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Definitions

The following definitions can be located in Guide RC4064, Medical and Disability-Related Information.

Cumulative effect of significant restrictions – applies to 2005 and later years

Cumulative effect refers to an eligibility criterion that views being significantly restricted * in two or more basic activities of daily living as the equivalent of being markedly restricted * in a single activity.

Note: Vision can be combined with any of the basic activities of daily living, however, life-sustaining therapy cannot.

To meet this criterion, all of the following must be true:

• The patient has at least one impairment in physical or mental functions that has lasted, or is expected to last, for a continuous period of at least 12 months

• Even with appropriate therapy, medication, and devices, the impairment results in a significant restriction, that is not quite a marked restriction (see definitions below), in two or more basic activities of daily living

• These significant restrictions exist together all or substantially all the time

• The cumulative effect of these significant restrictions is equivalent to a marked restriction in a single basic activity of daily living

Examples of cumulative effects equivalent to being markedly restricted in a basic activity of daily living (examples are not exhaustive):

• The patient can walk for 100 metres but then must take time to recuperate. He or she can perform mental functions necessary for everyday life, but can concentrate on any topic for only a short period of time.
  
• The patient always takes a long time for walking, dressing, and feeding.

Dressing – A patient is considered markedly restricted in dressing if all or substantially all the time, he or she:

• Is unable to dress himself or herself, even with appropriate therapy, medication, and devices;

OR

• Requires an inordinate amount of time to dress himself or herself, even with appropriate therapy, medication, and devices.

Examples of markedly restricted in dressing (examples are not exhaustive):

• The patient cannot dress without daily assistance from another person.  Due to pain, stiffness, and decreased dexterity, your patient requires an inordinate amount of time to dress on a daily basis.

Elimination (bowel or bladder functions) – A patient is considered markedly restricted in elimination if, all or substantially all the time, he or she;

• Is unable to personally manage bowel or bladder functions, even with appropriate therapy, medication, and devices;

OR

• Requires an inordinate amount of time to personally manage bowel or bladder functions, even with appropriate therapy, medication, and devices.

Examples of markedly restricted in elimination (examples are not exhaustive):

• The patient needs the assistance of another person to empty and tend to his or her ostomy appliance on a daily basis.
• The patient is incontinent of bladder functions all or substantially all the time and requires an inordinate amount of time to manage and tend to his or her incontinence pads on a daily basis.

Feeding – The patient is considered markedly restricted in feeding if all or substantially all the time, he or she:

• Is unable to feed himself or herself, even with appropriate therapy, medication, and devices;

OR

• Requires an inordinate amount of time to feed himself or herself, even with appropriate therapy, medication, and devices.

Examples of markedly restricted in feeding (examples are not exhaustive):

• The patient requires tube feedings all or substantially all of the time.
• The patient requires an inordinate amount of time to prepare meals or to feed himself or herself on a daily basis due to significant pain and decreased strength and dexterity of upper limbs.

Hearing – A patient is considered markedly restricted in hearing if all or substantially all the time he or she:

• Is unable to hear so as to understand another person familiar with the patient, in a quiet setting, even with the use of appropriate devices;

OR

• Takes an inordinate amount of time to hear so as to understand another person familiar with the patient, in a quiet setting, even with the use of appropriate devices.

Examples of markedly restricted in hearing (examples are not exhaustive):

• The patient must rely completely on lip reading or sign language, despite using a hearing aid, to understand a spoken conversation all or substantially all of the time.
• To be understood, it is necessary for the speaker to raise his or her voice and repeat words and sentences several times, and it takes a significant amount of time for the patient to understand, despite the use of a hearing aid.

Life Sustaining therapy (for 2000 and later years) – Life-sustaining therapy must meet both of the following conditions:

1. The therapy is required to support life, even if it alleviates the symptoms.
2. At least 3 times a week, for an average of at least 14 hours a week (do not include time needed to recuperate after therapy, for travel, medical appointments, or shopping for medication) must be dedicated to the therapy

The activities directly related to determining the dosage are considered part of the therapy, except for those activities related to exercise or following a dietary regime, such as carbohydrate calculation; and the time spent by primary caregiver performing and supervising the activities related to the therapy of a child because of his or her age is considered to be time dedicated to this therapy.

