Handitest

Un instrument d’analyse et de mesure
du handicap en quatre dimensions

Selon le Système d’Identification et
de Mesure du Handicap « S.I.M.H. »
(Paris, Porto, Montréal, Tunis,
Jérusalem, Padoue, Belgrade)

Versions arabophone et kabyle (tamazight)

Handicap/Disability Identification
and Measurement System

An international proposal for the quantified identification of disabilities (DIMS)

English translation by Edna Gregg, anthropologist, Ethical medicine and Forensic Department (Profesor Christian Hervé, University Paris-Descartes).

Claude Hamonet
MD, Phd. (Social Anthropology), Emerital Professor of Physical Medicine and Rehabilitation at the Faculty of Medicine, University Paris East Créteil (UPEC), Expert Consultant to the French Cour de Cassation.

Teresa Magalhaes
Professor of Forensic Medicine at the faculty of Medicine of the University of Oporto (Portugal).
Doctor in Forensics at the Insitute of Forensic Medicine of Oporto.

With the contribution of Marie de Jouvencel, neuro-psychologist.

Click here for a direct access to the Handitest

INTRODUCTION

A four dimensional concept

The body, functional capacity, life situations and individal subjectivity

Twenty years of applied research in a university setting has enabled us to work out a new proposal for defining handicap and identifying handicapped persons. Such a proposal allows for a better understanding of their needs in terms of providing appropriate rehabilitation and retraining care programmes.

Our objectives are to:

define all those constituent parts which make up handicap
quantify all these elements
to highlight all the needs of handicapped persons in order to respond with the most appropriate rehabilitation programmes.

We are not a classificatory system of disability (which could be stigmatising) but a system of identification which includes the full recognition of the person as a human being and a citizen within a specific social context. The system allow for the needs (the requirements) and the response (the offer) to be known and evaluates the results in terms of well-being, social integration and participation in social life. Four levels have been clearly defined: the body, aptitudes, life situations and personal subjectivity (Figure 1)

1) THE BODY: this level encompasses all the biological aspects of the human body in terms of its morphological, anatomical, histological, physiological and genetic aspects (Figure 2).

2) APTITUDES AND CAPACITIES: This level comprises the physical and mental functions of the human body, (actual and potential), taking into account the age and sex of the individual, irrespective of (independently of) the environment in which he/she lives.

3) LIFE SITUATIONS: This level addresses the confrontation (concrete or not) where a person is faced with the reality of the physical, social and cultural environment. The situations encountered are: all those daily situations whether they be within the family, in the field of education, work and leisure and all such other activities as charitable work, religious and other community activities included in the framework of social participation.

4) SUBJECTIVITY: This level addresses the person’s point of view regarding his/her health status and social position and includes their personal life histories.Within this context are considered all those subjective elements which may compromise, reduce or suppress a person’s equilibrium in daily life. It reveals how persons have dealt emotionally with traumatic events (the manner in which handicap appears and evolves, learning about and coming to terms with handicap, adapting to and living with their new condition.)

All these levels interact. It is precisely the interaction between these four levels which lead to (or not) to situations of handicap. (Figure 3). Certain changes in the body, due to pathology (illness or trauma) or physiological changes (the effects of age, pregnancy,…) may bring about limitations in aptitudes and capacitites. One sees thus that pathological changes are not the only causes of handicap.

Limitations in capacity and aptitude (real or supposed/imaginary), specific to each individual may result from changes in the body, but may also result fom changes in the person’s perception of his/her self.

Figure 1: The person

GENOME

Histology Physiology Anatomy Morphology

Figure 2: The body

Handicap appears each time that a person encounters, at a given moment, an obstacle (partial or total) which renders him/her incapable of accomplishing one or a number of his/her activities. These obstacles may be the result (consequence) of changes in the body, aptitudes, or his/her subjectivity. Equally obstacles may include situations which put the individual under particular stress which dis-enable the individual either completely or partially.

Figure 3: Conceptual scheme

These concepts concern all categories of persons who may find themselves in situations of handicap. Taken together the objective of these concepts is not to “lock in” the definition of handicap within a purely medical approach, but to “open up” this concept to embrace the organisation and integration into social, family, professional life. The “positive” character of this definition as opposed to a stigmatising one is thus emphasized.

AN IDENTIFICATORY SYSTEM OF HANDICAP (Disability)

This system of identification conforms with the four levels which have been defined in the previous chapter.

1) The body and bodily changes

Definition
This level comprises all those biological aspects of the human body, including morphological, anatomical, histological, physiological and genetic aspects.
Certain changes to the body of a pathological origin (illness or trauma) or of a physiological nature (e.g. ageing, pregnancy…) may engender limitations in functional capacity. Pathological causes are not the only source of potential handicap.

Quantitative Scale of Changes to the Body
0	No change
1	Minimal Change
2	Relatively important change
3	Important change
4	Very important change

