RF-PAI Tra i tt i tt g Marun I Efeuhte 04/01/04

DrScnnUON OFTHE LNWI-,S OFFUNCTTONAND TMM.

Sconrs.
IIIDEPEIIDEI\rI- Another person is not required for the activity (NO IIELPER).

7 Complete Independearce-The patient safely perfomos ali the tasks described

3s making up tha aotivity within a reasonable amount oftime, and does so
without modification, assistive dwices, or aids.

6 Modified [rdependence-One or moie of tie following may be true: the

activify requires aa assistive dwice or aid, the activity takes more than
reasonable timg or the activity ihvolves safefy (risk) corsideratiols.

. DEPENDENT- Patient roquires aribther person for either supervision or physical

assistancs in order to perform the activity, or it is not performed
(REQIIIRES IIELPER),

MsiIified Pependence: The patient expends half (50%) or more of the effort. The
levels ofassistaace requtetl are defined below

5 ' Superrrision or Setup--Tte patient requires no rhore heip tlal standby,

cuoing, or codring wittrout physical contac! alternatoly, tho helper sets up
needed items or applies orthoses or assistivdatlaptive devices.

4 Minimal Contact Aisistance-{he patient requires lo more help ttran

touching, and.expmds 7573 ol m- ore of tle effort
\
.) Moderate Assistance-The patient requires more help than tou.Iing, or
expends between 50 and 74Yo ofthe effort.

Complete Dependence: The patient e4pends less than half (ess than 5070) ofthe
efEort Maximal or total assistance is required. The levels of
assistance required are defined belorr.

2 Mriximal Assistance-The patient expends between 25 to 49% of tho effort.

7 Total Assistance--The patie,lrt expends less than 25% ofthe effort.

0 Aotivity Does Not Occur The patient does not perform the activity, and a helper
-
doeS uot perform the aotivity for the patient duriag the entire assessment time tame.
LUf,E: Do zol use this code only because you did not observe tle patie'lrt perform the
activity. h sucl cases, consult othei cliniciani, the patient's medioal recor4 the
patieni aad &e patient's family members to discoverwhether others observed the
patient perform the aotivitY.

copFighLo2oo I - 2004 IJB Fouldation Artivities, ftrc. (EFA, Jnq.) for compilation riShts; no copyrighls olaioed iu u.s.
Co'v""ia?"rrq,orLs i!"Iuded iE SectioE I, porfioEs ofsecion lV, epiendces I ard K, aad portious ofAppeodices B, C,
q G,Hard J.
AIr othercopyrishtsarercservedtotheirrespctiye-o.erels.-?liiil91193?rjlP_lHlllx,l,ijIlf:i,l;:"*f.H,?*
 IRF-PAJ Trainin g Man ual Effeaive 04/01/04

I]csrnUCTIONS FOR Tur USE OF TM trTMM DECISION

T'nrps

General Description of FIM Instrument

Levels ofFunction and Their Scores
Decision Tree, begin in lhe uDoer lefthand camer. Answer the questions and follow
tlle
To use the FlM
brancl'res to the conect score. You wiil nolice tirat behavlors and smres above the line indicate ttlat No
HELPER is needed, while behaviors and scores below the bottom line indicate that a HELPER is needed.
lf an activity does not ocqtr for self care, transfer or locomotlbn items on admission, enler code
"cf on
admission.

SCORE
Start
Does Patient
Does Patient need more than Not COMPLETE
need help? reasonable ti.rle
-No--+> ora def/ice-
INDEPENDENCE

or is ihere a clncem
forsafew \ SGORE
6.
No Helper
MODIFIED
Yes INDEPENDENCE

Helper

Does Patientneed
Does Patient SCORE
sefup orsupervision,
do halfor more -Yes+' 5
cuing or cqaxing !dY?
of the effort? -Yes--->,
SUPERVISION
OR SETUP

No
I
v'
No

Does
Does Patient \ Patientneed
need iotal only incidental
assistance? assistance?

No
/iu
es
/ \
No
SCORE
{ SCORE
4
SGORE
SCORE '2
EERATT::M,INIMAI-:=
ASSISTANCE ASSISTANCE
TOIAL MAXIMAL
\ ASSISTANCE ASSISTANGE

Coplriglt @2001 - 2004 Lts louudatioq Actiyities, Iac. (UBIA,Iic,) for colryilation rigbts; ao copyig}ts clairned iu U.S.
Govemlent vor*s included h Sectio!I, Portiols ofSection IV, Appeodices I a K, ard Portions ofAPPendices B, C, B, G, HaDd J
All othe!coplrishts arereservedto ther respcctive owlers. Corytisli @1993-20!1!tr9T9:1.j..*jJ-ljf:*:;13j:Y"i*
 IRF-PA) Trai ni ng Manual
ffictive A4/01/04

MBprony
Memoryiqcludds skllls relaled to recognhihg and remembering whlle perbrmini daily activtfes
In an Institutionalor
comrnunitysefting. Memory in this clntext includes the ability to stop and
retrle-ve in'formation, particularly verbal and
visual. e fun cubnal eviden ce of_memory-incrudes recogniztrg people frequenfiy
,Ti encountered,'remembjring dairy
rotmnes and e,xecudng requests without being reminded. A defcit in memory impaird
teamrng as wefl as performance
othsks. At level 7 the subjed recognEes peoprri fiequenuy encountere4 r# erirters aaly ;utines, and'exeortes
requests oiothers without need forrepetitjon. Code "y is not ayallable lor Memory

SCORE
Does 7
Does Patient have slight -No-->
Patient need help lo ditrrcsliy recognhing people, COMPLETE
renemberpeople, rerBernbeing daily roulines and INDEPENDENCE
rcufines and a\ecuting requesh wihout need for
requests? repelltioo. ordoes s/he use self-. .
initialed or envr'rDnmenlal cles to
rerrembe/f
SCORE
Yes---> 5

MODIFIED
No Helper Yes INDEPENDENCE

Helper

Does
Peiientremember
people, rculio8s and DoesPatlent
need help to recognize
requesls halfor anore
aniJ remember only rarely SCORE
of he time? Yes+
-Yes-> oronly undersLessful
condjtions (less ihan 10%
5

of the lime)?
SUPERVISION

l\o
* No

Does Dos Pa(eflt

Patjeot need he,p lo need help to recognize
temember all of EE Ohe or does s./ and remernber onv occaslonally
he not e,bclively recognize and 06ss tlan 25%
.renember? ofthe timeP

No
Yes
Yes No / {
I \ :SQORE SCORE
4
SCORE SCORE
1. 2 I ODERATE MINIMAL
PROI\,4PTING PROI\4PNN6
TOTAL MAXIMUI\,,I
ASSISTANCE PROMPTING

Copl,riglt @2001 -2004 UB Foundatio! Activities,lEc. (UBFA, fic.) forcomp ilatioB riglts: Do coplrights claimed io U.S.
 Effecrive A4/01/04
IR-F-PAI Traitin g Manual

recopizing while
and remembering
MEMORY: Me mary moludesskiils reiated to
in tbjs
;;ffif aJv urtl-riti., io an l*titotlonal or communr'ty sotting' Memory and
verbal
coniext irciudes tho *iUry to ,ti" *al"rl"ve irfomation,
partioularly
recomizing people ft-equeidy
visual. Tle fi:nctionuf ,via*"u of -Lory includes
without being
#".Li*"a, t"*"-tering dailyroutines, and executin-g asroquests
performance of tasks'
remiadsd. A deficit in memory'impairs leaming as well

NO}IEI?BR
people frequenfly
7 Complete hdependence-{he patient recognizes
of others
JrJoi"tti"a, ,i*t-ters daily routines, and execntqs requosts
without need for rePetition

Independence-Tha patient appears to have

only,mild difEottlty
6 Modif ed
and
;"glld:rgp*pk ftequently encountered, remembering daily routines'
;il;;dl"g a ;q.."ts of othtrs. The patient may use self-initiatetl or
environmental cues, prompts, or aids'

HEL?ER
repetition'
5 Suoonrision-The patient requires prompting (e'g', cueing'
r"Ji"a*.i"rfvLt t stessful or unramiliar conditions' but no more than
10% of the time.

75 to 90% of the
A Minimal Prompting-The patient reco mizes antl remembers
time.

rememb ors 50 to'lLYo of

J Moderate Prompting-The patient recomizes and
the timo.

25 to 49Yo of he
a Maximal Prompting-.The patient reoosilizes antl romembers
timg antl needs prompting more thamhalfth.e tima
than 25% of the
1 Total Assistanco-Tho patient reqognizos and remembers less
timg or tloes aot effectively reco8nize and remember'

Do not use code "0" for Memory.

U8 Iouoditior Acivities,Inc. (UBFA,Irc')for coEpilalg dqht; io

t^Ui;
Copyrisit @2001 - 2004 'oqe4t 1:]1{ -*,
 .IRFQAI Trainiry Manual Effectire A4/01/04

EATING: Eciting inclldes the ability to use suitable utensiis to bdng food to the mouttr,
as wellability to chew and swallow the food once the meal is presentetl in the
as the
customary manner on a tabie or tray. The patient performs this activity safely.

NOIIELPER

7 Complete Independence-The patient eats fiom a dish while maaaging a variety

and drhls &bm a cup or glass vrith the meal presented in
offood consiste,rcies,
the customary marner on a table or hay. The subject opers containers, butters
bread, cub mea! pours liquitls, and uses a Eoon or fork to bring food to the
moutl, where it is chewetl and swallowed. The patient performs this activity
safeiy.

6 Modified Independence--Porformaace of ttre activity involves safeff

considerations, or the patient requires aa atlaptive or assistive device such as a
long straw, sport or rocking kuife; requires moro than a reasonable time to eaq or
requires modifed food consistency ot blenderized food. Ifthe patient relies on
othff means of aiimxrtatior, such as parenteral or gastostomy feedings, then
(s)he self-administers the feedings.

IMLPER

5 Supervision or Setup-The palent requires supervision (e.g., standing by, oueing,

or coaxin_ g) or setup (applicatioo of orthoses or assistivdadaptive devices), or
anottrer person is requhed to opeur coptainers, butter bread, out meal, orpour
liquids.

,1
Mirjmal Contact Assistance-The patient perforrs 75% or more of eating tasls.

J Moderate Assistance-The patient performs 50% to 74%of ea{nglasks.

2 Maximal Assistance-The patient p tforms 25% to 49% of eating tasks'

1 Total Assistance-The patient performs less that25/;o of eating tasks, or tho

patie,nt rolies on parenteral ot gashostomy feedings (either whoiiy or partially)
and does not self-administer the feedings.

'
0 Activity Occr:r-Enter code 0 only for the admission assessme,lrl. The
Does Not
;iatient does not eat and doestotreoeive aayparenteral/enteral nukition during
the entire assessment time frame. Use ofthis code slrouiil be rase.

l
copyright @200i - 2004 IJB Foltrldetior Activitics, Inc. crBIA, Itro) for coopilation rights; uo copyrighb claioed in u-s.
Govimmeat .wo*s includcd il Section I, portions ofsection Iv, Appeadics I ald I! aad portions ofApPedices B, c, E, G, H and J.
A1l other coDvlidrts a.E reserved to thet rcspective o$,Ders. Coplright @ 1993-2001 IJB Foundation Activities, IDc. fo! th. e IlM Dab
 IRF-PAI Tra i td n g Mamral Effective 04/01/04

EarnEc
Eating includes the use of suitable utensils to bring food to the mouth, chewing and
srallowing, oncethe meal is presented in the customary manner on a table ortay. At
Ievel 7 the patient eats from a dish while managing all consistencies of food, and drinks
from a cup or glass with the meal presented in the o.ritomary nmnner on a table or tray.
The patent uses suitable utensils to bring food to the moiJfll; food is dtaued and
' swallowed. Performs independently and safely. lf activity does not occur, code "0' on
admission and "1' on discharge.

