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Rehabilitation Impairment Code __ __. __ __ __ __<br />
AROC v3 New Zealand DATA COLLECTION FORM<br />
Code using the AROC mod<strong>if</strong>ied FIM Impairment Codes, the impairment which, at the beginning of the episode, is ident<strong>if</strong>ied to be the major<br />
focus of rehabilitation and the primary subject of the rehabilitation plan. Use Code Allocation Guidelines <strong>if</strong> unsure.<br />
Stroke<br />
01.1 Left body involvement<br />
01.2 Right body involvement<br />
01.3 Bilateral involvement<br />
01.4 No paresis<br />
01.9 Other Stroke<br />
Brain Dysfunction<br />
Non-traumatic<br />
02.11Sub-arachnoid haemorrhage<br />
02.12 Anoxic brain damage<br />
02.13 Other non-traumatic brain dysfunction<br />
Traumatic<br />
02.21 Open injury<br />
02.22Closed injury<br />
Neurological Conditions<br />
03.1 Multiple Sclerosis<br />
03.2 Parkinsonism<br />
03.4 Polyneuropathy<br />
03.4 Guillian-Barre Syndrome<br />
03.5 Cerebral Palsy<br />
03.8 Neuromuscular Disorders<br />
03.9 Other Neurological<br />
Spinal Cord (SC) Dysfunction<br />
Non traumatic SC dysfunction<br />
04.111 Paraplegia, incomplete<br />
04.112 Paraplegia, complete<br />
04.1211 Quadriplegia, incomplete C1-4<br />
04.1212 Quadriplegia, incomplete C5-8<br />
04.1221 Quadriplegia, complete C1-4<br />
04.1222 Quadriplegia, complete C5-8<br />
04.13 Other non- traumatic SCI<br />
Traumatic Spinal Cord Dysfunction<br />
04.211 Paraplegia, incomplete<br />
04.212 Paraplegia, complete<br />
04.2211 Quadriplegia, incomplete C1-4<br />
04.2212 Quadriplegia, incomplete C5-8<br />
04.2221 Quadriplegia, complete C1-4<br />
04.2222 Quadriplegia, complete C5-8<br />
04.23 Other traumatic SCI<br />
Amputation of Limb<br />
05.1 Single Upper - - Above Elbow<br />
05.2 Single Upper Below Elbow<br />
05.3 Single Lower - Above Knee (includes<br />
through knee)<br />
05.4 Single Lower - Below Knee<br />
05.5 Double Lower - Above Knee (includes<br />
through knee)<br />
05.6 Double Lower – Above/below Knee<br />
05.7 Double Lower – Below Knee<br />
05.8 Partial Foot - (single or double)<br />
05.9 Other amputation<br />
Arthritis<br />
06.1 Rheumatoid Arthritis<br />
06.2 Osteoarthritis<br />
06.9 Other Arthritis<br />
Pain Syndromes<br />
07.1 Neck pain<br />
07.2 Back Pain<br />
07.3 Extremity pain<br />
07.4 Headache (includes migraine)<br />
07.5 Multi-site pain<br />
07.9 Other pain (includes abdo/chest wall)<br />
Orthopaedic Conditions<br />
Fractures (includes dislocation)<br />
08.111 Fracture of hip, unilateral (incl #NOF)<br />
08.112 Fracture of hip, bilateral (incl. #NOF)<br />
08.12 Fracture of shaft of femur<br />
08.13 Fracture of pelvis<br />
08.141 Fracture of knee<br />
08.142 Fracture of lower leg, ankle, foot<br />
08.15 Fracture of upper limb<br />
08.16 Fracture of spine<br />
08.17 Fracture of multiple sites<br />
08.19 Other orthopaedic fracture<br />
Post Orthopaedic Surgery<br />
08.211 Unilateral hip replacement<br />
08.212 Bilateral hip replacement<br />
08.221 Unilateral knee replacement<br />
08.222 Bilateral knee replacement<br />
08231 Knee and hip replacement, same side<br />
08232 Knee and hip replacement, d<strong>if</strong>f sides<br />
08.24 Shoulder replacement<br />
08.25 Post spinal surgery<br />
08.26 Other orthopaedic surgery<br />
Cardiac<br />
09.1 Following recent onset of<br />
new cardiac impairment<br />
09.2 Chronic cardiac<br />
insufficiency<br />
09.3 Heart and heart/lung<br />
transplant<br />
Pulmonary<br />
10.1 Chronic Obstructive<br />
Pulmonary disease<br />
10.2 Lung transplant<br />
10.9 Other Pulmonary<br />
Burns<br />
11 Burns<br />
Congenital Deformities<br />
12.1 Spina B<strong>if</strong>ida<br />
12.9 Other Congenital<br />
Other Disabling Impairments<br />
13.1 Lymphoedema<br />
13.2 Other disabling<br />
impairments that cannot be<br />
class<strong>if</strong>ied into a spec<strong>if</strong>ic group<br />
Major Multiple Trauma<br />
14.1 Brain+Spinal cord injury<br />
14.2 Brain+ Multiple<br />
fracture/amputation<br />
14.3 Spinal Cord+Multi<br />
fracture/amputation<br />
14.9 Other multiple trauma<br />
Developmental Disabilities<br />
15.1 Developmental Disabilities<br />
(excludes cerebral palsy)<br />
Re-Conditioning/Restorative<br />
16.1 Re-conditioning following<br />
surgery<br />
16.2 Reconditioning following<br />
medical illness<br />
16.3 Cancer rehabilitation<br />
Episode FIM Score<br />
Motor Subscale Start End FIM SCORES<br />
Date FIM Completed / / / /<br />
Eating<br />
No Helper<br />
Grooming<br />
7= Complete Independence<br />
Bathing<br />
6= Mod<strong>if</strong>ied Independence<br />
Dressing Upper Body<br />
Helper<br />
Dressing Lower Body<br />
5=Supervision or set up<br />
Toileting<br />
4=Minimal Assistance<br />
Bladder Management<br />
3= Moderate assistance<br />
Bowel Management<br />
2=Maximal Assistance<br />
Transfers- Bed/Chair/Wheelchair<br />
1=Total Assistance<br />
Transfer –Toilet<br />
Transfers- Bath/shower<br />
Walk/Wheelchair<br />
Stairs<br />
Cognitive Subscale<br />
Comprehension<br />
Expression<br />
Social Interaction<br />
Problem Solving<br />
Memory
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