[Federal Register Volume 62, Number 168 (Friday, August 29, 1997)]
[Notices]
[Pages 45908-45916]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22795]
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DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety Administration
[Docket No. 91-33, Notice No. 03]
Functional Capacity Index
AGENCY: National Highway Traffic Safety Administration (NHTSA),
Department of Transportation (DOT).
ACTION: Notice and request for comment on proposed Pediatric Functional
Capacity Index.
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SUMMARY: The National Highway Traffic Safety Administration (NHTSA) is
developing a scale to quantify the consequences of pediatric injuries
received in motor vehicle crashes based on adjusted life-years. This
index is an extension of the basic index described in Docket No. 91-33,
Notice No. 01. The factor used to adjust the injured person's remaining
life-years is called the Functional Capacity Index (FCI). It combines
decrements in each of ten dimensions of functioning into a whole body
score. The development of the definitions of the functional attributes
and their various capacity levels has
[[Page 45909]]
been completed. This notice requests comments on the approach being
taken and on the attribute definitions.
DATES: Comments are requested no later than October 14, 1997.
ADDRESSES: Written comments should refer to the docket and notice
number of this document and should be submitted, (preferably in ten
copies) to: Docket Section, National Highway Traffic Safety
Administration, Room 5109, Nassif Building, 400 Seventh Street S.W.,
Washington, D.C. 20590. (Docket hours are 9:30 a.m. to 4:00 p.m.)
FOR FURTHER INFORMATION CONTACT: Stephen Luchter, Senior Policy
Advisor, Office of Plans and Policy, National Highway Traffic Safety
Administration, 400 7th St. S.W., Washington, D.C. 20590. Telephone
202/366-2576.
SUPPLEMENTARY INFORMATION: NHTSA's mission is to save lives, prevent
injuries, and reduce traffic-related health and other economic costs.
To accomplish this mission efficiently, the agency needs accurate and
reliable methods of quantifying the consequences of injuries to those
who are injured, as well as to their families and society in general.
NHTSA has developed sophisticated methods for quantifying the
economic consequences of deaths and injuries. These have been available
for some time and are widely applied. NHTSA uses these for, among other
things, resource allocation, regulatory analysis, and in support of
state and local programs.
In addition, the agency is developing methods to quantify injury
consequences based on the injured person's functional capacity. An FCI
is being developed for measuring a previously healthy adult's
functional capacity one year post-injury. This notice describes a
program to develop a pediatric version of the FCI and requests comments
on the first phase of this effort, definition of functional attributes.
General Description
The basic assumption of the FCI is that life is its own best
measure of value. If there are things a person cannot do as well
following an injury as before, there is a reduction in their overall
functional capacity. With the functional capacity approach, individuals
of the same age and gender are counted equally. The injury consequences
to young children are not discounted, and the longer average lifespan
of females is accurately reflected.
The FCI is a measure of the relative degree to which an injured
person is unable to function at their pre-injury level on a scale of 0
to 100, where 0 represents no limitation of function and 100 represents
maximum limitation of function. The overall consequences of an injury
are found by multiplying the FCI, as a decimal between 0 and 1.0 by the
injured person's remaining life expectancy. Note that the FCI can vary
with time as the injured person's condition changes. The product of the
FCI and the life expectancy is the number of years of reduced
functional capacity. Any effects of reduced life expectancy as a result
of the injury also can be accounted for.
Attribute and Severity Level Definitions
The work of selecting the attributes to be included in Pediatric
Functional Capacity Index (PFCI), and defining each attribute and each
severity level has been completed. The same attributes were chosen for
the PFCI as for the adult version. The choice was pragmatic, attempting
to have as few as possible yet to have a sufficient number to fully
describe the functioning of a complete human being. In addition, the
effects of childhood development were accounted for by developing
definitions that vary with the child's age.
The number of levels within each attribute were chosen as needed to
reflect observable variation in functional capacity for that attribute
rather than arbitrarily deciding that some number of levels would be
used for all attributes. In some cases, the number of levels differs
from that in the adult FCI. Similarly, age categories required to
differentiate the differences in development as children mature were
also selected as appropriate for each attribute. Each attribute has
levels of functioning ranging from no reduction in functional capacity
to maximum reduction. Definitions were developed for each attribute and
each severity level as well as for appropriate age categories. The
definitions were reviewed and refined based on suggestions made by a
panel of nationally recognized experts in pediatric trauma, as well as
physicians and allied health professionals specializing in pediatric
rehabilitation medicine.
The results are shown in Tables 1 through 10.
Eating (Table 1)--Difficulty eating is characterized by limitations
in the ability to chew and swallow foods. Defined in this manner, the
ability to eat is independent of the ability to hold or use utensils.
Excretory Function (Table 2)--Excretory function is characterized
by control over urinary and fecal elimination.
Sexual Function (Table 3)--This function is determined by physical
capabilities anticipated to occur as an adult; dysfunction due to
psychological reasons is not considered. Note that this attribute is
the only one that does not relate directly to the injured child's
current situation.
Ambulation (Table 4)--Ambulation is characterized by the ability to
(1) stand, walk and run and (2) climb stairs. Limitations are described
in terms of distance, speed, the need for a mechanical device or human
assistance. Limitations may be due to motor impairments, contractures,
pain, loss of equilibrium, reduced sensation or poor cardiopulmonary
function.
Hand and Arm Function (Table 5)--Upper limb function is
characterized by the ability to (1) grasp and manipulate objects, (2)
write, (3) move hand to mouth, (4) move arms over head, and (5)
bilateral skills. Grasping and manipulating is described in terms of
the size of the object. Writing is described in terms of use of a
crayon in age appropriate motions. Hand to mouth movement is described
in terms of number of repetitions and speed. Bilateral skills are
described in terms of manipulating objects. Movement of the upper limbs
may be limited by motor impairment, contracture, pain, or reduced
sensation.
Bending and Lifting (Table 6)--Neuro-musculoskeletal function of
the trunk is characterized by the ability to bend over from a sitting
position and touch hand to foot, and by the ability to lift.
Limitations in bending and lifting may be due to motor impairments,
pain, or loss of equilibrium.
Visual Function (Table 7)--Visual function is characterized by
visual acuity and presence or absence of functional diplopia. The
levels of visual acuity parallel those delineated in the 9th revision
of the International Classification of Diseases (ICD-9).
Auditory Function (Table 8)--Auditory function is described by
degree of difficulty hearing under everyday listening conditions and by
the average of hearing threshold levels at four standard frequencies.
Speech (Table 9)--Limitations of speech include difficulties in
voice production and articulation and in use of age appropriate
vocabulary.
Cognitive Function (Table 10)--Cognitive function is described by
the capacity of the individual to perform age appropriate activities,
demonstrate age appropriate learning memory abilities, and for school
age children having age appropriate academic progress.
Applying the Definitions to the AIS 90 Dictionary
The attribute and severity levels will be applied to each injury
listed in the
[[Page 45910]]
AIS 90 Dictionary by an expert panel based upon their clinical
judgment. These judgements will then be validated by interviewing a
sample of people who experienced the injuries.