Does SGORE
Patient 7
Does
need an assistive -No--+.
device to eat ordoes s,he lake COMPLEIE
Paiient need help
nDre firafl reasonable tnE to eat iNDEPENDB'ICE
when eating mls or
or is thelB a corlcem lor
administering sddyordoes
ot' ehe rqulE nDdfied food
nutriuon? ong'$!s.rcy ordoes s/he
adnlnlster tube SCORE
feedings
6
-Yes-'
No Helper MODIFIED
INDEPENDENCE
Yes

Helper
Does Patiert
need only
supervision,
Does Patient oirE, @axing orhelp io
perform tra.lfor b SGORE
apply an od.hosls or help + 5
@Iq of eating crdfood, open codajnets,
tasks? pou lt+ids,
orbutet SUPERVISION
bead?
OR SETUP
I
i'lo
t
No Does Patient
Does need ohlv incidental
Patent require tolal help such as placerent
assistEnce to eat such as of utendls in his/iEr
tle helper holdrhg the ubmil and hard or occasioEl hdp
hinging all food and liquids to the to scoop food onto the
rnouth ordoes s/he need tcbl io* orspoon?
assisbnce \aith
tube feedngs?

(ve
No
Yo\No
R- \ SGORE SCORE
'4-
SCORE

MODERAIE MINIMAL CONIACI

TOTAL IIIAXMUM ASSISTANCE ASSISTANCE
ASSISiANCE ASSISTANCE

Coplriglt @2001 - 2004 UB trouidatio! Activities, Iic. (JBIA, Inc.) foi oapilatioo rights; no cop)rights claimed id U.s.
GoaerEleEt \rorla iicluded in Section ! portions ofSection IV, Appendices I and K, and portioEs ofAple0dices B, q B G,H and I i

All otler coplrights are rcseryed to their rEspeclive owllem. Copyright @1993-2001 IJB Foundatioa -Activities, I!c. for the IIM Dah
 RF-PAI Training Marrua| Effective 04/01/04

GROOMING: Grooming includes gral carg hair grooming (combing or brushing hair),
wasbing the hands*, washing the face*, and er shaving the face or applying make-up.
Ifthe subject neithor shaves nor applies make-up, Grooming inciudes ody the first four
tasks. The patient performs tlt
activity safely. This item includes obtaining articles
necessary for grooming.

NO ]IELPER

7 Complete Independence-The pafie,nt cleans teeth or dentures, combs or

brushos hair, washes the hands*, washes the face*, and either shaves the face
or applies make-up, iiroluding ali preparations. The patient performs this
aotivif safely.
i

6 Modif Intlependence-The patient requires specialized equipment

etl i

(including prosthesis or orthosis) to perform grooming activities, or takes

;
more than a reasonable time, oi there are safety considerations. l

i
IIELPER

5 Supenrision or Setup*{he patient requires supervision (e.g., stantling by,

I cueiug or coaring) or setup (application of orthoses or adapted/assistive
devices, setting out grooming equipmen! or initial preparation such as
appiying to-othpaste to toothbrush or opening make-up containers).

4 Minimal Contact Assistance-The patielrt performs 75% or more of grooming

tasls. I

J Moderate Assistance-{he patient performs 50% to 74% of grooming tasks.

) jng tasts.
Maximal Assistanoe--Ihe patient p erfoms 25o/o to 49% of groom
I

I Total Assistance-Ihs patienl perfoms less than 25% of gooming tasls. i

n Activity Does Not Occur--Enter code 0 orly for tho admission assessment'
The patient does not perform any grosmi"g activities (oral carg hair
grooming, washing the hands, washing the face, and eitter shaving the face or
applyag make-up), and is not groomed by a heiper during the entire
assessmont timo frame. Use of this code should be rare.

COMMENT: Assess only tle activities listetl in the defilitisl @166ming does not
i""toa" nooag teeth, shampooing hair, applying deodoran! or shaving legs' If the
(
zubject i! bald or ohooses not to shave or apply make-up, do not assess ttose activities.

+including rinsing and drying.

I

UB Foundation Activities,lEc. (UBFA, Inc) for comPilation ti8hts; no coflAishb

claiEr4lUrS'-
coDvriE[t 02001 - 2004 -- --
G;i:.;;";;; ;;ia"a iri""tiou r, portioos ;fsectioE M Appcfldica' I aod K ind porbbrs ofAppeodicas B' c' B G' H aad J' I

@1993-2001 UB FouldatioD Ac1fuiti9s, I!c' fol tLe EIM Dats I

A I I olher conwiehls alE rcscryed to their resp64ye ownels, cogyright I
 IRF -P,ti Tra ining Ma nual Effective A4/01/04

Gnoonmqc
crooming includes oral care, hair grooming (mmbing and brushing hak), washing the
hands and washing the face, and either sh,ving the face or applying make-up' lf the
patient neither shaves nor applies makeup, Grooming includes orily the nrst four tasks'
At Ievel 7 ihe patient cleans his/her teeth or denturcs, Gombs or brushes his/irer hair,
washes his/her hands and face, and may shave or apply make-uP, including all
preparations. Performs independenfly and safely' If activity does not occur, score '0" on
admission and "1' on discharge.

Does
Does SCORE
Peiieni
Paient
need he,pwhen
brushing teeth, combing
need an assi6h've -
dev.ice for groomlng
-No->
or brushing hair, COMPLETE
(such ai an adapted comb,
washing hands, washJng INDEPENDENCE
or unive6al c1.rff), or does.s/lE take
frce and eiher shaving
mor6 lhan Basonable lime lo
orapplying
groom orls lhere a
make-!p?
concem for saIEty
No
as lhg patent
grcon1s? SCORE

MODIFIED
No Helper INDEPENDENCE
Yes

Helper

Does Palient
need only supeMsion,
DOeS Patent
cuing, coaxing or help to SGORE
perform halt or more
set out gmoming -Yes'> 5
grooming tasks? -Yes-> equipment orhelp to
app)y an ofhosis? SUPERVISION
OR SETUP
I
No
f
\ Does Pallenl need
No

Does Paient require

total asslslance for grooming
I only inddental
help such as placement'of a
washcloth in his/her hand oa
such as ole helper holdng the hlp to perform .iust one of
glDomlng llems and peforning ihe several tasks induded
in grooming?
basically all the aclivilies ?

No Yes
Yes No
r' SCORE SGORE
SGORE SGORE 4
1
:MOEERA+E: .MINMPI.-CONIACT
TOTAL IVAXIMUM ASSISTANCE
ASSISTANCE ASSISTANCE
ASSISIANCE

Cop)'riglt @200 1 - 2004 UB louodatioE_Aclivities, Ir!c. PBF.A, Inc) for coEpilatioo rights; Do copyrights ciaiEed in U'S'
Govbriretrt lro!'lG inclxdd i! Sectio! I, portiors ofSection IV, Appendices I ad I( aod portioo ofApperdics B, C, E, G, H ald J.
Aii other copJn'iglts ue reserved t! dleirJEryectiye ownErs. copyiglt @ 199-2001 IJB louDddio! Activities, ,nc. for t# Ftrl Data
 IRF-PAI Tra ini ng Manua I Effecrire 04/01/04

BATEtfrlG: Bathlzg includes washing, rinsing, and drying the body from the neck down
(excluding the neck and backJ in either a tub, shower, or sponge/bed bath. The patiemt
performs the activity safeiy.

NOI{ELPER

7 Complete Independence-The patient safely bathes (washes, rinses aad dries)

the body.

6 Modifed Independenco-The patient requires specialized equipment

(inoluding prosthesis or orthosis) to bathe, or takes more than a reasonable
amount oftime, or there are safety considerations.

IMLPER

5 Superr.ision or Setup-The pationt requires supeffision (e.g., standing by,

cueing or coaxing) or setrip (appiication of assistive/adaptive deviees, setting
out bathing equipment, or initial preparation such as preparing the water or
wasbing materiais).

4 Mfuimal Contact Assistance-The patient p erforms 75/o or morc of bathing

tasks. I

J Moderate Assistance-The patient p erforms S}Toto 74% ofbathing tasks. I

I
I

2 Maximal Assistance-The patient p erforms 250/o to 49% of bathing tasks. I

1 Total Assistance-The patient performs less fian 25Yo ofbathing tasls. I

I
I

0 Activity Does Not Occur-Enter code 0 only for the admission assessment. i

The patient does not bathe sel{ and is notbathed by a helper. Use ofthis code I
I

should be rare. I

I
I
When scoring this iter, consider the body as divided up into ten areas or parts. Evaluato L

I
how the patie,nt bathes eaoh of the ten areas or parts, with each acoounting for 10% ofthe I

total: I
I

chest buttooks I

i
leftam left upper leg
right arm right upper leg ,

abdome,r ieft lower leg, inclurling foot I

l
perineal area right lower leg, inclutling foot I
i

i
I

Coplriglt 02001 - 2004 UB Foundatior Activities, Iio. (JBF.E, ItrcJ foJ coErpilation dghts; no colydghtsclaimed io U.S.
Govemrieit vorlG ilcluded iD Sectio! I, portiols ofsectioD fV, Appendices I aad K, aad portiols ofAppeudices B, C, E G, H aad I
'I I

AII other cop'rriglts are rcscnred to their respective ovme$- Copy-ight @1993-2001 UB Fo@datiotr Activities, hc- for the FIM Dat! I
 IEF-PA{ Trai ngManual Effecthe A4/01/04

BATm{c
Bathing.includes bathing (washing, rinsing and drying) the body from the neck down
(excluding the back); miybe either tub, shower orspongetled'bath' AtlevelT the
iatient bathes (was'hes, rinses and dries) the body, excludjng the
back' Performs
independenfly and safely.-lf activity does not occur, code "0" on admission and '1' on
discharge.

Does
SCORE
Patient
7.
' Does
need an assistive
device lor bathing
-No-+,
Paient (such as a bah mlt), or does s/he COMPLEIE
need help when take more than rgasonable time to INDEPENDENCE
washing, dnsing or bathe, or is theE a concem ior safetY
drying the body? such asregulating
water temperature
N o------! as he patient
balhes? SCORE
6

MODIFIED
No Helper INDEPENDENCE
Yes

Helper

Does Patient
Does need only supeMsion,
cuing, coaling olhelp to SCORE
Patr'ent periorm -be.llal
llglg ofthe bafiing -Yes-' set out bathing equipment, -Yes+
hsks? p rEpare the water or help
to apply ar orthosis?
SUPERVISION
OR SETUP
I
No
v Does
Patientneed
.No onty incidenbl
help such as placement of
Does Patient require I washcloth in his,her hand a tuw
total assishnce forbathhg
v times as s/he baihes or helP to
slch as the helperholding ttre balhe just one or two areas -
weshdoft and to\trEl and of the body, such as one llmb,
perbrming basically or the feet or
all fie aclivities ? d]e butocks?

l\o No
/vu
:{
\ SCORE
SCORE
SCORE
SCORE 4
1- -. 2---
MAXIMUM MODERATE MINIMAL CONTACT
TOTAL ASSISTANCE
ASSISTANCE ASSISTANCE
ASSISTANCE

Copyignt @200 1 - 2004 IIB Ioundatioa Activities, Iac. (JBFA" Iac) for conpilatiou riglrts; uo copyrigLts olaioed in U.S.
overolnent worh included i! SectioE I, portions of Secton iV, Appaldir:es I ana 6 ana portio* tfhp'peldices B, C, q G, H aod J.
a ll 6rh.r^^nciolt( -e r.qdc,l tn tiFir rcsner.tive nwnen Con! sltO1993-2001UB Foundation Adivities,IEc. foltleFM Dsla
 IP,F-PAJ Tra i ni n g Mo mn I Effecrite A4/01/04
t-
DRESSING - IIPIER BODA:. Dressing - tlpper Body ncfudes dressing and ur:dressing
above the waist, as well as applying and removing a prosthesis or orthosis when
appfioable. The patient performs tlis activify safely.

NOIIEL?ER

7 Complete Independence-The patient tlresses and rmdresses self. This

inoludes obtainipg clothes from their customary places (such as drawers and
closets), and may include managing a bra, pullover garmen! ftont-opening
Earmerr\ zipperg buttors, or snaps, as weli as the appiication and removal ofa
prosthesis or orfhosis (which is not used as an assistive device forupperbody
dls5sing) when applicable. The patient performs this activity safely.

6 Modifieil hdependence-The patient requires speciai adaptive closuro zuch as

a Velcro@ tr'astener, or an assisiive device (inoluding a prosfiesis or orttrosis)
to dross, or takes moro than a teasonablp amount of time.

IIELPER

5 Supervision or Setup--The patient requires superuision (e.g., standing by,

cueing, or coaxing) or setup (application of an upper body or limb
orthosis/prosthesis, application of an assistive/adaptive devicg or setting out
clothes or dressing equipment).