	0	1	2	3	4
1.1. SEGMENTARY SYSTEMS
1.1.1. Head
*1.1.1.1. Cutaneous (skin covering) layer and “phaneres”.*
*1.1.1.2. Bone and occipito-cervical joints.*
*1.1.1.3. Nerves*
*1.1.1.4. Vessels*
*1.1.1.5. Central nervous system (brain, cervical trunk…)*
*1.1.1.6. Hypophyse (¿)*
*1.1.1.7. Ear*
1.1.1.7.1. Right ear
1.1.1.7.2. Left ear
*1.1.2. Face (¿)*
*1.1.2.1. Cutaneous covering (layer) (skin covering) and phaneres (¿)*
*1.1.2.2. Muscles*
*1.1.2.3. Bones and joints*
*1.1.2.4. Nerves*
*1.1.2.5. Vessels*
*1.1.2.6. Parotides (¿) and channels of Stenon (¿)*
1.1.2.6.1.Right
1.1.2.6.2. Left
1.1.2.7. Eye
1.1.2.7.1. Right eye
1.1.2.7.2. Left eye
*1.1.2.8. Mouth cavity (including the tongue and sub-maxillary glands)*
*1.1.2.9. Nasal cavities*
1.1.3. Neck
*1.1.3.1. Skin*
*1.1.3.2. Muscles and tendons*
*1.1.3.3. Bones and joints (cervical rachis (¿)*
*1.1.3.4. Nerves (rootes and cervical plexus)*
*1.1.3.5. Spine Marrow (bone) (¿)*
*1.1.3.6. Vessels*
*1.1.3.7. Digestive tract*
*1.1.3.8. Airways*
*1.1.3.9. Vocal cords*
*1.1.3.10. Endocrine glands*
1.1.4. Thorax
*1.1.4.1. Skin covering (cutaneous layer)*
*1.1.4.2. Mammary glands*
*1.1.4.3. Muscles*
*1.1.4.4. Bones and joints*
*1.1.4.5. Dorsal spine(¿)*
*1.1.4.6. Thoracic cage (¿)*
*1.1.4.7. Roots and nervous trunks*
*1.1.4.8. Marrow*
*1.1.4.9. Heart*
*1.1.4.10. Vessels*
*1.1.4.11. Diaphragm*
*1.1.4.12. Respiratory apparatus*
*1.1.4.13 Digestive tract*
1.1.5.1. Abdomen and lumbar region
*1.1.5.1. Cutaneous covering*
*1.1.5.2. Muscles and tendons*
*1.1.5.3. Bones and joints (lumbar rachis ¿)*
*1.1.5.4. Nerves and nervous trunkcs (roots, lumbar plexus)*
*1.1.5.5. Marrow*
*1.1.5.6. Vessels*
*1.1.5.7. Digestive tract*
*1.1.5.8. Liver and biliary passages*
*1.1.5.9. Pancreas*
*1.1.5.10. Urinary system*
*1.1.5.11 Surrrenales (¿)*
*1.1.5.12. Spleen*
1.1.6. Pelvis and Perineum
*1.1.6.1. Cutaneous covering*
*1.1.6.2. Muscles*
*1.1.6.3. Bones and joints*
*1.1.6.4. Nerves (roots, solar plexus and nervous trunks (¿)*
*1.1.6.5. Vessels*
*1.1.6.6. Digestive tract*
*1.1.6.7. Urinary system*
*1.1.6.8. Sexual system*
1.1.7. Upper right limb
*1.1.7.1. Shoulder and arm*
1.1.7.1.1. Cutaneous covering
1.1.7.1.2. Muscles and tendons
1.1.7.1.3. Bones and joints
1.1.7.1.4. Root (Brachial plexus and nervous trunks?)
1.1.7.1.5. Vessels
1.1.7.2. Elbow and fore-arm
1.1.7.2.1 Cutaneous covering
1.1.7.2.2. Muscles and tendons
1.1.7.2.3. Bones and joints
1.1.7.4. Nerves
1.1.7.5. Vessels
1.1.7.3. Wrist, hand and fingers
1.1.7.3.1. Cutaneous covering
1.1.7.3.2. Muscles and tendons
1.1.7.3.3 Bones and joints
1.1.7.3.4 Nerves
1.1.7.3.5 Vessels
1.1.8. Upper left limb
1.1.8.1. Shoulder and arm
1.1.8.1.1. Cutaneous covering
1.1.8.1.2. Muscles and tendons
1.1.8.1.3. Bones and joints
1.1.8.1.4 Nerves (brachial plexus and nerve trunks)
1.1.8.1.5. Vessels
1.1.8.2. Elbow and fore-arm
1.1.8.2.1. Cutaneous covering
1.1.8.2.2. Muscles and tendons
1.1.8.2.3. Bones and joints
1.1.8.2.4. Nerves
1.1.8.2.5. Vessels
1.1.8.3. Wrist, hand and fingers
1.1.8.3.1. Cutaneous covering
1.1.8.3.2. Muscles and tendons
1.1.8.3.3. Bones and joints
1.1.8.3.4. Nerves
1.1.8.3.5. Vessels
1.1.9. Lower right limb
*1.1.9.1. Haunch and thigh*
1.1.9.1.1. Cutaneous covering
1.1.9.1.2. Muscles and tendons
1.1.9.1.3. Bones and joints
1.1.9.1.4. Nerves (roots, solar plexus, crural plesux?)
1.1.9.1.5 Vessels
1.1.9.2 Knee and leg
1.1.9.2.1. Cutaneous covering
1.1.9.2.2. Muscles and tendons
1.1.9.2.3. Bones and joints
1.1.9.2.4. Nerves
1.1.9.2.5 Vessel
*1.1.9.3 Ankle, foot and toes*
1.1.9.3.1. Cutaneous covering
1.1.9.3.2. Muscles and tendons
1.1.9.3.3. Bones and joints
1.1.9.3.4 Nerves
1.1.9.3.5 Vessels
1.1.10 Lower left limb
1.1.10.1. Haunch and thigh
1.1.10.1.1 Cutaneous covering
1.1.10.1.2. Muscles and tendons
1.1.10.1.3 Bones and joints
1.1.10.1.4.Nerves (roots, solar plexus and crucal plexus ¿)
1.1.10.1.5. Vessels
*1.1.10.2. Knee and leg*
1.1.10.2.1. Cutaneous covering
1.1.10.2.2. Muscles and tendons
1.1.10.2.3 Bones and joints
1.1.10.2.4 Nerves
1.1.10.2.5. Vessels
*1.1.10.3. Ankle, foot and toes*
1.1.10.3.1. Cutaneous covering
1.1.10.3.2. Muscles and tendons
1.1.10.3.3 Bones and joints
1.1.10.3.4. Nerves
1.1.10.3.5. Vessels
1.2. General systems
1.2.1. Height
1.2.2. Weight
1.2.3 Hydro-electrolytic balance and regulation
1.2.4 Metabolic regulations
1.2.5 Thermoregulation
1.2.6 Regulation of arterial pressure
1.2.7 Regulation of adaptation to stress
1.2.8 Growth regulation and development
1.2.9 Neurovegetative system
1.2.10 Hematopoic system
1.2.11 Immune system
1.2.12 Genome

2) Aptitudes and abilities (capacity)

Definition
This level includes physical and mental functions (actual or potential) of a human being, taking into consideration the person’s age and sex, independent of the environment in which he/she lives.
Limitations to abilities and aptitudes (real or imaginary) specific to each individual, can be the result of changes in the body but may also result from a person’s changed perception of him/herself.

Quantitative scale of abilities and aptitudes
0	No limitation in function ability
1	Discomfort or hindrance withouth any being able to objectify the limitation
2	Functional limitation requiring the use of a technical aid, whether medical or animal
3	Functional limitation requires partial recourse for assistance from another person
4	Incapacity or complete reliance on human assistance

