BI Asessment Tools
Functional Independence Measure (FIM)
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The FIM is an 18-item, seven level ordinal scale. It is the product of an effort to resolve the long standing problem of lack of uniform measurement and data on disability and rehabilitation outcomes. The FIM emerged from a thorough developmental process overseen by a National Task Force of rehabilitation research. The National Task force reviewed 36 published and unpublished functional assessment scales before agreeing on an instrument. Subsequent evaluation of the metric properties of the FIM have been reported extensively. The Uniform Data System for Medical Rehabilitation (UDS) provides training materials, a shared database for participating facilities, and requires overall 80% accuracy of raters at each facility for qualifying members. There is a membership fee. The FIM was intended to be sensitive to change in an individual over the course of a comprehensive inpatient medical rehabilitation program. The FIM can be completed in approximately 20-30 minutes in conference, by observation, or by telephone interview. Rasch analysis defines two FIM dimensions, labeled motor and cognitive. It was designed to assess areas of dysfunction in activities which commonly occur in individuals with any progressive, reversible or fixed neurologic, musculoskeletal and other disorders. One limitation relative to using the FIM in evaluating survivors of TBI is that it is not diagnosis specific. Although found to be reliable and valid, the scale has few cognitive, behavioral, and communication related functional items relevant to assessing persons with TBI. The FAM items were developed by clinicians representing each of the disciplines in an inpatient rehabilitation program. The FAM was developed as an adjunct to the FIM to specifically address the major functional areas that are relatively less emphasized in the FIM, including cognitive, behavioral, communication and community functioning measures. The FAM consists of 12 items. These items do not stand alone, but are intended to be added to the 18 items of the FIM. The total 30 item scale combination is referred to as the FIM+FAM. The time required to administer the FIM+FAM is approximately 35 minutes. What Items to Rate: A blank rating on any item indicates "not applicable," or "untested" or" unknown." Rarely is this rating appropriate to use, especially when a backup rater is available. Two examples of when it is appropriate to leave a blank are when Speech Pathology or Therapeutic Recreation has not evaluated a patient because no referral was made, the patient does not speak English, or patient refused the service, i.e. Therapeutic Recreation, and no backup discipline is available. Caution in Processing and Interpreting Scale Values: The functional abilities of the patient are rated on an ordinal scale which reflects a "better than" or "worse than" relationship between adjacent categories. Although numbers have been assigned to each level of the scale to facilitate computerization of the data, the reader is cautioned that these numbers do not necessarily represent equal distances between any comparable points on the scale. Therefore, mathematical operations performed on these ordinal data points will not necessarily result in valid computations. Conclusions drawn from invalid computations will be of questionable validity. Tips: FIM+FAM ratings Note that a FIM+FAM rating of 1 (total assistance) does not necessarily describe a person in coma or persistent vegetative state. A person can do up to 25% of a task and still be rated as 1.
THE FUNCTIONAL INDEPENDENCE MEASURE (FIM) FIM items FAM items Eating Swallowing Grooming Car Transfer Bathing Community Access Dressing Upper Body Reading Dressing Lower Body Writing Toileting Speech Intelligibility Bladder Management Emotional Status Bowel Management Adjust. to Limitations Bed, Chair, Wheelchair Transfer Employability Toilet Transfer Orientation Tub and Shower Transfer Attention Walking/Wheelchair Locomotion Safety Judgement Stairs Comprehension Expression Social Interaction Problem Solving Memory The FAM guidelines aid raters to a final score by asking a series of questions for each item. FAM: Developed at Santa Clara Valley Medical Center, 751 So. Bascom Ave., Box 70, San Jose, California 95128. Contact: Karyl Hall Ed.D., (408) 295-9896 x16; FAX (408) 295-9913. Source Material provided by Santa Clara Valley Medical Center. For more information, contact Jerry Wright. Wright, J. (2000). The Functional Assessment Measure. The Center for Outcome Measurement in Brain Injury. 
Functional Independence Measure (FIM)
Functional Assessment Measure (FIM) Rater's Instructions
Ratings are to reflect actual observed performance, not capability. The type of activity evaluated for Bathing, Transfers, and walking/wheelchair should be specified on the worksheet and rated the same way by all raters of the discipline required to assess those items.
It is easiest and most accurate, from our experience, to use the Decision Tree (flow chart) to rate the FIM+FAM rather than the GUIDE (syllabus). If you use the syllabus, read all definitions of ratings under an item, i.e., do not focus on a definition that may appear to describe the patient without also looking at the definitions of ratings above and below your choice. Also, sub-headings in bold (e.g., moderate assistance, etc.) can be misleading without reading the definitions that follow.
AND FUNCTIONAL ASSESSMENT MEASURE (FAM)
FAM Scoring Guidelines and Instructions Contact
FIM: Developed by the Uniform Data System for Medical Rehabilitation, State University of New York at Buffalo, 232 Parker Hall, SUNY So. Campus, 3435 Main St., Buffalo, New York 14214. (716) 829-2076, FAX (716) 829-2080. References