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APPENDIX 7:DISABILITY MEDICAL ASSESSMENTAND CATEGORIZATION GUIDELINES,2022

DISABILITYMEDICAL ASSESSMENT AND CATEGORIZATION GUIDELINES

2022

REPUBLICOFKENYA

MINISTRYOFHEALTH

DISABILITYMEDICALASSESSMENTAND CATEGORIZATIONGUIDELINES

2022

Ministry of HealthKenya.Disability Medical Assessment and CategorizationGuidelines,aimstoprovidetherightservices,attheright time,at theright place,at therightcost and by the right provider.

Disclaimer

All therightspertainingtothisDisabilityMedicalAssessmentand CategorizationGuidelines inKenyaare reservedbytheMinistryofHealthKenya.Theseguidelinesmaynotbereviewed,abstracted,reproducedor translatedinpartrwhole,orstoredinaretrievalsystem,bypersonsoutsidetheGovernmentwithoutprior writtenpermissionfromtheOfficeoftheDirectorGeneralforHealthinMinistryofHealthKenya.Itmaynot besoldorusedforcommercialpurposesorforprofit.

Whileeveryefforthasbeenmadetovalidatetheinformationin thisDisabilityAssessmentand Categorization Guidelines,theMinistryof Health isnot liableforanyissuesarisingfrom theuse/misuseof information containedherein.

This document is anadministrative document that is intended tofacilitate compliancebythepartieswithin thisguideline,theregulations and otherapplicable administrativepolicies.

Recommendedcitation:

Disability Medical AssessmentandCategorizationGuidelines.MINISTRYOF HEALTH.2022

Publishedby:MinistryofHealth AfyaHouse,Cathedral Road P.0.Box30016-00100,CitySquare Nairobi, Kenya Email: ps@health.go.ke Website:http:/www.health.go.ke

| Disclaimer | 3 | |----------------------------------------------------------------------------------------------|-----| | TableofContents | 4 | | List of Tables | 7 | | AcronymsandAbbreviations | 8 | | WorkingDefinitions | 11 | | Foreword | 13 | | Acknowledgements | 14 | | Preface | 15 | | CHAPTERONE:INTRODUCTION | 16 | | 1.1.Background | 17 | | 1.2Situational analysis | 17 | | 1.3Rationale | 17 | | 1.4 Overall Goal | 18 | | 1.5Purposeof theGuideline | 18 | | 1.6 0bjectives of Guideline | 18 | | 1.7Scope andApplication | 18 | | 1.8 Target Scope | 18 | | CHAPTERTWO:METHODOLOGY | 19 | | 2.0.Introduction | 20 | | 2.1Process of Development | 20 | | 2.2 Legal Frame | 20 | | 2.3Principles forDevelopment | 20 | | 2.4Structure of thisDocument | 21 | | 2.4.1DevelopmentSteps | 21 | | CHAPTER3:ORGANIZATIONALSTRUCTURE | 22 | | 3.0.Introduction | 23 | | 3.1.DisabilityAssessmentCommitteesinHealthFacilities | 23 | | 3.1.1 Introduction | 23 | | 3.1.2 Roles and responsibilities | 23 | | 3.1.4ConstitutionoftheCommittees | 24 | | 3.1.5 Criteria of Appointments | 24 | | 3.1.6GovernanceStructure | 24 | | 3.2DisabilityDomains/ Categories | 24 | | 3.3.DISABILITYCATEGORY:PHYSICALIMPAIRMENTS | 24 | | 3.3.1.Physical Impairments | 24 | | 3.3.2.TheEvaluationofPermanentPhysical ImpairmentofTrunk(Spine) | 33 | | 3.3.3.Non-TraumaticLesions | 34 | | 3.3.4.TheEvaluationofPermanentPhysical Impairment inAmputees | 37 | | 3.3.5.TheEvaluationofPermanentPhysical Impairment(PPl) of congenital deformitiesof thelimbs. | 40 | | 3.3.6.Deficiencies | 40 | | 3.3.7.ScoringforPhysical Disabilities | 45 | | 3.3.8.PhysicalDisabilityAssessmentTeam | 46 | | 3.4.DISABILITYCATEGORY:VISIONIMPAIRMENTS | 46 |

| 3.4.1.VisionImpairment | 46 | |---------------------------------------------------------------------------------------------------------|------| | 3.4.2:CategoriesofVisionImpairment | 46 | | | 48 | | 3.5.0.Introduction | 48 | | 3.5.1.SectionA:Hearing Impairment | 48 | | 3.5.2. Types of Hearing Loss | 48 | | 3.5.3.Categories of HearingImpairment(W.H.O) | 49 | | 3.5.4.Assessment forHearingImpairment | 49 | | 3.5.5:MedicalAssessment | 51 | | 3.5.8.EssentialsforDisabilityMedicalAssessment | 53 | | 3.5.9.DisabilityMedical assessmenttool(Appendices) | 53 | | 3.6DISABILITYCATEGORY:SPEECH,LANGUAGE,COMMUNICATIONANDSWALLOWINGIMPAIRMENTS | 54 | | 3.6.0.lntroduction | 54 | | 3.6.1.Classificationof Speech,Language,Communication andSwallowing | 54 | | 3.6.2.Impairment,Activity,Participation,Wellbeing/DistressSCALE | 60 | | 3.7.DISABILITYCATEGORY:MENTALHEALTHDISORDERS,INTELLECTUAL | | | DISABILITYANDAUTISMSPECTRUMDISORDERS | 62 | | 3.7.1. Definitions | 62 | | 3.7.2.Classification | 62 | | 3.7.3.Disability Assessment Criteria | 63 | | 3.7.4.DisabilityMedicalTeam{Mental HealthConditions/IntellectualDisabilities/SpecificLearningDisorders) | 65 | | 3.7.5.Procedure andDocumentation | 65 | | 3.7.6.Tools and Equipment | 66 | | 3.8.DISABILITYCATEGORY:CHRONICPROGRESSIVEDISORDERS | 70 | | 3.8.0.ChronicProgressiveDisorders | 70 | | 3.8.1.Criteria forDisabilityCategorization:ChronicProgressiveDisorders | 70 | | 3.8.2.MajorAssessmentCategories | 70 | | 3.8.3.Categories of ChronicProgressiveConditions | 72 | | 3.8.4.Interpretation of ExaminationReports. | 72 | | 3.8.5.Total DisabilityRating | 95 | | 3.9.DISABILITYCATEGORY:MAXILLOFACIALDISABILITIES | 95 | | 3.9.1.Head and NeckRegion(ICF Classification-S710) | 95 | | 3.9.2.ClassificationsorCategoriesWithinDentalDisabilityCategory | 95 | | 3.9.2.1.Definitions | 96 | | 3.9.3.Part2:MedicalAssessment | 96 | | 3.9.3.1.FunctionsrelatingdirectlytotheDental,Oral andMaxillofacialDisabilities | 96 | | 3.9.3.HealthProfessionals/Medical WorkersAssessmentTeamComposition | 104 | | 3.9.4.Assessment Tools | 104 | | Chapter4:Implementation,MonitoringandEvaluation | 105 | | 4.1.lmplementation and Compliance | 106 | | 4.2.Monitoringand Evaluation | 106 | | 5.0.Data Collection | 108 |

| REFERENCES | 110 | |---------------------------------------------------------------------------------------------------|-------| | Annex1A:Visual ImpairmentAssessmentTool | 112 | | AnnexIB:Visual AcuityScalesConversions | 115 | | AnnexIC:VisualFunctionalAssessment;InteractionwithTheEnvironment | 116 | | Annex2.Physical DisabilitiesAssessmentTool | 118 | | Annex3A:HearingAssessmentTool | 121 | | Annex3B:AssessmentToolforSpeech,Language,Communication andSwallowingDisabilities | 123 | | Annex4:AssessmentToolforMentalHealthDisorders/Intellectual DisabilitiesandAutismSpectrumDisorders | 128 | | ANNEX5:AssessmentToolforProgressiveChronicDisorders | 131 | | Annex6:AssessmentToolforDentalDisabilities | 134 | | Annex7.BodyStructuresasPerICFClassification | 136 | | Annex8.BodyFunctions | 140 | | Annex9.ActivitiesandParticipation | 144 | | Annex10.ICFDomainCoding-Mental | 150 | | Annex11.Listof Contributors | 152 |

LIST OF TABLES

| Table1:CategoriesofPhysical Conditions | 27 | |---------------------------------------------------------------------|------| | Table2:LevelsofStructural Impairments | 29 | | Table3:Normal JointRangesof MotionfortheUpperlimbs,lowerlimbs&trunk | 31 | | Table4:lmpairmentsof body structures&Assessment | 34 | | Table5:Restriction of function&Assessment (domains) | 47 | | Table6.PhysicalDisabilityQuantificationTable | 50 | | Table7:ReferenceforVisual lmpairmentQuantification | 54 | | Table8:Categoriesof HearingImpairment | 57 | | Table9:HearingAssessmentProtocol | 59 | | Table10:DeterminationoflevelofHearingDisobility | 60 | | Table11.Computationofpercentageof HearingDisability | 60 | | Table12.AssessmentTools | 69 | | Table13:AcceptableInterchangeableTermsforMentalDisorders | 79 | | Table14:ICFAssessmentofMentalHealthConditions | 80 | | Table15:ICFAssessmentofSpecificLearningDisorders | 80 | | Table16:ICFAssessmentofNeuro-developmentalDisorders | 81 | | Table17.DSMVDiagnosticCriteria | 81 | | Table18.Classificationsof IntellectualDisabilitySeverity | 83 | | Table19.DSMDiagnosticCriteria-SpecificLearningDisability | 83 | | Table2O.ICFAssessment ofProgressiveChronicConditions | 106 | | Table21.OxfordScale | 107 | | Table22.BergBalanceScale | 108 | | Table23.GaitTest:Tinetti,TimedUpandGo | 112 | | Table24.LowerExtremityFunctionalScale(LEFS) | 115 | | Table25:CategorizationofDental,OralandMaxillofacialDisabilities | 122 | | Table26:StructuralMedicalAssessment | |

125

ACRONYMSANDABBREVIATIONS

GAF

A/E

AboveElbow

A/K

AboveKnee

AAC

AphasiaCategoriesof Communicators

ABR

AuditoryBrainstemResponse

ACC AphasiaCategoriesof Communication

ACE Assessment of Compression and Expression

ACT Air Condition Thresholds

ADD AttentionDeficitDisorder

ADHD AttentionDeficitHyperactivityDisorder

ADLS

Activities of Daily Living

ADOS AutismDiagnosticObservationSchedule

AGPO

AccesstoGovernmentalProcurementOpportunities

AIDS

Acquired ImmunodeficiencySyndrome

ALS

AmyotrophicLateralSclerosis

ASLTK

AssociationofSpeechand LanguageTherapistsof Kenya

B/E

BelowElbow

B/K

BelowKnee

BERA

Brainstem ResponseAuditoryTest

BSA

Body SiteArea

CAT

ComprehensiveAphasiaTest

CELF

Clinical Evaluation of LanguageFundamentals

CFS

ChronicFatigue Syndrome

CHD Congenital HipDislocation

CLD Congenital Language Disorder

CMC CarpoMetacarpal

COPD ChronicObstructivePulmonaryDisease

CS CabinetSecretary

dB

Decibel

dBHL

Decibel Hearing Loss

DG

DirectorGeneral forHealth

DIP

Distal Iinter Phalangeal

DLA

Daily Living Activities

DLCO

Diffusion Capacity of thelungs for CarbonMonoxide

DLD

Development LanguageDelay

DOB

Dateof Birth

DRS

DisabilityRatingScale

DSM-5

DiagnosticandStatisticalManual ofMentalDisorders,5thEdition

EARC

EducationalAssessmentandResourceCentre

EEG

Electroencephalogram

ENT

Ear Noseand Throat

FEES

Fiber-opticEndoscopicEvaluationSwallowing

FEV

ForcedExpiratoryVolume

FVC ForcedVitalCapacity

Global AssessmentofFunction

GCS

GlasgowComaScale

GRBAS(

GradeRoughness breathiness Asthenia Strain

HAART

HighlyActiveAntiretroviralTherapy

HIV

Human ImmunodeficiencyVirus

ICF

InternationalClassificationofFunction

ICP

International CommunicationProject

IP

Inter Phalangeal

IQ

IntelligentQuotient

JROM

Joint Range of Motion

KRA

Kenya RevenueAuthority

LEFS

LowerExtremityFunctionalScale

LL

Limb Length

LSD

LysergicAcidDiethylamide

MC

Metacarpal

M-CHATModifiedCheckListforAutisminToddler

MCP

Metacarpal Phalangeal

MGUS

MonoclonalGammopathyofUnderminedSignificance

MMS

Manual MuscleStrength

MMSF

Mini Mental StateExamination

MMT

Manual MuscleTesting

MOH

Ministryof Health

MOVESMobilityVariedEnvironmentScore

NCPWDsNationalCouncilforPersonswithDisabilities

N-DAT

NewcastleDysarthriaAssessmentTool

NHL

Non-Hodgkin Lymphoma

NPL

No Perception of Light

NZAT

NewZealandArticulationTest

OMSE

Oral SpeechMechanismScreening

PulmonaryFunctionTests

PIP

Proximal InterPhalangeal

PLS-3

Pre-School LanguageScale-3

PPI

PermanentPhysical Impairment

PS

Principal Secretary

PSC

PaediatricSymptomsChecklist

PTA

PureToneAudiometryTest

PWDs

Persons withDisabilities

QAB

Quick Aphasia Battery

QOL

Quality of Life

RPwD

Rightsof thePerson withDisability

SDGs

SustainableDevelopmentGoals

SLI

Specific language Impairment

SLT

SpeechandLanguageTherapist

SNHL

Sensory Neural HearingLoss

SSI

StutteringSeverityInstrument

STAP

SouthTynesideAssessment of Phonology

TACL-3Test forAuditoryCompressionof Language,3rdedition

TMJ

Temporal-MandibularJoint

TOMS

TherapyOutcomeMeasure

TUG

Timed Up and Go

UMNL

UpperMotorNeuronLesion

VFSS

VideoFluoroscopicSwallowingStudy

WBC

WhiteBlood Count

WHO

WorldHealthOrganization

WNL

WithinNormal Limits

Y-PSC

YouthPaediatricSymptomChecklist

WorkingDefinitions

Activitiesof Daily Living:(ADLs)arebasictasksthat mustbeaccomplishedevery dayforanindividualto thrive.They areusedasameasurementofaperson'sfunctionalstatus.

AudiologistandSpeechTherapist:aretherapiststhatevaluate,manageand treatphysicaldisorders affectinghuman loss,speech disorders,andrelatedsensory andneural problems.Theyplanhearingscreeningprograms andprovide counsellingonhearingsafety and communicationperformance.

Disability:Longtermphysical,mental,intellectualorsensoryimpairementswhichininteractionwithvariousbarriersmay hinderfullandeffectiveparticipationinthesocietyonanequalbasiswithothers

PermanentDisability:lsamentalorphysical illnessoraconditionthataffectamojorlifefunctionoveralongtimeit appliestoanirreversibledamageorlessuseofsomepartafterofmaximumimprovementfromsurgery,medicalorother treatmenthasbeenreachedand theconditionisstationary

significant deteriorationfrom the normal andchances of completerecovery uncertaine.g.,Stroke,centralorperipheral nerveinjury.

ENTSpecialist:isamedicalpractitionerwhospecializesindiseasesthataffecttheears,nose and throataswellashead andneck.

Functional Limitation-Isapartial ortotal inabilitytoperformActivitiesofDailyLiving(ADLs).It maylastforashort time,longtimeorbepermanent.Functionalitycangetbetterwithintervention.Itmayremainstaticorgetworseovertime.

domainis.Asthefunctioningof anindividual occurs ina context,ICFalso includesalistof enviromental factors.ICFis a WHOframeworkformeasuringhealthanddisabilityatbothindividualandpopulationlevels.

Dentalfficers:Diagnose,treatandpreventdiseases,injuriesandabnormalitiesoftheteethmouthjawsandassociated surgical and othertechniquestopromote and restore oral health.

occupation.Theprimarygoal ofoccupational therapyisto enablepeopletoparticipateintheactivitiesof everyday life.

OccupationalTherapist:isahealthprofessional thataidsclientstodevelopnewskills,recover,improveinregardsto theywanttoneedto,orareexpectedtodo(activitiesofdailyliving)throughassessment,treatmentplanninganddiverse interventionsgeared towardssupportingoccupationalengagement.

They counseland advise on eye care and safety,and prescribe opticalaids orothertherapiesforvisualdisturbance.

OrthopaedicSurgeons:Doctorswhospecializeinprevention,diagnosisand treatmentof diseasesand injuriesof the musculoskeletalsystem-bones,joints,muscles,ligaments,tendonsetc

OrthopaedicTechnologists/Prosthetists/Orthotists:Healthworkerswhoassessandtreatphysicalandfunctional andeducateonuseandcareof anappropriateorthosis/prosthesisthatserveindividual'srequirements

Paediatrician:Amedicalpractitionerfocusingontheprevention,diagnosisandtreatmentof healthproblemsininfants, childrenandadolescents.

Physiatrist:Amedicalpractitionerwhospecializesinphysicalmedicineandrehabilitation,alsocalledphysicalmedicine andrehabilitationphysician.

humanmotorfunctions,maximizemovementability,relievepainsyndromes,andtreatorpreventphysical challenges programsforscreening,treatingandpreventionof commonphysical ailmentsand disorders.

Rheumatologist:Specialized physicianwho has expertiseintreatingarthritis,andothermusculoskeletal conditionsand autoimmunedisorders.

Rehabilitation:Definedasaset of interventionsdesignedtooptimizefunctioningandreducedisabilityin individualswith healthconditionsininteractionwiththeir environment.It isrebuildingorrelearningskillsthatwerelost.

Habitation:Referstoaprocessaimedathelpingdisabledpeopleattain,keeporimproveskillsandfunctioningfordaily living.Involves learning andmasteringbrand-newskillsparticularlyiftheperson learningthoseskillsis developmentally disabled

FOREWORD

TheConventionon theRightsofPersonswithDisabilities adopted by theUnitedNationsGeneralAssemblyon13thDecember2006,isan internationalhumanrightstreatyoftheUnitedNationsintendedto Convention arerequired topromote,protect,andensurethefullenjoyment ofhumanrightsbypersonswithdisabilitiesand ensurethattheyenjoyfull equalityunderthelaw.TheConventionhasserved asthemaqjorcatalyst inthe globalmovement fromviewingpersonswithdisabilitiesasobjectsof charity, medicaltreatmentandsocialprotectiontowardsviewingthemasfulland equal membersof society,withhumanrights.It is alsothe only UN human rightsinstrumentwithanexplicitsustainabledevelopmentdimension.The Convention wasthefirsthumanrights treaty of the third millennium.Kenya ratifiedthe

UNConventionontheRightsofPersonswithDisabilities(UNCRPD)on19th May2008creatinganobligationuponKenyatorespect,protectandfulfil the provisionsin theConvention.Pursuant to article2(6)of theConstitutionof

Kenya,theConventionformspart of Kenyanlaw.

Kenya hasanestimated O.9Mlillionpersonswithdisabilities(KNPHC2019).ThiskeySegmentof thepopulationis likely to haveprofoundsocialandculturaleffectsonpersonswithdisabilities,resultinginexclusionandcreatingofteninsurmountable obstaclesinrelationtohealthservices,educationandemployment.Suchexclusionanddiscriminationinturncontributesto and decision making.

ThisDisabilityAssessment andCategorizationGuidelinesthefirstofitskind intheCountyhavebeendevelopedinlinewiththe International Classification of Functioning,Disability and Health(ICF) model.Thisrepresents aradical shift from emphasizing onaperson'sdisabilitytoafocusontheirlevelofhealth.

ableto:

Provideascientificbasisforunderstandingandstudyinghealthandhealthrelatedstates,outcomes,determinantsand changesin healthstatusand functioning.
varioususerssuchashealthcareworkers,PwDs,researchers,policymakersandotherserviceproviders.
Permit comparisonof data acrossGovernment agencies,healthcaredisciplines andwithotherstakeholders
Provideasytematiccodingschemeforhealthinformationsystems.

Dr.PatrickAmoth,EBS Ag.DirectorGeneralforHealth

Acknowledgements

ThedevelopmentofDisabilityMedicalAssessmentand CategorizationGuidelineswasacollaborativeprocessundertaken byadedicatedteamfromtheMinistryofHealthwithseveralkey stakeholders andpartners.

Several meetings,contributionsandinputswerereceivedtowardsenriching throughvariousformstowardsthesuccessof theseguidelines.

IthankthetechnicalteamfromtheMinistryledbytheActingDirector GeneralforHealth,DrPatrickAmoth,AgDirector,DirectorateofHealthcare Services,Dr.Julius Ogato,Head,Department of National HealthSystems Strengthening,Dr.Zeinab Gura,the Head of Rehabilitative Services and ChiefPhysiotherapist,Wilfrida Otieno,AlexKisyanga,theChiefOrthopaedic Technologistand lreneGichohitheChief OccupationalTherapistforgiving lead

to theentireprocess.lalsowishto thankalltheprofessionalswhoworked underthemto ensure thetaskisaccomplished inthestipulated timelines.

IwishtorecognizetheimmensecontributionfromtheMinistry ofPublicService,Gender,SeniorCitizensAffairsandSpecial Programmes,National Council forPersonswithDisabilities (NCPWDs),Kenya RevenueAuthority(KRA),Associationfor thePhysically Disabled of Kenya (APDK),Kenyatta National Hospital (KNH),KenyaMedical TrainingCollege(KMTC),Jomo KenyattaUniversityofAgricultureandTechnology(UKUAT),TheAfricanMedicalandResearchFoundation(AMREF) University and United Disabled Personsof Kenya (UDPK)

successoftheexercise.

Dr.JuliusOgato

Ag.Director,Directorateof HealthcareServices

Preface

Theoverall aimof this document is toprovide a unified,standard languageandframeworkfortheassessmentofpersonswith disabilities.The documentwill providea usefulprofileofindividual's functioningdisabilityandhealthinvariousdisabilitydomains.Ithas adaptedaBio-psychosocial Model,whichaimstolinkboththesocial and medical modelsto come upwith categories of variousformsof disabilities. It isintheintricatebalanceof thispendulumthatqualityhealthcarelies.A balancethatnotonlyneedshealthcareproviderstomaintain,butalsothe patients/clientsandsocietiesinwhichthey livein.

physiologicalsystemswithanatomicalstructures.Thedocumentestablishes a commonlanguagedescribingdisability.componentsoffunctioningand disability andothercontextualfactors.Itisthefirstof itskind intheCountry

tobeusedbymedicalspecialiststodeterminetheexistenceof disabilitybyorganizingtheinformation in linewith International Classificationof Functioning,DisabilityandHealth(ICF) asfollows.

1.Body structure and itsfunctions
2.Activities andparticipation componentscoveringthe completerange of domaindenotingaspectsoffunctionsfromthe individualandasocietalperspective.
3.Environmental factors which form part of the contextual factors,with an impact in all components of functioningand disability.
4.Personal factors componentsforma large socialand cultural variance,thedocument helpmedicalpersonnel in assessing andcategorizingpersonswithdisabilities.

disabilitieseechanguageandHearingdisabilities,rogressiveChronicConditionsthatcausedisabilitiesndMaxillofacil Information integrated.

Dr.ZeinabGura Head,Departmentof National HealthSystemsStrengthening

INTRODUCTION

1.1Background

TheUNConventionontheRightsofPersonswithDisabilitiesadoptedbytheUnitedNationsGeneralAssemblyon13th December2006,is aninternational humanrightstreatyof theUnitedNationsintended toprotecttherights anddignity ofpersonswithdisabilities.PartiestotheConventionarerequiredtopromote,protect,andwarrantthefullenjoyment ofhuman rightsbypersonswithdisabilities andconfirm that theyenjoyfull equality under thelaw.TheConvention has servedasthemajorcatalystintheglobalmovementfromviewingpersonswithdisabilitiesasobjectsofcharity,medical 19th2008,Kenya amongst othercountries,endorsed theConvention on theRights of Persons withDisabilities(CRPD) of theConstitutionofKenya2010.

Kenyaisadevelopingcountrywithvariablesocial,cultural,geographicandeconomicbackground.lndustrialization,frming mechanization and increase inroadtraffic accidents have increased thenumber of PWDs,withcommunicable,noncommunicableand congenital defects considered asmajor problems'adding to the number of disabilities.The changing demographicpictureof lifeexpectancy,labourforce andactiveworkingpopulationintheruralandurbanestablishmenthas requiredisability evaluationandrehabilitation.

1.2Situationalanalysis

AccordingtotheWorldHealthOrganization(WHO),10%of theworldpopulationlivewithvariousformsof disabilities.Kenya has 0.9 millionPersonswithDisabilities (PWDs)according to the2019KenyaPopulation andHousingCensus(KHPC). Disabilityaffectsallaspectsofsocietyandnationaldevelopment.Importanttonoteisthechallengesposedbydisability owingtoadditionalfactorssuchasinformation/communicationgaps,HIV/AIDS,social-economicdevelopmentomissionof disability concerns intheUniversal HealthCoverage.

Consequently,afteracknowledgingthatonlyasmallpercentageofPwDsaccessessentialservicessuchashealththerewas provisionforthe enactment of PWDAct2003,that led to the establishedof National Council forPersonswithDisabilities (NCPWD)tolookintothewelfareofpersonswithdisabilities.One of itsmajorfunctionswastoregisterandcategorize personswithvariousforms of disabilities.Healthpersonnelof variousspecialtiesparticipateinassessmentand confirmation ofdisabilitiesasperthePWDAct2003,whichstatespersonswithdisabilitiesshouldnotbediscriminated.

Currentlythereisnoguidelinesonhowtoconductcredibleassessments,toenablesPWDsaccessvariousbenefitsrendered by theCouncil andother agencies.Theseservicesinclude,provisionof appropriatemobilitydevices,hearingaids,medical care,Brailleservices,educationbursaries,taxexemptiononincomes,andsupportinestablishingincomegenerationprojects.

1.3 Rationale

Assessmentandcategorizationovertheyearshasbeendonewithoutstandardizedassessmentguidelines,whichhave ByadaptingtheBio-psychosocialModel,aimedat linkingboththesocialandmedical models,assessorswillformulate theseguidelines,allhealthfacilitieswillhave uniform assessmentparametersand thereforeinformationdocumentedwill beaccurate.

1.40verallGoal

DisabilityMedical AssessmentandCategorizationGuidelinesaimstoprovideastandardprocess,unifiedandconsistent language,for conducting the assessment and categorization of persons with disabilities.

1.5PurposeoftheGuideline

Theguidelineisintended toensurethatstandardisedbestpractisesareachievedwhendeterminingexistenceof disability in a person.

1.60bjectivesofGuideline

·To determine theexistence ofdisability,andorganize theinformationintoInternational ClassificationofFunction(ICF) model.
To integratetheICFmodelsintoclinical practices.

1.7ScopeandApplication

Theguidelineswillbeusedbymedicalpersonnel inapproved healthfacilities,todeterminetheexistenceof disability,asper worldhealthorganization(WHO)internationalclassificationoffunctions(ICF)model,whichinclude;

1.Bodystructureanditsfunctions.
individualandasocietalperspective.
disability.
4.Personalfactorscomponentsformalargesocialandculturalvariance,necessaryformedicalpersonnel inassessingand categorizingpersonswithdisabilities.

1.8TargetScope

Thisguidelinewillfacilitate themedicalpersonnel and relevant authoritiestomakeinformed decisionswhen offering services toPersonswithDisabilities.

METHODOLOGY

2.0.Introduction 2.1ProcessofDevelopment

The process of developing this document started in August, 2020,after the inauguration of the Ministerial Disability MainstreamingCommittee.ThiswasfollowedbyaworkshopheldinNairobi,duringwhichaTechnicalWorkingGroup(TWG) wasconstituted todevelopafirstdraftinformedbytheMinistryof HealthStrategicPlan,MinisterialPerformanceContractand otherrelevant documents.Severalmeetings were held bytheTWG and the draft subsequently sharedwithboth internal and externalstakeholdersforinputsandcomments.Inaddition,severalconsensusmeetingswithkeystakeholdersforvalidation andwereundertakenandoutputslaterreviewed bytheMinistry of HealthHeadsofDirectoratestofurthercontextualizethe desireddisabilityassessmentandcategorizationguidelines.

2.2 Legal Frame

In order to ensure equal opportunities,empowerment,protection of rights and fullparticipationin service delivery toPWDs, asoutlinedintheUNConventionontheRightsofPersonswithdisabilitiesandasenshrinedintheConstitutionofKenya 2010,ThePersons withDisability Act 2003,Legal NoticeNo.36of 30thMarch 2010,a Ministerial DisabilityMainstreaming Committeewassetupon2ndOctober2013bythePrincipalSecretarywhoseTermsofReferencehasamongstothers,guided thedevelopmentof thisDisabilityAssessmentandCategorizationGuideline.