Developing a Numerical Scale
The final step in the development of the FCI is to translate the
sets of qualitative statements applicable to each injury into numerical
values. The approach taken for the PFCI follows that of the adult
version. Values are assigned to each severity level within an attribute
on a scale of 0 to 100. Each number on this scale represents a degree
of severity such that 50 is ten degrees higher than 40, 90 is ten
degrees higher than 80 and so forth. The number 0 reflects the lowest
degree of severity (no limitation in functional capacity), and 100
reflects the highest degree of severity (maximum limitation in
functional capacity). The numbers reflect the rater's judgment of the
relative severity of the limitation in terms of its likely impact on
overall function in everyday living. The major aspects of life for
children are intended to include social interaction and major usual
activity such as play, school or for older children, work. A separate
chart is used for each of the attributes. In these charts the end
points are preprinted and the rater places the remaining intermediate
levels of function on the scale such that the relative spacing between
levels reflects their judgments of the expected degree of severity.
Once the within-attribute scaling has been completed, the second
step is to rate the relative weights of the attributes with respect to
each other. This step is more complex than the rating within attributes
because it must consider the possibility that the attributes may not be
completely independent. Also, some combined states are added to assist
in the final step of combining into the whole body factor and to cover
situations not included in the single state listing, for example, total
blindness in one eye and both eyes, profound or total loss of auditory
function in one or both ears, quadriplegia, deaf-blind, and
simultaneously being at the most severe level on all 10 dimensions.
Death is also scaled to provide an anchor point.
In this step, the rater first considers the most severe level for
each of the attributes and identifies which has the greatest impact on
everyday living by placing a mark on a scale of 0 to 100. The rater
then places the remaining most severe states for the remaining nine
attributes on the scale relative to the one judged to have the greatest
impact. Death is scaled next. A scale value greater than 100 is
acceptable. Next, the rater assigns a numerical value to the state
representing the state of being at the most severe of all of the
dimensions, and to some combined states not included in the list of
attributes, such as quadriplegia and deaf-blind. These will be placed
at scale values less than the value assigned to death.
Following these two steps, the values and weights will be
normalized to a 0 to 100 scale with death as 100 and the remaining
states relative to that. These values will then be combined using an
appropriate model.
As part of this work the judgments of parents, teachers, both
special education and mainstream education, and children will be
obtained. In addition, an effort will be made to determine if value
judgements vary with cultural background.
Limitations
Although every attempt has been made to make the PFCI as broadly
applicable as possible, certain limitations are acknowledged. Some of
these are topics that could be considered for further development.
1. With a few exceptions, the index in its present state of
development is applicable to single injuries. Methodologies to estimate
the change in functional capacity resulting from any synergistic
effects of more than one injury, particularly injuries to different
body regions, remain to be developed.
2. Changes in functional capacity from pre-existing conditions are
not included, as this would require knowledge of differences in the
consequences of injuries to different sub-populations. An average
healthy child prior to injury is assumed in the current development.
3. The present effort to develop a PFCI will be limited to the
injury definitions in the 1990 version of the Abbreviated Injury Scale.
Although the International Classification of Disease injury
descriptions are widely used, they generally do not contain sufficient
detail for the agency's countermeasure development purposes.
Comments
NHTSA requests comments on the proposed PFCI. General and detailed
comments on this proposal are welcome in order to benefit from the
opinions that interested parties and the public may wish to forward.
All comments submitted in response to this notice will be considered by
the agency.
Comments are specifically solicited on the following issues with
respect to the material shown in Tables 1 through 10 of this Notice.
1. Do the 10 attributes reasonably cover the range of functions
found in people age 1 and older?
2. Do the levels of functional capacity shown in Tables 1 through
10 reasonably cover the range for the individual functions?
3. Are the definitions of the functional capacity levels shown in
Tables 1 through 10 unambiguous?
4. Are the definitions shown in Tables 1 through 10 comprehensible
to a lay person?
Written comments should be submitted to:NHTSA Docket Section,Room
5109, Nassif Building, 400 Seventh Street S.W., Washington, D.C. 20590.
Comments should refer to Docket #91-33, Notice 03.
It is requested, but not required, of interested persons that ten
copies of each comment be submitted. All comments must not exceed
fifteen pages in length. (49 CFR 553.21). Necessary attachments may be
appended to these suggestions without regard to the fifteen page limit.
This limitation is intended to encourage commenters to present their
views in a concise fashion.
All comments received before the close of business on the comment
closing date listed above will be considered and will be available for
examination in the docket at the above address both before and after
that date. To the extent possible, comments filed after the closing
date will be considered. However, this action may proceed at any time
after that date. The agency will continue to file relevant information
as it becomes available. It is recommended that interested persons
continue to examine the docket for new material. Those persons desiring
to be notified upon receipt of their comments by the docket should
include a self-addressed, stamped postcard in the envelope with their
comments. Upon receiving the comments, the docket supervisor will
return the postcard by mail.
Issued on: August 22, 1997.
William H. Walsh,
Associate Administrator, Plans and Policy.
[[Page 45911]]
Eating
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Level C:
Level B: No Requiring
dietary dietary
modifications. modifications. Level D: Limited
Level A: No Requires May require P.O. intake Level E: Tube
Function limitations supervision, supervision, supplemented by feeding only
compensatory compensatory tube feeding
strategies and/ strategies and/
or adaptive or adaptive
equipment equipment
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Swallowing Liquids 12 Drinks liquids Requires grading Requires use of Tolerates small All nutritional
mo+. primarily from amount of thickening amount of needs met via
cup, however liquid, or agent or rice liquid tube feeding as
may compensatory cereal to following child is unable
occasionally strategies safely tolerate safety to safely take
use bottle or (i.e., jaw liquids. precautions any liquids
breast. support, etc.). however, child P.O. secondary
Coughing and is unable to to impaired
choking are meet oral motor
rare. nutritional skills and/or
needs P.O. risk for
requiring tube aspiration.
feeding.
Swallowing Solids 12- Effectively Requires Requires pureed Tolerates small All nutritional
18 mo. chews and adaptive diet (i.e. baby amount of needs met via
swallows positioning food) secondary solids tube feeding as
ground, mashed, techniques, to difficulty following child is unable
or chopped adaptive chewing, safety to safely take
table foods. placement of swallowing or precautions any solids P.O.
May lose food in mouth digesting. however, child secondary to
minimal amounts (i.e. flat- is unable to impaired oral
of food/saliva based spoon) or meet motor skills
during chewing smaller sized nutritional and/or risk for
and swallowing. bolus to needs P.O. aspiration.
tolerate solids. requiring tube
feeding.
