106 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC.
3(ii)]
40.2. Guidelines for Assessment:
40.2.1. The guidelines used for every single disability shall be used for assessment of each disability of a person having
multiple disability in the first instance.
40.2.2. Subsequently, in order to arrive at the total percentage of multiple disabilities, the combining formula a + b (90-
a), shall be used where 90
“a” will be the higher score and
“b” will be the lower score. However, the maximum total percentage of multiple disabilities shall not
exceed 100%.
For example, if the percentage of hearing disability is 30% and visual disability is 20%, then by applying the
combining formula given above, the total percentage of multiple disabilities will be calculated as follows:-
30 + 20(90-30) = 43%
90
40.2.3 For certifying more than two disabilities, each disability will be evaluated and the degree of disability will be
calculated by the notified Specialists in the area. Based on the score received for each disability, they will be graded
from the most severe to the least severe. The formula:
a + b (90-a)
90
will be successively applied to subsequent disability till the last disability is covered. This calculation is subject to
maximum of 100%.
For example a person may have disabilities 1, 2 and 3, the score for 1 is the highest equal to (a); score for the second is
equal to (b) (second highest); and score for 3 is (c) the lowest score. According to the above formula:
a + b (90-a) = x
90
(score of disability 1 and 2 = x)
This (x) will become (a) for the purpose of calculation of disability 3 which is C.
x + c (90-x) = y
90
(score of disabilities 1, 2 and 3 = y)
Such calculation will continue till the last disability is covered subject to a maximum of 100%.
41. Medical Authority
The certification medical authority for certifying multiple disability shall comprise of the following:-
(a) The Medical Superintendent or Chief Medical Officer or Civil Surgeon or any other equivalent authority as
notified by the State Government – Chairperson
(b) Specialist required for assessing the disabilities as per the requirement of respective guidelines.
Appendix I
[see paragraph 1.2.3(a)]
Muscle strength grading (Medical Research Council- MRC Scale):
Grade Description
0 No contraction of muscle being tested
1 Flicker or trace of contraction of muscle being tested
2 Active contraction of the muscle with gravity eliminated
3 Active contraction of the muscle against gravity
4 Active contraction of the muscle against gravity and resistance
5 Normal strength
¹Hkkx IIµ[k.M 3(ii)º Hkkjr dk jkti=k % vlk/kj.k 107
Appendix II
[see paragraph 1.2.4 (b) and 2.2(b)]
FORM A:
ASSESSMENT PROFORMA FOR UPPER EXTREMITY
Name ___________..Age_______.Sex_____.
Reg. No. ........................................
Diagnosis______.
Address____________
O.P.D________.Deptt_________.
ARM COMPONENT (Total Value 90%)
ARM Component Normal Rt. Lt. Loss Loss Mean Sum Combining %
COMPONENT of of % of % value Rt. Summary
Value Side Side
loss loss Lt. value for
% %
(Degrees) Rt. Rt. component
Rt. Lt. Lt. Lt.
Side Side
Range of
Movement
(Active) Value
90%
Shoulder
Range of
Movement
(Active) Value
90%
Elbow
Range
of
Movement
(Active) Value
90%
Wrist
Muscle 1. Flexion
Strength Value 2. Extension
90% 3. Rotation -
Shoulder Ext
4. Rotation -
Int.
5. Abduction
6. Adduction
108 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
Muscle 1. Flexion
Strength Value 2. Extension
90% 3. Pronation
Elbow 4. Supination
Muscle 1. Dors Flexion
Strength Value 2. Palmar
90% Flexion
Wrist 3. Radial
Deviation
4. Ulnardeviatior
Coordinated 1. Lifting
overhead objects
Activities
remove and
Value 90% placing at the
same place 9%
2. Touching nose
with end of
extremity 9%
3. Eating Indian
Style 9%
4. Combing and
Plaiting 9%
5. Putting on a
shirt/kurta 9%
6. Ablution glass
of water 9%
7. Drinking Glass
of water 9%
8. Buttoning 9%
9 Tie Nara Dhoti
9%
10. Writing 9%
HAND COMPONENT (TOTAL VALUE 90%)
30%
prehension
1. Hand
Component
A.
Opposition
(8%)
B. Lateral
Pinch
(5%)
¹Hkkx IIµ[k.M 3(ii)º Hkkjr dk jkti=k % vlk/kj.k 109
C. Cylindrical
Grasp
D. Spherical
Grasp
E. Hook Grasp
2.
Sensation 30%
Strength 30%
Summary value for upper extremity is calculated from component and hand component values.
Add 10% for dominant extremity.
10% Additional weightage to be given to infection, deformity, malalignment, contracture, cosmetic appearance and
abnormal mobility.
Form B
ASSESSMENT PROFORMA FOR LOWER EXTREMITY
Name ___________..Age_______.Sex_____.
Reg. No. ........................................
Diagnosis______....................................................................................................
Address____________............................................................................................