2.3PrinciplesforDevelopment

Awell-functioninghealthservicedeliverysystemensuresvarioushealthfacilitiesandservicesofferedbythegovernmentare accessibletoPersons with disability(PwDs)without any discrimination and limitation,and therefore contributingtowelfare and livelihoods for PWDs.

IndevelopingtheseDisability assessmentandcategorizationguidelinesasetofprinciplesthatreflecttheoverallpolicy direction, havebeenconsidered,andinclude:

Inclusivity;all persons assessed anddeemed tohave disabilitieswill enjoyservices provided by theKenyalaws.

Integration ofcare:Provideframeworkforcomprehensiveand holisticpatientcare

Logic; applicable and ableto address the existing gaps in the disability assessment and categorization.

Relevance and acceptability: Meet demands and expectation of consumers.

Universality: Ensures the language used is acceptable and recognised internationally.

Validity anc reliability: Assessment conducted in different facilities produce similaresults, accurate, and complete.

2.4Structure of this Document

WHA54.21),while tryingtoprovideacoherentviewof differentperspectivesof healthfromabiological,individualand social perspective.

The guidelines is structured into six cross-cutting domains,namely:Physical Disabilities;Visual Disabilities;Hearing Speech and Language Disabilities; Mental Disabilities; Intellectual Disabilities; and Autism Spectrum Disorders, ProgressiveChronicConditionsandMaxillofacialDisabilities.Withineachdomain,therewillbesub-domains,whichwil furtherbreakdown thedomainsintosub-sectionsorcritical areasthattogetherdescribethescopeof that domain.

2.4.1 Development Steps

Thefollowing stepshavebeenconsidered during theguideline development.

STEP 1: Outlining the domain/ type of disability category.

(Introduction,keydefinition)

theirinteractionandcontributetothedisabilitydomain.

STEP 3: llustrating theassessment evaluation procedures and interpretation of theresults.

STEP 4:Specifying the Human Resources required for assessment and categorization of specific domain.

STEP5:Consideringminimum instruments and toolsrequired for assessment and categorization of specific domain.

ORGANIZATIONAL STRUCTURE

3.1.Disability Assessment Committees

3.1.1Introduction

ForanassessmentexercisetheCommitteeshallbecomposedofatleastthree(3)members,outof whichoneshallbe (Physiotherapist,OccupationalTherapistorOrthopaedicTechnologist)

In theabsenceofthelinespecialistinthathealthfacility,theophthalmicclinicalofficer/nurse,ENTclinicalofficer/nurse, psychiatricclinicalofficer/nursemaybeappointedasmembers

3.1.2 Roles and responsibilities

National Level

Theroleof theofficeof theDGforHealthand theNational levelfacilitiesistooddressappealsthatmayarisefromthe assessmentsatthecountylevel,providetechnicalassistancetothecountiesandandparticipateinvettingofpersonswith disabilityfortaxexemptionbyKRAwhencalledupon.

CountyLevel

2.Bookandkeeprecords of theirclients
3.Acquireconduciveandaccessibleassessmentpremises
4.Acquire,avail andensureproperuseof allthenecessarytoolsand equipment,
5.Referclientsforappropriateinterventionswherenecessary.
6.Submitdullyfilledandsigned assessmentreportspertheguidelinestorelevant authorities.

3.1.3ConstitutionoftheCommittees

TheMedicalSuperintendent/HospitalCEO/MedicalOfficerinChargewillappointthedisabilityassessmentcommittee. Membershipwillcomprise of the following;

Chairmanship: Medical Superintendent or a Medical Specialist/Medical Officer appointed in writing by the Medical Superintendent to sit in the commiteeonhis/herbehalf appoint in writing aMedicalSpecialist /Medical Officertorepresent him/her.
·Members shall include:physiotherapists, occupational therapists,orthopaedic technologists, opthalmologists, ENT

specialists,Psychiatrists.

Dentists,physicians,medical social workersetc.

TheChairmanmay co-optotherexpertsastheneedmayarise.

TheMedicalSuperintendent/HospitalCEO/MedicalOfficerinChargeshallappointasecretarytothecommittee.

3.1.4 Criteria of Appointments

TheMedicalSuperintendent/HospitalCEO/MedicalOfficerinChargeshallappointaspecialistforeachrespectivedomainto sit inthecommittee.

In the absenceof the linespecialist,a clinical officer or nurse whohas advanced qualifications in that linespeciality shall begivenconsideration.Thisshall includeophthalmicclinicalofficers/nurses,ENTclinicalofficers/nurses,psychiatricclinical officers /nurses.

associations

3.1.5GovernanceStructure

Authoritytoconduct Disabilityassessmentsshallbeconducted bydisabilityMedicalAssessmentCommittee dullyconstituted byNationalgovernmentandCountygovernments.

3.2DisabilityDomains/Categories

TheGuidelinesforevaluationofthefollowingdisabilitiesandprocedureforcertificationconsidersthefollowingdisability categories(domain)

1) Physical Disabilities

2. 2)Visual Impairments 3. 3)Hearing,Speechand LanguageDisabilities 4. 4)Mental HealthDisorders,IntellectualDisabilitiesandAutismSpectrumDisorders 5. 5)ProgressiveChronicConditions 6. 6)MaxillofacialDisabilities

3.3.DISABILITYCATEGORY:PHYSICALIMPAIRMENTS

3.3.1.Physicallmpairments

Definition

dexterity,whichuponinteractionwiththeenvironmenthindersfullandeffectiveparticipationwithinthesocietyonanequal basiswithothers

They canbecausedby;butnot limitedtoneurological,musculoskeletal,posttraumaticorcongenitaldisorders.Examplesof

Table 1: Categories ofPhysical Conditions

| Neurological | Musculoskeletal | Others Physical conditions | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------| | Acquiredbraininjuries Cerebralpalsy Congenital HipDislocation Erb's palsy Hemiplegia Hydrocephalus Klumpke'spalsy Monoplegia Multiplesclerosis Muscular dystrophy Paraplegia Poliomyelitis Quadriplegia Spina bifida Spinal cordinjuries | Amputation Arthritis Athrogryposis Ankylosing spondylosis Congenitaldeformities FreemanSheldomsyndrome Kyphoscoliosis OsteogenesisImperfecta Phocomelia/Amelia Scoliosis,kyphosis | Permanentcolostomy Dwarfism Gigantism |

VariablesinAssessingPhysical Disability

Thefollowingvariablesneedtobetakeninto considerationwhileassessingfunctionallossresulting intopermanent physical impcirment (PPI)

Muscle strength
MuscleGirth
Muscletone
Joint Range of motion
Degree of angulation/rotation
Height
·Skin pigmentation
·Co-ordination and balance
Stability
Limb length discrepancy
Hand function(prehension,grasp,sensation&strength)
Deformity
Sensation(Skinsensation,jointvibratory andmovement,stereognosisamongotherforms)
·Level of amputation
-Duration of illness/injury

AreasofAssessment

Function=b(body functions)
Structure=s(body structures)
Activity/Participation Restrictions=d(activities/participation)
Environmentalfactors=e(environmentalfactors)

Table2:LevelsofStructural Impairments

| | First Qualifier: Extentofimpairment | Second Qualifier: Nature of the change | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | 0.Noimpairmentmeans theperson hasno problem 1.Mildimpairmentmeansaproblemthatis presentlessthan25%ofthetime,withan intensityapersoncantolerateandwhich happensrarelyoverthelast30days. 2.Moderateimpairment meansthataproblem thatispresentlessthan5o%ofthetime,with anintensity,whichisinterferinginthepersons day todaylife andwhichhappens occasionally overthelast30days. 3.Severeimpairmentmeansthataproblem thatispresentmorethan5o%ofthetime,with anintensity,whichispartiallydisruptingthe personsdaytoday lifeandwhich happens frequently overthelast30days. 4.Completeimpairmentmeansthataproblem thatispresentmorethan95%ofthetime,with anintensity,whichistotallydisruptingthe personsdaytodaylifeandwhichhappens every dayoverthelast30 days. 8.Not specifiedmeans thereisinsufficient informationtospecifytheseverityof the impairment. 9.Notapplicablemeansit isinappropriateto applyaparticularcode(e.g,b650Menstruation | 0.Noimpairmentmeans theperson hasno problem 1.Mildimpairmentmeansaproblemthatis presentlessthan25%ofthetime,withan intensityapersoncantolerateandwhich happensrarelyoverthelast30days. 2.Moderateimpairment meansthataproblem thatispresentlessthan5o%ofthetime,with anintensity,whichisinterferinginthepersons day todaylife andwhichhappens occasionally overthelast30days. 3.Severeimpairmentmeansthataproblem thatispresentmorethan5o%ofthetime,with anintensity,whichispartiallydisruptingthe personsdaytoday lifeandwhich happens frequently overthelast30days. 4.Completeimpairmentmeansthataproblem thatispresentmorethan95%ofthetime,with anintensity,whichistotallydisruptingthe personsdaytodaylifeandwhichhappens every dayoverthelast30 days. 8.Not specifiedmeans thereisinsufficient informationtospecifytheseverityof the impairment. 9.Notapplicablemeansit isinappropriateto applyaparticularcode(e.g,b650Menstruation | 0.No changein structure 1.Total absence 2.Partial absence 3.Additional part 4.Aberrantdimensions 5.Discontinuity 6.Deviating position 7.Qualitativechangesinstructure,including accumulationoffluid 8.Not specified 9.Not applicable |

ACTIVITYLIMITATIONS&PARTICIPATIONRESTRICTION

Activityis theexecution of ataskoractionbyanindividual.Participationisinvolvementina lifesituation.
·Activitylimitationsaredifficultiesanindividualmayhaveinexecutingactivities.Participationrestrictionsare problemsan individual mayhavein involvement in lifesituations.

ThePerformancequalifierindicatestheextentofParticipationrestrictionbydescribingthepersonsactualperformance ofataskoractioninhisorhercurrentenvironment.Becausethecurrentenvironmentbringsinthesocietalcontext, performancecanalsobeunderstood as"involvement ina life situation"or"thelived experience"of people inthe actual context inwhichtheylive.Thiscontextincludes theenvironmental factors-allaspectsofthephysical,social and respondentexperiencesindoingthings,assumingthat theywanttodothem.

The Capacityqualifierindicates the extent ofActivity limitation bydescribing theperson ability to execute a task oran action.TheCapacity qualifierfocuses onlimitations thatare inherent orintrinsicfeatures of theperson themselves. Theselimitationsshouldbedirectmanifestationsoftherespondent'shealthstate,withouttheassistance.Byassistance wemeanthehelpof anotherperson,orassistanceprovided byanadapted orspeciallydesigned toolorvehicle,orany thatnormallyexpectedof theperson,ortheperson'scapacitybeforetheyacquiredtheirhealthcondition.

Levels ofFunctional Limitation/ParticipationRestrictions

FirstQualifier:Performance

ExtentofParticipationRestriction

ONodifficultymeansthepersonhasnoproblem
1 Milddifficultymeansaproblemthat ispresent lessthan25%of thetime,with anintensityapersoncantolerate and whichhappensrarelyoverthelast30days.
2 Moderate difficulty meansthata problem that is present less than 50%of thetime,with an intensity,which isinterfering
3Severe difficulty meansthataproblemthatispresentmorethan50%of thetime,withanintensity,whichispartially
4Completedifficultymeansthataproblemthatispresentmorethan95%of thetimewithanintensitywhichistotally
9 Not applicablemeansit isinappropriateto apply aparticular code(e.g,b650Menstruationfunctionsfor woman in pre-menarche orpost-menopause oge).

Second Qualifier:Capacity(withoutassistance)

ExtentofActivitylimitation

3-TierAssessment

Presenceof Impairment
Long-term/Recurrent-Tobeconsidered twelve(12)monthsafterthelast intervention
Substantially Limiting

Table 3: Normal Joint Ranges of Motion for the Upper limbs, lower limbs &trunk

| Joint | Movement | ActiveRange of Motion Norms(degrees) | |-------------|------------------|-------------------------------------------| | Upper limb | Upper limb | Upper limb | | Shoulder | Flexion | 0-180 | | Shoulder | Extension | 0-60 | | Shoulder | Abduction | 0-150 | | Shoulder | Adduction | 0-30 | | Shoulder | InternalRotation | 0-90 | | Shoulder | ExternalRotation | 06-0 | | Elbow | Extension | 0-180 | | Elbow | Flexion | 0-150 | | Forearm | Pronation | 0-80 | | Forearm | Supination | 0-80 | | Wrist | Radial Deviation | 0-20 | | Wrist | UlnarDeviation | 0-30 | | Wrist | Dorsiflexion | 0-70 | | Wrist | PalmarFlexion | 0-80 | | Thumb CMC | Flexion | 0-50 | | ThumbMCP | Flexion | 0-55 | | ThumbIP | Flexion | 06-0 | | ThumbMCP | Extension | 60-0 | | ThumbIP | Extension | 0-5 | | Thumb | Opposition | Tipofthumbtotipofeachfinger ofthesamehand | | Thumb | Adduction | 0-30 | | Thumb | Abduction | 0-70 | | FingersMCP | Extension | 0-45 | | FingersPIP | Extension | 120-0 | | FingersPIP | Flexion | 0-120 | | Fingers DIP | Extension | 80-0 | | Fingers DIP | Flexion | 0-80 |

| Fingers | Abduction | 0-30 | |-------------|------------------|-----------| | FingersMCP | Flexion | 0-90 | | Fingers PIP | Flexion | 0-115 | | Fingers DIP | Flexion | 06 -0 | | LowerLimb | LowerLimb | LowerLimb | | Hip | Flexion | 0-125 | | Hip | Extension | 0-30 | | Hip | Adduction | 0-25 | | Hip | Abduction | 0-45 | | Hip | InternalRotation | 0-45 | | Hip | ExternalRotation | 0-45 | | Knee | Flexion | 0-150 | | Knee | Extension | 0-180 | | Ankle | Eversion | 0-20 | | Ankle | Inversion | 0-30 | | Ankle | Dorsiflexion | 0-20 | | Ankle | Plantarflexion | 0-45 | | Cervical | Flexion | 0-50 | | Cervical | Extension | 0-60 | | Cervical | Lateral flexion | 0-45 | | Cervical | Rotation | 0-80 | | Lumbar | Flexion | 06-0 | | Lumbar | Extension | 0-30 | | Lumbar | LateralFlexion | 0-30 |

Calculating%of availableRangeof Motion(RoM)

Availablerangex100

Normalrange

For Example;

Normal ROMKneeextensionis0-180° If the available range is 90°

Availablerangeofmotionforkneeis50o Levelof impairmentismild impairment

Example 2-Joint limitation affecting differentmovements

A fracture of right Hipjointbones may affect different acts ofmovement forthejoint. Affected Joint-Rt.Hip:

| Arcof Movement | NormalROM | ActiveROM | %ageof availableROM | |---------------------|-------------|-------------|-----------------------| | Flexion-Extension | 0-155 | 0-70 | 45 | | Abduction-Adduction | 0-70 | 0-25 | 33 | | Rotation | 0-90 | 0-30 | 33 |

MeanofavailableR0MofRtHip=(45+33+33)/3=37%(Moderateimpairment)

InterpretationofResultsforJointRange

4: 0-4%-totaljoint stiffness/completeimpairment
3: 5-24%-severeimpairment
2: 25-49%-moderateimpairment
1: 50-95%-mild impairment
0: 0≥96%-full ROM-noimpairment

rehabilitation duration.

Congenital and acquired deformities tobe considered forregistration only after all possible interventions have been explored,anddespitecorrectionachievedthereisstillsignificantfunctional limitations.

Table4:ImpairmentsOfBodyStructures&Assessment

| Impairment | Assessment | Normative values | Levels/ percentage loss of strength | Interpretation | |-------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Upper8Lower limb,Trunk | Upper8Lower limb,Trunk | Upper8Lower limb,Trunk | Upper8Lower limb,Trunk | Upper8Lower limb,Trunk | | Muscle weaknessor paralysis | Manual muscle testing (MMT) | Grade5 Oxford scale | Grade 5(0%)=Normal Grade4(20%)=G00d Grade3(40%)=Fair Grade2(60%)=Poor Grade 1(80%)-Trace Grade0 (100%)-No activity | 5-Complete ROM againstgravitywith fullresistance 4-CompleteROM against gravity with someresistance 3-Complete ROM againstgravitywith noresistance 2-CompleteROM with gravity omitted 1-slight Contractibilitywith noROM O-No Muscle Contraction | | Girth circumference | Circumferential measurement (Tape) | +/-2cm | +-(3-6)=Mild +-(7-10)=Moderate +-(11)=Severe | 0-noimpairment 1-Mild 2-Moderate 3-Severe | | Limb length discrepancy despite surgical intervention | Trueleglength measurement (Tape) In comparison with the Normal Lower Limbs (Umbilicusto the medial malleolus) Upper Limbs (olecranon Processto the tip of themiddle finger) | | 0-3cm=Mild 3-6cm=Moderate Above6cm=Severe 3-6 cm can be corrected surgically or through shoeraise Shorteningof6 cm(2,5 inches) and above is considered disabling | O-no impairment 1-Mild 2-Moderate 3-Severe |

| Balance/coordin ation | Lower limb(rapid Heel -knee, rapid plantarflexion- dorsiflexion, walking, = Observe for ataxia, dysmetria, tremors Upper limb (Finger-nose, rapid pronation- supination) =observe for hypermetria, terminaltremors Standing opens arms, open eyes/ closed eyes, feet apart/feet together/ feet on | +/-Check on the ranges | Rapidmovementswith terminaltremors=mild Intention tremors=moderate Intention8termina tremors, dysmetria/hypermetria= severe | O-no impairment 1-Mild 2-Moderate 3-Severe 4-complete | |-------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------| | Height | Measurementof body length in centimetres | Average Adult height5ft 9"tallest Adult8ft 11" Short stature-4ft 10" (147cm) Gigantism 6ft10" | 0-Normal 4-gigantism/Short stature (Exampleincasesof pituitaryglandtumor/ acromegaly.e.t.c.) | 0-Normal 4- Gigantism/Short stature |

3.3.2.THEEVALUATIONOFPERMANENTPHYSICALIMPAIRMENTOFTRUNK(SPINE)

BasicGuidelines

Thelocaleffectsof thelesionsof thespinecanbedivided into traumaticandnon-traumatic.Thepercentageof PPl inrelation toeachsituationshouldbevalued asfollows:

TraumaticLesions

| Cervicalspine injuries | Percentage of PPlin relation to Spine | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------| | i)25%ormorecompressionofoneortwoadjacentvertebralbodieswithNo involvementofposteriorelements,Nonerverootinvolvement,moderate NeckrigidityandpersistentSoreness. | 20% | | i) Posteriorelement damage withradiological Evidence of moderateparties dislocation/sublimation including whiplash injury. Withfusionhealed,NopermanentmotororsensorychangesB)Persistent | 10% | | painwithradiologicallydemonstrableinstability. | 25% | | iii)SevereDislocation: Fairtogoodreductionwithorwithoutfusionwithnoresidualmotoror sensoryinvolvement; | 10% | | Inadequatereductionwithfusionandpersistentradicularpain | 15% |

| Cervical IntervertebralDiscLesions | Percentage ofPPlin relation to Spine | |-----------------------------------------------------------------------|----------------------------------------| | i)Treatedcaseofdisclesionwithpersistentpainandno neurological deficit | 10% | | ii)Treatedcasewithpainandinstability | 15% |

| Thoracicand ThoracolumbarSpine Injuries: | Percentage of TTspine | |----------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------| | i)Compressionof lessthan5o%involvingonevertebralbodywithno neurologicalmanifestation | 10% | | ii)Compressionofmorethan5o%involvingsinglevertebraormorewith involvementofposteriorelements,healed,noneurological manifestationspersistentpain,fusionindicated | 20% | | ii)Same as(b)withfusion,painonlyonheavy useofback | 15% | | iv)Radiologicallydemonstrableinstabilitywithfractureorfracture dislocationwithpersistentpain. | 30% |

LumbarandLumbosacralSpine:Fracture

| Lumbar and Lumbosacral Spine:Fracture | Percentage ofLLSspine | |-------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------| | a)Compressionof 25%orlessofoneortwoadjacentVertebralbodies, NodefinitepatternorneurologicalDeficit> | 15% | | b)Compressionofmorethan25%withdisruptionofPosteriorelements persistentpainandstiffness,healedwithorwithoutfusion,inability lift more than10kgs. | 30% | | c)RadiologicallydemonstrableinstabilityinlowlumbarorLumbosacral spine withpain | 35% |

| Disclesion: | Percentage of DL | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------| | a)Treatedcasewithpersistentpain | 15% | | b)Treatedcasewithpain andinstability | 20% | | c)Treated case of discdiseasewith pain activities of lifting moderately modified | 25% | | d)Treatedcase ofdiscdiseasewithpersistentpainandstiffness, aggravated by heavy lifting necessitating modification of all activities requiringheavy weight lifting | 30% |

3.3.3.NON-TRAUMATICLESIONS

Scoliosis

Basicguidelines-following modification is suggested:-Thelargeststructural curve should be accounted for while calculatingthePPlandnotthecompensatorycurveorbothstructuralcurves.

MeasurementofSpineDeformity

Cobb'smethod formeasurement,of angle of curve in theradiograph taken in a standingposition shallbe used.Thecurves are divided into the following groups depending upon the angle of majorstructural scoliotic deformity.

| Group | Cobb's Angle | Percentage PPl in relation to Spine | |---------|----------------|---------------------------------------| | | 0-20 | NIL | | II | 21-50 | 10% | | II | 51-100 | 20% | | IV | 1018above | 30% |

Torso Imbalance

InadditiontotheabovePPlshallbeevaluatedinrelationtothetorsoimbalance.Thetorsoimbalanceshallbemeasuredby droppinga plumb line fromC7spineandmeasuring thedistance of plumbline fromgluteal crease.

| Deviation of Plumb line | Percentage PPI | |---------------------------|------------------| | Upto1.5Cm | 4% | | 1.6-30Cm | 8% | | 31-50Cm | 16% | | 51Cm and above | 32% |

HeadTiltoverC7spinePPI

| Head Tilt overC7 spinePPI | Percentage PPI | |-----------------------------|------------------| | Upto 15 | 4% | | More than 15 | 10% |

CardiopulmonaryTest

Incaseswith scoliosisof severetypecardiopulmonaryfunctiontests andpercentagedeviationfromnormal should be assessedbyoneof thefollowingmethodswhicheverseemsmorereliable clinically athetimeof assessment.Thevaluethus obtainedshallbeaddedbycombiningtheformula.

| a.Chest Expansion | Percentage PPI | |--------------------------------------|------------------| | 4-5Cm. | Normal | | Lessthan4cmreductioninChestexpansion | 5%foreachcm | | No expansion | 25% |

b.Countingin one breathe

| Breath Count | PPI | |----------------|--------| | More than40 | Normal | | 0-40 | 5% | | 0-30 | 10% | | 0-20 | 15% | | 0-10 | 20% | | Less than5 | 25% |

Pain

| Mildly Interfering with ADL | 4% | |-------------------------------|------| | ModeratelyRestrictingADL | 6% | | SeverelyRestrictingADL | 10% |

CosmeticAppearance:

| -Noobviousdisfigurationwithclotheson | 1!N | |----------------------------------------|-------| | -milddisfigurement | 2% | | -severedisfigurement | 4% |

Leg Length Discrepancy:

| First1/2"shortening | Nil | |---------------------------|-------| | -Every1/2"beyondfirst1/2" | 4% |

Neurological deficit-Neurological deficitshallbecalculated asperestablished method of evaluation of PPl in suchcases. Value thus obtained shallbe added telescopicallyusing combining formula.

KYPHOSIS

Evaluationshallbedoneonthesimilarguidelinesasuseforscoliosiswiththefollowingmodifications:

| Spinal Deformity | PPI | |--------------------|-------| | Lessthan20 | 1.IN | | 21-40 | 10% | | 41-60 | 20% | | Above60 | 30% |

Torso Imbalance-Plumb line dropped from external earnormally falls at anklelevel.The deviation from normal shallbe measuredfromtheankleanteriorjointlinetotheplumbline.

| Lessthan5cminfrontofankle | 4% | |-----------------------------|------| | 5to10cminfrontofankle | 8% | | 10to15cminfrontofankle | 16% | | Morethan15cminfrontofankle | 32% |

MiscellaneousConditions:

Thoseconditionsof thespine,whichcausestiffnessetc.,areratedasfollows.

| | Conditions | Percentage PPI | |----|---------------------------------------------------------------------------------------------------------|------------------| | A | Subjectivesymptomsofpain,noinvoluntarymusclespasm,not substantiatedby demonstrable structural pathology | %0- | | B | Pain,persistentmusclesspasm,andstiffnessofspine,substantiated bymildradiological changes. | -20% | | | Same asBwithmoderateradiologicalchanges | -25% | | D | SameasBwithsevereradiological changesinvolvinganyoneof the regionsofspine | -30% | | E | SameasDinvolvingwholespine | -40% |

3.3.4. The Evaluation of Permanent Physical Impairment in Amputees

BasicGuidelines:

In cases of multiple amputeesif the total sum of permanent physical impairment is above100%,it should betaken as 100% only.

If thestumpisunfit forfittingtheprosthesisadditionalweightageof5%shouldbeaddedtothevalue.

Incaseof amputationinmorethanonelimb,percentageof eachlimbisaddedbycombiningtheformula andanother10% will beaddedbutwhenonlytoesorfingersareinvolvedonly5%willbeadded.

Any complication inform of stiffness of proximal joint,neuroma infection,etc.,should be givenuptoa total of10% additionalweightage.

Dominantupperextremityshallbegiven4%additionalweightage.

| | Upper Limb Amputations | pPl& loss ofphysical function of each limb | |-----|------------------------------------------------------------------------------------|----------------------------------------------| | 1. | Fore-quarteramputations | 100% | | 2. | ShoulderDisarticulation | %06 | | 3. | AboveElbowuptoupper1/3ofarm | 85% | | 4. | AboveElbowuptolower1/3offorearm | 80% | | 5. | Elbowdisarticulation | 75% | | 6. | BelowElbowuptoupper1/3offorearm | 70% | | 7. | BelowElbowuptolower1/3offorearm | 65% | | 8. | Wristdisarticulation | 60% | | 9. | Hand throughcarpal bones | 55% | | 10. | ThumbthroughC.M.orthrough1stMCjoint | 30% | | 11. | Thumbdisarticulationthrough metacarpophalangeal Joint or through proximal phalanx. | 25% | | 12. | Thumbdisarticulationthroughinterphalangeal jointorthroughdistalphalanx. | 15% |

| | | ndexFingerMiddle (15%) | Finger (5%) | RingFinger(3%) Little Finger | (2%) | |-----|----------------------------------------------------------------------|--------------------------|---------------|--------------------------------|--------| | 13. | AmputationthroughProximal phalanxorDisarticulation through M.P.Joint | 15% | 5% | 3% | 2% | | 14. | AmputationthroughMiddle PhalanxorDisarticulation throughPPjoint. | 10% | 4% | 2% | 1% | | 15. | AmputationthroughDistal Phalanxordisarticulation throughDIPjoint. | 5% | 2% | 1% | 1% |

LowerLimbAmputations:

| | LowerLimbAmputations | Percentage LLA | |-----|-------------------------------------|------------------| | 1. | Hind quarter | 100% | | 2. | Hip disarticulation | %06 | | 3. | Above knee up to upper 1/3 of thigh | 85% | | 4. | Abovekneeuptolower1/3ofthigh | 80% | | 5. | Through knee | 75% | | 6. | B.K. up to 8 cm | 70% | | 7. | B.K.uptolower 1/3ofleg | 60% | | 8. | Through ankle | 55% | | 9. | Syme's | 50% | | 10. | Up to mid-foot | 40% | | 11. | Up to fore-foot | 30% | | 12. | All toes | 20% | | 13. | Loss offirst toe | 10% | | 14. | Loss of second toe | 5% | | 15. | Lossof third toe | 4% | | 16. | Lossoffourthtoe | 3% | | 17. | Loss of fifth toe | 2% |

3.3.5.The Evaluation Of Permanent Physical Impairment(Ppi) Of Congenital Deformities Of The Limbs.

TRANSVERSEDEFICIENCIES

Functionally congenitaltransverselimb deficienciesare comparabletoacquiredamputationsand canbecalled synonymously

Thetransverselimbdeficienciesthereforeshallbeassessedonbasisof theguidelinesapplicabletotheevaluation of PPlin casesofamputeesasgivenintheprecedingchapter.

| For example: | PPI | |----------------------------------------------------------------------------|-------| | Transverse deficiencyRt.Arm complete (shoulderdisarticulation | 90% | | Transverse deficiency at thigh complete(hip disarticulation) | %06 | | Transverse deficiency Proximal Upper arm (AboveelbowAmp.) | 85% | | Transversedeficiencyatlowerthigh(Aboveknee Amp.Lower1/3) | 80% | | Transversedeficiencyforearmcomplete(elbow disarticulation) | 75% | | Transversedeficiency lowerforearm(Below Elbow Amp.) | 65% | | Transverse deficiency carpal complete (wrist disarticulation) | 60% | | TransversedeficiencyMetacarpalcomplete (Disarticulationthroughcarpalbones) | 55% |

3.3.6.Deficiencies

Basic Guidelines

In cases of longitudinal deficienciesof limbs dueconsiderationshouldbegiventofunctional impairment Inupper limb,lossofROMlossmuscularstrengthandhandfunctions likeprehension andgraspshould betestedwhile assessingthecaseforPPI

In lower limb clinical method of stability component and shortening of lower limb should begiven due weightage. In casesof lossof singleboneinforearm,theevaluation shallbebased onthe principlesof evaluationof Armcomponent, whichincludeEvaluationofROM,Musclestrength-andcoordinatedactivities.

