Activity/Question | With some difficulty | With much difficulty |
---|---|---|
3. Are you able to stand up from a chair without support? | a. With the support of one hand against the chair | a. With the support of both hands against the chair |
b. Succeed on the second attempt | b. Uncertainty / fear exists | |
c. Succeeds only on the third attempt or more | ||
4. Are you able to get in and out of bed? | a. Uses own technique of raising | a. Needs to take support in some way |
b. Succeed on the second attempt | b. Must use a different technique than usual | |
c. Succeeds only on the third attempt or more | ||
5. Are you able to cut your own meat? The meat is replaced with half an orange. Ordinary knife is used | a. A little clumsiness | a. Greater clumsiness, dropping of utensils |
b. Somewhat difficult with the grip | b. Uncoordinated cutting | |
c. Succeed on the second attempt | c. Very difficult to grip | |
d. Succeeds only on the third attempt or more | ||
6. Can you cook your own food? Patients prepare a soup according to recipe. Normal cooking time 10 min | a. A little clumsiness | a. Greater clumsiness, drops the utensils |
b. A bit difficult with grip and handling of pans and utensils | b. Difficult to open, to lift, must exert oneself | |
c. Hard to open a bottle, succeeds on the second try | c. Succeeds first on third attempt or more | |
7. Are you able to lift a full cup or glass to your mouth? | a. A little clumsiness | a. Overflows |
b. Uses an unusual grip | b. Uses both hands | |
8. Are you able to walk five steps down a stairway? | a. Little uncertainty exists | a. Holds on to the railing |
b. Watches carefully when taking a step | b. Takes one step at a time | |
c. Is very uncertain/afraid | ||
9. Are you able to walk outdoors on flat ground? | a. Pays close attention to the ground while walking | a. Very unstable |
b. A little unsteady | b. Not able to walk more than 15–20 m | |
c. Walks with caution | c. Fear of falling exists | |
10. Are you able to take a bath? Simulated in bathtub | a. A bit difficult to take the step over, succeeds on the second attempt | a. Succeeds on the third attempt to take the step over |
b. Careful when he / she sits down, supports with both hands | b. Supporting oneself with both hands on the bathtub edge to get in | |
c. Little uncertainty | c. Very difficult to get up, succeeds on the third attempt | |
d. Manages to get up on the second attempt | d. Very uncertain/afraid | |
11. Are you able to get on and off the toilet? | a. A little cautious, looking for some support with one hand | a. Takes support with both hands |
b. Manages to get up on the second attempt | b. Sits uncontrollably | |
c. Manages to get up on the third attempt | ||
12. Are you able to wash and dry your body? Simulated | a. A little clumsiness with soap and shampoo | a. Does not reach multiple body parts, > 2 |
b. Not able to reach everywhere (not back and feet) but almost | b. Very difficult with the balance when drying | |
c. Needs to sit | ||
13. Are you able to take a 2-k bag of sugar of a shelf at head height? | a. Takes help of both hands | a. Risk of dropping the bag due to weak grip |
b. Uses an unusual grip | b. Succeeds on the third attempt or more | |
c. Some effort succeeds on the second attempt | ||
14. Are you able to bend over to pick up clothing from the floor? | a. Some effort | a. Losing the grip |
b. Little clumsiness | b. Risk of fall | |
c. Succeed on the second attempt | c. Succeeds on the third attempt or more | |
15. Are you able to open car doors? | a. Difficulty with the grip, losing the grip, succeeding on the second attempt | a. Very heavy, using both hands |
b. Little difficult, it’s heavy | b. Succeeds on the third attempt | |
16. Are you able to open previously opened jars? | a. Not directly, succeeds on the second attempt | a. Greater clumsiness |
b. Little clumsiness | b. Uses both hands | |
c. Takes an unusual technique (for example holding the jar against the body) | c. Risk of dropping the jar due to the grip | |
17. Are you able to turn a water tap on and off? | a. Uses an unusual grip | a. Uses both hands |
b. Losing the grip | b. Succeeds on the third attempt or more | |
c. Succeeds on the second attempt | ||
18. Are you able to vacuum? Tested on delimited surface, same for all patients | a. Weak grip | a. Loses the grip |
b. Somewhat difficult to pull the vacuum cleaner | b. Very difficult to pull the vacuum cleaner | |
c. Not able to reach under low furniture | c. Takes short breaks | |
d. Uses an unusual technique (e.g. hose around waist) | d. Not able to reach everywhere on free surfaces | |
20. Are you able to get in and out of a car? | a. Uses an unusual technique | a. Sits uncontrollably |
b. Some risk of hitting the head | b. Losing balance | |
c. Succeeds on the second attempt | c. Risk of falling | |
d. Great risk of hitting the head | ||
e. Succeeds on the third attempt or more when raised |