Addendum C
Definitions for the Stroke Rehabilitation Flowsheet
A. Mobility
Mobility:
Refers to ability to get in/out of bed, walk or use a wheelchair, navigate
stairs or curbs, and get on/off various surfaces (chairs, car, toilet, etc.)
Encompasses the ability to complete the tasks safely and with no balance
or safety deficits.
Mobility (using Functional Independence Measure [FIM] definitions):
NO Helper Required:
 Independence - uses no device, and performs activities in a safe &
timely manner
 Modified Independent - person uses a device (walker, wheelchair,
cane, reacher, etc.) to complete task but no assist from helper
Helper Required:
 Supervision – supervision or cues to perform tasks, but no hands-on
assist by helper
 Minimal (min) Assist -person does 75% or more of the task
 Moderate (mod) Assist - person does 50% or more of the task
 Maximal (max) Assist - person does 25% or more of task
 Total Assist - person does <25% or requires two staff to assist with task
B. Self Care Definitions
Activities of Daily Living (ADLs):
Self-maintenance tasks that are typically a part of everyday life. These
include grooming (shaving/make-up/hair care), oral hygiene, bathing or
showering, toilet hygiene, dressing, feeding/eating, adhering to a
medication routine, responding to personal emergencies, functional
mobility, and sexual expression.
Instrumental Activities of Daily Living (IADLs):
More complex daily tasks that must be performed to enable an individual
to live independently in the community. IADL activities include meal
preparation tasks, house cleaning routines, laundry tasks, general
household chores (handling garbage/yard care), communication
activities (telephone use/handling mail/using computer), financial
responsibilities, emergency procedures and community level activities
including shopping and driving (or bus or taxi management).
Addendum C
C. Continuum of Care Criteria
Criteria for inpatient rehab program admittance:
1. Patient requires close medical supervision by a physician with
specialized training or experience in rehabilitation
2. Patient requires twenty-four hour rehabilitation nursing
3. Patient requires relatively intense level of rehabilitation services (can
benefit from and can tolerate at least three hours of therapy at
least five days per week)
4. Patient requires a multidisciplinary team approach to delivery of
program (needs at least two kinds of skilled therapy PT, OT and/or
speech)
5. Patient requires a coordinated program of care (needs team
conferencing)
6. It is expected that there will be significant practical improvement
(anticipate patient can improve to discharge to his/her previous
living setting with or without the help of caregiver[s])
7. Patient and providers have realistic goals (goals that can
reasonably be accomplished in an inpatient setting)
Subacute Criteria:
1. Patient requires physician, physician’s assistant, or nurse practitioner
oversight two or more times per week
2. Patient requires 4 hours of skilled nursing care per day or one to two
hours of skilled therapy services per day at least 5 days per week
3. Treatment plan is developed within 2 days of admission
4. Daily documentation of patient treatment and weekly summary of
patient response necessary
5. Weekly discharge planning with interdisciplinary team required
6. Reasonable clinical stability with expectation for clinical or
functional improvement
7. Potential need for specialty consultative services such as pharmacy
or diagnostic services
Home Care:
1. Patient must be homebound, meaning he/she can only leave the
home for physician appointments.
2. Nursing care (skilled) and therapy (PT, OT and/or speech) can be
provided at home, generally at a lower intensity than rehab or
subacute.
Outpatient Therapy:
Used for the patient who can independently manage in the home, or
manage safely with the assist of a caregiver, who has adequate
transportation available to travel to a therapy facility. May receive PT, OT
Addendum C
and/or speech services as an outpatient and at a lower intensity than
subacute or inpatient rehab.
D. Other Definitions
Visual Perception:
Refers to the ability to process and understand visual information and
visual fields, i.e. neglect or a visual field cut. Deficits in this area may
affect the ability to recognize and use common objects, prepare meals,
complete self cares, walk safely, drive, read, work, and handle
medications and finances.
A speech therapy evaluation should occur if any of the following issues
are present. The speech therapist can determine if these issues preclude
a safe home discharge.
Swallowing Concerns:
Swallowing issues may include slow to chew and propel food
 significant amounts of food or liquid remaining in mouth after
eating
 difficulty getting lip seal around spoon, cup or straw
 leakage of food from mouth or nose when eating or drinking
 signs or symptoms of aspiration while eating or drinking (coughing,
choking, wet voice, throat clearing and/or a decline in lung status)
 change in breathing pattern or patient becomes short of breath
with eating or drinking
 complaints of pain or discomfort when swallowing
 pt feels food does not clear from throat after swallowing
 recent unexplained weight loss
Communication Issues:
Refers to the patient with difficulty speaking, writing, and/or difficulty
understanding what is heard or read.
Cognition:
Refers to the patient who has
 Decreased carry-over/difficulty or inability to learn new skills
 Decreased problem solving
 Disorientation (person, place, time, reason for hospitalization)
 Impaired attention/concentration
 Impaired memory (recent, remote)
 Poor insight/awareness of deficits