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Evaluation of Permanent Physical Impairment

(Disability Evaluation)
 Disability
• Disability is any restriction or lack of
ability to perform an activity in the
manner or within the range considered
normal for a human being
 Evaluation
• To measure objectively & quantitatively
 Disability evaluation
• Measure disability objectively &
quantitatively
• Measured in terms of %
 Objectives
• To issue disability certificate
▫ To avail facilities & concessions
▫ Reservation in jobs
▫ Travel concessions
▫ Scholarship
▫ Loan
▫ Tax rebate
▫ Age relaxation in employment
• Difficult to evaluate disability since it is
multidimensional
• A similar impairment can cause different
disabilities
• Eg: amputee living in a plain area v/s in a hilly
area
• So in disability evaluation only the permanent
physical impairment is evaluated
Guidelines
• According to Medical Council of India, the
physical impairment certificate should be
issued by medical professionals
• Should be done by a medical board
constituted by central & state governments
• Medical board consists of 3 members, out of
which 1 shall be specialist in the field
• Guidelines for evaluation are there for visual,
speech & hearing, locomotor, MR & multiple
disabilities
• Body will be divided into 3 parts UL, LL &
trunk
• Each part have equal weightage of 100% &
whole body value is 100%
• Indian version of KESSLER’S formula is
used for calculation
• Certificate should be valid for a period of
5 years incase of temporary/ progressive
disability
Eligibility to avail facilities
• 40%
Disability evaluation
• Mental retardation
• Visual disability
• Speech & hearing disability
• Locomotor disability
• Multiple disabilities
Locomotor disability evaluation
 Locomotor disability evaluation
Evaluating permanent physical impairment
• Upper limb
• Lower limb
• Trunk
• Dwarfism
• Amputation
• Neurological conditions
• Cardiopulmonary conditions
Evaluation of upper limb disabilities
 Upper limb

Arm component(90%) Hand component(90%)

• ROM • Prehension
• M strength • Sensation
• Coordinated activities • Strength
Principles of evaluation of ROM
• The max value of ROM in the arm component
is 90%
• Each joint of the arm is weighted equally 30%
 Shoulder jt. Normal value Available % Loss of
active ROM ROM

Eg: Flexion- 0-220 110 50%

extension

Rotations 0-180 90 50%

Abdn-addn 0-200 100 50%

• Mean % loss = 50 + 50 + 50/3 = 50%

• Shoulder movt constitute 30% of ROM of
the arm component
• So % loss of ROM(from shoulder) of the arm
component = 50 x 0.3 = 0.15 =15%
Principles of evaluation of strength of muscles

• Graded from 0-5 as advocated by the

Medical Research Council
Manual muscle Loss of strength
strength grading in %
0 100%
1 80%
2 60%
3 40%
4 20%

• Mean % of loss5 0%
of muscle strength around a
joint is multiplied by 0.3
 Shoulder jt. Normal value MMT % Loss of
strength

Eg: Flexors 5 2 60%

Extensors 5 3 40%
Abductors 5 1 80%
Adductors 5 3 40%
Ext. rotators 5 2 60%
Int. rotators 5 3 40%

• Mean % loss = (60+40+80+40+60+40)/6 = 54%

• Shoulder constitute 30% of strength of the
arm component
• So % loss of strength(from shoulder) of the
arm component = 54 x 0.3 = 16.2%
Principles of evaluation of coordinated activities

• Total value 90%

Activities %
Lifting overhead 9%
Touching nose 9%
Eating Indian style 9%
Combing & plaiting 9%
Putting on shirt/ kurta 9%
Ablution Indian style 9%
Drinking glass of water 9%
Buttoning 9%
Tie nara/ dhoti 9%
• Total value of loss of arm component is
obtained by combining the value of loss
of ROM, M strength & coordinated
activities
• Kessler’s formula
[
a + b(90-a) ]
90
Where a = higher value
b = lower value
Eg:
• Loss of strength = 16.2 %
• Loss of ROM = 15%
• Loss of coordination = 9%
• a = 16.2 & b= 15
[
▫ 16.2 + 15(90-16.2)
90
]
= 28.5%

• a= 28.5 & b= 9

[
▫ 28.5 + 9 (90-28.5)
90
]
= 34.65 %
 Upper limb

Arm component(90%) Hand component(90%)

• ROM • Prehension
• M strength • Sensation
• Coordinated activities • Strength
 ?
? ..
Hand component
• Total value = 90%
• Functional impairment of hand is expressed
as
▫ Loss of prehension
▫ Loss of sensation
▫ Loss of strength
Principles of evaluation of prehension
• Total value = 30%
Opposition
Index finger = 2%
Middle finger = 2% 8%
Ring finger = 2%
Little finger = 2%
Lateral pinch 5%

Cylindrical grasp 6%

Spherical grasp 6%

Hook grasp 5%

Total 30%
Principles of evaluation of sensation
• Total value = 30%

Thumb 9%

Index finger 6%

Middle finger 5%

Ring finger 5%

Little finger 5%
Principles of evaluation of strength

• Total value = 30%

• Grip strength = 20%
• Pinch strength = 10%
• Tested using hand dynamometer & pinch
meter
• Combine the values of arm component & hand
component using Kessler’s formula for the
upper limb score
• Total upper limb score =
Arm component
+
Hand component
+
Additional weightage
Additional weightage
• Additional 10% weightage for any of the
following factors
▫ Pain
▫ Infection
▫ Deformity
▫ Mal-alignment
▫ Contractures
▫ Cosmetic disfigurement
▫ Dominant extremity
▫ Shortening