4 Minimal Contact Assistance-The patient performs 75% ormoreof dressing

tasks.

3 Motlerate Assistance-Tho patient performs 50% to 74% of dressing tasls.

a Maximal Assistance--The patient p erforns 25"/o to 49% of dressing tasks.

1 Total Assistance--Thrc patient performs less than 25% of dressing tasks.

0 Activity Does Not Occur-Enter codo 0 ody for the admission assessment'.
The paieart does not dress and ttre heiper does not dress the patient in olothing
that is appropriate to wear in public during the entire assessment time frame'
The subject who wears only a hoqpital gown would.be coded "0 - Activity
Does Not Occur." Putting on and taking off sorubs may be appiopriate for
purposes of assossment. Use ofthis code should be rare.

COMMENT: When absessing dressing and undressing, the subject must use olothing that
ii appropriate to wear in public. If the subject wears only horyital goms or
nighigov&s/pajamas, rat6 this activity as code 0. Starting at the time that the patient is
uailifi"a to tn" m.f and continuing during the admission asgessment time period the
patient
IRF's stafflmust make every atte,mpt to obtain aom any source cl0thing for the
rigbi; tro coMieht tl?*'Sh-U:S'^
CoDvriEht O2OO1 - 2004 UB Ioundation Actidtie.s, hc. (UBtrA, bc.) for compilation -. .-
ili:Hffi;;i;;;];d"d; #d;;ipo;;*orsecioulv,rtppenaces r ard r! ai:dportiors ofAppeodicesB, c,E,GH_audJ
a ]] .rlFr .n.riolrs aJ'e rcserved to theh rcslective o!rEp..s. Copldgnt @1993-2001 lrB Foudatiotr
Activities, Ioc. for fie FM Dala
 IR-F-PAI Tturiil in g Mailu&l Effecrh,e 04/0ilM
t-

For example, if patient is admitted wearing a hoqpital gow:r and wiftouf not
a
possessing, any oiher items of cloihing, ttren the staff of the IRF sfuduld immediately
'
ieque* th-;t the patient,s family or friends bring as soon as pos.sible to the patient clolhing
suitable for the patient to wear which wor:Id cover the patient's upper body and lower_ .
body inclul.ling ioohiear. Onoe clofting during the atlmission assessment time perioil is
available, then-any provious scoring duri:rg tho admission assessment time period should
be updaterl to refleCt the performance ofthis task with elsfhing. The task ofdressing
shorild be scored auring wnat is tle usual time ofthe day that ttre patient is awake and
alert. The result wor:ldbe that tle updated score would be more reflective of the patielth
actual functibnal performance whioh is not the case when a score of "0" is used, beoause
a ,,0,, scoro only indicates that the activity did not ocour dr:ring the admission assessment
time period.

Copl,riBht 02001 - 2004 UB Foundatio! Activities, L!c. C.IBIA; I!c) for cordpilatior rigla; Do coPyriShb claieed in U.S.
GovfiuertwDrk included h section I, poltioEs ofs.ction IV, Appe ices I and K and portions ofApPendices B, c, E G,HandJ.
All otler coDvristrts are rEserved to their resDective orrlers- CoDyristt @19912001 UB Foudation Activitics, IEc. fo. the FIM Data
 IR-F-PAf Tra itt i n g Manaal Efecrtue 04/0i/04

Dnpssnqc- UprpnBonv
Dressing Upper Body includes dressing and undressing above the waist as well as applying
and removing a prosthesis or orthosis when applicable. NoIe: this item may include
assessment of one to several activities, depending on whether the patient chooses to wear
one piece ofclothing (a sweatshirt for example) or several pieces of clothing (a bra, blouse
and sweater). At level 7 the patient dresses and undresses including obtaining clothing from
his/her drawers and closets; manages bra, pullover garmenf applies and removds orthosis
orprosthesiswhen.applicable. Performs independenfly and safely. lf activi{y does not occur,
code "0" on admlssion and "'l'on discharge.
Does
Patient SGORE
need an assislive 7
Does dsvice for upper body -No---t
Patient drelsirE (such as a button hooh COMPLETE
need help when Veldoo or reacher), o/ does s/he INDEPENDENCE
'Iake
dressing abov6 the mor than reasonable lime
waist? as 6/he dresses tlle upper body,
oris lhere a @ncern fot'
safetywhen Vhe dresses
lhe upper body? SCORE
es-+ 6
-No--------+,
MODIFIED
No Helper INDEPENDENCE
Yes
t

Helper

Does Palient
Dges need only $peMslon,
Patient cuing, coaxing o/help {D
pedonn lallprEgle of
SCORE
set out clothing and
the upper body dresslng dressing equlpmenl,o/ help
5
lasks? lo apply an orthosis
or prothesis? SUPERVISION
OR SETUP

No
{ I
Does
Palient need
No
onv lncidenlal
Does Paient help Fuch as help to
reqldE total initiaie dresslng abov8 fie \ ralst
assistance for dressing or asslslanca wilh
abovg the waist such as the bullons. z'ppor8 or
helper holdlng clothlng and snaps only?
performing baslc"lh/
a[ the activiiies ?

No
/yo
Yes No
s SCORE SCORE
SGORE SCORE 4
3
1 2
MODERATE MINIMAL CONTACT
TOTAL MAXIMUM ASSISTANCE
ASSISTANCE
ASSISTANCE ASSISTANCE

Copltight @2001 - 2004UB foundatioa Aqtivities,Iflc (UBFA, Ioc) for coEpilatiotr ricbts; rc copy chts clained ifl U'S'
ror+,. irAuded in Sertion ! pdrtions ofsection IV, Alpe ices I and K, and gortioru ofAppendices
B, C, QG,HaadJ,
Coi'..i"ot
^*,-,i +^ rLEf, r,6p.ri,e "*.^c."*ioat @1993-2001UB FouldatioEActivities, hc. for the FIM Data
 IRF-PAI Tlaining Ma nual Effecttue 04/0i/04
i

DRESSING - LO\4rER BODY: D ressing - Lower Body ttcludes drossing and

rmdressing from the waist dowg as well as applying a:ld re'lnoving a prosthesis or
orthoiis when applicable. The patient performs this activity safely.

NO IIELPER

.1
Complete Indepondenca-TLe patient dresses and rmdresses safely' This
includes obtaining ciothes Aomtheir customary places (such as drawers and
closets), and mayalso include managing underpants, slacks, skirl bolt
stockings, shoes, zippers, buttons, and $aps, as well as the application anil
,"*ouJ of u p.ostheiis or orthosis (which is not used as an assistive device
fo? iowei body dressfug) when apptcable'

6 Modifietl Independence-Ihe patient requires a special adaptive closme such

as a Velcro@ fastener, or an assistive device (including a prosthesis or
ortlosis) to dresS, or takes more th,m- a reasonabie amourt of time'

IIELPER

5 Supervision or Setlp-Thepatieat requires supervision (o.g.,. standing by,

I
cueing, or coaring) or setup (applicatioa of a lower body or Limb
orthosis/prosthesis, application ofan assistive/adaptive device or setting out
clolhes or dressing equipment).

4 IZiilii1a1 Contact Assistancs-Ihe patient perfomes 75% or more of dressing

tasks.

J Moderate Assistance-The patient p erfoms 50Yo to 74% of dressing tasks'

2 Maximal Assistance-The patient perfoms 25%oto 49% of dressing tasks'

1 Totai Assistance-The patient perfoms less than 25% of dressing tasks'

0 Activity Does Not Occur-Bnter code 0 only for the adrnission assessment'
The paient does not dress and the helper does not dress ttre patielrt in clothing
that is appropriate to welr il public dri.ring the entire assessment time ftamo.
For examplq the patient who wears only a hospital gow[ and/or underpatrts
andlor footwear would be coded "0- Activity Does Not Occut''forthis item'
Futting on and taki:rg off scrubs may be appropriate for purposes. of
assessment llse ofthis code shouldbe rara

COMMENT;Whenass essing dressing and u:rdressin& the subject must use olothing tlat
is appropriate to wear in public, Ifthe subject wears ody hospital gowns or
dghtgoms/pajamas, rate this activity as code 0. Starting at the time that the patient is
admitted to the IRF and continuing during the admission assessment time period the

Copyriglf @2001 - 2004 UB Fouodatiou Aclidties, hc. (UBFA, Inc.) for cordPilation righls; no coPydghts clathd h U'S.
Govern1ileot worts included io Sectio! 1, portioEi of Section IV, Appe[dices I aod tr, ad Portions ofAppeldices B, C, E, G, E ad J
l1l .]t a.
^^-;6Ir. 'r.,ac.-,d +^ rhpi'rpmF^r;,p n.ff.^ (-anuio}rr (AI0q1-2n01 IIB Torndab'or Activities- Irc. for tie FIM Dd
 IRF-PAI Tra i n itt g Ma nua I Effecrhte A4/01/04

IRF's staffmust make every attoapt to obtain from any source clothing for the patient.
For example, if apatient is admitted wearing a hoqpital gowa and withou! not
possessing, any otLer items of sl6+hing, then ttre staffof the IRF should inmediately
request that the patienth family or frieards bring as soon as possible to thq patient clothin3
suitable for the patient to wear which would cover the patient's upper body md lower
body inciuding footwear. Once clothing during the arlmission assessme,lrt time period is
available, then any previous scoring during the admission assessment time period should
be updated to reflect the performance ofttris task with olothing. The task ofdressing
should be scored during what is the usual time ofthe day that the patient is awake and
alert. The result would be that the updated score would be more reflective ofthe patient's
actuel fimctional perfomrance whioh is not the case when.a score of "0" is used because
a "0" score ody indicates that tho activity did not occur during the admission assessment
time period..

Copy ight 02001 - 2004 tiB Foudation Activitis, IEc. (tlBIA, IEc) for compilation lighB; no c.opyriglts claiEed in U.S.
Govmment worl(s iacluded i! Section I, portiols ofsectio! Iy, A?petrdics I aod K aad portions ofApPesdics B' q E, G, H ald J.
---^^a.^ ^---* d;-^J,t l 1 rID n^,6;;ri^. A.ridiiF( Tn^ f^rfh.FTMn,t
^rioa.nn
 IRF -PAI Training Manual Efrective A4/01/04

Bnnssnqc-LowrnBonY
Dressinj Lower Body includes dressing and undressing from the waist down as well as applying
and rem"oving a proihesis or orthosis ihen applicable. Note: this item typically includes
"oi
,"iu="r.nt ripying and removing severai pieces of cfothing. At level 7 the palient dresses
and undresses iniluding obtaining clothing from his/her drawers and closets; manages
slacks or s-kirt, socks, shoes;ipplies and removes orthosis br prosthesis when .
underpants,'e"tfo-s
uffl}nt". independenfly ana iafety. t{auivity aoes not occur code '0' on admission
and '1" on discharge.

SCORE
Does
7
Does
Paiient
need an aaslslive
-No--+
Patient devic lorlower body COMPLETE
ne6d helpwhen -}r dressing (such as e raacher), or INDEPENDENCE
dressing from lhe -No does s/ho tak more than reasonable
lime as s/he dresses the Iower body,
or is there a concem for
safely *ten s/he dresses
the lowet body? SGORE
Ye5--+ 6

I\,ODIFIED
No Helper INDEPENDENCE
Yes

Helper

Does Palient
Does need only supervision,
Patient bedorm helfor cuifl g, coaxing o/help {o SCORE
ElEof the lower body _Yes__+ set out dresslng -Yes> 5
dressing fusks? equipment or helP to aPPIY
odhosis 0r
SUPERVISION
OR SETUP

No No
\ Does
Patentneed
only incidental
Does Palient require help such as helPto
assiiiance for dressing initiate dressing fom tie wElst
bebw the waht such as the helper down oa asslstance wih
holding clothlng and 'UJ .ttons, zipPers or
performing besically snaps onlf?
all the activities ?

No
/Y*
Yes No
/ SGORE SCORE
SCORE SCORE 4
1 2
MODERATE MINIMAL CONIACT
TOTAL-' MIfiIMUM _
.ASSISTANCE -ASEfISiCE -
ASSISTANCE ASSISTANCE

Coplriglrt Activities, Inc. (JBFA" Iuo) 6r compilatioo rights; no copltiglts claiEe! ilujs'- ,- .
@2001 - 2004 UB Ioundation
-
Govemlentvorks incrudedioseetioa!portiousoli:fi"^Y:-i.-*,p*?,T,1";,"f,1#::T:tri:*.l3TT;."t;".*H#it
 IR-F-?lf Tr aini ng Manwl Effectitte 04/01/04

TOILETING: Toileting tucludes maintaining perineal hygiene and adjusting clotling

before and after using a toile!. commode, bedpan, or urinal. The patient performs this
activity safely.

