The range of motion to be measured is the range of active motion. The medical assessor should be satisfied that the claimant is making an appropriate effort to demonstrate the maximal range and that the measurements are consistent (that is, several repetitions). The normal ranges of motion of individual joints in the musculoskeletal system are set out on the next page.

Peripheral vascular disease affecting lower and upper extremities is assessed under Table 1.4 and Table 1.5 (Chapter 1 ? The Cardiovascular System).

For the purposes of Chapter 9, Activities of Daily Living are those in Figure 9-A.

Figure 9-A: Activities of Daily Living

Activity	Examples
Self care, personal hygiene.	Bathing, grooming, dressing, eating, eliminating.
Communication.	Hearing, speaking, reading, writing, using keyboard.
Physical activity.	Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising.
Sensory function.	Tactile feeling.
Hand functions.	Grasping, holding, pinching, percussive movements, sensory discrimination.
Travel.	Driving or travelling as a passenger.
Sexual function.	Participating in desired sexual activity.
Sleep.	Having a restful sleep pattern.
Social and recreational.	Participating in individual or group activities, sports activities, hobbies.

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Figure 9-B: Tables of normal ranges of motion of joints

Table	Joint	Plane	ROM from	ROM through	ROM to
9.1	Hindfoot/Ankle (subtalar)	Frontal	Eversion 20?	0?	Inversion 30?
9.2	Ankle (talocrural)	Sagittal	Extension 20?	0?	Flexion 40?
9.3	Knee	Sagittal	Extension 0?		Flexion 150?
9.4	Hip	Rotation	External Rotation 50?	0?	Internal Rotation 40?
9.4	Hip	Frontal	Abduction 40?	0?	Adduction 20?
9.4	Hip	Sagittal	Extension 30?	0?	Flexion 100?
9.8.1.a	Thumb ? IP joint		Extension 30?	0?	Flexion 80?
9.8.1.a	Thumb ? MP joint		Extension 40?	0?	Flexion 60?
9.8.1.b	Thumb ? Radial abduction/adduction		15? (full radial adduction)		50? (full radial abduction)
9.8.1.b	Thumb adduction		0 cm		8 cm
9.8.1.b	Thumb opposition		0 cm		8 cm
9.8.1.c	Index and middle fingers ? DIP joint		Extension 30?	0?	Flexion 70?
9.8.1.c	Index and middle fingers ? PIP joint		Extension 30?	0?	Flexion 100?
9.8.1.c	Index and middle fingers ? MP joint		Extension 20?	0?	Flexion 90?
9.8.1.d	Ring and little fingers ? DIP joint		Extension 30?	0?	Flexion 70?
9.8.1.d	Ring and little fingers ? PIP joint		Extension 30?	0?	Flexion 100?
9.8.1.d	Ring and little fingers ? MP joint		Extension 20?	0?	Flexion 90?
9.9.1.a	Wrist	Sagittal	Extension 60?	0?	Flexion 60?
9.9.1.b	Wrist	Frontal	Radial Deviation 20?	0?	Ulnar Deviation 30?
9.10.1.a	Elbow	Sagittal	Extension 0?	0?	Flexion 140?
9.10.1.b	Elbow (forearm)	Rotation	Supination 80?	0?	Pronation 80?
9.11.1.a	Shoulder	Sagittal	Extension 40?	0?	Flexion 180?
9.11.1.b	Shoulder	Rotation	External Rotation 90?	0?	Internal Rotation 90?
9.11.1.c	Shoulder	Frontal	Abduction 180?	0?	Adduction 50?

Part I

The Lower Extremities: Feet and Toes, Ankles, Knees and Hips

Part I ? Introduction

The impairments assessed for each region in the lower extremity are combined to obtain the overall impairment of the lower extremity for the individual extremity, subject to the notes accompanying the applicable tables, or any indication that combination is not permitted.

A WPI rating for one lower extremity may be combined with a WPI rating for the other lower extremity, except in the case of WPI ratings under Table 9.7: Lower Extremity Function, where the notes accompanying Table 9.7 are to be followed.

WPI ratings from Table 9.1: Feet and Toes, Table 9.2: Ankles, Table 9.3: Knees and Table 9.4: Hips must not be combined with a WPI rating under Table 9.7 if they assess the same condition in the same lower extremity.

Where a condition cannot be assessed under one of Tables 9.1, 9.2, 9.3 and 9.4, an assessment may be made under the provisions of the edition of the American Medical Association?s Guides to the Evaluation of Permanent Impairment current at the date of the assessment.

