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Guidelines for evaluation of various disabilities and procedure for certification - LOCOMOTOR DISABILITY PDF Print E-mail
Tuesday, 23 August 2011 16:09
Article Index
Guidelines for evaluation of various disabilities and procedure for certification
Thoracic and Thoracolumbar Spine Injuries
Torso Imbalance
Guidelines for Evaluation of Permanent Physical Impairment in Amputees
Table - VIII
Definition of Multiple Disabilities
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1.1 Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb
  1. The estimation of permanent impairment depends upon the measurement of functional impairment and is not expression of a personal opinion.
  2. The estimation and measurement should be made when the clinical condition has reached the stage of maximum improvement from the medical treatment. Normally the time period is to be decided by the medical doctor who is evaluating the case for issuing the PPI Certificate as per standard format of the certificate.
  3. The upper limb is divided into two component parts; the arm component and the hand component.
  4. Measurement of the loss of function of arm component consists of measuring the loss of motion, muscle strength and co-ordinated activities.
  5. Measurement of loss of function of hand component consists of determining the prehension, sensation and strength. For estimation of prehension opposition, lateral pinch cylindrical grasp, spherical grasp and hook grasp have to be assessed as shown in Hand Component of Form A Assessment Proforma for upper extremity.
  6. The impairment of the entire extremity depends on the combination of the functional impairments of both components
Total value of arm component is 90%

1.2.1 Principles of evaluation of range of motion (ROM) of joints
  1. The value of maximum ROM in the arm component is 90%
  2. Each of the three joints of the arm is weighed equally (30%;
The intra articular fractures of the bones of right shoulder joint may affect range of motion even after healing. The loss of ROM should be calculated in each arc of motion as. envisaged in the Assessment Form A (Assessment Proforma for Upper Extremity).

Arc of ROM Normal value Active ROM Loss of ROM
Shoulder Flexion- 0-220 110 50%
Rotation 0-180 90 50%
Abduction-Adduction 0-180 90 50%

Hence the mean loss of ROM of shoulder will be 50+50+50/3 =150/3 = 50%
Shoulder movements constitute 30% of the motion of the arm component, therefore the loss of motion for arm component will be 50 X 0.3d = 15% If more than one joint of the arm is involved the loss of percentage in each joint is calculated separately as above and then added together.

1.2.2. Principles of evaluation of strength of muscles:
  1. Strength of muscles can be tested by manual method and graded from 0-5 as advocated by Medical Research Council of Great Britain depending upon the strength of the muscles.
  2. Loss of muscle power can be given percentages as follows:

    Manual muscle Strength grading Loss of Strength in percentage
    0 100%
    1 80%
    2 60%
    3 40%
    4 20%
    5 0%
  3. The mean percentage of loss of muscle strength around a joint is multiplied by 0.30.
  4. If loss of muscle strength involves more than one joint the mean loss of percentage in each joint is calculated separately and then added together as has been described for loss of motion.
1.2.3 Principles of evaluation of coordinated activities:

1 The total value for coordinated activities is 90% Ten different coordinated activities should be tested as given in Form A. (Appendix.I of Annexure-A)

2. Each activity has a value of 9%

1.2.4 Combining values for the Arm Component:

The total value of loss of function of arm component is obtained by combining the value of loss of ROM, muscle strength and coordinated activities, using the combing formula.


where a = higher value
b = lower value

Let us assume that an individual with an intra articular fracture of bones of shoulder joint in addition to 16.5% loss of motion in arm has 8.3% loss of strength of muscles and 5% loss of coordination. These values should be combined as follows:

Loss of ROM - 16.5% 16.5+8.3(90-16.5)
Loss of strength of muscles - 8.3% =23.33%
To add
Loss of coordination - 5% 23.3+5(90-23.3)=27 0%

So the total value of loss of function in Arm component will be 27.0%


Last Updated on Thursday, 19 January 2012 15:24

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