Levels of Assistance and Precautions

Question 1

Independent

Answer 1

(I)
Pt requires no assistance or supervision from PT or device & is safe & secure to ambulate &/or complete tasks
Staff effort: 0%
Pt effort: 100%

Question 2

Modified Independence

Answer 2

(Mod I)
Pt completes task using assisted device (walker, cane, grab bar, bedside commode-BSC) &/or requires extra time to complete a task
Staff effort: 0%
Pt effort: 100%

Question 3

Supervision

Answer 3

(S)
No physical contact from PT/assistant, d/t cognitive issues PT/assistant should provide verbal cues to complete activity or assist with task set up
Staff effort: 0%
Pt effort: 100%

Question 4

Stand By Assist

Answer 4

(SBA)
No physical contact from PT/assistant, d/t fall risk PT/assistant should be close to pt to maximize safety to complete activity or assist with task set up
Staff effort: 0%
Pt effort: 100%

Question 5

Contact Guard Assist

Answer 5

(CGA)
Pt requires light physical contact from PT/assistant (i.e. PT hand on pt back to steady pt w/o physical support, may be d/t occasional LOB)
Staff effort: <5%
Pt effort: >95%

Question 6

Minimal Assistance

Answer 6

(Min A)
Pt requires 25% or less physical support or assistance to safely complete task/transfer/ambulation
Staff effort: <25%
Pt effort: 75%

Question 7

Moderate Assistance

Answer 7

(Mod A)
Pt requires 50% assistance from PT/assistant to safely complete task/transfer/ambulation
Staff effort: 50%
Pt effort: 50%

Question 8

Maximal Assistance

Answer 8

(Max A)
Pt requires 75% assistance or support from staff member to safely complete task/transfer/ambulation
Staff effort: 75%
Pt effort: 25%

Question 9

Dependent Total Assistance

Answer 9

(D) or (Total A)
Pt requires 100% assistance or support from staff member to complete task/transfer/ambulation
Staff effort: 100%
Pt effort: 0%

Question 10

Multiple Person Transfers

Answer 10

i.e. Max A x2 for supine to sit

Question 11

FWB

Answer 11

Full weight bearing, full body through extremity

Question 12

WBAT

Answer 12

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

Question 13

PWB

Answer 13

Partial weight bearing, 50% of BW through extremity

Question 14

TTWB

Answer 14

Toe touch weight bearing, only toes allowed to touch ground; primarily use limb to balance ab 25% of BW

Question 15

HTWB

Answer 15

Heel touch weight bearing, only heel allowed to touch ground; primarily use heel for balance ab 25% of BW

Question 16

NWB

Answer 16

Non weight bearing, no weight at all is allowed through extremity & must not allow extremity to touch support surface

Question 17

TKA Precautions

Answer 17

*if there is a WB precaution: it is WBAT initially and moving toward FWB
*pt w/ recent TKA would be WBAT d/t pain following surgery and limited ROM in joint

Question 18

THA Precautions

Answer 18

*if there is a WB restriction it would be WBAT initially and moving toward FWB

Question 19

THA Anterior Approach

Answer 19

*minimally invasive approach
*no extension of hip past neutral
*no ER of hip
*no adduction of hip
(position chair away from sx side ++ have pt turn towards sx side)

Question 20

THA Posterior Approach

Answer 20

*No IR of hip
*No hip flexion >90
*No adduction of hip past midline
(position chair next to sx side ++ have pt turn away from sx side)

Question 21

ORIF Precautions

Answer 21

*almost always has WB precautions: NWB or PWB
*

Question 22

Importance of WB Status

Answer 22

*precautions usually stated in chart or consult order
*helps PT know what pt’s assist level will be and DC plans

Question 23

Traditional Sternal Precautions

Answer 23

*maintained for 4-6 weeks
*do not reach arms OH (shoulder flexion >90)
*no not reach arms behind back
*do not lift >5-8lbs
*do not push with arms
* beneficial for pt to hold pillow w/ arms during functional tasks (rolling, supine to sit, and STS)
* beneficial to hold onto a pillow during cough or sneeze

Question 24

Spinal Precautions: Cervical

Answer 24

*no shoulder flexion >90
*no lifting >10lbs
*ASPEN collar in place at all times
*ROM restrictions per surgeon

Question 25

Spinal Precautions: Lumbar

Answer 25

*primarily after spinal laminectomy, decompression surgery
*No twisting
*No forward bending >90
*minimize side bending
*utilize log roll technique (when moving from supine to sit or sit to supine)

Question 26

TLSO or LSO

Answer 26

Thoracolumbar Sacral Orthosis or Lumbar Sacral Orthosis to be worn during movement
*majority of time orthosis can be worn during movement, majority of time orthosis can be taken off while sleeping depending on surgeon orders and type of surgery