If the medical assessor feels that the impairment is not adequately assessed using one of Tables 9.1, 9.2, 9.3 and 9.4, and the condition does not cause a reduction in the range of motion of a joint but there is significant interference with gait, the medical assessor should consider the effect of the injury on gait and determine the WPI rating using Table 9.7.

If permanent, conditions such as sesamoiditis, plantar fasciitis, plantar tendonitis, and pes planus, should be assessed under Table 9.7.

All ankylosis assessments from Tables 9.1, 9.2, 9.3 and 9.4 are alternative assessments to those for abnormal motion of the individual joints.

The maximum WPI rating for a single lower extremity in Tables 9.1, 9.2, 9.3 and 9.4 is 40%, including combined WPI ratings.

Steps in Calculating Lower Extremity Impairment

Step 1	Add abnormal motion/ankylosis impairment values within an individual joint.
Step 2	Combine abnormal motion/ankylosis impairment values for different joints in the toes.
Step 3	Add impairment values obtained for each individual toe and combine this value with the impairment values for other joints in the foot to obtain the total abnormal motion/ankylosis impairment assessment for a foot.
Step 4	Combine with abnormal motion/ankylosis impairment assessments for different regions in the lower extremity (that is, knee(s), hip(s)).
Step 5	Combine with impairment values for peripheral nerve injuries.
Step 6	Combine with impairment values for amputation.

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9.1 Feet and Toes

Table 9.1 assesses impairments to range of motion of the feet and toes, including ankylosis of one or more joints. The maximum WPI rating under Table 9.1 is 2% for impairment of two or more of the 2^nd, 3^rd, 4^th and 5^th toes of one foot.

In the case of toes, the ankylosis referred to in Table 9.1 is that of the metatarso-phalangeal joint.

Ankylosis of the interphalangeal joints of the 2^nd, 3^rd, 4^th or 5^th toe attracts a WPI rating of 0. The position of function is the neutral position.

Table 9.1: Feet and Toes

% WPI	Criteria (ONE required ? different conditions may be assessed separately)
0	Ankylosis of any one of the 2^nd, 3^rd, 4^th and 5^th toes in position of function.
1	Interphalangeal flexion of the 1^st toe restricted to less than 20? . Metatarso-phalangeal extension of the 1^st toe restricted to a range of 15? -30? . Metatarso-phalangeal extension of any one of the 2^nd, 3^rd, 4^th and 5^th toes restricted to less than 10? . Subtalar inversion restricted to a range of 10? -20? . Subtalar eversion restricted to less than 10? .
	Ankylosis of: any one of the 2^nd, 3^rd, 4^th and 5^th toes in full extension or full flexion; any two of the 2nd, 3rd, 4th and 5th toes in position of function; the 2^nd, 3^rd and 4^th toes in position of function.
	Metatarso-phalangeal extension of the 1^st toe restricted to less than 15? . Metatarso-phalangeal extension of any two of the 2^nd, 3^rd, 4^th and 5^th toes restricted to less than 10? Subtalar inversion restricted to less than 10? .
2	Ankylosis of: any two of the 2^nd, 3^rd and 4^th toes, plus the 5^th toe, in position of function; any two of the 2^nd, 3^rd, 4^th and 5^th toes in full extension or full flexion; all four of the 2^nd, 3^rd, 4^th and 5^th toes in position of function; the 2^nd toe with any two of the 3^rd, 4^th and 5^th toes in full extension; the 3^rd, 4^th and 5^th toes in full extension or full flexion; the 2^nd and 3^rd toes with either of the 4^th or 5^th toes in full flexion.
3	Ankylosis of: all four of the 2^nd, 3^rd, 4^th and 5^th toes in full flexion or full extension; the 2^nd toe with the 4^th and 5^th toes in full flexion.
4	Ankylosis of: the 1st toe in position of function or full extension; the 1st toe with any one of the 2^nd, 3^rd, 4^th or 5^th toes in position of function.
5	Ankylosis of: the 1st toe in full flexion; the 1st toe with any one of the 2^nd, 3^rd, 4^th and 5^th toes in full extension; the 1st toe with any two or three of the 2^nd, 3^rd, 4^th and 5^th toes in position of function.
6	Ankylosis of: the 1st toe with any two or three of the 2^nd, 3^rd, 4^th and 5^th toes in full extension; the 1st toe with all four of the 2^nd, 3^rd, 4^th and 5^th toes in position of function; the 1st toe with any one of the 2^nd, 3^rd, 4^th or 5^th toes in full flexion.
7	Ankylosis of: the 1st toe with any two of the 2^nd, 3^rd, 4^th and 5^th toes in full flexion; the 1st toe with all four of the 2^nd, 3^rd, 4^th and 5^th toes in full extension.
8	Ankylosis of the 1st toe with any three or all four of the 2^nd, 3^rd, 4^th and 5^th toes in full flexion.
10	Ankylosis of hindfoot with tibia-os calcis angle of 100? to 110? .
15	Ankylosis of hindfoot with tibia-os calcis angle of 90? to 95? .
20	Ankylosis of hindfoot with tibia-os calcis angle of less than 90? .

