Modified Berthel Index Form Page 3
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1
2
3
4INDEX ITEM
SCORE
DESCRIPTION
0
Total dependence in bathing self.
1
Assistance is required in all aspects of bathing, but patient is able to make some
contribution.
3
Assistance is required with either transfer to shower/bath or with washing or
drying; including inability to complete a task because of condition or disease, etc.
BATHING
Supervision is required for safety in adjusting the water temperature, or in the
4
transfer.
The patient may use a bathtub, a shower, or take a complete sponge bath. The
5
patient must be able to do all the steps of whichever method is employed without
another person being present.
0
The patient is dependent in all aspects of dressing and is unable to participate in
the activity.
2
The patient is able to participate to some degree, but is dependent in all aspects of
dressing.
DRESSING
5
Assistance is needed in putting on, and/or removing any clothing.
8
Only minimal assistance is required with fastening clothing such as buttons, zips,
bra, shoes, etc.
10
The patient is able to put on, remove, corset, braces, as prescribed.
0
The patient is unable to attend to personal hygiene and is dependent in all aspects.
Assistance is required in all steps of personal hygiene, but patient able to make
1
some contribution.
PERSONAL HYGIENE
Some assistance is required in one or more steps of personal hygiene.
3
(Grooming)
Patient is able to conduct his/her own personal hygiene but requires minimal
4
assistance before and/or after the operation.
The patient can wash his/her hands and face, comb hair, clean teeth and shave. A
5
male patient may use any kind of razor but must insert the blade, or plug in the
razor without help, as well as retrieve it from the drawer or cabinet. A female
patient must apply her own make-up, if used, but need not braid or style her hair.
0
Dependent in all aspects and needs to be fed, nasogastric needs to be administered.
Can manipulate an eating device, usually a spoon, but someone must provide
2
active assistance during the meal.
Able to feed self with supervision. Assistance is required with associated tasks
5
such as putting milk/sugar into tea, salt, pepper, spreading butter, turning a plate or
other “set up” activities.
FEEDING
Independence in feeding with prepared tray, except may need meat cut, milk
8
carton opened or jar lid etc. The presence of another person is not required.
The patient can feed self from a tray or table when someone puts the food within
reach. The patient must put on an assistive device if needed, cut food, and if
10
desired use salt and pepper, spread butter, etc.
11
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