1. Walking on level ground with a walking stick or other aid if such aid is normally used.
| 1.—(a) Cannot walk at all.
| 15 |
| (b)Cannot walk more than a few steps without stopping or severe discomfort.
| 15 |
| (c)Cannot walk more than 50 metres without stopping or severe discomfort.
| 15 |
| (d)Cannot walk more than 200 metres without stopping or severe discomfort.
| 7 |
| (e)Cannot walk more than 400 metres without stopping or severe discomfort.
| 3 |
| (f)Cannot walk more than 800 metres without stopping or severe discomfort.
| 0 | | (g)No walking problem.
| 0 |
2. Walking up and down stairs.
| 2.—(a) Cannot walk up and down one stair.
| 15 |
| (b)Cannot walk up and down a flight of 12stairs.
| 15 |
| (c)Cannot walk up and down a flight of 12 stairs without holding on and taking a rest.
| 7 |
| (d)Cannot walk up and down a flight of 12 stairs without holding on.
| 3 |
| (e)Can only walk up and down a flight of 12 stairs if he goes sideways or one step at a time.
| 3 |
| (f)No problem in walking up and down stairs.
| 0 |
3. Sitting in an upright chair with a back, but no arms.
| 3.—(a) Cannot sit comfortably.
| 15 |
| (b)Cannot sit comfortably for more than IO minutes without having to move from the chair.
| 15 |
| (c)Cannot sit comfortably for more than 30 minutes without having to move from the chair.
| 7 |
| (d)Cannot sit comfortably for more than 1 hour without having to move from the chair.
| 3 |
| (e)Cannot sit comfortably for more than 2 hours without having to move from the chair.
| 0 |
| (f)No problem with sitting.
| 0 |
4. Standing without the support of another person or the use of an aid except a walking stick.
| 4.—(a) Cannot stand unassisted.
| 15 |
| (b)Cannot stand for more than a minute before needing to sit down.
| 15 |
| (c)Cannot stand for more than IO minutes before needing to sit down.
| 15 |
| (d)Cannot stand for more than 30 minutes before needing to sit down.
| 7 |
| (e)Cannot stand for more than IO minutes before needing to move around.
| 7 |
| (f)Cannot stand for more than 30 minutes before needing to move around.
| 3 |
| (g)No problem standing.
| 0 |
5. Rising from sitting in an upright chair with a back but no arms without the help of another person.
| 5.—(a) Cannot rise from sitting to standing.
| 15 |
| (b)Cannot rise from sitting to standing without holding on to something.
| 7 |
| (c)Sometimes cannot rise from sitting to standing without holding on to something.
| 3 |
| (d)No problem with rising from sitting to standing.
| 0 |
6. Bending and kneeling.
| 6.—(a) Cannot bend to touch his knees and straighten up again.
| 15 |
| (b)Cannot bend or kneel as if to pick up a piece of paper from the floor and straighten up again.
| 15 |
| (c)Sometimes cannot bend or kneel as if to pick up a piece of paper from the floor and straighten up again.
| 3 |
| (d)No problem with bending and kneeling.
| 0 |
7. Manual dexterity.
| 7.—(a) Cannot turn the pages of a book with either hand.
| 15 |
| (b)Cannot turn a tap or control knobs on a cooker with either hand.
| 15 |
| (c)Cannot pick up a coin which is 2.5 centimetres or less in diameter with either hand.
| 15 |
| (d)Cannot use a pen or pencil.
| 15 |
| (e)Cannot tie a bow in laces or string.
| 10 |
| (f)Cannot turn a tap or control knobs on a cooker with one hand.
| 6 |
| (g)Cannot pick up a coin which is 2.5 centimetres or less in diameter with one hand.
| 6 |
| (h)No problem with manual dexterity.
| 0 |
8. Lifting and carrying.
| 8.—(a) Cannot pick up a paperback book with either hand.
| 15 |
| (b)Cannot pick up and carry a 0. 5 litre carton of milk with either hand.
| 15 |
| (c)Cannot pick up and pour from a full saucepan or kettle of 1.7 litre capacity with either hand.
