Dr Nitin Pandey Assistant Professor Department of physical medicine amp rehabilitation ID: 918331
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Slide1
Disability assessment and certification
Dr Nitin Pandey
Assistant Professor
Department of physical medicine & rehabilitation
SMS Medical College & attached hospitals
Jaipur, Rajasthan
Slide2Disability
Impairment -
Impairment is
any loss or abnormality
of psychological, physiological or anatomical structure or function
Functional Limitations -
Impairment may cause functional limitations
Disability -
:
A disability
is any restriction or lack
of
ability
to perform an activity in the manner or within the range considered normal for a human being
Loco motor Disability -
Person’s inability to execute distinctive activities associated with moving both himself and objects, from place to place and such inability resulting from affection of
musculo
-skeletal and/or nervous system
Slide3Slide4Variables-in assessing loco motor disability (PPI) In Loco motor Disability
1. Strength of Muscle (
MMC)
2. Range of Joint Motion
3. Coordination
4. Stability
5. Limb length discrepancy
6. Hand Functions (
prehension
, sensation &strength)
7. Sensation
8. Deformity
9. Complications like pain, infection etc.
10.Extremity dominant or non-dominant.
Slide5When certification should be done
Disability –
40%
or Above
Treatment is
complete
– Disability will not change
Condition
not likely
to Progress
PPI
should be certified only after
MMI
Slide6Upper Limb Assessment
Arm Component – 90%
Hand Component – 90%
Slide7ARM COMPONENT
Each of the three joints of the Arm is weighed equally - 30%
Strength of Muscles
Range of Motion
Coordination – Form A in Gazette Notification
10 activities to be tested
Each has value of 9%
Combining Values –
=
a+ b x (90-a)/90
Where a =higher value, b = lower value
Slide8HAND COMPONENT
Total value of Hand Component is
90%
The functional impairment of Hand is expressed as
loss of
Prehension
loss of Sensation
loss of Strength
Slide9PREHENSION
Total value of
Prehension
-
30%
Opposition
8%
Tested against -Index finger 2%
Middle finger 2%
Ring finger 2%
Little finger 2%
Lateral pinch
5%
Cylindrical grasp
6%
Large object of 4” size (diameter) 3%
Small object of 1” size (diameter) 3%
Spherical grasp
6%
Large object of 4 inches size 3%
Small object of 1 inch size 3%
Hook grasp
5%
Slide10SENSATION
Total value of Sensation in Hand
30%
Complete loss of Sensation Thumb ray 9%
Index finger 6%
Middle finger 5%
Ring finger 5%
Little finger 5%
Partial loss of Sensation: Assessment should be made according to percentage of loss of Sensation in thumb/finger
Evaluation of Strength
30%
Grip Strength 20%
Pinch Strength 10%
Slide11Additional weightage
Total additional weightage 10%
Pain
Infection
Deformity
Mal-alignment
Contractures
Cosmetic disfiguration
Dominant extremity-4%
Shortening of upper limb - First 1 inch no weightage, for each 1inch beyond that -2%
The extra points should not exceed 10% of the total Arm Component and total PPI should not exceed 100% in any case
Combining Values
Slide12Slide13Slide14Lower Limb
The measurement of loss of function in lower extremity is divided into two components:
Mobility
Stability components
Slide15Mobility
Total value of Mobility component
90%
It includes
Range of Movement (ROM) 90%
Muscle Strength 90%
Three joints – 30% each for ROM & Strength
Slide16Stability
Total value of the Stability component 90%
It should be tested by clinical method as given in ‘Form B’ (Assessment Performa for lower extremity)
There are nine activities, which need to be tested, and each activity has a value of ten per cent (10%)
The percentage value in relation to each activity depends upon the percentage of loss of stability in relation to each activity
Slide17Extra points
Extra points have been given for pain, deformities, contractures, loss of sensation and shortening Maximum points to be added are 10% (excluding shortening)
Deformity
In functional position 3%
In non-functional position 6%
Pain
Severe (grossly interfering with function) 9%
