Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part II of II) - Chapter X I 11. CENTRAL NERVOUS SYSTEM 11.1 GENERAL

MANUAL SINGLE NATIONAL DISABILITY
(PART II OF II)

CHAPTER XI
11. CENTRAL NERVOUS SYSTEM

11.1 GENERAL

Inducement or simulation of signs and symptoms of the patient is critical for the assessment of disability, it tends to mask, magnify or replace real underlying pathologies. Keep in mind that the degree of deficiency in the nervous system is not static so often we are faced with an evolutionary process. In this chapter you should analyze the following:

a) Brain

b) Spinal Cord

c) Cranial Nerves

11.2 Brain

11.2.1 Evaluation criteria for the deficiency of brain pathology.

For purposes of classifying the deficiency of brain pathology, will take into account the following criteria:

1. Sensory and motor disturbances.

2. Alterations in communication.

3. Alterations of complex and integrated functions of the brain.

4. Emotional disturbances.

5. Altered consciousness.

6. Episodic neurological disorders.

There may be more than one type of deficiency manifestations of pathology in the brain. In these cases, various degrees of deficiency are not added or combined, making the largest value of failure to represent the overall deficit.

Example: communication Altered brain damage (aphasia) = 18.0%. Alteration of the complex functions = 8.0%. = 0% emotional disturbance, altered consciousness = 25.0%. The overall deficit would be 25.0% and not 51.0% or 26.9% combined by the combination of values.

11.2.1.1 sensory and motor disturbances.

The muscle disorders, and some deformities secondary to neurologic injury, are reflected in loss of function and are not measured separately. Are rated according to defined criteria for restriction of movement and loss of muscle strength in Chapter I of Book I of this Manual. To evaluate the spasticity will take into account the criteria contained in Table 11.5 as follows: If it's upper extremities, are assigned a value according to the parameters set for "use of upper extremity" and if it is assigned lower extremities a value according to the parameters established for "poise and posture." 

Pain is individual, unmeasurable and variable according to the attention it gets dark. We can only assess the dermatome that point, the limitations it causes, antalgic positions and responses in pursuit of improvement. To get more background on pain should be reviewed in Chapter II, Peripheral Nervous System.

11.2.1.2. Communication Disorders

To qualify for the deficiency of communication disorders, will be considered disturbing the central mechanism of language including comprehension, storage and production thereof, which manifest as aphasia, dysphasia, agraphia, alexia or acalculia. Be considered for purposes of classifying not only the comprehension and understanding of

language of the patient but also the ability to produce a symbolic language intelligible and appropriate.

TABLE No. 11.1. Global DEFICIENCY DISORDERS OF COMMUNICATION.

Deficiency Disorders global communication (%)

You can understand the language and expression, but does so with difficulty. 0.0 - 9.9

You can understand the language but can not speak properly. 10.0 - 24.9

You can not understand the language and therefore is expressed as unintelligible or inappropriate. 25.0 - 44.9 can not understand or use language. 45.0 - 50.0

11.2.1.3. Alterations of complex and integrated functions of the brain These alterations are organic brain syndrome, with defects in orientation, comprehension, memory and behavior, then there are the criteria for assessment of deficiency:

TABLE No. 11.2 DEFICIENCY BY GLOBAL CHANGES OF COMPLEX FUNCTIONS OF THE BRAIN AND INCORPORATED.

Criteria of the whole person impairment (%)

You can perform the tasks of daily living. 1 - 9.9

Need of supervision 10.0 - 24.9

Need confinement 25.0 - 39.9

I could not take care of yourself 40.0 - 50.0

11.2.1.4. Emotional disturbances.

Emotional disturbances were graded according to the criteria set out in Chapter XII.

11.2.1.5. Altered consciousness.

TABLE No. 11.3 DEFICIENCY BY GLOBAL CHANGES OF CONSCIOUSNESS.

Altered consciousness of the whole person impairment (%)

Drowsiness 15.0 - 29.9

Stupor 35.0 - 45.0

50.0 Coma

11.2.1.6. Episodic Neurological Disorders.

These alterations may be mentioned, syncope, epilepsy, catalepsy and narcolepsy. The criteria for assessment of deficiency is given by the frequency and severity of attacks for each case described in the previous paragraphs.

TABLE No. 11.4. NEUROLOGICAL IMPAIRMENT BY GLOBAL Episodes.