Incasesof lossofsingleboneinleg,theevaluationshallbebasedontheprinciplesofevaluationof mobilitycomponent andstability componentsof thelowerextremity.

NOTE:Congenitalandacquired deformitiestobeconsidered forregistrationonly afterallpossibleinterventionshavebeen explored,anddespitecorrectionachievedthereisastillsignificantfunctionallimitation.Twoyearsfromdateofbirthwill be appropriatetimeformedicalintervention,surgicalcorrections/repairsandrehabilitation.

Registration asPWD shouldonly be considered twoyears afterbirthbut with exceptions of conditions likePhocomelia or missing limbs.

CranialNervesImpairments

| Type of Cranial Nerve Involvement | Physical Impairment | |-------------------------------------|-----------------------| | Motor cranial nerve | 20%foreachnerve | | Sensorycranialnerve | 10%foreachnerve |

MotorsystemDisability

| Neurological Involvement | Neurological Involvement | Physical Impairment | |---------------------------------------|---------------------------------------|---------------------------------------| | Hemiparesis/paraparesis/quadriparesis | Hemiparesis/paraparesis/quadriparesis | Hemiparesis/paraparesis/quadriparesis | | | Mild | 25% | | | Moderate | 50% | | | Severe | 75% | | | Complete | 100% |

Sensory System Disability

| ExtentofSensoryDeficit | PhysicalImpairment | |--------------------------|----------------------------------------| | Anaesthesia | Up to 10% for each limb | | Hypo aesthesia | Dependinguponthe%oflossofsensation | | Paraesthesia | Upto3o%dependinguponlossofsensation | | Hands/feetsensory loss | Depending upon the % of loss sensation |

| Severity of Ataxia | Physical Impairment | |-----------------------------|-----------------------| | Mild(Detectedonexamination) | 25% | | Moderate | 50% | | Severe | 75% | | Very Severe | 100% |

Bladderdisability duetoneurogenicInvolvement

| Bladder Involvement | Physical Impairment | |--------------------------------------------|-----------------------| | Mild (Hesitancy/Frequency) | 25% | | Moderate (precipitancy) | 50% | | Severe(occasionalbutrecurrentIncontinence) | 75% | | VerySevere(Retention/TotalIncontinence) | 100% |

Table5:Restrictionof function&Assessment(domains)

| Functional limitation | Assessment | Score | Interpretation | |-------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------| | Mobility | Ambulation(Mobility) Abletowalkaroundthe neighbourhoodwithout difficultyandwithout walkingequipment Abletowalkaroundthe neighbourhoodwith difficultybutdoesnot requirewalking equipmentorthehelpof anotherperson Abletowalkaroundthe neighbourhoodwith walkingequipmentbut withoutthehelpof anotherperson Abletowalkonly short distanceswithwalking equipment,andrequires a wheelchairtoget aroundthe neighbourhood Unable to walk alone, evenwithwalking equipment.Abletowalk shortdistanceswiththe helpofanotherperson andrequiresa wheelchairtoget around theneighbour hood. Cannotwalkatall | Abletowalkaround neighbourhoodwithout walkingaid=Normal Abletowalkaround neighbourhoodwith difficultybutdonotrequire walkingaidorhelpfrom anotherperson=Mild Abletowalkonlyshort distancewithaid =moderate Unabletowalkalone,even withwalking equipment, abletowalkshortdistance withhelp/assistantand requireswheelchair=severe Cannotwalkatall= complete | O-No difficulty 1-Mild difficulty 2-ModerateDiffculty 3-Severe 4-CompleteDifficulty |

| Self-care | Personalhygiene Dressing and eating | Requiresnoassistance=o Someassistance=1 Requires assistive device=2 Requireshelpevenwhile usinganassistive device=3 Requirestotal assistance=4 | O-No difficulty 1-Mild difficulty 2-Moderate Diffculty 3-Severe 4-completeDifficulty | |-------------------------------|----------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------| | Domestic life | Farming,cooking, cleaning,laundry, herding,homesecurity, reproduction etc. | Requires no assistance=0 Some assistance=1 Requiresassistivedevice=2 Requireshelpeven while usingan assistive device=3 Requirestotal assistance=4 | O-Nodifficulty 1-Mild difficulty 2-ModerateDiffculty 3-Severe 4-Complete Difficulty | | Majorlife roles | Career.Parenting | Requiresno assistance=0 Some assistance=1 Requires assistivedevice=2 Requireshelpevenwhile using an assistive device=3 | O-No difficulty 1-Mild difficulty 2-Moderate Difficulty 3-Severe 4-completeDifficulty | | Community, social, civic life | Politicalinvolvement religiousduties hobbies,cultural activities | Requiresno assistance=0 Some assistance=1 Requires assistive device=2 Requireshelp evenwhile using an assistive device=3 Requires total assistance=4 | O-No difficulty 1-Mild difficulty 2-ModerateDiffculty 3-Severe 4-CompleteDifficulty |

3.3.7.ScoringforPhysical Disabilities

Structurallmpairment

Uniformqualifierwiththenegativescale,used toindicatetheextentormagnitudeof animpairment:

xxx.0 NO impairment

(none, absent, negligible..)

0-4 %

xxx.1 MILD impairment

(slight, low..)

5-24%

xxx.2 MODERATE impairment

(medium, fair)

25-49 %

xxx.3SEVEREimpairment

(high,extreme,.)

50-95 %

xxx.4COMPLETEimpairment

(total...)

96-100%

xxx.8 not specified

xxx.9 not applicable

CodingActivities andParticipation

xxx.0NO difficulty

(none, absent, negligible..)

0-4 %

xxx.1 MILD difficulty

(slight, low..)

5-24 %

xxx.2MODERATEdifficulty

(medium, fair)

25 - 49 %

xxx.3SEVEREdifficulty

(high, extreme,..)

50 -95%

xxx.4 COMPLETEdificulty

(total...)

96-100%

xxx.8not specified

Table6.Physical DisabilityQuantificationTable

| 96-100%4COMPLETEimpairment | 4 | 4 | 8 | 12 | 16 | |------------------------------|------------------------|-------------------------|----------------------------|-----------------------------|-----------------------------| | 50-95%3SEVEREimpairment | 3 | 3 | 6 | 9 | 12 | | 25-49%2MODERATEimpairment | 2 | 2 | 4 | 6 | 8 | | 5-24%1MILDimpairment | 1 | 1 | 2 | 3 | 4 | | 0-4% ONOimpairment | 0 | | 2 | 3 | 4 | | | O NO difficulty 0 - 4% | MILD difficulty 5 -24 % | MODERATEdifficulty25-49% 2 | SEVERE difficulty 50-95 % 3 | COMPLETE difficulty 96-100% |

SCORING

ONoImpairments/Difficulty

1 MildDisability
2 -4 Moderate Disability
6-9SevereDisability
12-16CompleteDisability

3 Tier Assessment

PresenceofImpairment
LongTerm/Recurrent
Substantially Limiting

3.3.8.PhysicalDisabilityAssessmentTeam

Chairperson-Physicalrehabilitationprofessional/Physiatrist/MedicalOfficer/Surgeon OtherMembers

Physiotherapist
Occupational Therapist
OrthopedicTechnologist
GeneralSurgeon/OrthopedicSurgeon
Medical Socialworker

3.4DISABILITYCATEGOTY:VISUALIMPAIREMENTS

Impairment-ageneral termused to describe aproblem in the function or structure of aperson's body duetoahealth condition.

VisionImpairment:Visionlmpairmentalsoknownasvisualimpairmentorvisionloss,occurswhenaneyecondition affectsthevisualsystemandoneormoreof itsfunctionsandcausesadecreasedabilitytoseetoadegreethatcauses

Low vision:Apersonwith lowvisionisonewho hasimpairment of visualfunctioning evenafter treatment and/orstandard fromthepointoffixation,butwhouses,orispotentiallyabletouse,visionforplanningand/orexecutionofatask.

Visual acuity-Visual acuity is a simple,non-invasive measure of the visual system's ability to discriminate two high contrast points in space.

Visualfielddefect:Referstoanydeficitwhereapartof thefieldofvisionismissingsuchastunnelvisionorhemianopia Diplopia:(doublevision)is simultaneousperception of two separate or overlappingimages of thesame object when you should onlybe seeing one.

Aphakia:Absence of the naturallens of theeyefrom itsnormal anatomical position.

3.4.2:CategoriesofVisionlmpairment

NormalVision:Visualacuityequaltoorbetterthan6/12inthebettereye,afullfieldofvisionandnormalcolourvision asmeasuredusingstandardprocedures.

MildvisualImpairment:Bestcorrectedvisualacuityworsethan6/12upto6/18inthebettereye.

ModeratevisualImpairment:Bestcorrectedvisualacuityworsethan6/18to6/60inthebettereye.

Severevisual lmpairment:Bestcorrectedvisualacuityworsethan6/60andequaltoorbetterthan3/60orvisualfield loss toless than 200in thebetter eye.

Blind:Bestcorrectedvisualacuityworse than3/60oracorrespondingvisualfieldlosstolessthan100inthebettereye. AssessmentofVisionImpairment

A.Clinical Assessment

Pointsof Assessments;Visual assessment shall be doneinSubCounty referralhospitals,Countyreferral hospital ora National Referral Hospital.
Parameterstobeassessed:Visual acuity.fordistance,andnearshallbetheprimaryassessmentusedforcategorizing client'svisual impairment.Wherefound necessaryto conduct thefollowingspecialized tests,clients will bereferred to wheretheservicesareavailable:
a.Visual fieldAnalysis
b.ColourVisionTests
c..Stereopsis(DepthPerception)test
Skilledworkforcetodotheassessment;Visual assessment shallbedonebyan ophthalmologist,and incaseswherethere additiontothedisabilitymedicalassessmentteaminthefacility,chairedbyamedicalofficer.
·Procedure:Assessmentwillcompriseof distancevisualacuityandophthalmicexaminationofanterior andposterior segmentoftheeye.Whereindicated(astheassessorfinds),VisualfieldAnalysis,ColourVisionTests,Stereopsis(Depth Perception)testmayalsobeassessed.
Distancevisualacuitywillbeassessed usingaSnellen'sChartatafixed distance.ltwillbeconductedinwell-lit roomusing a6mor3mSnellen'schartplaced6mor3mrespectively.Thesmallest lineread onthe chart iswrittenasafraction, wherethenumeratorreferstothedistanceatwhichthechartisviewed,and thedenominatoristhedistanceatwhicha "healthy"eyeisabletoread thatlineof thevisionchart(usuallywrittenonthechart).
OcularExamination:Theobjectiveofophthalmicexaminationistoassessthehealthstatusof thestructuresof theeye and theresultingimpairment.Theexaminationof theanteriorandposteriorsegmentsof theeyeshallbedonepreferably usingaSlitLampandanOphthalmoscope.
formatforNear.
Quantification,andDecision:Theexaminerswillusetable7belowtocompletetheVisual Impairmentassessmenttool (AnnexIA)(Percentageof disability)
Aconversionisalsoprovided(AnnexIB)

Note:Officerwhosignsthisformshall indicate theirregulatoryCouncilregistrationnumberandshallbearpersonal, professionalresponsibility of theinformationintheform.

B.FunctionalAssessment

Functional Assessmentshouldbedonewiththeuseof theSF-12tool(modified)whichisawidelyused instrumentfor toassessphysicalandmental health.Thetool hasbeenvalidatedacrossanumberofdiseasesandconditionshenceitis notdisease-specifictheassessmentwillbedonetoaclientwheretheopinionof theprimaryassessmentrecommends (e.g,forplacement,postcare,environmental adaptationand others).Astandardizedfunctionalassessmenttool,(Annexl C),shallbeused byajoint team,comprisingof Ophthalmologist,Occupational Therapist andSocial Worker.

C.OtherConditionsAnd ConsiderationsForAssessment

Progressivedegenerativeconditionswillbeconsideredasrecurring,andshallbeassessedperiodically,aswillchangewith time.
Lossof Eyeball,(Enucleation/Evisceration/Exenteration)(40%)
Constant uncorrectable/intractablediplopia:(25%)

Oneeyenormalandtheothereyeaphakic,correctableto6/9orbetter:(15%):
Botheyesaphakiccorrectableto6/9orbetter:(20%)
One eye blind,other eye aphakic and correctable to 6/9 orbetter:(35%)
Specializedtestsareonlytobedoneif indicated.

Table7:ReferenceforVisual ImpairmentQuantification

| 3/60 | 3/60 | 80 | Svi | |--------|--------|------|-------| | 3/60 | NPL | 80 | Svi | | <3/60 | <3/60 | 100 | BL | | NPL | NPL | 100 | BL |

Key:N;Normal,Mi;MildImpairment,Mo:ModerateImpairment,SV:SevereVisual Impairment,Bl:BlindR:RecommendedforRegistration

Adopted from The Work Injury Benefits Act, 2007

3.5.0.Introduction

Hearinglossisoftenreferredtoasahiddendisability.WorldHealthOrganization(2018)466millionpeopleworldwide have disablinghearingloss34millionbeingchildren.

Dependingontheseverity,itaffects:

Interpersonal communication
Social interactions
·Development of speech and language in children
Educationalperformance
Employment prospects
·Cognitive decline

3.5.1.Section A:Hearing Impairment

Definitions

Hearing loss-means any reduction of or difficulties in hearing sounds.
Hearingimpairment-meansanylevel orgradeof hearing loss.
·Deafness-profound hearing loss
DisablingHearingLoss-Moderateorabovehearinglossinthebetterear
Decibels-Unit of measurement of sound intensity

3.5.2.Types ofHearingLoss

·ConductiveHearingloss:This occurswhensound cannotget through the outer earand middleearand can oftenbe correctedmedicallyorsurgically.
·Sensorineural hearingloss(SNHL):This occurs when thereis damage to the inner ear (cochlea) or to the nerve pathways formtheinnereartothebrain.Itresultsinpermanenthearinglossrangingfrommild,moderate,severetoprofound.
It results inpermanenthearing lossrangingfrommild,moderate,severe to profound.
Mixed Hearingloss:ThisoccurswhenaconductivehearinglosshappensincombinationwithSNHL

There maybe damage in theouter ear,middle ear,inner ear(cochlea) orthe auditory nerve.

3.5.3.Categories of Hearing Impairment(W.H.o)

Table8:CategoriesofHearingImpairment

| Category | Level of hearing IndBHL | Functional limitation | DHL-Moderate or greater in better hearing ear | |-----------------------------|---------------------------|---------------------------------------|-------------------------------------------------| | Grade O-Normal Hearing | 25dBand below | No problems | | | Grade 1-mild | 26-40dB | Hears/repeatswords innormalvoiceat1m | | | Grade2-child Moderate-Adult | 31-60dB 41-60dB | Hears/repeats words raisedvoice at 1m | Disabling hearing loss | | Grade3-Severe | 61-80 dB | Hears somewords shouted | Disablinghearingloss | | Grade4-Profound | 81and above | Cannot hear/understand shoutedvoice | Disabling hearing loss |

3.5.4.AssessmentforHearing Impairment Hearing Tests

SUBJECTIVETEST

PURETONEAUDIOMETRY(PTA)

OBJECTIVETEST

AUDITORYBRAINSTEMRESPONSEAUDIOMETRY(ABR)

Procedure

PURETONEAUDIOMETRYTEST(PTA)

Puretone audiometry is a subjective test of hearing.
·AirConductionthresholdsusingPureToneAudiometry willbemeasured forright andleftearseparately
ThePTAresultswillberecorded onanAudiogram
Pure tone average willbeobtained foreachearatfrequencies(500Hz,1000Hz,2000Hz,4000Hz)
ThePuretoneaveragewill determine thelevel/gradeof hearingforthespecificear.

Normal Audiogram

AUDITORYBRAINSTEMRESPONSEAUDIOMETRY(ABR)

Also known as Brainstem ResponseAudiometryTest (BERA)isan objective test of hearing assessment
Theteststimulusthatshall beusedwillbeeitherClick stimulus at frequency range 2.0-4.0 KHz or Tone burst at frequency range 0.5,1.0, 2.0, 4.0 KHz.
ABRmeasurementsshall be conducted foreach ear separately.

3.5.5:MedicalAssessment

HEARINGASSESSMENTPROTOCOL

Documentation:

TheAudiogramandABRreportshallbeattached totheMinistry of Health(MoH)PersonswithDisabilityMedical assessmentreport.

Location-Thehearingassessment shall beconducted intheSubCounty Referral Hospital,Countyhospital orNational referral hospital.

Assessors-Hearingassessmentshall beconductedbyanAudiologistorAudiologytechnologistandincaseswherethereis no Audiologist orAudiology technologist stationed inthe facility,the assessment shallbe doneby an ENT Clinical Officer.The ENTSurgeonwill bethe professional lead(where available)and will includetheprofessionalregistrationdetails.

Equipment-Theequipment required for the assessment shall bea calibrated DiagnosticAudiometerandAuditoryBrainstem Response(ABR) machine.

Table9:HearingAssessmentProtocol

| Age Categorisation | Hearing Tests to be conducted | |-------------------------|----------------------------------------------------------------------------------------------------| | Adults | Both AuditoryBrainstem Response Audiometry report(ABR/BERA)andPure Tone Audiometry Testreport(PTA) | | Below3years | ABR hearing test. | | Children aged3-5years | Conditioned Play audiometry orABR test | | Children aged5-18 years | P.T.AorABRtest |

Modeofcommunicationforpersonswithhearingimpairmentordeafness:-

·Auditoryverbal communicationforpersonswhousehearingaidsorcochlearimplants.
·Signlanguageforpersonswithprofounddeafnessand havehadno hearing interventionorthosewhoobtainminimal benefit from usinghearingaids.

Table1o:DeterminationoflevelofHearingDisability

| Category | Level | PTA of better Ear in dBHL | Speech discrimination score of better Ear | Percentage of disability | |------------|----------|-----------------------------|---------------------------------------------|----------------------------| | (1) | Mild | 26-40 | 80-100% | <40% | | (1a) | Moderate | 41-60 | 50-80% | 40-50% | | (1b) | Severe | 61-80 | 40-50% | 51-70% | | (OT) | Profound | 81 dB and above | <40% | 71-100% |

| Monoaural PTAin dBHL | % HearingDisability | |------------------------|-----------------------| | 25 | 1 | | 30 | 1 | | 35 | 3 | | 40 | 8 | | 45 | 13 | | 50 | 18 | | 55 | 23 | | 60 | 40 | | 65 | 48.55 | | 70 | 57.1 | | 75 | 65.65 | | 80 | 74.2 | | 85 | 82.75 | | 90 | 91.3 | | 95 | 100 |

Calculation ofPercentageof HearingDisability

CalculatethePuretoneaverageof AirconductionThresholds(ACT)for500Hz,1000Hz,2000Hzand4000Hzseparately (wherethereisNoresponseatanyfrequency.ACTwillbeconsideredtobe95dB)

PercentageofHearingDisability=

(Betterear%of hearing disabilityx5)+(Poorerear%of hearing disability)/6

As a guide,

Persons withhearinglossof more than4OdBHLinthebetterearand profound hearing loss in thepoorerear,will yielda hearing disability of 25%and above.
Personswith hearinglossof above60 dBHLin thebetterearwillyielddisabilityof40%and above.
Personswithnormal hearinginoneearandprofound hearinglossinpoorerearwill yield ahearingdisability of 17.5%

| Level | PTAofbetterearin dBHL | Percentage of disability | Recommendation | |------------------|-------------------------|----------------------------|-------------------------------| | ModeratetoSevere | 45-80dB | 25 -75% | Hearing Aids | | Profound | 81dB | 76-100% | Hearing Aids CochlearImplants |

3.5.6.EssentialsforDisability Medical Assessment

Location

Thehearingassessment shallbeconducted intheSubCountyReferral Hospital,Countyhospital orNationalreferral hospital.

Assessors

Hearingassessment shallbeconducted byanAudiologistorAudiologytechnologistand incaseswherethereisnoAudiologist orAudiologytechnologiststationed inthefacility,theassessmentshallbedoneby anENTClinical Officer.
·ENTSurgeonwillbetheprofessional lead(where available)andwillincludetheprofessional registrationdetails.

Equipment

(ABR) machine.

DisabilityAssessmentCommittee

Thecommitteewillconstituteof thefollowingmedicalprofessionals:

Chairperson-Medical Officer/ENTsurgeon
·Audiologist/AudiologyTechnologist or ENT Clinical Officer.
of thecoreteam.

3.5.7.Disability Medical assessment tool (Appendices)

PWDMedicalAssessmentReport
ThePure ToneAudiogram
TheABRreport
ICFChecklist

ICFCHECKLISTISATTACHED

| | | Code | Score | |---------------------|---------|--------|---------| | b2 Sensory Function | Hearing | B230 | |

Scoreratingasperthedisabilityrating

Rehabilitation

1.Hearing Aids

RecommendedforclientswithMildtoSevereSensorineural HearingLoss.

2.CochlearImplants

Recommendedforclientswith:-

a)Severesensorineuralhearingloss(SNHL)withminimal ornobenefit fromhearingaids
b)Profoundsensorineural hearingloss

3.6DISABILITYCATEGORY:SPEECH,LANGUAGE,COMMUNICATION ANDSWALLOWING IMPAIRMENTS

3.6.0.lntroduction

Speech,Language,Communication and SwallowingImpairments may be congenital oracquired;stable,improving or progressive.Theymay betemporary orpermanent.Access to education,work,social activitiesand thelegal system is oftendependentoncommunicationskills.

DEFINITIONS

Speech:saying sounds accurately and in the right places in words of a language or dialect so that others peoplecan

combiningthemtoformsentencesandlongertexts(suchasstoriesandinstructions).Languageallowspeopletointeract shareideas,expresswantsand needs,and canbespoken,written,orsigned.

Communicationreferstohowweinteractwithothers;beingabletotalktopeopleandtaketurnsaswellasusingappropriate languagetosuitthesituation.Itincludesnon-verbalcommunicationsuchaseyecontact,gesture,andfacialexpression Inaddition,communicationrelatestobeingabletoconsideranotherperson'sperspective,intentions,andthewidersocial used.These include low tech(e.g,picture-based communicationbooksorboards) orhigh tech(e.g.,speech-generating devices)systems(ICPInternational CommunicationProject2018)

SWALLOWING IMPAIRMENT (DYSPHAGIA) - Is difficulty in eating, drinking and swallowing. Good nutrition/ hydrationisessentialtolifeand underpinshealthandrehabilitation.Dysphagia/feedingdifficultiescancausemalnutrition, dehydration,pneumonia(viaaspiration-food/drink/saliva enteringtheairways),deathandpsychologicaldistress.

3.6.1.ClassificationofSpeech,Language,Communication andSwallowing

1.SPEECHIMPAIRMENT

A.DYSFLUENCY-STAIMIMERINGorSTUTTERING-Dysfluent speech is thedisruptionof theforward flow and timingofspeechbyrepetitionofsoundssyllablesorwords,soundprolongationand/orblockingonsoundssilentoraudible. These differfrombreaksinfluencytypically experienced,suchashesitations,pausestoprocessideationorproduction,as head/body movements),physicaltension,negativereactions,and avoidanceofsounds,wordsorsituationsordecreased overall communication.Disordersoffluencycomprisedevelopmental stammeringinchildren,youngadults andadults;

CLUTTERING:involvesspeechthat soundsrapid,unclear and/ordisorganized.Thelistenermay hearexcessivebreaks inthe whatonewantstosay.Thestruggleseenwithstammeringisnotusuallypresent.

B.VOICE DIFFICULTIES-Voice disorders are a range of conditions which affect the larynx.They can cause changes tothevoicecalleddysphoniaorlossofvoiceaphonia.Voicedisorderscanalsomakethethroatfeeldifferent,forexample,it lowmood orisolation insomecases.

APHoNiA-totallossof voicecanbetemporary(forexample,duetoaviralinfection)orpermanent(e.g.,duetolaryngectomy)
DYSPHoNIA-partiallossofvoice.Thevoicemaysound hoarse,creakystrained,breathyorweak.Thiscanbetemporary (e.g,due tooveruse or misuse of thevoice) orpermanent(e.g,due tovocal nodules orcongenital malformation such os laryngealweb)unlesstreatedwithasurgicalorotherintervention.Dysphoniacanbetheearliestsignofaprogressive neurological disorder(e.g,Parkinson's,MotorNeuronDisease)orof laryngeal,breast orlungcancerand therefore always needtobeinvestigatedbyanENTConsultant.

C.ARTICULATioN -Speech Sound Disorders are common in children (although they may not have resolved by adulthood if thechildwasunabletoaccessSpeechandLanguageTherapy)andMotorSpeechDisorderscanbefound inchildrenand adults.

·SPEECHSoUNDDISORDERS:isatermusedtocoverdifficultiesthatsomechildrenhavewiththeirarticulation, phonological and/or prosodic development.A variety of other terms is alsoused to describespeech sound disorders including

MOTORSPEECHDISORDERS:

butfeltbyspeakers'throughto'absenceof anyspeechorvoice:Lesionsmaybelocalized,e.g.,strokeorsystemic,motor neuron disease,dementia.They canbesudden onset orslowly orrapidlyprogressive.Congenitalcauses include cerebral palsy.

TraumaticBrainInjuryorneurodegenerativeconditionssuchasdementia.Verbalapraxia/dyspraxiacanbeassociated withotherapraxiasuchaslimbapraxia

cleft lip andpalate,injuries dueto trauma(accidentsorpost-surgery)orduetocancer.Surgical interventionsmayhelpthese typesofdifficulty

2.LANGUAGE DISORDERS: 'Language Disorder' refers to children and adults with language difficulties that create is usually'acquired'throughbrain injury(forexample,duetostroke,head injuryordementia)and isalsocalledaphasia.People learning.

A.DEVELOPMENTAL LANGUAGE DELAY aNd DISORDER (DLD)/SPECIFIC LANGUAGE IMPAIRMENT (SLI): These terms are used when the language disorder is not associated with a known condition. These children struggle with school and may bebehind theirpeers in literacy skills as well as spoken communication and listening/understanding.DLD/SLIcouldbeassociatedwithlearningdifficultiessuchasdyslexia,dysgraphia,dyscalculia.A Special NeedsTeachershould beinvolved inthe assessment,diagnosis and management of learningdifficulties.

B.CONGENITALLANGUAGEDISORDERduetoconditionsinchildrenandadults-suchasautismspectrumdisorder, geneticconditionssuchasDown'ssyndromeandsensorineuralhearingloss.Learningdisability orintellectualdisabilitysuch

C. APHASIA: This is an acquired language disorder in adults; difficulties with understanding others, speaking, reading and writingduetostroke,headinjury ordementia.Thisaffectsabilitytoloveindependently andtoworkandcareforothers.

3.COMMUNICATIONIMPAIRMENT:Peoplewithsocialcommunicationdisorderhaveprominentdifficultieswith impairment'and'semantic-pragmaticlanguagedisorder:Peoplewithautismanddementiamayalsohavecommunication impairment.

4.DYSPHAGIA:describes eating,drinking and swallowing difficulties in infants,children and adults.People with dysphagia swallowingcanbeaffected:

Pre-oral(gettingthefoodordrinktothemouth)
Oral stage(chewing,manipulatingthefood/drink,keepingit within themouth,propellingit tothebackof themouthto initiateaswallow)
·Pharyngeal stage(initiation of swallowand movement of food and drink back into the pharynx and down to thetop of theoesophagus)

WHATTOASSESS

History of Condition:Birth history forapplicant presentingwitha developmental disorderandrelevantmedicalhistory for applicantwithacquireddisorder
Pre-linguistic skills
ReceptiveLanguage
ExpressiveLanguage
Speech
Swallowingscreen(detailedbelow)
·Administerappropriatestandardized test

ASSESSMENTTEAM

Medical Officer
Speech and LanguageTherapist
Membersdrawnfrom:(includeotherrehabilitationprofessionalse.g.psychiatrist,occupationaltherapist,physiotherapist incasesthatpresentwithcomorbidities)

N.B: Solely,a qualified Speech and Language Therapist make Majority of the speech, language, communication and Swallowingdiagnoses detailed above.However,with thefewernumberof SLTprofessionalsinKenya,anENTspecialist, Paediatrician,PaediatricNeurologist,NeurologistorNeurosurgeon canbeconsultedforamoregeneralized diagnosis.An ENTSurgeon/Laryngologistshall reviewall voicepatients.

