SITI NUR HAFIDZOH OMAR OCCUPATIONAL THERAPIST

y PERSONAL HYGIENE y BATHING SELF y FEEDING y TOILETING y STAIRS CLIMBING y DRESSING

y BOWEL CONTROL y BLADDER CONTROL y CHAIR/BED

TRANSFERS y AMBULATION y WHEELCHAIR

SCORE 0

JUSTIFICATION The clients is unable to attend to personal hygiene and is dependent in all aspects [clients is totally dependent on assistance to brush teeth/denture, comb hair, wash hands, wash face, shave and/or apply make-up] Assistance is required in all steps of personal hygiene [clients may complete one or two the above activities. Generally requires assistant to provide more effort than self for each of activities, loosen denture, shave, etc] Some assistance is required in one or more steps of personal hygiene [assistance required in applying make-up, help to wash one hand, help to apply pressure to brush teeth, shave under chin, comb back of hair, and help to dry one hand . Need constant cueing or coaxing to complete tasks] Clients is able to conduct his/her own personal hygiene but requires minimal assistance before and/or after the operation [there may be concerns about safety such as plugging a plug, fixing a razor blade, hot water or some assistance may be required with set up and/or tidy up or smoothing smudged make-up] The clients can wash his/her hands and face, comb hair, clean teeth and shave [clients can perform all personal hygiene task independently and safely]

1

3

4

5

SCORE 0

JUSTIFICATION Total dependence in bathing self [clients is totally dependent in bathing self, or bathing is not performed or drying all parts of the body is not performed] Assistance is required in all aspects of bathing [clients requires assistance and direction in all aspect of bathing. Maybe able to wash chest and both arms] Assistance is required with either transfer to shower/bath or with washing or drying including inability to complete as task because of conditions or disease [clients requires assistance and direction in all aspect of bathing. Maybe able to wash chest and both arms] Supervision is required for safety in adjusting water temperature, or in the transfer [bathing may take more than three times in normal time. Assistance may be required to set up bathing equipments the water, washing materials, etc . Some prompting or supervision with transfer may be required] The clients may use a bath tub, a shower or take a complete sponge bath. The clients must be able to do all the steps of whichever method is employed without another person being present [client may use specialize equipment, long handle sponge to wash legs and feet. Clients is able to complete all steps independently, and may take up to twice the normal time to complete the tasks]

1

3

4

5

SCORE 0

JUSTIFICATION Dependent in all aspects and needs to be fed Clients only chews and swallow food while an assistant scoops all the food and bring it to mouth. Maximal help with tube feeding such as pouring, connecting, purging, regulating the rate is required] Can manipulate an eating device, usually a spoon, but someone must provide active assistance during the meal [clients can bring food to mouth but an assistant scoops all food onto the utensil] Able to feed self with supervision. Assistance is required with associated tasks such as putting milk and sugar into tea, adding salts and pepper, spreading butter, turning a plate or other set up activities [clients scoop food, brings it to mouth, and eats. May need assistance with pouring, drinking, opening containers and/or cutting meat, with application of cuff, orthosis, and prosthesis. Assistance with set up is required. Standing by cueing, coaxing and supervision throughout meal may be required for possible choking and eating in hurry] Independence in feeding with prepared tray except assistance may be required to cut meat, open milk carton, jars lid, etc. presence of other person is not required [longer than usual time is taken to eat. They may be some concerns for safety due to quality of swallowing or may require modified food for consistency, but no further help from assistant is required] The clients can feed self from a tray or table when someone puts the food within reach. The client must put on an assistive device if needed, cut the food, and if desired, use salts and pepper and spreads butter, etc [the clients is able to use spoon. Fork cup, glass, long straw, adapted devices, cuff, open containers, pours liquid, and cuts meat with no risk. No help is required]

