Key Formulas & Equations
Total FIM: Range 18-126 (18 = total dependence; 126 = complete independence)
Motor FIM: 13 items (eating, grooming, bathing, dressing, toileting, bladder, bowel, transfers, locomotion)
Cognitive FIM: 5 items (comprehension, expression, social interaction, problem solving, memory)
Feeding: 10 = Independent; 5 = Needs help; 0 = Dependent
Bathing: 5 = Independent; 0 = Dependent
Grooming: 5 = Independent; 0 = Dependent
Dressing: 10 = Independent; 5 = Needs help; 0 = Dependent
Bowels: 10 = Continent; 5 = Occasional accident; 0 = Incontinent
Bladder: 10 = Continent; 5 = Occasional accident; 0 = Incontinent/catheterized
Toilet use: 10 = Independent; 5 = Needs help; 0 = Dependent
Transfers: 15 = Independent; 10 = Minor help; 5 = Major help; 0 = Unable
Mobility: 15 = Independent; 10 = Wheelchair independent; 5 = Walks with help; 0 = Immobile
Stairs: 10 = Independent; 5 = Needs help; 0 = Unable
Activity of Daily Living (ADL) Categories:
Basic ADLs: Dressing, bathing, eating, grooming, toileting, transferring
Instrumental ADLs: Cooking, cleaning, shopping, managing money, using phone, transportation
Range of Motion (ROM): Measured with goniometer
Spasticity (Modified Ashworth Scale): 0 = No increase in tone; 1 = Slight increase; 1+ = Slight increase with catch; 2 = More marked increase; 3 = Considerable increase; 4 = Rigid
Core Concepts
Model of Human Occupation (MOHO)
A theoretical framework explaining how occupation is motivated, patterned, and performed. Includes volition, habituation, and performance capacity.
Occupational Performance
The ability to carry out activities of daily living, work, leisure, and social participation. Assessed and addressed through therapeutic intervention.
Adaptive Equipment
Devices that assist with daily activities: reachers, dressing aids, adapted utensils, grab bars, and environmental control units.
Sensory Integration
Theory explaining how the brain processes sensory information. Used in pediatric OT for children with sensory processing difficulties.
Hand Therapy
Specialized rehabilitation of the upper extremity. Includes splinting, exercise, scar management, and activity modification.
Pediatric Occupational Therapy
Treatment of children with developmental delays, sensory processing disorders, autism, and learning difficulties through play-based therapy.
Ergonomics
The science of fitting the job to the worker. Includes workstation assessment, body mechanics training, and injury prevention.
Community Reintegration
Helping clients return to community life after illness or injury. Includes vocational rehabilitation, driving assessment, and social skills training.
Worked Examples
Example 1: Barthel Index
Problem: Patient scores: Feeding 10, Bathing 5, Grooming 5, Dressing 10, Bowels 10, Bladder 5, Toilet 10, Transfers 15, Mobility 15, Stairs 5. Calculate total.
Solution:
Total = 10 + 5 + 5 + 10 + 10 + 5 + 10 + 15 + 15 + 5 = 90/100
Interpretation: Mild dependence (61-90 = mild dependence)
Example 2: FIM Interpretation
Problem: A patient has Motor FIM = 70 and Cognitive FIM = 30. Interpret the scores.
Solution:
Motor FIM 70/91 = Modified independence to minimal assistance
Cognitive FIM 30/35 = Modified independence to minimal assistance
Example 3: ROM Measurement
Problem: Shoulder flexion: start 30°, end 150°. Calculate ROM.
Solution:
ROM = 150° - 30° = 120° (normal shoulder flexion: 180°)
Practice Problems
Problem 1
Interpret Barthel Index score of 45.
Answer: Severe dependence (0-40 = severe dependence; 41-60 = moderate dependence)
Problem 2
Calculate ROM for elbow flexion: start 10°, end 140°.
Answer: ROM = 140° - 10° = 130°
Problem 3
Identify the difference between basic ADLs and instrumental ADLs.
Answer: Basic ADLs = self-care tasks (dressing, bathing); Instrumental ADLs = complex life skills (cooking, managing money)
Problem 4
Interpret Modified Ashworth Scale score of 2.
Answer: More marked increase in muscle tone through most of ROM, but affected part easily moved
Problem 5
Calculate total FIM if Motor = 85 and Cognitive = 32.
Answer: Total FIM = 85 + 32 = 117/126
Problem 6
What does a COPM performance score of 3 indicate?
Answer: Able to perform the activity but with difficulty or modifications (1-10 scale)
Problem 7
Calculate grip strength average if trials are: 20 kg, 22 kg, 24 kg.
Answer: Average = (20 + 22 + 24)/3 = 22 kg