Levels of Assistance

Question 1

What is the definition of Independent (I)?
% provided by staff, % provided by patient?

Answer 1

-The patient requires no assistance or supervision from the PT or a device and is safe and secure to ambulate or complete tasks
-0% provided by staff
-100% provided by patient

Question 2

What is the definition of Modified Independence (Mod I)?
% provided by staff, % provided by patient?

Answer 2

-patient completes task using assistive device or requires extra time to complete a task
-0% provided by staff
-100% provided by patient

Question 3

What is the definition of Supervision (S)?
% provided by staff, % provided by patient?

Answer 3

-there is NO physical contact by PT but due to fall risk or cognitive deficits, PT is close to pt to maximize safety or PT provides verbal cues to complete an activity or setup of a task
-do NOT need to be right next to pt
-0% provided by PT
-100% provided by patient

Question 4

What is the definition of Stand By Assist (SBA)?
% provided by staff, % provided by patient?

Answer 4

-there is NO physical contact by PT but due to fall risk or cognitive deficits, PT is close to pt to maximize safety or PT provides verbal cues to complete an activity or setup of a task
-need to be NEXT to pt
-0% provided by PT
-100% provided by patient

Question 5

What is the definition of Contact Guarding (CGA)?
% provided by staff, % provided by patient?

Answer 5

-patient requires light physical contact from PT, there is no physical support, can be due to occasional loss of balance
-less than 5% effort from PT
-76% to greater than 95% of effort from patient

Question 6

What is the definition of Minimal Assistance (Min A)?
% provided by staff, % provided by patient?

Answer 6

-the patient requires 25% or less physical support or assistance to safely complete a task/transfer/ambulation
-less than 25% effort from PT
-51% to 75% effort from patient

Question 7

What is the definition of Moderate Assistance (Mod A)?
% provided by staff, % provided by patient?

Answer 7

-patient requires 50% assistance from PT to safely complete task/transfer/ambulation
-50% of effort from PT
-26% to 50% effort from patient

Question 8

What is the definition of Maximal Assistance (Max A)?
% provided by staff, % provided by patient?

Answer 8

-patient requires 75% assistance or support from PT to safely complete the task/transfer/ambulation
-75% of effort from PT
-1% to 25% of effort from patient

Question 9

What is the definition of Dependent Total Assistance (D) (Total A)?
% provided by staff, % provided by patient?

Answer 9

-Patient requires 100% assistance or support from staff to complete task/transfer/ambulation
-100% effort from PT
-0% effort from patient

Question 10

What levels of assistance do NOT require physical touch from the PT or PTA?

Answer 10

Independent (I)
Modified Independence (Mod I)
Stand by Assist (SBA)
Supervision (S)

Question 11

All patient must wear ______ in a hospital, rehab center, SNF, long term care facility, and outpatient setting if they are _____.

Answer 11

gait belt
high risk for falls

Question 12

What is FWB?

Answer 12

Full weight bearing
the pt can have full body weight through the extremity

Question 13

what is WBAT?

Answer 13

Weight bearing as tolerated
as much body weight as patient can tolerate through the extremity usually limited by pain or ability

Question 14

what is PWB?

Answer 14

Partial weight bearing 50% of body weight through the extremity

Question 15

what is TTWB?

Answer 15

Toe touch weight bearing
only toes allowed to touch the ground, primarily use the limb for balance, around 25% of bodyweight

Question 16

what is HTWB?

Answer 16

heel touch weight bearing
only the heel is allowed to touch the ground, primarily use heel for balance, around 25% of body weight

Question 17

what is NWB?

Answer 17

Non weight bearing
no weight at all is allowed through the extremity and do not allow extremity to touch support surface

Question 18

What are the precautions of a TKA?

Answer 18

In a total knee replacement, you want people to move. Weight bearing precautions for a patient with a recent TKA would be WBAT due to pain following surgery and limited ROM in the joint. Will always be moving toward FWB.

Question 19

what are the precautions for THA?
Anterior vs posterior

Answer 19

-For a total hip arthroplasty, a weight bearing restriction would be WBAT initially moving toward FWB.
-For an anterior approach there is NO hip EXT past neutral, NO hip ER, NO hip ADD
-For a posterior approach, there is NO hip FLEX >90 degrees, NO hip IR, NO hip add

Question 20

What is ORIF?

Answer 20

Open reduction internal fixation is when there are pins, rods, or screws put in place following a hip fracture.

Question 21

what are the precautions for ORIF?

Answer 21

Since these are broken bones, they have weight bearing precautions. Look in the consult order or chart, will typically be NWB or PWB.

Question 22

what are traditional sternal precautions?

Answer 22

Traditional sternal precautions should be maintained for 4-6 weeks.
-NO shoulder flex & abd past 90 degrees
-NO reaching arms behind your back
-NO lifting more than 5-8 pounds
-NO pushing with arms
-Allow patients to fold a pillow with arms during functional tasks like rolling and supine to sit or sit to stand
-allow patients to hold onto pillow to cough or sneeze

Question 23

what are cervical spinal precautions?

Answer 23

If in place…
-No lifting greater than 10 lbs
-Aspen collar in place all the time
-ROM restriction per surgeon
- NO shoulder flex past 90 degrees

Question 24

what are lumbar spinal precautions?

Answer 24

-Common after laminectomy or decompression surgery
-NO twisting, no forward bending greater than 90 degrees, minimize side bending
-utilize LOG ROLL to move from supine to sit or sit to supine

Question 25

what is Fowler’s positioning? What are the benefits? What are the variations of Fowler’s?

Answer 25

-the patient is sitting upright in the bed with legs resting on the bed
-will facilitate abdominal drainage, relieve difficulty breathing, tension on abdominal sutures, facilitate eating, reading, socializing, and relax muscle of the back
-High fowlers: 75-90 degrees
-Semi Fowlers: 40-45 degrees
-Low Fowlers: 30 degrees

Question 26

what is Trendelenburg positioning? what are the benefits?

Answer 26

-the head of the bed is lowered and the foot of the bed is raised in a straight incline
-can facilitate venous return for patients with poor peripheral perfusion or postural drainage

Question 27

what are the three levels of transfers?

Answer 27

1. Independent: the patient consistently performs all aspects of the transfer including set up in a safe manner without assistance
2. Assisted: Patient actively participates but also requires assistance from clinicians
3. Dependent: Patient does NOT actively participate or only very minimally and the clinicians perform all aspects of the transfer