ADDITIONALNOTESONASSESSMENTOFDYSPHAGIA

A.Non-Instrumental SwallowingAssessment(bedsideassessment)checkthepatientbehavioursassociated withswallowfunctionby observingthepresence orabsenceofsignsandsymptoms ofdysphagia,withconsiderationfor factors such asfatigue duringfeedingposture,positioning,and environmental conditions.lt includes case history taking basedoncomprehensivereviewof medical/clinicalrecordsaswellasinterviewswithcaregiversandotherhealthcare professionals.

B-Oral MechanismExam including cranialnerveassessment,structural assessmentof face,lips,tongue,hard nd soft palate,jaw,oral pharynxand oral mucosa.
C-Functionalassessmentof musclesandstructuresused inswallowing
D-Assessoverallphysical,social,behavioural,cognitiveandcommunicationstatus.
F-Monitoring of physiological status includingheart rateand oxygen saturation
aftertheswallow.

Note:These SLTs should use the Dysphagia checklist included in the assessment tool and refer applicant toa dysphagia specialist if needed.

B.InstrumentalSwallow-this isfor evaluating oral,pharyngeal,laryngeal,upperoesophageal andrespiratory functions as they apply to normal swallowing.

Swallowing(FEES)

SPEECH&LANGUAGETHERAPY&ASSESSMENTRESOURCES

SpeechandLanguageTherapistsdiagnose communication,voiceandswallowing disorderswithformal and informal assessment tools.Thesetoolsarealsoused asabaselinemeasuretodetermineapatient'stherapyprogressovertime.

Table 12.AssessmentReferenceTools

| NAME | PUBLISHER/AUTHOR | CLIENTGROUP | |------------------------------------------------------------------------------|-------------------------------------------|-------------------------------| | TheQuickScreener | CarolineBowen | Phonology-paediatrics | | NewZealandArticulationTest(NZAT) | MinistryofEducationNew Zealand-JayneMoyle | Phonology-paediatrics | | ArticulationScreener | LittleBeeSpeech | Phonology -paediatrics | | SouthTynesideAssessmentof Phonology (STAP) | SusanArmstrong&Maureen Ainley | Phonology-paediatrics | | Clinical Evaluationof Language Fundamentals3(CELF3rdEdition) | Pearson | Language - paediatrics | | RenfrewActionPictureTest | Speechmark | Language -paediatrics | | BusStoryTest | Speechmark | Language - paediatrics | | PreschoolLanguageScale-3(PLS-3) | ThePsychological Corporation | Language-paediatrics | | EastAfricaExpressive&Receptive Language Test | YellowhouseKenya | | | RapidScreeningTest | DerbyshireLanguageScheme | Language-paediatrics | | DetailedTestofComprehension | Derbyshire Language Scheme | Language-paediatrics | | ModifiedChecklistforAutismin Toddlers(M-CHAT) | Robins,Fein8Barton | Autism-paediatrics | | AutismDiagnosticObservation Schedule(ADOS) | WPS | Autism-paediatrics/adults | | AssessmentofComprehension8 Expression(ACE3) | Pearson | Language - paediatrics | | TestforAuditoryComprehensionof Language3"dEdition(TACL-3) | Pro-ed | Language-paediatrics | | Comprehensive AphasiaTest(CAT) | Swinburn,Porter8Howard | Language -adults,brain injury | | MountWilgaHighLevel Language Test(revisededition) | Fiona Simpson | Language-adults,brain injury | | QuickAphasiaBattery(QAB) | VanderbiltUniversity | Language-adults,brain injury | | ACC-Aphasia Categoriesof CommunicatorsChecklistandthe AphasiaNeedsAssessment | (unknown) | Language-adults,brain injury |

| NAME | PUBLISHER/AUTHOR | CLIENTGROUP | |--------------------------------------------------------------------------|------------------------------------------|--------------------------------| | StrokeSpecificQualityofLifeScale (SS-QOL) | Williams,Weinberger,Harris, Clark8Biller | QualityofLife-adults,stroke | | VASES:VisualAnalogueSelfEsteem Scale | Speechmark | Mood/self-esteem-adults,stroke | | VoiceHandicapIndex | Jacobsonetal. | Voice-adults | | StutteringSeverity Instrument(SSI) | Glyndon Riley | Stammering-paediatrics/adults | | Frenchay Dysarthria Assessment 2nd Edition | Pro-ed | Speech-adults | | NewcastleDysarthriaAssessment Tool (N-DAT) | (unknown) | Speech-adults | | GRBAS(grade,roughness, breathiness,asthenia,strain)scale | (unknown) | Voice-adults | | Mini MentalStateExamination (MMSE) | (unknown) | Cognition-adults | | TherapyOutcomeMeasuresfor Rehabilitation Professionals 3rd Edition(TOMS) | Enderby&John | General-paediatrics/adults | | OralSpeech MechanismScreening Examination3'dEdition(OMSE-3) | Pro-ed | Speech-paediatrics/adults | | KiswahiliArticulationTest | (unknown) | Speech-paediatrics/adults | | DiagnosticAssessmentofReading 2ndEdition | Roswell,Chall,Curtis8 Kearns | Reading-teenagers/adults | | GaggingSwallowingScreen | (unknown) | Swallowing | | PenetrationAspirationScale | (unknown) | Swallowing |

NOTE:Periodic reviews should be doneregularly to allowimproved diagnosis and clientmanagement.

Speech and Language Therapists also use informal assessments in assessingpatientswith speech,language,voice and swallowingdisorders.Theseareoftenlocallydesigned and implemented.Giventhemixed linguisticbackgroundof theKenyan population,furtherworkisrequiredtodevelopculturallyandlinguisticallyappropriatestandardizedasessments.

3.6.2.Impairment,Activity,Participation,Wellbeing/DistressSCALE (Adapted from Therapy OutcomeMeasuresENDERBY 2015)

| | Impairment:Speech-Fluency,Articulation,Voice/LanguageCommunication/ Dysphagia(CircleThoseRelevant) | Tick | |----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------| | 0 | Noimpairment,normal. | | | 1 | Milddifficultiese.g.,easyrepetitionsorcovert stammeringwithmild secondarybehaviours(avoidance),diffcultywithsome soundsonly,or articulationproblemsonlywhentired,intermittentorverymilddysphonia infrequentwordfindingdifficultiesorhigher-levelreadingdifficulties.Mild dysphagiawithnoevidenceofaspiration. | | | 2 | Moderatetomild-e.g.,occasionalmoderatestammerormildconsistent dysphoniaormilddysarthria,ormild frequentexpressivespeech/wordfinding difficultiesormildfrequentwritingdifficultyand/ormildauditory comprehensiondiffculty.Mild tomoderate dysphagia,mildorno aspiration risk. | | | 3 | Moderatee.g.,moderatestammeringwith/withoutmoderatesecondary behaviours,orseveretomoderatestammeringinconsistently,ormoderate dyspraxia,orconsistentmoderatedysphonia,ormoderatedifficultywith auditorycomprehensionandreadingandmoderateexpressivespeechand/or wordfindingerrors.Moderatedysphagia,swallowandcoughreflexpresent, someaspirationrisk. | | | | severedyspraxia,severedysphonia,severeaphasiawithauditory comprehension,severespeechdiffcultiesandseverereading/writing difficulties.Severe dysphagia,highriskof aspiration. | | | 5 | Profound-unabletosaywordsinanysituationwithoutseverestammering aphonia(e.g.,dueto laryngectomy),globalprofoundaphasiawith nowordsin speechandnowritingplus difficultyunderstandingand reading.Aphagia (unabletoswallow),signsofaspiration,nocoughreflex. | |

| | Activity(Disability) | Tick | |----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------| | 0 | No difficulties,normal abilitytogetamessage acrosstoa listener. | | | 1 | Milddifficultyingettingamessage acrossordiffcultyonlywithunfamiliar listeners(9o%intelligibleinconversation)ordifficultyonlywhentiredor difficultyonlyinspecificsituations.Canbeunderstoodinmostsituationsby anylistener. | | | 2 | Mildtomoderatediffcultygettingamessageacross(around70-80% intelligible)inmostsituations.Interactionmildlyaffected.Consistently ableto makeneedsknownthoughcanmakemoreinformationknown. | | | 3 | Moderatedifficultygettingamessageacrosswith around40-60% intelligibility.Interactionmoderatelyaffected. | | | 4 | Interactionseverelyaffected.Canmakebasicneedsknowwithfamiliarperson andinfamiliarenvironmentsometimes. | |

| 5 | Profounddifficultygettingamessageacrosseventoclosefamilyandinall situations.(Needsaugmentativeandalternativecommunication).Interaction profoundlyaffected.Unabletomakebasicneedsknown(e.g.,can'letcarers knowifhungryoruncomfortable) | |-----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| | Participation(Handicap) | Tick | |----|-------------------------------------------------------------------------------------------------------------------------------------------|--------| | 0 | Nodifficulty,normal levelofparticipationinsocial/family/education/work/ communityroles.Achievingpotential. | | | 1 | Milddifficultyinsomesituationsonly,mainlyabletomakedecisionsand interactwithothers. | | | 2 | Mildtomoderatedifficultyinparticipatinginliferoles,someself-confidence anddecisionmakinginfamiliarsituations. | | | 3 | Moderatedifficultyinparticipatinginliferoles,someself-confidence,some participationandmakessomedecisions. | | | 4 | Severedifficultytoparticipateinliferoles.Limitedsocialinteractionoronly any situation. | | | 5 | Profounddifficulty.Noabilitytoparticipateinsocial/family/education/work/ communityroles.Notable tomake decisions andinfluencewhathappens. | |

| | Wellbeing/Distress | Tick | |----|----------------------------------------------------------------------------------------------------------------------------------------------------------------|--------| | 0 | Nodifficulty,nodistress.Welladjusted,stableandabletocopeemotionallywith mostsituations,goodinsightandacceptsownlimitations. | | | 1 | Mild and/oroccasionaldistressetc.Ableto controlemotionsinmostsituations, occasionalsupportneeded. | | | 2 | Mildconsistenttomoderateinconsistentdistressetc.Controlsemotionswith support,vulnerableto changeinroutine,spontaneously usesmethodsto assist emotionalcontrol. | | | 3 | Moderateconsistentdistressetc.inunfamiliarsituations,frequentsupport needed. | | | 4 | Frequentlyseveredistressinmanyormostsituations,withconstantneedfor support.Losesemotionalcontroleasily. | | | 5 | Severeconstantdistress/frustration/anger/embarrassment/withdrawal/severe | |

3.7.Disability Category:Mental HealthDisorders,Intellectual Disability And Autism Spectrum Disorders

3.7.1. Definitions

Mental HealthDisorders:-Aredisordersof themind characterizedby clinicallysignificantdisturbancein an developmentalprocessesunderlyingmentalfunctioning.

AutismSpectrumDisorders-Areneuro-developmental disorderscharacterizedbyimpairedsocialinteraction andcommunication,repetitiveandstereotypedpatternsofbehaviour,andunevenintellectualdevelopmentoftenwith intellectual disability.

IntellectualDisabilities-Asneuro-developmentaldisordersthatbegininchildhoodandarecharacterizedby intellectualdifficultiesaswellasdifficultiesinconceptualocialandpracticalareasof living

resultinginimpairmentstotheperson.

3.7.2.Classification ClassificationofMental Disorders

Neuro-developmentalDisorders
Schizophreniaspectrumandotherpsychoticdisorders
BipolarandRelatedDisorders
DepressiveDisorders
AnxietyDisorders
Others(TraumaandStressrelateddisorders,SomaticSymptomsandrelateddisorders)

Neuro-developmentalDisorders

Intellectual Disability
AutismSpectrumDisorder
AttentionDeficitHyperactivityDisorder
SpecificLearningDisorder

Intellectual Disability-The term"intellectual disability" isaspecifictype of disability.It iscaused by limited mental capacity.Limitedmentalcapacitymakesit difficulttodevelopimportantmentalabilities.Thisincludes reasoning,planning,thinking,and judgment.Thislimited mental capacity makes it difficult to learn newthings.The abilitytolearnisaveryimportantmentalability.Welearnnewinformationandskillsinschool.Welearnfromourpast mistakes.Welearnhowtodomanythingsbywatchingothers.Whenthisabilitytolearn is lacking,it causesmany problems ineveryday life.

developmentaldisorderthatbeginsduringschoolage,althoughmaynotberecognizeduntil adulthood.Beloware common types of specific learning disabilities.

Dyslexia:Dyslexia is the most common form of all learning disabilities.Itis a language-based disability in which a personhastroubleunderstandingwords,sentences,orparagraphs.

Dyscalculia: is a life-long learning disability that affectsthe ability to grasp and solve math concepts.

Dysgraphia:isawritingdisabilitywherepeoplefindit hardtoformlettersandwritewithinadefinedspace.Many peoplewithdysgraphiapossesshandwritingthatisunevenandinconsistent.

Dyspraxia: isa disorder that affects thedevelopment of motor skills.People with dyspraxia have trouble planning and executing fine motor tasks,which can range from waving goodbye to getting dressed.

AuditoryProcessingDisorders:aredisordersthatmaycauseapersontostrugglewithdistinguishingsimilarsounds,aswell as other difficulties.

thedifferencesbetweensimilarlettersnumber,objects,colours,shapesandpatterns.

AttentionDeficitHyperactivityDisorder-Apersistentpatternof inattentionand/orhyperactivity-impulsivity

3.7.3.DisabilityAssessment Criteria

The assessmentteamwillbase their clinicalassessmentson theDiagnosticStatistical Manual forMentalDisorders5to identifyspecificmentalhealthcondition.

Intellectual Disability

Intellectualdisability(intellectualdevelopmentaldisorder)includesbothintellectualandadaptivefunctioningdeficitsin conceptual,social,andpractical domains.Thefollowingcriteriashallbemet:

academiclearning,and learningfromexperience,confirmedbybothclinicalassessmentandindividualied,standardized intelligencetesting.

B.Deficits in adaptivefunctioning that result in failure to meet developmental and socio-cultural standards forpersonalindependence andsocialresponsibility.Without ongoing support,the adaptive deficits limit functioning in oneormoreactivitiesofdailylife,suchascommunicationocialparticipationandindependentlivingacrossmultiple environments,suchashome,school,work,and community.

AutismSpectrumDisorders

in communication.

Stereotyped orrepetitivebehavioursincludesimple motorstereotypes(e.g.,hand flapping,finger flicking),repetitive useof objects(e.gspinningcoins,lininguptoys)andrepetitivespeech(e.g.,echolalia,thedelayedorimmediateparrotingofheard words;use of"you"whenreferring to self;stereotyped use of words,phrases,orprosodicpatterns).

at apparentlysmallchanges,suchasinpackagingof afavouritefood;insistenceonadherencetorules;rigidityof thinking)or ritualized patterns of verbal or nonverbal behaviour(e.g, repetitive questioning,pacingaperimeter).

attached to a toy).

objects,and sometimes-apparent indifference to pain,heat,or cold.

Extremereaction to orrituals involving taste,smell,texture,orappearance of foodorexcessivefood.

AttentionDeficitHyperactivityDisorder(ADHD)

characterizedby(1)and/or(2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistentwithdevelopmental leveland that negativelyimpactsdirectlyonsocialandacademic/occupationalactivities:

Note:Thesymptoms arenot solelya manifestation of oppositionalbehaviour, defiance,hostility, or failure to understand tasks orinstructions.

Forolderadolescentsand adults(age17and older),at least fivesymptomsarerequired.

a.Oftenfailstogivecloseattentiontodetailsormakescarelessmistakesinschoolwork,atwork,orduringotheractivities

(e.g.,overlooksormissesdetails,work is inaccurate).

b.Oftenhasdifficultysustainingattentionintasksorplayactivities(e.g.,hasdifficultyremainingfocusedduringlectures, conversations,orlengthyreading).
c.Often does notseem tolisten whenspoken to directly (e.g.,mind seems elsewhere,even in the absence of anyobvious distraction).
d.Oftendoes notfollowthroughoninstructionsand failsto finishschoolwork,chores,ordutiesintheworkplace(e.g,starts tasksbutquicklylosesfocusandiseasilyside-tracked).
e.Often has difficulty organizingtasks and activities(e.g,difficulty managingsequentialtasks;difficultykeeping materials andbelongings in order;messy,disorganized work;has poor time management;failsto meet deadlines).
f.Oftenavoids,dislikes,orisreluctanttoengageintasksthatrequiresustainedmentaleffort(e.g,schoolworkorhomework;
g.Oftenlosesthingsnecessaryfortasksrctivitiese.g,schoolmaterialspencils,books,tools,wallets,keyspaperwork eyeglasses,mobiletelephones).
h.Is ofteneasily distractedbyextraneousstimuli(forolderadolescentsandadults,mayincludeunrelated thoughts).
i.Isoftenforgetfulin daily activities(e.g.,doingchores,runningerrands;forolderadolescents andadults,returningcalls payingbills,keeping appointments).

toadegreethatisinconsistentwithdevelopmentalleveland thatnegativelyimpactsdirectlyonsocial andacademic/ occupationalactivities:

Note:The symptoms arenot solelyamanifestation of oppositional behaviour, defiance,hostility,ora failureto

a.Oftenfidgetswithortapshands orfeet orsquirmsinseat.
officeorotherworkplace,orinothersituationsthatrequireremaininginplace).
restless.)
d.Oftenunabletoplayorengageinleisureactivitiesquietly.
f.Oftentalksexcessively.
turninconversation).
h.Often has difficulty waiting his or her turn (e.g., while waiting in line).
i.Ofteninterruptsorintrudes onothersle.g.,buttsinto conversations,games,oractivities;may startusingotherpeople's things without asking orreceiving permission;foradolescents and adults,may intrude into or take over what others are doing).
C.Severalinattentiveorhyperactive-impulsivesymptomsarepresentintwoormoresettingse.g,athome,schoolorwork; withfriendsorrelatives;inotheractivities.
D.There is clear evidence that the symptoms interfere with,orreduce the qualityof,social,academic,or occupational functioning.
E.The symptoms do not occurexclusively during the course of schizophrenia or another psychotic disorder and are not better explainedbyanothermentaldisorder(e.g,mooddisorder,anxietydisorder,dissociativedisorderpersonalitydisorder

Table13:AcceptableInterchangeableTermsforMental Disorders

| Condition | AcceptableInterchangeableTerm(s) | |--------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Mental Health Disorder | MentalDisorder/PsychiatricIllness/Mentalillness/ Cognitive/PsychosocialDisabilities/Psychosocial Disorders | | Intellectual Disability | General LearningDisability/Mental Retardation | | Autism Spectrum Disorder | Autism,AutisticDisorderorClassicAutism,Rett's DisorderorRettSyndrome,ChildhoodDisintegrative Disorder,Asperger'sDisorderorAsperger Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified(PDD-NOS | | SpecificLearningDisorder | Learningdisorder/LearningDisability/Dysgraphia/ Dyscalculia/Dyslexia |

3.7.4.Disability1MedicalTeam(MentalHealthConditions/Intellectual Disabilities/ SpecificLearningDisorders)

Chairperson-MedicalOfficer-/Psychiatristifavailable
MentalHealthNurse/Clinical OfficerPsychiatrist
Occupational Therapist
Physiotherapist
■MedicalSocial Worker
Psychologist

3.7.5.Procedureand Documentation

Locationof Assessment:TheDisabilitymedical assessmentsinthisdomainshallbeconducted inagovernmenthealthfacility. Insituationswherethereisnomentalhealthexpertintheassessmentteam,theclientshouldbereferredtoafacilitywiththe expertsandthenecessaryreportprovided.

Clientshouldpresentmedicalevidence(radiologicalevidenceandaradiologistreporttoshowtheextentof injury andother medicalreports)where applicable.

ResourceCentre(EARC)reports(incaseswheretheclientisattendingschool).

andasindicatedby variousscreening tools.

Table 14:ICFAssessmentofMental Health Conditions

| CONDITIONS | IMPAIRMENT | ACTIVITY LIMITATION | PARTICIPATION RESTRICTION | |--------------------------------------------------------------------------------------------------------|----------------------------------------------|---------------------------------------|------------------------------| | Schizophrenia and Related Disorders,BipolarandRelated Disorders expressive Disorders, AnxietyDisorders | Cognitive,Mobility (psychomotor disturbance) | Self-care, activities of daily living | Difficultiesin Getting along |

Table 15: ICFAssessment of SpecificLearningDisorders

| CONDITIONS | IMPAIRMENT | ACTIVITY LIMITATION | PARTICIPATION RESTRICTION | |---------------------|-------------------|----------------------------------------------|----------------------------------------------------------------| | Dyslexia | Reading | Difficulty in reading | Lack of practical life skills, conceptual skills | | Dyscalculia | Calculating | Difficultyincalculating | Lackofpractical lifeskills, conceptualskills | | Dysphasia/Aphasia | Speaking | Difficultywith language | Problems understanding spoken language,thus poor communication | | Dyspraxia | Motorcoordination | Difficultieswithfine motorskills | Hand-eye coordination and balance problems. | | Dysgraphia | Writing | Difficultyin writing | Problemswithhandwritingand organizing ideas | | Auditory processing | Listening | Difficulty hearing differencesbetween sounds | Problemswithreading, comprehensionand language | | Visualprocessing | Seeing | Difficultyinterpreting visualinformation | Problemswithreadingmath, mapscharts and tables |

Table16:ICFAssessmentofNeuro-developmentalDisorders

| Condition | Impairment | Activity Restriction | Participation Limitation | |--------------------------|----------------------------------------------|-----------------------------------------|----------------------------------------------------| | Autism Spectrum Disorder | Learning, Speech/ Language and social skills | Behavioural disturbances, Communication | Difficulty in learning, establishing relationships |

3.7.6.ToolsandEquipment

ChildFriendly environment forChildrenwithlearningdisorders and autismspectrumdisorders(CognitiveToys,PlayArea)
·Sensory Integration Toolkit

AssessmentTools/Batteries

disorders in adults)
PaediatricSymptomsChecklist(PSC)
·Disability Rating Scale(DRS)
Daily LivingActivities(DLA20):AdultMental Health
GlobalAssessmentofFunctioning(@AxisV,DSMIVTR)-GAF

Table17.DSMVDiagnosticCriteria

DIAGNOSTICCRITERIAFORAUTISMSPECTRUM DISORDER

A.Persistent deficits in social communication andsocialinteraction acrossmultiple contexts, as manifested by the following,currently orby history (examples are illustrative,but not exhaustive;)
B.Restricted,repetitivepatternsofbehaviour, interests,oractivities,asmanifestedbyatleast twoofthefollowing,currentlyorbyhistory (examplesareillustrative,notexhaustive;see text)

SPECIFICSYMPTOMS/SIGNS

Deficitsinsocial-emotionalreciprocity,ranging,for example,from abnormalsocialapproach andfailureof normal back-and-forth conversation;toreduced sharingof interests,emotions,oraffect;tofailuretoinitiateor respond to social interactions.

1. Deficits in nonverbal communicative behaviors used forsocialinteraction,ranging,forexample,frompoorly integrated verbal and nonverbal communication;to abnormalitiesin eye contact and body language or deficits in understanding and useof gestures;to a total lack of facial expressions andnonverbal communication. 2. Deficits in developing,maintaining,and understandingrelationships,ranging,forxample,from difficultiesadjustingbehavior to suitvarious social contexts;to difficulties in sharing imaginative play or in making friends;to absence of interestin peers. 1. Stereotypedorrepetitivemotormovements,useof objects,orspeech(e.g,simplemotorstereotypies,liningup of toysorflippingobjects,echolalia,idiosyncraticphrases) 2. Insistenceonsameness,inflexibility,adherenceto routines,orritualizedpatternsofverbalornonverbal behavior(e.g.,extremedistressatsmallchanges,difficulties withtransitionsrigidthinkingpatterns,greetingrituals need totakesamerouteoreatsamefoodeveryday day). 3. Highlyrestricted,fixatedintereststhatare abnormal in intensity orfocus(e.g.,strong attachment toor preoccupationwithunusualobjects,excessively circumscribed orperseverativeinterests). 6. 4 Hyper-orhypo-activity tosensoryinput orunusual interestin sensory aspectsof theenvironment(e.g apparentindifferencetopain/temperature,adverse responsetospecificsoundsortextures,excessivesmelling ortouchingofobjects,visual fascinationwithlightsor movement).

C. Symptoms must be present in the early developmental period (but may notbecome fully manifest until social demands exceed limited capacities,or may be masked by learned strategies in later life).
D. Symptomscauseclinicallysignificantimpairmentinsocial,occupational,orotherimportantareasof currentfunctioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder)or global developmental delay.Intellectual disability and autism spectrum disorder frequency cooccur;to make co-morbid diagnoses of autism spectrum disorder and intellectual disability,social communication should be below that expected for general developmental level.

Table 18.Classifications of Intellectual Disability Severity

| Severity | Approximate Category Percent Distribution of IQ categories) Cases by Severity | DSM-IV Criteria (severity levelswerebased only on | DSM-5Criteria(severity classified on the basis of daily skills) | |--------------|----------------------------------------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------------------------------------------------------| | Mild | 85% | ApproximateIQrange50- 69 | Canliveindependentlywithminimumlevels of support. | | Moderate10% | | ApproximateIQrange36- 49 | Independent living may be achievedwith moderatelevelsofsupport,suchasthose available ingroup homes. | | Severe | 3.5% | ApproximateIQrange20- 35 | Requiresdailyassistancewithself-care activitiesandsafety supervision. | | Profound1.5% | | IQ<20 | Requires 24-hour care. |

FormulaeforcalculatinglQ

Intelligence quotient (IQ) can be obtained by the equation MA/CA x100 =IQ,where MA is mental age and CA is chronological age.

Condition

Specific Learning Disability

Diagnostic Criteria

A.Difficulties learning and using academic skills,as indicated by the presence of at least one of the following symptoms that have persisted for at least6months,despite the provision of interventions that target those difficulties:
1.Inaccurate or slow and effortful word reading(e.g.,reads single words aloud incorrectlyor slowly and hesitantly,frequently guesseswords,has difficulty sounding out words).
2.Difficulty understanding the m eaning of what is read (e.g.,may read text accuratelybutnotunderstand thesequence,relationships,inferences,or deeper meanings of what is read).

3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).

4.Difficulties with written expression(e.g.,makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression ofideas lacksclarity).

5. Diffculties mastering number sense, number facts, or calculation (e.g.-has poor understandingof numbers,theirmagnitude,and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do;gets lost in the midst of arithmetic computation and may switch procedures).

6.Difficultie s with mathematical reasoning (e.g.,has severe difficulty applyingmathematicalconcepts,facts,orprocedurestosolve quantitative problems).
B.The affected academic skills are substantially and quantifiably below thoseexpected

for the individual's chronological age, and cause significant interference with academic or occupational performance,orwith activities of daily living, asconfirmedbyindividually administeredstandardized achievement measures and comprehensive clinical assessment.Forindividuals age 17 years and older, a documented history of impairing learning difficulties may be substitutedfor the standardized assessment.

C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual's limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academicloads).

2. D.The learning difficulties are not better accounted for by intellectual neurological disorders,psychosocial adversity,lack ofproficiency in the language of academic instruction, or inadequate educational instruction.

Note;The four diagnostic criteria are to bemet based on a clinical synthesis of thendividual'shistory(developmental,medical,family,educational), school reports, and psycho -educational assessment.

3.8.DISABILITYCATEGORY:CHRONICPROGRESSIVEDISORDERS 3.8.0.ChronicProgressiveDisorders Definition

ChronicProgressiveConditionisadiseaseorhealthconditionthatgetsworseovertime,resultinginageneraldeclinein healthorfunction.Commonexamplesofprogressivedisordersincludebutarenot limited tomusculardystrophy,multiple sclerosis,Alzheimer'sdisease,andtypesofvisionandhearinglossthatgetworseovertime.

Diseaseorhealthconditionsthatgetworseovertimeresultingingeneraldeclineinhealthorfunction.

Commonexamplesincludebutarenotlimitedtomusculardystrophy,multiplesclerosis,Alzheimer's

typesof support thatonemayneed,includinghealthbenefits,workaccommodations,andequipment(suchascrutches orwheelchairs)also change.

That does not mean one cannot have a satisfying life.However,it does mean that you need to adapt to your changing disability andplanforhowthingsmaybedifferent inthefuture.

Characteristics ofChronicProgressive Conditions

Haveapatternofrecurrence,ordeterioration;theimpairmentsubsidesandflaresagainaftersometimewithsubstantial painortissuedamageandit isnevercured
Haveapoorprognosiswhichislikelytogetworsewithtime
Produceconsequences,orsequelaethatimpactontheindividual'squality of life
Longterm;theimpairment haslasted fororislikely topersistforat least twelvemonths
·Substantially limits aperson'sabilitytoperformessentialfunctions oractivities of daily living

3.8.1.CriteriaforDisability Categorization:ChronicProgressiveDisorders

Underthiscategory,relevantmedicalspecialistswillexaminespecificmedicalconditions.Clientswhoshallbeconsidered tohavedisabilityduetoaprogressivechronicdisordershould meet thefollowingcriteria:

1)Theclienthassufferedfromamedicalconditionforaperiodnotlessthan12months.
2)Thereshouldbeevidenceofcontinuedrelevanttreatmentandrehabilitationwithoutsatisfactoryimprovementforthe sameperiod of 12months.
3)Thereispresenceofphysical impairmentorlimitationof activitythatismeasurable.
4)Theconditionof theclientaffectstheirabilitytofunctionintheusualworksettingorenvironment
5)Theclientneedsconsiderationforalternativetaskswithinthesameenvironment
6)Incaseofachild,theyshouldbeatleast2yearsofageormoretoallowsufficienttimefortreatment/interventionsand expecteddevelopment.Thispointshouldbereconsideredassomeprogressiveillnessesinchildhoode.g,cysticfibrosis expected.

