|Year : 2012 | Volume
| Issue : 3 | Page : 530-537
Spreadsheet software to assess locomotor disability to quantify permanent physical impairment
Department of Plastic Surgery, St. John's Medical College and Hospital, Sarjapura Road, Bangalore, Karnataka, India
|Date of Web Publication||12-Jan-2013|
Department of Plastic Surgery, St John's Medical College and Hospital, Sarjapura Road, Bangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Assessment of physical disability is an important duty of a plastic surgeon especially for those of us who are in an institutional practice. Aim: The Gazette of India notification gives a guideline regarding the assessment of the disability. However, the calculations as per the guidelines are time consuming. In this article, a spreadsheet program which is based on the notification is presented. The aim of this article is to design a spreadsheet program which is simple, reproducible, user friendly, less time consuming and accurate. Materials and Methods: This spreadsheet program was designed using the Microsoft Excel. The spreadsheet program was designed on the basis of the guidelines in the Gazette of India Notification regarding the assessment of Locomotor Disability to Quantify Permanent Physical Impairment. Two representative examples are presented to help understand the application of this program. Results: Two spreadsheet programs, one for upper limb and another for the lower limb are presented. The representative examples show the accuracy of the program to match the results of the traditional method of calculation. Conclusion: A simple spreadsheet program can be designed to assess disability as per the Gazette of India Notification. This program is easy to use and is accurate.
Keywords: Disability assessment; locomotor impairment; spreadsheet program
|How to cite this article:|
Ellur S. Spreadsheet software to assess locomotor disability to quantify permanent physical impairment. Indian J Plast Surg 2012;45:530-7
|How to cite this URL:|
Ellur S. Spreadsheet software to assess locomotor disability to quantify permanent physical impairment. Indian J Plast Surg [serial online] 2012 [cited 2019 Jun 19];45:530-7. Available from: http://www.ijps.org/text.asp?2012/45/3/530/105968
| » Introduction|| |
Assessment of disability is often done by plastic surgeons. The Gazette of India Notification 2001 , forms the guideline to assess disability as per the Government of India recommendation. The calculations involved in the assessment are complex, confusing, time consuming and less easily reproducible.
In today's era of Smart phones, tablet PCs and Netbooks where a spreadsheet program in the form of Excel is readily accessible by most plastic surgeons, it should be possible to adapt the said Gazette Notification to a spreadsheet program. This way the Gazette Notification recommendations can be easily calculated in a simple, clear, faster, reproducible, accurate and user-friendly manner.
The aim of this article is to design a spreadsheet program based on the Gazette of India Notification 2001 for assessment of locomotor disability of upper [Figure 1] and lower limbs [Figure 2] and check the accuracy of such spreadsheet program for the extremes of values in the assessments.
| » Materials and Methods|| |
The spreadsheet program is based on the Guidelines for evaluation of various disabilities and procedure for certification issued by Ministry of Social Justice and Empowerment vide Notification dated the 1 st June 2001 in the Gazette of India. , The spreadsheet program used is Microsoft Excel version 2010. 
Two representative cases are presented to help understand the usefulness of this program. Patient A [[Figure 3] - Form A], a 28-year-old male patient presented with a history of workplace injury sustained about 5 months ago. His right upper limb was accidentally dragged into a conveyor belt at his workplace resulting in severe injuries to his arm, forearm and his hand. He then underwent multiple surgical procedures which included wound debridement, reconstruction of injured musculotendinous units and split skin grafting. He is presently assessed for disability. The findings of his examination along with the calculation of his disability are presented in the Form A which is based on the Gazette of India Notification dated 01 June 2001. Patient B [[Figure 4] - Form B], a 34-year-old female patient presented with a history of road traffic accident sustained about 6 months ago with crush injury of her right lower limb. After she underwent intramedullary nailing for her fracture tibia, she was transferred to the plastic surgery unit. Here she underwent a free latissimus dorsi flap for a right plantar avulsion injury. She is presently assessed for disability. The findings of her examination along with the calculation of her disability are presented in the Form B which is based on the Gazette of India Notification dated 01 June 2001.
|Figure 3: Form A. Representative case of locomotor disability of upper limb|
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|Figure 4: Form B. Representative case of locomotor disability of lower limb|
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The values in the Form A were then applied to the spreadsheet program for the upper limb [Figure 5] and the values in the Form B were applied to the spreadsheet program for the lower limb [Figure 6].
|Figure 5: Spreadsheet for a representative case of upper limb as in Form A|
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|Figure 6: Spreadsheet for a representative case of lower limb as in Form B|
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| » Results|| |
A spreadsheet program for the upper and lower limb disability assessment is presented. It may be noted that the calculations in the spreadsheet program are accurate from the representative examples provided above.
| » Discussion|| |
India is a vast country with a rapidly developing economy. Increasing numbers of industries and vehicles have meant increasing numbers of industrial and road traffic accidents. A large number of these patients are treated by plastic surgeons at some point during the course of their treatment. Many of these patients come to us for assessment of their disability. Assessing patient's disability is an extension of our care in the overall management of the injured patient. Most often, properly assessed disability goes a long way in rehabilitating these injured patients. We may be called up and asked to give expert evidence in labour courts for industrial accident cases and courts designated for motor vehicle accident cases in road traffic accident cases. Disability assessment may also be necessary to award compensations, employment, conveyance allowance, travel concessions, tax deductions and admission to courses for the disabled.