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9.2 Ankles

Table 9.2 assesses impairments to range of motion and deformity of the ankle, as well as ankylosis. Ankle deformity with movement is assessed separately from ankylosis.

Ankylosis in the optimal position is equivalent to a WPI of 4 %. The optimal position is the neutral position without flexion, extension, varus or valgus. This is the base level of ankylosis impairment in the ankle.

When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.2 for ankylosis in each direction. Then add the base figure of 4% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the ankle and hindfoot is 25% WPI. If the total WPI rating obtained by adding different WPI ratings is higher than 25% WPI, then the final WPI rating for the ankle is 25%.

Table 9.2: Ankles

% WPI	Criteria (ONE required ? different conditions may be assessed separately ? but see notes on ankylosis above)
3	Plantar flexion capability restricted to 15? -20? . Dorsiflexion restricted to less than 10? .
4	Ankylosis in optimal position only (see notes).
	Deformity with: varus angulation of 10? ; valgus angulation of 10? -20? .
5	Ankylosis not in optimal position: in less than 10? of internal malrotation; in 15? of external malrotation.
6	Plantar flexion capability restricted to 10? or less. Plantar flexion contracture of 10? -15? .
7	Ankylosis not in optimal position: in 10? to 15? of dorsiflexion or plantar flexion.
	Deformity with varus angulation of 15? -20? .
10	Ankylosis not in optimal position: in varus angulation of 5? ; in valgus angulation of 10? to 15? ; in 10? to 15? of internal malrotation; in 20? to 25? of external malrotation;
12	Plantar flexion contracture of at least 20? .
15	Ankylosis not in optimal position: in 20? to 25? of plantar flexion; in at least 20? of dorsiflexion; in varus angulation of 10? to 15? ; in valgus angulation of 20? to 25? ; in 20? to 25? of internal malrotation; in 30? to 35? of external malrotation.
17	Ankylosis not in optimal position: in varus angulation of 20? to 25? .
20	Deformity with varus angulation of 25? or greater.
21	Ankylosis not in optimal position: in varus angulation of at least 30? ; in at least 30? of plantar flexion; in valgus angulation of at least 30? ; in at least 30? of internal malrotation; in at least 40? of external malrotation.

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9.3 Knees

Table 9.3 assesses impairments to range of motion and deformity of the knee, as well as ankylosis. Knee deformity with movement is assessed separately from ankylosis. ?Deformity? is measured by the femoral-tibial angle: 3? -10? valgus is considered normal.

Ankylosis in the optimal position is equivalent to 27% WPI. The optimal position is 10? -15? of flexion with good alignment. This is the base level of ankylosis impairment in the knee. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.3 for ankylosis in each direction. Then add the base figure of 27% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the knee is 40% WPI. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the knee is 40%.

Table 9.3: Knees

% WPI

Criteria (ONE required ?

different conditions may be assessed separately)

Flexion of 80? -105? .

Flexion contracture of 5? .

Deformity with:

varus angulation of 2? valgus-0? (neutral);
valgus angulation of 10? -12? .

Ankylosis not in optimal position:

in 10? to 15? of internal malrotation;

in 10? to 15? of external malrotation;
in less than 10? of varus;

in 10? to 15? of valgus;

in 20? to 25? of flexion.

Flexion of 60? -75? .

Flexion contracture of 10? -15? .

Deformity with:

varus angulation of 1? -7? ;
valgus angulation of 13? -15? .

Ankylosis not in optimal position:

in 20? to 25? of internal malrotation;
in 20? to 25? of external malrotation;
in 10? to 15? of varus;
in 20? to 25? of valgus;
in 30? to 35? of flexion.

Ankylosis not in optimal position:

in at least 30? of internal malrotation;
in at least 30? of external malrotation;
in at least 20? of varus;
in at least 30? of valgus;
in at least 40? of flexion.