Class Description of criteria Global Deficit (%)

I controlled disease treatment or occasional occurrence (1 to 2 episodes per year).

1.0 - 9.9

II disease that causes episodes occurring frequently (more than two episodes per year), despite receiving appropriate treatment and no evidence of sequelae of brain function. 10.0-24.9

III disease that causes the occurrence of frequent episodes (more than two episodes per year), despite receiving appropriate treatment and evidence of sequelae of brain function. 25.0 - 34.9

IV disease that causes episodes occurring more than once per month, despite receiving appropriate treatment and evidence of impairment of brain function. 35.0 - 45.0

Note: For evaluation of neurological deficiency and episodic is important to note that the treatment has been well run and in sufficient doses as specialized concept.

11.2.2. Criteria for the assessment of impairment of skull trauma - Brain Injury (TBI). Deficiency caused by the aftermath of a traumatic brain injury is assessed according to criteria established in paragraph 11.2.

11.2.3. Disorders of movement and posture. Within this group of diseases include disorders that involve disorder of posture and movement such as Parkinson's syndrome, ataxia, dyskinesias, tremor, rigidity and dystonia. In the case of Parkinson's, significant rigidity, bradykinesia or tremor in two extremities alone or in combination, result in a continuous alteration of the movement, gait or posture of the individual. It must prove conclusively that the patient is well-run treatment with sufficient doses and treatment time of not less than six (6) months, to proceed to qualify.

11.2.4. Brain tumors. Will be assessed according to the criteria set out in Chapter VIII.

11.2.5. Brain lesions that cause a deficiency of 40% However the above values, the following describes some neurological damage that cause a deficiency of 40%.

11.2.5.1. Stroke and central nervous system sequelae of head trauma. With one of the following characteristics after three months of the stroke occurred

a) motor or sensory aphasia resulting in ineffective speech or communication;

b) O, significant and persistent disturbance of motor function in two extremities, resulting in an alteration of movement or gait and posture of the individual.

11.2.5.2 Parkinson syndrome.

When involving two or more limbs with impaired movement continues, being treated well run, with the proper dosage and therapy for a while at least six months without improvement.

11.3. SPINAL CORD

In the course of the diseases of the spinal cord, autonomic autonomic disturbance may occur, such as sweating, circulatory phenomena and disorders in the regulation of body temperature and trophic injuries, urinary tract stones, osteoporosis, nutritional disorders and states psychological items, which are valued according to the relevant chapters.

11.3.1 Evaluation criteria for the deficiency of spinal cord pathology. For purposes of assessing impairment due to abnormalities of the spinal cord, is taken into account the following criteria:

1. Poise and posture.

2. Using upper extremities.

3. Breathing.

4. Bladder function.

5. Anorectal function.

6. Sexual function.

There may be more than one type of manifestations of deficiencies by spinal cord pathology in these cases, to determine the overall deficit will be made combination of values.

TABLE No. 11.5 global deficiency disorders Spinal Cord

Criteria of the whole person impairment (%)

Posture and poise:

Stands upright but with difficulty walking 5.0 - 9.9

Stands upright and walks alone on the flat 10.0 - 19.9

Stands upright but can not walk 20.0 - 30.0

Can not stand or walk 50.0 feet

Breathing:

Difficulty with exertion 5.0 - 9.9

You have to limit ambulation 10.0 - 24.9

Has to be in bed 25.0 - 40.0

Has no spontaneous breathing 50.0

Bladder function:

Can not be contained when it urgent 1.0 - 4.9

Reflexes without voluntary control 5.0 - 9.9

Poor reflexes without voluntary control 10.0 - 17.4

No reflection and no voluntary control 17.5-30.0

Anorectal function:

Limited voluntary control 1.0-2.4

Reflex regulation without voluntary control 2.5 - 7.4

Without regulation of reflexes and voluntary control 7.5 - 12.5

Sexual Function:

Mild difficulty 2.5 - 4.9

Reflex function but not seen 5.0 - 7.4

Unable to sexual function 7.5 -10.0

Using upper extremities:

Parent Tip Tip No Extra Both dominant deficiency. Some difficulty in hand and finger dexterity. 1.0 - 4.9 1.0 -2.4 2.5 - 9.9

You do not have in hand and finger dexterity. -14.9 5.0 2.5 - 9.9 10.0 -19.9

It serves only as auxiliary limb. 15.0 -19.9 10.0 -14.9 25.0 - 35.0

It has no functionality. 20.0 - 30.0 15.0 -20.0 40.0

11.3.2. Spinal Cord Injury with a 40% deficiency

The following are diseases of the spinal cord by their severity and complexity are given a 40% deficiency

11.3.2.1 Spinal Cord Injury. Complete spinal section due to any cause.

11.3.2.2 Multiple Sclerosis with:

a) When there is engine damage two or more limbs.

b) Or, visual or mental harm, according to the criteria applied in the chapters on organs of vision or psychiatric disorders.