18 mo+................ Effectively Requires Requires pureed Tolerates All nutritional
chews and adaptive diet (i.e. baby limited amount needs met via
swallows all positioning food) secondary of solids tube feeding as
solids well techniques, to difficulty following child is unable
with good lip adaptive chewing, safety to safely take
closure. No placement of swallowing or precautions any solids P.O.
loss of food/ food in mouth digesting. however, child secondary to
saliva during (i.e. flat- is unable to impaired oral
swallowing. based spoon) or meet motor skills
smaller sized nutritional and/or risk for
bolus to needs P.O. aspiration.
tolerate solids. requiring tube
feeding.
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Reference: Pre-Feeding skills--Suzanne Evans Morris, PhD and Marsha Dunn Klein, M.Ed, OTR, Therapy Skill
Builders, 1987, P.O. (Per Os)=By Mouth.
Excretory Function
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Level B:
Level A: No Controllable Level C: Moderate Level D: Severe
Function limitation excretory excretory excretory
difficulty difficulty difficulty
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1yr-<2yrs (12-23="" mnths).....="" no="" significant="" no="" retention="" moderate="" retention.="" severe="" difficulty="" difficulty="" problems.="" difficulty="" eliminating="" urine="" eliminating="" urine="" dependent,="" but="" eliminating="" urine="" or="" fecal="" matter="" or="" fecal="" matter="" controlled="" use="" of="" or="" fecal="" matter="" (into="" diaper)="" (into="" diaper);="" no="" catheterization="" (into="" diaper)="" despite="" use="" of="" constipation="" or="" device="" +/or="" ostomy="" despite="" use="" of="" catheterization="" urinary="" retention.="" or="" controlled="" with="" catheterization="" device="" +/or="" ostomy="" medication="" +/or="" device="" +/or="" ostomy="" or="" medication="" +/or="" diet.="" or="" controlled="" with="" ostomy="" or="" medication="" +/or="" medication="" +/or="" diet.="" diet.="" 2yrs-3\1/2\yrs="" (24-42="" mnths)="" no="" significant="" no="" retention="" moderate="" retention.="" severe="" difficulty="" difficulty="" problems.="" difficulty="" eliminating="" urine="" eliminating="" urine="" dependent,="" but="" eliminating="" urine="" or="" fecal="" matter="" or="" fecal="" matter="" controlled="" use="" of="" or="" fecal="" matter="" (into="" diaper)="" (into="" diaper);="" no="" catheterization="" (into="" diaper)="" despite="" use="" of="" constipation="" or="" device="" +/or="" ostomy="" despite="" use="" of="" catheterization="" urinary="" retention.="" or="" controlled="" with="" catheterization="" device="" +/or="" ostomy="" medication="" +/or="" device="" +/or="" ostomy="" or="" medication="" +/or="" diet.="" or="" controlled="" with="" diet.="" medication="" +/or="" diet.="">3\1/2\yrs-10yrs (42-120 mnths). difficulty Controlled use of incontinence (urinary +/or
controlling the catheterization (urinary +/or fecal); frequency
elimination of device +/or ostomy fecal); frequency everyday & night
urine or fecal with 1 person greater than 2x/wk despite use of
matter. No assistance or by night and by catheterization
incontinence day/ controlled with day despite use of device +/or ostomy
night; No medication +/or catheterization with 1 person
constipation or diet. No retention device +/or ostomy assistance or
urinary retention. problems. with 1 person controlled with
Dependent, but assistance or medication +/or
controlled use of controlled with dietary influence.
catheterization medication +/or Severe retention
device +/or ostomy diet. Moderate difficulty despite
or controlled with retention use of
medication +/or difficulty despite catheterization
diet. use of device +/or ostomy
catheterization or medication +/or
device +/or ostomy diet.
or medication +/or
diet.
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Sexual Intercourse Functioning (Prediction of Adult Sexual Function)
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Level C: Severe
Function Leval A: No limitation Level B: Moderate limitation (or no sexual
difficulty function possible)
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1yr + (12+ mnths)................. Sexual function will be Sexual function will be Sexual function will not
possible without possible but with be possible or there
difficulty. varying degrees of will be severely
difficulty due to impaired difficulty.
physical impairment(s).
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Ambulation (Stair Climbing)
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Level C:
Independent, Level D: Minimally
Function Level A: No Level B: Minor requires device, dependent; requires Level E: Moderately Level F: Completely
limitations limitations takes more than assistance dependent dependent
reasonable time
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Stair climbing 12-17 Crawls up or down ................... May require extra ................... ................... Severe limitation,
months. stairs, may walk up time and/or an no ability to
stairs with one assisted device. climb stairs.
hand held.
18-23 months............. Walks up and down Walks up w/one hand ................... Crawls on stomach ................... Severe limitation,
holding rail. May held, may crawl up and elbows (not no ability to
need one hand held or down stairs. quadruped) up climb stairs.
walking down stairs. stairs.
24-29 months............. Walks up and down Needs 1 hand held Crawls up or down ................... Crawls on stomach Severe limitation
holding rail. walking down stairs, may walk and elbows (not no ability to
stairs. up with one hand quadruped) climb stairs.
held and/or use upstairs.
assisted device.
30-35 months............. Alternates feet Alternates feet Walks up and down Crawls up or down ................... Severe limitation,
going up and down going down stairs. holding rail, may stairs. crawls on stomach
stairs. need 1 hand held up stairs, no
and/or assisted ability to stair
device. climb.
[[Page 45912]]
36 months and older...... No limitation. Minimal limitation, Climbing 12 stairs Can climb minimum Stair climbing less Severe limitation,
Climbs up and down may have without assistance of 12 steps with than 12 steps with cannot walk up
12 steps without deviations in gait takes more than a or without or without minimum of 12
difficulty. pattern. reasonable time, assistance and/or assistance and/or steps.
requires device or device. device.
handrail.
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Ambulation (Standing, Walking, Running)
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Level C:
Independent,
Level A: No Level B: Minor requires device, Level D: Minimally Level E: Moderately Level F: Completely
Function limitations limitations takes more than dependent; requires dependent dependent
reasonable amount assistance
of time
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Standing/Walking/Running Walks alone seldom Walks with 1 hand Walks with 2 hands Cruises with 1 hand Cruises with 2 Completely
12-17 Months. falls (may be wide held. held may require (may need assisted hands (may need dependent, crawl
based gait) may assisted device device). assisted device). and/or stands at
only walk several (orthotics, rail, including no
steps independently. walker, etc.). crawling or
standing or pull
to standing
position.
18-23 Months............. Walks alone without Walks alone seldom Walks with 1 hand Walks with 2 hands Cruises with 1 hand Completely
falling, runs. falls. held may require held may require (may need device). dependent; crawls,
some device. device. stands, cruises
with 2 hands; may
not crawl or pull
to stand.
24 Months and Older...... No limitations, able Some limitation, Can walk 150' Can walk minimum of Walking limited to Difficulty standing
to walk at least can walk 150' without 150' with 50-150' with/or for long periods
150', no deviations without assistance assistance, but assistance may or without assistance of time or walk
in gait pattern. but with takes more than a may not require and/or device. minimum of 50'
increasing reasonable amount device. including unable
problems over of time and to walk at all.
increased requires some
distances; may device.
have minimal
deviation; does
not require device.
