Activity

Score

Feeding
0 = unable
5 = needs help cutting, spreading butter, etc., or requires modified diet
10 = independent

Bathing
0 = dependent
5 = independent (or in shower)

Grooming
0 = needs to help with personal care
5 = independent face/hair/teeth/shaving (implements provided)

Dressing
0 = dependent
5 = needs help but can do about half unaided
10 = independent (including buttons, zips, laces, etc.)

0     5     10

Bowels
0 = incontinent (or needs to be given enemas)
5 = occasional accident
10 = continent

0     5    10

Bladder
0 = incontinent, or catheterized and unable to manage alone
5 = occasional accident
10 = continent

Toilet Use
0 = dependent
5 = needs some help, but can do something alone
10 = independent (on and off, dressing, wiping)

Transfers (bed to chair and back)
0 = unable, no sitting balance
5 = major help (one or two people, physical), can sit
10 = minor help (verbal or physical)
15 = independent

Mobility (on level surfaces)
0 = immobile or < 50 yards
5 = wheelchair independent, including corners, > 50 yards
10 = walks with help of one person (verbal or physical) > 50 yards
15 = independent (but may use any aid; for example, stick) > 50 yards

Stairs
0 = unable
5 = needs help (verbal, physical, carrying aid)
10 = independent

0     5     10

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