3.8.2.MajorAssessmentCategories

Thefollowingareasshall beassessed

1.Mobility:Walking&MovingAround
2.Changing&MaintainingBodyPosition
3.Carrying,Moving,&Handling Objects
4.Self-Care
5.Swallowing,
6.AttentionandMemory

Medical Assessment

Past medical history:Description of The Condition,
TheDateof Diagnosis,the date of onsetand prognosis
Cell level tests:Labs,imaging
·System level Assessment:Based on diagnosis
AssessmentofBothImpairmentsandFunctional Limitations,activityrestrictions
Documentationofcurrentlevelversusnormalvalue
Typeof Rehabilitationoffered

Body Structures

Thenervoussystemstructures
Theeye,ear and related structures
Structuresinvolved invoiceandspeech
Cardiovascular,immunologicalandrespiratorySystems
·The digestive,metabolic and endocrine systems
hegenitourinaryandreproductivesystems
Structuresrelatedtomovement
Skin andrelatedstructures

Body Functions

Mental
■ensory and Pain
VoiceandSpeech
Cardiovascular,Haematological,ImmunologicalandRespiratorySystems
Digestive,MetabolicandEndocrineSystems
GenitourinaryandReproductiveFunctions
Neuro-musculoskeletalandMovement-RelatedFunctions
Skin andRelatedStructures

Members /Assessors (Name, Professional body Reg. no.)

1.Chairperson:Medicalspecialistintheareaofconcern(e.g.,Dermatologist,Neurologist,Rheumatologist, Cardiologist,OrthopedicSurgeonetc)/Medicalofficer
2.Physiotherapist

3. Occupational Therapist

4.SpeechTherapist
5.Any othermemberasperneed/area of concern.

3.8.3.Categories ofChronicProgressiveConditions

| CategoriesofChronicProgressiveConditions | CategoriesofChronicProgressiveConditions | CategoriesofChronicProgressiveConditions | |--------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------| | SYSTEMS | CONDITIONS | DIAGNOSTICTESTS | | Cardiopulmonary orCardiovascular | √ COPD √ ChronicIschemicHeartDiseases √ Cardiomyopathy Cystic fibrosis: Rheumaticheartdisease: Echocardiogram(echo) Symptomaticcongenitalheartdisease- birthdefectsintheheartwhichcause malfunctions. | 6minutes'walktest,PFTs,MMT, Functionalmobilitytest, Echocardiogram Thesweattest,spirometry, functional mobilitytest | | Musculoskeletal: Musculoskeletal disorders may be congenital or acquired, and may include deformities, amputations,or other abnormalities. | √ Fibromyalgia √ Severeosteoarthritis √ SevereSystemicLupusErythematosus Rheumatoid arthritis Ankylosing spondylitis Reiter'ssyndrome Polymyositis | ROM,Visual analogpainscale, MMT,Bergbalancescale,TUG, Tinetti,Lowerextremity functionalscaletest | | Neurological | √ Dementia √ ALS(Amyotrophiclateralsclerosis) Parkinson's √ Multiplesclerosis Muscular dystrophy √ Hereditary neuropathy Epilepsy √ Inclusion type Myositis Huntington's disease Motor Friedreich'sataxia √ Spinocerebellar degeneration √ coma and persistent vegetative state √ Chronicfatigue syndrome √ Stroke | Electroencephalogram(EEG), ROM,Visualanaloguepainscale, MMT,Bergbalancescale,TUG, lowerextremityfunctionaltests, Tinetti,cognitivetests, swallowingtests, |

| | √ Cerebral Palsy Spinal Cord Injury √ Arachnoiditis | | |-----------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------| | Cancers/ malignancies | √ Haematologicale.g.,leukemia √ Solid organs Bone/softtissuetumorsresultingin amputation Head and neck tumours e.g., laryngeal cancerleadingtoaphonia √ Braintumours | Histologyreports Stagingimaging-CTscans,MRI, PETscans | | Gastro-intestinal disorders | Inflammatorybowerdiseases √ Liver cirrhosis Chronic pancreatic | | | Dermatological conditions | √ Albinism Vitiligo √ Psoriasis Hydradenitissuppurativa Scleroderma. | PFTs,ROM,MMT | | Vascular conditions | Lymphedema/Elephantiasis(should specifythecause,measurement comparedtootherlimb,activity limitation) Associationof lymphedemaand mastectomy Mastectomyshouldonlybeconsidered forregistrationifitsbilateralformothers of child bearing age or where there is markedlymphoedemawithassociated functional limitations | | | Genito-urinary | Bowelandbladderincontinence(dueto anirreversiblemedicalcondition | | | Frailty | | | | HIV/AIDS8HIV associated illnesses | | Laboratorytests Imaging Anyotherrelevanttests |

| Chronicobstructivepulmonary disease: | % | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------| | More thanFEV-1of71-to80-percent predicted,or;FEV-1/FVCof 71to80 percent,or;DLC0(SB)66-to80-percent predicted | 0% | | FEV-1of71-to80-percentpredicted,or;FEV-1/FVCof71to80 percent,or;DLC0(SB)66-to80-percent predicted | 10% | | 56-to65-percentpredicted | 30% | | FEV-1of40-to55-percentpredicted,or;FEV-1/FVCof40to55percent,or;DLC0(SB)of (withcardio-respiratorylimit) | 60% | | FEV-1lessthan40percentofpredictedvalue,or;theratioofForcedExpiratoryVolume inonesecondtoForcedVitalCapacity (FEV-1/FVC)lessthan40percent,or; DiffusionCapacityof theLungforCarbon MonoxidebytheSingleBreathMethod ml/kg/minoxygenconsumption(withcardiacorrespiratorylimitation),or; hypertension(shown by Echo or cardiac catheterization),or; episode(s) of acute respiratory failure,or;requires outpatient oxygen therapy | 100% | | Client'sactivityshouldbeevaluatedusingthe6-minutestresstest. | | | SleepApneaSyndromes(Obstructive,Central,Mixed): | | | Asymptomaticbutwithdocumentedsleepdisorderbreathing | 0% | | Persistentday-timehypersomnolence | 30 | | Requiresuse of breathing assistance device such as continuous airway pressure(CpAP) machine | 50% | | Chronicrespiratoryfailurewithcarbondioxideretentionorcorpulmonale,or;requires tracheostomy | 100% |

CONDITIONSLIMITINGTRUNKRANGEOFMOTION

Thegeneralratingformulathatisusedtoratetheconditionslistedaboveismainlybasedon range of motion(RoM) measurements.The cervical spine(neck) and the thoracolumbar spine(low back) arerated accordingto thefollowingcriteria:

| CervicalSpine | Thoracolumbar Spine | RATING | |----------------------------------------------------------------------|----------------------------------------------------------------------------|----------| | Flexion≥45degrees,ORcombinedROM≥ 340degrees | Flexion≥90degrees,ORcombinedROM≥ 240degrees | 0% | | Flexionbetween30and45degrees,OR combinedR0Mbetween175and340 degrees | Flexionbetween60and90degrees,OR combinedR0Mbetween125and240 degrees | 10% | | Flexionbetween15and35degrees,OR combinedR0M≤170degrees | Flexionbetween30and65degrees,OR combinedR0M≤120degrees | 20% | | Flexion≤15degrees,ORentirecervical spineisfrozeninafavorableposition | Notapplicableto thoracolumbarspine | 30% | | Entirecervicalspineisfrozeninan unfavorableposition | Flexion≤30degrees,ORentire thoracolumbarspineisfrozenina favorableposition | 40% | | Not applicabletocervical spine | Entirethoracolumbarspineisfrozeninan unfavorableposition | 50% | | Entirespineisfrozeninan unfavorable position | Entirespineisfrozeninanunfavorable position | 100% |

| HIV-Related Illness | %Rating | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------| | Those who are asymptomaticwithout decreased T4 cell counts or evidence of lymphadenopathy. | 0% | | 10%percent ratingforthosewho developsymptomsof HiV-relatedproblems,have qualifyingT4cellcounts,andhaveevidenceofdepressionormemorylossthatcan affectemployment. | 10% | | Recurrentconstitutional symptoms,intermittentdiarrhea,anduse of approved medication"orthatmeetcertainT4cellcountcriteria. | 30% | | For HiV-relatedillnessispossible(dependingon circumstances) incaseswhere oneor morearepresent: Refractory constitutional symptoms Diarrhoea Pathologicalweight loss MinimumratingfollowingdevelopmentofAiDs-relatedopportunistic infectionorneoplasm | 60% |

In cases where the patient described as having AiDSwith"recurrent opportunistic infections."

100%

Cases where AlDS and secondary diseases affect multiple systems in the body. HIVrelated illness "with debility" and progressive weight loss is also rated at 1o0%.

NB:SinceHIVcomplicationscanbecorrected byinitiationof HAART,itshouldbeconsidereda causeofdisabilityonlywhenthereisirreversiblephysicallimitationduetotheillness

| combiningthe evaluationsforresidualsundertheappropriatesystem | % Rating | |-------------------------------------------------------------------|------------| | StablenoExacerbations | 0% | | Exacerbationsonceortwiceayearorsymptomaticduringthepast2years | 10% | | Exacerbationslastingaweekormore,2or3timesperyear | 60% | | Acute,withfrequentexacerbations,producingsevereimpairmentofhealth | 100% |

| CHRONICFATIGUESYNDROME(CFS) Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness,orconfusion),oracombinationofothersignsandsymptoms: | % Rating | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Whichwaxandwanebutresultinperiodsofincapacitationofatleastonebutlessthan6 weeks total duration peryear,or;symptoms controlled by continuousmedication | 0% | | Whichwaxandwanebutresultinperiodsofincapacitationofatleast6weeks total duration per year, or; symptoms controlled by continuous medication | 10% | | Whicharenearlyconstantandrestrictroutinedailyactivitiesbylessthan 25percentofthepre-illnesslevel,or;whichwaxandwane, resultinginperiodsofincapacitationofatleast2butlessthanfourmonthstotalduration peryear | 20% | | Whichare nearlyconstant andrestrict routine daily activitiesto50 to75percentof the pre-illnesslevel,or;whichwaxandwane,resultinginperiodsofincapacitationofatleast fourbutlessthansixmonthstotaldurationperyear | 40% | | Whicharenearlyconstantandrestrictroutinedailyactivitiestoless than50percentof thepre-illnesslevel,or;whichwax andwane,resultinginperiodsof incapacitationofatleastsixmonthstotaldurationperyear | 60% | | Whicharenearlyconstantandsosevereastorestrictroutinedaily activities almost completelyandwhichmayoccasionallyprecludeself-care | 100% |

| POLYCYTHEMIAVERA | % Rating | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Requiringperipheralbloodorbonemarrowstem-celltransplantorchemotherapy(including myelosuppressant)forthepurposeofamelioratingthesymptomburden. | 100 | | Requiringphlebotomy6ormoretimesper12-monthperiodormolecularlytargetedtherapyfor thepurposeofcontrollingRBCcount | 60 | | Requiringphlebotomy4-5timesper12-monthperiod,orifrequiringcontinuousbiologic therapy ormyelosuppressive agents,to includeinterferon,to maintain platelets<2oo,ooo or whitebloodcells(WBC)<12,000 | 30 | | Requiringphlebotomy3orfewertimesper12-month periodorifrequiringbiologictherapy or interferononanintermittentbasisasneededtomaintainallbloodvaluesatreferencerange levels | 10 |

| IMMUNETHROMBOCYTOPENIA | % Rating | |----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Requiringchemotherapyforchronicrefractorythrombocytopenia;oraplateletcount3o,ooo or belowdespitetreatment | 100 | | Requiringimmunosuppressive therapy;orforaplateletcount higher than30,ooo but not higher than5o,ooo,withhistoryofhospitalizationbecauseofseverebleedingrequiringintravenous immuneglobulin,high-dose parenteral corticosteroids,and platelet transfusions | 70 | | Plateletcounthigherthan30,ooobutnothigherthan50,oo0,witheitherimmune thrombocytopenia ormildmucousmembrane bleedingwhich requires oral corticosteroid therapyorintravenousimmuneglobulin | 30 | | Plateletcounthigherthan30,ooobutnothigherthan5o,ooo,notrequiringtreatment | 10 | | Plateletcountabove5o,ooo andasymptomatic;orforimmune thrombocytopeniainremission | 0 |

| MultipleMyeloma | % Rating | |----------------------------------------------------------------------------------|------------| | Symptomaticmultiplemyeloma | 100 | | Asymptomatic,smoldering,ormonoclonalgammopathyofundeterminedsignificance (MGUS). | 0 | | NB:Shouldbecausingirreversiblephysicallimitation | |

| Lymphoma | % Rating | |-----------------------------------------------------------------------------------------------------------------------|------------| | Non-Hodgkin'slymphoma:Withactivediseaseorduringa treatmentphase | 100 | | Hodgkin'slymphoma:Whenthereisactivedisease,during treatmentphase,orwithindolent andnon-contiguousphaseof low-gradeNHL | 100 | | NB:Shouldbecausingirreversiblephysicallimitation | |

| SICKLECELLANEMIA | %Rating | |---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------| | Withatleast4ormorepainfulepisodesper12-monthperiod,occurringinskin,joints, bones,oranymajororgans,causedbyhemolyticandsicklingofredbloodcells,with anaemia,thrombosis,andinfarction,withresidual symptoms precludingeven light manual labor | 100 | | With3painfulepisodesper12-monthperiodorwithsymptomsprecludingotherthan lightmanual labor | 60 | | With1or2painfulepisodesper12-monthperiod | 30 | | Asymptomatic,establishedcaseinremission,butwithidentifiableorganimpairment | 10 | | Sicklecelltraitalone,withoutahistoryofdirectlyattributablepathologicalfindings,is notaratabledisability | 0 |

| ESSENTIALTHROMBOCYTHEMIAANDPRIMARYMYELOFIBROSIS: | % Rating | |---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Requiring either continuousmyelosuppressivetherapy or,for sixmonthsfollowing hospital admission,peripheral bloodorbonemarrowstemcell transplant,orchemotherapy,or interferontreatment | 100 | | Requiringcontinuousorintermittentmyelosuppressivetherapy,orchemotherapy,or interferon treatment tomaintain plateletcount<500 x10\L | 70 | | interferontreatmenttomaintainplateletcountof200,o00-400,oo0,orwhitebloodcell (WBC)countof4,000-10,000 | 30 | | Asymptomatic | 0 | | NB:Shouldbecausingirreversiblephysicallimitation | |

| ACQUIREDHEMOLYTICANEMIA | % Rating | |---------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------| | Requiringa bonemarrow transplantorcontinuousintravenous orimmunosuppressive therapy(e.g.,prednisone,Cytoxan,azathioprine,orrituximab) | 100 | | Requiringimmunosuppressivemedication4ormoretimesper12-monthperiod | 60 | | Requiringatleast2butlessthan4coursesofimmunosuppressivetherapyper12-month period | 30 | | Requiring one course of immunosuppressive therapy per12-month period | 10 | | Asymptomatic | 0 | | NB:Shouldbecausingirreversiblephysical limitation | NB:Shouldbecausingirreversiblephysical limitation |

DERMATOLOGYDISABILITYCATEGORIZATION

Albinism

Criteria-Three of the followingrequired:

Apparent at birth and characterized by partial or complete absence of melanin in the skin, hair and eyes (oculocutaneous albinism) or limited to the eyes(ocular albinism)
Cutaneous manifestations include generalized hypopigmentation of the skin and hair, solar lentigines,melanocyticnaevi8 and an increased susceptibility to melanoma and/ornonmelanoma skincancers
Visual complications include nystagmus, strabismus, photophobia, refractive errors and foveal hypoplasia

AND

Evidence of receiving definitive treatment for albinism from aregistered healthcare provider since birth

| Vitiligo | | | |--------------------|-----------|---------------| | Body Site Involved | %BSA Area | %BSA Involved | | Head,Face8Neck | 0-9% | | | Trunk | 0-36% | | | UpperLimbs | 0-18% | | | Lower Limbs | 0-36% | | | Genitalia | 0-1% | | | Total | 0-100% | |

Criteria-Twoofthefollowingrequired:

Characteristicskinlesionsinvolvingmore than3o%oftheentirebodysurfacearea

OR

AND

Evidenceofreceivingdefinitivetreatmentforvitiligofromaregisteredhealthcareproviderfor aminimumperiodof12months

NBAnotherexampleisthatofanindividualwithvitiligoonthefacebutnootherphysicalcomplaints. This cosmeticproblem produces no limitationsincapacity.However,theindividual may liveina setting wherevitiligoismistakenforleprosyandsoconsideredcontagious.Intheperson'scurrent environment,therefore,thisnegativeattitudeisanenvironmentalbarrierthatleadstosignificant performanceproblemsininterpersonalinteractions

Characteristicskinlesionsinvolvingmore than5%ofexposedbody surface area,includingthe faceand/orthehands

| Psoriasis | | | |--------------------|----------------|----------------| | Body Site Involved | %BSA Area %6-0 | Head,Face8Neck | | | 0-36% | Trunk | | | 0-18% | Upper Limbs | | | 0-36% | Lower Limbs | | | 0-1% | Genitalia | | Total | 0-100% | |

Criteria-Twoofthefollowingrequired:

Characteristicskinlesionsinvolvingmorethan3o%oftheentirebodysurfacearea

OR

AND

Evidenceofreceivingdefinitivetreatmentforpsoriasisfromaregisteredhealthcareprovider foraminimumperiodof12months

Hidradenitis Suppurativa

Criteria-Two of thefollowingrequired:

Skin lesions characterized by multiplerecurrent abscesses,nodules,sinus tracts,fistulas and scars involving more than 2 body areas including the axillae and/or the perineum

OR

AND

Evidence of receiving definitive treatment for hidradenitis suppurativa from a registered healthcareproviderforaminimumperiodof12months
Characteristicskinlesionsinvolvingmorethan5%ofexposedbodysurfacearea,includingthe faceand/orthehands
Severepsoriaticarthritischaracterizedby arthritismutilansaffectingsmalljointsinthehands andresultinginpermanentdeformity&disability
Diffuse involvement or multiple interconnected tracts and abscesses across an entire area with associated permanent disfigurement and/or scarring

Scleroderma

Criteria-Four of the following required:

Characterized by rapid onset of skin fbrosis, Raynaud's phe nomenon, telangiectasia and/or calcinosis cutis
Associated with extensive involvement of multiple organ systems resulting in interstitial lung disease, esophageal dysmotility8 dysphagia, cardiac arrythmias, sarcopenia, arthritis and renal failure
Extensive skin involvementof more than 3o% of the entire body surface area
Characteristic skin lesions involving more than 5% of exposed body surface area, including the faceand/orthehands and/orthefeet

OR

AND

Evidence ofreceivingdefinitive treatmentforscleroderma fromaregisteredhealthcare providerfora minimum periodof12months

CongenitalIchthyosis

Criteria-Four of the followingrequired:

Onset at birth and characterized by severe symptoms including extreme skin xerosis with large adherentscale,erythroderma,pruritus,palmoplantarkeratoderma,heatintoleranceand/or scarring alopecia
Ocular manifestations include cicatricial ectropion, exposure keratopathy& corneal scarring whichmay resultinvisualimpairment/loss
Extensiveskininvolvementofmorethan3o%oftheentirebodysurfacearea
Characteristic skin lesions involving more than 5% of exposed body surface area, including the face and/orthe hands
Evidence ofreceiving definitive treatmentfor severe congenitalichthyosisfrom aregistered healthcareprovidersincebirth

OR

AND

Xeroderma Pigmentosa

Criteria-Three of the followingrequired:

Onsetatearlyinfancy andcharacterizedbyseverephotosensitivity,solarlentigines,solar keratoses,mottledpigmentation,and associated melanoma and/ornon-melanoma skin cancers
Ocularmanifestationsincludeseverephotophobia,exposurekeratitis,cornealopacification and/orneoplasiawith associatedvisualimpairment/loss
Extensive skin involvement of more than3o%of the entirebody surface area
Characteristic skin lesions involving more than 5% of exposed body surface area,including the faceand/orthehands

OR

AND

Evidence ofreceivingdefinitive treatmentfor xerodermapigmentosafrom aregistered healthcare provider since infancy

EpidermolysisBullosa

Criteria-Four of the followingrequired:

Onset at birth or early infancy and characterized by severe blistering of the skin andmucous membranesfollowingminimaltrauma.
Extensive skin involvement of more than3o%of the entire body surface area
Characteristic skin lesions involving more than5% of exposed body surface area,includingthe faceand/orthehandsand/orthefeet
Associated with prominent scarring, nail dystrophy, pseudo syndactyly of hands & feet and/or osteoporosis

OR

AND

Evidence of receiving definitive treatment for epidermolysis bullosa from a registered healthcare providersincebirth orearly infancy

Neurofibromatosis

Criteria-Four of the followingrequired:

Onset atbirth or early infancy andcharacterized by the following cutaneousmanifestations: multiplecafe-au-laitspots,axillaryfreckling,neurofibromas and/orplexiform neurofbromas.
Associatedwithocularinvolvement(Lischnodules),skeletalabnormalities(scoliosis,tibial dysplasia) andfunctionalimpairments(hearingloss,speechproblems &learning disabilities)
Extensive skin involvement of more than 3o%of the entire body surface area
Characteristic skin lesions involving more than 5% of exposed body surface area, including the faceand/orthe hands and/orthefeet

OR

AND

Evidenceofreceivingdefinitive treatmentforneurofibromatosisfrom aregisteredhealthcare provider since birth or early infancy

| ACNE | %Rating | |--------------------------------------------------------------------------------------------------------------------------------------------------|-----------| | Superficial acne(comedones,papules,pustules)of anyextentorrateasdisfigurementof thehead,face,orneckorscars,dependinguponthepredominantdisability | 0% | | Deep acne(deepinflamed nodulesandpus-filled cysts)affectinglessthan 40percentofthefaceandneck,ordeepacneotherthanonthefaceandneck | 10% | | Deep acne(deepinflamednodulesandpus-filledcysts)affecting40percent ormoreofthefaceandneck | 30% |

| BURNS | %Rating | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------| | NOTEPRESENCEOFTHEFOLLOWINGDISFIGUREMENT: Scar5 ormore inches(13 ormore cm.)in length.Scar at least one-quarterinch(0.6 cm.) wideatwidestpart. Surfacecontourofscarelevatedordepressedonpalpation. Scaradherenttounderlyingtissue. | 0% | | Withonecharacteristicofdisfigurement | 10% | | Withvisibleorpalpabletissueloss andeithergrossdistortion orasymmetry of one featureorpairedsetoffeatures(nose,chin,forehead,eyes(includingeyelids),ars (auricles),cheeks,lips),or;withtwoorthreecharacteristicsofdisfigurement | 30% | | Withvisible orpalpabletissuelossandeithergross distortion orasymmetry of two featuresorpairedsetsoffeatures(nose,chin,forehead,eyes(includingeyelids),ears (auricles),cheeks,lips),or;withfourorfivecharacteristicsofdisfigurement | 50% | | Burnscar(s)ofthehead,face,orneck;scar(s)ofthehead,face,orneckduetoother causes;orotherdisfgurementofthehead,face,orneck:Withvisibleorpalpable tissue loss and eithergross distortion or asymmetry of three ormore features orpaired setsoffeatures(nose,chin,forehead,eyes(includingeyelids),ears(auricles), cheeks,lips),or;with six ormore characteristics of disfigurement | 80% |

| RATINGSOFTHEGENITOURINARYSYSTEM | % Rating | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Hydronephrosis,onlyanoccasionalattackofcolic,notinfected andnotrequiring catheterdrainage | 10 | | Hydronephrosis(cont.):Frequent attacks of colic,requiring catheter drainage Penis, removal of glans Penis,deformity,withlossoferectilepower Testis,atrophy complete:Both Renal tubular disorders(such as renal glycosurias,aminoacidurias,renal tubular acidosis, Fanconi'ssyndrome,Bartter'ssyndrome,related disordersof Henle'sloopandproximalordistalnephronfunction,etc.): | 20 | | BothTestisremoval: Kidney,removalofone Nephritis,chronic:Pyelonephritis,chronic Nephrolithiasis,Hydronephrosis:Severe;Rate asrenal dysfunction.Frequent attacksofcolicwithinfection(pyonephrosis),kidneyfunctionimpaired Penis,removalofhalformore | 30 | | Malignantneoplasmsofthegenitourinarysystem Postoperative,suprapubiccystotomy Multipleurethroperinealfistulae Kidneytransplantsurgery | 100 |

| DIABETESMELLITUS | % Rating | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Manageablebyrestricteddietonly | 0% | | Requiringoneormoredailyinjectionofinsulinandrestricteddiet,or;oralhypoglycemic agentandrestricteddiet | 10% | | Requiringoneormoredailyinjectionofinsulin,restricteddiet,andregulationofactivities | 40% | | Requiringoneormoredailyinjectionof insulinrestricteddiet,andregulationofactivities withepisodesof ketoacidosis orhypoglycemicreactionsrequiringoneortwo hospitalizationsperyearortwiceamonthvisitstoadiabeticcareprovider,plus complicationsthatwouldnotbecompensableifseparatelyevaluated | 60% | | Requiringmore thanonedailyinjectionofinsulinrestricteddiet,andregulationofactivities (avoidance of strenuousoccupational andrecreational activities) with episodesof ketoacidosis orhypoglycemic reactions requiring at least three hospitalizations peryearorweeklyvisitstoadiabeticcareprovider,pluseitherprogressivelossofweight andstrengthorcomplicationsthatwouldbecompensableifseparatelyevaluated | 100% |

Table 20.ICF Assessment ofProgressive Chronic Conditions

| Conditions | Impairments | Activity limitation | Participation/ Restriction | |--------------|-------------------------------------------------------------------------|------------------------------------------|--------------------------------------------------------------------------| | Multiple | Fromcell level>tosystem level ROM,Muscle strength, balance coordination | Functional mobility, ADLS,ALs,uchas work | Varied.Unabletoaccess and participate their environment,work, recreation |

Assessment Tools and Equipment

Assesscognition,ointRangeofMotionmuscletonecoordination,balancegaitradiologicalimagingcardiorespiratorytts functional mobility tests,as appropriate.The tools and equipment below may be necessary in assessment of the persons with progressivechronicconditions

OniometersDynamometers
·BP machines
Spirometers
Pulse oximeters
Cycle's ergometers
Tape measures
·Peg boards
Cones
Timers
Stairs
=Toys
Lifting boxes
Wheelchair
Chairs
Monofilaments

Standardized Tests (See Annex)

Oxford Scalefor Manual MuscleTesting
GaitTest:Tinetti,TimedUp andGo
LowerExtremityFunctional Scale(LEFS)
Berg balance test

ChronicProgressive Conditions Assessment Tests

Table21.0xfordScale

MMT:MUSCLESTRENGTH:Grade3(Fair;5O%):

| OXFORD SCALE | EXPLANATION | |----------------|-----------------------------------------------------| | 0 | Nocontractionpresent | | 1 | Thereisflickeringcontraction | | 2 | Fullrangeofmotionwithgravity | | 3 | Fullrangeofmotionagainstgravity | | 4 | Fullrangeofmotionwithagainstgravity+addedresistance | | 5 | Musclefunctionnormally |

Table22.BergBalanceScale

BERGBALANCESCALE

Interpretation:41-56=lowfallrisk,21-40=mediumfallrisk,0-20=highfallrisk

Registerif>21points

SITTINGTOSTANDING

INSTRUCTIONS: Please stand up. Try not to use your hand for support.

·4 able to stand without usinghands and stabilize independently
·3abletostandindependentlyusinghands
2abletostandusinghandsafterseveraltries
1needsminimalaidtostandorstabilize
·Oneedsmoderateormaximalassisttostand

STANDINGUNSUPPORTED

INSTRUCTIONS:Pleasestandfortwominuteswithoutholdingon.

4abletostandsafelyfor2minutes
3abletostand2minuteswithsupervision
2abletostand30secondsunsupported
·1needsseveraltriestostand30secondsunsupported
·0 unabl e to stand 30 seconds unsupported

Proceedtoitem#4.

SITTINGWITHBACKUNSUPPORTEDBUTFEETSUPPORTEDONFLOORORONASTOOL

INSTRUCTIONS:Pleasesitwitharmsfoldedfor2minutes.

4abletositsafely andsecurelyfor2minutes
3abletosit2minutesundersupervision
·2abletoabletosit30seconds
·1able tosit 10 seconds
·0unable tositwithout support 10seconds

STANDINGTOSITTING

INSTRUCTIONS:Pleasesitdown.