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Note: Cruising: ``Sidewards walking, holding rail for support, shifting hands.'' Taken from Manual of Developmental Diagnosis by Knobloch, Stevens and
Malone (p. 68).
Pediatric Better Hand and Arm Function
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Level B: Minor Level C: Major Level D: No
limitation in hand limitation in hand limitation in hand Level E: Moderate Level F: Complete
Function Level A: No function: No function: No function: Min to limitation in hand or near paralysis
limitation limitation in arm limitation in arm moderate limitation and arm function or loss of both
function function in arm function limbs
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Grasp and release of Grasps tiny objects Uses immature grasp Uses immature grasp No difficulty Moderate difficulty Max difficulty or
small and large objects using tips of thumb (scissor grasp) of (palmer grasp) grasping pellet or grasping small and inability to grasp
(12 mos. +). and index finger. tiny object with with max large objects. large objects small and large
No difficulty with increased time. No difficulty with Release is using immature objects. Release
large objects in difficulty with tiny and large controlled. grasp patterns is uncontrolled.
relation to the large objects. objects (including (raking). May
child's hand. Requires increased not being able to require increased
Releases objects in time for do it at all). time. Release is
a controlled manner. controlled release. Release is clumsy but
uncontrolled. purposeful.
Writing (15-23 mos.)..... Holds crayon in palm Minor difficulty to Max difficulty No difficulty Moderate difficulty Max difficulty
and scribbles grasp crayon in grasping crayon grasping crayon in to grasp crayon in grasping crayon
spontaneously. palm and write including palm. May require palm and write including
Writes using whole using whole arm inability to grasp increased time to using whole arm inability to grasp
arm movement. movement. Imitates crayon effectively scribble using movement. Requires crayon or
scribble with for scribble. whole arm increased time to scribble.
increased time. movements. scribble.
(24-30 mos.)............. Holds crayon in palm Holds crayon in Max difficulty No difficulty Moderate difficulty Max difficulty
and writes using palm and writes grasping crayon grasping crayon in to grasp crayon in grasping crayon;
forearm movement. using forearm including palm. Writes using palm and write including
Imitates vertical movement. inability to grasp whole arm using whole arm inability to grasp
stroke and circular Demonstrates crayon effectively movements. movements. crayon or
scribble. vertical stroke for scribble. Demonstrates age- Requires increased scribble.
and circular appropriate time to grossly
scribble with strokes. imitate vertical
increased time. and circular
strokes.
(31-59 mos.)............. Holds crayon with Holds crayon with Max difficulty No difficulty Uses immature grasp Max difficulty
fingers and writes fingers and writes grasping crayon. grasping crayon (palmer) to hold grasping crayon
using whole hand using whole hand Uses immature with fingers. crayon and writes including
and wrist movement. and wrist grasp patterns Writes using whole using forearm or inability to grasp
Imitates horizontal movement. Imitates (palmer). Writes hand or wrist arm movement. crayon or
stroke, V+H strokes. horizontal, V+H using forearm movement with Requires increased scribble.
strokes with movement. forearm supported. time to grossly
increased time. Demonstrates age- imitate horizontal
appropriate and vertical
strokes. strokes.
(60 mos. +).............. Holds crayon with Holds crayon with Max difficulty No difficulty Requires increased Max difficulty
fingers and writes fingers and writes grasping crayon. grasping crayon. time to grasp grasping crayon
using fine finger using wrist and Uses whole hand or Writes using fine crayon with including
movement. Prints finger movement. forearm movement finger movements fingers and write inability to grasp
own name. Prints own name to write. Imitates with forearm using forearm crayon or
with increased immature stroke supported. movement. Grossly scribble.
time. patterns grossly. Demonstrates age- prints own name.
appropriate
strokes.
Hand Movement to mouth(12 No difficulty moving No difficulty No difficulty Minimal to mod Requires increased Cannot move either
mos. +). hands to mouth at moving hands to moving hands to difficulty moving time to take hand hand to mouth at
least 5 times. mouth at least 5 mouth at least 5 hands to mouth at to mouth. least 5 times.
times. times. least 5 times.
Arm Movement over head(12 No difficulty No difficulty No difficulty Min to mod Requires increased Cannot reach over
mos. +). reaching for toys reaching for toys reaching for toys difficulty time or assistance head with either
over head with both over head with over head with reaching over head to reach above arm.
arms. both arms. both arms. for toys with one head.
or both arms.
Bilateral UE skills (12- No difficulty using Min difficulty Max difficulty or No difficulty using Uses uncoordinated Max difficulty or
15 mos.). both hands to using both hands inability to use both hands to movement patterns inability to use
manipulate to manipulate both hands to manipulate to manipulate both hands to
different objects different objects manipulate different objects different objects manipulate
simultaneously. simultaneously. different objects simultaneously. simultaneously in different objects
May require simultaneously. both hands. May simultaneously.
increased time. drop objects
frequently during
task.
[[Page 45913]]
16-23 mos.).............. No difficulty Min difficulty Min to mod Min to mod Moderate difficulty Max difficulty or
stabilizing object stabilizing object difficulty difficulty to stabilize inability to
with one hand while with one hand stabilizing object stabilizing object object with hand stabilize object
manipulating object while manipulating with one hand with hand while while manipulating with one hand
with the other hand. object with the while manipulating manipulating with object with other while manipulating
other hand. May with the other the other hand. hand. May use object with other
use forearm rather hand. Uses forearm Uses forearm trunk or leg to hand.
than hand to rather than hand rather than hand assist to
stabilize. to stabilize. to stabilize. stabilize object.
(24 mos. +).............. No difficulty Min difficulty Max difficulty or Min to Mod Requires increased Max difficulty or
completing completing inability to difficulty time to complete inability to
bilateral opposing bilateral opposing complete bilateral completing bilateral opposing complete bilateral
UE movements (i.e., UE movements. May opposing UE bilateral opposing UE movements. May opposing UE
tearing paper). require increased movements. UE movements. May require several movements.
time. require increased attempts to
time. successfully
complete task.
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Bending and Lifting
----------------------------------------------------------------------------------------------------------------
Level A: No Level B: Minor Level C: Major Level D: Cannot
Function limitation limitation limitation bend or lift
----------------------------------------------------------------------------------------------------------------
Bending from Sitting No difficulty Minimal difficulty Can bend over from Cannot with
Position (1 yr. +). bending over from bending over from sitting position in controlled motion
sitting position in sitting position in an appropriate bend over from
appropriate sized appropriate sized sized chair, touch sitting position,
chair to touch hand chair to touch hand hand to foot and touch hand to foot
to foot and return to foot and return return to sitting and return to
to sitting at least to sitting 5 times. at least 2 times. sitting position.
5 times. May require Requires maximum
increased amount of increased time or
time. use of adaptive
techniques, i.e.,
assisting with
upper extremities
to push self up
into sitting.