	0	1	2	3	4
2.1. POSTURAL MAINTENANCE
2.1.1 To hold up one’s head
2.1.2 To stand upright
2.1.2.1 On both lower limbs
2.1.2.2 On one lower limb
2.1.2.2.1 the right leg
2.1.2.2.2 the left leg
2.1.3. To be able to sit up
2.1.3.1 Legs hanging
2.1.3.2 Legs crossed ( “en tailleur”)
2.1.4 To be able to hold oneself in a lying position
2.1.4.1 on the stomach
2.1.4.2 on the back
2.1.4.3 on one side
2.1.4.3.1 right side
2.1.4.3.2 left side
2.1.5 To be able to hold oneself in a kneeling position
*2.1.5.1 Haunch held upright*
*2.1.5.2 Sitting on one’s heels*
2.1.6 To hold oneself in a crouching or squatting position
2.1.7 To hold onself on all four limbs (“on all fours”)
2.2. CHANGES IN POSITION
2.2.1 To be able to turn round when in a lying position
*2.2.1.1. On one’s back – on one’s side*
*2.2.1.2. On one’s stomach – on one’s stomach*
*2.2.1.3. on one’s side – on one’s back*
*2.2.1.5 on one’s back - on one’s stomach*
2.2.2. To move from a lying position to a sitting position
2.2.3 To move from a sitting position to a lying position
2.2.4 To move from a lying position to a standing position
2.2.5 To move from a standing position to a lying position
2.2.6 To move from a standing position to a sitting position
*2.2.6.1 Legs hanging*
*2.2.6.2 Legs folded (en tailleur?)*
2.2.7. To move from a sitting position to a standing position
2.2.8 To move from a standing position to a kneeling position
2.2.9 To move from a kneeling position to a standing position
2.2.10 To move from a standing position to a squatting position
2.2.11 To move from a squatting position to a standing position
2.2.12 To move from a lying position to a position on all fours
2.2.13 To get up from the floor
2.3 MOVEMENTS (walking with or without support such as a chair)
2.3.1 To walk or move forwards
2.3.2 To walk of move backwards
2.3.3 To walk or to move sideways
*2.3.3.1 on the right side*
*2.3.3.2 on the left side*
2.3.4. To advance whilst hopping (skipping)
*2.3.4.1 on both feet*
*2.3.4.2 on one foot*
2.3.4.2.1. the right foot
2.3.4.2.2 the left foot
2.3.5 To do a half circle
2.3.5.1 towards the right
2.3.5.2 towards the left
2.3.6 to move on one’s knees
2.3.7 to move on all fours
2.3.8 to crawl
2.3.9 to roll one’s body to one side
*2.3.9.1 towards the right side*
*2.3.9.2 towards the left side*
2.3.10 To roll one’s body forward (to do a “galipette”)
2.3.11 To run or to move rapidly
2.3.12 To jump
2.3.12.1 on both feet
2.3.12.2 on the right foot
2.3.12.3 on the left foot
2.3.13 to lift one’s foot (“to stride”)
*2.3.13.1 to the right*
*2.3.13.2 to the left*
2.3.14 The ability not to fall
2.4. PREHENSION (¿)
2.4.1 To position/move an upper limb and a hand in space
2.4.1.1. forwards
2.4.1.2. backwards
2.4.1.3. upwards
*2.4.1.4. downwards*
*2.4.1.5 towards the right*
*2.4.1.6 towards the left*
2.4.2 To grasp (to take)
*2.4.2.1 To grasp with the right hand*
2.4.2.1.1 To grasp between the column(¿) of the thumb and another finger
2.4.2.1.1.1 To grasp between the column of the thumb and the second finger (to be added in)
2.4.2.1.1.1.1
2.4.2.1.1.1.2
2.4.2.1.1.1.3
2.4.2.1.1.1.4.
2.4.2.1.1.2 To grasp between the column of the thumb and the third finger
2.4.2.1.1.2.1
2.4.2.1.1.2.2
2.4.2.1.1.2.3
2.4.2.1.1.2.4
2.4.2.1.1.3 To grasp between the column of the thumb and the fourth finger
2.4.2.1.1.3.1
2.4.2.1.1.3.2
2.4.2.1.1.3.3
2.4.2.1.1.3.4
2.4.2.1.1.4 To grasp between the column of the thumb and the fifth finger
2.4.2.1.1.4.1
2.4.2.1.1.4.2
2.4.2.1.1.4.3
2.4.2.1.1.4.4
2.4.2.1.2 To grasp using three fingers
2.4.2.1.2.1 grasp using thumb- IInd-IIIrd fingers
2.4.2.1.2.2. grasp using thumb – IIIrd-IVth fingers
2.4.2.2.1.3. to grasp without using the column of the thumb
2.4.2.1.3.1. grasp using middle digits
2.4.2.1.3.1.1 IInd-IIIrd
2.4.2.1.3.1.2 IIIrd-IVth
2.4.2.1.3.2. to grasp using digito-palmaire
2.4.2.1.3.2.1
2.4.2.1.3.2.2
2.4.2.1.3.2.2.1
2.4.2.1.3.2.2.2
2.4.2.2. To grasp with the left hand
2.4.2.2.1 To grasp between the column of the thumb and another finger
2.4.2.2.1.1. To grasp using the column of the thumb and the second finger
2.4.2.2.1.1.1
2.4.2.2.1.1.2
2.4.2.2.1.1.3
2.4.2.2.1.1.4
2.4.2.2.1.2 To grasp using the column of the thumb and the third finger
2.4.2.2.1.2.1
2.4.2.2.1.2.2
2.4.2.2.1.2.3
2.4.2.2.1.2.4
2.4.2.2.1.3 To grasp using the column of the thumb and the fourth finger
2.4.2.2.1.3.1
2.4.2.2.1.3.2
2.4.2.2.1.3.3
2.4.2.2.1.3.4
2.4.2.2.1.4 To grasp using the column of the thumb and the fifth finger
2.4.2.2.1.4.1
2.4.2.2.1.4.2
2.4.2.2.1.4.3
2.4.2.2.1.4.4
2.4.2.2.2 To grasp using three fingers
2.4.2.2.2.1 Three digit grasp thumb – IInd – IIIrd fingers
2.4.2.2.2.2. three digit grasp thumb – IIIrd – IVth fingers
2.4.2.2.2.3 three digit grasp thumb – IVth – Vth fingers
2.4.2.2.3 Grasp without using the column of the thumb
2.4.2.2.3.1 Interdigital grasp
2.4.2.2.3.1.1. IInd –IIIrd
2.4.2.2.3.1.2 IIIrd – IVth
2.4.2.2.3.1.3 IVth – Vth
2.4.2.2.3.2. Grasp using
2.4.2.2.3.2.1
2.4.2.23.2.2.1
2.4.2.2.3.2.2.2
2.4.2.3 To grasp using both hands (simulatenously)
2.4.2.3.1 with the fingers
2.4.2.3.2 between the palms
2.4.2.3.3 between the wrists
2.4.2.4 Grasping by alternative means (substitution of hands by other limbs)
2.4.2.4.1 To grasp or take by one’s mouth
2.4.2.4.2 to grasp or take with one’s teeth
2.4.2.4.3 to bite
2.4.2.4.4 to take between the head and shoulder
2.4.2.4.4.1 on the right
2.4.2.4.4.2 on the left
2.4.2.4.5 to take between an arm and the thorax
2.4.2.4.5.1 on the right
2.4.2.4.5.2 on the left
2.4.2.4.6 to pick up with both feet
2.4.2.4.7 to grasp with one’s toes
2.4.2.4.7.1 on the right
2.4.2.4.7.2 on the left
2.4.2.4.8 to take or grasp between one’s knees
2.4.3. To let go (to stop taking up)
2.4.4. to throw (to fling)
*2.4.4.1 towards the ground/downwards*
*2.4.4.2 upwards*
*2.4.4.3 in front of oneself*
*2.4.4.4 behind oneself*
2.4.5. To catch an object “in flight” (¿)
*2.4.5.1 with the right hand*
*2.4.5.2 with the left hand*
*2.4.5.3 with both hands*
2.4.6. to push
*2.4.6.1 with the right hand*
*2.4.6.2 with the left hand*
*2.4.6.3 with both hands*
2.4.7. to pull
*2.4.7.1 with the right hand*
*2.4.7.2 with the left hand*
*2.4.7.3 with both hands*
2.4.8 to scratch with the hands
*2.4.8.1 with the right hand*
*2.4.8.2 with the left hand*
*2.4.8.3 with both hands*
2.4.9 to rub
*2.4.9.1 with the right hand*
*2.4.9.2 with the left hand*
*2.4.9.3 with both hands*
2.4.10 to hit
*2.4.10.1 with the right hand*
2.4.10.1.1 with the palm
2.4.10.1.2 with the fist
2.4.10.1.3 with the cubital(¿) (“slicing”) edge of the hand
2.4.10.2 With the left hand
2.4.10.2.1 with the palm
2.4.10.2.2 with the fist
2.4.10.2.3 with the cubital side “slicing” side of the hand
2.4.11 To join both hands, one against the other
2.4.12 to clap both hands, one against the other
2.4.13 to wave one’s hand
2.4.13.1 wave one’s right hand
2.4.13.2 wave one’s left hand
2.4.14 to point with one’s finger
2.4.14.1 with the right hand
2.4.14.2 with the left hand
2.4.15 To touch
2.4.15.1 with one finger
2.4.15.2 with several fingers of one hand
2.4.15.3 with both hands
2.4.16 To feel/finger (Palper)
2.4.16.1 with one hand
2.4.16.2 with both hands
2.4.17 to caress
2.4.17.1 with one hand
2.4.17.2 with both hands
2.4.18 to move an object from one hand to another
2.4.18.1 from the right hand to the left hand
2.4.18.2 from the left hand to the right hand
2.4.19 “pianoter”
2.4.19.1 with the right hand
2.4.19.2 with the left hand
2.5. COMMUNICATION
2.5.1 Hearing
2.5.1.1 Hearing acuity
2.5.1.1.1 Right ear
2.5.1.1.2 left ear
*2.5.1.2 Excessive auditory sensations/feelings (hyperacousie)*
2.5.1.2.1 Right ear
2.5.1.2.2 Left ear
2.5.1.2.3 ACOUPHENES (whistling)
2.5.1.3.1 Right ear
2.5.1.3.2 Left ear
*2.5.1.4 Difficulty in perceiving noises and sounds (dysacousie)*
2.5.1.4.1 Right ear
2.5.1.4.2 Left ear
*2.5.1.5 Localising sources of sound*
2.5.2 Vision
2.5.2.1 Visual acuteness
2.5.2.1.1. Right eye
2.5.2.1.2 Left eye
*2.5.2.2. Field of vision*
2.5.2.2.1 to the right