NO.IIELPER

7 Complete Independence-The patie,nt safoly cleames.self 211sr v6idirg and

bowel movements, and safely adjusts clothing before and after using toilel
bedpan, commode or urilal.

6 Mo9ifi ed Independence-The patie,nt requires specialized equipment

(including orthosis or prosthesis) duriag toileting or takes more than a
reasonable amount oftime, or thero are safety considerations.

IMLPER

5 Superi,ision or Setup-The pationt requftes superyision (e.g., standing by,

cueing, or coaxing) or setup (applicatior ofadaptive devices or opening
packages).

(
4 Minimal Contact Assistance-The patient perfoims 75% or more of toiletilg
tasks.

3 Moderate Assistance-The patient performs 50% to 74% oftoileting tastrs.

rt"'r+ ' -

2 Maximal Assistance-The patierlt p erforms 25Yo to 49% of toileting tasks.

1 Total AssistancerThe p atient performs less thaa 25% of toileting tasks.

0 Aotivity Does Not Occur-Enter cod6 0 only for the admission assesm.ent
The patient does not performany of +he toileti:rg tasks (perineal cleansing
slqrhing adjus'tnentbefore and after toilet use), and a helper does not perform
any oftheso activities for fle subjeot. Use ofthis cotls should be rare.

' copJdgnt o20ol -2004t,B louDdatior Activities,lnc. (UEFA,Inc) for coDPilatioE righh; Eo coPylichts cl4d{ itr uts.- -, _-
Goven ent yorls iocluded in Section t ponions ofSe-ction IV, Appendices I aad K, a.ndportiors ofAppeodicesB, C, E G, H and J.
*.-Ln -'.{-*:-.-.;a.^:-. --"*;,r+^ i..i.--."rn,a amuiEl.r (al qq?-r il TlB Fomdation Activities- hc. for the Fn,I Dah
^.her
 IR-F-PAl Tr ai ni n g Monua I Efetive 04/01/04
I

Totr-,ETtr,'{G
Toileling includes maintaining perineal hygiene and adjtsting clothing before and after
usinj toltet or beOpan, lf levJl of assistance for care differs between voiding and bowel
mov6ments, record the lower score. At level 7 the patient cleanses self after voiding and
'
bowel movements; adjusts clothing before ind.afier using toilet or bedpan' Performs
independenfly and safely. lf aciivity ooes not occur, code'0' on admission and '1' on
disaharge

Does SCORE
Does Pa!ent 7
Patienl nedsn assis{ive -No---+
need help device br toileling, COMPLEIE
adjusiing clotlring ordoes s/ho take mole INDEPENDENCE
before and afrer th6fl reasonable lime as s'i]e
loilet useand perbnns toileling
cleansing? No-> acliwet, orls there a
coacefl fua safety du.ing
toileiing acil'ltties? SCORE
Yes->
MODIF]ED
No Helper yils
I INDEPENDENCE

Helper

Does Patent
Does need only supeMslon,
Patent pedorn la.lfuI SGORE
cuing, coaxing or help to -Yes.>
ugq ofthe toileting -Yes-+, set out toileting
iasks?
equipment?
SUPERVISION
OR SETUP

No
Does
Patlent need
No
onty hcldental
help sucfi as helP to
Does Palient requlrE
sleady or balancs while she does
total asslstance foaloiletng aciivltles
the cleansing or adjusling fie
such as the helper adJusilng all clothes?
clohing before and after toilel use
aswell as the cleansing?

t\o
Yo\No
{ SGORE SGORE
SCORE SCORE 4
.71- L-
I\,IODERATE MINIMAL CONIACT
TOTAL MAXMUM
ASSISTANCE ASSISTANCE
ASSISTANCE ASSISIANCE

Copyrigit @2001- 2004 UB trouodarion Activities, hc. ([JBFA,Inc) forcimp ation rightu; no coplticq. i1U:S'-
"1*1d --
Govimoeat worlc included iD Sectioo ! portioru ofseltio! IV, Appeldics I aad K, and portiors ofAppendices B, C, X, G,H aDd f,
--
.---* .a-.;chr raloo?-rnn1 IIP F^rhilrti^n Aofiwitics- Iflc. forthe FMnata
 IRF-PAI Trainin g Manual Effective 04/01/04
!
BLAD-DER MANAGEMEIflI - Level of Assistance: -B ladder Management - Leve[ of
Assistance uclades ttre safe use ofequipment or agents for bladder manageolnt fNote: Use
ttrese defilitions to score th'e Frmcfion tftoafi"r, ftrIn Zq refer to the com]:rerf below to score
Item 39G).

NO ]JELPER

7 Corrplete Independence-TLe patient.conEols bladder completd and intentionafly

vithout equi,pment or devices, and is z ever incontinent (to acoidats).

6 Modified Indepeadence-The patient requires a urinal, bedpan, cattreto, bedside

commode, absorbeat pad diaper, urinary collecting device, or uri:rary diversion, or
uses medication for contol. Ifcatheter is used, the patieat clea::s, sterili.ies, and sets
up the equr'pment for irrigation without assistance. If the individual uses a tlevice,
(s)he assembies and applies an extemal catheter with drainage bags or an ileal
appliaace withorit assistance ofaoother persoq the patient also empties, puts oa,
removes, and cleans leg bag, or empties and sleans ileal Eppliairce bag.

EEi.PER

5 Supervision or Setup-The patient requires superrrision (e,g., standing by, cueing or

coaxing) or sehrp (placing or errptying) ofequipment to maintain either a satisfactory
voiding pattem or an ertemal device in the past 3 days.
{

4 Mdmd Contact Assistance-Ihe patieot requires rninimal contact assistance to

maintain an extErnal device, atdperforms 75Yo or more ofbladdel tash
"nanagil0eot
in i-he past 3 days.

.] Moderate Assistalce-The patient requires moderate assistance to maintain.al

external device, and performs 50Yo to 74% ofbTaddr mmagement tastrs in the past 3
days.

Maximai Assistance-?atient perfoims 2549% of bladdet managemefiptasls in ttre

past 3 days,

1 Total Assistance-?atient performs less than 25% of bladder manage,ment taslrs in

the past 3 tlays.

Do not use code "0" for Bladder Management - Level ofAssistaace.

COMMENT: The fimctional goal of bladder malagement is to open the urinary sphincter only
when neerletl and to keep it closeil the rest ofthe time, fhis may require devices, medications
(agents), or assistance for some iadividuals, Ttis item deals with the level of assistance reguired
to eomplete bladder ma:ragement taski. Ifthe sutject does not void (e,g., subject has renal failure
and is o:r hemodialysis or peritoneal dialysis), then code leveI 7 - Complete Independence (see
Appeadix Il Frequently Asked Questions, for oelanation).
A separate lrmcti oaModifrer, Bladder Management-Frequmcy of Accid.enfs (Item 3 0), deals
vri& ttre success of the bladder maragemeDt program.

Item 39G Enter into Item 39G (Bladded the iower score from the two
Functioa Modifiers (Items 29 aud 30).

Copyrigh! @2001 : 2004 I-I8 louaddion Aotivities, Inc. CIBFA, I!c.) for conpilation rights; no copyiSbb clellEd itr U.S.
GovernEert works iDcluded i! section i, FortioDs of section IY, Appendices I and I! atrd portions ofAPpe6dices B, q B q H and J,
A Il ortrer nn-wiolrrt qe eedcd t^ f}teifFsneclive ownen- Corvrieht @ 1993-2001 UB louudatio! Activities, Iao. for the FIM Data
 IRF-PA{ Training Mmnal Effective A4/01/04
I

EI-,AINPN MAXAGEMENT . LPWT, OF ASSISTANCE

and' if
eLaO"t w"nrgur"nt includes complete and intentional conirol of the urinary bladder
n ecessary, usJ of equipment or agents for bladder control. At level
7 the patient controls
are
bladder completely ani intentionatly and is never incontinent. No. equiprnent or agents
required. Bl;dde;Management with two function modifiers, levelof assistance for bladder
management and frequency of accidents. Score the function modifers separately'
Then'
,"*rith" Io*"r. on lie FlM instrumenl Do not use code '0" for Bladder
Management. ".ore
SCORE
7
Does Does
. Paflent Pafient -No--+.
COMPLETE
need help with need an assistive
INDEPENDENCE
bladder device for bladder management
n (such as a cathehr, urinal,
bedpan or absobent Pad), or
does
s,lhe usually use
medicationfoa
er'control?
-No-------i+. -Yes--+ [,4ODIFIED
No Helper
Yes INDEPENDENCE

Helper

Does Patient
Does need only supervision,
Patient pertorm hElf cuing, coaxrng orhelP to SCORE
e5.>
or moreofthe set out bh dder 5
bhdder management -Yes-> management
tasks? equipment? SUPERVISION
ORSEIUP

No No
v Does
Patient need
only incidental
Does Paiient
help such as placement oi
equipment in hls/her hand or
require tohl assisbncefor
help to perForm iust one of the
bladder management with a
several bsks included in
helper doing basically all of the
bladder rnanagement?
handling olequipmenl?

Yes No No Yes

S CORE
/
SGORE
SCORE
r' \
SCORE
1 4

TqIAL::-: MAXIMUM
fE-_ - :EINIMESgFlIfrCT::
ASSISTANCE
-ASSISIANCE ASSISTANCE ASSISTANCE

Copyriglt @2001 - 2004 UB Foundation Activities, Inc- (UBFA, Inc.) fo! caEpilation riShts; no cop,.tights claincd in U-S.
Govea'nocnt work incttded h Section I, portions ofS.ctiooV, AirPetrdices I aad K, ald Po*ions ofAppcodicag B, C, q G,H.nd J.
A ll ,rF *pnpd i^ rtc;. r.6..h'va AMer cmrioht 61041?001TIR Formditinn Acti'rities- Inc. fDrthe FIM Dah
 RF-PAI T?aining Manwl Effeciive 04/0j/04
L

BO\ilEL MANAGEMENT - Level of Assistalce: Bowel Maiagement - Level of

Assistance irLclttdes uso of equipment or agents for bowel management. (Notd usethese
. definitions to score the Function Modifier, Item 3 1; refer to the comment below to score ftem
39r0.

NOIIELPER

7 Complete Indelendeoce--The patient contols bowels. completely and intentionaily

witlout equipment or devjces, anddoes not have any bowel accidents'

6 Modified Independence-The patient requires abedpan, bedside commode, digitai.

stimulatioa or stool softeners, suppositories, laxatives (otter tlan nah:ral laxatives like
prunes), or enemas on a regular basis; altemately, the patient uses other medications
for conkol lfthe individual has a colostomy, (s)he tdiiiiains it.

IIBLPER

5 Supervision or.setup-The patient has required sripervisioa (e.g., standing by,

cueing, or coaxing) or setup of equipment necessary for the individual to maintaia
either a satisfactory excretory pattem or an ostomy device at any time drring the past
3 daYs.

4 Minimal Coatact Assistance-Palient requires minimal contact assistance to mairlnin

- a satisfactory excretory pattem by using suppositories, enemas, or an extemal dovice'
Patient perfonm 75% or more of bowel matragement tasl$ inthe past 3 days'

3 Moderate Assistance-The patient requires moderate assistance to maintain a

satisfactory excretory pattem by using suppositories, enemas, or an extemal device'
Th" patient performs 50 to 74o/o of tasks in the past 3 days'.
.bowelrn^ttagement

2 Maximal Assistalce-Patient performs )J])/g gf $gwg!fianagement task i:r the

past 3 daYs.

1 Totai Assistance-Patie,let performs less than 25% of bowel management tasks in ttre
past 3 days.

Do not use code "0" for Bowel Ma:ragemstrt - Level ofAssistance.

GoMMENT: The frnctional goai of b6v7s[ menagement is to open the anal sphincter onty when
,""d"d-*dto k"rp it closed the rest of the time. This may require devices, medications (agents),
or assistance in some individuais. This item deals with the level ofassistance requiretlto
complete bowel management tests.

