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Life of a PTA

The Min-Mod-Max Debate

Published January 6, 2012 11:24 AM by Allison Young

One of the first aspects of patient care I learned in the PTA program was the percentage between the levels of minimum to maximal assist. Being able to recognize the functional assist level is pivotal in the safety of the patient, as other therapists, including nursing staff, look to this recommendation in the patient's plan of care, for safe transfers.

Recently during one of our brief lunch breaks, a few of the physical therapists were discussing a new patient's transfer status. The patient in question was a tall man, nearly 300 pounds with sternal precautions. One of the therapists casually stated that when transferring this man edge-of-bed to his wheelchair, "My mod assist will not be the same as Allison's mod assist." The other PTs in the room took issue with that statement. I should preface this exchange by stating I was the only therapist I the room with less than 10 years experience (so I just intently listened).

I found the following friendly debate that ensued after that statement fascinating. The therapist who disagreed explained that "an assist" is based on the effort put forth by the patient - not the effort of the person transferring this patient. Therefore if I were to transfer this patient with a "mod assist," I could expect 50-75 percent patient effort. The therapist who made the original statement countered that if a smaller person (like me) would still be transferring potentially 150 pounds, it might "feel" like a "max assist" vs. a "mod assist."

I have to admit it was refreshing to find that even seasoned therapists can still debate and question even the most fundamental physical therapy rules. Even better, they listened and respected each other's thoughts without judgment, and left the conversation considering the opposite viewpoint. As a new therapist, this type of open exchange makes for a more receptive environment to ask the many physical therapy questions I still have, no matter how basic.

2 comments

Very observant of you to cue in on their interaction as much as the actual content.  Sounds like you have a great environment to learn and work in!

I'm concerned with the verbage used by one of your co-workers: "assist is based on the effort put forth by the patient".  This infers the therapist can reliably ascertain how much effort the patient is giving.  More troublesome is that it doesn't translate into how much the patient accomplished.  For example, a strong patient with minimal deficits could put forth relatively little effort and accomplish supine to sit and a transfer from bed to chair independently, while a patient who suffered a severe stroke could put forth maximal effort and not be able to roll over.  

I think a better explanation is not how much effort the patient puts forth, but what percentage of the task the patient completes without assistance.  I found this scale online:

Modified Independent: No assist, needs equipment or increased time to complete.

Stand by Assist: Requires cues to complete, stand by assist for safety, or set up

Minimal Assist: Performs 75% of task without assist

Moderate assist: Performs 50-75% of task without assist, requires assist of 1 person

Maximum assist: Performs 25-50% of task without assist, assist of 1 person only

Dependent: Performs less than 25% of task without assist or assist of 2 people

Another comment I found food for thought, hmmm I think I'll hold it for a blog post of my own!  Coming up next week!

Thanks for posting this!  Amazing how even the most basic skills can still be fodder for discussion!

Jane Goude January 8, 2012 6:04 PM

Some places will put percentage values on transfers too.  I recall one place had a number scale 1-5 so it would be "easier" for others to read and one person mentioned a transfer was a "mid"

at another place I worked. I think it was somewhere between min and mod assist.  

Jason Marketti January 7, 2012 11:14 PM

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