Guidelines for Evaluation of permanent physical Impairment in Lower Limb

Guidelines for various disabilities and procedure for certification:

Locomotor disability is defined as a persons inability to execute distinctive activities associated with moving both himself and objects, from place to place and such inability resulting from affliction of musculoskeletal and/or nervous system.

• Categories of Locomotor Disability

The categories of locomotor disabilities are enclosed at Annexure-A.

• Process of Certification

1. Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

ANNEXURE-A LOCOMOTOR DISABILITY

The measurement of loss of function in lower extremity is divided into two components: Mobility and standing components

2.1 Mobility Component:-

• Total value of mobility component is 90%
• It includes range of movement (ROM) and muscle strength

2.1.1. Principles of Evaluation of Range of Movement:

• The value of maximum range of movement in mobility component is 90%
• Each of three joints i.e. hip, knee and foot-ankle component is weighed equally – 30%.

Example:

A fracture of right hip joint bones may affect range of motion of the hip joint. Loss of ROM of the affected hip in different are should be assessed as given in Form B (Assessment Proforma for lower extremity). (Appendix.I of Annexure.A)

Affected Joint – Rt. Hip:

Arc of Movement	Normal ROM	Active ROM	Loss in percentage
Flexion-Extension	0-140	70	50%
Abduction-Adduction	0-90	60	33%
Rotations	0-90	30	66%

Mean loss of ROM of Rt Hip = (50+33+66)/3 = 50%

Since the hip constitute 30% of the total mobility component of the lower limb the loss of motion in relation to the lower limb will be 50 x 0.30=15%

If more than one joint of the limb is involved the mean loss of ROM in percentage should be calculated in relation to individual joint separately and then added together as follows to calculate the loss of mobility component in relation to that particular limb.

For example.

Mean loss of ROM of Rt. Hip: 50%

Mean loss of ROM Rt. Knee: 40%

Loss of mobility component of Rt. Lower Limb will be: (50 x 0.30)+(40 x 0.30) = 27%

2.1.2. Principle of Evaluation of Muscle Strength:

• • The value for maximum muscle strength in the limb is 90%
  • Strength of muscles can be tested by Manual Method and graded 0-5 as advocated by MRC of Great Britain depending upon the residual strength in the muscle group.
  • Manual muscle grading can be given percentage like below:
    

    Power Grade of Ms	Loss of strength in percentage
    0	100
    1	80
    2	60
    3	40
    4	20
    5	0

  • Mean percentage of muscle strength loss around a joint is multiplied by 0.30 to calculate loss in relation to limb
  • If there has been a loss muscle strength involving more than one joint the values are added as has been described for loss of ROM

2.1.3. Combining values for mobility component:

1. The values of loss of ROM and loss of muscle strength should be combined with the help of

combining formula: a+b(90-a)/ 90 (a = higher value, b = lower value)

Example: Let us assume that the individual with a fracture of right hip bones has in addition to 16% loss of motion, 8% loss of muscle strength also.

Combined values

Motion-16%: 16+8(90-16)/ 90

Strength-8% =22.6%

2.2 Stability component:

• Total value of the stability component is 90%
• It should be tested by clinical method as given in From B (Assessment Proforma 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 valued in relation to each activity depends upon the percentage of loss stability in relation to each activity.

2.3 Extra points:

Extra points have been given for pain, deformities, contractures, loss of sensations and shortening Maximum points to be added are 10% (excluding shortening). Details are as following.

Continue Read – 3.Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)