Flexion of 30? -55? .

Flexion contracture of 20? or greater.

Deformity with:

varus angulation of 8? -12? ;
valgus angulation of 16? -20? .

Flexion of less than 30? .

Deformity with:

varus angulation over 12? ;
valgus angulation over 20? .

Ankylosis in optimal position only (see notes above).

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9.4 Hips

Table 9.4 assesses impairments of range of motion and deformity of the hip, as well as ankylosis. Hip deformity with movement is assessed separately from ankylosis.

Ankylosis in the optimal position is 20% WPI. The optimal position is 25? -40? of flexion with neutral rotation, abduction and adduction. This is the base level of ankylosis impairment in the hip. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.4 for ankylosis in each direction. Then add the base figure of 20% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the hip is 40%. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the hip is 40%.

Table 9.4: Hips

% WPI

Criteria (ONE required ?

different conditions may be assessed separately)

Flexion restricted to 80? -100? .

Flexion contracture of 10? -15? .

Internal rotation of 10? -15? .

External rotation of 20? -30? .

Abduction restricted to 15? -25? .

Adduction restricted to 15? or less.

Abduction contracture of 5? or less.

Flexion restricted to 50? -70? .

Flexion contracture of 20? -25? .

Internal rotation restricted to less than 10? .

External rotation restricted to less than 20? .

Abduction restricted to 5? -10? .

Abduction contracture of 6? -10? .

Ankylosis not in optimal position:

in 20? or 40? of flexion;
in 5? of internal rotation;
in 10? -15? of external rotation.

Flexion restricted to less than 50? .

Flexion contracture of 30? or greater.

Abduction restricted to less than 5? .

Abduction contracture of 11? -20? .

Ankylosis not in optimal position:

in 10? or 50? of flexion;
in 10? of internal rotation;
in 20? of external rotation;
in 5? -10? of abduction;
in 5? of adduction.

Abduction contracture of greater than 20? .

Ankylosis not in optimal position:

in 0? or 60? of flexion;
in 20? of internal rotation;
in 30? of external rotation;
in 15? -20? of abduction;
in 10? of adduction.

Ankylosis in optimal position (see notes above).

Ankylosis not in optimal position:

in at least 70? of flexion;
in at least 30? of internal rotation;
in at least 40? of external rotation;
in at least 25? of abduction;
in at least 15? of adduction.

9.5 Lower Extremity Amputations

Table 9.5 is the only table used to assess impairment arising from amputations in the lower extremity.

Table 9.7: Lower Extremity Function must not be used in cases involving amputations.

A WPI rating from Table 9.5 may be combined with other WPI ratings for lower extremity conditions above the amputation site.

Table 9.5: Lower Extremity Amputations

% WPI	Criteria (ONE required ? different conditions may be assessed separately)
0	Amputation through: interphalangeal joint (distal or proximal) of any one of 2nd, 3rd, 4th or 5th toes; any phalanx of any one of the 2nd, 3rd, 4th or 5th toes. Amputation of any portion of soft tissue of any toe.
1	Amputation of any one of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
2	Amputation of: the first toe at the interphalangeal joint; any toe except the first toe through the metatarsal; any two of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
3	Amputation of any three of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
4	Amputation of all four of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
5	Amputation of the first toe at the metatarso-phalangeal joint.
8	Amputation of the first metatarsal (first toe).
10	Amputation of all toes of one foot at the metatarso-phalangeal joints.
16	Transmetatarsal amputation.
18	Midfoot amputation.
25	Syme amputation of hindfoot.
28	Amputation of lower leg more than 7.5cm below knee.
32	Amputation of lower leg 7.5cm or less below knee. Knee disarticulation. Amputation above knee through distal portion of thigh.
36	Amputation above knee through midthigh.
40	Amputation above knee through proximal thigh. Hip disarticulation.
50	Hemipelvectomy.

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9.6 Spinal Nerve Root Impairments and Peripheral Nerve Injuries Affecting the Lower Extremities

Figure 9-C: Grading System

Grading

Sensory Deficits or Pain

Motor Function

Criteria

No sensation;

Severe pain that prevents all activity.

No contraction.

No protective sensibility with abnormal sensations;

Severe pain that prevents most activity.

A flicker.

Decreased protective sensibility with abnormal sensations;

Severe pain that prevents some activity.

Active movement with gravity eliminated.

Diminished light touch AND two-point discrimination with some abnormal sensations;

Slight pain that interferes with some activity.

