comprehensive
level |
amt of assistance |
function |
ot tx |
1- no response |
total assistance |
No response to any kind of stimuli, including visual, auditory or tactile input or movement. |
-Passive range of motion -Splinting and positioning to manage contractures -Sensory stimulation |
II - generalized response |
total assistance |
Begins to respond to sensory stimuli, including visual, auditory or tactile input or movement -Responses are inconsistent -Responses are the same to all types of stimuli -Responses are not purposeful -Responses may include chewing, sweating, changes in respiration rate, increased blood pressure, or others. |
-Passive range of motion -Splinting and positioning to manage contractures -Sensory stimulation |
III - localized response |
total assistance |
1. Awake on and off 2. Displays more movement 3. Starts reacting more specifically to different types of stimuli -jumps at loud noise or withdraws from pain -turns head to look at specific people or objects -turns head in the direction of noise reactions are slow and inconsistent 4. Begins to respond to family and friends. 5. Responds to simple instructions 6. Begins to answer simple yes and no questions |
-Passive range of motion -Sensory stimulation -Visual and auditory tracking activities -Adaptations for safety and restraint reduction |
IV- confused/agitated |
max assistance |
1. Displays confusion and fear 2. Does not understand feelings or what is happening in surroundings -may not understand that other people are providing help 3. Responds to stimuli by acting out – hitting, yelling or screaming, using abusive language -extreme behavior due to confusion -may need restraints to avoid self injury 4. Overly focused on basic needs, such as eating, going to the bathroom, etc. 5. Displays difficulty attending for more than a few seconds 6. Has difficulty following directions 7. Recognizes family and friends inconsistently 8. Completes simple, routine tasks with assistance |
Active or active assistive range of motion as person will tolerate -Simple reaching activities -Simple cognitive activities such as picture or object identification -Participate in simple activities of daily living with assistance, i.e. washing face, brushing hair, self feeding |
V - confused, inappropriate, non agitated |
max assistance |
1. Pays attention for a few minutes at a time 2. Confused, difficulty making sense of anything beyond self 3. Disoriented 4. Needs step by step instructions to complete simple, everyday tasks 5. May become restless when overwhelmed or when too many people are around 6. Poor short term memory -May remember events prior to injury better than daily routine -May try to fill in gaps in memory by making things up -May become frustrated as elements of memory start to return 7. May get stuck on a thought or activity and may need assistance transitioning to the next activity or step 8. Continues to focus on basic needs |
-Active or active assistive range of motion -Simple reaching and single step fine motor tasks -Simple cognitive activities including orientation to self, place, locating own room, etc. -Basic hygiene, grooming and dressing tasks with step by step cues -Adaptations for safety, such as a bed alarm |
VI - confused, appropriate |
moderate assistance |
1. Some confusion due to memory problems. -may remember main events or main points, but will forget the details2. Ability to follow a schedule with assistance-may become confused by changes in routine 3. Orientation to month and year 4. Attend to task for about 30 minutes. -may be distracted by noisy environments -may be confused by tasks with too many steps 5. Will complete basic self care tasks with help -will be aware of need to use the toilet 6. May be impulsive, do or say things without thinking first 7. Will be aware of hospitalization due to injury but may not have insight into existing problems -will be more aware of physical problems than cognitive problems -may associate problems with being in the hospital and may have the expectation that problems will go away upon return home 8. Able to make sense when speaking |
-Therapeutic exercise and activity as appropriate for physical condition with direct supervision and cuing -Cognitive activities including short term memory exercises, simple sequencing, structured single step problem solving -Basic hygiene, grooming and dressing tasks with supervision and periodic cues -Simple cold food preparation -Simple, familiar housekeeping tasks -Adaptations to immediate surroundings, including labels on drawers and closets for clothing and personal items |
VII - automatic, appropriate |
min assistance for daily living skills |
