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Can you do the following tasks? For each item score the lowest category which applies. Sit unsupported with feet on floor. Can you sit to stand.
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able to sits safely and securely for 2 minutes 4 no hands and stabilises independently 4 able to sit 2 minutes under supervision 3 stand independently using hands 3 able to sit 30 seconds 2 stand using hands after several tries 2 Able to sit 10 seconds 1 minimal assistance to stand or stabilise 1 Unable to sit without support for 10 seconds 0 moderate or maximal assistance to stand 0
Able to stand safely for 2 minutes 4 feet together independently, stand for > 1 m 4 Able to stand for 2 minutes with supervision 3 feet together independently, stand for 1m + SB 3 Able to stand 30 seconds unsupported 2 feet together independently, stand < 30 s 2 several tries to stand 30 seconds unsupported 1 Assistance to attain position, stand > 15 s 1 Unable to stand 30 seconds unassisted 0 Assistance to attain position, stand < 15s 0
Able to stand 10 seconds safely 4 Can reach forward confidently > 26cm 4 Able to stand 10 seconds with supervision 3 Can reach forward > 13 cm 3 Able to stand 3 seconds 2 Can reach forward >5 cm 2 Eyes closed < 3 seconds but stays steady 1 Reaches forward but needs supervision 1 Needs help to keep from falling 0 Needs help to keep from falling 0
transfers safely with minor use of hands 4 Sits safely with minimal use of hands 4 transfers safely with definite need of hands 3 Controls descent by using hands 3 transfers with verbal cueing and/or SB 2 Uses back of legs against chair to control descent
Needs one person to assist 1 Sits independently, uncontrolled descent 1 two people to assist or supervise to be safe 0 Needs assistance to sit 0
Able to pick up object safely and easily 4 Look behind from both sides + weight shift 4 Able to pick up object but needs SB 3 Looks behind one side only, - weight shift 3 Unable to pick up but keeps balance 2 Turns sideways only but maintains balance 2 Unable to pick up and needs SB 1 Needs SB when turning 1 Unable to try and max assist 0 Needs assistance while turning 0
Able to turn 360 degrees < 4s 4 Safely completes 8 steps < 20s 4 Able to turn 360 degrees one side only < 4s 3 Safely completes 8 steps > 20s 3 Able to turn 360 degrees safely and slowly 2 Completes 4 steps without aid + SB 2 Needs close SB or verbal cueing 1 Completes 2 steps needs minimal assistance 1 Needs assistance while turning 0 Needs assistance to keep from falling 0
Tandem step independently > 30s 4 Able to lift leg independently, hold > 10s 4 Foot in front > 30s 3 Able to lift leg independently, hold > 5s 3 Small step in front > 30s 2 Able to lift leg independently, hold > 3s 2 Needs help to step, hold for > 15s 1 Attempts to lift leg independently, hold < 3s 1 Loses balance while stepping or standing 0 Unable to try 0