Active movement against gravity.

Diminished light touch with or without minimal abnormal sensations;

Pain that is forgotten during activity.

Active movement against gravity and resistance.

Normal sensation;

No pain.

Normal power.

9.6.1 Spinal Nerve Root Impairment Affecting the Lower Extremity

Table 9.6.1 is to be used where there is involvement of a single spinal nerve. Where there are multiple nerves involved, the respective WPI ratings for each involved nerve should be combined.

Values obtained for pain, discomfort and/or sensory loss should be combined with values obtained for loss of strength, using the Combined Values Chart (see Appendix 1).

Where the SAME nerve root is assessed, Table 9.6.1 must not be used in conjunction with Table 9.17: Lumbar Spine.

Table 9.6.1: Spinal Nerve Root Impairment Affecting the Lower Extremity

	Impairment Causing Pain, Discomfort and/or Sensory Loss						Impairment Causing Loss of Strength
	Grading						Grading
	5	4	3	2	1	0	5	4	3	2	1	0
Nerve Root	% WPI						% WPI						Nerve Root
L3	0	1	1	2	3	3	0	2	3	5	7	8	L3
L4	0	1	1	2	3	3	0	3	6	8	12	14	L4
L5	0	1	1	2	3	3	0	3	6	9	13	15	L5
S1	0	1	1	2	3	3	0	2	3	5	7	8	S1

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9.6.2 Peripheral Nerve Injuries Affecting the Lower Extremities

WPI ratings obtained for sensory impairment should be combined with WPI ratings for dysaesthesia, and the total combined with WPI ratings for motor impairment, using the Combined Values Chart (see Appendix 1).

Where the SAME nerve is assessed, Table 9.6.2a and Table 9.6.2b must not be used in conjunction with Table 9.17: Lumbar Spine.

Use the grading system shown in Figure 9-C: Grading System.

Table 9.6.2a: Sensory Impairment due to Peripheral Nerve Injuries Affecting the Lower

Extremities

	Sensory Grading						Dysaesthesia Grading
	Sensory Grading						Dysaesthesia Grading
	5	4	3	2	1	0	5	4	3	2	1	0
Nerve	% WPI						% WPI						Nerve
Femoral	0	0	0	1	1	1	0	1	1	2	3	3	Femoral
Lateral femoral cutaneous	0	0	0	1	1	1	0	1	1	2	3	3	Lateral femoral cutaneous
Sciatic	0	1	3	5	6	7	0	1	2	4	5	5	Sciatic
Common peroneal	0	0	1	1	2	2	0	0	1	1	2	2	Common peroneal
Tibial	0	1	2	4	4	5	0	1	1	3	3	3	Tibial
Superficial peroneal	0	0	1	1	2	2	0	0	1	1	2	2	Superficial peroneal
Sural	0	0	0	1	1	1	0	0	1	1	2	2	Sural
Medial plantar	0	0	1	1	2	2	0	0	1	1	2	2	Medial plantar
Lateral plantar	0	0	1	1	2	2	0	0	1	1	2	2	Lateral plantar

Table 9.6.2b: Motor Impairment due to Peripheral Nerve Injuries Affecting the Lower Extremities

	Motor Grading
	5	4	3	2	1	0
Nerve	% WPI
Femoral	0	3	6	9	13	15
Obdurator	0	1	1	2	3	3
Superior gluteal	0	5	10	15	21	25
Inferior gluteal	0	3	6	9	13	15
Sciatic	0	6	12	18	26	30
Common peroneal	0	3	6	9	13	15
Tibial	0	3	6	9	13	15
Medial plantar	0	0	1	1	2	2
Lateral plantar	0	0	1	1	2	2

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9.7 Lower Extremity Function

Table 9.7 should only be used to assess impairment from objectively identified orthopaedic or neurological conditions arising in and affecting the lower extremities. It may not be used to assess impairment from conditions manifesting principally as pain with no clinically demonstrable lower extremity pathology.

A secondary dysfunction consequent to disuse is only assessable under Table 9.7 if this dysfunction is permanent (that is, not likely to improve as a result of surgery, medication or other rehabilitative treatment) and there are objective clinical findings that can be validly assessed using other tables in Chapter 9, Part 1 ? The Lower Extremities.

If permanent, conditions such as sesamoiditis, plantar fasciitis, plantar tendonitis, and pes planus, should be assessed under Table 9.7.

Table 9.7 must not be used in cases involving amputations.

