DISABILITY AND DISABILITY

EVALUATION

SNEHA MARY JACOB

LECTURER
ALVA’S COLLEGE OF PHYSIOTHERAPY
 DISABILITY

According to WHO,disability is any restriction or

lack(resulting from any impairment) of ability to
perform an activity in the manner or within the
range consider normal for a human being.
 DEFINITION

 Definitions provided by the World Health Organization

(1980) in The International Classification of Impairments,
Disabilities, and Handicaps:
 CLASSIFICATION/TYPES OF DISABILITY

VISUAL DISABILITY
COMMUNICATION DISABILITY
LOCOMOTOR DISABILITY
MENTAL RETARDATION
MULTIPLE DISABILITIES
 VISUAL DISABILITY

“The Blind are those who suffer from either of the

following conditions:
a) Total absence of sight.
b) Visual acquity not exceeding 6/60 or 20/200
(snellen) in the better eye with correcting lenses.
c) Limitation of the field of vision subtending an
angle of degree 20 or worse.
 HEARING DISABILITY

MILD- loss of more than 30 but not more than 45

decibels in the better ear.
MODERATE- loss of more than 45 but not more
than 60 decibels in the better ear.
SEVERE- loss of more than 60 decibels but not more
than 90 decibels in the better ear.
 LOCOMOTOR DISABILITY

Means a Person’s inability to execute distinctive

activities associated with moving both himself and
object, from place to place and such inability
resulting from affliction of either bones, joints,
muscles or nerves.
 CATEGORIZATION

MILD- less than 40%

MODERATE- 40% and above.
SEVERE- 75% and above.
PROFOUND/TOTAL- 100%.
 MENTAL RETARDATION

Means a condition of arrested or incomplete

development of mind of a person which is specially
characterized by sub normality of intelligence.
CATEGORIZATION-
MILD MR- IQ 50-70
MODERATE MR- IQ 35-49
SEVERE MR- IQ 20-34
PROFOUND MR- IQ < 20
 CAUSES OF DISABILITY

Congenital or perinatal disturbances

 Mental retardation
Non-genetic disorders
Communicable diseases
 Poliomyelitis
 Leprosy
Trauma/Injury
 Traffic accidents
 Occupational accidents
 Home accidents
Malnutrition
Functional psychiatric disturbances
Alcoholism and drug abuse
Social causes
 PREVENTION of DISABILITY

Primary Prevention- refers to avoidance of

occurrence of impairment by tackling the basic
causes

 Health promotion
 Specific protection measures
Secondary Prevention- refers to methods for limiting
or reversing disability caused by impairments such
as by treatment or surgery.
Tertiary Prevention- measures to stop impairments
from developing into disability and handicap such as
taking care of the environment and external factors.
Primordial Prevention- aims at risk factor
prevention.
DISABILITY EVALUATION
 Guidelines for certification

1) The empowered persons to give disability certificate,

will be a Medical Board, consisting of at least three
members, out of which at least one shall be a
specialist in the particular field for assessing
loco motor/visual including low vision/
hearing & speech disability, mental retardation
and leprosy cured as the case may be, duly
constituted by the Central and State Government
2) Specified tests as indicated in guidelines should be
conducted by the medical board and recorded before
a certificate is given

3) The certificate would be valid for a period of five

years for those whose disability is temporary, while in
permanent disability the validity is life long
4) The minimum degree of disability should be 40% in order to be
eligible for any concession/benefit

Person with disability’ means a person suffering from not less

than forty per cent of any disability as certified by a medical
authority

5) As per PWD Act and in its compliance, various benefits &

concessions are to be provided to the ‘persons with disability’
The ‘disability’ under PWD act means -
i. Blindness,
ii. Low vision,
iii.Leprosy-cured,
iv. Hearing impairment,
v. Locomotor disability,
vi.Mental retardation,
vii. Mental illness.
PRINCIPLES OF DISABILITY EVALUATION
1) Functional Loss

2) Personal opinion

3) Where to decide percentage on extent of

function/activity
a. No loss – activity can be performed normally without
assistance
b. Partial loss – activity can performed partly or with
assistance
c. Total Loss - activity can not be performed even with
assistance
4) Trick movement

5) Authority

6) Testing Tools and Guidelines

7) When to Assess: For purpose of certification, disability should be

assessed when the specialist is satisfied that further medical
treatment/intervention is not like to reduce the
extent of impairment. Normally, a period of six months is considered in
such medical conditions
8) Certification in condition of deformity,
which is likely to be modified by surgery

9) Validity of certificate
 Guidelines for Evaluation of
Permanent Physical Impairment
 The estimation of permanent impairment
depends upon the measurement of functional
impairment,
 The estimation and measurement must be made
when the clinical condition is fixed and
unchangeable.
 UPPER EXTREMITY

 The upper extremity is divided

into two component parts :
1. arm component and
2. hand component.
 Measurement of the loss of arm
component consists in measuring
the
1. loss of motion,
2. muscle strength and
3. coordinated activities.
 Measurement of the loss of
function of hand component
consists in determining the
1. prehension,
2. sensation and
3. strength.
The impairment of the entire
extremity depends on the
combination of the functional
impairment of both
components.
 ARM COMPONENT

 Total value of arm component is 90%.