A separate Iuncti on Modifier, Bowel Management-Frequency ofaccidenls (Iten 32), deals

with frequency ofbowel accidenb.

Scorine Item 39H Eowei): Enter into Item 39I{ @owel) the lower score tom the two Functioa

Modifteirs {tems 3 1 nd32).

. CoD,isht O2O0l - 2004 Ub Fourdation Activities, hc. CJBIAe IDc) fo! cor1pil':tio. rights; tro copfriehb ctai6ed i! U S'

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's?u n V uoBlpunod 811 t00Z - i00ZO 1q3p,GoC

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-=_:=4JdH:tgo{4t--i,-!itnrttDy}rl= ++ .
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'uaql
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ISNYTSISS'V ito TflAflT - J,NflX i[CYN\rr\i TS LOffi

,0/Ja/ho a.\pagV I ntltlpw 3 ululD.4z IYd-,{aI

 IR.F-PAI Tra ini ng Manua I Effective 04/ail04

TRANSIERS: BED, CEAIR, WHEELCEAIR: Transfers: Bed, Chatr, Weelchair

'
includes all aspects of tansferring ftom a bed to a chair and back, dr ftom a bed to a
wheelchair and back, or coming to a standing position ifwalking is the typical mode of
locomotion. The patient performs the activity safely.

NO IIELPER

7 Compiete Independence:

Ifwatking, patiefr. safely approaches, sits down on a regular chair, and gets up to
I 512ading position from a regular chair. ?atient aiso safely tra:rsfers from bed to
chair-

If in a wheelchair, patient approaches a bed or chair, loctrs brakes, fias foot rests,
removes arm rest ifnecessary, and performs either a standing pivot or sliding
transfer (without a board) ald returns. the padent performs this activity safely.

6 Modifetl Independence-The patient requires an adaptive or assistive device

*.tr us a 5ljding boar4 a lift, grab bars, or a special seat/ohair/brace/crutches;
or the aotivity takes more than a teasonable ao.ount oftime; or there are safetlz
corsiderations. }: this casq aprosthesis or orthosis is considered an assistive
device ifused for the kalsfer.

HELPER

5 Supervision or Setup-The patient requircs $pervision (e.g., stantling by,

cueing or coaxing) or setup (positioning 5fiding board, moving foot rests,
etc;).

4 Mnimal Contact Assistance--The patie,lrt requires no more help than

toucbing and performs 75% or more oftua:rsferring tasls.

J Moderate Assistance-The patient requires more help lhan touching or

-pqrforms 5}to 74% of tansfming tasks.
+asks'
z Maximal Assistance--The patient p erforfrls 25 to 4970 of fuansferring

1 Total Assistance-The patient performs less than 25% of tramferriag tasks'

0 Activity Does Not Occur-Enter code 0 only for the admission assesslent'
The pafuent does not fuansfe,J to or from tte bed or a chair, antl is not
han#rred fo or ftom flre'66tr di h cf,air by a helper or liftfurg devibe' Use of
this code shoultl be rare.

COVIIv{E}l'XrDwing tte bed-to-chaii harsfer, the su6ject begirs and ends in tlie tsupine
ppsl{igl.
Copyrigit 02001 - 2004 UB FoDndatioa Activities,Irc. (UBFA,I!c) for co'mPilati-oo rights; uo copyrighs "1ii'4 '1U-S'-- --
coiimient works includd in Sectioa I, porricios ofSection IV, Appeodices I ard I! and portions ofAppcudices B, C E G,II andJ.
 IRF-PAJ Training Manual Effetive a4/N/A4

TzulqsBnRs: BEn, CHAm., Wmgr,esAm.

Transfers: Bed, Chair, trVheelchair includes all aspecis oftransfening from bed to a
chair, or wheelchair, or coming to a standing position, if walking is the typical mode of
Iocomotion. At level 7 the subject approaches, sits down on and gels up to a standing
'position fiom a regular chair; aansfeE from bed to chair. Performs independenfly and
safely. ltin a wloelchah approaches a bed or chair,locks brakes, lifts foot rests,
-removes arm rests ifnecessary, performs either a standing pivot or sliding transfer
(without a board) and Ietums. Performs independently and safely. If activity does not
occur, code "0" on admlssion and "1" on discharge.

Does SCORE
Palient 7
Does _No need an asslslive -No->
Palient COMPLEIE
device br bed, chair, wheelclEir
need help geting INDEPENDENCE
t'ansfers (such as a sfiding board,
into broutofa grab bar or brace), ordoes s,he lakd
bed, c.Ealr oa
morb ihan re.sr_otiable time or is there
wheelchain
a concem for safev when s.ho
pedorms fansfeE?
SGORE
Yes-+ 6

MODIFIED,
I
No Helper Yes INDEPENDENCE

Helper
Does
Patient Do6s Patint
Derform half or more need onY supervl's'on,
ofthe effodfor bed, cuing, coaxing oa help lo SCORE
chair, wheelchair
-Yes-+,
set oot transfer equipmenl -Yes>
trensfers? orhelp 10 lock brakes end/
or lift foot rests?
SUPERVISION
OR SEIUP

No
No
\ \ Does
Patient need
only lnddenbl
Dos Palient rcquke help such as conlaclguarding
lokl assislance for bed, chair, orsteadying during bed, chair,
hheelc,tlair hansfers such as the vrheelchair transfers?
hdper doing basically all the lifling
oruse of a mechanical 1i11?

No Yes
Yes No / rt
,l \ SCORE SCORE
J 4

1 2 iVODERATE l\,4lNll\rAL CONTACT

.ASSISTANCE
ASSISTANCE
TOIAL MAXMUM
ASSISTANCE Aisl$.IA\rcE-

Copyiglt @2001 - 2004 UB Soundatio! Actilities, IDc. (tiBtrA, Iic.) for coEpilatioD right; tro copydghts clairled i! U.s.
GoverElent worlc ircluded in Section I, portiols ofsctioE IV, Ap!6'dices I and i!
aad portions ofAppendices B, C, X' G, H aad J.
 IRF -P,41 Tra i ni ng Man aa I
Effective 0t,/01/04 I

PRonr-,ru Sor-,ynrc
Ploblem solving Includqs skrs related fo solving probrems ol dairy
safe, and timely deotsions regarding fnancial,
living. This means ma*ng reasonable,
sJiiuf p"oonui"#,*, initl-#ng, _a
seir-corecting lasks and acfvides fo sotvp pro. ,-.
is a problem, makes appropriate decjstons.
"ra
bLr", At Lvut 7 ft;;;j;J Jn.i"ffi
"nj ""ar"nang
r"cogni."" fi tf,"ru
problems untr'the task is comptered,
initates and canies out a sJlr.iJ#.-tup" to
-;.oi"I6iil'ro, *rpfu,
Problem Solving.
and setf-correds tf ;;;r";;""d". "ofr"
"*,uot"ro,

Does
Does SCORE
Pafent ned 7
Pabrent
need exlra fme to m4ke
-No___+
problems,ike CO[,,IPLETE
rnan?ging a checklng decisionq or solve problems,
ac.oufit or codrEnting -No or does s,he haye slight diffiqrlty INDEPENDENCE

p.oblems?
deciding, iniliating orself- --
in unfamiliar situations

SCORE
--->
6

No Helper Yes MorirFrED

INDEPENDENCE

Helper

Does {
Do6s
Patent solye
Patr'ent n eed help to
routine problems
solve rouline problems
appropdatelyXaltq SCORE
--Yes-_rr only rarely or only when
ofthe fime?
under stessful -Yes+ 5
clllditiors (essfian
a% ofth tirne SUPERVIS]ON

No
f No

Does
Patient
Does need help to solve routine
Patient needheh to solve problems efrectively only
problems allthe tjme orJs s/he
occasionally
unable to solve problems? (less than 25% ofthelimeF
I

I No
Yes
i

Yes No d {
I \ SCORE SCORE
4
SCORE SCORE
I
1 2 MODERATE MINIMAL
DiRECTION DIRECTION
IOTAL M/XlMUilrl
ASSISTANCE DIRECTION

copydght @200i - 2004 uB lourdatiotr Actil'r'ties,Ioc. ([DFA,

hc] for camp aioa right; ao opyi:'gbb ciaitred i, u.s.
.Ol"^TT:y.1Ttr*ed
in Sectioo.t portioos of SectionW, AppcaOices I*an *Ipo'*i"* ofappeDdices B, C, E, c, H End J.
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 IRF-PAI Trainin g Mr*ma I Effective M/01/04

Socrar,ImrgnacrroN
social interaction includes skills related to getting along and participating with others.ii'
therapeutic and social situations. lt represents how ond deals with bne's-.own needs together:with
the needs of otherc. At level 7 the subject interacts apprbpriately with staff, other patieits, and
family mernbers (e.g., controls temper, accepts criticish, is awai'e that words and actions'have an
' impact on others.) subject does not requhe medication for control. Gode "0"
is not available for
Social lnteraction,

Does _No___+ SCORE

Does Palient need e\l,?
Patient need help fme in social siluaiions, o/"
io interEct wiih does s/he inlerac-t appropdately COMPLETE
otfiers in social and with staE otherpaiienls INDEPENDENCE
therdpeulic and fumily membec only in
situations? sklcfured br modiiied envircnmenfs
ordoes s/he equke
medLadon for-
sochl intredion? SCORE
Yes-> 6

MODIFiED
No Heloer Yes
INDEPENDENCE

I I
V
Helper

Does Does
Palient interact Palient rieed help
appropriately to interact appropriately
halformore of lhe only rarely or only\afien SCORE
lime? -Yes_-t under unfEmiliar or -Yes+ 5
stressful conditons
(less than 10% of
SUPERVISION
fhe drDe)?

No
* No
\ Does
Patient
Does need help to lrteract
Patient interact apprcpdately w'h ohers
approprlately less than 25% of only occasionally
the {irne despite any 0ess dran25% oflhe time)?
assistance?

I No
Yes
Yes No {
I \ SGORE SCORE
4
SCORE SCORE
1 I'ODEFATE MINIMAL
: -
TO.IAL I\,4AX[.,tUr\,4
A$SISTANCE DIRECIION --._E{REeT{OiF-:----DIREi1eN-:

Copyright @2001 - 2004 UB Fouodafibr Activities, IDc. (UBFA, Irc) for compilarioD n'gtrts; !o coplrights claincd iB U.S.
 Effeerive 04/01/04
IRF-PAI Tra ining Ma nzml

soCIALINTERACT|I)N:SociallnteractionilcbldgsskijlsrelatetltogettingaJolg
It represexfs how one
and soci'hituations'
;#rtd*rG*itn otlo' io tntt'pt'tio
;H;{h;;t;;" wt 4eeds together with rceds of othem''
the

NOHEI}ER
with staff, other
7 cnmni ete IndeDendence-Tho pationt interacts appropriately
;r'#;;;-#rlffi;;t"' ti'e', *"r"ls
temper' accepts criticism' is
I#it., *"ra" -a u"tioo. i-pact on others), and does not require
m#L
medioation for confuol. .

appropriately with stafl other

6 Modified Intlependence--{he patient interacts loses
in mott situatiors' and only ocoasionally
,r[r"TiJ, *Jt;Jrm"mtn, byt m'y ttl111 u
control. The patient aoes not reiuir" superyisigu 1,ol^" 'h*
,"*"rrtf" u-"*t of time to ailjust to social situatiols' or may requfe
medication for contoi. :

]IELPER
(e' g'' monitoring' verbal
5 Supervision-{he patient requires supervision
oi *f'-iU* conditions' but
confol, cueing, or coaong) oory uodtr tt""snti to idt'ate
i*. tdr-io'Z "rm tm". rte putient may require encouragement
participatioa

appropriately 75 to 90% of ttre time'

4 Minimal Direction-The patimt interacts

3. Direction--Ihe patient interacts appropriately

50to74%ofhe
Motlerate
time.

appropriately 25 to 4|% ofthe

2 Maximal Direction-The patie'nt i:rteraots
;;, d; *"y need restraiit due to socially inappropriate behaviors'
less ttran 25Yo oflhe
tL Total Assistance-'The patient interacts appropriately
due to socially inappropriate
tiIr,",' o, oot at aU alld;ay neetl restuaint
behaYiors.

