3.6.3.70 Guidelines to Table 7 - Brain Function

Explanation: Where a person meets the required descriptors for 5 points but does not meet sufficient required descriptors for 10 points, the correct impairment rating is 5 points. Their impairment CANNOT be assessed as moderate, severe or extreme and neither 10, 20 nor 30 points can be allocated.

Example 1: A 58 year old woman was diagnosed with post-herpetic neuralgia following an episode of shingles 2 years ago. She suffers from frequent burning pain in the affected dermatome which covers part of the back of the right forearm and hand. Symptoms persist despite extensive treatment from her neurologist and the chronic pain clinic. Sleep may be affected and her medical records state there is a moderate impact on attention and concentration as a result of chronic pain. She continues long-term treatment with gabapentin and nortriptyline and takes oxycodone as required. Non-narcotic analgesics had no beneficial effect on pain. She has difficulty using a pen, doing up buttons, unscrewing the lid on a bottle and picking up 1L of liquid. She requires occasional assistance from her partner to complete some daily tasks due to impaired concentration. The condition is considered fully diagnosed, treated and stabilised. This person would receive an impairment rating of 10 points under Table 7, due to the moderate impact her condition of chronic neuropathic pain and its treatment has on her cognitive function and the resulting assistance required. Under the 10-point descriptor she meets (1)(b). The difficulties with using the affected upper limb led to a rating of 10 impairment points under Table 2, meeting descriptors (1)(a), (c), (d) and (f).

Example 2: A 20 year old male has a diagnosed permanent condition of ASD. The medical evidence outlines that as a result of his condition he has occasional difficulty controlling his behaviour in routine situations. For example, when grocery shopping, he can lose his temper for minor reasons including a shop assistant misunderstanding him. He has difficulties engaging in social interactions, often missing nonverbal cues, talking over others, taking things literally and struggling to empathise with others. He lacks self-awareness of the extent of his difficulties in these circumstances. This person has undergone an assessment of intellectual functioning and has above average intelligence. He is particularly skilled in the area of computer programming and can become entrenched in such activity at the expense of other tasks. While he lives alone, his mother needs to visit a couple of times per week to ensure he attends to his household duties, providing assistance with household shopping, cleaning and bill paying. The condition is considered fully diagnosed, treated and stabilised. This person would receive an impairment rating of 10 points under Table 7, due to the moderate impact his condition of ASD has on his ability to function and his resultant need for occasional assistance. Under the 10-point descriptor he would meet both (1)(h) and (j). He would not be rated under Table 9 as he does not present with low intellectual function.

Example 3: A 27 year old woman suffers from regular migraines. She was first diagnosed with this condition at around 8 years of age and her migraines have significantly impacted her functioning for almost 20 years. The condition has responded poorly to the past preventative and acute episode treatments recommended by her neurologist, and is not expected to significantly improve within the next 2 years. This woman experiences unpredictable severe migraines approximately once or twice a fortnight. These migraines leave her bedridden for periods of between 6- 24 hours. She prefers to live with her parents, as she needs occasional assistance from her parents, especially when she is having an acute episode. She is unable to reliably plan to attend future events, due to the unpredictable nature of her migraines. When she is having an acute migraine, she is unable to concentrate and is unable to tolerate bright light or loud noises. In between migraine episodes she is able to concentrate and problem solve without any functional impairment. Past attempts at working full-time have been short lived due to absences as a result of her symptoms.

The condition is considered fully diagnosed, treated and stabilised. This is an episodic condition and she is severely impaired during the acute episode and recovery period, but at other times she can function normally. This person would receive an impairment rating of 10 points under Table 7 due to the overall moderate functional impact of the migraines and her need for occasional assistance and supervision. Under the 10 point descriptor she would meet (1)(b) and (d).

Example 4: A 62-year-old male had a right cerebral infarct and they presented with a left sided hemiplegia. He spent 2 weeks in an acute stroke unit where it was observed that he would often forget to put his left arm into a sleeve, ignore visitors seated to his left, only ate the food on the right hand side of his plate and would bump into walls on his left when the physiotherapist was performing mobility rehabilitation. The neurologist asked him to draw a clock and he only drew the right side, so a left sided spatial neglect was diagnosed. He was transferred to a stroke rehabilitation unit where he spent the next 2 months. With appropriate rehabilitation, the left sided neglect improved, although he still had to be reminded about looking to the left.

Six months after the stroke the neurologist reported that there had been some improvement in the left sided neglect and further significant improvement was unlikely within the next 2 years. When he was asked to draw a clock they drew the entire clock, but with more detail on the right side. The man tended to walk close to the wall on the left, as he was fearful of bumping into objects or people on that side that he had failed to notice and his partner usually accompanied him when he left the house. His partner had to frequently remind him to comb his hair and brush his teeth on his left side. He was unable to have a driving licence, as the neurologist considered that he would not be safe when making turns to the left and using roundabouts. He also had trouble following directions. His partner received a carer payment, as he required frequent assistance and supervision. He made a claim for a DSP several weeks after the 6-month review by the neurologist.

The spatial neglect is considered to be fully diagnosed, treated and stabilised, as the neurologist said that no significant functional improvement was expected within the next 2 years. This person would receive a 20 point rating under Table 7 due to the severe functional impact of the spatial neglect. He needs daily assistance and supervision, and met the descriptor (g) for visuo-spatial function at the 20-point impairment level.

Example 5: A 32-year-old man fell off a stepladder and hit his head on a concrete driveway. He was unconscious when the ambulance arrived and spent the following 24 hours in a coma. He had sustained an extensive frontal lobe intracerebral haematoma. He spent 4 weeks in an acute neurosurgical unit and was then transferred to a brain injury rehabilitation unit. He had a further 3 months of inpatient rehabilitation and was then discharged to his parents' home. The rehabilitation medicine discharge summary stated that he had had a severe traumatic brain injury (TBI). He continued with appropriate outpatient rehabilitation. Six months after the accident, he made an application for a DSP. His rehabilitation medicine specialist reported that there may be a slight improvement over the next 2 years, but any improvement was unlikely to be significant. This was consistent with the initial severe injury. He continued to live with his parents and would be unable to live independently. He needed frequent assistance and supervision on a daily basis:

• He needed to be reminded verbally about appointments, even though he kept a diary and appointments were listed on a calendar.
• He could not be trusted to cook their own meals, as they forgot to turn off the gas burners and used metal bowls in the microwave.
• His parents had to assist with his financial management and were his Centrelink nominees.
• He was unable to plan a visit to a friend or what to buy them for a birthday present.
• He was unable to follow basic instructions on using a computer and could not complete even basic tasks such as reading emails. He was also easily distracted after more than about 10 minutes.
• If he got frustrated he often responded with verbal abuse.
• He could not understand why he was no longer able to drive the family car and could become very irritable about this.

The TBI is considered to be fully diagnosed, treated and stabilised, as the rehabilitation medicine specialist said that no significant functional improvement was expected within the next 2 years. This person would receive a 20-point rating under Table 7 due to the severe functional impact of their TBI. He needs daily assistance and supervision, and while only one descriptor needs to be met, the following descriptors (a), (b), (c), (d), (e), (f), (h) and (j) were met at the 20-impairment point level.