2

5

8

10

SCORE 0 2

JUSTIFICATION

Fully dependent in toileting [clients is dependent in all aspects of toileting Assistance required in all aspects of toileting [clients requires maximal assistance with transfers, clothing adjustment, use of toilet paper and perineal hygiene] Assistance may be required with management of clothing, transferring or washing hands [supervision and assistance with transfer/balance while washing hands, adjusting clothing, with zipping/unzipping fly/skirt, may be required] Supervision may be required for safety with normal toilet. A commode may be used at night but assistance is required for emptying and cleaning [supervision for safety, initial preparation such as handing the clients the toilet tissue may be required. May use a commode at night. Prompting and cueing to locate toilet may be required The clients is able to get on and off the toilet, fasten and unfasten clothes, prevent soiling of clothes and use of toilet paper without help. If necessary, the clients may use a bed pan or commode, or urinal at night, but must be able to empty it and clean it [clients adjust clothing prior to using the toilet, wipes front or back, approaches, gets on and off the toilet, adjust clothing after using the toilet, and fastens clothing. Can use required equipments such as tongs, dressing stick, zipper-pull, or grasp bars. Maintains balance and is safe]

5

8

10

SCORE 0 2

JUSTIFICATION

The clients is unable to climb stair [the stairs imply a flight of stairs] Assistance is required in all aspects of stairs climbing, including assistance with walking aids The clients is able to ascend/descend but is unable to carry walking aids, and needs supervision and assistance Generally no assistance is required. At times, supervision is required for safety due to morning stiffness, shortness of breath, etc The clients is able to go up and down a flight stairs safely without help or supervision . The clients is able to use handrails, cane or crutches when needed and is able to carry these devices as he/she ascends or descends

5 8

10

SCORE 0

JUSTIFICATION The clients is dependent in all aspects of dressing and is unable to participate in the activity [clients may lean forwards, backwards, may be able to use bed side rails, may thread a sleeve, or bring a garment together, but assistance dresses the clients totally . If clients wears a gown the score is 0] The clients is able to participate to some degree, but is dependent in all aspect of dressing [clients may requires maximal assistance in set up dressing. Clients may wear a shirt on his upper body and thread the sleeves, but assistance bring it over the head. Clients can thread bra straps but the assistant fits and fasten the bra hook. Clients may assist pulling the pants leg but the assistant completes the lower limb dressing] Assistance is needed in putting on and/or removing any clothing [assistance is needed in obtaining clothing, applying devices, and initiating and completing upper and lower extremity dressing and undressing] Only minimal assistance is required with fastening clothing, such as buttons, zips, bro, shoes, etc [clients may required start up assistance but clients dresses and undresses. Assistance may obtain clothing from the closet, may assist in application of orthotics or prosthesis, and may assist with fastening, clothing, buttons, zips, bra, etc. coaxing prompting and/or cueing on sequencing may be required and dressing may take up three times the normal time] The clients is able to put on, remove and fasten clothing and shoe laces, or put on, fasten and remove corset or braces as prescribed [clients is able to obtain clothes, put on, remove and fasten clothing and shoe laces or put on, fasten and remove corset, brace, or prosthesis as prescribed, clients manages underpants, slacks, skirt, belt, stocking and shoe laces. Clients manages bra turtle necks, zippers, buttons and snaps, and can use special adaptive closure such as Velcro and zipper pull, and dressing stick, reacher, sock aid, and complete task in reasonable time]

2

5

8

10

SCORE 0 2

JUSTIFICATION

The clients is bowel incontinent [the clients needs to wear diapers or absorbent pads] The clients needs help to assume appropriate position, and with bowel movement facilitatory techniques [despite assistance, clients may be soiled frequently and necessitates wearing absorbent pads] The clients can assume appropriate position but cannot use facilitatory techniques or clean self without assistance and has frequent accidents. Assistance is required with incontinence aids, such as pads, etc [clients can assume position, but has occasional accidents, need assistance to clean self and/or to apply incontinence aids] The clients may require supervision with the use of suppository or enema and has occasional accidents [clients requires supervision with the use of suppository, enema or an external device. Bowel accidents are rare and prompting, cueing and adherence to the routine to maintain continence may be required] The clients can control bowels and has no accidents. Can use suppository or take enema when necessary [clients can control bowels completely and intentionally and has no accidents, can use digital stimulation or stool softeners, suppositories, laxative use, or enemas on a regular basis. If clients has a colostomy he/she maintains it]