Bending from Standing Holds supporting Holds supporting .................... Cannot bend from
Position (12-18 mos). surface to bend surface to bend standing to pick
from standing from standing up object from
position and return position and return floor and return
to upright position to upright position to upright.
at least 3 times. at least 3 times.
May lose balance Requires repeated
occasionally. attempts secondary
to frequent loss of
balance.
Bending from Standing No difficulty Minimal difficulty Maximal difficulty Cannot bend over
Position (18 mos +). bending over from bending over from bending over from from standing
standing position standing position standing position position to pick
to pick up object to pick up object to pick up object up object from
from floor and from floor and from floor and floor and return
return to upright return to upright return to upright to upright
position at least 5 position at least 5 position. Requires position for a
times. times. May require increased time and minimum of 2
increased time or may use adaptive times. Includes
adaptive techniques, i.e. not being able to
techniques, i.e. holding onto stable bend in a
holding onto stable surface. controlled manner
surface. from standing at
all.
Lifting from Standing * No difficulty Minimal difficulty Major difficulty or Inability to lift
(1 yr. +). lifting amounts lifting amounts inability to lift any weight.
appropriate for age appropriate for age. amounts appropriate
and body weight. for age; but able
to lift a lesser
amount.
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* Norms are needed for ``appropriate'' amount and minimal amount of weight to age for a pediatric population.
Vision
--------------------------------------------------------------------------------------------------------------------------------------------------------
Level B: No loss Level E: Severe Level F:
Function Level A: No in VA but with Level C: Near- Level D: Moderate- low vision (legal Preferred low Level G: Total
limitations Diplopia normal vision low vision blindness in USA) vision blindness
--------------------------------------------------------------------------------------------------------------------------------------------------------
1yr-<2yrs (12-23="" .................="" .................="" able="" to="" i.d.="" recognizes="" .................="" everything="" close="" without="" visual="" mnths).="" favorite="" toy="" 5cm="" relative="" across="" to="" face.="" response="" even="" to="" in="" size="" from="" room="" without="" without="" light.="" across="" room="" with="" voice.="" recognition="" of="" nystagmus.="" with="" possible="" faces="" or="" objects="" nystagmus.="" without="" cues.="" with="" nystagmus="" possible.=""><5yrs (24-59="" .................="" .................="" near-normal="" moderate="" low="" .................="" profound="" low="" total="" visual="" mnths).="" vision;="" va="" is="" 20/="" vision;="" va="" is="" 20/="" vision;="" va="" is=""><5 impairment;="" 30-20/60.="" 70-20/160.="" 200="" (count="" black="" blind;="" no="" look="" out="" window="" without="" fingers="" at="" less="" light="" and="" id="" objects="" recognition="" of="" than="" 3="" mo)="" but="" perception.="" i.e.="" birds.="" people="" without="" with="" light="" not="" on="" top="" of="" tv.="" stimuli.="" perception.="" recognizes="" without="" seeing="" near="" tv,="" loses="" relative="" across="" small="" objects="" interest="" if="" not="" room="" without="" out="" the="" window="" close.="" voice.="" with="" possible="" everything="" close="" nystagmus.="" to="" face.="" without="" recognition="" of="" faces="" or="" objects="" without="" stimuli="" with="" possible="" nystagmus.="" [[page="" 45914]]=""><10yrs (60-119="" normal="" vision;="" no="" no="" significant="" near-normal="" moderate="" low="" .................="" profound="" low="" total="" visual="" mnths).="" significant="" loss="" loss="" of="" va;="" va="" vision;="" va="" is="" 20/="" vision;="" va="" is="" 20/="" vision;="" va="" is=""><5 impairment;="" of="" va;="" va="" is="" 20/="" is="" 20/25="" or="" 30-20/60.="" 70-20/160.="" 200="" (count="" black="" blind;="" no="" 25="" or="" better;="" no="" better="" but="" face="" close="" to="" fingers="" at="" less="" light="" functional="" functional="" page="" than="" 3mo)="" but="" perception.="" diplopia.="" diplopia="" is="" up="" close="" to="" with="" light="" present.="" blackboard="" or="" perception.="" front="" of="" room.="">10 yrs120 months. significant loss loss of VA; VA vision; VA is 20/ vision; VA is 20/ vision; legally vision; VA is <5 impairment;="" of="" va;="" va="" is="" 20/="" is="" 20/25="" or="" 30-20/60.="" 70-20/160.="" blind="" in="" usa;="" va="" 200="" (count="" black="" blind;="" no="" 25="" or="" better;="" no="" better="" but="" is="" 20/200-5/200.="" fingers="" at="" less="" light="" functional="" functional="" than="" 3="" mo)="" but="" perception.="" diplopia.="" diplopia="" is="" with="" light="" present.="" perception.="" --------------------------------------------------------------------------------------------------------------------------------------------------------="" best="" eye--remember="" most="" pedi="" injuries="" unilateral="" and="" until="" 8-10="" years="" old="" children="" will="" have="" only="" transient="" diplopia="" and="" then="" suppression="" of="" the="" poorer="" eye.="" school="" age--can="" ask="" regarding="" school="" eye="" screen.="" without="" visual="" field.="" auditory="" function="" in="" one="" ear="" ----------------------------------------------------------------------------------------------------------------="" level="" e:="" function="" level="" a:="" no="" level="" b:="" minor="" level="" c:="" level="" d:="" severe="" profound="" or="" limitations="" loss="" moderate="" loss="" loss="" total="" loss="" ----------------------------------------------------------------------------------------------------------------=""><2yrs (12-23="" no="" significant="" ................="" moderate="" to="" ................="" profound="" to="" mnths).="" loss="" able="" to="" moderately="" total="" loss;="" non-="" hear="" under="" severe="" loss;="" correctable;="" everyday="" average="" hearing="" average="" hearing="" listening="" level="" at="" 500,="" level="" at="" 500,="" conditions;="" 1000,="" 2000="" and="" 1000,="" 2000="" and="" average="" hearing="" 3000="">z is 41- 3000 is Hz >91
level at 500, 70 Difficulty Difficulty
1000, 2000 and with hearing all but
3000 Hz 25 with beyond 3-5 ft., sounds Failure
understanding classroom or to respond,
of simple group awaken, or move
phrases. discussion with to loud
significant environmental
difficulty sounds.
understanding
simple phrases.
2yrs->10yrs (24mnths-- No significant Minor loss Moderate to Severe loss; Profound to
120 mnths). loss able to correctable moderately average hearing total loss; non-
hear under with readily severe loss; level at 500, correctable;
everyday available average hearing 1000, 2000 and average hearing
listening hearing aid; level at 500, 3000 Hz is 71- level at 500,
conditions; average hearing 1000, 2000 and 91 Difficulty 1000, 2000 and
average hearing level at 500, 3000 Hz is 41- with anything 3000 Hz is >91
level at 500, 1000, 2000 and 70 Difficulty but shouted or Difficulty
1000, 2000 and 3000 Hz is 26- with amplified hearing all but
3000 Hz25. with faint or beyond 3-5 ft., sounds.
distant speech. classroom or
group
discussion.
