FAST Score Assessment for Bed-Bound Patient with Preserved Speech
Based on the clinical scenario described, this patient cannot be accurately scored using the FAST (Functional Assessment Staging) scale, as FAST is specifically designed for staging dementia progression in Alzheimer's disease, not for assessing functional mobility or language capabilities in isolation.
Understanding the Confusion
The question appears to conflate two different assessment tools:
FAST (Functional Assessment Staging): A 7-stage scale used exclusively for tracking functional decline in Alzheimer's disease and related dementias, progressing from normal function through severe dementia 1
FAC (Functional Ambulation Category): A 6-point scale (0-5) that specifically measures walking ability and independence in ambulation after stroke or neurological injury 2, 3
If Assessing Mobility (FAC Score)
A bed-bound patient who cannot ambulate would score FAC 0 (non-functional ambulation), regardless of their language abilities 3. The FAC scale specifically evaluates:
- FAC 0: Patient cannot walk or requires assistance from 2 or more people 2, 3
- FAC 1-5: Progressive levels of walking independence with decreasing assistance 3
The ability to speak more than 20 words is irrelevant to FAC scoring, as this scale measures only physical ambulation capacity 2, 3.
If Assessing Nutritional Risk (MNA Mobility Component)
In the Mini Nutritional Assessment screening tool, a bed-bound patient would score 0 points on the mobility component (item C), with the following categories 1:
- 0 = bed or chair bound
- 1 = able to get out of bed/chair but does not go out
- 2 = goes out
Again, language ability does not factor into this mobility assessment 1.
If Assessing Stroke Severity (NIHSS Language Component)
If the clinical question concerns a stroke patient's language function, the NIH Stroke Scale Item 9 (Best Language) would score this patient based on their speech quality 1, 4:
- Score 0: Normal language with ability to speak more than 20 words fluently 5
- Score 1: Mild to moderate aphasia if speech is partly comprehensible 4
- Score 2-3: Severe aphasia or mutism 1, 4
The bed-bound status does not affect the language scoring on the NIHSS 1.
Critical Clinical Pitfall
Do not confuse functional mobility scales with cognitive or language assessment tools. A patient can be completely bed-bound (FAC 0, Barthel mobility 0) while maintaining intact language function (NIHSS language 0), or conversely, can be fully ambulatory while having severe aphasia 1, 2, 3. These domains are assessed independently and reflect different neurological and functional systems.