Do not uso codo "0" for Social lnteraction

include temper hntums; '
COMMENI: Examples ofsocialiy inappropriate behaviors physical attack; or very
loil f-oo1* utoriv" 1*goug"; "*".rri* hgniog o. crying;
vrithdrawa or non-interactive behavior'

copyrieht @2001 - 2004 uB Fouadation Activities'I"' qIB$' Il'c.) {T T-T-'Sy:*:li:""::I1{1,]:,:]-'*1.%Yib. , *u ,

 IRF-PAI Trai n ing Ma nu al
Effective 04/01/04
t

E:cngssrorc
Expression includes clear vocal or nonvocal expression of
lan guage. This item includes
either intelligible speech or clear expression of lan guage using writing
or a
communication dev ice. At leyel 7 the subject expresses complex
or abstract ideas
clearlyand fluenfly. Evaluate and indicate the more usual mode of eipression (Vocal"
or "Nonvocal'). lfboth are used abgut equally, code "Both". Code "0"
is not available
for Expression

Does SCORE
Does Pabent need exha 7
t-me, require an assist\e -No_-->
exprsshg cornplex and device (such as an augmentalive COMPLETE
abshaciideas,such as
-No_______> communication system) o/ INDEPENDENCE
bmily matlels, curEnt does s/he have mild difficulty
expresslng complex snd abshact
idas (rocludlng mild dysarthda
ormild word -
fnding prDblems)? SCORE
Yes-> 6

MODIFIED
No Helper
Yes INDEPENDENCE

J
Helper

D6es I

basb neds ofldeas

Does
(sud] as hullgr, dri's{ or Patient need help io
dBconfod) halfor _Yes-_t express basic needs
Yes+ SCORE
only rarely
Ure lime? (less than 10% ofthe
lime)?
STANDBY
PROMPTING
No
I No

Does
Patient
need help to express basic
Is the Patienl
basically uneble tD express or does
needs and ideas only
sfie express Lqapprcpria let or. occasionally
Inconslsteniiy despite prompting? (less than 25% oftietime)?

I No
Yes
Yes No / {
I \ SCORE SCORE
4
SCORE SGORE
1 2 MODERATE MINIMAL
PROMPTING PROMPTING
TOTAL MAXMUM
ASSISTANCE PROI\,,IPTING

@2001 - 2004 uB Fouadarion Activities, Inc- (JBFA, h;J for'crepilation

9opydgnt dghi; no copyrightu claimed in'C_E,
U.s.
Covem,e,t r,/orks i.cl,ded in Section.I, portions ofS ectiou W, ,Appeadcer
il"a n--t. l"rti"i,, i,ili,p*A"". S, e E *a :
AI Olher anMohta . rE
 Effecrive 04/01/04
IRF-PAI Tra in in g Ma nual
I

or nonvocal expression of
la:rguage-
clear vocal '
E)ORESSION: Erpression irclttdes of language using vntng
rhis item includes ,ith* *t'ilici;;*;"; :i"r'f :T-1T^Y of oxpression
a"oit"' s'ffoui"'and indicate tle more usual mode
oi a communioatioo
*" *1d about equallv' code'tsott"'
['f"rfld:\r;;#r. ru'tl
NOffiLPER
ideas
patient exprt.xses complex or abstract
7 Compieto lrdqpendence-The
Jr.Iiv n iruv (not necessarily in English)'
^a
6 Modifiedlntlepentlence-Inmostsituations,thepatientexpressescomplexor
lr JE rnd AfgcultY' the Patient does
abstract ideas taTatively olearty "Jy
tut 1'1t' mavrequire an ausmentauve
ffiffi;;;;iltiog,or sYstem'
commudcation device

I#LPER
ideas morc
Prompting-Tho patient express es.basic daily needs^and
5 Standby
time. nuq,*".
("'g', t"qu*t repetitior) less thau
iffitiog
than 90% of the
1 O% of the. timu to
be understood'
{

ideas 'l 5 to
exprosses basic d'aily needs and
4 Minimal Prompting-The patient
90% of the time.

patient expresses basic dailY needs

aid ideas 50 ta
-] Motlorato ho4 pting-The
74%of+helimo.
and ideas 25 to
e4presses basic daily needs
2 Maximal Prompting-The patient antl (s)he
oniy- sirgt" w*a" or geshres,
49% of the tiis. The patient usl"s
p-*pmg uoro than half the time'
o".at
and ideas less than'
expresses basic daily needs
Total Assistance-Tho patient
1
t*i"aipropriately or consistently
25%of the fime,o, aoo oo, urfirlr. """a"
desPite PromPting'

Do not use coale "0" for E4pression'

jrclude fbut are n ot limited to)
or absfiact ideas
COMMEITI'I: Exanlolesof complex others' Exoressionof basic needs
discussirq current J""r?o"'Jt'pt-*'a
"u"oo,"ur{ii neceisarv daily activities
and ideas rcferst" th' p'd"ot"';tii;;'"-J"t-'i'i"*" 'tout
and slep @hysiologicai neods)'
such as nutition, f
ia",
'fi'it'i"*"iygiene'

lay"ert@2001..20041*I"t""*L*"T,jll;*l;ffi'#ffir#":T*x'fl_;fffiHTfr*JlHg,'",'f",r*,
 I?,F-Pli Tra ini ng Mawal Effeotue A4/01/04 i

Conmnenmwsrorv
Comprehension includes understanding ofeither auditory orvisual communi,cation (e.9.,
writing, sign language, gestures). At level 7 the subjeci understands dkections and
conversation that are complex or absfact; understands eiiher spoken or written language, not
necessarily English. Evaluate and indicate the more usual mode of comprehension ('Auditory''
or "Visual"). lf both are used about equally, code "Both." Do not use Code '0'for
Comprehension.

_No,__+, SGORE
Does futient
Doas need exka tlme,
7
Palient need help N o-------!
require an assistive device
to undelsland comple( (such as glasses for visual COMPLETE
and abst?ct ideas, such INDEPENDENCE
comprehension or a
as fanrily maitels, cunnt
e!nls or housefrold hearing aid for auditory
comprehension) or
does s/he have mild
difficulty undeFtandind
complex and absirQt SGORE
infonnalion?
es--->

MODIFIED
No Helpdi Yes INDEPENDENCE

I
Y
Helper
Ooes
Pdient
- Does
queslions or6Hements Habent need nelp to
about basic daily needs ...-Yes* hdersfund dlrcclions and
SCORE
(such as hungeror conversalion ab;ui basic Yest
daily needs only Brely
lssof lhe (ess lhan l0% ofthe
lime?
tme)? SIANDBY
PROMPTlNG

No
No
\
Does
Patient
need help to undersbnd
Is the Paiient
baslcailli unable to understand or dhectbns and conveEalion about
baslc daily needs only
does s/he Espond inappropdately
or ioconsislentiy despiie
occasionally (le'ss than 25%
prcmptins? ofihe fme)?

No
Yes
Yes No { {
I \ SGORE SGORE
4
SCORE I;coR;l
'--"2 l,toDEffirr"-' ='MIN
.
PROMPTING PROMPTING
TOTAL MAXMUM
ASSISTANCE PROMPTING

CopFiglt@2001 - 20041lB Fouadation Acti'yities, [lc. (tlBtrA, hc) for colliilation righis; no coB,iights clairEed in U,S.
Govemment worl(s included in Sectioa T, portioas ofSectipo M Appedices I and K, a.nd portions ofAppeildices B, C, E, G, H ard J,
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.req1o !p pnsp. ro Suueeq z e.rmbe.r tlzu eq(s) q8noql qduord er.mbe:1ou seop
1"r1qii ,qL '"olr*ralaoo p1111 suoura;np
pn4sqo n
taldwo illpcgJlp pJm '{uo
q1pa. :o dlpzsr spuep.rei un psqzd eq1 'suotr?rqrs +soTtr Trl--sirepuedepq pegpol'1 9
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a.qvaffi p*uoyy 1u.tuuttl IYd-M

t70/10/?A
 IRF-PAJ Tr a in i t g t14a nu a I Effe*tue04/01/04

tr-ocouorrox: STAIRS
Stairs includes gohg up and down 12 to 14 stairs (one flight). At level 7 the patient goes up and down one fiight-
ofstairs without any type of handrall or support Perlorms independently and safely. lf activl'ty does not occui code
"0" on admissior aod"1" on dischaee,

Does
SCORE
patient
7
' Does _No require an assisttve
-No---+-
paientBeed help device (sllch as handrails
COMPLETE
io go up and down or cane)to go up and
INDEPENDENCE
l21o 14 stairs? down one flight of slairs
ordoes s,fie dake mole than
rcasonable llme or
Does
pa{jentgo u! and
is therc a
t-.
LYES+ doltn et least 4 to 6 concem for safety?
Yes---'
SCORE
stats without help 6
(wlthorwithouta
device)? MODIFIED
No Helper SCORE
INDEPENDENCE
es> 5
Exception (Household Ambulafi on)
(
No

Helper

Does
Does patient
Paiient go uP and
down a minimum of need only supervislon,
Yes-> SCORE
l2 to 14 siairs with cuing or coaxing help to Yes+
of
e assislance go a minimum of 12to
oneheheP 'I4 staks?
SUPERVISION

No
i No
Does
patientneed
Does only incldental
pafleot go up and dolrn help such as
less than 4 to 6 stairs cortact guarding or steadyi[g
oris the asslltance to go up ahd down 12to 14
of two persons required stairs?
{or shirs?

No
Yes
Yes No /
I \ SCORE SGORE
4
SGORE SCORE
.4-- :-- - MOEERA+F-.-- - --MIN \rUit4 -
ASSISTANCE ASSISTANCE
TOTAL MAXIMUM
ASSISTANCE ASSISTANCE

Copltiglt @2001 ' 2004liB Iouadation Actirties, Inc. (tlBFle Inc.) for compiiation riglis; !o copyrights claimed h U-S.
Goverament 'lvorlc included in Section I, portions ofSectiol IV, Appendices I aiid K, and
lortioEs ofAppendices B, q E, G, H and J.
A11 other copyriglis are resewed to their respeciive oirse$. CopJrigtt @ i993-2001 IIB tr'ouedation Activitiei, hc. for tbe FIM Data
 IRF-PA] Traint ng Manual Effectitte A4/01/04

LOCOMOTION:STAIRS:Zocomotton:StairsbrclutlesgoingupanddownL2toi4
stairs (one flight) fudoors in a safe mamer.

NO IIELPER
at least oae
7 Complete Indopendence-Ihe patient safely goes up-and down
flighi ofstairs without depending on any type ofhanilrail or support'

6 Moditretl lndependence-The patient goes up and dow:r at least one fliglt of

or the
stairs but requires a side support, handrail, ca:re, or portable supports;
activity takes more thaa a reaso.nable apount of time; or tlere are safety
considerations.

5 Exception (IIousehold Ambulation)-The patient goes up and down 4 to 6

stabi independently,with or vithout a device. The aotivity takes mote
than a
reasonabli amount oftime, or ttere are safety consirlerations'

}IEI.PER

( 5 Superrrision-The patient requires supervision (e.g., standing by, cuei:rg br

coaxir:g) to go up and dow:r one fligtLt ofstairs-

A Minimal contact Assistance-The patient performs 75% or more of ihe effort

to go up and down one flight ofstairs.

.] Moderate Assista:rco-The patient perfo rns 50 to 74Y' ofthe effort to go up

and down one flight ofstairs.

2 Maximal Assistanoe---Tt pationt porforss 25 to 49% of the effort to go up

e

antl down 4 to 6 stairs, and requires tle assistanco of one person ody'

1 Total Assistance-The patient performs Tess thanZ1Yo of the efforl or

stairs'
requires the assistance of two people, or goos up ani down fewer thaa 4

0 Aotivity Does Not Occur-Enter code 0 only for the admission assessment'
The subj'ect does not go up or down stairs, and a helper does not carry the

subject up or down stairs.

(.

no copltights claimed h U.S.

CoD!..isht @2001 - 2004 UB loundation Activities, I!c, (UBIA,IDc) for compilation rights; -- --
aad porrions of Appendices B, g E, G, H ald J
;;flJffi;;rl" ;;i;d.d ir-i""tt* i, p"a*, dr s
""ioo
Iv, App"rdices r *d K
om ,n^r rTEr^nnd,+i^E l.Ivities Tnc. fortheFIM Data
 IRF-FAI Traini n g Manual Effecttue A4/01/04
1_
Lo conaorroN: WmELCHATR

Score both function modiflers on

Indicate
the

SCORE
6
Does Patiflt No
need help to go MODIFIED
150 feet (50 m) In INDEPENDENCE
a wheelchair?