----------------------------------------------------------------------------------------------------------------
Reference
* Goodman, A.C. and Chasin, W.D.: In Gellis, SS and Kagan B.M. (Eds): Current Pediatric Therapy 7th Ed W.B.
Saunders Co. Phila, 1976 p.518 (or whole Pedi Catalog Vol 1 p.15).
Speech/Language
----------------------------------------------------------------------------------------------------------------
Level C: Moderate-
Function Level A: No Level B: Mild severe limitations Level D: Global
limitations limitations limitations
----------------------------------------------------------------------------------------------------------------
12-14 mos............. Vocabulary of 4-6 Vocabulary of 1-2 Sparse output mainly Maximum difficulty;
words; recognizes words; imitates jargon; does not no speech; minimal
own name; mixes sounds of adults recognize name or comprehension of
words with jargon; inconsistently; follow motor commands.
follows simple motor minimal language instructions.
instructions (esp. comprehension;
if accompanied by smiles in response
visual cue). to presence of
caregiver or
familiar person;
listens at least
momentarily when
spoken to by a
caregiver.
15-18 mos............. Vocabulary of 8-20 Vocabulary of 4-6 Vocabulary of 1-2 Maximum difficulty;
words; uses words words; recognizes words; recognizes no speech; minimal
and jargon in own name, but does own name, but does comprehension of
conversation; not follow motor not follow motor commands.
identifies some body instructions; smiles instructions;
parts; sings in response to intelligibility of
spontaneously. presence of speech compromised
caregiver or other by articulation
familiar person; defect.
mild articulation
defect without
compromise of
intelligibility.
19-23 mos............. Vocabulary of 30-300 Vocabulary of 8-20 Vocabulary of 4-6 Maximum difficulty;
words; uses ``I'' words; mixes words words; mixes words no speech; minimal
and ``mine''; tries with jargon; follows with jargon; comprehension of
to tell experiences; simple motor follows simple commands.
uses short, instructions and motor instructions;
incomplete identifies some body intelligibility of
sentences; uses parts; mild speech compromised
prepositions and articulation defect by articulation
regular verb without compromise defect.
endings; follows 1-2 of intelligibility.
step commands.
24-36 mos............. Uses a range of words Vocabulary of 30-300 Vocabulary of 8-20 Maximum difficulty;
which is normal for words; uses words words; mixes words no speech; minimal
age (vocabulary of and jargon in short, with jargon; comprehension of
900-1000 words); incomplete follows simple commands.
sentences have 8 or sentences; motor instructions;
more words; uses identifies some body intelligibility of
``he'' and ``she'' parts; sings speech compromised
correctly; recites spontaneously; mild by articulation
rhymes, songs; articulation defect defect.
follows 2-3 step without compromise
commands; identifies of intelligibility.
2 colors; sentences
have subject and
verb; talks about
present.
37-47 mos............. Uses a range of words Uses a range of words Vocabulary of 30-300 Maximum difficulty;
which is normal for slightly below other words; uses words no speech; minimal
age (Vocabulary of children of same age and jargon in comprehension of
1,000-1,500 words); (vocabulary of 900- short, incomplete commands.
talks about the 1000 words); sentences;
present; states sentences have 8 or identifies some
number of siblings. more words; uses body parts; sings
``he'' and ``she'' spontaneously;
correctly; recites intelligibility of
rhymes, songs; speech compromised
follows 2-3 step by articulation
commands; identifies defect.
2 colors; sentences
have subject and
verb; talks about
present; mild
articulation defect
without compromise
of intelligibility.
48-59 mos............. Uses a range of words Uses a range of words Uses significantly Maximum difficulty;
which is normal for slightly below other fewer words than no speech; minimal
age (vocabulary of children of same age other children of comprehension of
1500-2200 words); (vocabulary of 1000- same age commands.
increases complexity 1500 words); uses (vocabulary of 900-
of sentences; ``I'' and ``mine''; 1000 words); uses
recounts the past; tries to tell words and jargon in
asks many questions; experiences; uses conversation;
understands most short sentences identifies body
questions about the which range from parts;
immediate complete with intelligibility of
environment; has subject and verb to speech compromised
75%+ grammar incomplete by articulation
acquisition; sentences; follows 1- defect.
discusses feelings; 2 step commands;
follows 3-step mild articulation
commands. defect without
compromise of
intelligibility.
[[Page 45915]]
5-<8 years............="" uses="" a="" range="" of="" words="" uses="" a="" range="" of="" words="" uses="" significantly="" maximum="" difficulty;="" which="" is="" normal="" for="" slightly="" below="" other="" fewer="" words="" than="" no="" speech;="" minimal="" age="" (vocabulary="" of="" children="" of="" same="" age="" other="" children="" of="" comprehension="" of="" 2,500+="" words);="" (vocabulary="" of="" 1500-="" same="" age="" commands.="" understands="" a="" range="" 2200="" words);="" (vocabulary="" of="" 1000-="" of="" words="" which="" is="" sentences="" have="" 8+="" 1500="" words);="" uses="" normal="" for="" age="" words;="" uses="" ``he''="" ``i''="" and="" ``mine'';="" (20,000-24,000="" and="" ``she''="" tries="" to="" tell="" words);="" uses="" all="" correctly;="" follows="" 2="" experiences;="" uses="" parts="" of="" speech="" to="" step="" commands;="" mild="" short,="" incomplete="" some="" degree;="" articulation="" defect="" sentences;="" follows="" verbalizes="" ideas;="" without="" compromise="" 1-2="" step="" commands;="" talks="" a="" lot.="" of="" intelligibility.="" intelligibility="" of="" speech="" compromised="" by="" articulation="" defect.=""><10 years...........="" uses="" a="" range="" of="" words="" uses="" a="" range="" of="" words="" uses="" significantly="" maximum="" difficulty;="" which="" is="" normal="" for="" slightly="" below="" other="" fewer="" words="" than="" no="" speech;="" minimal="" age="" (vocabulary="" of="" children="" of="" same="" age="" other="" children="" of="" comprehension="" of="" 5,000+="" words);="" (vocabulary="" of="" same="" age="" commands.="" understands="" a="" range="" 2,500+="" words);="" 75%="" (vocabulary="" of="" 1500-="" of="" words="" which="" is="" grammar="" acquisition;="" 2200="" words);="" normal="" for="" age="" follows="" 3="" step="" recites="" alphabet;="" (25,000+="" words);="" commands;="" verbalizes="" tells="" plot="" of="" a="" able="" to="" write="" ideas;="" mild="" fairy="" tale;="" follows="" fluently="" either="" in="" articulation="" defect="" 2-step="" commands;="" cursive="" or="" in="" without="" compromise="" 25%="" grammar="" printed="" characters;="" of="" intelligibility.="" acquisition;="" prints="" or="" writes="" intelligibility="" of="" sentences="" of="" 3="" to="" 4="" speech="" compromised="" words;="" reads="" at="" or="" by="" articulation="" above="" second="" grade="" defect.="" level;="" gives="" complex="" directions="" to="" others.="">10 years............. Uses a range of words Uses a range of words Uses significantly Maximum difficulty;
which is normal for slightly below other fewer words than no speech; minimal
age (vocabulary of children of same age children of same comprehension of
25,000+ words); (vocabulary of age (vocabulary of commands.
talks a lot; 5,000+ words); 2,500 words);
understands a range increases complexity sentences have 8+
of words which is of sentences using words; uses ``he''
normal for age all parts of speech and ``she''
(approximately to some degree; correctly; follows
50,000 words). understands a range 2 step commands;
of words slightly intelligibility of
below other children speech compromised
of same age (20,000+ by articulation
words); 75% grammar defect.
acquisition; follows
3-step commands;
mild articulation
defect without
compromise of
intelligibility.