4sitssafelywithminimaluseofhands
3controlsdescentbyusinghands
·2usesbackoflegsagainstchairtocontrol descent

·1sitsindependentlybuthasuncontrolleddescent

·Oneedsassisttosit

TRANSFERS

INSTRUCTloNS:Arrange chair(s)for pivot transfer.Asksubject to transfer one way toward a seatwitharmrestsandoneway towardaseatwithout armrests.Youmay usetwochairs(one withandonewithoutarmrests)orabedandachair.

·4 able to transfer safely withminor use of hands
·3 able to transfer safely definite need of hands
·2able to transferwith verbal cuingand/or supervision
1needsonepersontoassist
·Oneedstwopeopletoassistorsupervisetobesafe

STANDINGUNSUPPORTEDWITHEYESCLOSED

INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.

4abletostand10secondssafely
·3abletostand10secondswithsupervision
2abletostand3seconds
·1unable tokeep eyes closed3secondsbut stays safely
Onedshelptokeepfromfalling

STANDINGUNSUPPORTEDWITHFEETTOGETHER

INSTRUCTiONS: Place your feet together and stand without holding on.

·4 able toplace feet together independently and stand 1 minute safely
3 able to pl ace feet together independently and stand 1 minute with supervision
2 able to place feet together independently but unable to hold for 30 seconds
·O needs help to attainpositionand unable to hold for 15 seconds

INSTRUCTioNS: Lift arm to 90 degrees.Stretch out your fingers and reach forward as far as you should not touch therulerwhilereachingforward.Therecorded measure is the distance forward that thefingersreachwhile thesubjectisin themost forwardlean position.When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.)

·4 can reach forward confidently 25 cm(10 inches)
·3canreachforward12cm(5inches)

·2canreachforward5cm(2inches)
·1reachesforward but needssupervision
·Olosesbalancewhile trying/requires external support

PICKUPOBJECTFROMTHEFLOORFROMASTANDINGPOSITION

INSTRUCTIONS: Pick up the shoe/slipper, which is place in front of your feet.

·4 able to pick up slipper safely and easily
·3able topick up slipper but needs supervision
·2 unable to pickupbut reaches 25 cm(1-2 inches) from slipper and keeps balance independently
1 unable to pick up and needs supervision while trying
·O unable to try/needs assist tokeep from losingbalance or falling

TURNINGTOLOOKBEHINDOVERLEFTANDRIGHTSHOULDERSWHILESTANDING

twistturn.

·4 looksbehind from both sides andweight shiftswell
·3 looksbehind one side only other side shows lessweight shift
2 turns sideways only but maintains balance
·1 needs supervision when turning
·0 needs assist to keep from losing balance or falling

TURN360DEGREES

INSTRUCTIoNS:Turn completely aroundin a full circle.Pause.Then turn a full circlein the otherdirection.

·4abletoturn360degreessafelyin4secondsorless
3abletoturn360degreessafelyonesideonly4secondsorless
2 able to turn 360 degrees safely but slowly
·1needsclosesupervisionorverbalcuing
·0 needs assistance while turning

PLACEALTERNATEFOOTONSTEPORSTOOLWHILESTANDINGUNSUPPORTED

INSTRUCTIONS: Place each foot alternately on the step/stool.Continue until each foot has touchthestep/stoolfourtimes.

s

·2abletocomplete4stepswithoutaidwithsupervision
·1abletocomplete>2stepsneedsminimalassist
Oneedsassistancetokeepfromfalling/unabletotry

STANDINGUNSUPPORTEDONEFOOTINFRONT

INSTRUCTIONS:(DEMONSTRATETOSUBJECT)Placeonefootdirectlyinfrontoftheother.If youfeelthatyoucannotplaceyourfootdirectlyinfront,trytostepfarenoughaheadthat the heelofyourforward footis aheadof thetoesof theotherfoot.(Toscore3points,thelength ofthestepshouldexceedthelengthoftheother

foot and thewidthof the stanceshould approximatethesubject'snormal stridewidth.)

·4 abletoplacefoot tandem independentlyandhold30seconds
·3abletoplacefoot aheadindependently andhold30seconds
·2 able to take small step independently and hold 30 seconds
·1needshelptostepbutcanhold15seconds
·olosesbalance whilestepping orstanding

STANDINGONONELEG

INSTRUCTIONS:Stand on oneleg as long asyou can without holding on.

·4 able to lift leg independently and h old >10 seconds
·3able to lift legindependently and hold 5-10 seconds
·2 ableto lift legindependentlyandhold≥3seconds
·1 triestoliftlegunabletohold3secondsbut remainsstandingindependently.
Ounable to try of needs assist toprevent fall
TOTALSCORE(Maximum=56)

Table 23. Gait Test: Tinetti, Timed Up and Go

| TINETTI | DATE | COMMENTS | |------------------------------------------------------------------------------------------------------------------|--------|------------| | BalanceTests:Subjectisseatedonhard,armlesschair | | | | SITTINGBALANCE Leans or slidesin chair =0,steady,safe =1 | | | | ARISES Unable without help =0;Able,uses arms =1,Able without using arms = 2 | | | | ATTEMPTSTORISE: Unable w/o help=0;Able,requires >1 attempt =1;Able in 1 attempt =2 | | | | IMMEDIATESTANDINGBALANCE(frst5seconds) Unsteady(sway/stagger/feetmove)=o;Steady,w/ support=1;Steady w/osupport=2 | | | | STANDINGBALANCE Unsteady=0;Steady,stance>4-inchBOS8requires support =1; Narrowstance,w/o support=2 | | | | STERNALNUDGE(feetclose together) Begins to fall =0;Staggers,grabs, catches self =1; Steady =2 | | | | EYESCLOSED(feetclosetogether) Unsteady =0; Steady =1 | | | | TURNING360DEGREES Discontinuous steps=o;Continuous steps=1 | | | | TURNING360DEGREES Unsteady (staggers, grabs) =0; Steady =1 | | | | SITTINGDOWN Unsafe(misjudges distance,falls)=o;Uses arms,ornota smooth motion=1; | | COMMENTS | | Safe,smoothmotion=2 | | | | BALANCESCORETOTAL | /16 | | | GAITINITATION(immediateaftertold"go) Any hesitancy,multiple attempts to start =o;No hesitancy =1 STEPLENGTH | | | | Rswingfoot passesLstanceleg=1;Lswingfoot passesR=1 | | |

| FOOTCLEARANCE Rfootcompletelyclearsfloor=1;Lfootcompletelyclearsfloor=1 | | |-------------------------------------------------------------------------------------------------------------------------|-----| | STEPSYMMETRY R and L step length unequal =o; R and L step length equal=1 | | | STEPCONTINUITY Stop/discontinuitybetweensteps=o;Stepsappearcontinuous=1 | | | PATH(excursion) Markeddeviation=o;Mild/moderatedeviationoruseofaid=1; Straightwithoutdevice=2 | | | TRUNK Markedswayorusesdevice=o;Noswaybutkneeor trunkflexionor spread arms whilewalking=1;None of the above deviations=2 | | | BASEOFSUPPORT Heels apart =o; Heels close while walking =1 | | | GAITSCORETOTAL | /12 | | ASSISTIVEDEVICE | | | TOTALSCORE(BALANCE+GAIT) FALLRISK(minimal>23,Mod.19-23,High/Severe<19) | /28 | | Therapistinitials | |

Table 24.Lower Extremity Functional Scale(LEFS)

| Activities | Activities | Extreme difficulties or unable to perform an Activity | Quitea bit of difficulty | Moderate difficulty | A little bit of difficulty | No difficulty | |--------------|---------------------------------------------------|---------------------------------------------------------|----------------------------|-----------------------|------------------------------|-----------------| | a. | Anyofyourusual work, homeworkorschool activities | 0 | 1 | 2 | 3 | 4 | | b. | Yourusualhobbies recreational,orschool activities | 0 | 1 | 2 | 3 | 4 | | C. | Gettingintooroutofthe bath | 0 | 1 | 2 | 3 | 4 | | d. | Walkinginbetweenrooms | 0 | 1 | 2 | 了 | 4 | | e. | Putting on your shoes or sock | 0 | 1 | 2 | 3 | 4 | | f. | Squatting | 0 | | 2 | 3 | 4 | | g. | Liftinganobject like abag ofgroceriesfromthefloor | 0 | 1 | 2 | 了 | 4 | | h. | Performinglightactivities aroundyourhome | 0 | 1 | 2 | 3 | 4 | | i. | Performingheavyactivities aroundyourhome | 0 | 1 | 2 | 3 | 4 | | j. | Gettingintooroutofacar | 0 | 1 | 2 | 了 | 4 | | k. | Wallkingtwoblocks | 0 | 1 | 2 | 了 | 4 | | L. | Walkingamile | 0 | 1 | 2 | 了 | 4 | | m. | Goingupordown10stairs | 0 | 1 | 2 | 了 | 4 | | n. | Standingforonehour | 0 | 1 | 2 | 了 | 4 | | 0. | Sittingforonehour | 0 | 1 | 2 | 了 | 4 | | p. | Runningon evenground | 0 | 1 | 2 | 了 | 4 | | Q | Running on uneven ground | 0 | 1 | 2 | 3 | 4 | | r. | Makingsharpturnswhile runningfast | 0 | 1 | 2 | 3 | 4 | | s. | Hopping | 0 | 1 | 2 | 3 | 4 | | t. | Rollingoverinbed | 0 | 1 | 2 | 3 | 4 | | ColumnTotals | ColumnTotals | | | | | |

Thepatient'sscoreistalliedatthebottomof thepage.Themaximumpossiblescoreis80points,indicatingveryhighfunction TheminimumpossiblescoreisOpoints,indicatingvery lowfunction.

1.Disability Rating; This will be final depending on impairment or loss of body part and functional limitation in theperson's environment.

Thosewithdisabilityratingover25%willbeeligibleforregistration

.0NO impairment(none,absent,negligible,)

0-4%

.1MILD impairment (slight, low,)

5 - 24 %

.2MODERATEimpairment(medium,fair)

25 - 49 %

.3SEVEREimpairment(high,extreme,)

50 -95%

.4 COMPLETE impairment (total)

96- 100%

3.8.4.Interpretation of Examination Reports.

Differentexaminers,atdifferenttimes,willnotdescribethesamedisabilityinthesamelanguage.Featuresofthedisability whichmusthavepersistedunchanged,maybeoverlookedorachangeforthebetterorworsemaynotbeaccuratelyappreciated ordescribed.Itistheresponsibilityoftheratingspecialisttointerpretreportsofexaminationinthelightof theholisticrecorded history,reconcilingthevariousreportsintoaconsistentpicturesothatthecurrentratingmayaccuratelyreflecttheelements sufficientdetail,itisincumbentupontheratingboardtoreturnthereportasinadequateforevaluationpurposes.

3.8.5. Total Disability Rating

Totaldisabilitywillbeconsideredtoexistwhenthereispresentanyimpairmentof mindorof bodywhichissufficienttorender it impossiblefortheaveragepersontofollowasubstantiallygainful occupation;Provided,thatpermanenttotal disability shall betakentoexistwhentheimpairmentisreasonablycertaintocontinuethroughoutthelifeof theperson.Thefollowingwill beconsideredpermanenttotaldisability:thepermanentlossoftheuseofbothhands,orofbothfeet,orofonehandandone foot,orof thesightofbotheyes,andbecomingpermanentlyhelplessorpermanentlybedridden.Othertotal disabilityratings arescheduledinthevariousbodilysystemsofthisratingschedule.

3.9.DISABILITYCATEGORY:MAXILLOFACILALDISABILITIES 3.9.1.Head and NeckRegion(ICF Classification-S710) Definition:

Theseareconditionsrelatedtotheoral,dentalandmaxillofacialstructures;leadingtopermanentconsiderablelossoffunction

Thesedisabilities arecharacterizedbyorofacialpain,infection,orpathologicalconditionand/orlackoffunctional dentition aoffectingnutritionalintake,growthanddevelopment,orparticipationinlifeactivities.

3.9.2. Classifications or Categories Within Maxillofacilal Disability Category Classifications or Categories

Impairments affecting:

1)The teeth
2) Jaws
3)Temporomandibularjoints
4)Nerves
5) Soft tissues
6)SalivaryGlands

3.9.2.1.Definitions Impairments affecting teeth

Congenitallack of growth of teethon one orboth jaws.

Impairments affectingJaws

Lossofbothoronejaw,partialorcompletecausedbytrauma,infectionormalignancy/tumourorcongenitalanomalyOR totalresorptionof thejawsthatdoesnotallowprostheticrehabilitationORabnormalgrowthofeitherorbothjaws.

Impairments affecting theTemporo-mandibular Joint(TMJ)

TMJ ankylosisonbothsidesand onesidepartialorcompletecaused by trauma,infection,tumourorcongenitalanomaly

Impairments affecting nerves

Bell'spalsyoranyothernerveimpairmentaffectingeitheroneorbothsidesof thefacecausedbyinfection,trauma,tumour, iatrogenicoridiopathyORabnormalmovementofmusclesof thefaceormouth

Facial pains and syndrome

neuralgia,ora groupof nerves or of neurological origin.This should be considereda disability with the following facts inmind (thatpaincancausedisability,thatpainisvery subjectiveand hencea compressivereportfromtheattendingmedical/dental professional iscrucial,thattheremustbeprovethatthepainisnotamenabletoallavailableinterventionsandthateffecton functionalityshould bedemonstrated).

Impairmentsof thesofttissuesandorgans

malignancy/tumoursorcongenitallymissing.

Xerostomia

malignancy/tumour or of unknown origin.

Cleftlip andpalate

Congenitalcleftslipsand/orpalatebilateralandunilateral

3.9.3.Part2:MedicalAssessment

IIMPAIRMENTSOfBODYFUNCTIONS

BodyFunctionsarethephysiologicalfunctionsof bodysystems Impairmentsareproblemsinbodyfunctionasasignificantdeviationorloss.

3.9.3.1.Functionsrelating directly to theDental,Oral and Maxillofacial Disabilities

b510Ingestionfunctions

Functionsrelated to takingin and manipulatingsolids orliquidsthroughthe mouth intothebody. Inclusions:functionsof suckingchewingand bitingmanipulatingfood inthemouth,salvation,swallowing.

b5100 Sucking

Functionsof drawing into themouthby a suctionforce producedbymovements of the checks,lips and tongue.

b5101 Biting

Functions of cutting into,piercing or tearing off food with the front teeth.

b5102 Chewing

Functionof crushinggrinding and masticatingfoodwith thebackteeth(e.g.,molars)

b5103Manipulationoffoodin themouth

Functions of movingfood around themouthwith theteeth and tongue.

b5104Salivation

Function of productionof saliva within themouth

b5105 Swallowing

Functionsof clearingthefood and drinkthroughthe oralcavity.pharynxand oesophagusintothestomachat an appropriate rate and speed.

b5106QualityofSpeech

Functionrelatedtospeechandverbalcommunication

Inclusions: oral, pharyngeal dysphagia: impairments in esophageal passage of food.

3.7.2.1:Additional sensory functions

B250 Tastefunction

Sensory functions of sensing qualities of bitterness,sweetness,sourness and saltiness. Inclusions:gustatoryfunctions:impairmentssuchasageusiaand hypogeusia

B280Sensationofpain

Sensationof unpleasantfeelingsindicatingpotentialoractualdamagetosomebodystructure.

Inclusions:sensationsfgeneralizedorlocalizedpain,inoneormorebodypart,painindermatome,tabbingpain,burning pain,dullpain,achingpain:impairments such as myalgia,analgesia and hyperalgesia.

B 2801Pain inbody part

Sensationofunpleasantfeelingindicatingpotentialoractual damagetosomebodypartstructurefeltinaspecificpart,or parts, of the body.

First Qualifier: Extent of impairments

oNo impairment means the person has no problem
1 Mild impairment means a problem that is present less than 25% of the time, with an intensity s
2Moderateimpairment means thata problem ispresent less than5o%of the time,with an intensity which interferes in day-to-day life and which happens occasionally over the last 30 days
3Severe impairment meansthata problem ispresent more than5o%of the time,with an intensitywhichpartially disruptsday to day life andwhichhappensfrequently overthelast30 days
4Complete impairment means that a problem is present over 95% of the time, with an intensity that totally disrupts day to day life and happens every day over the last 30 days.
8 Not specified means there is insufficientinformation to specify the severity of theimpairment
9 Not applicable means it is inappropriate

FUNCTIONS RELATINGDIRECTLY TO THE DENTAL,ORALAND MAXILLOFACIALDISABILITIES

| Body Function | Body Function | Qualifier | Qualifier | Qualifier | Qualifier | | | | |-----------------|----------------------------------|-------------|-------------|-------------|-------------|----|----|----| | b250 | Taste | 0 | 1 | 2 | 3 | 4 | 8 | 9 | | b5100 | Sucking | 0 | 1 | 2 | 3 | 4 | 8 | 9 | | b5101 | Biting(front teeth) | 0 | 1 | | 3 | 4 | 8 | 9 | | b5102 | Chewing(backteeth) | 0 | 1 | 2 | 3 | 4 | 8 | 9 | | b5103 | Manipulation of food in themouth | 0 | 1 | 2 | 3 | 4 | 8 | 9 | | | b5104Salivation | | 1 | 2 | 3 | 4 | 8 | 9 | | | b5105 Swallowing | 0 | 1 | 2 | 3 | | 8 | 9 | | b5106 | Quality ofSpeech | | 1 | 2 | 3 | 4 | | 9 |

Table 25: Categorization ofDental,Oral and MaxillofacialDisabilities

| Category of Impairment | Classification | Functions | Level of disability | |----------------------------------------|-------------------------------------------|---------------------------------------------------------|-----------------------------| | | | lost | Qualifier | | 2.1Impairmentsofteeth | Total anodontia | Biting, chewing, Food manipulation, swallowing, speech. | Complete impairment | | 2.2ImpairmentofJaws | Loss/ Missingof jaws | Biting, chewing, Food manipulation, swallowing, speech. | Severe/ Complete impairment | | 2.2ImpairmentofJaws | Total Jaw Resorption | Biting, chewing, Food manipulation, swallowing. speech. | Severe/Complete impairment | | 2.2ImpairmentofJaws | Micrognathia | Biting, chewing, Food manipulation, swallowing, speech. | Completeimpairment | | 2.2ImpairmentofJaws | Macrognathia | Biting, chewing, Food manipulation, swallowing, speech. | UnilateralorBilateral | | 2.3ImpairmentofTemporomandibular Joint | Trismus | Biting, chewing, Food manipulation, swallowing, speech. | Severe/ Complete impairment | | | Temporal- Mandibular Joint(TMJ) Ankylosis | Biting, chewing, Food manipulation, swallowing, speech. | Unilateral orbilateral |

| 2.4Impairments affecting nerves | Bell'sPalsy andother motornerve defects | Biting, chewing, Food manipulation, swallowing, Speech, Facial expressions, Eye closure | UnilateralorBilateral | |-------------------------------------------|----------------------------------------------------------------|-------------------------------------------------------------------------------------------|--------------------------------------------| | 2.5 Facial pains and Facial pain syndrome | Facialpain syndromes | Chewing, Facial expression, Oral hygiene | Severe pain | | 2.5 Facial pains and Facial pain syndrome | Ageusia | Taste | Completeimpairment | | 2.6Impairmentsofthesofttissuesand organs | Loss/ Missing soft tissuese.g.. Tongue, Facial muscles, cheeks | Lost tissue | Severe/Complete impairment | | 2.7Salivaryglands disorders | Salivary glands disorders | Food manipulation, swallowing, speech. | Completeimpairment | | 2.8CleftLip and Palate | Cleft lip and palate | chewing, Food manipulation, swallowing, Speech, Drinking Suckling | Unilateralor bilateral Partial or complete |

Table26:Structural Medical Assessment

| Impairment | Condition | What should be assessed | Measurable variables | Assessment procedure and documentation | |-----------------------------|-------------------------------------------|---------------------------|------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | 3.1 Impairments ofteeth | Total anodontia | Teeth | Lackofteeth | 1.Observemouth-total lackofteeth as compared to the client's age 2.Listen to speech-difficulty in speech | | 3.2 Impairment ofJaws | Loss/ Missing of jaws | Jaws | Lack of jaws | 1.Observe face-Missingjaw 2.Listen to Speech-difficulty in speech 3. Palpate the affected area - missing | | | Total Jaw Resorption | Jaws | Resorbed jaw | 1.Observeface-poorly defined jaw 2.Listen to Speech-Difficulty in speech | | | MicrognathiaLower Jaw | | Small lowerjaw | 1.Observeface-small lowerjawas comparedtoupperjaw | | | MacrognathaLowerJaw | | Large lower jaw | 1.Observe face-large jaw as comparedto upperjaw | | 3.3 Impairment of Temporoma | Trismus | TMJ Opening of Jaws | Jawmovement | 1.Observe face-jaw clamping, involuntary muscle movement 2.Listen to speech-Difficulty in speech | | ndibular Joint | Temporal- Mandibular Joint(TMJ) Ankylosis | TMJ | Jointmovement | 3. Palpation for jaw movement 4. Assess degree of jaw opening 1.Observeface-Partial TM]-facial asymmetry 2.Listen to speech-Difficulty in speech 3.Palpation forjaw movement |

| 3.4 Impairments affecting nerves | Bell's Palsy sandother motornerve defects | Face | Facial asymmetry, reduced or absent muscle movement | 1.Observe face-asymmetry, difficultymakingfacialexpressions, inability to blink, facial droop, drooling of saliva, | |------------------------------------------------|----------------------------------------------------------------|-----------------------|---------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------| | 3.5Facial pains and Facial pain syndrome | Facial pain syndromes | Distress | History taking Visual analog scale for pain and Numerical pain assessment scale | 1.Observe-demeanor of thepatient 2.Measure pain levels 3.Numericalpain assessmentbya pain specialist | | | Ageusia | Loss oftaste | Numericaltaste assessment bya taste specialist | | | 3.6 Impairments of the soft tissues and organs | Loss/ Missing soft tissuese.g.. Tongue, Facial muscles, cheeks | Soft tissues | Missing tissue | 1. Observe face, mouth - Missing tissue 2. Listen to Speech -Difficulty in speech | | 3.7 Salivary Glands Disorder | Salivary Glands Disorder | Dry lips, dry tongue, | Dry mouth | 1. Observe face - dry lips 2. Listen to speech -Difficulty in speech 3.Examine mouth-dry tongue | | 3.8 Cleft Lip and Palate | Cleft lip and palate | Mouth | Cleft lip,cleft palate or both | 1.Observe face-cleft lipvisible 2.Listen to speech-Difficultyin speech 3.ExaminemouthforCleftpalate |

Table 27: Criteria for the Decision on Disability Rating

| Condition | Degree of loss | % Loss of Function | |------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------| | Lossof Jaw | Complete-100% | 100% | | Lossof Jaw | Partial->=50% | 100% | | Loss/ Missing soft tissues e.g Tongue,Facialmuscles,cheeks | Complete-100% | 100% | | Loss/ Missing soft tissues e.g Tongue,Facialmuscles,cheeks | Partial->50% | 100% | | TotalJawResorption | Complete -100% | 100% | | Total anodontia | Complete-100% | 100% | | Micrognathia/Macrognathia | Complete-100% | 75% | | Trismus | Teethtoteeth calipermeasureof the widest opening of themouth Mild1(35-26mm), | 75% | | Trismus | Moderatell(25-16mm),SevereIll(15-0 mm). | 100% | | Temporal-Mandibular Joint(TMJ) Ankylosis | Complete - 100% | 100% | | Temporal-Mandibular Joint(TMJ) Ankylosis | Partial-50% | 75% | | Cleft lip and palate | Complete-100% | 100% | | SalivaryGlandDisorder | Complete-100% | 100% | | Bell'sPalsy andothermotornerve defects | Severe-100% | 100% | | Facialpainsyndromes | Acomprehensivereportfromtheattendingofficeris requiredtoestablishthattheproblemcannotbe managed.Lossoffunctionalityshouldalsobe demonstrated. | Acomprehensivereportfromtheattendingofficeris requiredtoestablishthattheproblemcannotbe managed.Lossoffunctionalityshouldalsobe demonstrated. | | Ageusia | Lossoftastecanonlybeadisabilitywhentastingwasthe sourceoflivelihoodforexample,winetasters,coffee | Lossoftastecanonlybeadisabilitywhentastingwasthe sourceoflivelihoodforexample,winetasters,coffee |

3.9.3.Health Professionals/Medical Workers AssessmentTeam Composition

Chairperson:Dentist/Maxillofacialsurgeon
Medicalofficer(onconditiontheclientcomeswithaduly filledassessment formfroma dentist.)
·Dental Technologist
OccupationalTherapist/Physiotherapist/OrthopaedicTechnologist/MedicalSocialWorker NB:A multi-disciplinary approach should behighly considered when theteam decision is inconclusive.

3.9.4.Assessment Tools

1)Caliperformeasuring-Trismus
2)Painscale
3)Muscletone
4)Nervesensation

Implementation, Monitoring and Evaluation

Thismonitoringandevaluationframework,is intended togenerate credible information thatwill guide decision making processes.During assessment and categorization data will be collected for purposes of understanding clients need and hence the effectiveness of assessment exercises,informing thefuture direction ofthe program.suchas:need to expand orrelocatedservices,resourcemobilization,andservice deliverypoliciesandstrategiestobeadaptedamongotherkey programdecisions.

4.1.ImplementationandCompliance

Theseguidelinesare designed to place emphasisontheinter-linkagesbetweenministry atnationalandcounty levels,and regulatorybodies,intheoperationalizationandimplementation.

Toensure complianceforms derived from these disability assessment and categorization guidelines willbeused,to audit andreport the extent of compliancewith thesestandards.Audit reportsissuedby theassessmentcommittee willindicate the extentofdisability,andmayallowtheindependentregulatorto issuecertificatesregardingthedegreeofdisability.

4.2.MonitoringandEvaluation

The Ministry of Health has put in placemechanisms to ensure generation and management of information to guide evidence-baseddecisionmaking,intheprovisionof healthservicesatbothnational andcountylevels.Hencehealthcare providerswill beexpected toreport on information emanatingfromdisabilityassessment exercise.

For thedayto dayrunningof thedisabilityassessment/categorizationguideline,programdata willbeutilizedtounderstand andevaluatingeachstandard.

| Result Area | Performance Indicator | Frequency | Definition | Source of Data | Person Responsible | Point of Use | |-------------------------------------------------------------------------------|----------------------------------------------------------|-------------|------------------------------------------------------------------------------------------------------------------|-------------------------------|--------------------------------------------|--------------------------------------| | Establish thenoof facilities with assessment committees | No.facilities with assessment committees established | Annually | Total numberof health facilities having operational disability assessment committees | County administrative records | County Directorof Health | Nationaland County management teams | | Determine numberof health facilities approvedto conduct disability assessment | Noof facilities approvedto conduct disability assessment | Annually | Determine numberof health facilities approved (using the disability guidelines) to conduct disability assessment | KHIS | Director Generalfor Health | Nationaland County management teams | | Establish thenumber ofclients accessing disability assessment services | Numberof clients accessing assessment services | monthly | Total numberof clients accessing assessment inthe month | OPD Register KHIS | Secretary, Disability Assessment Committee | National and County management teams | | Establish thenumber ofclients with disabilities referredfor further services | No of male cases referred. No of male cases referred. | monthly | Total no.of male cases referred. Total No of male cases referredfor further services. | OPDRegister | Secretary, Disability Assessment Committee | Nationaland County management teams | | Establish occurrence the per disability domain | Percentage of persons with disability perthe domain | monthly | Total no.of the domain caseper | KHIS | Secretary, Disability Assessment Committee | County National and management teams |

DATA COLLECTION

5.0.DataCollection

Themain purpose of data collectionisto understand client needsand therefore effectiveness of the disability assessment and categorizationtorespond to clients'needs efficiently.Data iscollected forpurposesof informing thefuturedirection of thedisabilityassessmentandcategorizationsuchasneedtoexpandorrelocateservices,resourcemobilizationandservice deliverystrategiestobeadopted amongotherkey decisions.Inadditiontoinformingprograms,data also provides credible evidencefortheformulation andguidereviewof related policieswhicharecriticalpillarsof advocacy.Fordayto dayrunning of thedisability assessments,datawillbeutilized to:

1.Understand thenumber of clientsaccessingdisabilityassessmentandreferred for services
Il.Established thedifferentneeds amongpersonswithdisability
Ill.Establishreferraluptakeandcaseoutcomes

1.AmericanPsychiatricAssociation,D.S.,&AmericanPsychiatricAssociation.(2013).Diagnosticand statistical manual ofmentaldisorders:DSM-5.
2.Ministry of Social Justice and Empowerment.(2oo9),Govt.of India.Guidelinesforevaluation of locomotor,visual, hearing,mental retardation and multiple disabilities.Press Information Bureau,Government of India,Ministry of HealthandFamilyWelfare.
3.Rights of thePersons withDisability Act 2016(RPwDAct 2016).Gazette of India(ExtraOrdinary);28December, 2016
4.TheNational Council forPersons withDisabilities(2003).PersonsWithDisabilitiesActNo.14 Of 2003.
5.WHO:WorldHealthOrganization.(2007).Gradesofhearingimpairment.
6.World HealthOrganization.(2007).InternationalClassificationofFunctioning,Disability,andHealth:Children&Youth Version:ICF-CY.WorldHealthOrganization.
7.World report on hearing:Executive summary.Geneva:World Health Organization;2021.License:CC BY-NC-SA3.0IGO.

