Guidelines for Evaluation of Permanent Physical Impairment in Lower Limbs IN MOTOR ACCIDENTS CLAIMS CASES:

Guidelines for Evaluation of Permanent Physical Impairment in Lower Limbs IN MOTOR ACCIDENTS CLAIMS CASES:

 

The lower extremity is divided into two components: Mobility

component and Stability component.

MOBILITY COMPONENT: Total value of mobility component is 90%. It includes range of movement and muscle strength.

Principles of Evaluation of Range of Movement:

The value of maximum range of movement in the mobility

component is 90%.

2. 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 27degree. The lift hip exhibits a range

of active abduction of 54degree. Hence, there is loss of 50% of

abduction movement of the right hip. The percentage loss of

mobility component in the hip is 50, 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.

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:1.

The value for maximum muscle strength in the leg is 90%.

2. Strength of muscles can be tested by manual testing like 05

grading.

3. 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%

4. Mean percentage of muscle strength loss is multiplied by

0.30.

5. 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.

Combining Values for the Mobility Component: MACP

Let us assume that the individual with a fracture of the right hip

joint has in addition to 16% loss of motion 8% loss of strength

of muscles.

Combing Values:Motion

16%, Strength 8%

= 16 +8(9016)/

90 =22.6%

Where 'a' = higher value, 'b' = lower value.

STABILITY COMPONENT:1.

Total value of stability component is 90%

2. It is tested by 2 methods

3. Based on scale method.

4. Based on clinical method

Three different readings (in kilograms) are taken measuring the

total body weight (W), scale ‘A’ reading and scale ‘B’ reading.

The final value is obtained by the formula :

Difference in body weight divided by Total body weight,

multiplied by 90.

In the clinical method of evaluation nine different activities are

to be tested as given in the proforma. Each activity has a value

of ten percent (10%).

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

The local effects of lesions of spine can be divided into traumatic and non traumatic lesions.

TRAUMATIC LESIONS

Cervical Spine Fracture Percent Whole body Permanent Physical Impairment and Loss of Physical Function to Whole Body.

A. Vertebral compression 25%, one or two vertebral adjacent

bodies, no fragmentation, no involvement of posterior elements,

no nerve root involvement, moderate neck rigidity and

persistent soreness.

B. Posterior elements with Xray evidence of moderate partial

dislocation.

(a) No nerve root involvement, healed15

(b) With persistent pain, with mild motor and sensory

Manifestations25

(c) With fusion, healed no permanent motor or sensory

changes25

C. Severe dislocation, fair to good reduction with surgical fusion

(a) No residual motor or sensory changes25

(b) Poor reduction with fusion, persistent radicular pain, motor

involvement, only slight weakness and numbness 35

(c) Same as (b) with partial paralysis, determine additional

rating for loss of use of extremities and sphincters.

Cervical Intervertebral Disc:1.

Operative, successful removal of disc, with relief of acute

pain, no fusion, no neurological residual10

2. Same as (1) with neurological manifestations, persistent

pain, numbness, weakness in fingers20

Thoracic and Dorsolumbar Spine Fracture:Percent

Whole body Permanent Physical Impairment and Loss

of Physical Function to Whole Body

A. Compression 25%, involving one or two vertebral bodies,

mild, no fragmentation, healed no neurological manifestations.10

B. Compression 50%, with involvement posterior elements,

healed, no neurological manifestations, persistent pain, fusion

indicated.20

C. Same as (B) with fusion, pain only on heavy use of back. 20

D. Total paraplegia. 100

E. Posterior elements, partial paralysis with or without fusion,

should be rated for loss of use of extremities and sphincters.

Low Lumbar:

1. Fracture

2. Vertebral compression 25%, one or two adjacent vertebral

bodies, little or fragmentation, no definite pattern or

neurological changes.15

3. Compression with fragmentation posterior elements,

persistent pain, weakness and stiffness, healed, no fusion, no

lifting over 25 pounds 40

4. Same as (B), healed with fusion, mild pain 20

5. Same as (B), nerve root involvement to lower extermities,

determine additional rating for loss of industrial function to

extremities

6. Same as (c), with fragmentation of posterior elements, with

persistent pain after fusion, no neurologic findings 30

7. Same as (c), with nerve root involvement to lower

extremities, rate with functional loss to extremities

8. Total paraplegia 100

9. Posterior elements, partial paralysis with or without

fusion,

should be rated for loss of use of extremities and sphincters.

@. Neurogenic Low Back Pain – Disc Injury

A. Periodic acute episodes with acute pain and persistent body

list, tests for sciatic pain positive, temporary recovery 5 to 8

weeks 50

B. Surgical excision of disc, no fusion, good results, no

persistent sciatic pain 10

C. Surgical excision of disc, no fusion, moderate persistent pain

and stiffness aggravated by heavy lifting with necessary

modification of activities 20

D. Surgical excision of disc with fusion, activities of lifting

moderately modified 15

E. Surgical excision of disc with fusion, persistent pain and

stiffness aggravated by heavy lifting, necessitating modification

of all activities requiring heavy lifting – 25

NONTRAUMATIC LESIONS:Scoliosis

The whole Spine has been given rating of 100% and region wise

the following percentages are given:

Dorsal Spine 50%

Lumbar Spine – 30%

Cervical Spine – 20%

Kobb’s method for measurement of angle of curve in standing

position is to be used. The curves have been divided into three

sub groups :

Particulars Cervical

Spine

Thoracic spine Lumber Spine

30degree

(Mild)

2.00% 5.00% 6.00%

3060degree

(Moderate)

3.00% 15.00% 12.00%

Above

60degree

(Severe)

5.00% 25.00% 33.00%

In the curves ranging above 60 0, cardiopulmonary

complications are to be graded separately. The junctional curves

are to be given that rating depending upon level of apex of

curve. For example, if apex of dorsolumbar curve falls in the

dorsal spine the curve can be taken as a dorsal curve. When the

scoliosis is adequately compensated, 5% reduction is to be given

from final rating (for all assessment primary curves are

considered for rating).

Kyphosis

The same total rating (100%) as that suggested for scoliosis is

to be given for kyphosis. Regionwise percentages of physical

impairment are:

Dorsal Spine – 50%

Cervical Spine – 30%

Lumbar Spine – 20%

For dorsal spine the following further gradings are :

Less than 20degree – 10%

21degree – 40degree – 15%

41degree – 60degree – 20%

Above 60degree – 25%

For kyphosis of lumbar and cervical spine 5% and 7%

respectively have been allocated.

Paralysis of Flexors & Extensors of Dorsal and Lumbar Spine:The

motor power of these muscles to be grouped as follows :

Normal Weak

5%

Paralysed 10%

Paralysis of Muscles of Cervical Spine:Particulars

Normal Weak Paralysed

Flexors 0 5.00% 10.00%

Extensors 0 5.00% 10.00%

Rotation 0 5.00% 10.00%

Side

Bending

0 5.00% 10.00%

Miscellaneous:Those

conditions of the spine which cause stiffness and part

etc., are rated as follows :

A. Subjective symptoms of pain, No involuntary muscle spasm,

Not substantiated by demonstrable structural pathology.0

B. Pain, Persistent muscle spasm and stiffness of spine,

substantiated by demonstrable and radiological changes.10%

C. Same as B, with moderate radiological changes.15%

D. Same as B, with severe radiological changes involving any

one of the region of spine (cervical, dorsal or lumbar)20%

E. Same as D, involving whole spine30%

In Kyphoscoliosis,both curves to be assessed separately and

then percentage of disability to be summed.