2.5.2.2.2 to the left
*2.5.2.3 Perception of colours*
2.5.2.3.1 Right eye
2.5.2.3.2 Left eye
*2.5.2.4 Night vision*
*2.5.2.5 Appreciation of distances*
*2.5.2.6 Guiding one’s look/vision*
2.5.2.6.1 Right eye
2.5.2.6.2 Left eye
2.5.3 Language
2.5.3.1 Voice Characteristics
2.5.3.1.1 Articulation of sounds
2.5.3.1.2 Intensity of the voice
2.5.3.1.3 Tone (identity) of the voice
2.5.3.1.4 Speed of articulation (¿)
2.5.3.1.5 Rhythm (prosody) of the word
2.5.3.1.6 Ability to make pauses
2.5.3.1.7 accentuating sounds
2.5.3.1.8 sing
2.5.3.1.9 to hum a tune
2.5.3.1.10 to cry
2.5.3.1.11 to whisper
2.5.3.1.12 to murmur
2.5.3.2 Oral semantic expression
2.5.3.2.1 by words
2.5.3.2.2. by phonemes
2.5.3.2.3 by onomatopeia
2.5.3.2.4 by numbers
2.5.3.2.5 by mathematical language
2.5.3.2.6 by the language of music
2.5.3.3 Written expression
2.5.3.3.1 Graphical (drawing)
2.5.3.3.2 orthography (writing)
2.5.3.3.3 by numbers
2.4.3.3.4 by mathematical language
2.5.3.4 Using body language to express oneself
2.5.3.4.1 by a look
2.5.3.4.2 by mimickry
2.5.3.4.3 by movements of one’s head
2.5.3.4.4 by the movements of the upper right limb
2.5.3.4.5 by movements expressed by the left limb
2.5.3.4.6 by movements expressed by both upper limbs
2.5.3.4.7 by movements expressed by the lower right limb
2.5.3.4.8 by movements of the lower left limb
2.5.3.4.9 by movements of the trunk (¿)
2.5.3.4.10 by the attitudes expressed by the whole body
2.5.3.4.11 by tears
2.4.3.4.12 by a smile
2.4.3.4.13 by laughter
2.4.3.4.14 by hugging
2.5.3.4.15 by giving a kiss (physical contact)
2.5.3.4.16 by sending a kiss (remotely)
2.5.3.5 Oral comprehension
2.5.3.5.1 of Phonemes
2.5.3.5.2 of Onomatopeia
2.5.3.5.3 of language content
2.5.3.5.4 Of numbers
2.5.3.5.5 of mathematical language
2.5.3.5.6 of the language of music
2.5.3.6 Written comprehension
2.5.3.6.1 of images (drawings, photos, films)
2.5.3.6.2 of edited texts
2.5.3.6.3 of numbers
2.5.3.6.4 of symbols (other than mathematical expressions)
2.5.3.7 Understanding of body language
2.5.3.7.1 a look
2.5.3.7.2 mimics
2.5.3.7.3 movements of the head
2.5.3.7.4 movements of the upper right lim
2.5.3.7.5 movements of the left limb
2.5.3.7.6 movements of both upper limbs
2.5.3.7.7 movements of the lower right limb
2.5.3.7.8 movements of the lower left limb
2.5.3.7.9 movements of the torso
2.5.3.7.10 attitudes expressed by the whole body
2.5.3.7.11 tears
2.5.3.7.12 a smile
2.5.3.7.13 laughter
2.5.3.7.14 when being hugged
2.5.3.7.15 when receiving a kiss
2.6. Cognition and Cognitive Behaviour
2.6.1 States of wakefulness and of sleep
*2.6.1.1. Vigilance (wakefulness)*
2.6.1.1.1. Capacity to be constantly conscious, and awake, outside of periods of sleep
2.6.1.1.2 The capacity not to be react brutally to a suspension of the state of wakefulness (during an epileptic attack for example)
2.6.1.2 Sleep
2.6.1.2.1. The ability to fall asleep
2.6.1.2.2 Quality of sleep
2.6.1.2.3 The duration of sleep
2.6.1.2.4 The ability to dream
2.6.1.2.5 The ability not to have nightmares
2.6.1.2.6 the ability not to have respiratory problems during sleep
2.6.2 The ability to perceive and identify (gnosis)
*2.6.2.1 The ability to perceive and identify different parts of the body (somatognosis)*
2.6.2.1.1 The ability to perceive the right side of one’s body
2.6.2.1.2 the ability to perceive the left hand side of one’s body
2.6.2.1.3 the ability to distinguish the right from the left side of one’s body
2.6.2.1.4 the ability to perceive, feel and locate the different parts of the body
2.6.2.1.5 the ability to feel and locate sensations of touch (tact) at the level of one’s body
2.6.2.1.6 the ability to perceive and locate painful sensations at the level of the body
2.7.2.1.7 the ability not to have distorted feelings/sensations
2.6.2.1.7.1 The ability of not having the illusion of different parts of the body moving
2.6.2.7.2 the ability of not having the illusion of a morphological transformation of one’s body
2.6.2.1.7.3 the ability to feel pain (in the absence of lesion in pain patthways)
2.6.2.1.8 the ability to recognise the movement of different parts of the body (kinesthesia)
2.6.2.2 The ability to identify and recognise a face (prosognosia)
2.6.2.3 the ability to identify and recognise an object
2.6.2.3.1 The ability to identify and recognise a shape
2.6.2.3.2 the ability to identify and recognise the consistency of an object
2.5.2.3.3 the ability to identify and recognise the nature of an object
2.6.2.4 the ability to identify and to recognise by auditive means (auditive gnosies)
2.6.2.4.1 the ability to identify and recognise a sound
2.6.2.4.2 the ability to identify and recognise a noise
2.6.2.4.3 the ability to identify and recognise a voice
2.6.2.4.4 the ability ro identify and recognise a melody
2.6.2.4.5 the ability to not have auditive hallucinations
2.6.2.4.6 the ability of not having a distorted perception of sounds and noises
2.6.2.5 the ability to identify and recognise by visual means (visual gnosies, “mental imagery”)
2.6.2.5.1 The ability to identify and recognise colours
2.6.2.5.2 the ability to identify and recognise an object
2.6.2.5.3 the ability to identify and recognise the details of a place
2.6.2.5.4 the ability to identify and recognise a place in its entirety
2.6.2. 5.5 the ability of not having a distorted perception of objects (morphopsy)
2.6.3 The ability to find one’s bearings in a given space
2.6.3.1 the ability to distinguish the right from the left
2.6.3.2 the ability to distinguish above from below
2.6.3.3. the ability to distinguish the front from behind
2.6.3.4 the ability to distinguish between what is close-far
2.6.3.5 the abilitliy to conceive of a journey,distance, an itinerary
2.6.3.6 the ability to refind a journey, an itinerary
2.6.4 The ability to find one’s bearing in time
2.6.4.1 In the present
2.6.4.1.1 To locate the hour
2.6.4.1.2 to locate the day
2.6.4.1.3 to locate the month
2.6.4.1.4 to locate the year
*2.6.4.2 In the past*
2.6.4.2.1 Location of hours
2.6.4.2.2 location of days
2.6.4.2.3 location of months
2.6.4.2.4 location of years
*2.6.4.3 In the future*
2.6.4.3.1 location of hours
2.6.4.3.2 location of days
2.6.4.3.3 location of months
2.6.4.3.4 location of years
2.6.5 Memory (the ability to remember and/or to rercognise information)
*2.6.5.1 the ability to recall and/or recognise new informatin (short term memory)*
2.6.5.1.1 According to auditive mechanisms
2.6.5.1.2 according to visual mechanisms
*2.6.5.2 the ability to remember and/or recognise old information (long term memory)*
2.6.5.2.1 the ability to recall socio-cultural and acquired knowledge (semantic memory)
2.6.5.2.1.1 According to visual mechanisms
2.6.5.3.2.2 according to auditive mechanisms
2.6.5.2.2 the ability to remember facts relating to daily life (episodic memory)
2.6.5.2.2.1 according to visual mechanisms
2.6.5.2.2.2 according to auditive mechanisms
2.6.5.2.3 the ability to remember procedures and the “right way of doing things” (procedural memory)
2.6.5.2.3.1 according to visual mechanisms
2.6.5.2.3.2 according to auditive mechanisms
2.6.5.2.4 the ability to retain new knowledge
2.6.6 the ability to organise movement (the ability to execute a “gesture relating to the right way to do things”)
*2.6.6.1 the abiilty to use objects to undertake a simple task*
*2.6.6.2 the ability to use objects for a complex task*
*2.6.6.3 the ability to show expressive gestures (in the absense of limiting joint or muscular lesions)*
*2.6.6.5 the ability to imitate the gestures of others*
*2.6.6.6 the abilty to reproduce shapes*
2.6.7 The ability to use acquired notions in intentional conscious activities or on demand (functions of execution)
*2.6.7.1 the ability to analyse, to appreciate facts, needs and issues (sense of judgement)*
*2.6.7.2 the ability to formulate an objective, to order in a hierarchical framework what needs to be done and anticipate outcomes (to plan)*