| 15 |
| (d)Cannot pick up and carry a 2.5 kilogramme bag of potatoes with either hand.
| 8 |
| (e)Cannot pick up and carry a 0. 5 litre carton of milk with one hand.
| 6 |
| (f)Cannot pick up and carry a 2.5 kilogramme bag of potatoes with one hand.
| 0 |
| (g)No problem with lifting and carrying.
| 0 |
9. Reaching.
| 9.—(a) Cannot raise either arm to put something in the top pocket of a coat or jacket.
| 15 |
| (b)Cannot raise either arm to his head to put on a hat.
| 15 |
| (c)Cannot put either arm behind his back to put on a coat or jacket.
| 15 |
| (d)Cannot raise either arm above his head to reach for something.
| 15 |
| (e)Cannot raise one arm to his head to put on a hat.
| 6 |
| (f)Cannot raise one arm above his head to reach for something.
| 0 |
| (g)No problem with reaching.
| 0 |
10. Speech.
| 10.—(a) Cannot speak.
| 15 |
| (b)Speech cannot be understood by family or friends.
| 15 |
| (c)Speech cannot be understood by strangers.
| 15 |
| (d)Strangers have great difficulty understanding speech.
| 10 |
| (e)Strangers have some difficulty understanding speech.
| 8 |
| (f)No problem with speech.
| 0 |
11. Hearing with a hearing aid or other aid if normally worn.
| 11.—(a) Cannot hear sounds at all.
| 15 |
| (b)Cannot hear well enough to follow a television programme with the volume turned up.
| 15 |
| (c)Cannot hear well enough to understand someone, talking in a loud voice in a quiet room.
| 15 |
| (d)Cannot hear well enough to understand someone talking in a normal voice in a quiet room.
| 10 |
| (e)Cannot hear well enough to understand someone talking in a normal voice on a busy street.
| 8 |
| (f)No problem with hearing.
| 0 |
12. Vision in normal daylight or bright electric light with glasses or other aid to vision if such aid is normally worn.
| 12.—(a) Cannot tell light from dark.
| 15 |
| (b)Cannot see the shape of furniture in the room.
| 15 |
| (c)Cannot see well enough to read 16 point print at a distance greater than 20 centimetres.
| 15 |
| (d)Cannot see well enough to recognise a friend across the room.
| 12 |
| (e)Cannot see well enough to recognise a friend across the road.
| 8 |
| (f)No problem with vision.
| 0 |
13. Continence.
| 13.—(a) No voluntary control over bowels.
| 15 |
| (b)No voluntary control over bladder.
| 15 |
| (c)Loses control of bowels at least once a week.
| 15 |
| (d)Loses control of bowels at least once a month.
| 15 |
| (e)Loses control of bowels occasionally.
| 9 |
| (f)Loses control of bladder at least once a month.
| 3 |
| (g)Loses control of bladder occasionally.
| 0 |
| (h)No problem with continence.
| 0 |
14. Remaining conscious other than for normal periods of sleep.
| 14.—(a) Has an involuntary episode of lost or altered consciousness at least once a day.
| 15 |
| (b)Has an involuntary episode of lost or altered consciousness at least once a week.
| 15 |
| (c)Has an involuntary episode of lost or altered consciousness at least once a month.
| 15 |
| (d)Has had an involuntary episode of lost or altered consciousness at least twice in the 6 months before the day in respect of which it falls to be determined whether he is incapable of work for the purposes of entitlement to any benefit, allowance or advantage.
| 12 |
| (e)Has had an involuntary episode of lost or altered consciousness once in the 6 months before the day in respect of which it falls to be determined whether he is incapable of work for the purposes of entitlement to any benefit, allowance or advantage.
| 8 |
| (f)Has had an involuntary episode of lost or altered consciousness once in the 3 years before the day in respect of which it falls to be determined whether he is incapable of work for the purposes of entitlement to any benefit, allowance or advantage.
| 0 |
| (g)No problem with consciousness.
| 0 |
