Schedule 1 Criteria for benefits for attendant care services
regulations 4E and 4F
1 Spinal cord injury
Injury Acute traumatic lesion of the neural elements in the spinal canal (spinal cord and cauda equina)
Criteria The injury has resulted in:
(a) a permanent neurological deficit – determined in accordance with the ISNCSCI classification tool and evidenced by a score of A to D on the ASIA Scale at the date of assessment; or
(b) significant residual impact on the functioning of the person's autonomic nervous system (with particular reference to resultant bladder and bowel dysfunction) – evidenced by a score of 0 in any of the elements of the ISAFSCI assessment tool.
Definitions
In this item:
"ASIA" means the American Spinal Injury Association.
"ASIA Scale" means the American Spinal Injury Association Impairment Scale published by the ASIA.
"ISAFSCI" assessment tool means the International Standards to document remaining Autonomic Function after Spinal Cord Injury assessment tool.
"ISNCSCI classification tool" means the International Standards For Neurological Classification of Spinal Cord Injury classification tool published by the ASIA.
2 Brain injury
Injury Traumatic brain injury
Criteria
1 If the eligible person is 8 or more years of age at the date of assessment – the injury has resulted in the eligible person:
(a) having either of the following:
(i) 7 days or more of post-traumatic amnesia – measured using a recognised PTA scale;
(ii) a significant brain imaging abnormality; and
(b) having a score of 5 or less on any item in the FIM Guide at the date of assessment.
2 If the eligible person is 3 or more, but less than 8, years of age at the date of the assessment – the injury has resulted in the eligible person:
(a) having one of the following:
(i) a score of less than 9 on the Glasgow Coma Scale – assessed within 24 hours of the motor accident;
(ii) 7 days or more of post-traumatic amnesia – measured using a recognised PTA scale;
(iii) a significant brain imaging abnormality; and
(b) having a score of at least 2 less than the age norm for the eligible person on any item on the WeeFIM Instrument at the date of assessment.
3 If the eligible person is less than 3 years of age at the date of the assessment – as a result of the injury, the person will probably have a permanent impairment which will have a significant adverse impact on their normal development, as determined by a medical practitioner specialising in paediatric rehabilitation.
Definitions
In this item:
"FIM Guide" means the FIM™ (Guide for the Uniform Data Set for Medical Rehabilitation) published by the Uniform Data System for Medical Rehabilitation.
"Glasgow Coma Scale" means the Glasgow Coma Scale published by Teasdale and Jennett.
"recognised PTA scale" means the Westmead Post Traumatic Amnesia Scale published by the Westmead Hospital or a similar clinically accepted, validated scale for post-traumatic amnesia.
"WeeFIM Instrument" means the WeeFIM® Instrument published by the Uniform Data System for Medical Rehabilitation.
3 Amputations
Injury Amputation or injury equivalent to an amputation
Criteria The injury is one of the following:
(a) brachial plexus avulsion or rupture that is equivalent to an amputation;
(b) single forequarter amputation;
(c) single shoulder disarticulation;
(d) single amputation of lower limb at or above 65% of femur;
(e) 2 or more of the following:
(i) amputation of lower limb at or above 50% of tibia;
(ii) amputation of upper limb at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.
Measurement procedure for amputations
Percentage loss of length of tibia or femur is:
(a) to be calculated:
(i) using pre- and post-amputation x-ray imaging; or
(ii) if x-ray imaging is not available – by comparison of length of amputated tibia or femur and length of contralateral tibia or femur; or
(b) if calculation under paragraph (a) is not possible in respect of tibia amputation, the percentage loss of length of the tibia is taken to be 50% of tibial length calculated from estimated knee height (based on the person's total height prior to the motor accident).
Definition
In this item:
"forequarter amputation" means amputation of the humerus, scapula and clavicle.
4 Burns
Injury Burns
Criteria
1 For this item, the criteria in clauses 2 and 3 must be satisfied.
2 One of the following as evidenced by a burn impact score of 50 points on a recognised burns scale:
(a) full thickness burns to:
(i) if the person is more than 16 years of age at the date of the motor accident – at least 40% of the body; or
(ii) if the injured person is aged 16 years of age or less at the date of the motor accident – 30% of the body;
(b) permanent inhalation burns causing long-term significant respiratory impairment;
(c) full thickness burns to the hands, face or genital area.
3 The injury has resulted in the person:
(a) if the person is 8 or more years of age at the date of the assessment – having a score of 5 or less on one or more items in the FIM Guide at the date of assessment; or
(b) if the person is 3 or more, but less than 8, years of age at the date of the assessment – having a score of at least 2 less than the age norm on any item on the WeeFIM Instrument at the date of assessment; or
(c) if the person is less than 3 years of age at the date of the assessment – the person will probably have permanent impairment due to the burns resulting in significant adverse impact on their normal development, as certified by a medical practitioner specialising in paediatric rehabilitation.
Definitions
In this item:
"FIM Guide" means the FIM™ (Guide for the Uniform Data Set for Medical Rehabilitation) published by the Uniform Data System for Medical Rehabilitation.
"recognised burns scale" means the Greenwood Burns Scale published by the Royal Adelaide Hospital or a similar clinically accepted, validated scale for burns.
"WeeFIM Instrument" means the WeeFIM® Instrument published by the Uniform Data System for Medical Rehabilitation.
5 Blindness
Injury Blindness
Criteria Permanent blindness as evidenced by any of the following:
(a) visual acuity on the Snellen Scale after correction by suitable lenses is less than 6/60 in both eyes;
(b) field of vision is constricted to 10 degrees or less of arc around central fixation in the better eye, irrespective of corrected visual acuity (equivalent to 1/100 white test object);
(c) a combination of visual defects resulting in the same degree of visual loss as that mentioned in paragraph (a) or (b).