*2.6.7.3 the ability to adapt one’s reasoning (the ability to be flexible, “mental flexibility” or “agility”)*
*2.6.7.4 the ability to adapt onself to changes in situations or in the facts (mental movement)*
*2.6.7.5 the ability to verify the success of results obtained (verification)*
*2.6.7.6 the ability to use mathematical reasoning*
2.6.7.6.1 Simple
2.6.7.6.2 Complex
*2.6.7.7 the ability for abstract thought and conceptualisation*
*2.6.7.8 the ability to rapidly undertaken mental procedures*
2.6.8 Dynamics of thought and action
*2.6.8.1 Attention*
2.6.8.1.1 the ability to sustain one’s attention over time, to remain concentrated on a particular task
2.6.8.1.2 the ability to focus one’s attention, to not be easily distracted
2.6.8.1.3 the ability to divide one’s attention (attention sharing) or the ability to be able to undertake two (or more) tasks at the same time
2.6.8.2 The ability to resist to mental fatigue (mental resistance)
2.6.8.2.1 The ability to remain effective for the duration of mental and cognitive effort
2.6.8.2.1.1 during the realisation of a single task
2.6.8.2.1.2 during the realisation of a number of tasks performed simultaneously
2.6.8.2.2 the ability to maintain effort without feeling the sensation of premature “saturation”
*2.6.8.3 The ability to complete a task which one has started*
*2.6.8.4 the ability to show and demonstrate initiative and creativity*
*2.6.8.5 the ability to show interest, to motivate oneself for a task or activity and to persevere in its realisation*
2.6.9 Abilities relating to self perception
*2.6.9.1 ability to know one’s own real or potential difficulties*
*2.5.9.2. the ability to know one’s own possibilities, real or potential*
*2.6.9.3 the ability to be able to judge one’s limits and possibilities (the sense of knowing when to make a decision)*
2.7. FEELINGS and FEELING BEHAVIOURS
2.7.1 The ability for self estime and emotivity (self image)
*2.7.1.1. the ability to control one’s emotions*
*2.7.1.2 the ability to have a stable temper*
*2.7.1.3 the ability to have desires*
*2.7.1.4 the ability of not being anxious*
*2.7.1.5 the ability to not be depressed*
*2.7.1.6 the ability to not have obsessional ideas*
*2.7.1.7 the ability to not have phobias*
*2.7.1.8 the ability to not have delirious or frenzied ideas*
*2.7.1.9 the ability to channel the train of one’s thought (avoiding the “escaping of ideas”)*
*2.7.1.10 the ability to exercice self-censorship*
*2.7.1.11 the ability of not feeling blamed*
*2.7.1.12 the ability to establish psychological defence mechanisms*
*2.7.2 The ability to socialise and integrate with others (self projection)*
*2.7.2.1 the ability to realise activities in association (or co-operation) with others*
*2.7.2.2 the ability to imitate the behaviour of others*
*2.7.2.3 the ability to respect rules, social conventions and daily habits*
*2.7.2.5 the ability to open up towards others*
*2.7.2.6 the ability to react to a situation (to be affable, courteous, kind, have a sense of repartee)*
*2.7.2.7 the ability to be patient*
*2.7.2.8 the ability to feel interest for others*
*2.7.2.9 the ability to feel the experience of others (empathy)*
*2.7.2.10 the ability to understand the joy or the pleasure of others*
*2.7.2.11 the ability to have a sense of one’s responsibilities*
*2.7.2.12 the ability to express one’s authority*
*2.7.2.13 the ability to assert oneself*
*2.7.2.14 the ability to express one’s shyness*
*2.7.2.15 the ability to make oneself independent of others spontaneously*
*2.7.2.16 the ability to amuse oneself*
*2.7.2.17 the ability to relax*
*2.7.2.18 the ability to enter into competition*
*2.7.2.19 the ability to preserve one’s intimacy*
*2.7.3 Abilities to control one impulses and needs*
*2.7.3.1 the ability to have appropriate eating behaviours*
*2.7.3.2 the ability to respect one’s appearance*
*2.7.3.4 the ability to appreciate risks to one’s body (sense of security)*
2.7.3.4.1 For oneself
2.7.3.4.2 for others
*2.7.3.5 the ability not to form dependency on substances which are harmful for one’s health*
2.7.3.5.1 Tobacco
2.7.3.5.2 Alcohol
2.7.3.5.3 Drugs
2.7.3.5.3.1 “soft drugs”
2.7.3.5.3.2 “hard drugs”
*2.7.3.6 The ability to avoid dependency on gambling*
*2.7.3.7 the ability of avoiding “impulse” buying behaviours – excessive or useless items*
2.8. Control of Urine and Fecal Matter
2.8.1 Control of urine
*2.8.1.1 Perception of the need to urinate*
*2.8.1.2 Control of miction (urinary incontinence)*
*2.8.1.3 the ability to empty one’s bladder (to urinate)*
2.8.2 Control of Fecal Matter
*2.8.2.1 Perception of the need to pass stools*
*2.8.2.2 Control of defecation (fecal incontinence)*
*2.8.2.3 The ability to eliminate waste matter (defecation)*
*2.8.2.4 the ability to retain gas*
*2.8.2.5 the ability to release gas*
2.9 Sexuality and Love Life
2.9.1 Sexuality
*2.9.1.1 Male sexuality*
2.9.1.1.1. to be able to have a quality erection
2.9.1.1.2 to be able to have a stable erection
2.9.1.1.3 to be able to ejaculate
2.9.1.1.4 to be able to feel pleasure
*2.9.1.2 Female sexuality*
2.9.1.2.1 to be capable of sexual and vaginal arousal (wetness)
2.9.1.2.2 to be able to be penetrated
2.9.1.2.3 to be able to reach orgasm
2.9.1.2.4 to be able to experience pleasure
2.9.2 Love Life
*2.9.2.1 the ability to have amorous desires*
*2.9.2.2 the ability to seduce*
*2.9.2.3 the ability to show amorous gestures*
*2.9.2.4 the ability to give pleasure*
*2.9.2.5 the ability to receive pleasure*
*2.9.2.6 the ability to have sexual fantasies*
*2.9.2.7 the ability to share intimacy*
2.9.3 the ability to procreate
*2.9.3.1 the ability to bring a pregnancy to term*
*2.9.3.2 the ability to give birth*
2.10 ABILITY TO UNDERTAKE PHYSICAL EFFORT
*2.10.1 the ability to realise effort whilst retaining respiratory ease (absense of breathlessness)*
*2.10.2 the ability to undertake effort without feeling muscular, joint or other discomfort*
*2.10.3 the ability to undertake effort without feeling a sensation of fatigue*
*2.10.4 the ability not to fear effort*
*2.10.5 the ability to recuperate after effort*
2.11 ABILITY TO RESIST AGRESSION TO SKIN AND/OR MUCOUS TISSUES
*2.11.1 The ability to resist to agression to the skin whether from a mechanical or thermal source (risk of scarring or burns)*
*2.11.2 the ability to resist to aggression to mucous passages, whether from a mechanical or thermal source (risk of scarring or burns)*
*2.12 THE ABILITY OF ENSURING THE CLEANLINESS AND OPENNESS OF AIR WAYS*
*2.12.1 The ability to cough*
*2.12.2 The ability to spit*
2.13 The ability to resist to variations in temperature
2.13.1 The ability to resist heat
*2.13.2.1. For all parts of the body*
*2.13.1.2 for certain parts only of the body*
2.14 the ability to masticate
*2.14.1 the ability to section of tear food with one’s teeth*
*2.14.2 the ability to chew*
*2.14.3 the ability to mumble(¿)*
2.15 the ability to ingest one’s food
*2.15.1 the ability to suck*
*2.15.2. the ability to suck at the breast*
*2.15.3 the ability to lick*
*2.15.4 the ability to swallow (deglutinate?) solid food (or solid medicine)*
*2.15.5 the ability to deglutinate (¿) liquid food (or a liquid medicine)*
*2.15.3 the ability to belch*
*2.16 ABILITY TO PERCEIVE AND RECOGNISE ODOURS*
*2.16.1 the ability to smell and recognise simple odours*
*2.16.2 the ability to smell and recognise complex smells*
*2.17 ABILITY TO PERCEIVE AND RECOGNISE THE TASTE OF A SUBSTANCE*
*2.17.1 the ability to perceive and recognise elementary taste sensations*
*2.17.2 the ability to perceive and recognise complex taste sensations*
*2.18 ABSENCE OF PAIN*
2.18.1 absence of spontaneous pain
2.18.2 absence of provoked pain
*2.18.2.1 by the position of the body*
*2.18.2.2 by movement*
*2.18.2.3 by contact*
2.19 AESTHETICS AND APPEARANCE
*2.19.1 the aesthetic appearance of the side(front?) and face*
*2.19.2 the aesthetic aspect of the hands*
*2.19.3 the aesthetic aspect of other parts of the body*

