FIM Functional Independence Measure

Functional Independence Measurement (FIM) Used as an outcome measurement tool to assess change in a patient FIM scores are given to the pt at Evaluation FIM Level Predicted FIM level for D/C at evaluation Actual FIM level at D/C FIM is copyrighted. The following slides are descriptions similar to FIM but may not be actual FIM descriptions or scoring.

The Burden of Care Task of BADL or mobility the pt can complete How much assistance is needed to perform the task Consider: Time Personnel Assistive Devices All personnel, all environments, 24 hrs a day

FIM FIM Scores include: Tasks Defined by a specific task Uses physical assistance Tasks Eating Feeding Grooming Dressing Bathing Bowel and Bladder Transfers – Bed mobility and surface / Toilet Transfer Locomotion Stairs Expression Memory Problem Solving Social Interaction Comprehension

FIM Physical Assistance Levels Independence 7 Complete Independence (timely, safely, assumes responsibility) Modified Independence (device, safety, extra time, assumes responsibility) Modified Dependence 5 Supervision (cueing, setup prior to task or removal/disposal, coaxing) 4 Minimal Assistance (pt = 75% or more: contact guard, guiding assist) 3 Moderate Assistance (pt = 50% to 74%, provides a lift to trunk) Complete Dependence 2 Maxiamal Assistance (pt = 25-49%) 1 Total Assistance (pt < 25%, two person assist) No Helper Helper

Use of Code 0 Pt did not perform activity Pt unsafe Pt refuses Medical reason

Physical Assistance The amount of assistance a patient requires in order to perform a task Definitions may vary pending institution

Physical Assistance Dependant/Total Max Mod Min SBA-CG or Hand hold or Hands on Assist Mod I Independent

Physical Assistance Percentage of help Mod for 2 LE and min for 1 LE Mod boost at trunk 75%, 50%, 25% (any time you lift from trunk they are mod-raise or lowering) Two person assist –even if 2nd person is just there for safety. Is total assistance Equipment/SBA Dividing the task into parts Grading two parts of the task = total task Always default to the higher level of assistance. Verbal or tactile cueing (grab hand to prevent injury) Usually not calculated into the assistance unless SBA, Mod I, or Indep. to assist with safety

Physical Assistance Documentation Bed Mob: supine to sit min PA Bed Mob: supine to sit min PA at the trunk Bed Mob: supine to sit min PA L LE Bed Mob: supine to sit log roll mod PA at trunk x 1, min PA L LE X1 = total assist

FIM – Bed mobility and Surface Transfer Pt must perform the entire supine to sit, sit to supine and surface to surface which may include sit to stand and stand to sit (Get in/out of bed, sit to stand, surface to surface mobility) Must use hospital bed to score Assess physical assistance for each task and take the lowest score

FIM – Transfers Slides 59 - 66 Transfers: include bed mobility, sit to stand, surface to surface Able to perform on own Indep 7 Need for time, use of arms/equip Mod Indep 6 Needs to have some standing by SBA 5 Needs min assist Min 4 Steadying, assist with 1 LE Needs mod assist Mod 3 Assist to lift trunk, assist with 2 LE Needs max assist Max 2 Needs total assist or two people Total 1 Activity did not occur UTA 0

Locomotion – Gait or W/C Slides 72 - 79 Distance the patient walks How much assistance was needed Distance the patient propels the w/c If independent with a w/c is still mod I because of the w/c according to FIM Always score the lowest score

Locomotion – Gait or W/C If able to walk or wheel 150 ft no assist Independent 7 If able to walk or wheel 150 ft with device or increased time Modified Indep 6 If able to walk or wheel 150 ft with SBA SBA 5 With min asst Min 4 With mod Mod 3 With max Max 2 If able to walk or wheel 149 -50 ft or less any assist Max 2 Walks or wheels less than 50 ft Total 1 Needs total assist Total 1 Activity did not occur 0

Locomotion – Stairs Slides 80-82 Stairs – Full Flight is 14 steps If able to perform 12-14 stairs, no use of device Indep 7 If able to perform 12-14 stairs with assist or need of time Mod I 6 If able to perform 12-14 stairs with need of SBA SBA 5 with min assist Min 4 with mod Mod 3 If able to perform 4-6 stairs any assist Max 2 Less than 4 steps Total 1 Activity Did Not Occur 0