Principles of evaluation of range of motion of joints

1.The value for maximum range of

motion in the arm component is
90%.
2.Each of the three joints of the arm
is weighed equally (30%).
Principles of evaluation of strength

 Manual muscle gradings can be

given percentages like
0 - 100%
1 - 80%
2 - 60%
3 - 40%
4 - 20%
5 - 0%
The mean percentage of
muscle strength loss is
multiplied by 0.3.
If there has been a loss of
muscle strength of >1 joint, the
values are added
Principles of evaluation of coordinated activities

 The total value for co-ordinated

activities is 90%.
 10 different co-ordinated
activities are to be tested.
 Each activity has a value of 9%.
 COMBINING VALUES FOR THE ARM COMPONENT

 The value of loss of function of

arm component is obtained by
combining the values of range of
movement, muscle strength &
co-ordinated activities, using the
combining formula.
a +[ b (90 – a) ]/ 90
Where a = higher value
& b = Lower value
 Example;

Let us assume that an individual with a fracture of

the right shoulder joint has in addition to 16.5% loss
of motion of his arm, 8.3% loss of strength of
muscles, and 5% loss of coordination. We combine
these values as:
Range of motion: 16.5%
Strength of Muscles: 8.3%
16.5 + 8.3 (90-16.5) / 90 = 23.3%
Co-ordination: 5%
23.3+5(90-23.3)/90=27
So total value of area =27%
 HAND COMPONENT

 Total value of hand component is

90%
 The functional impairment of
hand is expressed as loss of
1. prehension,
2. loss of sensation,
3. loss of strength
 Principles of Evaluation of Prehension

Total value of Prehension is

30%. It includes
Opposition (8%),
Middle finger (2%),
Ring Finger (2%)
Little finger (2%)
Lateral Pinch (5%).
Cylindrical Grasp (6%).
Spherical Grasp (6%).
Hook Grasp (5%).
 Principles of Evaluation of Sensations

Total value of sensation is 30%. It

includes;
Radial side of thumb (4.8%)
Ulnar side of thumb (1.2%)
Radial side of each finger (4.8%).
Ulnar side of each finger (1.2%).
Principles of evaluation of strength

Total value of strength is 30%.

 It includes:
 Grip strength (20%)
 Pinch Strength (10%)
10% additional weightage to be given to
the following factors:
 Infection
 Deformity
 Malalignment
 Contractures
 Cosmetic appearance
 Abnormal Mobility
 Dominant Extremity (4%)
Combining values of the hand component

The final value of loss of function

of hand component is obtained by
summing up values of loss of
prehension, sensation and strength.
 Combining Values for the Extremity

Values of impairment of arm

component and impairment of
hand component are combined by
using the combining formula.
Example:
Impairment of the arm = 27.0%
Impairment of the hand = 64%
 64 + 27 (90-64) / 80 = 71.8%
GUIDELINES FOR EVALUATION OF PERMANENT
PHYSICAL IMPAIRMENT IN LOWER LIMBS
The lower extremity is divided into
two components: Mobility
component and Stability
Component.
 Mobility component

 Total value of mobility component

is 90%. It includes
1. range of movement and
2. muscle strength.
 Principles of Evaluation of Range of Movement

 The value of maximum range of movement in the

mobility component is 90%.
 Each of the three joints i.e. hip, knee, foot-ankle
component, is weighted equally – 0.30.
 Example:

 A fracture of the right hip joint may affect range of

motion so that active abduction is 27o. The left hip
exhibits a range of active abduction of 54%. Hence,
there is loss of 50% of abduction movement of the right
hip. The percentage loss of mobility component in the
hip is 50 x 0.30 or 15% loss of motion for the mobility
component.
 If more than one joint is involved, same method is
applied and the losses in each of the affected joints are
added.
 For Example:
 Loss of abduction of the hip = 60%
 Loss of extension of the knee = 40%
 Loss of range of motion for the mobility component
 = (60 x 0.30) + (40 x 0.30) = 30%.
Principles of Evaluation of Muscle Strength

 The value of maximum muscle strength in the leg is

90%.
 Strength of muscles can be tested by manual
testing like 0-5 grading.
 Manual muscle gradings can be given percentages
like
Grade 0 = 100%
Grade 1 = 80%
Grade 2 = 60%
Grade 3 = 40%
Grade 4 = 20%
Grade 5 = 0%
 Mean percentage of muscle strength loss
is multiplied by 0.30.
 If there has been a loss of muscle strength
of more than one joint, the values are
added as has been described for loss of
range of motion.
 STABILITY COMPONENT

 Total value of stability

component is 90%.
 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).
Thank you!