Acute Care Index of Function (ACIF) Administration A. General guidelines 1.

The patient information section should be completed on initiation and discharge 2. Appropriate rating should be indicated on data sheet and subsets and total scores computed and recorded. 3. Place of evaluation, equipment and special circumstances should be noted in comments section. 4. Initial evaluations should be completed within 24 hours of initial patient contact. 5. Follow-up evaluation should be performed as follows: a. on a 7 day interval b. within 48 hours of discharge 6. The order of administration of items may be varied according to circumstances. All items should be completed within 24 hours. 7. The patient should be informed before taking the ACIR that the task performance will be rated. 8. Instructions should be given verbally or visually by the rater before asking the patient to perform the task. 9. No time constraints exist for completion of any test item. 10. If a patient cannot be tested on a given item because of some factor other than his own physical ability, an asterisk should be placed next to the item and a noted made in the comments section. Ex include: unable to test stair climbing because of IV treatment; Unable to test standing balance because of physicians order fo r bed-rest, and patient refused. 11. When testing patients who cannot follow directions, rating of test items will be done by observation over a 24 hour period and noted in the comments section. 12. Mental status items should be evaluated first. 13. Impaired safety awareness is assessed throughout administration of the test. B. Operational definitions (see text) C. Directions for mental status evaluation 1. Guidelines a. Mental status items measure the presence or absence of a defined behavior (yes=present, no=absent) b. If a patient can follow verbal commands as defined, he/she is also given credit for ability to follow commands. c. If a patient cannot follow verbal commands, he/she must be tested for ability to follow commands as defined. d. In rating ability to learn, the patient is given a yes if he/she demonstrates the ability to initiate the sequences of steps of the task given up to 24 hours earlier. e. In rating impaired safety awareness, the patient is given a yes if he/she requires verbal or physical intervention during administration of the evaluation. 2. Directions a. Able to follow verbal commands: The therapist verbally instructs the patient to perform one of the following: 1. Close your eyes 2. Open your eyes 3. Lift your arm 4. Lift your leg The task should be within the patients capabilities. The command may be given no more than twice. b. Able to follow commands with visual cueing> The therapists gives on of the above verbal commands while simultaneously performing the motor task. No physical contact with the patient is allowed. The command may be given a maximum of three times. c. Able to learn: The patient is informed that he/she will be given a task and will be expected to remember how to perform the task later. On initial contact, the patient is instructed in a sequence of steps to a motor task. Within 24 hours, the patient is asked to perform the initial step of the task without assistance. The task should be appropriate to the patients physical status. d. Impaired safety awareness: Because of impaired judgment, the patient requires supervision in performing any functional task to ensure safety (ie, to avoid situations that could potentially harm the patient) D. Directions for physical function evaluation 1. Guidelines a. The patient is not allowed to use bedrails, tables, or armrests during performance of items a-c, f-n b. The patient may use any method that is functional to carry out a task. c. Note that rating of physical assistance for sitting or standing balance applies to patients who require assistance to maintain the position and patients who cannot meet the other stated criteria.

Acute Care Index of Function (ACIF) d. In rating transfers, the rater is allowed to perform the necessary setup for a transfer if the patient is not being tested specifically on wheelchair setup. e. The patient can be tested with any mobility devices that are functional for him/her. f. In rating gait with or without a device, the patient may use any prosthesis or orthosis necessary. Directions a. Rolling supine to right and to left: Patient is positioned supine. Patient is asked to roll from supine to right side. Patient is asked to roll from supine position to left side. b. Supine to sit: Patient is positioned supine. Patient is asked to come up to a sitting position on side of supporting surface. c. Sit to supine: Patient is sitting on the side of the supporting surface. Patient is asked to lie down. d. Transfer from wheelchair or chair to bed or mat: Patient is sitting in wheelchair. Patient is asked to move from wheelchair to mat. e. Transfer from bed or mat to wheelchair or chair: Patients is sitting on edge of the supporting surface, Patient is d to move from mat to wheelchair. f. Sit to stand: Patient is seated on support surface. Patient is asked to come to the standing position. g. Stand to sit: Patient is standing with back to supporting surface. Patient is asked to sit. h. Sitting balance: Patient is asked to maintain balance unsupported while seated on edge of mat with feet flat on floor. Patient clasps hands together (assistance may be given). Patient reaches forward then returns to balanced position. Repeat process reaching forward and to right. Repeat process reaching forward and to left. i. Standing balance: Patient is asked to maintain balance unsupported while standing. Patient is instructed to clasp hands together (assistance my be given). Patient lifts arms in midline to shoulder height. Patient reaches forward in midline and returns to starting position. Patient repeats the lift, then reaches forward and to the left, and forward and to the right. j. Gait with device: Patient is asked to ambulate with any assistive device necessary including an orthosis, prosthesis or parallel bars for a distance of 50 on a level surface. Within this distance, patient must turn around 180* one time and walk backwards three steps. A patient who ambulates with the parallel bars may only receive A grade of dependent even if he/she meets all other criteria. k. Gait without device: Patient is asked to ambulate without an assistive device, except for orthosis or prosthesis for a distance of 30 to 50 on a level surface. Within this distance, patient must turn around 180* one time and walk backwards three steps. l. Ascend stairs: Patient is asked to ascend five stairs. Patient may use handrails or any assistive device necessary. m. Descend stairs: Patient is asked to descend five stairs. Patient may use handrails or any assistive device necessary. n. Wheelchair mobilitysetup: Patient approaches surface to transfer appropriately, locks brakes, and removes necessary wheelchair parts to transfer. o. Wheelchair mobilitypropulsion: Patient propels wheelchair a distance of 30 to 50 on a level surface. The patient must then display the ability to propel backward, turn around 180* and maneuver corners to the right and left.

2.

Acute Care Index of Function (ACIF) Name: Date:

Mental status score Bed mobility score Transfer score Mobilty score 6 Total score

Subset Mental status

Item Follow verbal directions Follow verbal directions with visual cueing Ability to learn Impaired safety awareness Roll supine to right Roll supine to left Supine to sit Sit to supine Wheelchair to mat or bed Mat or bed to wheelchair Sit to stand Stand to sit Sitting balance Standing balance Gait with device Gait without device Ascend stairs Descend stairs Set up wheelchair Propel wheelchair

Date: Yes 2 1 2 0 Unable 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

No 0 0 0 1 Dep (Assisted) 4 4 4 4 5 5 5 5 5 5 14 21 7 7 7 14

(sum)/6 =

Indep. 10 10 10 10 10 10 10 10 10 10 20 30 10 10 10 20 (sum)/ 40 =

Bed mobility

Transfers

(sum)/ 50=

Mobility

(sum)/ 100= No stairs (sum)/ 80=

KEY: Unable: Patient cannot physically assist to perform the activity Dependent/Assisted: Patient assists to perform the activity but requires physical or verbal assistance to complete the activity Independent: Patient performs the activity meeting all stated criteria without verbal or physical assistance.

Score interpretation for discharge: 71 or >: Home > Rehabilitation 31-70: Rehabilitation> Nursing Home> Home <30: Nursing home

Roach KE, VanDillen LR. Development of an Acute Care Index of Functional Status for Patients with Neurologic Impairment. Phys Ther. 1988; 68: 1102-1108.