FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE - EATING

The helper applies the universal cuff on to the patient’s hand before she eats. The patient
Level
then brings food to her mouth, chews & swallows by herself.

The helper scoops all food onto the patient's spoon. The patient is then able to bring the
Level
spoon to his mouth, chew and swallow the food.

The patient needs the helper to provide hand over hand assistance to get food onto the
Level spoon and/or fork and then hand over hand assistance to bring the utensil to the patient's
mouth, so the patient can chew and swallow the food.

Level The helper feeds the patient.

The patient requires the use of a universal cuff to eat. The patient applies the universal
Level
cuff by herself

The patient eats all consistencies of food independently. She eats safely and in a
Level
reasonable amount of time. No helper is required while the patient eats her meals.

The helper places the spoon in the patient’s hand at the start of the meal. With prompting,
Level the patient is able to scoop food onto the spoon, bring the food to the mouth, chew &
swallow.

FIM EXERCISE - GROOMING

The patient washes his own hands, washes his face and does his oral care
Level independently. A helper combs the patient's hair and shaves his face.

The helper plugs in an electric razor and shaves under the patients chin; the patient
Level completes shaving his face and does the rest of the grooming activities (oral care, hair
grooming, washing the hands and face) without assistance.

The patient uses a long-handled comb to comb her hair independently. She completes
Level the rest of her grooming activities independently (oral care washing the face and hands).
She does not wear make-up.

The patient washes his hands and face independently; the helper must complete the rest
Level of the grooming activities (combing the hair, oral care, and shaving).

Prior to the grooming tasks, a helper is needed to open the patient’s make-up containers
Level and the packet containing her denture cleaning tablet. The patient then does all grooming
activities (oral care, hair grooming, washing the hands and face) by herself at the bedside.

The patient does all grooming activities (oral care, hair grooming, shaving, washing the
Level hands, and washing the face) independently. The clinician is present as the patient
completes these tasks, as he is assessing the patient’s need for assistance.

Level The helper must provide all grooming care for the patient.

1
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE - BATHING

The patient washes, rinses and dries her body independently in a safe and timely manner.
Level
No assistive devices are required.

The patient washes, rinses and dries only his chest, abdomen and right arm. The helper
Level bathes the patient's left arm, the front and back perineal areas, and both upper legs and
lower legs, including the feet

The helper washes, rinses and dries the patient's lower legs, including his feet. The
Level
patient then washes and dries the rest of the body.

The patient is only able to wash, rinse and dry his chest and abdomen. The helper
Level
washes rinses and dries the rest of the body.

The patient washes rinses and dries his arms, chest, abdomen and upper legs. The
Level
helper washes the patient's back, the front and back perineal areas and both lower legs.

The patient washes rinses and dries her body independently. She uses a long-handled
Level sponge to wash her lower legs including her feet (feet are considered part of the lower
leg).

The helper applies a bath mitt. The patient is then able to bathe (wash, rinse and dry) the
Level
body without further assistance

FIM EXERCISE – DRESSING UPPER BODY

The patient wears a sweatshirt and needs the helper to put his affected arm through the
Level sleeve and his head through the neckline of the sweatshirt. The patient is able to thread
his unaffected arm and pull the sweatshirt down over his trunk.

The patient needs prompts and cues to complete dressing above the waist. The patient
Level
has no limitation in range of motion or muscle strength.

The patient dresses and undresses his upper body independently, including obtaining his
Level own clothes. Dressing and undressing are completed in a safe and timely manner. No
helper or assistive device is required.

The helper starts the upper body dressing tasks by threading the sleeve of the sweatshirt
over the patient's right arm. The patient is then able to pull his head through the
Level
sweatshirt neckline, thread his left arm and pull the sweatshirt down over his trunk. The
patient undresses independently.

The helper threads the left sleeve over the patient's left arm, pulls the neckline over the
patients head and then threads the patient’s right arm. The patient’s is then able to pull
Level
the sweatshirt down over his trunk. The patient requires the same amount of assistance to
undress.

