Table 12 - Neurological Function

The five Neurological Function Tables are:

Table 12.1 - Cranial Nerves
Table 12.2 - Communication Disorders - Comprehension
Table 12.3 - Communication Disorders - Expression
Table 12.4 - Cognitive Function - Memory
Table 12.5 - Cognitive Function - Reasoning

The Approved Guide outlines the structure of the Tables:

Neurological function is divided into three sub-groups - Cranial Nerves (Table 12.1), Communication (Tables 12.2 & 12.3) and Cognitive Function (Tables 12.4 & 12.5).

Communication and Cognitive Function are each divided into two sub-sections: The sub-sections of Communication are Comprehension (Table 12.2) and Expression (Table 12.3); the sub-sections of Cognitive Function are Memory (Table 12.4) and Reasoning (Table 12.5).

Table 12.1 - Cranial Nerves

The different cranial nerves are numbered I to XII. For a description of what they are, refer to a medical text or other reference source such as Chapter 2 of the American Medical Association Guides to the Assessment of Permanent Impairment.

Please note that assessments for sight, smell and taste can be made under other tables. They have been included here as well so that this table is complete. Do not make two separate assessments and combine them. Use one or the other. The other relevant tables are Table 6.1 “Visual System”, and Table 7.2 “Ear, Nose and Throat Disorders - Miscellaneous”.

% WPI	UNILATERAL LOSS OR PARALYSIS	CRITERIA BILATERAL LOSS OR PARALYSIS	OTHER
0	I	I
0	XII
5	V (motor)	VII (complete loss of taste)
10	V (sensory)	XII (swallowing impairment, with diet restricted to semi-solids)	Swallowing impairment due to one or two combinations of IX, X and XI, and resulting in diet restricted to semi-solids
15	VII
20			Atypical facial neuralgia
25	II OR
25	III, IV, VI alone or in combination (diplopia corrected by covering one eye
30		XII (swallowing impairment, with diet restricted to liquids)	Swallowing impairment due to one or two combinations of IX, X and XI, and resulting in diet restricted to liquids
35		V (sensory)
45		V (motor)
50			Intractable typical trigeminal neuralgia or tic douloureux
60		XII (swallowing impairment, with diet by tube feeding or gastronomy	Swallowing impairment due to one or two combinations of IX, X & XI, and resulting in diet by tube feeding or gastronomy
85		II

These tables should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to the assessment of the consequences of neurological injury or disease.

Communication Disorders

Communication

Notes: Communication disorders may arise as a result of interference with comprehension and/or expression. They are the result of neurological damage arising for example from head injury or cerebro-vascular accident. Comprehension may be further divided into hearing and reading skills and expression into verbal and written skills. A report from a Speech Pathologist or Rehabilitation Specialist will generally be necessary to enable impairment of this function to be accurately assessed. In all cases the employee's abilities prior to the injury or disease must be taken into account. It would be inappropriate to assess an illiterate person with respect to reading and writing skills. Similarly where English is a second language, it may be more appropriate to base assessment on interference with ability to understand and speak the first language.

Table 12.2 - Communication Disorders - Comprehension

% WMI	CRITERIA HEARING*	CRITERIA READING
5	Understands speech in most situations, BUT has difficulties in groups or when fatigued	Reads books and magazine articles, BUT does not understand details
10	Understands speech in one to one situations, BUT cannot cope in group situations	Can get the gist of simple articles, for example newspapers, but has great difficulty with details
20		Restricted to simple sentences
25	Understands simple sentences although repetition is sometimes needed
30		Able to read single words only
35		Unable to read at all
40	Able to understand single words only
50	Unable to understand any language

* Note:Hearing refers to the ability to comprehend spoken language ie. with the ability to interpret auditory signals not to receive such signals. It does not refer to hearing impairment which is assessed using Table 7.1.

Table 12.3 - Communication Disorders - Expression

% WPI	CRITERIA VERBAL	CRITERIA WRITTEN
5	Can sustain conversation, BUT has minor word retrieval problems and/or hesitancy	Can write simple letters, BUT cannot write complex documents
10	Can converse in simple sentences only and may have difficulty with word finding and expressing complex ideas	Can write postcards and letters of about 5 lines (spelling and grammatical errors may be apparent, BUT cannot write longer documents
15		Can write only short simple sentences (spelling errors may be evident)
20	Only able to respond in short sentences or phrases	Cannot write sentences, BUT can write single words
25		Able to write or copy only a family sequence of letters, for example own name OR
25		Unable to write at all
30	Limited to single words and/or social or stereotyped phrases
35	No useful speech (includes unintelligible speech and speech limited to swearing)

Cognitive Function

Notes:Cognitive function has two components - memory and reasoning ability. These functions are affected where there is neurological damage eg, from head injury, cerebro-vascular accident etc. Difficulties with memory or reasoning ability consequent to some other process eg, psychiatric illness should not be assessed using these tables. Instead Table 5.1 [Psychiatric Conditions] should be used.

Table 12.4 - Cognitive Function - Memory

% WPI	CRITERIA MEMORY
0	No appreciable effect. Reliance on notes, lists etc is comparable to others of same age and lifestyle
10	Difficulties with names and appointments and tends to misplace objects. There may be partial compensation by reliance on notes, lists, diaries or other people
25	Failure to keep appointments or fulfil other obligations despite use of memory aids AND Difficulties recalling details of recent events AND Tendency to get lost in non familiar surroundings
40	Signs similar in range to previous category but greater in extent AND Some supervision by another necessary
60	Unable to recall recent events or experiences AND Constant supervision necessary to avoid harm resulting in inability to live independently
70	As in previous category but may be of greater severity AND Disorientation in familiar surroundings AND Inability to recognise familiar faces or objects

Notes:Assessment should be carried out by a neurologist or clinical psychologist.

Table 12.5 - Cognitive Function - Reasoning

% WPI	CRITERIA REASONING
0	Abilities intact
10	Able to cope with routine activities and situations but experiences minor difficulties in new situations
25	Still able to cope with routine activities but has moderate difficulties in new situations AND Complex decision making and abstract thinking are affected
40	Major difficulties in new situations AND Difficulties with routine activities and problems becoming manifest AND Complex decision making and abstract thinking seriously affected
60	Major difficulties in carrying out routine daily activities Perseverative thinking may be evident
70	Needs prompting and assistance with even the simplest activities

Notes:Assessment is carried out by examining the degree of interference with the ability to plan and carry out tasks involving a number of steps, ability to solve problems and make decisions which involve the examination of new and old material, ability to think in abstract terms eg, interpret proverbs. Generally complex tasks and decisions will be first affected as will decisions involving unfamiliar factors. Assessment should be carried out by a neurologist or clinical psychologist.

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