1. Will be able to follow a schedule. 2. Will complete basic self care tasks independently 3. May have problems in new situations 4. May have problems planning, initiating, and completing activities 5. May have trouble paying attention in noisy, crowded settings or stressful situations, such as sporting events or family gatherings -may demonstrate slower processing speed in stressful situations 6. May not be aware of how changes in memory and cognitive skills affect the future -may expect to return to previous job or roles 7. Will demonstrate impaired safety awareness and judgment 8. May be inflexible, rigid in thinking, stubborn 9. May express interest in completing an activity, but may require assistance actually completing it |
-Therapeutic exercise and activity as appropriate for physical condition with initial instruction and general in-clinic supervision –Cognitive activities including short term memory exercises, simple problem solving, decision making, basic executive function tasks -Hygiene, grooming and dressing tasks with set-up and periodic supervision -Simple cooking tasks with assistance and direct supervision, instruction in use of microwave oven, toaster -Basic housekeeping tasks -Basic home maintenance or tool use -Adaptations including labels on kitchen cupboards, closets |
VIII - purposeful, appropriate, |
stand by assistance |
1. Will realize that there is a problem with memory and cognitive skills 2. Will start to be more flexible and less rigid in thinking 3. Will begin to compensate for problems 4. Will be able to learn new information at a slower rate 5. May be ready to resume driving or undergo a return to work evaluation 6. Continues to display difficulty dealing with stressful situations 7. Will display poor judgment in new situations and may require assistance 8. May need guidance when making decisions 9. Cognitive problems may not be obvious to people who do not know the person |
-Therapeutic exercise and activity as appropriate for physical condition -Home exercise program with repeated instruction in clinic and supervision in follow through from staff or a family member -Higher level cognitive activities including problem solving, decision making, judgment, executive function -Hygiene, grooming, dressing tasks completed independently, monitor for thoroughness -Housekeeping tasks and food preparation with set-up help, supervision, cuing to problem solve -Instruction in the use of memory aids including calendars, planners, pill organizers, timers, and other devices -Instruction and practice in energy conservation and work simplification techniques |
IX - purposeful appropriate |
stand by assistance |
1. Will be able to pay attention for long, sustained periods of time. 2. Aware of limitations -may need some assistance to problem solve during tasks -may become depressed or have low frustration tolerance 3. Will complete all familiar tasks -may ask for help problem solving 4. Will compensate for memory loss by using memory aids 5. Will consider the point of view of others during conversation 6. May return to work or daily routine with some assistance |
-Therapeutic exercise and activity as appropriate for physical condition -Home exercise program, may complete independently after repeat in-clinic instruction -Able to complete hygiene, grooming and dressing tasks independently -Housekeeping and food preparation tasks with supervision, assist with problem solving as needed -Continued instruction in the use of memory aids -Instruction and assistance with higher level instrumental activities of daily living (IADLs), including money management, taking medications, making and keeping appointments -Assessment to determine potential to resume driving -Instruction in relaxation techniques |
X - purposeful appropriate |
mod independence |
1. Will complete all daily activities with adaptations or extra time 2. May need rest breaks 3. Will compensate for memory loss, using adaptive aids or methods 4. Will problem solve and make decisions with extra time or adaptations 5. May become depressed or display low frustration tolerance when sick or tired 6. Will return to work or daily routine with adaptations |
Home exercise and activity programs with follow up monitoring -Instruct in use of and monitor follow through with memory aids, including calendars, pill boxes, alarms and timers, assistive technology -Follow up checks to insure independence with housekeeping, food preparation, safety at home -Periodic monitoring of medications, money management, appointments -Driving instruction to regain drivers license if appropriate |
|
|
simple
I |
no response, total assistance |
II |
generalized response, total assistance |
III |
localized response, total assistance |
IV |
confused, agitated, max assistance |
V |
confused, inappropriate non agitated, max assistance |
VI |
confused appropriate moderate assistance |
VII |
automatic appropriate minimal assistance for daily living skills |
VIII |
purposeful appropriate stand by assistance |
IX |
purposeful appropriate standby assistance on request |
X |
purposeful appropriate modified independent |
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