Guidelines for neurological disability.

1. NEUROLOGICAL
DISABILITY
By Dr. Millind Dunakhe

2. GUIDELINES FOR ASSESSMENT OF PHYSICAL
IMPAIRMENT IN NEUROLOGICAL CONDITIONS
 Assessment in neurological condition is not the
assessment of disease but it is the assessment of
the effects, i.e. clinical manifestations.
 Any neurological assessment has to be done after
six months of onset.
 These guidelines will only be used for central and
upper motor neurons lesions.

3.  Proforma A&B will be utilized for assessment of
lower motor neuron lesions, muscular disorders
and other locomotors conditions.
 Total percentage of physical impairment in
neurological conditions will not exceed 100%.
 In the mixed cases the highest score will be taken
into consideration. The lower score will be added to
it and calculations will be done by the formula:
𝑎 +
𝑏 100−𝑎
100
 Additional rating of 4% will be given for the
dominant upper extremity.
 Additional 10% has been given for sensation in
each extremity but the maximum total physical
impairment will not exceed 100%.

4. TABLE - I
Disability rate
Altered Sensorium 100%
Altered Sensorium : Loss of intellectual and
cognitive function is know as Altered Sensorium.

5. Cognitive Function :
Cognitive Function is the intellectual
activity that includes mental process such as
attention, processing speed, learning and memory,
executive function, verbal fluency and working
memory.

6. TABLE - II
INTELLECTUAL DISABILITY(TO BE ASSESSED BY CLINICAL
PSYCHOLOGIST)
Disability rate
Mild(I.Q. 80-90) 25%
Moderate(I.Q. 70-80) 50%
Severe (I.Q. 60-70) 75%
Very Severe (I.Q. below 60) 100%

7.  INTELLIGENCE QUOTIENT :
An intelligence quotient (IQ) is a
total score derived from several standardized tests
designed to assess human intelligence.

8. TABLE - III
SPEECH DISABILITY
Disability rate
Mild 25%
Moderate 50%
Severe 75%
Very Severe 100%
 Tested by 100 word text. Ability to read (in
educated), comprehend when read out, answer
question on text clearly and ability to write a
synopsis (in educated).

9. TABLE - IV
CRANIAL NERVE DISABILITY
A. Motor Cranial nerves (total or partial) :
20% each nerve.
B. Sensory (total or partial) : 10%for each nerve.
C. Optic or Auditory nerves:
Unilateral Bilateral
Mild 20% 30%
Moderate 40% 70%
Serve 60% 100%

10.  CRANIAL NERVES :
The cranial nerves are 12 pairs
of nerves that can be seen on the ventral (bottom)
surface of the brain. Some of these nerves bring
information from
the sense organs to the
brain; other cranial
nerves control muscles;
other cranial nerves
are connected to glands
or internal organs such
as the heart and lungs.

11.  LIST OF THE CRANIAL NERVES :
 Olfactory (Smell)
 Optic (Sight)
 Oculomotor (Moves eyelid and eyeball and adjusts the pupil
and lens of the eye)
 Trochlear (Moves eyeballs)
 Trigeminal (Facial muscles incl. chewing; Facial sensations)
 Abducens (Moves eyeballs)
 Facial (Taste, tears, saliva, facial expressions)
 Vestibulocochlear (Auditory)
 Glossopharyngeal (Swallowing, saliva, taste)
 Vagus (Control of PNS e.g. smooth muscles of GI tract)
 Accessory (Moving head & shoulders, swallowing)
 Hypoglossal (Tongue muscles - speech & swallowing)
10 out of 12 cranial nerves originate in brain stem,

12.  GRADING OF MUSCLE POWER :
 Grade 0- complete paralysis
 Grade 1 -flicker of contraction present
 Grade 2- active movement with gravity eliminated
 Grade 3-Active movement against gravity
 Grade 4-Active movement against gravity and
some resistance described as poor, fair, moderate
strength.
 Grade 5- Normal power.

13. TABLE - V
MOTOR SYSTEM DISABILITY
Disability rate
Monoparesis 25%
Monoplegia
Hemiparesis
50%
Paraparesis 75%
Paraplegia 100%
Hemiplegia
Quadriparesis
75%
Quadriplegia 100%

14. TABLE - VI
SENSORY SYSTEM DISABILITY
Disability rate
Anaesthesia
Hypoaesthesia
Paraesthesia
Each limb 10%
For involvement of hard/hands,
foot/feet
25%

15. TABLE – VII
BLADDES DISABILITY DUE TO NEUROGRNIC
INVOLVEMENT
Disability rate
Mild (Hesitancy / Frequency) 25%
Moderate (Precipitancy) 50%
Severe (Occasional incontinence) 75%
Very Severe ( retention / Total
incontinence)
100%

16. TABLE – VIII
POST HEAD INJURY FITS & EPILEPTICS
Disability rate
Mild (Occurrence of a convulsion) 25%
Moderate (1-5 fits/month on
adequate medication)
50%
Severe (6-10 fits/month on
adequate medication)
75%
Very Severe (10 fits/month on
adequate medication)
100%

17. TABLE – IX
ATAXIA (SENSORY OR CEREBELLAR)
Disability rate
Mild (Detection on examination) 25%
Moderate (Symptomatic but no
disability)
50%
Severe (partial disability) 75%
Very Severe (Total Disability) 100%

18. THANK
YOU