Moderate (moderately interfering with function) 6%
Mild (mildly interfering with function) 3%
Slide18Extra points
Loss of Sensation
Complete Loss 9%
Partial Loss 6%
Shortening
First 1/2” Nil (For every additional ½” shortening 4%
Complications
Superficial complications 3%
Deep complications 6%
Slide19Slide20Slide21Spine - Traumatic
Cervical Spine injuries
25% or more compression of one or two adjacent vertebral bodies with No involvement of posterior elements. No nerve root involvement. Moderate Neck Rigidity and persistent Soreness 20%
Posterior element damage with radiological evidence of moderate partial dislocation/sub-luxation including Whiplash injury
With fusion healed, No permanent motor or sensory change - 10%
Persistent pain with radiologically demonstrable instability – 25%
Severe Dislocation
Fair to good reduction with or without fusion with no residual motor or sensory involvement – 10%
Inadequate reduction with fusion and persistent radicular pain – 15%
Slide22Cervical Inter vertebral Disc Lesions in relation to spine
Treated case of disc lesion with persistent pain and no neurological deficit 10%
Treated case with pain and instability 15%
Slide23Thoracic and Thoraco-Lumbar Spine Injuries
Compression of less than 50% involving one vertebral body with no neurological manifestation 10%
Compression of more than 50% involving single vertebra or more with involvement of posterior elements, healed, no neurological manifestations Persistent pain, fusion indicated 20%
Same as above with fusion, pain only on heavy use of back 15%
Radiologically demonstrable instability with fracture or fracture dislocation with persistent pain 30%
Slide24Lumbar and Lumbo-Sacral Spine
Compression of 25% or less of one or two adjacent vertebral bodies, No definite pattern or neurological deficit 15%
Compression of more than 25% with disruption of posterior elements, persistent pain and stiffness, healed with or without fusion, inability to lift more than 10
kgs
30%
Radiologically demonstrable instability in low lumbar or Lumbo-sacral spine with pain 35%
Slide25Disc lesion
Treated case with persistent pain 15%
Treated case with pain and instability 20%
Treated case disc of disease with
pain,activities
of lifting moderately modified 25%
Treated case of disc disease with persistent pain and of heavy weight stiffness; aggravated by lifting of heavy weight, necessitating modifications of all activities requiring heavy weight lifting 30%
Slide26NON TRAUMATIC LESIONS
Scoliosis
The largest structural curve should be accounted for, while calculating
thePPI
and not the compensatory curve or both structural curves
Cobb’s method
for measurement of angle of curve
0-20 Nil
21-50 10%
51-100 20%
101 & above 30%
Torso Imbalance -
Deviation of Plumb line
Up to 1.5
cms
4%
1.5-3.0
cms
8%
3.1-6.0
cms
16%
6.1
cms
and more 32%
Slide27Head Tilt over C7 Spine
Upto
15 4%
More than 15 10%
Cardiopulmonary Test
Slide28Kyphosis
Spinal Deformity
Less than 20 Nil
21-40 10%
41-60 20%
Above 60 30%
Torso Imbalance
Less than 5 cm in front of ankle 4%
5 to 10 cm in front of ankle 8%
10 to 15 cm in front of ankle 16%
More than 15 cm in front of ankle 32%
Slide29Slide30Amputation – Basic considerations
In case of multiple amputees if the total sum of permanent physical impairment is above 100%, it should be taken as 100% only.
If the stump is unfit for fitting the prosthesis, additional weight-age of 5% should be added to the value.
Slide31Amputation – Basic considerations
In case of amputation in more than one limb percentage of each limb is added by combining formula and another 10% will be added but when only toes or fingers are involved only 5% will be added.
Any complication in form of stiffness of proximal joint,
neuroma
, infection
etc.,should
be given up to a total of 10% additional weight-age.
Dominant upper extremity should be given 4% additional weight-age
.
Slide32Amputations – Upper limb
Slide33Amputation- Lowe limb
Slide34Amputations - foot
Slide35Slide36Slide37Thanks for being patient