Does
Ly".+ Patient go
al leastS0teet
m) wit'rout

No Helper
Yes> 5
(Exceplion) Household Locomotjon

Helper
I
Does .Does Padent
Paiieot go a
need only supervision,
minimum of
cuing orcoaxjng to go a SGORE
1 50 feet (50 m) in a

laheelcielr wi$ the -Yes-->

minimum of 150 feet -Yes+
ofonlyon (50 m)whileln a
helpeP wheelchair? SUPERVISION

No No
Y
\ Does
Does Patient need
Paiientvheel only incidental
less than 50 feet(17 m) .heh such as arcund comers
oils the assishnce oroverthresholds?
oftwo per$ons
rEquired?

No
Yes
No / .l

I \ SGORE SGORE
4
SCORE SGORE
1. MODERATE MINIMAL COIIIACT
ASSISIANCE ASSISTANCE
TOTAL MAX]MUM
ASSISIANCE ASSISTANCE

eopi;rigii @200i - 2004 UB ForEdatioE Activities, hc. (UBFA, hc,) fo! compilation rights; no copyrighb claiilcd ir U.s,
Goyemment work included h S ectioa I portiors ofse.tidtr IV, AppeDdices I ard Iq rld portions ofAppedices B, C, B, G E od J.
A ll othe! co$dglts ar_6 ,eserved to thei rcspectiw,owlers. Copyrighl @ 1993-2001
l"-*d:t'T +:dld:tl
-lrts 11 I.t {: P{ ?11"
 -" Effecthte A4/01/04
IRF-PN Trairing Manaal
t

LOCOVIOTION: Y/EEELCHAIR: Locomotion: Wheelchatr imc\tdes using a

stleelchair on a levei surfaoe once in a seated position. The patient performs the activity
safely. This is the second fmction.modffior.

NO }IELPER

7 fhis score is uot to be used ifthe patient uses a wheelchair for Locomotioe

6 Modifietl Independenco-Ihe patient operates a manual or motorizetl wheelchair

independentlyior a -inim,lrn of 150 feet (50 meters); tums around; maneuvers ttre
chaii to a table, be( toilet; negotiates at least a 3 percent grade; antl mmeuvers on
rugs antl over door sills.

5 Exception (Ilousehoid Locomotion)-{he patient operates aoanual ormotorized

wheil",har'ind"p"ndenfly oI,Ty shorl distances (a minimum of 50 feet or 15 meters).

IIELPER
go
5 Supervision--The patieot requires sta:rdby supervision, cueing or coaxing to a

minimrrrn of 150 feet (50 meters) in a iuheelchiir.

(
4 Minimal Coatact Assistance-The patient performs 75% or moro of locomotion
effort to go a minimrrm of 150 feet (50 meters).

Moderate lGsistance-The patient performs 50 to 74% otlocomotion effort to

go a

minimnm of 150_feet (50 meters).

2 Maximal Assistauce-The patient performs 25 to 49% of iocomotibn effort to

persoo
go a
only'
.rninimr:mof50 feet (15 meters), and requires the assistance of one

1 Total Assistance--Ihe patient perforos less than 25Yo of effort, orrcqutes the
assistance oftwo people, or wheels less than 50 feet (15 meters)'

0 Activity Does Not occul-.Enter code 0 only for the admission assessment. The
patient does not rise a wheelchair, and is not pushed in a wheelchair by a helper"

COMMENI: Ihere aro two Locomotion fimction modifiers (Items 37 a:rd 38)' Soore
both fro.ti* *odifiers on admission and disoharge.. on the HIMM instumenl the mode
of locomotion (walk or wteelchafu) must be the same on admission aad disoharge. If the
patient changes the mode of locomotion between admission aad discharge (usually
wheelchair to walking), recoral the admission mode and scores based onthe more
Indicale the more
frequent mode .of locrlmotion at discharge orthe6frupr fustrume,rrtl
frefiuent mode of locomotion (Waik or Wheelchair). If both are used about equally, code
,tsoth- ffboth are used aboui equally at discharge, use the score for Walk (Item 37) to
complete both the admission anil discharge portio:rs of Item 39L.

copydglto200l-2004UBlorrudationActivities,hc.(JBIAI!c)fo!compil+:nrisbt;trocqylishbclaiEgdinu]s.--
c"il'fi.ri""it"ir,"rrde.ditr sectio"r,podions ofse*iooIV,Appeadices.I*l,t3jL:T:f,_"1i3.rfl,1T",:;""**#trit
 RF-?AI Tratiing l,{anual Effectite 04/01/04

LocomorroN: WAIK
Score both function

instrument.
equally, code'Both,"

Does SGORE
Palient 7
Does Patient need an assistr'te -No-',
COMPLETE
need help lowalk device (such as an orthosis,
INDEPENDENCE
150 feet (50 m)? prcsihesis,
-No-', crutches, or walker) to g o 1 50 feet
. (50m), ordoes
Does s/he take more than
Patient go
reasonable time oris SGORE
(15 rn) luthout help there a concem Yes--j.
(with orwiLhout a for safeEn
devic)? MODIFIED
No Helper
INDEPENDENCE
Yes,. SCORE
5
No (Eyceplion) Household Ambulation

(
Helper

Does
Patient walk a Does Pafient
minimum oi need only supervision,
150 feet (50 m) with Yes+ SGORE
cuing or maxjng to walk
the assislance oi only -Yes--+. 5
a mrntmum oI 1cu leet
one helper?
(50 m)?
SUPERVISION

No No
I \ Does
Palient need
Does onlylncidenhl
PEtientwalk help such as contact guarding
Iess than 50 feet(15 m) or steadying to walk 1 50 feet
oris the assistance. (50 m)?
of two persons
required ior
ambulation?
No
Yes

No
/
Yes
f \ SCORE SGqRE
4
SGORE SCORE
1 2 MODERATE MINIMAL CON'TACT
ASSISTANCE ASSISTANCE
,rcr4.l!4xlli,'ql!.
Assrs-rA-[cE:--.--=---ssilstA-It- 1

Coplr:iglt @200 1 - 2004 llB Foundatr'on Actilities, Inc. (tEFA, hc).for compilafion righis; no coppights claimed in U S,
Gove@&eit wo (s included in Section I, portions ofsectioE fV, AppeDdices I aad K, and pofiions ofAppetrdices B, qE G,H and J.
a1l
^1L-..^-.;-,r. ".. -..-,.,r r^ +r.i..."-*ii-" ^.h... a^nvri'dfir adl qq1-?001 lTB ldrnditio Activitias.Inc. for theFndDah
 IW-PA{ Training Mam.ml Effeotve A4/01/04

LOCOMOTION ALK: Locomofion; ffalfu in,clodes walking on a leve1 surface once in a

:W
standing positioa. The patient performs the activity safely. This is the first oftwo locomotio:l
fimction rnodiflers.

NOI{EIPER

7 Complete Independence-The patient walks a minimrrm of 150 feet (50 meters)

without assistive devices. The patient performis the activity safely.

6 Modified Indepeldence-Thti patieut walks a rn'inimrrm of 150 feet (50 meters), but
uses a brace (orthosis) or prosthesis on 1eg, special adaptive shoes, caae, crutches, or
walkerette; or takes mote than a reasonable amount of time to corylete the activity;
or there are safelr considratiors.

5 Exception (IIousehold Locomotion)-The patient nalts or:ly short ilistances (a

minimum of50 feel or 15 meterO in dependently with ot without a device. The
activilt takes more than a reasonable amount of time, or there are safety
considerations.

IIELPER

5 Supewision--The patieat requircs staEdby supervision, susing, or coaxing to go a

minimrrtn of 150 feet (50 meters).

4 Minimal Contact Assistance-The patieot performs 75% or more of walking effort to

go a minimum of 150 feet Q0 meters)

3 Moderate Assistance-The patimt perfonns 50 to 74% of w2'lktug effort to go a

minimrrm of 150 feet (50 meters).

2 Maximal Assistance-The patielrt performs 25 to 49/o of walkin9 effort to go a

minimrrm of 50 feet (15 meters), and requires the assistance of one person only'

i Total Assistance-The.patientperforms less than 25Yo of effort, onequhes the

assista:rce oftwo people, or walks to iess than 50 feet (15 meters).

0 Activity Does Not Occru-Enter code 0 only for tle adurissiou assessment. The
patient does not walk For example, use 0 ifthe patient uses only a wheelchair for
locomotion or ttre patient is on bed rest.

COMMENT: If tle patient tequires an assistivb device for locomotion (prosthesis, walker, cane,
AFO, adapted shoe, etc.), then tle Locomotion: Walk score can never be higher than level 6.

There are two locomotion fi:aotion modifi.ors, Score both fimctioo mldifiers on admission mtl
discharge. On the FIMBa inshumenl item 39! the mode of iocomotion (Walk or Wheelchair)
must be the same on ad:rrissio:r and disctrarge. If the patient changes the mode ofiocomotion
between admission and disclarge (usoally wheelchair to wa]'lcing), recortl the admission mode
a::d scores based onthe more frequent mode oflocomofion at discharge or:'theFIN[M
irskumelt.l Indicate the most ftequerf mode of locomotion (Wa1k or Wheelclair). If both are
used about equally, code 'tsotl,"

Cop,.right @2001 - 2004 fD lomdation Activities, hc. (LBIA,Iao) for conpilatioo rights: no coPyli8hB claimed iE U.S. --
Go*mment works included io Sectioa I, portiotrs of5eqtio! If,APpe ice3IandI( and portions ofAppe'dices B, C, E G,H ?rd J'
---.-,i +a.r.-:- 6..a,ir6 --hiF r,ffiFi;tf 6loo?-rnoi TTR Fnn.,l^ti.n A.Jiwities Tnc- for tie FM Dala
 IRF-PAJ Trainin g Manual Effioive 04/01/04

TRANSFERS: SHowER
Transfers; Shower includes getting into and out of a shower btall. At level 7 the subject
approaches, gets in and out ofa showerstall. Performs independently and safely, Ifina
wheelchair, approaches shower, Iocks brakes, lifts foot rests, removes arm rests ifnecessary,
performs either a standing pivot or sliding transfer (wlthout a board) and retums. Performs
independbntly and safely. Do not use code "0" for Transfers: Shower. COMMENT: There is a
separate function modifier that addresses transfers into a fub. Score the functioi modifiers
separately. lfthe patient uses only one mode, record this score on the FlMry instrument lfthe
patient transfers into the fub and shower, record the score for the more frequent tlpe of hansfer.

Does
Patient SCORE
Does need an assist'\
> 7
Patient device for showertransieE
need help (such as e grab bar or COMPTEIE
geting into and speclal seat), ordoes she take INDEPENDENCE
outofthe more lhan rasonalle tlme
oris iieP a concem
shower?
for safelywhen s/he
perfoams transFeE?

SCORE
6
-Yes--+.
MODIFIED
No Helper INDEPENDENCE
Yes

Helper

Daes Patlent
Does need only supervision,
P6lient perform cuing, coaxing or help to SGORE
jdfprllgE of the
_Yes__+ Yes+
set out transfer equipmeol, 5
transferin0 tasks? or help lo lock brakes and/
or Im foot rests?
SUPERVISION OR
SETUP
No
+ No
\ Does
Palienl need
only inddental
Does Pa{ent lequite help such as contact guading or
totel assistanca for shower steadyjng during shower transFers
hansfeE such as the helper dolng or help to lift one leg into the
basically all ths lifting?

/
No
Yes
Yes No / {
I \ SGORE SCORE
4
S6ORE SddRE
1 2 MODERATE MINII\,IAL CONIACT
ASSISTANCE ASSISTANCE
TOTAL MAxMUI!,I \
ASSISTANCE ASSISTANCE

Coryriglt @2001 - 2004 UB Fouadalion Activities, Inc. (tlBFA, Inc) for conpilati6n rights; no cogrights claiaed iE U.S.
Gorernr:leEt worlc included in Section I, portioDs ofSectioa IY, Appeadices I and K, and portiols ofAppcndices B, C, E, G, E,nd J-
 IR-F-PAI Training Manual Ef,ecrive 04/01/04
I

TRANSFERS: SHOWER: Transfers: Shoiuer includes gettfug into and out of a shower. The
patient perlorms the activity safety. (Note: use these definitions to score the Frmction Moilifier,
Item 34; iefer to the cqmmld belo'q/ to score Item 39K).