The helper puts the sweatshirt on the patient. The patient leans forward as the helper
Level pulls the sweatshirt over the patient's trunk. The patient requires the same amount of
assistance to undress.

2
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

The patient dresses and undresses his upper body independently, including obtaining his
Level own clothes. He independently uses a button hook and reacher to help him accomplish
upper body dressing and undressing in a safe and timely manner.

FIM EXERCISE – DRESSING LOWER BODY

The helper dons an ankle-foot orthosis (AFO). The patient completes the rest of lower
Level
body dressing without assistance.

Level The patient is able to complete lower body dressing and undressing by himself.

The patient is able to dress his lower body independently. He uses elastic shoe laces as
Level
he is unable to tie up regular shoe laces. He undresses independently.

The patient wears underwear, pants, socks and slip-on shoes on his lower body. The
helper threads the right and left legs of the patient's underwear and both left and right
Level
pant legs. The patient pulls up his underwear and pants over his hips. The patient can put
on his own shoes after the helper puts on both socks.

The patient is able to put on his pants, underwear and his socks. The helper puts both
Level
shoes on the patient.

Level The helper dresses and undresses the patient completely.

The patient puts on his pants by himself. The patient does not wear underwear. Once the
Level
helper puts on the patient's socks the patient can put on his own (slip-on) shoes.

FIM EXERCISE - TOILETING

The patient adjusts his clothing before and after bowel and bladder management. He
Level
wipes himself after the helper passes him toilet tissue.

The patient adjusts his clothing independently before and after using the toilet while
Level
holding onto a grab bar. He also manages perineal hygiene independently.

The patient needs a helper to pull his pants up and down before and after toilet use. The
Level
patient wipes himself independently.

The patient adjusts her clothing before and after bowel and bladder management. The
Level
helper gives total assistance with perineal hygiene.

The patient manages perineal hygiene and adjusts her clothing before and after toilet use.
Level
Tasks are performed safely and in a timely manner

3
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

The patient needs steadying assistance while adjusting clothing before and after toilet
Level
use. The patient manages her own perineal hygiene independently

Level The patient is unable to help with any aspects of toileting

FIM EXERCISE – BLADDER MANAGEMENT

The helper assists with positioning of the legs as the patient performs the intermittent
Level
catheterisation. The patient never has bladder accidents.

The patient empties her bladder by performing an intermittent catheterisation every 4 to 6

Level
hours. She is independent in performing the procedure and never has bladder accidents.

Level The patient uses the toilet when voiding. He has bladder accidents twice a week.

The patient has an indwelling catheter. The helper manages all care related to the
Level
catheter. The patient never has accidents.

The patient does all bladder management tasks, does not use any equipment or agents
Level
for control, and never has accidents.

The patient uses a urinal when voiding. The urinal is emptied by the helper. The patient
Level
never has accidents.

Level The patient uses a toilet for voiding during the day, but has accidents every night.

FIM EXERCISE – BOWEL MANAGEMENT

The patient uses a bedpan for bowel management. The helper leaves the bedpan on the
Level bedside table for the patient to use and then empties the bedpan once the patient is
finished. The patient required a clothing change for soiling 8 days ago.

The patient has a colostomy. The nurse gives the patient verbal instruction as the patient
Level takes care of the colostomy. The patient has not had accidents as the colostomy has not
leaked.

The patient uses the toilet independently for bowel management. He eats prunes three
Level
times a week as part of his breakfast. He does not have accidents.

The patient soils linen/clothing daily and does not assist with any of his bowel
Level
management.

4
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

The patient takes a stool softener every day for bowel management. She uses the toilet
Level
independently.

The patient has a neurogenic bowel. He uses a suppository every other morning. He
Level inserts the suppository himself and then the nurse does digital stimulation. The patient
never has bowel accidents.

The patient is able to use the toilet independently, but soils linen/clothing twice in each
Level
week.