----------------------------------------------------------------------------------------------------------------
Cognition
----------------------------------------------------------------------------------------------------------------
Level C: Moderate-
Function Level A: No Level B: Mild severe limitations Level D: Global
limitations limitations limitations
----------------------------------------------------------------------------------------------------------------
12-14 mos............. Uses common objects Brings 2 blocks Inconsistent No response to book;
appropriately; helps together, usually response to book; no response to
to turn pages; tries lifting them and variable response blocks; no use of
to pick up cubes; comparing them, but to blocks; no use crayon; fails to
builds tower of 2 does not build a of crayon; attend to
blocks; tower; touches book inconsistently interactive toy or
spontaneously but does not turn maintains attention. picture.
scribbles or page; picks up
imitates; searches crayon but fails to
for objects; scribble; maintains
maintains attention attention for one
for 2 minutes to an minute to an
interactive toy or interactive toy/
picture. picture.
Learning/memory....... Searches in a Fails to consistently No response to Max difficulty; does
location where an search for hidden hidden object. not search.
object was last object.
hidden.
15-18 mos............. Imitates adult object Uses common objects Inconsistent No response to book;
use and motor acts; appropriately; helps response to toy or no response to
turns 2-3 pgs at a to turn pages; tries to book; blocks; no use of
time; initiates to pick up cubes; inconsistently uses crayon; no response
crayon stroke; builds tower of two crayon; no response to toy; no response
builds 3 block blocks; to placing to placing
tower;places spontaneously different shaped different shaped
different shaped scribbles or objects in objects in
objects in different imitates; searches different sized different sized
sized holes; for objects; mild holes; fails to holes; max
maintains attention difficulty maintain attention difficulty.
for 2 minutes or sustaining attention for 2 minutes to an
more to an for more than 2 interactive toy or
interactive toy or minutes, easily picture; brings 2
picture. distracted. blocks together,
usually lifting
them and comparing
them, but does not
build a tower.
Learning/memory....... Remembers places Searches in a Fails to Max difficulty; no
where familiar location where an consistently search response.
objects are usually object was last for hidden object.
located (toys in hidden.
toybox).
19-23 mos............. Builds tower of 5-7 Builds 3 block tower; Builds tower of 2 No response to book;
blocks; imitates turns 2-3 pages at a blocks; no response to
circular scribble time; initiates inconsistently uses blocks; no use of
and/or vertical crayon stroke; crayon; crayon; no response
stroke; places places different inconsistently to toy; no response
different shaped shaped objects in places different to placing
objects in different different sized shaped objects in different shaped
sized holes even holes; mild different sized objects in
after rotation; sits difficulty holes; inconsistent different sized
alone for short sustaining attention response to toy; holes; max
periods with book; for more than 2 to 3 scribbles with difficulty.
maintains attention minutes, easily crayon;
for 3 to 4 minutes distracted. inconsistently
or more to an maintains attention
interactive toy or for 2 minutes.
picture.
Learning/memory....... Recognizes pictures Remembers places Searches in a Max difficulty;
in picture book. where familiar location where an minimal search.
objects are usually object was last
located (toys in hidden.
toybox).
24-30 mos............. Matches familiar Builds 5-7 block Builds tower of 3 or No response to book;
objects; builds tower; scribbles fewer blocks; plays no response to
tower of 8-9 blocks; spontaneously with a with crayon but not blocks; no use of
makes circular crayon; places without prompting/ crayon; no response
strokes with crayon; different shaped imitation scribbles to toy; no response
knows big and little objects in different using crayon; tries to placing
concepts;maintains sized holes even but usually unable different shaped
attention for 5 after rotation; mild to place different objects in
minutes or longer on difficulty shaped objects in different sized
one interactive sustaining attention different sized holes; max
activity. for more than 3-4 holes. difficulty.
minutes, easily
distracted.
Learning/memory....... Remembers one item; Recognizes pictures Remembers places Max difficulty;
repeats 2 items, 1 in picture book. where familiar minimal search.
of 3 trials. objects are usually
located (toys in
toybox).
31-36 mos............. Creates Builds 8-9 block Builds 5-7 block No response to book;
representational tower; imitates a tower; places no response to
art; matches primary circular scribble; different shaped blocks; no use of
colors; engages in mild difficulty objects in crayon; no response
make-believe play sustaining attention different shaped to toy; no response
unconstrained by for more than 5 holes even after to placing
objects; builds minutes; easily rotation; different shaped
tower of 10 cubes; distracted. inconsistently objects in
imitates bridge; maintains attention different sized
copies circle; for 3-4 minutes on holes; max
places 7 different one toy or activity. difficulty.
shaped objects in
different sized
holes; maintains
attention for 6-7
minutes or longer on
one interactive
activity.
Learning/memory....... Remembers 2 items; Remembers one item; Recognizes pictures Max difficulty;
repeats 3 items, 1 repeats 2 items, 1 in picture book. minimal search.
of 3 trials. of 3 trials.
37-47 mos............. Knows 4 actions; Creates Builds 8-9 block No response to book;
maintains attention representational tower; imitates a no response to
for 10-11 min; can art; matches primary circular scribble; blocks; no use of
show use of 2 colors; engages in mild difficulty crayon; no response
objects; imitates a make-believe play sustaining to placing
square or better; unconstrained by attention for more different shaped
can build a bridge objects; builds than 5 minutes; objects in
with blocks. tower of 10 cubes; easily distracted. different sized
imitates bridge; holes; max
copies circle; difficulty.
places 7 different
shaped objects in
different sized
holes; maintains
attention for 6-7
minutes or longer on
one activity.
Learning/memory....... Remembers 3 items; Remembers 2 items; Remembers one item; Inconsistently
repeats 4 items, 1 repeats 3 items; 1 repeats 2 items, 1 recognizes picture
of 3 trials. of 3 trials. of 3 trials. Max difficulty; no
response.