3) Life situations

Definition
This level covers the confrontation (concrete or not) between a person and the reality of his/her physical, social and cultural environment.
Situations encountered are: daily life situations whether these are within the family, in the field of education, leisure, work, and all other life activities including charitable work, religious and other community activities encompassed in the framework of social participation.

Quantitative table of life situations (situation of handicap)
0	No difficulty
1	discomfort or hindrance, without a limitation that can be objectified
2	handicap compensated by technical aid
3	handicap requiring partial recourse to human assistance
4	total handicap which requires total recourse to human assistance

	0	1	2	3	4
3.1. Habitual activities of daily life
3.1.1. to nourish oneself (or feed oneself)
3.1.1.1. Prepare one’s meals
3.1.1.1.1. To take food out of their packaging
3.1.1.1.1.2 Preparing foods
3.1.1.1.2.1 To cut up
3.1.1.1.2.2 To chop
3.1.1.1.2.3 to crumble
3.1.1.1.2.4 to mix
3.1.1.1.2.5 to sprinkle (upon foods)
3.1.1.1.2.6 to pour a liquid
3.1.1.1.3 to ensure the cooking of liquids or solids
3.1.1.1.3.1 In a hollow recipient
3.1.1.1.3.2 in a flat recipient
3.1.1.1.3.3 under a grill
3.1.1.1.3.4 directly on a source of heat
3.1.1.1.3.5 in an oven
3.1.1.1.4 to pick up and move recipients containing foods
*3.1.1.2 Carry the foods and serve them*
3.1.1.2.1 carry a dish/course
3.1.1.2.2 carry a pitcher or carafe
3.1.1.2.3 carry a bottle
3.1.1.2.4 lay the instruments used for drinking and eating (laying the table)
3.1.1.2.5 tidy up the dishes and the tableware
*3.1.1.3 Take meals*
3.1.1.3.1 Eating
3.1.1.3.1.1. To fill one’s plate (to serve oneself)
3.1.1.3.1.2 to cut up food
3.1.1.3.1.3 to break the bread
3.1.1.3.1.4 to cut bread
3.1.1.3.1.5 to push food on one’s plate
3.1.1.3.1.6 to grasp food with one’s fingers
3.1.1.3.1.7 to stick a knife in food to grasp it
3.1.1.3.1.9 grasp food with chopsticks
3.1.1.3.1.10 to take a piece of food with a fork without piercing it
3.1.1.3.1.11 take liquid with a spoon
3.1.1.3.1.12 to carry a piece of food to one’s mouth
3.1.1.3.2 Drinking
3.1.1.3.2.1. to fill the recipient in which one drinks
3.1.1.3.2.3 to carry this recipient to one’s mouth
3.1.1.3.2.4 to use a straw to drink with
3.1.1.3.3. to wipe one’s mouth
3.1.1.3.4 to use a toothpick
3.1.2 To go to the toilet
3.1.2.1. to prepare oneself to urinate
3.1.2.2 to prepare onself to defecate
3.1.2.3 to wipe oneself or to clean oneself (washing) with the right hand
3.1.2.4 to wipe oneself or to clean oneself (wash oneself) with the left hand
3.1.2.5 to get up and put one’s clothes back into place
3.1.3 To tidy oneself up
*3.1.3.1 to wash one’s hands*
*3.1.3.2 to wipe oneself*
*3.1.3.3. to cut one’s fingernails*
3.1.3.3.1 right hand
3.1.3.3.2 left hand
*3.1.3.4 to wash one’s face*
*3.1.3.5 to wash one’s hair (using a shampoo)*
*3.1.3.6 to dry one’s hair*
*3.1.3.7 to do one’s hair*
*3.1.3.8 to make oneself up*
3.1.3.8.1 the eyes
3.1.3.8.2 the face
*3.1.3.9 to shave oneself*
*3.1.3.10 to brush one’s teeth*
*3.1.3.11 to wash one’s upper limbs (excepting the hands)*
*3.1.3.12 to wash the front part of one’s torso*
*3.1.3.13 to wash the other side of one’s torso (“the back”)*
*3.1.3.14 to wash one’s feet*
*3.1.3.15 to cut one’s toe nails*
3.1.3.15.1 on the right foot
3.1.3.15.2 on the left foot
*3.1.3. 16 to take a shower*
*3.1.317 to take a bath*
*3.1.3.18 to use a bidet*
3.1.4 to dress and undress oneself
*3.1.4.1 to dress and undrerss the upper part of the body*
3.1.4.1.1. to put on one’s clothes
3.1.4.1.2 to take off one’s clothes
3.1.4.1.3 to put on a bra
3.1.4.1.4 to take off a bra
3.1.4.1.5 to put an appliance on the upper part of the bod
3.1.4.1.5.1 from the torso
3.1.4.1.5.2 from the upper limbs
3.1.4.1.6.to take off an appliance from the upper part of the body
3.1.4.1.6.1 from the torso
3.1.4.1.6.2 from the upper limbs
*3.1.4.2 to dress and undress the lower part of the body*
3.1.4.2.1 to put on clothes
3.1.4.2.2. to take off clothes
3.1.4.2.3 to put on one’s shoes
3.1.4.2.4 to take off one’s shoes
3.1.4.2.5 to put on stockings, tights or socks
3.1.4.2.6 remove stockings, tights or socks
3.1.4.2.7 to put on an appliance on the lower part of the body
3.1.4.2.7.1 on the pelvic area (pelvis)
3.1.4.2.7 2 on the lower limbs (including orthopaedic shoes or soles)
3.1.4.2.8 to remove an apparatus from the lower part of the body
3.1.4.2.8.1 from the pelvic area (pelvis)
3.1.54.2.8.2 from the lower limbs
*3.1.4.3 to close one’s clothes*
*3.1.4.4 to open one’s clothes*
3.1.5 To access and move around in one’s living quarters
*3.1.5.1 to enter into one’s living areas and exit from it*
*3.1.5.2 to move around in one’s living area*
3.1.5.2.1 in the bedroom only
3.1.5.2.2 in all living areas
*3.1.5.3 to go to bed*
*3.1.5.4 to get out of bed*
*3.1.5.5 to sit in a chair*
*3.1.5.6 to get up from a chair*
*3.1.5.7 to move from one chair (or support) to another*
*3.1.5.8 to open the doors of one’s living areas or move the internal dividers separating rooms or living areas*
*3.1.5.9 close the windows of one’s living area or move the internal dividers separating rooms or living areas*
*3.1.5.10 open the windows*
*3.1.5.11 close the windows*
*3.1.5.12 climb the stairs*
*3.1.5.13 come down the stairs*
3.1.6 To undertake domestic activities
*3.1.6.1 Maintain the cleanliness and order in one’s living areas*
3.1.6.1.1 to brush the floor
3.1.6.1.2 to hoover the floor
3.1.6.1.3 to wax the parquet flooring
3.1.6.1.4 to wash the floor
3.1.6.1.7 to pick up a light object from the floor
3.1.6.1.8 to raise and move a heavy and/or cumbersome object
3.1.6.1.9 to wipe the furniture
3.1.6.1.10 to move the furniture in order to clean them
3.1.6.1.11 make the bed
3.1.6.1.12 clean the windows
*3.1.6.2 Clean the crockery (table service) and kitchen implements*
3.1.6.2.1 Wash them
3.1.6.2.2. wipe them
3.1.6.2.3 put them away
*3.1.6.3 Maintenance of household linen and clothes*
3.1.6.3.1 Wash household linen and clothes
3.1.6.3.2 dry linen and clothes
3.1.6.3.3. iron linen and clothes
3.1.6.3.4 clean shoes
3.1.7 Access information and communicate from where one lives
*3.1.7.1 To be able to call for help in case of need or difficulty*
*3.1.7.2 to telephone*
3.1.7.2.1 to telephone using a fixed line
3.1.7.2.2 to telephone using a mobile phone
*3.1.7.3 To write*
3.1.7.3.1 with a pencil, a pen, a brush
3.1.7.3.2 with a word processor, a computer
*3.1.7.4 to read a newspaper or magazine*
3.1.7.4.1 to open a newspaper
3.1.7.4.2. to turn over the pages of a newspaper
3.1.7.5 to read a book
3.1.7.5.1 to hold the book
3.1.7.5.2 to open the book
3.1.7.5.3 to turn the pages of the book
*3.1.7.6 To fax*
*3.1.7.7 By using Internet*
*3.1.7.8 by using other means: tap on the floor using the handle of a broom or by calling from the* window
3.1.8 Moving about outside of one’s place of residence
3.1.8.1. climb a slope more than 5%
3.1.8.2 descend a slop more than 5%
3.1.8.3 climb a pavement of 25cm in height
3.1.8.4 Use one of the means of public transport
3.1.8.5.1 Bus
3.1.8.5.2 Tramway, train, underground
3.1.8.5.3 Aeroplane
3.1.8.5.4 Boat
3.1.8.5.5 Funicular railway
*3.1.8.6 Using one’s own means of transport*
3.1.8.6 Using a form of pedestrian transport on wheels (roller skates, skateboard, child’s scooter…)
3.1.8.6.2 using ski rackets
3.1.8.6.3 Using skis
3.1.8.6.5 using ice skates
3.1.8.6.5 Using a bicycle
3.1.8.6.6 Using/drinking a motorcycle
3.1.8.6.7 using an automobile
3.1.8.6.7.1 Entering and leaving