FIM EXERCISE – TRANSFER: BED, CHAIR, WHEELCHAIR

The patient transfers into and out of her bed and onto a bedside chair with the assistance
Level
of two helpers.

The patient transfers into and out of her bed to an armchair with only steadying
Level
assistance from a helper.

The helper applies the wheelchair brakes, and removes the armrest and footrest. The
Level
patient is then able to transfer from the wheelchair into the bed by herself.

The patient transfers into and out of the bed with maximal assistance from a helper. The
helper provides steadying assistance as the patient gets from a supine to a sitting position
Level on the bed. The helper is providing more of the effort than the patient as the patient
moves from a sitting to a standing position. The helper then steadies the patient during
the pivot, and the helper eases the patient down into the wheelchair.

The patient transfers into and out of the bed by herself in a safe and timely manner. No
Level
help is required during the transfer, and no assistive device is used.

The patient transfers out of the bed with the helper providing some lifting assistance
during the transfer. The helper provides steadying assistance as the patient pivots, and
Level
the patient lowers herself into the wheelchair. The patient is taking most of their own
weight.

The patient performs a sliding transfer to get into and out of her bed to a wheelchair. She
Level
performs the transfer safely using a transfer board.

FIM EXERCISE – TRANSFER: BATH/SHOWER

The patient does a stand pivot transfer from the wheelchair into the shower with the
Level helper supervising the transfer. The patient transfers from the shower to the wheelchair
with the helper providing steadying assistance.

The patient gets a bed bath every day, and never transfers into and out of a bath or
Level
shower.

The patient transfers into the shower with the helper providing moderate lifting assistance
Level to get the transfer started. The helper then provides steadying assistance as the patient
pivots and transfers onto the shower chair. The same level of assistance is required to
5
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

return back to the wheelchair.

The patient transfers into and out of the shower by himself, using shower rails for safety
Level
reasons.

The patient transfers into and out of the shower by himself in a safe and timely manner.
Level
No helper is required during the transfer, and no assistive devices are used.

The patient transfers onto the shower chair with maximal assistance from a helper. The
helper is providing more of the effort than the patient as the patient moves from a sitting to
Level a standing position. The helper then steadies the patient during the pivot, and eases the
patient down onto the shower chair. The patient returns to his wheelchair with the same
level of assistance.

Level The patient transfers into and out of the shower with the helper providing only supervision.

FIM EXERCISE – TRANSFER: TOILET

The patient wheels himself to the toilet in his wheelchair but requires prompting to
Level
complete the toilet transfer safely.

The patient transfers onto the toilet with maximal assistance from a helper. The helper is
providing more of the effort than the patient as the patient moves from a sitting to a
Level standing position. The helper then steadies the patient during the pivot and the helper
eases the patient down onto the toilet while the patient holds on to a rail. The patient
returns to his wheelchair with the same level of assistance.

The patient transfers on and off the toilet without the need for assistance or using
Level
assistive devices.

Level The patient transfers on and off the toilet with steadying assistance from a helper.

The patient transfers on and off the toilet independently but requires the use of a raised
Level
toilet seat.

The patient transfers onto the toilet with moderate assistance from the helper to get the
transfer started. The helper then provides steadying assistance as the patient pivots and
Level
as the patient lowers herself onto the toilet. The same level of assistance is required to
return back to the wheelchair.

Level The patient is wheeled over the toilet on a commode chair by the helper.

6
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE – LOCOMOTION: WALK/WHEELCHAIR

Level The patient walks over 50mtrs independently and safely.

Level The patient is able to walk 50mtrs with occasional steadying assistance of one helper.

Level The patient is able to walk 20mtrs and requires the assistance of 1 helper.

The patient is able to walk 20mtrs with the use of a walking frame. No helper is required
Level
to be present.

Level The patient is able to walk 10mtrs and requires the assistance of 2 helpers.

The patient is able to walk a minimum of 50mtrs but needs prompting and steadying with
Level
the helper taking a little of the patients weight.

The patient uses a single point stick when walking. She can manage to walk a minimum
Level
of 50mtrs without a helper being present.