[[Page 45916]]
48-59 mos............. Knows own right and Matches familiar Builds 10 block No response to book;
left; develops time objects; knows big tower; imitates a no response to
concepts; recognizes and little; builds circle; repeats 1 blocks; no use of
relationships of bridge with blocks; item, 1 of 3 crayon; no response
parts to whole; imitates a circle trials, places 7 to formboard or
categorizes types of with a crayon; knows different shaped other toy; max
animals; counts big and little objects in difficulty.
rotely up to 13; can concepts; mild different sized
show 3 objects; difficulty holes;
understands concepts sustaining attention inconsistently
of 3; labels some for 10 minutes; maintains attention
coins; maintains easily distracted. for 7-8 minutes.
attention for 11-13
minutes on one
interactive activity.
Learning/memory....... Remembers 4 Remembers 3 items; Remembers 2 items; Max difficulty; may
items;repeats 5 remembers places repeats 3 items, 1 recall 1 item.
items, 1 of 3 where familiar of 3 trials.
trials; learns objects are usually
sequences such as located; repeats 4
days of the week; items, 1 of 3 trials.
recalls gist of a
short story;
recognizes series of
pictures.
5-<8 years............="" longer="" attention="" span="" builds="" tower="" of="" 6-7="" builds="" tower="" of="" 4-5="" no="" response="" to="" book;="" for="" 15="" minutes="" or="" blocks;="" creates="" blocks;="" imitates="" a="" no="" response="" to="" more="" on="" one="" representational="" circle;="" blocks;="" no="" use="" of="" activity;="" knows="" left="" art;="" matches="" primary="" inconsistently="" crayon;="" no="" response="" and="" right="" of="" others;="" colors;="" engages="" in="" maintains="" attention="" to="" placing="" understands="" make-believe="" play="" for="" 9-10="" minutes.="" different="" shaped="" conversation;="" knows="" unconstrained="" by="" objects="" in="" differences="" and="" objects;="" mild="" different="" sized="" similarities;="" reads="" difficulty="" holes;="" max="" spontaneously.="" sustaining="" attention="" difficulty.="" for="" more="" than="" 10="" minutes,="" easily="" distracted.="" learning/memory.......="" remembers="" and="" repeats="" remembers="" 4="" items;="" remembers="" 1-2="" items;="" max="" difficulty.="" 5="" items;="" learns="" a="" learns="" sequences="" partial="" recall="" of="" a="" list="" of="" 6-8="" words.="" such="" as="" months="" of="" short="" story;="" the="" year;="" recalls="" repeats="" 1-2="" items,="" gist="" of="" a="" short="" 1="" of="" 3="" trials="" story;="" recognizes="" a="" remembers="" 3="" items;="" series="" of="" pictures;="" remembers="" places="" repeats="" 5="" items,="" 1="" where="" familiar="" of="" 3="" trials.="" objects="" are="" usually="" located;="" repeats="" 4="" items,="" 1="" of="" 3="" trials.="" academic="" progress.....="" no="" change="" from="" some="" decline="" in="" some="" or="" all="" classes="" homebound="" or="" preinjury.="" grades="" since="" injury="" are="" resources="" institutionalized.="" but="" remains="" in="" (special="" similar="" classes="" education),="" but="" (e.g.="" mainstream).="" attends="" school="" full="" time.=""><10 years...........="" reads="" books="" at="" second="" knows="" own="" right="" from="" builds="" tower="" of="" 6-7="" max="" difficulty;="" no="" to="" fourth="" grade="" left;="" develops="" time="" blocks;="" creates="" response="" to="" book="" or="" level;="" writes="" neatly="" concepts;="" recognizes="" representational="" blocks.="" most="" of="" the="" time;="" relationships="" of="" art;="" matches="" can="" give="" complex="" specific="" parts="" to="" primary="" colors;="" directions="" to="" whole;="" counts="" rotely="" engages="" in="" make-="" others,="" i.e.="" how="" to="" up="" to="" 13;="" prints/="" believe="" play;="" use="" key="" to="" unlock="" writes="" at="" least="" 10="" inconsistently="" door;="" knows="" right="" words="" from="" memory="" maintains="" attention="" and="" left="" of="" others;="" states="" month="" and="" day="" for="" 10-15="" minutes.="" understands="" of="" birthday;="" recites="" conversation;="" alphabet;="" reads="" at="" maintains="" attention="" least="" 3="" common="" for="" 30="" minutes="" or="" signs;="" mild="" more="" on="" one="" activity.="" difficulty="" sustaining="" attention="" for="" 15="" minutes="" or="" more;="" easily="" distracted.="" learning/memory.......="" remembers="" and="" repeats="" remembers="" and="" repeats="" remembers="" 4="" items;="" max="" difficulty;="" 6="" items;="" recalls="" 5="" items;="" learns="" a="" learns="" sequences="" minimal="" recall="" or="" events,="" actions="" of="" a="" list="" of="" 6-8="" words;="" such="" as="" months="" of="" recognition="" of="" 1-2="" short="" story;="" learns="" recalls="" gist="" of="" the="" year;="" recalls="" items.="" a="" list="" of="" 8-10="" words.="" story="" but="" not="" gist="" of="" a="" short="" specific="" events="" and="" story;="" recognizes="" a="" actions.="" series="" of="" pictures;="" repeats="" 5="" items,="" 1="" of="" 3="" trials.="" academic="" progress.....="" no="" change="" from="" some="" decline="" in="" some="" or="" all="" classes="" homebound="" or="" preinjury.="" grades="" since="" injury="" are="" resource="" institutionalized.="" but="" remains="" in="" (special="" similar="" classes="" education),="" but="" (e.g.="" mainstream).="" attends="" school="" full="" time.="">10 years... Plans future actions; Knows left and right; Knows own right and No response to book;
engages in abstract understands left; develops time no response to
thought; i.e. can conversation; knows concepts; blocks; no use of
interpret proverb differences and recognizes crayon; no response
providing more than similarities; reads relationships of to form board or
a concrete spontaneously; mild parts to whole; other toy; max
explanation; solves difficulty categorizes; counts difficulty.
problems with only sustaining attention rotely up to 13;
minimal physical for more than 30 can show 3 objects;
input; writes in minutes, easily understands concept
cursive, maintains distracted. of 3; labels some
attention for 60 coins;
minutes or more on inconsistently
one activity. maintains attention
for more than 15
minutes.
Learning/memory....... Remembers and repeats Remembers and repeats Remembers and Max difficulty; may
7 items; repeats 6 items; learns a repeats 5 items; recall or recognize
details of short list of 8-10 words. learns a list of 6- 1-3 items.
story; learns a list 8 words.
of 11-12 words;
recognizes series of
100+ pictures;
memory approaches
the level in
adolescents and
young adults (e.g.,
recognizes faces of
100+ classmates,
friends, relatives).
Academic progress..... No change from Some decline in Some or all classes Homebound or
preinjury. grades since injury are resource institutionalized.
but remains in (special
similar classes education), but
(e.g. mainstream). attends school full
time.
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[FR Doc. 97-22795 Filed 8-28-97; 8:45 am]
BILLING CODE 4910-59-P
