Levels of Independence & Tone Scales

Question 1

Independent

Answer 1

FIM score: 7
Patient performed: 100% of the physical task with no helper, no equipment/devices safely and within reasonable amount of time

Question 2

Modified Independent

Answer 2

FIM score: 6
Patient performed 100% of the physical task without the need of another person at all; used an assistive device, brace, or other equipment or took extra time for task

Question 3

Supervision or Standby Assist

Answer 3

FIM score: 5
Patient performed 100% of the physical task; needed another person there for things like verbal cuing or to watch for safety

Question 4

Contact Guard Assist

Answer 4

FIM score: 4
Patient performed basically 100% of the physical task… needed “light touching”

Touch or direct instruction

Question 5

Minimal Assistance

Answer 5

FIM score: 4
Patient performed 75% or more
Helper performed 25% or less

Add up number of steps and divide to get percentage

Question 6

Moderate Assistance

Answer 6

FIM score: 3
Patient performed 50%-74%
Helper performed 24%-50%

Add up number of steps and divide to get percentage

Question 7

Maximum Assistance

Answer 7

FIM score: 2
Patient performed 25%-49%
Helper performed 51%-75%

Add up number of steps and divide to get percentage

Question 8

Total Assistance/Complete

Answer 8

FIM score: 1
Patient performed less than 25%
Helper performed more than 75%

Add up number of steps and divide to get percentage

Question 9

Ashworth’s Scale

Answer 9

0 = normal tone
1 = slight increase in tone, “catch” but able to go through full rom
1+ = slight increase in tone, “catch” at ½ mark or more
2 = significant increase in tone, but still able to go through full rom
3 = considerable increase, rom is compromised or very difficult
4 = limb is rigid, little to no rom

Question 10

Types of tone

Answer 10

Normal

Hypertonic
- Increase in tone that results in resistance during passive stretch

Spasticity (sometimes just considered hypertonic)
- Resistance to stretch occurs in the first 1/3 of the range

Rigidity
- Resistance throughout the range, preventing movement
- Extreme hypertonicity

Hypotonic
- Low tone, muscle is “floppy”, not firm to touch

Flaccid
- No tone at all

Question 11

How do we assess tone using the mild-moderate-severe scale?

Answer 11

Mild: catch occurs only at the last 25% of the range
Moderate: catch occurs at mid range (50%)
Severe: catch occurs as soon as range is initiated (first 25%)
Rigid: little or no movement possible
HYPER or HYPO (flaccid) tone is not PNS. It is CNS
- Takes a lot of effort to move normally.