Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary

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

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

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

8.1 Basic Guidelines:-

• Modified New York Heart Association subjective classification should be utilised to assess the functional disability.
• The assessing physician should be alert to the fact that patients who come for disability claims are likely to exaggerate their symptoms. In case of any doubt patients should be referred for detailed physiological evaluation.
• Disability evaluation of cardiopulmonary patients should be done after full medical, surgical and rehabilitative treatment available, because most of these diseases are potentially treatable.
• Assessment of cardiopulmonary impairment should also be done in diseases which might have associated cardiopulmonary problems, e.g.,amputees, myopathies, etc.
• For respiratory assessment, routine respiratory functions test should be done, however, in cases of interstitial lung diseases, diffusion studies may be done.
• In cases of Angina pectoris (chest pain) base line studies in resting ECG should be done. When there is persistence of symptoms, exercise or stress test should be done.

8.2 The proposed classification with loss of function is as follows:-

Group 0: A patient with cardiopulmonary disease who is asymptomatic (i.e. has no symptoms of breathlessness, palpitation, fatigue or chest pain).

Group 1: A patient with cardiopulmonary disease who becomes symptomatic during his ordinary physical activity but has mild restriction (25%) of his physical activities.

Group 2: A patient with cardiopulmonary disease who becomes symptomatic during his ordinary physical activity and has 25-50% restriction of his ordinary physical activities.

Group 3: A patient with cardiopulmonary disease who becomes symptomatic during less than ordinary physical activity so that his ordinary physical activities are 50-75% restricted.

Group 4: A patient with cardiopulmonary disease who is symptomatic even at rest or on mildest exertion so that his ordinary physical activities are severely or completely restricted (75-100%).

Group 5: A patient with cardiopulmonary disease who gets intermittent symptoms at rest (i.e. patients with bronchial asthma, paroxysmal nocturnal dyspnoea, etc.)

• Definition of Multiple Disabilities:

Multiple disabilities means a combination of two or more disabilities as defined in clause (i) of Section (2) of the Persons with Disabilities. (Equal Opportunities, Protection of Rights and Full Participation) Act, 1’995, namely –

I. Locomotor disability including leprosy cured

II. Blindness/low vision

III. Speech and hearing impairment

IV. Mental retardation

V. Mental illness.

• Guidelines for Evaluation:-

In order to evaluate the multiple disability, the same guidelines shall be used as have been developed by the respective sub-committees of various single disability, viz. Mental retardation, locomotor disability, visual disability, and speech and hearing disability and recommended in the meeting held on 29.2.2000 under the Chairmanship of Dr. S.P. Agarwal, Director General of Health Services, Government of India, with reference to Order No.16-18/96-Nl.l, dated 28th August, 1998 and communicated to Ministry of Social Justice & Empowerment, Government of India, vide letter No.S-13020/4/98-MH, dated 16th March, 2000.

However, in order to arrive at the total percentage of multiple disability, the combining formula a + b (90-a)/90 as given in the Manual for Doctors to Evaluate

Permanent Physical Impairment, Developed by Expert Group meeting on Disability Evaluation”, shall be used, where “a” will be the higher score and “b” Will be the lower score. However, the maximum total percentage of multiple disabilities shall not exceed 100%.

For example, if the percentage of hearing disability is 30% and visual disability is 20%, then by applying the combining formula given above, the total percentage of multiple disability will be calculated as follows:-

30 + 20(90-30) = 43%

90

3. Procedure for Certification of Multiple Disability:-

The procedure will remain the same as has been developed by the respective sub-committees on various single disabilities and finalized in a meeting under the Chairpersonship of Dr. S.P. Agarwal held on 29.2.2000. The final disability certificate for multiple disability will be issued by Disability Board which has given higher score of disability by combining the score of different disabilities using the combining formula, i.e., a + b (90-a). In case, where two scores of disability are

90

equal, the final certificate of multiple disability will be issued by any one of them as decided by Local authority.

APPENDIX.I OF ANNEXURE.A

FROM A

ASSESSMENT PERFORMA FOR UPPER EXTERMITY

Name ___________..Age_______.Sex_____.Diagnosis______.

Address____________O.P.D________.Deptt_________.

ARM COMPONENT (Total Value 90%)

Summary value for upper extremity is calculated from component and hand component values Add 4% for dominant extremity 10%. Additional weightage to be given to infection, deformity, malalignment, contracture, cosmetic appearance and abnormal mobility

APPENDIX .I OF ANNEXURE . A

FROM B

ASSESSMENT PROFORMA FOR LOWER EXTERMITY

Name________.Age________..Sex_______..Diagnosis__________..

Address______________..O.P.D. No_________..Deptt_______.

Diagnosis______________________

MCBILITY COMPONENT (Total Value (90%)

STABILITY COMPONENT (Total Value 90%)

Based CLINICAL METHOD of Evaluation

1. Walking on plain surface 10

2. Walking on slope 10

3. Climbing Stairs 10

4. Standing on both legs 10

5. Standing on affected leg 10

6. Squatting on floor 10

7. Sitting Cross leg 10

8. Kneeling 10

9. Taking turns 10

Total 90

10% is given for complications like (I) Infection (ii) Deformity (iii) Loss of sensation.

APPENDIX.II OF ANNEXURE .A

Ready Reckon Table for A + B(90-A)/90

READY RECKONER TABLE FOR A + B(90-A)/90

More Ref : http://www.ccdisabilities.nic.in/page.php