A single assessment only may be made under Table 9.7, irrespective of whether one or two extremities are affected by the injury. The impairment assessed is of overall lower extremity function, rather than that of individual extremities.

Before using Table 9.7 the medical assessor should check the instructions (see Part I ? Introduction) preceding the specific joint impairment tables (Tables 9.1?9.4) and use Table 9.7 strictly in accordance with those instructions.

Where one limb only is affected, regardless of the number of impairments found in that limb, the limb should be assessed using the relevant Tables other than 9.7 and all impairments combined using the Combined Values Table. The combined impairment rating should then be compared to the rating taken from the relevant row in Table 9.7 and the higher rating obtained from the two methods chosen.

Where both limbs are affected, each limb should be assessed using the relevant Tables other than 9.7 and all impairments in both limbs combined using the Combined Values Table. The combined impairment rating should then be compared to the rating taken from the relevant row in Table 9.7 and the higher rating obtained from the two methods chosen.

Table 9.7 may be used to assess lower extremity impairment arising as a result of spinal cord damage. Observe the special procedure set out in the introduction to Part III of this Chapter. However, Table 9.7 is not to be used to assess lower extremity impairment arising as a result of nerve root compression, or other neurological sequelae of other spinal conditions. These should be assessed under:

Table 9.6.1, Table 9.6.2a or Table 9.6.2b (tables dealing with Spinal Nerve Root Impairments and Peripheral Nerve Injuries Affecting the Lower Extremities); or
Table 9.15: Cervical Spine; or
Table 9.16: Thoracic Spine; or
Table 9.17: Lumbar Spine.

To fulfil the requirements of a WPI rating in Table 9.7, there must be one major criterion, and at least two minor criteria, present (where minor criteria are listed).

?Manifest difficulty? is difficulty (such as stumbling, or an altered gait) evident to the medical assessor. The difficulty must be tested clinically: history alone cannot be relied upon in the assessment.

Table 9.7: Lower Extremity Function

% WPI

Major Criteria

(at least one required)

Minor Criteria

(at least two required where listed)

Walks at a normal pace in comparison with peers on level ground or uneven ground and can avoid obstacles;

Distance walked is not restricted by the condition being assessed (although other factors such as the level of fitness may cause restriction).

Walks at a normal pace in comparison with peers on level ground but has manifest difficulty negotiating uneven ground and avoiding obstacles;

Walking is restricted to 1000m or less at a time (may be able to walk further after resting).

Legs give way or lock occasionally without resulting in falls.

Can negotiate three or more stairs or a ramp (up and down) without the use of a walking aid or hand rails.

Walks at a normal pace in comparison with peers on level ground but is unable to negotiate uneven ground without use of a walking aid or personal assistant;

Walking is restricted to 500m or less at a time (may be able to walk further after resting).

Legs give way or lock occasionally without resulting in falls.

Is unable to negotiate three or more stairs or a ramp (up and down) without the use of a walking aid or hand rails.

Walks at a moderately reduced pace in comparison with peers on level ground;

Walking is restricted to 250m or less at a time (may be able to walk further after resting).

Legs give way occasionally resulting in falls.

Is unable to negotiate three or more stairs or a ramp (up and down) without use of rails.

Is unable to rise from sitting to standing position without use of one hand but can stand without support.

Walks at a significantly reduced pace in comparison with peers on level ground;

Walking is restricted to 100m or less at a time (may be able to walk further after resting).

Legs give way frequently resulting in falls.

Demonstrated medical need for a brace or walking aid (walking stick or crutches) on level ground.

Is unable to negotiate three or more stairs or a ramp (up and down) without assistance from someone else.

Is unable to rise from sitting to standing position without use of both hands but can stand without support.

Walks at a greatly reduced pace in comparison with peers on level ground;

Walking is restricted to 50m or less at a time (may be able to walk further after resting).

Is restricted to walking around house and yard.

Demonstrated medical need for a walking aid (walking stick or crutches) when walking on level ground.

Is unable to negotiate three or more stairs or a ramp (up and down) under any circumstances.

Is unable to rise from sitting to standing position without personal assistance and is unable to stand without support.

Walks at a very slow pace in comparison with peers on level ground;

Walking is restricted to 25m or less at a time (may be able to walk further after resting).

Is restricted to walking around house.

Demonstrated medical need for a quad stick or walking frame as support when standing and walking.

Is unable to negotiate any steps or ramps.

Is unable to rise from sitting to standing position without personal assistance and is unable to stand without support.

Can stand with support of personal assistant but is unable to walk.

Unable to stand or walk.