AlphaFIM®

Case Study

Examples

Scenario : Jim is an 80 year old male with a long history of

diabetes mellitus. He presents with a left hemisphere stroke with

right –sided weakness and expressive aphasia. Functional

assessment on admission included the following observations:

Eating: Jim is on a diabetic diet with 2000 calories per day. A helper opens

Jim’s containers and cuts his meat, after which Jim finishes his meal

without further assistance

AlphaFIM® rating = 5

Rationale: Jim requires ‘set up' of his meal but no further assistance Which places him at Level 5 ‘supervision /set up’

Grooming: A helper sets up Jim’s grooming supplies in the

bathroom.

Jim washes, rinses and dries his face and hands; he also combs his

own hair and brushes his teeth. The nurse must shave Jim

AlphaFIM® Rating = 4

Rationale: Again Jim requires set up which would place him at a Level 5 but he requires assistance with shaving which places him

at a Level 4

Bowel Management: Jim is constipated because of limited mobility since his stroke.

He takes a laxative every day, uses the toilet and is continent

of stool. Jim has not had an accident.

AlphaFIM Rating® = 6

Rationale:Jim needs a laxative to assist with bowel movements. This is considered a medical ‘agent’and so is rated at a Level 6,

assisted device.

Note: ‘natural’ agents e.g. prune juice and high fibre diets are

NOT considered assistive devices for bowel management.

Transfers Bed,Chair: During the day, Jim transfers from his bed to a chair with contact

guard assistance from a helper. At night, when Jim is more

fatigued , he requires lifting assistance to stand, and a helper lifts

Jim’s right leg into bed.

AlphaFIM® Rating = 3

Rationale: Although Jim needs only contact guard assistance during the day which would put him at Level 4, he needs lifting

assistance to stand and a helper places his leg on the bed

which puts him at the lower rating of Level 3.

Transfers:Toilet Jim requires assistance to transfer on and off the toilet. A helper

provides close supervision as Jim transfers from sitting to standing

and provides contact guard assistance as Jim completes the

transfer.

AlphaFIM® Rating = 4

Rationale: Although Jim requires just close supervision to transfer from sitting to standing (Level5)he requires contact

guard assistance to complete the transfer, Level 4.

Locomotion: Walk Jim walks 150 feet. A helper advances Jim’s right foot at the end

of long walks.

AlphaFIM® Rating = 3

Rationale: Although Jim is walking 150 feet, at the end of the walk the helper has to advance his foot forward, which is

considered moderate assistance i.e. the patient performs 50% -

74% of walking effort.

(If the helper only occasionally moved the foot forward this

would be classified as Level 4)

Expression: Jim has difficulty expressing himself . He uses simple gestures and

short phrases to communicate his needs and requires prompting

more than half of the time.

AlphaFIM® Rating = 2

Rationale: Using simple gestures and needing prompting for over 50% of the time places him under Maximal prompting,

Level 2.

Memory: Jim recognizes his therapists, physician, friends and family, but

requires direction throughout the day to remember his daily tasks.

He requires prompting to sequence basic activities, such as

bathing and transfer techniques, more than half the time.

AlphaFIM® Rating = 2

Rationale: As Jim requires assistance to remember to sequence basic activities more than 50% of the time, he requires

maximal assistance ( patient performs task 25%-49% of time)

In this case scenario which items

would you NOT rate to get a

projected full FIM rating?

Answer= Eating

Grooming

Rationale: Jim is walking 150 feet and therefore the Eating and Grooming items are replaced by Transfers: bed,chair and Walking

Bowel management = 6

Transfers:Bed,Chair = 3

Transfers: Toilet = 4

Locomotion: Walk = 3

Expression = 2

Memory = 2

PORTAL

RawMotor= 52 Raw Cognition = 12 64

Hours of Help Needed = 3-4 hours

Level of Severity (Garraway et al. 1981,1985)

Mild Moderate Severe

“upper band” “Middle Band” “Lower band”

Early FIM® Score

(Ween et al 1996) > 80 40-80 <40

Early Motor FIM®

(Stineman 1998) >62 38-62 < 38

Triage - Background

Alpha FIM® score > 80 = outpatient

rehabilitation

Alpha FIM® score 40-80= inpatient

rehabilitation

Alpha FIM® score 40-60= ? Inpatient

rehabilitation

Alpha FIM® score <40= options for

restorative/ongoing assessment

Stroke Reference Group Recommendations

In this case scenario Jim had a projected FIM rating of 64

and needs 3-4 hours of help.

• How would you describe Jim’s level of stroke severity?

Mild?

Moderate?

Severe?

• Would Jim be considered a suitable candidate for

inpatient rehabilitation?

Using the Stroke Reference Group recommendations

• Determine the level of stroke severity

• Appropriate discharge destination

for the following case scenarios:

Alessandro is 70 years old and suffered a Rt. sided stroke

(ischemic infarct, left hemisphere) He lives with his wife

and has 2 adult children and 4 grandchildren. Both his

son and daughter live close by.

6 Item rating

Transfers Bed, Chair = 4

Locomotion, walk = 4

Bowel = 4

Transfers, toilet= 4

Expression = 5

Memory = 5

Raw Motor = 49

Raw cognition = 26

Help needed = 2-3 hours

Projected Full FIM = 75

Scenario A

Edith is an 83 year old lady with Lt sided stroke (ischemic infarct, Rt.

hemisphere). She lives alone in an apartment, but has a daughter that

lives nearby. Her daughter is married, has 3 teenage sons and works

fulltime.

Eating= 1

Grooming=2

Bowel = 2

Transfers, toilet = 1

Expression = 5

Memory = 2

6 item rating: Raw Motor = 18

Raw Cognition = 18

Help Needed= 6-7hrs

Projected Full FIM = 36

Scenario B

Amir is 55 years old, he experienced a Rt. sided stroke.

(Ischaemic infarct, Lt. hemisphere)

He is married and lives with his wife and four adult

children. He works in management in the hospitality

industry.

6 Item rating

Transfers Bed, Chair = 6

Locomotion, walk = 6

Bowel = 7

Transfers, toilet = 6

Expression = 3 Memory = 4

Raw Motor = 74

Raw cognition = 19

Help needed = <1 hours

Projected Full FIM = 93

Scenario C

Mike is a 60 year old accountant with left sided stroke.

(hemorrhagic stroke, Rt. hemisphere) He is married with four

children and three grandchildren. Mike is an avid skier and

golfer.

6 Item rating

Eating = 2

Grooming = 2

Bowel = 2

Transfers, Toilet = 2

Expression = 7

Memory = 7

Raw Motor =24

Raw cognition = 35

Help needed = 4-5 hours

Projected Full FIM = 59

Scenario D