Annex1A:Visual ImpairmentAssessmentTool

REPUBLICOFKENYA

MINISTRYOFHEALTH

Ref:M0H/276B

ASSESSMENTFORMFORVISUALIMPAIRMENTS

Date:

DD

MM

Name of Health Facility:

Applicant Information forthe purpose of reporting on DisabilityAssessment:

Name:

ID No.

Gender:

Dateof Birth:

DD/MM/YYYY

Occupation:

Phone No.

Age:

Sub-

County:

Marital Status:

NextofKinDetails:

Name:

Relation:

Phone No.

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility Official Stamp | |-------------|--------|-----------|-------------|---------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(l understand thatgivingfalseinformationispunishableby the lawsof Kenya) Note:thecommitteeshouldhaveaminimumofthreeMembers HISTORY

ASSISTIVEDEVICE

MEDICALHISTORY

OCULARHISTORY

Distance Visual

Acuity

RightEye

Left Eye

NearVisionTest

OphthalmicExamination

| Examination | Right Eye | Left Eye | Left Eye | Right Eye | Left Eye | |-----------------|-------------|------------|-----------------|-------------|------------| | Present eyeball | | | Cornea | | | | Squint | | | AnteriorChamber | | | | Nystagmus | | | Iris | | | | Tearing | | | Pupil | | | | Lids | | | Lens | | | | Conjunctiva | | | Fundus | | |

With Correction Without Correction

Specialized Tests

Test

HumphreysVisual Field

ColourVision

Stereopsis

Conclusion

| Category | Tick | Cause of Vision Impairment | Cause of Vision Impairment | Cause of Vision Impairment | |-----------------------|--------|------------------------------|------------------------------|------------------------------| | Normal | | | | | | Mild Impairment | | Percentage Disability | | | | Moderate Impairment | | | | | | SevereImpairment | | Any Possible Intervention | Yes | | | Blind | | | No | | | NearVision Impairment | | Recommendation | | |

[ ] TEMPORARY

[ ] PERMANENT

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

Name..

Date

Signature...

Findings/Defect COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

AnnexI B:Visual AcuityScales Conversions

| Visual acuity scales Conversions | Visual acuity scales Conversions | Visual acuity scales Conversions | Visual acuity scales Conversions | |------------------------------------|------------------------------------|------------------------------------|------------------------------------| | Foot | Metre(6m) | Decimal | LogMAR | | 20/200 | 6/60 | 0.10 | 1.00 | | 20/120 | 6/36 | 0.17 | 0.80 | | 20/80 | 6/24 | 0.25 | 0.60 | | 20/60 | 6/18 | 0.3 | 0.50 | | 20/40 | 6/12 | 0.50 | 0.30 | | 20/30 | 6/9 | 0.7 | 0.20 | | 20/20 | 6/6 | 1.00 | 0.00 |

Annex I C:Visual Functional Assessment; Interaction with The Environment

SF-12 tool-assessinghealthrelatedquality of life amongpeoplelivingwithvisionimpairment(modified)

1.Ingeneral,wouldyousayyourvisionis;

Excellent

[ ] 口1

Very good

[ ] □2

[ ] pooD

[ ] 3

Fair

[ ] 4

Poor

[ ] 5

2.Thefollowingquestions are about activitiesyou might do duringa typical day.Doesyour visionnowlimityouin theseactivities?Ifso,howmuch?

| | No,notlimited at all | Yes,limiteda little | Yes,limiteda lot | |--------------------------------------------------------------------------------------------|------------------------|-----------------------|--------------------| | a.Moderateactivities,such as moving a table,fetching water,washingclothesor carryinga baby | 口1 | 2 | 3 | | b. Climbing a hill | 1 | 2 | 3 |

3.Duringthepast4weeks,howmuchof thetimehaveyouhadanyof thefollowingproblems withyourworkorotherregulardailyactivitiesasaresultofyourvision

Noneofthe

time

□1

口1

Alittleof

thetime

2

□2

Someof

thetime

3

Mostof

thetime

4

Allofthe

time

5

a.Accomplished less

thanyouwouldlike

b.Werelimitedinthe

kindofworkorother

activities?

4.Duringthepast4weeks,howmuchof thetimehaveyou had any of thefollowingproblems withyourworkorotherregulardailyactivitiesasaresultofanyemotionalproblems(suchas feelingdepressedoranxious)?

None of theA littleof

time thetime

口1

□2

[ ] □2

Someof

thetime

3

[ ] 3

Mostofthe

Allofthe

time

4

[ ] □4

time

5

[ ] 5

a)Accomplishedless

thanyouwouldlike

b.Didworkoractivities

lesscarefullythanusual

bothworkoutsidethehomeandhousework)?

Notatall

[ ] 口1

A littlebit

2

Moderately

3

Quite a bit

□4

Extremely

[ ] 5

6.These questions are about how youfeel and how thingshave been withyou during thepast 4weeks.Foreach question,please give the one answer that comes closest to theway you havebeenfeeling.How muchof the time during thepast4weeks.
7.Duringthepast4weeks,howmuchof the timehasyourvisual statusoremotional problems related interfered with your social activities(like visitingfriends,relatives,etc.)?

| | Allofthe time | Mostofthe time | Someof thetime | A littleof thetime | Noneofthe time | |-------------------------------------------|-----------------|-------------------|------------------|----------------------|------------------| | a.Have you felt calm and peaceful? | □1 | □2 | 3 | 4 | 5 | | b.Didyouhavealotof energy? | □1 | 2 | 3 | 4 | 5 | | | Noneofthe time | Alittleof thetime | Someof thetime | Mostof thetime | Allofthe time | | c.Have you felt downheartedand depressed? | 口1 | □2 | 3 | 4 | □5 |

Noneofthetime

口1

Alittleofthe

time

□2

Someofthe

time

3

Mostofthetime

4

Toscore:addtotalsfromNo1to7where1is1pointand5is5points Allofthetime

| Equalorlessthan12 | 13 to28 | 29 to 42 | Greaterthan42 | |---------------------|-----------------|--------------------|-------------------| | Welladapted | Mild Limitation | ModerateLimitation | Severe Limitation |

口5

Annex2.Physical DisabilitiesAssessmentTool

REPUBLICOFKENYA

MINISTRYOFHEALTH

Ref:M0H/276A

ASSESSMENTFORMFORPHYSICALDISABILITIES

Name of Health Facility:

Date:

DD

Applicant Informationfor thepurpose of reportingonDisabilityAssessment:

Name:

Date of Birth:

Age:

County:

NextofKinDetails:

Name:

Occupation:

SubCounty:

Relation:

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility Official Stamp | |-------------|--------|-----------|-------------|---------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(lunderstand thatgivingfalseinformationispunishablebythelawsof Kenya) Note:thecommitteeshouldhaveaminimumofthreeMembers

SUMMARYFINDINGS

BriefMedicalHistory

DateofInjury/Onsetoflllness

DateofLastIntervention

CauseofDisability ID No.

DD/MM/YYYY

MM

YYYY

Gender:

Phone No.

Marital Status:

Phone No.

STRUCTURALIMPAIRMENTS

s7.STRUCTURE:(Tick Region/partbeingassessed that hasIMPAIREMENT)

s710Headandneckregion

s720Shoulderregion

s730Upperextremity(arm,hand)

s740Pelvis

s750Lowerextremity(leg,foot)

s760Trunk

S8.SKINANDRELATEDSTRUCTURESANYOTHERBODYSTRUCTURES

REGION(S)AFFECTED

| | Findings | ScoreVfornatureofimpairments | ScoreVfornatureofimpairments | ScoreVfornatureofimpairments | ScoreVfornatureofimpairments | ScoreVfornatureofimpairments | Remarks | |-----------------------------------------|------------|--------------------------------|--------------------------------|--------------------------------|--------------------------------|--------------------------------|-----------| | Assessment Area | | Impairment | Impairment Mild | Impairment Moderate | Impairment | Impairment Compete | | | MusclePowerofaffected musclegroups | | | | | | | | | Range of motion of joints affected | | | | | | | | | Degreeofstructural angulation/deviation | | | | | | | | | Levelof limbAmputation | | | | | | | | | Bilateral LowerLimbLength | | | | | | | | | Balanceandcoordination | | | | | | | | | OtherPhysicallmpairments (Specify) | | | | | | | | | SCOREFORIMPAIRMENTS | | | | | | | |

FUNCTIONANDPARTICIPATIONRESTRICTIONS

| | Score√ ForNature ofDifficulty | Score√ ForNature ofDifficulty | Score√ ForNature ofDifficulty | Score√ ForNature ofDifficulty | Score√ ForNature ofDifficulty | Remarks | |-----------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|-------------| | Area | Difficulty | Difficulty Mild | Moderate Difficulty | Difficulty Severe | Complete Difficulty | Remarks | | | | | | | | Mobility | | Self-Care | | | | | | | | DomesticLife | | | | | | | | MajorLifeAreas | | | | | | | | Community,Social, | | | | | | CivicLife | | ScoreForFunctionand Participation | | | | | | Restriction |

Disability Rating

No disability

Mild

Moderate

Severe

Complete

CONCLUSION

[ ] TEMPORARY 口

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERREQUIREDSERVICES.

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

Name.

Date

Signature..

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

[ ] PERMANENT

Ref:M0H/276C

ASSESSMENTFORMFORHEARINGIMPAIRMENTS

Name of Health Facility:

Date:

DD

Applicant Informationforthepurpose of reportingon Disability Assessment:

Name:

Date of Birth:

Age:

County:

NextofKinDetails:

Name:

Occupation:

Sub-

County:

Relation:

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility OfficialStamp | |-------------|--------|-----------|-------------|--------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(lunderstandthatgivingfalseinformationispunishablebythelawsofKenya)

Note:thecommitteeshouldhaveaminimumofthreeMembers

ID No.

DD/MM/YYYY

REPUBLICOFKENYA

MINISTRYOFHEALTH

MM

Gender:

Phone No.

Marital Status:

Phone No.

History

History of HearingLoss

HistoryofHearingDevices

Usage

3.0HearingTestResults

Hearing Test

Right Ear

Left Ear

Typeof HearingLoss

Degree(Grade)ofHearing Loss

4.0CalculationofHearingDisability

Ear

Hearing Level in dBHL

Monoaural Percentage of

Overall(Binaural) Percentage of Disability

Disability

Right

Left

CONCLUSION

[ ] TEMPORARY 口

[ ] PERMANENT

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERREQUIREDSERVICES.

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

Name..

Date...

Signature.....

Annex 3B: Assessment Tool for Speech, Language, Communication and Swallowing Disabilities

REPUBLICOFKENYA

MINISTRYOFHEALTH

Ref:M0H/276D

Name of Health Facility:

Date:

DD

ApplicantInformationforthepurposeofreportingonDisabilityAssessment:

Name:

Dateof Birth:

Age:

County:

NextofKinDetails:

Name:

Occupation:

Sub-

County:

Relation:

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility OfficialStamp | |-------------|--------|-----------|-------------|--------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(lunderstand thatgivingfalseinformationispunishablebythelawsofKenya)

Note:thecommitteeshouldhaveaminimumofthreeMembers

Reasonforreferral:

ReferredBy:

MedicalDiagnosis(ifavailable):

ID No.

DD/MM/YYYY

MM

Gender:

Phone No.

Marital Status:

Phone No.

Historyof Condition:

(FillinrelevantBirthHistoryforDevelopmentalDisorderorMedicalHistoryforAcquiredDisorder)

Domainstobeassessed:(pleasetick)

[ ] LANGUAGE

[ ] SPEECH

[ ] DYSPHAGIA

[ ] COMMUNICATION

CompletetheareasbelowforDevelopmentalDisordersonly:(pleasetick)

Delayin MotorMilestones:Yes/ No

SensoryImpairment:

Visual:Yes/No

Other:

Pleaseattachrelevantreports,ifavailable

Speech and Language Milestonesachieved thusfar:

Pre-LinguisticSkills:(please tickif age appropriate or not)

EyeContact:Yes/No

A.LANGUAGEIMPAIRMENTS

Thissectioniscommonforapplicantswith developmental oracquired disorders.Please completebriefly and usefindingsfrom standardized testscored toinformfurther.

| (i).RECEPTIVE LANGUAGE | REMARKS | |--------------------------------------------------------------------------------------------------|-----------| | Attention,Memory | | | Listening,AuditoryProcessing PhonologicalAwareness | | | SyntacticComprehension(no.of informationcarryingwordsthat applicant can understand in1 sentence) | | | SemanticComprehension | | | ReadingComprehension | |

AttentionSpan:Yes/No

[ ] Auditory:Yes / No

Imitation skills:Yes/No

| (ii).EXPRESSIVELANGUAGE | REMARKS | |-------------------------------------|-----------| | Sound,word,sentencelevel production | | | Non-verbal Communication | | | Pragmatics | | | Play/Work | | | Writtenoutput | |

| | Check for: | Remarks | |--------------|---------------------|-----------| | FLUENCY | Stuttering | | | | Cluttering | | | VOICE | Aphonia | | | | Dysphonia | | | ARTICULATION | SpeechSoundDisorder | | | | MotorSpeechDisorder | |

(ii).EXPRESSIVELANGUAGE

REMARKS

Sound,word,sentencelevel

production

Non-verbal Communication

Pragmatics

Play/Work

Writtenoutput

B.SPEECHIMPAIRMENTS

Check for:

Remarks

FLUENCY

Stuttering

Cluttering

VOICE

Aphonia

Dysphonia

ARTICULATION

SpeechSoundDisorder

MotorSpeechDisorder

STANDARDISEDTESTRESULTSANDINTERPRETATION

C.DYSPHAGIA

SLTswho are not dysphagia trainedshould use thechecklist belowtoprovidemore information on applicant'sswallow.If objective swallow assessmentfindingsare available, attachreportandskipthechecklist.

BasicSigns&SymptomsofDysphagia Checklist

ASLTK(AssociationofSpeechandLanguageTherapistsKenya2021)

Pleasecompletechecklistbelowifsuspectingthat applicanthasdysphagia andreferonto dysphagiaspecialistforfurtherassessment,confrmeddiagnosisandmanagement.

[ ] DHistoryofrecurrentchestinfectionswithorwithouthospitalization

[ ] Currentchestinfection that arerelated to difficultiesswallowing

[ ] Dehydration and malnutrition related to difficulties eating & drinking.

[ ] Unintentionalweightlossshortorlongterm.

[ ] Takingalongtimetoeat/drinkasmallamountoffoodorunabletomanageanormal amountoffood/drink.

[ ] Avoidanceofparticularfoodsordrinks.

[ ] Avoidanceofeating/drinkinginsocial situations.

[ ] Distress before/during/after eating and/or drinking.

Pre-oralStageDifficulties:(please tick)

[ ] Difficulty with self- feeding (as appropriate to age).

OralStageDifficulties:(pleasetick)

[ ] Losingfoodor drinkfrom the mouth(oralescape),ageappropriate.

[ ] Restricted oral movements due to neurological/ neuromuscularproblem.

[ ] Food residue in mouth after swallowing.

[ ] Difficulty managing saliva/ drooling.

Pharyngeal StageDifficulties:(please tick)

Blinking,eyebulging,squeezingeyes,tearingup/crying,redeyes,orgrimacingassociated withswallowing.

Coughing, throat clearing during or soon after swallowing.

[ ] Nasal/ oral regurgitationof food/ drinks during/ just after swallowing.

'Wet' or gurgly voice after swallowing.

Esophageal StageDifficulties:(please tick)

[ ] Reflux(heartburn,chest pain,acid) during orafter(up to 30 minutes) swallow.

[ ] Coughingwhen lying down.

[ ] Breathingdifficulties orchokingepisodes,sometimesonsalivaoronno oral intake.

SCORE:Total no.of ticks on all stage:

Please note that personwithdysphagia maypresent with one or more of thesesymptoms.

CONCLUSION

SLT DIAGNosIs:Includeseverity and completeattachedscaletorateimpairment,activity, participation,well-being,anddistress.

Severity(circleasappropriate): Profound

Mild

Moderate

Severe

Impactofdisability onfulfillingPwD'sroles andresponsibilities.

ImpactonCareer

Recommendations:(pleasetickandexpandbelow)

Furthermanagementof speech,language,communication,swallowing disorder.

[ ] Referraltootherprofessionals

[ ] Communicationaids

Cause of disability

Dateofinjury/onsetof illness

Acute

Chronic

Dateoflastintervention

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERREQUIREDSERVICES.

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

Name.

Date

Signature...

Annex 4:Assessment Tool for Mental Health Disorders/ Intellectual Disabilities and AutismSpectrumDisorders

REPUBLICOFKENYA

MINISTRYOFHEALTH

Ref:M0H/276E

Name of Health Facility:

Date:

DD

ApplicantInformationforthepurposeofreportingonDisabilityAssessment:

Name:

Date of Birth:

Age:

County:

NextofKinDetails:

Name:

Occupation:

Sub-

County:

Relation:

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility Official Stamp | |-------------|--------|-----------|-------------|---------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(lunderstand thatgiving falseinformationispunishablebythelawsof Kenya)

Note:thecommitteeshouldhaveaminimumofthreeMembers

BRIEFCLINICALHISTORY(PastandPresentMedical History)

ID No.

DD/MM/YYYY

MM

YYYY

Gender:

Phone No.

Marital Status:

Phone No.

Mental StatusEvaluation

CompletetheAssessmentTool BelowbyScoringAppropriately

Knowshowandwhentofeed,toiletorgroomself

| Feeding | Toileting | Grooming | |----------------------------|---------------------------|----------------------------| | o.o Completely Independent | o.oCompletely Independent | o.o Completely Independent | | 1.0Partial | 1.0Partial | 1.0 Partial | | 2.0Minimal | 2.0Minimal | 2.0Minimal | | 3.o None(Dependent) | 3.0 None(Dependent) | 3.0None(Dependent) |

| Dependence on Others | Dependence on Others | Psychosocial Adaptability | |-------------------------------------------------|-------------------------------------------------------------|---------------------------------------| | Level of Functioning | Level of Functioning | Employability/ Schooling | | Physical &cognitive disability | Physical &cognitive disability | Asfull-time worker,homemaker, student | | 0.0 | Completely Independent | 0.0NotRestricted | | 1.0 | Independentinspecialenvironment | 1.0Selectedjobs,competitive | | 2.0 | MildlyDependent-Limited assistance | 2.0Shelteredworkshop,Non-competitive. | | 3.0 | ModeratelyDependent-moderate assistby Personinhome | 3.0NotEmployable/ notinschool | | 4.0 | MarkedlyDependentAssistancewithallmajor activities,alltimes | | | 5.0 | TotallyDependent | | | Total Disability RatingScore(Sum of all Scores) | Total Disability RatingScore(Sum of all Scores) | = |

Scoring Key:

Conclusion:

DurationofIllness:

Major Cause of Disability:..

LevelofDisability:.

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERREQUIREDSERVICES.

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

Name.

Date

Signature......

Total DR Score

0

1-4

5-8

9-12

13-17

Level of Disability

None

Mild

Moderate

Severe

Very Severe

Ref:M0H/276G

ASSESSMENTFORMFORPROGRESSIVECHRONICDISORDERS

Date:

DD

MM

YYYY

Name of Health Facility:

Applicant Information for the purpose of reporting onDisability Assessment:

Name:

ID No.

Gender:

Date of Birth:

DD/MM/YYYY

Occupation:

Phone No.

Age:

Sub-

County:

Marital Status:

NextofKinDetails:

Name:

Relation:

Phone No.

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility OfficialStamp | |-------------|--------|-----------|-------------|--------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(1understand thatgivingfalseinformationispunishablebythelawsofKenya) Note:thecommitteeshouldhaveaminimumofthreeMembers

REPUBLICOFKENYA

MINISTRYOFHEALTH

SUMMARYFINDINGS

Medical History(brief)

DateofInjury/Onsetofllness

DateofLastIntervention

ListPastandOngoingInterventions

CauseofDisability

STRUCTURALIMPAIRMENTS

REGION(S)AFFECTED

| Assessment Area | ScoreVForNature of Impairments | ScoreVForNature of Impairments | ScoreVForNature of Impairments | ScoreVForNature of Impairments | ScoreVForNature of Impairments | Remarks | |---------------------------------|----------------------------------|----------------------------------|----------------------------------|----------------------------------|----------------------------------|-----------| | Assessment Area | No lmpairment | Mild Impairment | Moderate Impairment | SevereImpairment | CompeteImpairment | Remarks | | Cardiopulmonary/ Cardiovascular | | | | | | | | Respiratory | | | | | | | | Malignancies/ Cancer | | | | | | | | Musculoskeletal | | | | | | | | Neurological | | | | | | | | Gastro- intestinal disorders | | | | | | | | Dermatological | | | | | | |

Hematologic

system

Vascular

conditions

Genito-urinary

Frailty

Other

FUNCTIONANDPARTICIPATIONRESTRICTIONS

| AREA | Score For Nature of Difficulty | Score For Nature of Difficulty | Score For Nature of Difficulty | Score For Nature of Difficulty | Score For Nature of Difficulty | REMARKS | |-----------------------------------------------|----------------------------------|----------------------------------|----------------------------------|----------------------------------|----------------------------------|-----------------| | | Difficulty ON | Diffculty Mild | Moderate Difficulty | Difficulty Severe | Complete Difficulty | REMARKS | | Mobility | | | | | | | | | | | | | | Self-care | | Domesticlife | | | | | | | | | | | | | | Major lifeareas | | Community,social,civiclife | | | | | | | | ScoreForFunction and ParticipationRestriction | | | | | | |

Disability Rating

No disability

Mild

Moderate

Severe

Complete

CONCLUSION

[ ] TEMPORARY

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERSERVICESREQUIRED

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

Name...

Date

Signature...

[ ] PERMANENT

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

Annex 6:AssessmentTool for Maxillofacial Disabilities

REPUBLICOFKENYA

MINISTRYOFHEALTH

Ref:M0H/276F

ASSESSMENTFORMAXILLOFACIALDISABILITIES

Date:

DD

MM

YYYY

Name of Health Facility:

Applicant Informationforthepurposeof reportingonDisabilityAssessment:

Name:

ID No.

Gender:

Date of Birth:

DD/MM/YYYY

Occupation:

Phone No.

Age:

Sub-

County:

Marital Status:

NextofKinDetails:

Name:

Relation:

Phone No.

AssembledMedicalTeamdetails:

| MEMBERS | NAME | REG.NO. | SIGNATURE | HealthFacility OfficialStamp | |-------------|--------|-----------|-------------|--------------------------------| | Chairperson | | | | | | Member | | | | | | Member | | | | | | Member | | | | |

(1understand thatgivingfalseinformationispunishablebythelawsofKenya)

Note:thecommitteeshouldhaveaminimumofthreeMembers

SUMMARYFINDINGS

Medical History

Dental History

Dental Assessment

CONCLUSION

[ ] TEMPORARY

[ ] PERMANENT

RECOMMENDEDASSISTIVEPRODUCT(S).

OTHERSERVICESREQUIRED

VERIFIEDBYTHECOUNTYDIRECTOROFHEALTH

COUNTYDIRECTOROF HEALTHOFFICIALSTAMP

Name

Date

Signature....

Annex 7.ICF Domain Coding-Mental

Table 1: World Health Organization Disability Assessment Schedule 2.0, 36 items over six domains with the corresponding International Classification of Functioning, Disability and Health (ICF)codes

Domain Domain question

ICFcode d55

| | Inthelast30days,howmuchdifficulty 1:Cognition did you have in: | | | |------------|---------------------------------------------------------------------------------|------------------------------------------|--------------------------------------------------| | 1.1 | Concentrating on doing somethingfor10d16Focusingattention;b140Attention minutes | 0 | functions; | | | | d110-d129Purposefulsensoryexperiences | d110-d129Purposefulsensoryexperiences | | 1.2 | Rememberingto doimportant things | b14 4 | Memoryfunctions | | 1.3 | Analysingandfindingsolutionsto problemsinday-to-daylife | | d17Solvingproblems;d130-d159Basic learning | | | Learninganewtask,forexample,learningd155 | Learninganewtask,forexample,learningd155 | Learninganewtask,forexample,learningd155 | | 1.4 | howtogettoa | 1 | Acquiringcomplexskills | | | newplace | | | | 1.5 | Generallyunderstandingwhatpeoplesayo | | d31Communicatingwith-receiving- spoken messages | | 1.6 | Starting andmaintaininga conversation | | d350Startingaconversation;d3501 Sustaininga | | | | conversation | conversation | | 2:Mobility | In thelast30days,howmuchdifficulty didyouhavein: | | | | 2.1 | Standingforlong periodssuch as30 minutes | d415 4 | Maintainingastandingposition | | 2.2 | Standingupfromsittingdown | d410 4 | Standing | | 2.3 | Movingaroundinsideyourhome | d460 0 | Movingaroundwithinthehome | | 2.4 | Getting outofyour home | 2 | d460Movingaroundoutsidethehomeand otherbuildings | | 2.5 | Walkinga longdistancesuchasa kilometre(orequivalent) | d450 1 | Walkinglongdistances | | | Inthelast30days,howmuchdifficulty 3:Self-care did you have in: | | | | | Washing your whole body | | d5101Washingwholebody | | 3.1 | | d54 0 | | | 3.2 | Getting dressed | | Dressing |

3.3

Eating

0 Eating

d510-d650Combinationofmultipleself- careanddomestic

3.4

Staying by yourself for a few days

lifetasks

4:Getting along

Inthelast30days,howmuchdifficulty didyou havein

d73

4.1

Dealing with people you do not know

0 Relatingwithstrangers

d750

4.2

Maintaininga friendship

Informalrelationshipswithfriends

Getting alongwith people who are close toyou

d76 6Familyrelationships;d770Intimate 0 relationships;

4.3

d75

0 Informalsocialrelationships

d750

4.4

Making new friends

0 Informalrelationshipswithfriends;

d720

0 Formingrelationships

d770

4.5

Sexualactivities

2 Sexualrelationships

5:Life

In thelast30days,how muchdiffculty did you have in:

activities

Takingcareof yourhousehold responsibilities

5.1

d6Domesticlife

Doingmostimportanthouseholdtasks

d64Doinghousework;d210Undertakinga 0 single task;

5.2

well

d22

0 Undertakingmultiple tasks

Gettingallthehouseholdworkdonethatd64

Doinghousework;d210 Undertakinga 0 singletask;

5.3

youneeded todo

d22

0 Undertakingmultiple tasks

Getting yourhouseholdwork done as

d64Doinghousework;d210Undertakinga 0 single task;

5.4

quicklyasneeded

d22

0 Undertakingmultipletasks

d85Remunerativeemployment;d830

5.5 Yourday-to-daywork/school

0 Higher education;

d82Vocationaltraining;d820School

5 education

Doing your most important work/school

d85Remunerativeemployment;d830

5.6 taskswell

0 Higher education;

d82Vocational training;d820School

5 education;d210

Undertakingasingletask;d220Undertaking multipletasks

Gettingdonealltheworkthatyouneededd85Remunerativeemployment;d830

5.7 todo

0 Highereducation;

d82Vocational training;d820 School

5 education;d210

Undertakinga singletask;d220Undertaking multipletasks

Gettingyourworkdoneasquicklyas

d85Remunerativeemployment;d830

5.8 needed

0 Highereducation;

d82Vocationaltraining:d820School

5 education;d210

Undertakinga singletask;d220Undertaking multipletasks

6: ParticipationHowmuchofaproblemdoyouhave:

| 6.1 | Joiningin community activities | Community life | |-------|-------------------------------------------------------|--------------------------------| | 6.2 | Becauseofbarriersorhindrancesinthe world | d9Community,socialandciviclife | | 6.3 | Living with dignity | d94 0 Human rights | | 6.4 | Fromtimespentonhealthcondition | Notapplicable(impactquestion) | | 6.5 | Feelingemotionallyaffected | 2 Emotionalfunctions | | 6.6 | Becausehealthisa drainonyourfinanciald870 resources 0 | Personaleconomicresources | | 6.7 | Withyourfamilyfacingdifficultiesdueto yourhealth | Notapplicable(impactquestion) |

d91

Recreationandleisure

aTheWHODAS2.Oalsoincludestwopreliminary sectionsthataskaboutdemographicvariablesand general health.These sections are tobe used if the WHO DAS2.0isused alone,but maybe droppedormodified if WHODAS2.0isusedinconjunctionwithother instrumentsthatalreadycollectsuchinformation.Afinal optionalsection asks about the attributes and impact of identifiedproblems

