398The following procedure should be used in assessing cerebral function.

398     The following procedure should be used in assessing cerebral function.

| Step 1 | Assess whether disturbance is present in the level of consciousness or awareness (Table 12.1.1: Permanent disturbances of levels of consciousness and awareness, Table 12.1.2: Epilepsy, seizures and convulsive disorders and Table 12.1.3: Sleep and arousal disorders). This may be a permanent alteration or an intermittent alteration in consciousness, awareness or arousal. Use the most applicable of Table 12.1.1, Table 12.1.2 or Table 12.1.3. | | Step 2 | Evaluate mental status and highest integrative functioning (Table 12.2: Impairment of memory, learning, abstract reasoning and problem solving ability). | | Step 3 | Identify any difficulty with comprehension and the use of language (Table 12.3: Criteria for rating impairment due to aphasia or dysphasia) Use the higher of the WPI ratings from these two tables. | | Step 4 | Evaluate any emotional or behavioural disturbances, such as depression, that can modify cerebral function (Table 12.4: Emotional or behavioural impairments). | | Step 5 | Identify the most severe cerebral impairment from steps 1 to 4 above. Combine the most severe WPI rating with WPI ratings from any tables in Chapter 12 – The neurological system including and following Table 12.5.1: The olfactory nerve (I), or with WPI ratings from other chapters. |

399     For the purposes of Chapter 12 – The neurological system, activities of daily living are those in Figure 12-A.

Figure 12-A: Activities of daily living

| Physical activity | Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising. |

Notes regarding station, gait and movement disorders

1. Station, gait and movement disorders:

(i)        station and gait disorders affecting the lower extremities are to be assessed under Table 9.7: Lower extremity function (see Chapter 9 – Musculoskeletal system);

(ii)      movement disorders affecting the upper extremities are to be assessed under Table 9.14: Upper extremity function (see Chapter 9 – Musculoskeletal system); and

(iii)     except as provided for in the case of injury involving spinal cord damage (see notes to Table 9.15: Cervical spine – diagnosis-related estimates, and , ), station, gait and movement disorders may not be combined with any other WPI ratings from Chapter 9 for the same condition, but may be combined with other WPI ratings under .