3.1.8.6.7.2 Being transported in an automobile
3.1.8.6.7.3 to drive an automobile
3.1.8.6.8 To mount an animal (horse, donkey, camel, reindeer, llama, elephant, cattle…)
3.1.8.6.9 to drive an animal, or animals in order for them to be used for drawing vehicles (horse carriage, dog sled, cart, sledge)
3.1.8.6.10 to move by boat
3.1.8.6.11 Move by swimming
3.1.8.6.12 Transport oneself by aeroplane or helicopter
*3.1.8.7 To do one’s shopping*
*3.1.8.8. Respect the highway code*
3.2 EMOTIONAL LIFE, FAMILY LIFE AND SOCIAL LIFE
3.2.1. To have relations with one’s family
*3.2.1.1 To exercise one’s family responsabilities*
3.2.1.1.1 In relation to one’s spouse
3.2.1.1.2 in relation to one’s children
3.2.1.1.3 in relation to one’s antecedents (parents, grand parents, great grand parents)
3.2.1.1.4 In relation to one’s siblings (brothers, sisters)
*3.2.1.2 To have affectionate relations with members of one’s family*
3.2.1.2.1 to have affectionate relations with one’s spouse
3.2.1.2.2 to have sexual relations with one’s spouse
3.2.1.2.3 to have affectionate relations with one’s children
3.2.1.2.4 to have affectionate relations with other members of one’s family
3.2.2 To have relationships with those who are close outside of the family setting
*3.2.2.2 to have courteous relations with one’s neighbours*
*3.2.2.3 to have non conjugal sexual relations*
3.2.2.4 to have relations with those persons responsible for ensuring services in the nearby environment (postmen, concierges, policemen, municipal employees, shopkeepers, personnel belonging to the administration…)
3.3. Leisure Activities, Relaxation and Pleasure
3.3.1 To have leisure activities of a passive nature
*3.3.1.1. to use a television set*
*3.3.1.2 to use a radio*
*3.3.1.3 to use a cassette reader (audio, CD)*
*3.3.1.4 to use a walkman*
*3.3.1.5 to use a video recorder or DVD reader*
*3.3.16 To read*
3.3.1.6.1 newspapers, illustrated magazines
3.3.1.6.2 cartoons
3.3.1.6.3 books
*3.3.1.7 To use the Internet*
*3.3.1.8 to dream*
*3.3.2 to practice individual active leisure activities*
*3.3.2.2 to do dressmaking, knitting or embroidery*
*3.3.2.3 Collect objects*
*3.3.2.4 To establish written correspondence*
3.3.2.4.1 by post
3.3.2.4.2 by Internet
3.3.2.4.3 by fax
3.3.2.5 to do the races or other gambling games
3.3.2.6 to draw
3.3.2.7 to paint
*3.3.2.8 to go out from one’s home*
3.3.2.8.1 to go for a walk
3.3.2.8.2 to go for a meal
3.3.2.8.3 to go for a drink
3.3.2.8.4 to visit an exhibition, a museum
3.3.2.8.5. to go to the cinema, a show, to listen to a concert, a singer, or a conference, to a sporting event
*3.3.2.9 To travel*
*3.3.2.10 to go to the gym*
*3.3.2.11 to do muscular exercice*
*3.3.2.12 to use a piece of machinery in one’s home for personal fttness training (training cycle or other)*
*3.3.2.13 to go jogging*
*3.3.2.14 to practice an individual sport*
3.3.2.14.1 Swimming
3.3.2.14.2 Athletics
3.3.2.14.3 Archery
3.3.2.14.4 Golf
3.3.2.14.5 A nautical sport
3.3.2.14.5.1 Surfing
3.3.2.14.5.2 Windsurfing
3.3.2.14.5.3 Sailing
*3.3.2.15 Praticising some form of relaxation*
*3.3.2.16 Practice of yoga or some other form of corporal discipline*
*3.3.2.17 to go fishing*
*3.3.2.18 to go hunting*
*3.3.2.19 to do gardening*
*3.3.2.20 to play a musical instrument*
*3.3.2.21 to sing*
*3.3.2.2.22 to play children’s games*
*3.3.2.22.1 for girls*
*3.3.2.22.2 for boys*
*3.3.3. To practice active leisure sports with others*
*3.3.3.1 Dancing*
*3.3.3.2 to meet up with friends*
*3.3.3.4 to take part in sports*
3.3.3.4.1 combat sports (martial arts, boxing, fencing)
3.3.3.4.2 Team games (foot-ball, base-ball, rugby, basket-ball, volley-ball, water sports, hockey on ice)
*3.3.3.5 To play cards*
*3.3.3.6 to play chess*
*3.3.3.7 to play dominoes*
*3.3.3.8 to play other society games*
*3.3.3.9 to play collective children’s games*
3.3.3.9.1 for girls
3.3.3.9.2 for boys
*3.3.3.10 to make music (within a group setting or orchestra)*
*3.3.3.11 to sing in a group or in a chorale*
3.4. Community and Charitable Activities for social solidarity
3.4.1 Association Activities
*3.4.1.1 To hold a position of responsibility in an association*
*3.4.1.2 to take part in the activities of an association*
*3.4.1.4 to be an activist in trade union activities*
*3.4.1.4 to hold a position of responsibility in a trade union*
*4.3.1.5 to hold a position of responsibility in one’s building or in one’s local community environment*
*4.3.1.6 to be an activist in a political movement*
*3.4.1.7 to have a position within politics*
*4.3.1.8 to accomplish religious acts and rituals*
*4.3.19 to have a responsibility within religious or spiritual domains*
3.5 TO STUDY OR UNDERTAKING SOME FORM OF TRAINING
3.5.1 The type of training followed
*3.5.1.1 Preschool Education*
*3.5.1.2 Educatin at primary level (elementary)*
*3.5.1.3 Education at secondary school*
*3.5.1.4 University education*
*3.5.1.5 Professional training*
*3.5.1.6 Other type of training*
3.5.2 To travel in order to go to school or to one’s place of training and return home
*3.5.2.1 On foot*
*3.5.2.2 With one’s own means of transport (bicycle, velomotor, motocyclette, or automobile)*
*3.5.2.3 With public modes of transport*
*3.5.2.4 with school buses*
3.5.3 To undertake common activities of daily life in one’s place of training or education
*3.5.3.1 to travel to one’s place of training or education*
*3.5.3.2 to go to the toilet in one’s place of training or tuition*
*3.5.3.4 to establish good relationships in one’s place of training or tuition*
3.5.3.4.1 with the teachers
3.5.3.4.2 with the other students or pupils
3.5.3.4.3 with the management staff, personnel in administration and support functions
3.4.3.4.4 with service personnel
3.6 TO EXERCICE OR SEARCH FOR A PROFESSIONAL ACTIVITY
3.6.1 Quality of professional guidance
3.6.2 Quality of the research process for work
3.6.3 to travel to the place of work
*3.6.3.1 on foot*
*3.6.3.2 on two wheels*
*3.6.3.3 by car*
*3.6.3.4 by public transport*
*3.6.4 Reply to the requirements of the professional environment*
*3.6.4.1 to respect working hours*
3.6.4.1.1 full time
3.6.4.1.2 part-time
3.6.4.1.3 variable working hours
3.6.4.1. 4 fixed hours
3.6.4.1.5 by day
3.6.4.1.6 by night
*3.6.4.2 to ensure a stability and continuity in the work*
*3.6.4.3 to be well adapted to one’s work station*
3.6.4.3.1 The position of the body and lower limbs
3.6.4.3.2 the position of the upper limbs
3.6.4.3.3. the stability of the whole of the body, balance
3.6.4.3.4 Realisation of effort with constraints
3.6.4.3.5 rapidity of execution
3.6.5. To have the possibility of professional progression/promotion
3.6.6. to maintain good relations in the work place
*3.6.6.1 with the hierarchy*
*3.6.6.2 with colleagues and associates at work*
3.6.7 to be able to face the demands of daily life in one’s workplace
*3.6.7.1 to travel to one’s place of work*
*3.6.7.2 to use toilets at one’s place of work*
*3.6.7.3 to refresh oneself at one’s place of work*
3.7. TO BE ABLE TO ENSURE CARE FOR ONESELF
3.7.1 Follow medical consultations
3.7.2 To take one’s medication
3.7.3 To do one’s bandages
3.7.4 To ensure for oneself that one’s air passages are free from congestion
3.7.5 to know how to prevent the appearance of scarring
3.7.6 to do one’s own self testing
3.7.7. to follow rehabilitation sessions
*3.7.7.1 Kinesitherapie*
*3.7.7.2 Ergotherapy*
*3.7.7.3 Orthophony*
*3.7.7.4 Psychomotoricity*
*3.7.7.5 Orthopty*
*3.7.7.6 Other*
3.7.8 To ensure one’s own reeducation programme (self- retraining)
3.7.9 Benefit from psychological consultation

