|Level||Cognition||FIM||Level of Assist||Attention Span||Manual Activities|
|1||Global cognition is profoundly impaired.
Patient responds to internal cues only. A change in the level of arousal is a specific response to an external stimulus that produces pain or has an instinctive survival value.
|Total Assistance||Seconds||No level of participation in any manual activity.
Motor actions are Automatic/Reflexive.
|2||Global cognition is severely impaired.
Patient’s awareness is limited to own postural actions (proprioceptive cues) to move body in space or overcome effects of gravity. There is a lack of awareness of the effects that actions have on objects or other people.
|Max Assistance||Minutes||No level of participation in any manual activity.
|3||Global cognition is severely impaired.
Patient performs spontaneous manual actions in response to tactile cues. Repetitive actions demonstrate an awareness of material objects but lack of awareness of cause and effect, end product, or goal.
|Mod Assistance||30 minutes||Simple manual tasks with repetitive and routine steps.
3.0 Grasp objects – purposeful grasp and release
3.2 Distinguishes between objects
3.4 Sustains actions on objects (may look perseverative)
3.6 Cause and effect – notices effects have on objects, by manipulating them e.g. able to sort objects, uses mirrors during ADLs
3.8 Uses all objects and knows when an activity is completed
|4||Global cognition is moderately impaired.
Patient is aware of tangible cues (what can be seen and touched) and understands visible cause-and-effect relationships. Goal-directed actions demonstrate an
Attention span is usually good for up to one hour.
|Goal-directed actions – demonstrates an awareness of a familiar end-product but fails to solve new problems, anticipate, or correct mistakes. There is no independent new learning and cannot invent new motor actions. Do not recognize errors unless clearly visible, and may request help when mistakes are noticed.|
|5||Global cognition is mildly impaired.
The Patient is able to learn new ways of doing things through trial-and-error problem solving. The Patient detects the best effect by exploring distinctive properties of objects and trying different actions. They exercise poor judgment with no symbolic thought to plan actions or anticipate potential mistakes. They may make hasty or impulsive decisions or make abrupt changes in their course of action. The determination of what is best may be made according to personal preferences or social standards. The Patient can imitate a series of new directions; new learning is recognized and repeated during the process of doing an activity.
|Standby Assistance||Weeks||Able to imitate a series of new directions; new learning is recognized and repeated during the
process of doing an activity.
|6||ABSENCE OF COG DISABILITY
Absence of dysfunction, task performance is planned and premeditated, anticipates errors, and able to use abstract and symbolic reasoning. Considers several hypothetical plans of actions and establishes abstract criteria for selecting the best plan. Able to make plans for the future, taking into account possible risks to health and well-being for one’s self and others.
|Independent||Attention span is defined by desires and priorities||Absence of dysfunction, task performance is planned and premeditated|
|1||Requires 24-hour total nursing care,||May tolerate hand-over-hand oral feeding techniques|
|2||Requires 24-hour assistance to initiate and assist with daily activities of daily living||Level 2.0 – assists with transfers and body position changes.
Level 2.4 – gross body movements, aimless walking.
Level 2.8 – may use grab bars and furniture to stabilize their balance.
|3||Group home – 24-hour supervision||With assistance and supervision, able to perform BADLs.||Supported employment Unskilled work in sheltered workshop, with supervision|
|4||Level 4.4 – May live with someone who does a daily check on the environment and removes any safety hazards and solves any new problems. May be left alone for part of the day with procedure for obtaining help by phone or from a neighbor.
Level 4.6 – May live alone with daily assistance to monitor personal safety. May require reminders to do household chores
Level 4.8 – May live alone with daily assistance to monitor safety and check problem- solving methods.
|Level 4.0 – May fix self a cold meal or snack and make small purchases in the neighborhood.
Level 4.2 – May spend a daily allowance, walk to familiar locations in the neighborhood, or follow a simple, familiar bus route.
Level 4.4 – May manage a daily allowance and go to familiar places in the neighborhood.
Level 4.6 – May require reminders to attend familiar community events, or to do anything in addition to daily household routine.
Level 4.8 – May get self to a regularly scheduled community activity
|Level 4.8 – may succeed in a supportive employment environment.|
|5||Level 5.0 – May live alone with weekly checks to monitor safety and check problem-solving methods.
Level 5.2 – May live alone with weekly checks to monitor safety and examine potentially dangerous effects of impulsive behavior.
Level 5.4 – May live alone
|Level 5.6 – May drive.||Level 5.0 and 5.2 – May succeed in supportive employment with a job coach
Level 5.4 – May work in a job with a wide margin of error. May not be safe in jobs with a high potential for industrial accidents.
Level 5.6 – May work in a suitable job and be relied upon to consistently follow safety precautions.
|6||Independent||Independent||May work in competitive employment|