 6 (modified) or lower
❌ Scoring based on potential instead of actual performance
✅ Score what patient DOES, not what they COULD do with more effort
❌ Giving credit for partial completion
✅ Patient must complete ENTIRE task for score. Partial = lower score
❌ Not accounting for time taken
✅ If task takes unreasonable time (>3x normal) = Level 6 even if independent
❌ Scoring cognitive items like motor items
✅ Cognitive items don't use equipment. Level 6 = modified methods (writing, gestures)
❌ Overestimating patient effort percentage
✅ Be honest about helper effort. If you're doing half the work = Level 3
❌ Not documenting what helper actually does
✅ Document specific helper actions: 'RN held walker steady' vs. 'RN assisted'
❌ Scoring admission FIM too high
✅ Admission FIM should reflect TRUE baseline, not potential. Be conservative.
Patient uses adaptive utensils (built-up handles) but feeds self completely without any assistance. No setup needed.
What FIM score should be assigned?
Patient requires therapist to hold walker steady and provide standby supervision for safety, but performs transfer without physical contact.
What FIM score should be assigned?
Patient walks 50 feet with walker. Therapist provides minimal physical assistance (touching) to maintain balance 25% of the time.
What FIM score should be assigned?
Patient pulls pants up halfway, then nurse completes the task. Patient and nurse each do about 50% of the work.
What FIM score should be assigned?
Nurse washes patient's entire body. Patient makes minimal effort to assist and performs less than 25% of the task.
What FIM score should be assigned?
Patient remembers daily schedule and therapy appointments 90% of the time without reminders.
What FIM score should be assigned?
Patient solves routine problems (what to do if therapy is cancelled) but requires prompting for complex situations 50% of the time.
What FIM score should be assigned?
Patient cannot perform any part of stair climbing. Two staff members provide total assistance.
What FIM score should be assigned?