The worldwide incidence of disability varies from 4% in developing countries to 7% in industrialized nations.  The incidence in India is between 1.8% and 2.2%. 
The World Health Organization  draws on a three-fold distinction between impairment, disability and handicap. Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function. Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap is a disadvantage, for a given individual, resulting from impairment or a disability, which prevents the fulfilment of a role that is considered normal (depending on age, sex and social and cultural factors) for that individual.
The legislative framework for the protection of the rights of disabled people is covered by four acts in India.  The Mental Health Act 1987, The Rehabilitation Council of India Act 1992, The Persons with Disabilities Act 1995 and The National Trust Act 1999. Prior to 1986, doctors were using a variety of guidelines, namely Workman's Compensation Act, ESI Act and ALIMCO booklet (reprint of guidelines developed by American Academy of Orthopaedic Surgeons, 1962). In 1986, the Ministry of Welfare, Govt. of India, issued an O.M. No. 4-2/83-HW.-III, dated 6 August 1986 dealing with uniform definitions and general guidance for evaluation and assessment of various disabilities. Based on the experience of use of the above-mentioned guidelines and in view of the Persons with Disabilities Act 1995, the Ministry of Social Justice and Empowerment, Government of India set up five committees one each in the area of mental retardation, Locomotor disability, Visual disability and Speech and Hearing disability and assessment of multiple disabilities. In June 2001, the final guidelines for disability evaluation and certification were issued through a Govt. of India Gazette notification. It contains methods of estimation of different types of impairments and disabilities, a copy of the proposed format for disability certificate, and a ready reckoner to compute figure by using combining formula (a + b (90 - a)/90). ,
The disability which usually concerns us as plastic surgeons is the locomotor disability. However we regularly assess locomotor disability based on the said Gazette Notification in our unit, we often encountered various problems which I would like to list below.
With a goal to simplify the calculation, I have explored the possibility of adapting the Gazette of India Notification 2001 to a spreadsheet. With this, the calculations happen automatically and they are reproducible in the form of a printout which can easily explain how the final figure was arrived at in the court. The spreadsheet makes the whole process of assessment faster and user friendly. In this article, I have presented two spreadsheet programs, one each for the upper limb and lower limb which are based on the Gazette of India Notification 2001. ,
- The calculations involved in the assessment are time consuming.
- The calculations appear confusing when reviewed at a later date.
- It is often difficult to explain in the court how a final figure was arrived at.
Each of these programs was thoroughly tested for the entire range of values which are possible. Two representative cases are also presented to help understand the applicability of these programs.
A spreadsheet is a computer application that simulates an accounting worksheet. It displays multiple cells which together make up a grid comprising of rows and columns. It can be used to store, process, analyse and graphically represent data. A formula entered in a cell in the spreadsheet defines how the content of that cell is to be calculated from the contents of any other cell(s) each time the content of the other cell(s) is updated.
VisiCalc is historically regarded as the first spreadsheet application (year 1979). The spreadsheet application which is most popular currently is familiar to most of us as Microsoft Excel.  Although an Excel spreadsheet is ideal for arranging entries in columns and rows, that's not its main purpose. One can do that with a table in a word processing application like Microsoft Word. What makes a spreadsheet so powerful is that it can perform calculations using various values from the spreadsheet. It is hoped that this program which is freely usable is useful to all doctors who are care givers for these traumatized patients.
There is no intention to sell this program commercially.
| » References|| |
|1.||Guidelines for evaluation of various disabilities and procedure for certification issued by Ministry of Social Justice and Empowerment vide Notification No. 16-18/97-NI. Idated the 1 st June 2001 in the Gazette of India. Published by Authority, Govt. of India, New Delhi. |
|2.||Available from: http://www.ccdisabilities.nic.in/page.php. [Last accessed on 2012 Feb 02]. |
|3.||Available from: http://office.microsoft.com/en-us/excel/. [Last accessed on 2012 Feb 15]. |
|4.||Metts R. Disability Issues. Trends and Recommendations for the World Bank. Washington, DC: World Bank; 2000. |
|5.||Census of India. Disabled population by type of disability, age, sex and type. New Delhi: Registrar General Office; 2001. |
|6.||World Health Organisation. Document A29/INFDOCI/1.Geneva, Switzerland; UN, World Health Organization 1976. |
|7.||Thomas P. Mainstreaming disability in development: India Country Report. 2005. Available from: http://www.healthlink.org.uk/PDFs/Mainstreaming-disability-in-dev-India-country-report.pdf. [Last accessed on 2012 Feb 15]. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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