4) Subjectivity

Definition
This level addresses the person’s point of view regarding his/her health status and social position and includes their personal life histories. Within this context are considered all those subjective elements which may compromise, reduce or suppress a person’s equilibrium in daily life. It reveals how persons have dealt emotionally with traumatic events (the manner in which handicap appears and evolves, learning about, acknowledging and coming to terms with the handicap, adapting to and learning to live with their new condition).

Proposal of a scale to quantify subjectivity (proposition not validated)
0	no modification in a person’s subjectivity
1	minimal subjective impact
2	significant subjective impact
3	important subjective impact
4	very important impact on subjectivity

	0	1	2	3	4
4.1. ATTITUDE TOWARDS THE CIRCUMSTANCES IN WHICH A CHANGE TO THE BODY HAS TAKEN PLACE (ILLNESS, TRAUMA, OTHER)
4.1.1. Awareness of the reality of the situation (absence of denial or of a “flight from reality” reaction)
4.1.2 attitude towards the fear and terror initially experienced at the moment of the accident, the consequences of the accident and the ensuing trauma that these have provoked
4.1.3 attitudes and reactions towards the initial state of shock and stress
4.1.4 Attitude towards the perception of a feeling of guilt
4.1.5 Attitude towards the presence of obsessive thoughts and images
4.1.6 Attitude towards the growing awareness of the definitive character of one’s own state
4.1.7 Attitude towards the necessity of adapting to new situations created by the accident
4.1.8 Attitude towards the possible emergence of feeling of vengeance
4.1.9 Attitude towards the unexpected arrival of a feeling of anger
4.1.10 Attitude towards repetitive situatins (reminders of the painful experience of the initial episode)
4.1.11. Attitude towards intense emotional reactin (anger, refusal, dispute)
4.1.12 Attitude towards reactions of anguish
4.1.13 Attitude towards the possible unexpected arrival of a reaction of depression
4.1.14 Attitude towards suffering felt
4.2 PERCEPTION OF ONE’S PHYSICAL BODY
4.2.1 Attitude towards the feeling of being different (infirm, soiled, impure, dishonoured)
4.2.2 Attitude towards the necessity of being exposed to the view of others
4.2.3 Attitude towards the feeling of being unaesthetic, even “monstruous” in relation to:
4.2.3.1 one’s own familty ; spouse or partner, children, others
4.2.3.2 One’s friends
4.2.3.3 One’s neighbours, one’s colleagues and work or school associates
4.2.3.4 Other persons not mentioned in the previous categories
4.2.4 Attitude towards the feeling of having been “made dirty”, “impure”
4.2.5 Attitude towards the feeling of having been “dishonoured”
4.2.6 The expression of emotions
4.3. PERCEPTION OF ONE’S FUNCTIONAL STATE AND ONE’S CAPABILITIES
4.3.1 Attitude towards the feeling of having been diminished, made weak
4.3.2 to be aware of one’s remaining capabilities
4.3.3 to have the ability to undertake new activities
4.3.4 to be able to accept one’s limits
4.4 PERCEPTION OF LIFE SITUATIONS
4.4.1 Attitude faced with the feeling of being excluded, rejected
4.4.2 Attitude towards the feeling of hostility on the part of others
4.4.3 Attitude towards the feeling of pity on the part of others
4.4.4 Acceptance of situations of handicap
4.4.5 Attitude towards a possible withdrawal into oneself, of attempting to flee (refusal of reality)
4.4.6 Attitude towards the feeling of being a burden, an embarrassment for others and of “handicapping” them
4.4.7 Atittude towards to fear of integrating oneself into the field of work
4.4.8 Attitude towards the sentiments of mistrust on the part of others
4.5 FEELINGS IN RELATION TO ONE’S STATUS
4.5.1 The maintaining of hope of an improvement in functional capacities
4.5.2 to have the desire to progress, to evolve, to be motivated
4.5.3 to have hope for the future
4.5.4 to stick to a re-education programme
4.5.5 Stick to a programme of social reintegration
4.5.6 to have an attitude of constant stimulation
4.5.7 to make the most of new opportunities, to be enterprising
4.5.8 personal investment in a spiritual (or religious) undertaking
4.5.9 to be able to put priorities on the important things in life

TERESA MAGALHAES is a legal doctor at the Medico-legal Institute and Professor at the Faculty of Medicine in Oporto. She is a member of the International Academy of legal Medicine, of the International Academy of Law and Mental Health and of the International Socieyt for child abuse and neglect. She has published more than 80 articles and has contributed to the realisation of the publication “ Methodology for Assessment of Corporal Damages in the EU”.

CLAUDE HAMONET, pupil and friend of of the founders of this speciality in France, Professor Andre Grossiord. He is professor at the Faculty of Medicine at Creteil and created a University Department in Functional Rehabilitation at the University Paris 12, with the school of ergotherapy. He has dedicated himself, since 1980, to defining and evaluating handicap, as well as to the analysis of the mechanisms which lead to social exclusion. In order to better understand these questions, he became, under the direction of Professor Louis-Vincent Thomas, Doctor in Social Anthropology on the theme of handicap andexclusion. He was also originator of the creation at the University of Paris 12 of a new faculty of “Communication and Integration into society” which he led for five years. He is accredited expert at the Cour of Cassation. He taught as associate professor (the Anthropology of Handicap) at the University of Kansas in 1993. He was expert in medical research to the European Commission (DG12) and expert in the Medicine of Re-education to the World Health Organisation. He has participated, for the last twenty years, in the network of Centres who collaborate in the WHO World Programme for the prevention of violence. He is an “Emerite Professor” in University Paris-East-Creteil and a consultant in Hotel de Paris Hospital especially about Ehlers-Danlos disease.

This is an original document which all those persons concerned by handicap, its repair and compensation through reeducation have needed. This work is the culmination of a long and patient research programme initiated at the University Paris-Val-de Marne, at the beginning of the 1970s and at the Medico-Legal Institute of Oporto since 1993. The objectives of this work are to better define the meaning of handicap and handicapped persons, to analyse those mechanisms with result in their exclusion from social life and to indicate means by which they may be reintegrated into society. The authors afford a contribution and an alternative to the current taxonomic discussions regarding handicap and whose progression is difficult. This contribution has particular significance at this moment when indeed a large number of countries are considering a profound reform of their legislative measuree concerning handicapped persons, the time of construction of a social Europe. SIMH is focused on the person by using socio-anthropological and medical approaches to health. The medico-legal expertise has enabled for the constitution of a priviledged framework to validate this new concept of handicap. A simple, validated instrument “handicapometer”, which means that the measurements for three out of four levels and an overall level of handicap can be guaged. A guide of passation is appended. The last part is made up of a complete lexicon of terms relating to handicap and to medical rehabilitation. In total, this work is a valuable contribution in a transdisciplinary field which for many remains confused. The authors point out that this publication is only the first step. But it already provides the presentation of a overall method of analysis which is, for doctors, a new “semiological guide”

See second version (translation by Drs. M. Farjad (Tehran, Iran), M . Asheghan (Tehran, Iran) and S. Farjad (Créteil, France)

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Un instrument d’analyse et de mesure du handicap en quatre dimensions

Selon le Système d’Identification et de Mesure du Handicap « S.I.M.H. » (Paris, Porto, Montréal, Tunis, Jérusalem, Padoue, Belgrade)