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Functional assessment scales in rehabilitation (FIM, Barthel, Berg and others)
Rehabilitation measures function, not only impairment: the ICF model separates body impairment, activity limitation and participation restriction, and each scale measures a different level — NIHSS measures neurological impairment, FIM and Barthel measure activity, and Berg measures balance.
Why it matters in the exam
The WHO ICF model (2001): body functions and structures (for example weakness), activity (for example walking or dressing), participation (for example work and hobbies), and environmental and personal factors that affect them all. The FIM has 18 items — 13 motor and 5 cognitive — each rated from 1 (total assistance) to 7 (complete independence), so the total ranges from 18 to 126; it measures how much help the patient actually needs. The Barthel index is scored from 0 to 100 and tests ten basic daily activities.
The modified Rankin Scale (mRS) from 0 to 6 summarises outcome after stroke (6 — death). The NIHSS (0 to 42) measures the severity of neurological impairment in acute stroke; it weighs language and left hemisphere functions more and is less sensitive to posterior circulation stroke. The Fugl-Meyer measures motor impairment after stroke (up to 66 points in the upper limb, 34 in the lower). GOS and GOS-E summarise outcome after brain injury. In CP the GMFCS (levels I–V) is used for gross motor function.
Balance and falls: Berg includes 14 tasks, a maximum score of 56, and a score below about 45 indicates increased fall risk; it can be less sensitive in high-functioning people (a "ceiling effect"). Timed Up and Go (stand up, walk 3 metres, return and sit) — a time longer than about 13.5 seconds in an older person in the community raises fall risk. The 6-minute walk test measures endurance. Cognition: the MoCA is more sensitive than the MMSE to mild cognitive impairment. A good scale must be valid, reliable and responsive to change.
Key points
- ICF: body, activity, participation, surrounding factors.
- FIM: 18 items, 1–7, total 18–126.
- Barthel 0–100; mRS 0–6.
- NIHSS 0–42 — impairment, not function.
- Berg 0–56; below 45 — fall risk.
Summary table
| Scale | What it measures | Range | Note |
|---|---|---|---|
| FIM | Help needed in daily activities (motor and cognitive) | 18–126 | 18 items, each 1–7 |
| Barthel | Ten basic daily activities | 0–100 | Simple; ceiling effect |
| mRS | Overall outcome after stroke | 0–6 | 6 — death |
| NIHSS | Severity of neurological impairment in acute stroke | 0–42 | Less sensitive to the posterior circulation |
| Berg | Balance | 0–56 | Below 45 — fall risk |
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Sources
- WHO International Classification of Functioning, Disability and Health (ICF), 2001 — Components of functioning and disability
- Uniform Data System for Medical Rehabilitation: FIM instrument guide, version 5.1 (1997) — Items and rating levels
- Braddom's Physical Medicine and Rehabilitation, 6th edition (2021) — Quality and Outcome Measures for Medical Rehabilitation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.