FIM EXERCISE – LOCOMOTION: STAIRS

The patient uses the handrail & requires extra time to go up and down a flight of 12 stairs
Level
without the presence of a helper.

Level The patient is able to manage a flight of 12 stairs with supervision only.

Level The patient is not able to go up or down stairs.

Level The patient can go up and down a flight of 12 stairs but requires prompts and the helper
to take a little of the patients weight.

Level The patient can go up and down 6 stairs with the help of 1 person

Level The patient is able to go up and down 14 stairs safely and independently.

The patient is able to go and down a flight of stairs with occasional steadying assistance
Level
from 1 helper only.

7
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE – COMPREHENSION

The patient understands conversations about basic daily needs over 90% of the time but
Level
sometimes needs information to be repeated.

The patient understands complex information but requires extra time to fully understand
Level
new information and some directions.

The patient understands basic information only and requires prompting more than 50% of
Level
the time.

The patient understands directions and fully participates in discussions relating to family
Level
matters, current events and finances.

The patient understands basic information only and requires prompting about 20% of the
Level
time.

The patient understands basic information only and requires prompting about 40% of the
Level
time

The patient requires constant prompting to understand information about basic daily
Level
needs and responds appropriately less than a quarter of the time.

FIM EXERCISE – EXPRESSION

The patient expresses her basic daily needs most of the time and requires prompting less
Level
than 10% of the time.

The patient can express her basic daily needs only and requires prompting about 20% of
Level
the time.

The patient requires constant prompting to express her basic daily needs appropriately
Level
less than a quarter of the time.

The patient only expresses basic information and requires prompting more than 50% of
Level
the time.

The patient expresses complex information & ideas but requires extra time to express
Level
their needs.

The patient expresses basic information only and requires prompting about 40% of the
Level
time

The patient expresses complex ideas and fully participates in discussions relating to
Level
family matters, current events and finances.

8
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE – SOCIAL INTERACTION

Level The patient requires one-on-one supervision 24hrs a day.

The patient interacts appropriately some of the time but requires prompting more than
Level
50% of the time.

Level The patient interacts appropriately with staff, other patients and visitors at all times.

The patient interacts appropriately at least 75% of the time and requires only occasional
Level
prompting.

The patient requires more than occasional prompts – interacts appropriately over half the
Level
time.

Most of the time the patient interacts appropriately in social situations and rarely needs
Level
prompting (only in unfamiliar situations).

The patient is on a daily antidepressant due to her history of long standing depression.
Level
She interacts appropriately in all situations.

FIM EXERCISE – PROBLEM SOLVING

Level The patient is unable to solve routine problems.

The patient is able to recognise where complex problems exist and takes appropriate
Level
steps to overcome them all of the time.

Level The patient is able to solve routine problems about 40% of the time without prompting.

The patient usually recognises where complex problems exist but in unfamiliar situations
Level
he requires extra time to solve them.

The patient needs minimal prompting to solve routine problems – prompting is required
Level
less than 25% of the time.

Level The patient is able to solve routine problems about 60% of the time without prompting.

Level The patient is able to solve routine problems only and rarely needs prompting.

9
 FIM ITEM SCORING EXERCISE SHEETS – 2015

ASSIGN A SCORE FROM 1 - 7 FOR EACH OF THE FOLLOWING BEHAVIOURS.

EACH SCORE CAN BE USED ONLY ONCE.

FIM EXERCISE – MEMORY

The patient needs help more than half of the time to remember people frequently
Level
encountered and daily routines.

The patient requires prompting to remember people frequently encountered, routines and
Level
requests 25% of the time.

Level The patient does not require any help to remember people, routines or requests.

The patient needs help to remember people frequently encountered ,routines & requests
Level
all of the time.

The patient recognises people & routines and only in stressful situations does he need
Level
verbal prompting.

The patient requires more than occasional prompting but can remember people, routines
Level
& requests about 60% of the time.

Level The patient independently uses a daily diary to remember daily routines & therapy times.

10