5

8

10

SCORE

JUSTIFICATION

0

The clients is dependent in bladder management, is incontinent or had indwelling catheter [clients may be catheterized, is incontinence of urine day and night, wet on daily basis. External catheter, drainage bag, night bag, all requires to be cared for by assistant] The clients is incontinent but is able to assist with the application of an internal or external device [clients requires to be positioned but can hold bed pan or urinal in place. External urinary drainage devices, tubing, drainage bag, all require to be cared for. Clients is incontinence but able to assist with the applications of devices] The clients is generally dry by day, but not at night, and needs some assistance with the devices [clients void but needs help in positioning self, equipments, pads, and other devices. Can place pennies in the urinal, hold leg apart, insert catheter, and is occasional incontinent. Coaxing, cueing and supervision may be required] The clients is generally dry by day and night, but may have an occasional accident, or need minimal assistance with internal or external devices [if unable to find toilet or if not quick enough, clients may have an accident. May require minimal assistance with set up and/or devices, may need medication to maintain voiding pattern. Prompting, cueing and adherence to the routine to maintain continence may be required] The clients is able to control bladder day and night and/or is independent with internal or external devices. [clients is independent is continent, and independent in the use of equipment required and use of medications. Is able to change pads, diapers, before soiling

2

5

8

10

SCORE

JUSTIFICATION

0 3 8 12

Unable to participate in transfer. Two assistance are required to transfer the clients with or without a mechanical device Able to participate, but maximum assistance of one other person is required in all aspects of the transfer The transfer requires assistance of one other person . Assistance may be required in any aspect of the transfer The presence of another person is required, either as a confidence measure, or to provide supervision for safety [can position sliding boards or move footrest or set-up, position chair and lock brakes. Minimal help is required] The clients can safely approach the bed in wheelchair, lock the brakes, lift the footrest, move safely to bed, lie down, come to a sitting position on the side of the bed, change the position of the wheelchair, transfer back into it safely. The clients must be independent in all phases of the activity [clients can come to a standing position if walking is the mode of locomotion. If walking, client approaches, sit down, and gets to a standing position from a regular chair, transfer from bed to chair, perform tasks safely. Can approach, enter and leave a tub or shower stall. Clients may use a sliding board, a lift, grab bars, or special seat. Clients may take more than the usual time, but less than three times the usual time to perform tasks]

15

SCORE 0 3 8

JUSTIFICATION Dependent in ambulation [clients just not ambulate, to attend to ambulate, required two assistance] Constant presence of one or more assistance is required during ambulation [clients requires maximal assistance to ambulate] Assistance is required with reaching aids and/or their manipulation. One person is required to offer assistance [clients requires assistance to reach for walking aids and to provide a steadying effect around corners, over thresholds and over rougher terrains but is able to ambulate] The clients is independent in ambulation but unable to walk 50m without help or supervision is needed for confidence or safety in hazardous situations [clients may require cueing and prompting and more than reasonable time to complete distances] The clients must be able to wear braces if required, lock and unlock these braces, assume standing position, sit down and place the necessary aids in positions for use. The clients must be able to use crutches, canes or a walkerette and walk 50m/yards without help or supervision [clients walk length of corridor back and forth. There is no concerns for safety, falling or wandering. Clients independent with walker, cane prosthesis, orthosis, special shoes, etc]

12

15

Do not score ambulation if clients is unable to ambulate and is trained in wheelchair management

SCORE 0 1

JUSTIFICATION Dependent in wheelchair ambulation The clients can propel self short distances on flat surface but assistance is required for all other steps of wheelchair managements [assistance needs to push wheelchair for the majority of the time, is especially required to apply brakes, adjust armrest, cushion, maneuver around furniture, over ledges, loose rugs, and rougher terrains] Presence of one person is necessary and constant assistance is required to manipulate chair to table, bed, etc [ clients can propel wheelchair, but need assistance with maneuvering in and around furniture and in limited spaces] The clients can propel self for a reasonable duration over regularly encountered terrain . Minimal assistance may be required in tight corners [occasional verbal prompting and assistance with maneuvering in limited space may be required] To propel wheelchair independently the client must able to go around, maneuver the chair to a table, bed, toilet, etc. the clients must be able to push the chair at least 50 m/yards.

3

4

5

Not applicable if clients is able to ambulate