WHAT ARE THE PRINCIPLES OF EVALUATION OF IMPAIRMENT IN THE UPPER LIMB FOR ISSUING A DISABILITY CERTIFICATE ?
A 3 INTRODUCTION
1 The estimation of permanent impairment depends upon the measurement of functional impairment and is not expression of a personal opinion.
2 The estimation and measurement should be made when the clinical condition has reached the stage of maximum improvement from the medical treatment vv imp
3 Normally the time period is to be decided by the medical doctor who is evaluating the case for issuing the PPI Certificate as per standard format of the certificate.
FOR UPPER LIMB CERTIFICATION FOR PPI
A ) The upper limb is divided into two component parts - the arm component and the hand component.
A1 ) Measurement of the loss of function of arm component consists of measuring the loss of motion, muscle strength and co-ordinated activities.
A2 ) Measurement of loss of function of hand component consists of determining the prehension, sensation and strength.
1 - For estimation of prehension opposition, lateral pinch cylindrical grasp, spherical grasp and hook grasp have to be assessed
B ) The impairment of the entire extremity depends on the combination of the functional impairments of both components ( V IMP )
C ) Total value of arm component is 90%
D ) The value of maximum ROM in the arm component is 90%
E ) Each of the three joints of the arm is weighed equally - 30%
F ) Strength of muscles can be tested by manual method and graded from 0-5 as advocated by Medical Research Council of Great Britain depending upon the strength of the muscles
G ) The mean percentage of loss of muscle strength around a joint is multiplied by 0.30.
H ) If loss of muscle strength involves more than one joint the mean loss of percentage in each joint is calculated separately and then added together as has been described for loss of motion.
I ) The total value for coordinated activities is 90%
1 - Ten different coordinated activities should be tested as given in Form A.
- Each activity has a value of 9%
J ) Total value of hand component is 90%.
1 - The functional impairment of hand is expressed as loss of prehension, loss of sensation and loss of strength.
2 - Total value of prehension is 30% it includes -
A ) Opposition-8%
B ) Tested against-Index finger -2%
-Middle finger-2 %
-Ring -2%
-Little finger - 2%Lateral pinch -5% -
C ) Tested by asking the patient to hold a key between the thumb and lateral side of index finger.
D ) Cylindrical grasp - 6% Tested forLarge object of 4 inches size -3%Small object of 1 inch size - 3%
E ) Spherical grasp -6% Tested forLarge object of 4 inches size - 3%Small object of 1 inch size - 3%
F ) Hook grasp - 5% -Tested by asking the patient to lift a bag
3 Principles of Evaluation of sensation
Total value of sensation in hand is 30%
It should be assessed according to the distribution given below:
Complete loss of sensationThumb ray 9%
Index finger 6%
Middle finger 5%
Ring finger 5%
Little finger 5%Partial loss of sensation:
Assessment should be made according to percentage of loss of sensation in thumb/finger(s)
Principles of Evaluation of strength
Total value of strength is 30%It includes:Grip strength 20%Pinch strength 10%Strength of hand should be tested with hand dynamo-meter or by clinical method (grip method).
Additional weightage - A total of 10% additional weightage can be given to following accompanying factors if they are continuous and persistent despite treatment
PamInfectionDeformity
Mat-alignment
Contractures
Cosmetic disfigurationDominant extremity-4%
Shortening of upper limbFirst 1" - No weightage
For each 1" beyond first 1" -2%
USE OF FORMULA - A + B ( 90 - A ) upon B