Markedly restricted – You are markedly restricted if, all or substantially all the time, you are unable (or it takes you an inordinate amount of time) to perform one or more of the basic activities of daily living, even with therapy (other than life-sustaining therapy) and the use of appropriate devices and medication.

Mental functions necessary for everyday life – A patient is considered markedly restricted in performing the mental functions necessary for everyday life (described below) if all or substantially all the time, he or she:

• Is unable to perform them by himself or herself, even with appropriate therapy, medication, and devices (for example, memory aids and adaptive aids);

OR

• Requires an inordinate amount of time to perform them by himself or herself, even with appropriate therapy, medication, and devices. An inordinate amount of time means that your patient takes significantly longer than an average person who does not have the impairment.

Mental functions necessary for everyday life include:

• Adaptive functioning (for example, abilities related to self-care; health and safety; social skills; and common, simple transactions);
• Memory (for example, the ability to remember simple instructions, basic personal information such as name and address, or material of importance and interest); and
• Problem-solving, goal-setting, and judgment, taken together (for example, the ability to solve problems, set and keep goals, and make appropriate decisions and judgments).

Important – a restriction in problem-solving, goal-setting, or judgement that markedly restricts adaptive functioning all or substantially all the time would qualify.

Examples of markedly restricted in mental functions necessary for everyday life (examples are not exhaustive):

• The patient is unable to leave the house all or substantially all the time due to anxiety, despite medication and therapy.
• The patient is independent in some aspects of everyday living. However, despite medication and therapy, he or she needs daily support and supervision due to an inability to accurately interpret his or her environment.
• The patient is incapable of making a common, simple transaction without assistance all or substantially all the time.
• The patient experiences psychotic episodes several times a year. Given the unpredictability of the psychotic episodes and the other defining symptoms of his or her impairment (for example, avolition, disorganized behaviour and speech), the patient continues to require daily supervision.
• A four-year-old patient who cannot play interactively with peers or understand simple requests.

Prolonged – An impairment is prolonged if it has lasted, or is expected to last, for a continuous period of at least 12 months.

Qualified practitioner – Qualified practitioners are medical doctors, optometrists, audiologists, occupational therapists, physiotherapists, psychologists, and speech-language pathologists.

Significantly restricted – means that although you do not quite meet the criteria for markedly restricted, your ability to perform a basic activity of daily living is still substantially restricted.

Speaking – A patient is considered markedly restricted in speaking if all or substantially all the time, he or she:

• Is unable to speak so as to be understood by another person familiar with the patient, in a quiet setting, even with appropriate therapy, medication, and devices;

OR

• Takes an inordinate amount of time to speak so as to be understood by a person familiar with the patient, in a quiet setting, even with appropriate therapy, medication, and devices.

Examples of markedly restricted in speaking (examples are not exhaustive):

• The patient must rely on other means of communication, such as sign language or a symbol board, all or substantially all of the time.
• The patient must be asked to repeat words and sentences several times, and it takes a significant amount of time to make himself or herself understood. 

Vision – The individual is considered blind if, even with the use of corrective lenses or medication:

• Visual acuity in both eyes is 20/200 or (6/600) or less with the Snellen Chart (or an equivalent);

OR

• The greatest diameter of the field of vision in both eyes is 20 degrees or less

Walking – A patient is considered markedly restricted in walking if, all or substantially all the time, he or she:

• Is unable to walk even with appropriate therapy, medication, and devices

OR

• Requires an inordinate amount of time to walk, even with appropriate therapy, medication, and devices.

Examples of markedly restricted in walking (examples are not exhaustive):

• The patient must always rely on a wheelchair outside the home, even for short distances.
• The patient can walk 100 metres (or approximately one city block), but only by taking a significant amount of time, stopping because of shortness of breath or because of pain, all or substantially all of the time.
• The patient experiences severe episodes of fatigue, ataxia, lack of co-ordination, and problems with balance. These episodes cause the patient to be incapacitated for several days at a time, in that he or she becomes unable to walk more than a few steps. Between episodes, your patient continues to experience the above symptoms, but to a lesser degree. Nevertheless, these less severe symptoms put the patient at significant risk of injury due to loss of balance, lack of co-ordination, or falling and cause him or her to require an inordinate amount of time to walk all or substantially all of the time.