Activity | Score |
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 to help with personal care | |
5 = Independent face/hair/teeth/shaving (implements provided) |
Dressing |
0 = Dependent | |
5 = Needs help but can do about half unaided |
10 = Independent (including buttons, zips, laces, etc) |
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, but can do something alone |
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 <50 yards | |
5 = Wheelchair independent, including corners, >50 yards |
10 = Walks with help of one person (verbal or physical) >50 yards |
15 = Independent (but may use any aid; for example, stick) >50 yards |
Stairs |
0 = Unable | |
5 = Needs help (verbal, physical, carrying aid) |
10 = Independent |
Total (0-100): | |