11.3.2.3. Amyotrophic Lateral Sclerosis with:

a) Evidence of significant bulbar commitment;

b) Or, impaired motor function of two or more limbs.

11.3.2.4. Polio Back to:

a) persistent difficulty swallowing or breathing;

b) Or, slurred speech;

c) O, impaired motor function of two or more limbs.

11.3.2.5. Myasthenia Gravis with:

a) major difficulty speaking, swallowing and breathing despite adequate treatment.

b) major weakness of limb muscles despite being under treatment

properly controlled and properly managed.

11.3.2.6. Muscular dystrophy with:

When there is impairment of motor function of two or more limbs.

11.3.2.7. Tabes Dorsal with:

a) Crisis tabeta that occurs more than once per month;

b) O, or ataxic gait causing significant restriction hesitant motion, verified

by persistent signs of alteration of the posterior columns of the spinal cord.

11.3.2.8. Syringomyelia with:

a) Evidence of significant bulbar disorders;

b) Or, impaired motor function of two or more limbs.

11.4 Cranial Nerves

TABLE No. 11.6: VALUE OF DEFICIENCY FOR CRANIAL NERVE ABNORMALITIES

Criteria global deficiency (%)

I. Olfactory

Unilateral complete loss 0

3.0 bilateral complete loss

II. Optical

Unilateral complete loss 17.0

Bilateral complete loss 50.0

III-IV-VI-oculomotor. Abducens pathetic (alone or in combination)

Diplopia in the highlands of sight. 4.0

Diplopia in the bottom of the field. 9.0

Diplopia on lateral gaze. 7.5

Diplopia in all gaze positions (not compensable and that force to occlude one eye). 11.5

V. Trigeminal

5.0 unilateral complete sensory loss

Complete bilateral sensory loss 17.5

Trigeminal neuralgia typically intractable tic douloureux or 5.0 - 25.0

Atypical facial neuralgia 10.0

Motor lost 2.5 unilateral complete

22.5 Motor complete bilateral loss

VII. -Facial

Complete loss of taste (very rare) 3.0

7.5 Unilateral paralysis

Bilateral paralysis 22.5

VIII. Auditory

Cochlear:

Complete unilateral hearing loss 4.2

Complete bilateral hearing loss 25.0

Buzz 0.0

Vestibular:

Unilateral complete loss 0.0

Bilateral complete loss 1.0-15.0

Vertigo with imbalance

1) Do not interfere with activities 1.0

2) Do not interfere with the activities except those that cause danger to personnel or for other

like driving a car or take a bike 5.0

3) Do not interfere with activities of daily living, need help very activities

simple as caring for oneself, the house, walking down the street or ride in a vehicle

driven by someone else. 15.0

4) It is possible to carry out activities of daily living without assistance other than personal care 25.0

5) It is possible to carry out activities of daily living without assistance other than personal care and home confinement is necessary 35.0

IX - X - XI Glossopharyngeal, Vago or vagus, Espinal. Alterations in one or more of these nerves, which produce deficiency in swallowing and requires:

a) semi-sólidab Diet) Diet 10.0 15.0 liquid

c) tube feeding or gastrostomy. 30.0

Alterations in one or more of these nerves that causes weakness in the speech:

a) You can speak most of the time required 2.0

b) You can tell a lot about many times. 5.0

c) You can talk about some of the time required. 10.0

d) Few can speak many times .. 15.0

e) Can not speak 20.0

XII Hypoglossal

Unilateral paralysis 0.0 While the optic nerves (I) olfactory (II) and ocular motor (III-IV-VI) are mentioned in the chapter on Sense Organs, like the eighth or auditory, for clarity of text values ​​are repeated in this chapter deficiency allowing greater ease in the studies of various pathologies.