Ot 2nd Quarter 2014
Mr. X, a 72 yo male, fell down a flight of stairs and was admitted to the acute care hospital with confused sensorium and incomplete motor and sensory tetraplegia due to fracture dislocation at C6-7. There was no loss of conciousness. He had a cervical traction applied. The CT scan showed a right parietal subdural hematoma. Burrhole evacuation of the subdural hematoma was performed under local anesthesia. Two days later the cervical spine was reduced and fused posteriorly. He was then transferred to an IRF, Inpatient Rehab Facility.
- 1.EATING: Mr. X eats a regular diet, however, he requires some (less than 50%) physical assistance with eating.The helper applies a universal cuff and scoops each spoonful of food onto Mr. X's spoon. Mr X then brings the food from the plate into his mouth and is able to chew and swallow without difficulty. What is the FIM score?
- A.
3 or Mod Assist
- B.
1 or Total Assist
- C.
5 or Supervision/Set up
- D.
6 or Mod I
- 2.GROOMING: Mr. X washes his left hand after having a wash mitt applied to his right hand. Mr. X also washes his face, combs his hair and brushes his teeth. The helper washes his right hand and assists with shaving. Patient is able to complete 3 out of the 5 or 60% of the tasks for Grooming. What is the FIM score?
- A.
6 or Mod I
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
3 or Mod Assist
- 3.BATHING - Mr. X washes, rinses and dries 2 body parts without assistance: chest and left arm. The helper washes, rinses and dries the remaining 8 body parts. In other words, the patient is able to complete 2 out of 10 tasks or less than 25% without assistance. What is the FIM score?
- A.
5 or Supervision/Set up
- B.
4 or Min Assist
- C.
2 or Max Assist
- D.
1 or Total Assist
- 4.UPPER BODY DRESSING: Mr X typically wears a pullover sweatshirt. The helper places the shirt over Mr. X's head and threads each arm. Mr. X then leans forward so the helper can pull the sweatshirt down over his trunk. Mr. X does less than 25% of the tasks to complete upper body dressing What is the FIM score?
- A.
1 or Total Assist
- B.
3 or Mod Assist
- C.
5 or Supervision/Set up
- D.
7 or Independent
- 5.LOWER BODY DRESSING: Mr. X usually wears sweat pants with an elastic waist, antiembolic stockings, socks and sneakers. The helper applies the antiembolic stockings and then threads both pant legs to Mr. X's knees. Mr. X then shifts side to side so the helper can pull up the pants over his hips.The helper then puts on Mr. X's socks and sneakers. The patient performs less than 25% of the lower body dressing tasks. What is the FIM score?
- A.
2 or Max Assist
- B.
5 or Supervision
- C.
6 or Mod I
- D.
1 or Total Assist
- 6.TOILETING: Mr. X shifts from side to side as the helper adjusts his clothing before and after his intermittent catheterizations and bowel movements. Mr. X wipes himself. The patient can complete 1 out of the 3 (33%) of the tasks for Toileting What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision/Set up
- C.
2 or Max Assist
- D.
Activity did not occur
- 7.BED/CHAIR/WHEELCHAIR TRANSFER: Mr. X requires assistance from 2 staff members, a max assist of 2, to get into and out of bed. During one of those transfers, one of the 2 helpers does not physically assist the patient but is there for safety reasons. What is the FIM score?
- A.
6 or Mod I
- B.
7 or Independent
- C.
2 or Max Assist
- D.
1 or Total Assist
- 8.TOILET TRANSFER: Mr. X requires help from 2 staff members to get on and off the toilet, one to physically assist and the second one to be there "just in case". What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
2 or Max Assist
- 9.TUB/SHOWER TRANSFER: Mr. X does not perform bath or shower transfers during the first 3 days of admission because he refused. He bathes in bed each morning. What is the FIM score?
- A.
7 or Independent
- B.
1 or Total Assist
- C.
0 or Activity did not occur
- D.
5 or Supervision/Set up
- 10.COMPREHENSION: Mr. X consistently understands questions that the staff asks him about routine every day matters such as meals, and need for pain medication. He watches television programs, but cannot understand abstract information such as the plot of a movie, current events or humor. He requires prompting less than 10% of the time. What is the FIM score?
- A.
2 or Maximal Prompting
- B.
4 or Minimal Prompting
- C.
5 or Stand by Prompting
- D.
1 or Total Assist
- 11.EXPRESSION: Mr. X consistently expresses information about daily needs clearly, but cannot discuss abstract information such as financial and insurance matters. With prompting 10% of the time, he expresses such things as menu choices, and makes statements about activities in which he is involved during occupational and physical therapy. What is the FIM score?
- A.
0 or Activity did not occur
- B.
5 or Stand by Prompting
- C.
1 or Total Assist
- D.
3 or Moderate Prompting
- 12.SOCIAL INTERACTION: Mr. X is very cooperative with the rehab staff and interacts well with patients. What is the FIM score?
- A.
5 or Supervision Set up
- B.
3 or Mod Assist
- C.
7 or Independent
- D.
6 or Mod I
- 13.PROBLEM SOLVING: Mr. X. consistently recognizes and solves routine problems, such as asking for help when unable to reach something or putting on his call light. However, he cannot make decisions about household finances, discharge plans or transportation arrangements. He requires supervision no more than 10% of the time. What is the FIM score?
- A.
5 or Supervision/Standby
- B.
4 or Minimal Direction
- C.
3 or Moderate Direction
- D.
2 or Maximal Direction
- 14.MEMORY: Mr. X. recognizes the rehab staff who treat him but cannot always recall their names. He can list his daily activities to the staff. He responds to requests appropriately, but needs repetition less than 10% of the time in a stressful or unfamiliar circumstance. What is the FIM score?
- A.
7 or Independent
- B.
5 or Supervision or requires prompting no more than 10% of the time.
- C.
2 or Maximal Prompting or requires prompting more than half of the time
- D.
4 or Minimal Prompting or requires prompting 10-25% of the time
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