Level Of Assistance

Question 0

Modified independent

Answer 0

Pt uses adaptive or assistive equipment

Question 1

Independent

Answer 1

Able to perform activity safely, in acceptable time frame without assistance from another person or equipment

Question 2

Assisted

Answer 2

Requires assist from another person for safety or in an appropriate timely manner. May be tactile or verbal cueing

Question 3

Minimal assistance

Answer 3

Pt performs 75% or more of the activity! requires assist to complete task

Question 4

Moderate assistance

Answer 4

Pt performs 50-75% of the activity! requires assist to complete the task

Question 5

Maximal assistance

Answer 5

Pt performs 25-50% of the activity, assistance required to complete task

Question 6

Standby (supervision) assistance

Answer 6

Pt requires verbal or tactile cueing by a person close by, but not touching. Assistance available if pt safety is threatened

Question 7

Dependent assistance

Answer 7

Pt requires total physical assistance from one or more persons, special equipment may be necessary

Question 8

Guarding (close, contact)

Answer 8

Pt requires guarding during the activity for safety (usually posterior lateral)

Question 9

Close guarding

Answer 9

Caregiver positioned close, but not touching the pt. protection required to the pt is minimal

Question 10

Contact guarding

Answer 10

Caregiver positioned close to pt with hands on the pt for safety, or on gait belt. Protection likely to be needed