Annex8.BodyStructuresasPerICFClassification

Chapter1Structuresofthenervoussystem

s110Structureof brain

s120Spinal cord andrelated structures

s130Structure of meninges

s140Structureofsympatheticnervoussystem

s150Structureofparasympatheticnervoussystem

s198Structureof thenervoussystem,otherspecified

s199Structureofthenervoussystem,unspecified

Chapter2Theeye,earandrelatedstructures

s210Structureofeyesocket

s220Structure of eyeball

s230Structuresaroundeye

s240Structureofexternalear

s250Structureofmiddleear

s260Structureofinnerear

s298Eye,earandrelatedstructures,otherspecified

s299Eye,earandrelatedstructures,unspecified

Chapter3Structuresinvolvedinvoiceandspeech

s310Structureofnose

s320Structureofmouth

s330Structure of pharynx

s340Structureof larynx

s398Structuresinvolved invoice andspeech,otherspecified

s399Structuresinvolvedinvoiceandspeech,unspecified

Chapter4Structuresofthecardiovascular,immunologicalandrespiratorysystems

s410Structureofcardiovascularsystem

s420Structureof immunesystem

s430Structureofrespiratorysystem

s498Structuresof thecardiovascular,immunologicalandrespiratory systems,otherspecified

Chapter5Structuresrelatedtothedigestive,metabolicandendocrinesystems

s510 Structure of salivary glands

s520Structureof oesophagus

s530Structure of stomach

s540Structureof intestine

s550 Structure ofpancreas

s560Structureof liver

s570Structureofgallbladderandducts

s580Structureof endocrineglands

s599Structuresrelatedtothedigestive,metabolicandendocrinesystems,unspecified

Chapter6Structuresrelatedtothegenitourinaryandreproductivesystems

s610Structureof urinarysystem

s620Structureofpelvicfloor

s630Structureofreproductivesystem

Chapter7Structuresrelatedtomovement

s710 Structure of head and neck region

s720 Structure of shoulderregion

s730Structure of upperextremity

s740Structure of pelvicregion

s750Structureoflowerextremity

s760 Structure of trunk

s770Additionalmusculoskeletalstructuresrelatedtomovement

s798Structuresrelatedtomovement,otherspecified

s799Structuresrelatedtomovement,unspecified

Chapter8Skin andrelatedstructures

s810Structureof areasof skin

s820Structureof skinglands

s830 Structure of nails

s840Structureofhair

s898Skinandrelatedstructures,otherspecified

s899Skinandrelatedstructures,unspecified

Annex4.BodyFunctions

Chapter1Mentalfunctions Global mental functions(b110-b139)

b110 Consciousnessfunctions

b114 Orientationfunctions

b117Intellectualfunctions

b122Globalpsychosocialfunctions

b125Dispositionsand intra-personalfunctions

b126Temperamentandpersonalityfunctions

b130Energyanddrivefunctions

b134Sleepfunctions

b139Global mental functions,other specified and unspecified

Specificmentalfunctions(b140-b189)

b140 Attentionfunctions

b144Memoryfunctions

b147Psychomotor functions

b152Emotional functions

b156Perceptualfunctions

b160Thought functions

b163Basiccognitivefunctions b164Higher-levelcognitivefunctions b167 Mental functions of language b172Calculationfunctions b176Mentalfunctionof sequencing complexmovements b180Experienceofselfand timefunctions b189Specificmentalfunctions,otherspecifiedandunspecified b198Mentalfunctions,otherspecified b199Mentalfunctions,unspecified

Chapter2Sensoryfunctionsandpain Seeingandrelatedfunctions(b210-b229)

b210Seeingfunctions

b215Functionsof structures adjoining theeye

b220Sensationsassociatedwiththeeyeandadjoiningstructures

b229Seeingandrelatedfunctions,otherspecifiedandunspecified

Hearingandvestibularfunctions(b230-b249)

b230Hearingfunctions

b235Vestibularfunctions

b240Sensationsassociatedwithhearingandvestibularfunction

b249 Hearing and vestibular functions,otherspecified and unspecified

Additionalsensoryfunctions(b250-b279)

b250 Taste function

b255Smellfunction

b260Proprioceptivefunction

b265Touchfunction

b270Sensoryfunctionsrelatedtotemperatureandotherstimuli

b279 Additionalsensoryfunctions,otherspecifiedandunspecified

Pain(b280-b289)

b280 Sensation of pain

b289Sensationofpain,otherspecifiedandunspecified

b298Sensoryfunctionsandpain,otherspecified

b299 Sensory functions and pain,unspecified

Chapter3Voiceandspeechfunctions

b310 Voice functions

b320Articulationfunctions

b330Fluency andrhythm of speechfunctions

b340Alternativevocalizationfunctions

b398Voiceandspeechfunctions,otherspecified

b399Voiceandspeechfunctions,unspecified

Chapter4Functionsof thecardiovascular,haematological,immunological and respiratorysystems

Functionsofthecardiovascularsystem(b410-b429)

b410 Heart functions

b415Bloodvesselfunctions

b420 Blood pressurefunctions

b429Functionsofthecardiovascularsystem,otherspecifiedandunspecified

Functionsofthehaematologicalandimmunologicalsystems(b430-b439)

b430Haematologicalsystemfunctions

b435 Immunological systemfunctions

b439Functionsof thehaematological and immunologicalsystems,otherspecified and unspecified

Functionsof therespiratory system(b440-b449)

b440Respirationfunctions

b445Respiratorymusclefunctions

b449Functionsof therespiratorysystem,otherspecifiedandunspecified

Additionalfunctions andsensationsofthecardiovascularandrespiratory systems (b450-b469)

b450Additionalrespiratoryfunctions

b455Exercisetolerancefunctions

b460Sensationsassociatedwithcardiovascularandrespiratoryfunctions

b469 Additionalfunctions and sensations of the cardiovascularand respiratory

systems,otherspecifiedandunspecified

b498Functionsof thecardiovascular,haematological,immunological and respiratorysystems,otherspecified

Two-levelclassificationICF-CY

b499Functionsof thecardiovascular,haematological,immunologicaland respiratorysystems,unspecified

Chapter5Functionsofthedigestive,metabolicandendocrinesystems Functionsrelatedtothedigestivesystem(b510-b539)

b510 Ingestion functions

b515Digestive functions

b520 Assimilationfunctions

b525Defecationfunctions

b530Weightmaintenancefunctions

b535Sensationsassociatedwiththedigestivesystem

b539Functionsrelatedtothedigestivesystem,otherspecifiedandunspecified

Functionsrelated tometabolismand theendocrinesystem(b540-b569)

b540General metabolicfunctions

b545Water,mineralandelectrolytebalancefunctions

b550Thermoregulatoryfunctions

b555Endocrineglandfunctions

b560Growthmaintenancefunctions

andunspecified

b598Functionsofthedigestive,metabolicandendocrinesystems,otherspecified b599Functionsof thedigestive,metabolicandendocrinesystems,unspecified

Chapter6Genitourinary andreproductivefunctions Urinaryfunctions(b610-b639)

b610 Urinaryexcretory functions b620 Urination functions b630Sensationsassociatedwithurinaryfunctions b639Urinaryfunctions,otherspecifiedandunspecified

Genital andreproductivefunctions(b640-b679)

b640Sexualfunctions

b650Menstruationfunctions

b660Procreationfunctions

b670Sensationsassociatedwith genitalandreproductivefunctions

b679Genitalandreproductivefunctions,otherspecifiedand unspecified

b698Genitourinaryandreproductivefunctions,otherspecified

b699Genitourinary andreproductivefunctions,unspecified

Chapter7Neuromusculoskeletalandmovement-relatedfunctions Functionsofthejointsand bones(b710-b729)

b710Mobility of joint functions

b715Stability of jointfunctions

b720Mobilityofbonefunctions

b729Functionsof thejointsandbones,otherspecified and unspecified

ICF-CYTwo-level classification Musclefunctions(b730-b749)

b730Muscle power functions

b735Muscletonefunctions

b740Muscleendurancefunctions

b749Musclefunctions,otherspecified andunspecified

Movementfunctions(b750-b789)

b750Motorreflexfunctions

b755Involuntarymovementreactionfunctions

b760Controlofvoluntarymovementfunctions

b765Involuntarymovementfunctions

b770Gait patternfunctions

b780Sensationsrelatedtomusclesandmovementfunctions

b789Movementfunctions,otherspecifiedandunspecified

b798Neuromusculoskeletalandmovement-relatedfunctions,otherspecified

b799Neuromusculoskeletalandmovement-relatedfunctions,unspecified

Chapter8Functionsoftheskin andrelatedstructures Functionsofthe skin(b810-b849)

b810Protectivefunctions of the skin

b820Repairfunctionsoftheskin

b830Otherfunctionsof theskin

b840Sensationrelatedtotheskin

b849Functionsof theskin,otherspecifiedandunspecified

Functionsofthehairandnails(b850-b869)

b850Functionsof hair

b860 Functions of nails

b869Functionsof thehairandnails,otherspecifiedandunspecified

b898Functionsof theskinandrelatedstructures,otherspecified

Two-levelclassificationICF-CY

Annex5.ActivitiesandParticipation Chapter1 Learningandapplyingknowledge Purposeful sensory experiences(d110-d129)

d110Watching

d115Listening

d120 Other purposeful sensing

d129Purposefulsensoryexperiences,otherspecifiedandunspecified

Basiclearning(d130-d159)

d130Copying

d131Learningthroughactionswithobjects

d132Acquiringinformation

d133Acquiringlanguage

d134 Acquiring additional language

d135Rehearsing

d137Acquiring concepts

d140Learningtoread

d145Learningtowrite

d150Learningtocalculate

d155 Acquiring skills

d159 Basic learning,otherspecified and unspecified

Applyingknowledge(d160-d179)

d160Focusing attention

d161Directingattention

d163Thinking

d166 Reading

d170Writing

d172Calculating

d175Solving problems

d177Makingdecisions

d179 Applyingknowledge,otherspecifiedand unspecified

d198Learning and applying knowledge,other specified

d199Learningand applyingknowledge,unspecified

Chapter2General tasks anddemands

d210Undertakinga singletask

d220Undertakingmultipletasks

d230 Carrying out daily routine

d240Handlingstressandotherpsychologicaldemands

d250Managingone'sownbehavior

d298Generaltasksanddemands,otherspecified

d299 General tasksand demands,unspecified

Chapter3Communication Communicating-receiving(d310-d329)

d310Communicatingwith-receiving-spokenmessages

d315Communicatingwith-receiving-nonverbalmessages

d320Communicatingwith-receiving-formalsignlanguagemessages

d325Communicatingwith-receiving-writtenmessages

d329 Communicating-receiving,otherspecified and unspecified

Communicating-producing(d330-d349)

d330 Speaking

d331 Pre-talking

d332Singing

d335Producingnonverbalmessages

d340Producingmessagesinformal signlanguage

d345Writingmessages

d349 Communication-producing,other specified and unspecified

Conversation and useofcommunication devices andtechniques(d350-d369)

d350Conversation

d355Discussion

d360Usingcommunicationdevicesandtechniques

d369Conversationanduseofcommunicationdevicesandtechniques,other

specifiedandunspecified

d398Communication,other specified

d399Communication,unspecified

Chapter4Mobility

Changing and maintaining body position (d410-d429)

d410 Changingbasicbodyposition

d415Maintainingabodyposition

d420Transferringoneself

Carrying,movingandhandlingobjects(d430-d449)

d430Liftingandcarryingobjects

d435Movingobjectswithlowerextremities

d440 Fine hand use

d445Handandarm use

d446Finefootuse

d449 Carrying,moving and handling objects,otherspecified and unspecified

Walkingandmoving(d450-d469)

d450Walking

d455Moving around

d460Movingaround indifferentlocations

d465Movingaroundusingequipment

d469Walkingandmoving,otherspecifiedandunspecified

Movingaroundusingtransportation(d470-d489)

d470Usingtransportation

d475Driving

d480Ridinganimalsfortransportation

d489 Moving around using transportation,otherspecified and unspecified

d498Mobilityotherpecified

Chapter5Self-care

d510Washing oneself

d520 Caring for body parts

d530Toileting

d540Dressing

d550 Eating

d560Drinking

d570 Lookingafterone's health

d571Looking afterone's safety

d598Self-care,otherspecified

d599Self-care,unspecified

Chapter6Domesticlife

Acquisitionofnecessities(d610-d629)

d610 Acquiringaplace to live

d620Acquisitionofgoodsandservices

d629Acquisitionofnecessities,otherspecifiedandunspecified

Householdtasks(d630-d649)

d630Preparingmeals

d640Doinghousework

d649Householdtasks,otherspecifiedand unspecified

Caringforhouseholdobjects andassistingothers(d650-d669)

d650 Caringforhouseholdobjects

d660Assistingothers

d669Caringforhousehold objectsandassistingothers,otherspecifiedand

unspecified

d698Domesticlife,otherspecified

d699Domesticlife,unspecified

Chapter7Interpersonal interactions andrelationships Generalinterpersonal interactions(d710-d729)

d710Basicinterpersonalinteractions

d720Complexinterpersonalinteractions

d729General interpersonal interactions,otherspecified andunspecified

Particularinterpersonalrelationships(d730-d779)

d730Relatingwithstrangers

d740Formalrelationships

d750Informalsocialrelationships

d760Familyrelationships

d770Intimaterelationships

d779Particularinterpersonalrelationships,otherspecifiedandunspecified

d798Interpersonalinteractionsandrelationships,otherspecified

d799 Interpersonal interactions and relationships,unspecified

Chapter8Majorlifeareas Education(d810-d839)

d810 Informaleducation d815Preschooleducation d816Preschoollifeandrelatedactivities d820Schooleducation d825Vocational training d830Highereducation d835Schoollifeandrelatedactivities d839Education,otherpecifiedandunspecified

Workandemployment(d840-d859)

d840Apprenticeship(workpreparation)

d845Acquiring,keepingandterminatingajob

d850Remunerativeemployment

d855Non-remunerativeemployment

d859Workandemployment,otherspecifiedandunspecified

Economiclife(d860-d879)

d860Basiceconomictransactions

d865Complexeconomictransactions

d870Economicself-sufficiency

d879Economic life,otherspecified and unspecified

d880Engogement inplay

d898Majorlifeareas,otherspecified

d899Majorlifeareas,unspecified

Chapter9Community,socialandciviclife

d910Communitylife

d920Recreationandleisure

d930Religionandspirituality

d940Humanrights

d950Politicallifeandcitizenship

d998Community,socialandcivic life,otherspecified

d999Community,socialandciviclife,unspecified

Annex6.EnvironmentalFactors

Chapter1Products andtechnology

e110Productsorsubstancesforpersonalconsumption

e115Productsand technology forpersonaluse in daily living

e120Productsand technologyforpersonal indoorand outdoormobilityand transportation

e125Productsand technologyforcommunication

e130Productsand technologyforeducation

e135Productsandtechnologyforemployment

e140Productsandtechnologyforculture,recreationandsport

e145Productsandtechnologyforthepracticeofreligionandspirituality

e160Productsandtechnologyof landdevelopment

e165Assets

e198Productsandtechnology,otherspecified

e199Products and technology,unspecified e210Physicalgeography e215Population e220 Flora and fauna e225Climate e230Naturalevents e235Human-causedevents e240Light e245Time-relatedchanges e250Sound e255Vibration e260Airquality e298Natural environment and human-madechangesto environment,other specified e299 Natural environment and human-made changes to environment,unspecified

Chapter3Supportandrelationships

e310lmmediatefamily

e315Extendedfamily

e320Friends

e325Acquaintances,peers'colleagues,neighborsandcommunitymembers

e330Peopleinpositionsofauthority

e335Peopleinsubordinatepositions

e340Personalcareprovidersandpersonalassistants

e345Strangers

e350Domesticatedanimals

e355Healthprofessionals

e360Otherprofessionals

e398Supportandrelationships,otherspecified

e399Supportandrelationships,unspecified

Chapter4Attitudes

e410Individualattitudesofimmediatefamilymembers

e415Individualattitudesofextendedfamilymembers

e420Individualattitudesoffriends

e425Individualattitudesofacquaintances,peers,colleagues,neighborsand communitymembers

e430Individualattitudesofpeopleinpositionsof authority

e435Individualattitudesofpeopleinsubordinatepositions

e440Individualattitudesofpersonalcareprovidersandpersonal assistants

e445Individualattitudesofstrangers

e450Individualattitudesofhealthprofessionals

e455Individualattitudesofotherprofessionals

e460Societalattitudes

e465Socialnorms,practicesandideologies

e498Attitudes,otherspecified

e499Attitudes,unspecified

Chapter5Services,systemsandpolicies

e515Architectureandconstructionservices,systems andpolicies

e520Openspaceplanningservices,systemsandpolicies

e525Housingservices,systemsandpolicies

e530Utilitiesservices,systemsandpolicies

e535Communicationservices,systemsandpolicies

e540Transportation services,systems andpolicies

e545Civil protection services,systems and policies

e550Legalservices,systemsandpolicies

e555Associationsandorganizationalservices,systemsandpolicies

e560Mediaservices,systemsandpolicies

e565Economicservices,systemsandpolicies

e570Socialsecurityservices,systems andpolicies

e575Generalsocialsupportservices,systemsandpolicies

e580Healthservices,systemsandpolicies

e585Educationandtrainingservices,systemsandpolicies

e590Labourandemploymentservices,systemsandpolicies

e595Politicalservices,systemsandpolicies
e599Services,systemsandpolicies,unspecified

Annex7.Speechand LanguageICFAssessments

PART1a:IMPAIRMENTSofBODYFUNCTIONS

Impairments areproblems in body function as a significant deviation or loss.

FirstQualifier:Extentofimpairments

0.No impairment means theperson has no problem
1.Mild impairment-meansaproblemthat ispresentlessthan25%of thetime,withanintensityapersoncan tolerateand whichhappensrarely overthelast30 days.
2.Moderateimpairment-meansthataproblemthatispresentlessthan5o%ofthetime,withanintensity,whichis s
partiallydisruptingthepersonsdaytodaylifeandwhichhappensfrequentlyoverthelast3odays.
4.Completeimpairment-meansthataproblem thatispresentmorethan95%of thetime,withanintensity,whichis totally disruptingthepersons day today life andwhichhappens every dayover thelast 30 days.
5.Not specified-meansthereisinsufficient information to specifytheseverity of theimpairment.
6.Not applicable-means it is inappropriatetoapply aparticularcode(e.g.,b650Menstruation functions forwoman inpre-menarcheorpost-menopauseage).

ShortListofBodyFunctionsQualifier

b1.MENTALFUNCTIONS

b11oConsciousness

b1140rientation(time,place,person)

b117Intellectual(incl.Retardation,dementia)
b130Energyanddrivefunctions
b134Sleep
b140Attention
b144Memory
b152Emotionalfunctions
b156Perceptual functions
b164Higherlevelcognitivefunctions
b167Language

b2.SENSORYFUNCTIONSANDPAIN

b210Seeing

b230Hearing

b235Vestibular(incl.Balancefunctions)

b280Pain

b3.VOICEANDSPEECHFUNCTIONS

b310Voice

b4.FUNCTIONSOFTHECARDIOVASCULAR,HAEMATOLOGICAL, IMMUNOLOGICALANDRESPIRATORYSYSTEMS

b410Heart b420Bloodpressure b430Haematological(blood) b435lmmunological(allergies,hypersensitivity) b440Respiration(breathing)

b5.FUNCTIONSOFTHEDIGESTIVE,METABOLICANDENDOCRINESYSTEMS

b515Digestive

b525Defecation

b530Weightmaintenance

b555Endocrineglands(hormonal changes)

b6.GENITOURINARYANDREPRODUCTIVEFUNCTIONS

b620Urinationfunctions

| ANNEX9:LISTOFCONTRIBUTORS | ANNEX9:LISTOFCONTRIBUTORS | ANNEX9:LISTOFCONTRIBUTORS | ANNEX9:LISTOFCONTRIBUTORS | |-----------------------------|-----------------------------|----------------------------------------------------------|-----------------------------| | S/NO | NAME | DESIGNATION | INSTITUTION | | 1 | Dr. Julius Ogato | Director,DirectorateofHealthCareServices | MOH | | 2 | Dr. Laban Thiga | FormerDirector,DirectorateofHealthCareServices | MOH | | 3 | Dr.Zeinab Gura | Head,National HealthSystemsStrengthening | MOH | | 4 | Dr.David Soti | Technical Assistant Officeof theDirector General | MOH | | 5 | Dr.Michael Gichangi | ChiefOphthalmologist | MOH | | 6 | AlexKisyanga | Head,RehabilitativeServices/Chief OrthopedicTechnologist | MOH | | 7 | Wilfrida Otieno | FormerHead,RehabilitativeServices/ Chief Physiotherapist | MOH | | 8 | lrene Gichohi | Chief Occupational Therapist | MOH | | 9 | Martha Mmasi | CurrentChiefPhysiotherapist | MOH | | 10 | Dr.Estella Waiguru | Deputy Directorof Medical Services | MOH | | 11 | Dr.PeresWambui | Psychiatrist | MOH | | 12 | Dr.Monicah Bitok | Ophthalmologist | MOH | | 13 | Nicholas Nyamweya | Deputy Chief Occupational Therapist | MOH | | 14 | Titus Kilika | FormerHead of RehabilitationServices | MOH | | 15 | MargaretKiburi | Former ChiefOccupational Therapist | MOH | | 16 | Teresa Ogumbo | Snr.Physiotherapist | MOH | | 17 | Josephine Kaburu | Snr.Physiotherapist | MOH | | 18 | Anne Marimbet | Snr.OrthopedicTechnologist | MOH | | 19 | DouglasKotut | Physiotherapy Council of Kenya | MOH | | 20 | Ida Ombura | Health Standards Officer | MOH | | 21 | PeterO.Ongubo | OrthopaedicTechnologist | MOH | | 22 | FredrickOchieng | Physiotherapist | MOH |

| S/NO | NAME | DESIGNATION | INSTITUTION | |--------|----------------------|--------------------------------------|----------------------------------------| | 23 | Doreen Gatwiri | Orthopedic Technologist | MOH | | 24 | Michael Ochieng | Physiotherapist | MOH | | 25 | Margaret Ong'era | Medical Social Worker | MOH | | 26 | Dr.Carole Okoth | Physician | NSIRH | | 27 | Dr.Catherine Nyabuto | Orthopedic Surgeon | NSIRH | | 28 | Dr.Peter Kihara | Surgeon | NSIRH | | 29 | Christopher Mutinda | Snr.Occupational Therapist | NSIRH | | 30 | Dr. Nicholas Tinega | Surgeon | Mbagathi Hospital | | 31 | Dr.Moses Agunda | Orthopedic Surgeon | Mbagathi Hospital | | 32 | Dr.Peris Wambui | Psychiatrist | Mathari Teaching and Referral Hospital | | 33 | BentaObam | Snr.Occupational Therapist | Mathari Teaching and Referral Hospital | | 34 | Dr.Musa Kipng'or | ENTSpecialist | KNH | | 35 | Dr.Etau Ekwom | Physician Rheumatologist | KNH | | 36 | Dr.Roops Saini | Consultant Dermatologist | KNH | | 37 | John Ondiege | Chief OrthopaedicTechnologist | KNH | | 38 | Celestine Omondi | DeputyChiefOccupationalTherapist | KNH | | 39 | Joseph Kolli | AssistantChiefPhysiotherapist | KNH | | 40 | Nicholas Samora | SpeechTherapist | KNH | | 41 | Florence Nyambura | Occupational Therapist | KNH | | 42 | Serah Ndegwa | Consultant Audiologist | University of Nairobi | | 43 | Paul Aloo | Head,OrthopaedicTechnologyDepartment | KMTC | | 44 | Eunice Ndirangu | Head,OccupationalTherapyDepartment | KMTC | | 45 | Dr.AgnesMithamo | ConsultantPediatrician | Nyeri County Referral Hospital |

| S/NO | NAME | DESIGNATION | INSTITUTION | |--------|--------------------|----------------------------------------|---------------------------------------| | 46 | Dr. Joseph Matheri | Head of Rehabilitation School | JKUAT | | 47 | Dr.Nassib Tawa | Snr.Lecturer | JKUAT | | 48 | Daniel Kariuki | Occupational TherapyProgramCoordinator | JKUAT | | 49 | Nelson Njue | DDHRMD | PublicService Commision | | 50 | Harun Hassan | ExecutiveDirector | NCPWD | | 51 | Cynthia Mosoti | Legal Officer | NCPWD | | 52 | Isaac Rogito | Snr.Disability Service Officer | NCPWD | | 53 | Leonard Dawafula | Snr.Disability Service Officer | NCPWD | | 54 | Phoebe Nyagudi | Director | StateDepartment of Social Protection | | 55 | Jacob Madara | Social Development | State Department of Social Protection | | 56 | Dr.CatherineWambua | Snr.LecturerPhysiotherapySchool | AMREFUniversity | | 57 | Benson Kiptum | Ag.CEO | APDK | | 58 | Raphael Owako | Disability Specialist | CHANF | | 59 | Macharia Njoroge | Representative | UDPK | | 60 | Joash Kamollo | DomestictaxDepartment | KRA | | 61 | Rosemary Kihoto | Deputy Country Director | CHAI | | 62 | Dr Antony Ngatia | Program Director | CHAI | | 63 | Arphaxade Sifuna | Analyst | CHAI |

REPUBLICOFKENYA

MNISTRYOFHEALTH

Nairobi, Kenya: Government of Kenya;

PUBLISHED BY: Ministry of Health Afya House,Cathedral Road PO Box30016Nairobi00100 http://www.health.go.ke

Ministry of Health Kenya. Disability Medical Assessment and Categorization Guidelines, aims at empowering service providers to provide quality, affordable, available, acceptable and accessible services.

DISABILITYMEDICALASSESSMENTAND CATEGORIZATION GUIDELINES

2022

Thispolicyisintended asa guideforthehealthsectoronDisabilityMedicalAssessments&CategorizationinKenya towardstheprovisionofqualityhealthcare

Machine-extracted text (docling) from a scanned document — may contain recognition errors. Original PDF — parliament.go.ke.

← Back to Labour And Social Welfare

Report Of The Standing Committee On Labour And Social Welfare On A Petition To The Senate By Ms. Beatrice Likwop Concerning Pt 2

APPENDIX 7:DISABILITY MEDICAL ASSESSMENTAND CATEGORIZATION GUIDELINES,2022

DISABILITYMEDICAL ASSESSMENT AND CATEGORIZATION GUIDELINES

DISABILITYMEDICALASSESSMENTAND CATEGORIZATIONGUIDELINES

Disclaimer

Recommendedcitation:

TABLEOFCONTENTS

LIST OF TABLES

ACRONYMSANDABBREVIATIONS

WorkingDefinitions

FOREWORD

Acknowledgements

Preface

INTRODUCTION

1.1Background

1.2Situationalanalysis

1.3 Rationale

1.40verallGoal

1.5PurposeoftheGuideline

1.60bjectivesofGuideline

1.7ScopeandApplication

1.8TargetScope

METHODOLOGY

2.0.Introduction 2.1ProcessofDevelopment

2.2 Legal Frame

2.3PrinciplesforDevelopment

2.4Structure of this Document

2.4.1 Development Steps

ORGANIZATIONAL STRUCTURE

3.1.Disability Assessment Committees

3.1.1Introduction

3.1.2 Roles and responsibilities

National Level

CountyLevel

3.1.3ConstitutionoftheCommittees

3.1.4 Criteria of Appointments

3.1.5GovernanceStructure

3.2DisabilityDomains/Categories

3.3.DISABILITYCATEGORY:PHYSICALIMPAIRMENTS

3.3.1.Physicallmpairments

Definition

Table 1: Categories ofPhysical Conditions

VariablesinAssessingPhysical Disability

AreasofAssessment

ACTIVITYLIMITATIONS&amp;PARTICIPATIONRESTRICTION

Levels ofFunctional Limitation/ParticipationRestrictions

Second Qualifier:Capacity(withoutassistance)

3-TierAssessment

Calculating%of availableRangeof Motion(RoM)

For Example;

Example 2-Joint limitation affecting differentmovements

InterpretationofResultsforJointRange

3.3.2.THEEVALUATIONOFPERMANENTPHYSICALIMPAIRMENTOFTRUNK(SPINE)

BasicGuidelines

TraumaticLesions

LumbarandLumbosacralSpine:Fracture

3.3.3.NON-TRAUMATICLESIONS

Scoliosis

MeasurementofSpineDeformity

Torso Imbalance

HeadTiltoverC7spinePPI

CardiopulmonaryTest

b.Countingin one breathe

Pain

CosmeticAppearance:

Leg Length Discrepancy:

KYPHOSIS

MiscellaneousConditions:

3.3.4. The Evaluation of Permanent Physical Impairment in Amputees

BasicGuidelines:

LowerLimbAmputations:

3.3.5.The Evaluation Of Permanent Physical Impairment(Ppi) Of Congenital Deformities Of The Limbs.

TRANSVERSEDEFICIENCIES

3.3.6.Deficiencies

Basic Guidelines

CranialNervesImpairments

MotorsystemDisability

Sensory System Disability

Bladderdisability duetoneurogenicInvolvement

3.3.7.ScoringforPhysical Disabilities

ACTIVITYLIMITATIONS&PARTICIPATIONRESTRICTION

SPEECH&LANGUAGETHERAPY&ASSESSMENTRESOURCES