O.P.D________.Deptt_________.
MOBILITY COMPONENT (Total Value (90%)
Joint Component Normal Rt. Lt. Loss Loss Mean Mean Combining %
Rt. value Rt. Summary
Value Side Side of of %
Lt. value of
Lt.
% % Rt. mobility
component
Rt. Lt. Lt.
Side Side
Range of
Movement
(Active)
HIP
Range of
Movement
(Active)
Knee
Range of
Movement
(Active)
Ankle &
Foot
110 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
Muscles
Strength
HIP
Muscles
Strength
KNEE
Muscles
Strength
ANKLE &
FOOT
STABILITY COMPONENT (Total Value 90%)
Based on CLINICAL METHOD of Evaluation
1. Standing on both legs 10
2. Standing on affected leg 10
3. Walking on plain surface 10
4. Walking on slope 10
5. Climbing Stairs 10
6. Taking turns 10
7. Squatting on floor 10
8. Kneeling 10
9. Sitting Cross leg 10
Total 90
10% is given for complications like (i) Infection (ii) Deformity (iii) Loss of sensation.
Appendix III
[see paragraph 1.2.4(d)]
Average Normal Range (degrees) at different Joints:
Joint Movement Average Normal Range
(degrees)
Shoulder Flexion 0-180
Extension (hyper) 0-50
Abduction 0-180
Adduction 0-50
Medial (Internal) rotation 0-80
Lateral (External) rotation 0-90
Elbow Flexion 0-150
Extension 0
Forearm Pronation 0-80
Supination 0-85
Wrist Flexion 0-80
Extension 0-70
¹Hkkx IIµ[k.M 3(ii)º Hkkjr dk jkti=k % vlk/kj.k 111
Radial deviation 0-20
Ulnar deviation 0-50
Thumb CMC Abduction 0-70
Flexion 0-15
Extension 0-20
Opposition Tip of thumb to base or tip of fifth
digit
Thumb MCP Flexion 0-50
Thumb IP Flexion 0-80
Digits 2-5 Flexion 0-90
MCP
Extension 0-30
PIP Flexion 0-90
DIP Flexion 0-90
Hyperextension 0-10
Joint Movement Average Normal Range (degrees)
Hip Flexion 0-125
Extension (hyper) 0-15
Abduction 0-45
Adduction 0-30
Lateral (External) 0-45
rotation
Medial (Internal) 0-40
rotation
Knee Flexion 0-135
Extension (hyper) 0-10
Ankle Dorsiflexion 0-20
Plantarflexion 0-50
Ankle/Foot Inversion 0-35
Eversion 0-25
Adduction 0-20
Abduction 0-10
MTP joints Flexion 0-30
Extension 0
IP joints of Flexion 0-50
toes
Extension 0
Thoracolumbar Flexion 0-100 (Thoracic = 40, Lumbar = 60)
spine (Back)
Extension 0-60 (Thoracic = 25, Lumbar = 35)
112 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
Lateral flexion 0-30 (Thoracic and Lumbar are almost
equal)
Rotation 0-45 (on either side, left and right)
Neck Flexion 0-50
Extension 0-60
Lateral bending 0-45
Rotation 0-80
Appendix IV
[see paragraph 23.3 and 25.2]
Indian Disability Evaluation and Assessment Scale (IDEAS)
Indian Disability Evaluation and Assessment Scale (IDEAS) is a scale for measuring and quantifying disability in mental
disorders, to be used for assessment of disability related to mental illness, as given below.
Items -
I. Self Care: Includes taking care of body hygiene, grooming, health including bathing, toileting, and dressing, eating,
and taking care of one's health.
II. Interpersonal Activities (Social Relationships): Includes initiating and maintaining interactions with others in
contextual and social appropriate manner.
III. Communication and Understanding: Includes communication and conversation with others by producing and
comprehending spoken/written/non-verbal messages.
IV. Work: Three areas are Employment/Housework/ Education Measures on any aspect.
1. Performing in Work/Job: Performing in work/employment (paid) employment/self-employment/
family concern or otherwise. Measure ability to perform tasks at employment completely and
efficiently and in proper time. Includes seeking employment.
2. Performing in Housework: Maintaining household including cooking, caring for other people at home,
taking care of belongings etc. Measures ability to take responsibility for and perform household tasks
completely and efficiently and in proper time.
3. Performing in school/college: Measures performance education related tasks.
Scores for each item:
0- NO disability (none, absent, negligible)
1- MILD disability (slight, low)
2- MODERATE disability (medium, fair)
3- SEVERE disability (high, extreme)
4- PROFOUND disability (total cannot do)
TOTAL SCORE : Add scores of the above 4 items (self-care, interpersonal activities, communication and
understanding, and work) and obtain a total score
Weightage for Duration of illness (DOI) :
DOI: < 2 years: score to be added is 1
2-5 years: add 2 .
6-10 years: add 3
> 10 years: add 4