NO IIELPER

7 Coiplete Independence

Ifwalking,thepztte.tt approaches a shower stall, and gets into and out ofit' The
patient performs the activity safely'

If in a wheelchair, the patieat aplnoaches a shower sta[ locks brakrcs, iifts foot
rests, removes arm rests ifneceiiary, aail d6s5 sithsl a sfetrdjig pivot or siiding
transier (without a board) and retums. The patient performs the activity safely'

6 Modified Independence-The patient requires an adaptive or assistive dwice

(inclurling a piosthesis or orrhosis) sustr 35 n 5liding board, a lift, grab bars, or qpecial
seaq or takes more than a reaso::able amouat of time to complete the activity; or there
are safety considerations.

}IELPER

5 Supervision or Setup-The patient requires supervision (e,g., standing by, cueing' or

coaxing) or setup (pssitieniig sliding board moving foot rests, etc').

4 Minimal Contaot Assistance-The patient requires lo more help than touching and
peforuts 75't/o or more of Fansfrring tash.

3 Moderate Assistance-The patient requires aore help than touching or performs 50

to 74% of tasferring tasks.

2 Maximal Assistance-The patient requires more help than tour-'hirrg or performs 25 to

49% of transfering tasb.

1 Totai Assistance--The patient performs less than 25% oftralsio'i'g t"t"'

Ifthe patient does NoT transfer into and out ofa tr,rb oR showet code Tub Transfer (Item 33) as
-0,,, anti leave Shower Transfer (Item 34) blanlr. Do not use code "0" for showel Transfer. '

GoMMENT: There is a separate Function Morlifier that addresses tansfrs into a tub. code
orty ilrU(tt * Ss) or Showir Transfers (Item 34) tutnot botb- ThaI is, if a score is recorded in
Item 34, liave ltem 33 bla::k Ifthe patient transfers into a tub and shower, record the score for
the more fiequent type of tansfer.

The score for Item 39K should rratch the score for either Item 33 or 34 (i.e., vrhichever type
of
traosfer was. performeii).

Copyright @2001 - 20M UB FoEddios Acti'ritis,lnc. (UBFA, IDc') for codpilatioE righb; Eo copyrithts claiEed in U'S'-
-- . -
c"iL?*t*,.r"mr,aaios""tioor,pdrylryl"J:._1ry.*1m",fi1,1#1"*f:"T"{_,qj-Tjf":;:,,*Si^13'#
 IRF -PA) Trainin g Manaal Effeetive 04/01/04

TRANSFERS: TI]B
Transfers:Tubincludesgettingintoandoutofatub.AtlevelTthesubjectapproaches'getsin
and out ofa tub. Performis ind6pendently and safely' tf in awheelchair, approaches fub or .-
shower, locks brakes, lifts foot iests, removes arm iests if necessary performs eithei a standing
pivot oisliding transfer (without a board) and retums. Performs independently anqjafely' If
activity does n-ot occur, iode "0" on admission and '1" on discharge. COMMENT: There isa
sepaiite function modifier that addresses transfers into a shower stall. Score the function
mddifiers separately. If the patient uses only one mode, record this.score on the FlMru
instrument. it the patient transfers into the tub and shower, record the score fpr lhe more
frequent type of transfer.

Does
Palient SCORE
Does need an assistive
Patient device for fub transfers
(such as a grab bar or COMPTETE
need help
getting into and special seal), ordoes s/he lake INDEPENDENCE
morc than reasdnable tlme
out of he tub? -N or is flerB a con@m
for safetywheo s/h6
perfonns b'ansfers?
SCORE
6
-Yes--+>
i,rlODlFlED (

No Helper I INDEPENDENCE
Yes

I
Helper Y

Does Patient
Does need ooly supervisioo,
Paljent perform cuing, coaTjng oa help lo SGORE
ialfltrole ofthe
-YeS-+,
set od tEnsfer equlPmenL
transferdng tasks? orhelp to lock brdkes and/
or lifr foot rcsts?
SUPERVISION OR
SETUP

No
t No
\ Does
P6lienl need
only incjderdal
help. suoh as contact warding or
Does Patigrt requiE sleadying dldng tul, t_ansfers ot
' tiiel assislance for tub ftansfers
help to lifi one leg lnto the tub?
such as the helper doing basically
8ll fl'le lifling?

No
I /
Yes
{
Yes No
t _f_ SGORE
- - .-Y-- SCORE
5 --4-
SCORE SGORE
1 2 MODERATE MINIIVIAL CONTACT
ASSISTANCE ASSISTANCE
TOTAL MAXIMUM
ASSISIANCE ASSISTANCE

Coplright @2001 - 2004 UB Fouadation Activities, Itrc. 0JBIA, Iuc) for conpilatioo rigbt; ao oJyriEhb claiE.d iE U.S.
.Govem$etrt'work! included in section I, portioEs ofS eclion IV, Appendiccs I rld K, aod ?ofiioEs ofAppendices B, g q G, H and J.
An.ri.",. --i.r,r".- +i.i.,,6...,\F
-.m,.,1i. a^ffiolr lal aO?-rooi TlRrdmdrti^n A.riviti.s- Tnc- for the IIM Data
^[hFR
 IRF-PAI Trai nin g fufanua| Effective 04/a)/04

TRANSEERS: TIJB: Transfers: Tub rcltfies getlmg into and out ofa tub. The patient performs
the activity safely. (Note: Use tiese definitions to score the Fmctisn tr4sdifier,Iterx 33; refer to
the comment below to score Item 39K)

NO IIELPER

7 Complete Indeperrdence

If walking,thepatient approaches a tub, aflaI gets into and out ofit The patienl
performs the activit5r safely.

If in a wheelchair, the patient approaches a tub, locks brakes, lifts foot rests,
removes arm rests ifnecessary, and does eittrer a stalding pivot or sliding
transfer (without a board) andretums. The patient performs ttre activity safely.

6 Modifieil Independence---The patient requires an adaptive or assistive device

(including a prosthesis or orthosis) suc.h as a sliding board, a lifr, grab bars, or special
seat; or takes more than a reasonable amormt oftime to complete the activity; or there
are safety considerations.

HELPER
(

5 Supervision or Setup-The patient requires supervisioa (e.g., sta:rding by, cueing or

coaxing) or setup (positioning sliding toard, moving foot rests, etc).

4 Minimal Contact Assistance-The pdtient requires no more help than touchiug, and
performs 75% or more oftransferring tasks.

Moderate Assistaoce-The patient iequires more help than touching or performs 50

to 74% of transferring tastrs.

2 Maxin:al Assistance-The patient p erforim 25 to 49% of xarcforring tasks.

1 Total Assistance--The patient performs less than 25% oftra::sferring tasks.

Iftle patient does NOT tarsfer into and out of a tub OR slower, code Traasfer-s: Tub (Item
33) as "Q" aad leave Tr4rsfers: Shower Stem 34) blank Code "0" may te used for
Transfers: 1ug s1 6dmission anil discharge.

COMMENT: There is a separate Function Modifier tlat addresses hansfers into a shower
staIl. Code only Tub (Item 33) or Shower Transfers (tem 34) but::ot both. That is, ifa
score is recorded in Item 33, leave Item 34 blank. If the patient tansfers into a tub and
showeq record the score for the more ftegueot t5?e oftmnsfer.

The score for Item 39K strould match the score for either Item 33 or 34 (i.e., whichever type
of transfer was performed).

copltigtt @2001 - 2004 UB lomddion Activities, Ino. (rBI4 I|c) for coEPildion riglrts; no copyriglts claiEed in uJ.
Governie* worla included in Section I, portious ofsectiod IV, ApeDdices I arrd K" aud portions of APPe[dioes B' C, B, G' H ald J.
^'-.. .^6w?iafir.61qo1.2ool ITR F.rhdatim Activities. IDc. forthelIMData
 IRF -PAJ Training Man ual Effetrive A4/01/04

T'naNsrnns: ToILET
Transfers: Toilet includes getting on and off a toilet. At level 7 the subject approaches, sits
down on and gEts up trom a standard toileL Perlorms independenlly and safely' /fin a
wheelchair, afprouihe. toiteq locks brakes, Iifts foot rests, removes am rests ifnecessary,
performs eithei a standing pivot or sliding transfer (without a board) ard.retums. Perfoims
independenfly and safety. ifaAVity does not occur, code Tf on admission and '1" on
discharge.

Does
Patient _No---+. SCORE
7
need an assistive
Does device fortoilet kansfers
Patient need
COMPLElE
(suchasagrab bar or INDEPENDENCE
help getting on special seai), or does s/he tuke
and ofthe more than reasonable {ime to
toilet? perform ioilet iiEnsiers OT IS iirere
a con cem for safuty when
she performs SCORE
toilet tansfers? -> 6

MODIFIED
No Helper INDEPENDENCE
Yes

Helper

. Does Palient
Does need only supeiision,
Patient periorm !a!l cuing, coaring or helP to SCORE
Yes+
or more ofthe set outtransfer equipmenl
ng
-Yes--+. or help to lock brakes an
or liftfoot Ests?
SUPERVISION
OR SETUP ,

No
t No
\ Dos
Pali6nt need
only incidenhl
hdp sudr as conlact glading or
Does Patient requlre steadylng during
total assistance for tollet bllet ttansfeB?
hansfers soch as the helper
doing baslcally all the liftng?

No Yes
Yes No / {
I \ SCORE SGORE
4
SCORE
2- T4ODEMTF MINIMAL CONIACI
ASSISTANCE ASSISTANCE
TOTAL MAXiMUM
ASSISTANCE ASSISTANCE

Copyright 0200 1 - 2004 UB FoEdaioa Activitis, Itrc. (UBtrA, lEc) fo. polopilatiou dghts; Eo copyrigits claiEcd in U.S.
GovenraeDt \aodc i-ncluded io sectiotr I, portioDs ofs cction IV, Alpendices I etrd & aod portions ofAppodices B, c, E, G, E Atrd J.
 IR.F-FAI Tra ining Manual Effective a4/A1/04

TRANSFERS: TOILET: Transfers: Toiletinoiudes safely getting on and offa standard

toilet.

NO}IEL?ER

7 Complete hdependelce

If walking,pailent approaches, sits down on a standartl toiie! aatl gets up

from a standard toilet. the patient performs the activity safely.

Ifin a wheelchatr, patient approaches toilet, locks brakes, Iifts foot rests,
removes ann rests'ifnecessary, and does eitLer a standing pivot or sliding
transfer (without a board) and retums. The patient performs the activity
Da.turji.

6 Modified lndependence--The patie,nt requfues ar adaptive or assistive devico

*16 as a 5ljding board, a fift, grab bars, or special sea! or takes more than a
reasonable amount oftime to complete the activitg or there are safet5l
considerations. Iu this case, a prosthesis or orthosis is considered aD assistive
deyice ifused for tle foansfer.

IIELPER

5 Supervision or Setup-The patient requires supeivision (e.g., standing by,

cueing, or coaxjng) or setup (positioning slitling boand, moving foot rests,
etc.).

4 Minimal Contact Assistaace-The patie,rrt requires no more trelp than

touching and performs 75%o or morc of transferring tasks.

3 Modorate Assistanco--Ihe patient requires more help thaa touching or

performs 50 to 74% oftansferring tasls.

2 Maximal Assistance-The patient p eforir:rs 25 to 49% of transfering tastrs.

I Total Assistarice-The patient performs less fuar.Z1Yo of transferring tasks.

0 Activity Does Not Occur-Enter code 0 only for the adriission assessment
The patient does not traasfer on or offthe toilet/commodg and is not
hansfeffed on or offthe toileVcommode by a helper or lifting device. For
examplq th patiqnt uses only a bedpan antVor urinal. Use oftlis code should
be rare. .

copyr-iElt @2001 - 2004 uB lormdation Activities, Ioa (lJBrA, Lrc) for collil1qltr riglG: Do copyrigh8 claiEed id u.s. . _ ,
co-vffi"otvortsinaudediDsectionf,portioE"l*,:!:"^Y:1tf"*,:,:1fl.*,1#S:.:Yi,T"":*,HliT":";"t**#i:*t