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
2.Guidelines for Evaluation of permanent physical Impairment in Lower Limb
Basic guidelines:
1. As permenanent physical impairment caused by spinal deformity tends to change over the years, the certificate issued in relation to spine should be reviewed as per the standard format of the certificate given at Annexure -B of Appendix.III.
2. Permanent physical impairment should be awarded in relation to spine and not in relation to whole body.
3. Permanent physical impairment due to neurological deficit in addition to spinal impairment should be added by combining formula. The local effects of the lesions of the spine can be conventionally divided into traumatic and non-traumatic. The percentage of PPI in relation to each situation should be valued as follows:
3.1 TRAUMATIC LESIONS:
| 3.1.1 Cervical spine injuries | Percentage of PPI in relation to Spine | |
|---|---|---|
| i) 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% | |
| ii) Posterior element damage with radiological Evidence of moderate parties dislocation/subluxation including whiplash injury. A) With fusion healed, No permanent motor or sensory changes B)Persistent pain with radiologically demonstrable instability. | 10% 25% | |
| iii) Severe Dislocation: a) Fair to good reduction with or without fusion with no residual motor or sensory involvement; b) Inadequate reduction with fusion and persistent radicular pain | 10% 15% | |
| 3.1.2. Cervical Intervertebral Disc Lesions | Percentage of PPI In relation to Spine | |
| i) Treated case of disc lesion with persistent pain and no neurological deficit | 10% | |
| ii) Treated case with pain and instability | 15% | |
3.1.3. Thoracic and Thoracolumbar Spine Injuries:
| i) Compression of less than 50% involving one vertebral body with no neurological manifestation | 10% |
|---|---|
| ii) Compression of more than 50% involving single vertebra or more with involvement of posterior elements,healed, no neurological manifestations persistent pain, fusion indicated | 20% |
| iii) Same as (b) with fusion, pain only on heavy use of back | 15% |
| iv) Radiologically demonstrable instability with fracture or fracture dislocation with persistent pain. | 30% |
3.1.3. Thoracic and Thoracolumbar Spine Injuries:
| i) Compression of less than 50% involving one vertebral body with no neurological manifestation | 10% |
|---|---|
| ii) Compression of more than 50% involving singlevertebra or more with involvement of posterior elements, healed, no neurological manifestations persistent pain, fusion indicated | 20% |
| iii) Same as (b) with fusion, pain only on heavy use of back | 15% |
| iv) Radiologically demonstrable instability with fracture or fracture dislocation with persistent pain. | 30% |
3.1.4 Lumbar and Lumbosacral Spine: Fracture
| a)Compression of 25% or less of one or two adjacent Vertebral bodies, No definite pattern or neurological Deficit> | 15% |
|---|---|
| b)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% |
| c)Radiologically demonstrable instability in low lumbar or Lumbosacral spine with pain | 35% |
3.1 5 Disc lesion:
| a)Treated case with persistent pain | 15% |
|---|---|
| b)Treated case with pain and instability | 20% |
| c)Treated case of disc disease with pain activities of lifting moderately modified | 25% |
| d)Treated case of disc disease with persistent pain and stiffness, aggravated by heavy lifting necessitating modification of all activities requiring heavy weight lifting | 30% |
3.2 NON TRAUMATIC LESIONS:
3.2.1 Scoliosis:
Basic guidelines – following modification is suggested:- The largest structural curve should be accounted for while calculating the PPI and not the compensatory curve or both structural curves.
3.2.2 Measurement of Spine Deformity:
Cobb’s method for measurement, of angle of curve in the radiograph taken in standing position should be used. The curves have been divided into following groups depending upon the angle of major structural scoliotic deformity.
| Group | Cobb’s Angle | PPI in relation to Spine |
|---|---|---|
| I | 0-20 | NIL |
| II | 21-50 | 10% |
| III | 51-100 | 20% |
| IV | 101 & above | 30% |
3.2.3 Torso Imbalance:
In addition to the above PPI should also be evaluated in relation the torso imbalance. The torso imbalance should be measured by dropping a plumb line from C7 spine and measuring the distance of plumb line from gluteal crease.
| Deviation of Plumb line | PPI |
|---|---|
| Upto 1.5 Cm | 4% |
| 1.6 – 30 Cm | 8% |
| 3.1 – 50 Cm | 16% |
| 5.1 and above | 32% |
3.2.4 Head Tilt over C7 spine PPI
| Upto 15 | 4% |
|---|---|
| More than 15 | 10% |
3.2.5 Cardiopulmonary Test
In cases with scoliosis of severe type cardiopulmonary function tests and percentage deviation from normal should be assessed by one of the following method whichever seems more reliable clinically at the time of assessment. The value thus obtained may be added by combining formula.
| a. Chest Expansion | PPI |
|---|---|
| 4 – 5 Cm. | Normal |
| Less than 4 cm reduction in Chest expansion | 5% for each cm |
| No expansion | 25% |
b counting in one breathe:
| Breathe Count | PPI |
|---|---|
| More than 40 | Normal |
| 0-40 | 5% |
| 0-30 | 10% |
| 0-20 | 15% |
| 0-10 | 20% |
| Less than 5 | 25% |
3.2.6 Associated Problems: To be added directly but the total value of PPI in relation to spine should not exceed 100%.
a) Pain
| -mildly interfering with ADL | 4% |
|---|---|
| -moderately restricting ADL | 6% |
| -severely restricting ADL | 10% |
b) Cosmetic Appearance:
| -No obvious disfiguration with clothes on | Nil |
|---|---|
| -mild disfigurement | 2% |
| -severe disfigurement | 4% |
c) Leg Length Discrepancy.
| -First1/2 ” shortening | Nil |
|---|---|
| -Every1/2″ beyond first1/2″ | 4% |
d) Neurological deficit – Neurological deficit should be calculated as per established method of evaluation of PPI in such cases. Value thus obtained should be added telescopically using combining formula.
3.3 KYPHOSIS
Evaluation should be done on the similar guidelines as use for scoliosis with the following modifications:
| 3.3.1 Spinal Deformity | PPI |
|---|---|
| Less than 20 | Nil |
| 21-40 | 10% |
| 41-60 | 20% |
| Above 60 | 30% |
3.3.2 Torso Imbalance – Plumb line dropped from external ear normally falls at ankle level. The deviation from normal should be measured from ankle anterior joint line to the plumb line.
| 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% |
(Add directly)
Miscellaneous conditions:
Those conditions of the spine which cause stiffness and pain etc. are rated as follows.
| Conditions | Percentage PPI | |
|---|---|---|
| A | Subjective symptoms of pain, no involuntary muscle spasm,, not substantiated by demonstrable structural pathology | -0% |
| B | Pain, persistent muscles spasm and stiffness of spine, substantiated by mild radiological change. | -20% |
| C | Same as B with moderate radiological changes | -25% |
| D | Same as B with severe radiological changes involving any one of the regions of spine | -30% |
| E | Same as D involving whole spine | -40% |
Continue reading :
4.Guidelines for Evaluation of PPI in cases of Short Stature/Dwarftsm
5.Guidelines for Evaluation of Permanent Physical Impairment in Amputees
6.Guidelines for Evaluation of Permanent Physical Impairment of Congenital deficiencies of the limbs
7.Guidelines for Evaluation of Physical Impairments in Neurological conditions
8.Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary
