45908 Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices

DEPARTMENT OF TRANSPORTATION

Coast Guard

[CGD 97–058]

Towing Safety Advisory Committee

AGENCY: Coast Guard, DOT.

ACTION: Notice of meetings.

SUMMARY: The Towing Safety Advisory

Committee (TSAC) and its working

groups will meet to discuss various

issues relating to shallow-draft inland

and coastal waterway navigation and

towing safety. All meetings are open to

the public.

DATES: The meeting of the TSAC

working groups will be held on

Tuesday, September 30, 1997, from 9

a.m. to 3 p.m. The TSAC Committee

meeting will be held on Wednesday,

October 1, 1997, from 9 a.m. to 1 p.m.

Written material and requests to make

oral presentations should reach the

Coast Guard on or before September 19,

1997.

ADDRESSES: The TSAC working groups

will meet in Room 2415, second floor,

and the Committee meeting will be held

in the Baruch Room, fourth floor, U.S.

Coast Guard Headquarters, 2100 Second

St. SW., Washington, DC. Written

material and requests to make oral

presentations should be sent to

Lieutenant Lionel Mew, Commandant

(G–MSO–1), U.S. Coast Gaurd

Headquarters, 2100 Second St. SW.,

Washington, DC 20593–0001.

FOR FURTHER INFORMATION CONTACT:

Lieutenant Lionel Mew, Assistant

Executive Director, telephone (202)

267–0218, fax (202) 267–4570.

SUPPLEMENTARY INFORMATION: Notice of

these meetings is given pursuant to the

Federal Advisory Committee Act, 5

U.S.C. App. 2.

Agenda of Meeting

Towing Safety Advisory Committee

(TSAC). The agenda includes the

following:

(1) Progress report from the Electronic

Charting working group.

(2) Final report from the Tankbarge

Structural Soundness working group.

(3) Progress report from the Fire

Suppression working group.

(4) Progress report from the Licensing

working group.

(5) Status of the implementation of

the International Management Code for

the Safe Operation of Ships and for

Pollution Prevention (International

Safety Management (ISM) Code).

(6) Status of the Towing Vessel

Licensing rulemaking project.

(7) Final report of the American

Waterways Operators/U.S. Coast Guard

Tankbarge Transfer Spills Quality

Action Team.

Procedural

All meetings are open to the public.

At the Chairperson’s discretion,

members of the public may make oral

presentations during the meetings.

Persons wishing to make oral

presentations at the meeting should

notify the Assistant Executive Director

no later than September 19, 1997.

Written material for distribution at the

meeting should reach the Coast Guard

no later than September 19, 1997. If a

person submitting material would like a

copy distributed to each member of the

committee or subcommittee in advance

of the meetings, that person should

submit 25 copies to the Assistant

Executive Director no later than

September 9, 1997.

Information on Services for Individuals

With Disabilities

For information on facilities or

services for individuals with disabilities

or to request special assistance at the

meeting, contact Lieutenant Mew as

soon as possible.

Dated: August 22, 1997.

R.L. Skewes,

Captain, USCG, Acting Director of Standards,

Marine Safety and Environmental Protection.

[FR Doc. 97–23075 Filed 8–28–97; 8:45 am]

BILLING CODE 4910–14–M

DEPARTMENT OF TRANSPORTATION

Coast Guard

[CGD 96–044]

International, Private-Sector Tug-ofOpportunity System, Notice of

Availability of a Ship-Drift Analysis for

the Northwest Olympic Peninsula and

the Strait of Juan de Fuca

AGENCY: Coast Guard, DOT.

ACTION: Notice of extension; request for

comments.

SUMMARY: The Coast Guard made

available the Ship-Drift Analysis for the

Northwest Olympic Peninsula and the

Strait of Juan de Fuca, prepared by the

National Oceanic and Atmospheric

Administration (NOAA), through a

notice published in the Federal Register

on July 24, 1997 (62 FR 39885). The

Coast Guard is extending the comment

period, which closed on August 14,

1997, until August 29, 1997, to let the

public participate more fully in this

rulemaking.

DATES: Comments must be received by

August 29, 1997.

ADDRESSES: Submit written comments

to LT William Pittman, Commandant

(G–MOR), U.S. Coast Guard

Headquarters, 2100 Second Street, S.W.,

Washington, DC 20593–0001, telephone

(202) 267–0426, fax (202) 267–4085.

FOR FURTHER INFORMATION CONTACT:

CDR William Carey, Commander,

Thirteenth U.S. Coast Guard District

(mep), telephone (206) 220–7221, fax

(206) 220–7225. The telephone number

is equipped to record messages on a 24-

hour basis.

SUPPLEMENTARY INFORMATION: The

comment period is being extended to

allow for comments that, because of

their technical nature, may require

additional time to prepare. This

extension results from requests from the

public for more time. The Coast Guard

is seeking comments from the public on

how to apply the NOAA analysis to the

marine-safety criteria set forth in a

Report to Congress on International,

Private-Sector Tug-of-Opportunity

System for the Waters of the Olympic

Coast National Marine Sanctuary and

the Strait of Juan de Fuca.

Dated: August 22, 1997.

R.C. North,

Rear Admiral, U.S. Coast Guard, Assistant

Commandant for Marine, Safety and

Environmental Protection.

[FR Doc. 97–23069 Filed 8–28–97; 8:45 am]

BILLING CODE 4910–14–M

DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety

Administration

[Docket No. 91–33, Notice No. 03]

Functional Capacity Index

AGENCY: National Highway Traffic

Safety Administration (NHTSA),

Department of Transportation (DOT).

ACTION: Notice and request for comment

on proposed Pediatric Functional

Capacity Index.

SUMMARY: The National Highway Traffic

Safety Administration (NHTSA) is

developing a scale to quantify the

consequences of pediatric injuries

received in motor vehicle crashes based

on adjusted life-years. This index is an

extension of the basic index described

in Docket No. 91–33, Notice No. 01. The

factor used to adjust the injured

person’s remaining life-years is called

the Functional Capacity Index (FCI). It

combines decrements in each of ten

dimensions of functioning into a whole

body score. The development of the

definitions of the functional attributes

and their various capacity levels has
Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices 45909

been completed. This notice requests

comments on the approach being taken

and on the attribute definitions.

DATES: Comments are requested no later

than October 14, 1997.

ADDRESSES: Written comments should

refer to the docket and notice number of

this document and should be submitted,

(preferably in ten copies) to: Docket

Section, National Highway Traffic

Safety Administration, Room 5109,

Nassif Building, 400 Seventh Street

S.W., Washington, D.C. 20590. (Docket

hours are 9:30 a.m. to 4:00 p.m.)

FOR FURTHER INFORMATION CONTACT:

Stephen Luchter, Senior Policy Advisor,

Office of Plans and Policy, National

Highway Traffic Safety Administration,

400 7th St. S.W., Washington, D.C.

20590. Telephone 202/366–2576.

SUPPLEMENTARY INFORMATION: NHTSA’s

mission is to save lives, prevent injuries,

and reduce traffic-related health and

other economic costs. To accomplish

this mission efficiently, the agency

needs accurate and reliable methods of

quantifying the consequences of injuries

to those who are injured, as well as to

their families and society in general.

NHTSA has developed sophisticated

methods for quantifying the economic

consequences of deaths and injuries.

These have been available for some time

and are widely applied. NHTSA uses

these for, among other things, resource

allocation, regulatory analysis, and in

support of state and local programs.

In addition, the agency is developing

methods to quantify injury

consequences based on the injured

person’s functional capacity. An FCI is

being developed for measuring a

previously healthy adult’s functional

capacity one year post-injury. This

notice describes a program to develop a

pediatric version of the FCI and requests

comments on the first phase of this

effort, definition of functional attributes.

General Description

The basic assumption of the FCI is

that life is its own best measure of

value. If there are things a person cannot

do as well following an injury as before,

there is a reduction in their overall

functional capacity. With the functional

capacity approach, individuals of the

same age and gender are counted

equally. The injury consequences to

young children are not discounted, and

the longer average lifespan of females is

accurately reflected.

The FCI is a measure of the relative

degree to which an injured person is

unable to function at their pre-injury

level on a scale of 0 to 100, where 0

represents no limitation of function and

100 represents maximum limitation of

function. The overall consequences of

an injury are found by multiplying the

FCI, as a decimal between 0 and 1.0 by

the injured person’s remaining life

expectancy. Note that the FCI can vary

with time as the injured person’s

condition changes. The product of the

FCI and the life expectancy is the

number of years of reduced functional

capacity. Any effects of reduced life

expectancy as a result of the injury also

can be accounted for.

Attribute and Severity Level Definitions

The work of selecting the attributes to

be included in Pediatric Functional

Capacity Index (PFCI), and defining

each attribute and each severity level

has been completed. The same attributes

were chosen for the PFCI as for the adult

version. The choice was pragmatic,

attempting to have as few as possible yet

to have a sufficient number to fully

describe the functioning of a complete

human being. In addition, the effects of

childhood development were accounted

for by developing definitions that vary

with the child’s age.

The number of levels within each

attribute were chosen as needed to

reflect observable variation in functional

capacity for that attribute rather than

arbitrarily deciding that some number of

levels would be used for all attributes.

In some cases, the number of levels

differs from that in the adult FCI.

Similarly, age categories required to

differentiate the differences in

development as children mature were

also selected as appropriate for each

attribute. Each attribute has levels of

functioning ranging from no reduction

in functional capacity to maximum

reduction. Definitions were developed

for each attribute and each severity level

as well as for appropriate age categories.

The definitions were reviewed and

refined based on suggestions made by a

panel of nationally recognized experts

in pediatric trauma, as well as

physicians and allied health

professionals specializing in pediatric

rehabilitation medicine.

The results are shown in Tables 1

through 10.

Eating (Table 1)—Difficulty eating is

characterized by limitations in the

ability to chew and swallow foods.

Defined in this manner, the ability to eat

is independent of the ability to hold or

use utensils.

Excretory Function (Table 2)—

Excretory function is characterized by

control over urinary and fecal

elimination.

Sexual Function (Table 3)—This

function is determined by physical

capabilities anticipated to occur as an

adult; dysfunction due to psychological

reasons is not considered. Note that this

attribute is the only one that does not

relate directly to the injured child’s

current situation.

Ambulation (Table 4)—Ambulation is

characterized by the ability to (1) stand,

walk and run and (2) climb stairs.

Limitations are described in terms of

distance, speed, the need for a

mechanical device or human assistance.

Limitations may be due to motor

impairments, contractures, pain, loss of

equilibrium, reduced sensation or poor

cardiopulmonary function.

Hand and Arm Function (Table 5)—

Upper limb function is characterized by

the ability to (1) grasp and manipulate

objects, (2) write, (3) move hand to

mouth, (4) move arms over head, and (5)

bilateral skills. Grasping and

manipulating is described in terms of

the size of the object. Writing is

described in terms of use of a crayon in

age appropriate motions. Hand to mouth

movement is described in terms of

number of repetitions and speed.

Bilateral skills are described in terms of

manipulating objects. Movement of the

upper limbs may be limited by motor

impairment, contracture, pain, or

reduced sensation.

Bending and Lifting (Table 6)—Neuromusculoskeletal function of the trunk is

characterized by the ability to bend over

from a sitting position and touch hand

to foot, and by the ability to lift.

Limitations in bending and lifting may

be due to motor impairments, pain, or

loss of equilibrium.

Visual Function (Table 7)—Visual

function is characterized by visual

acuity and presence or absence of

functional diplopia. The levels of visual

acuity parallel those delineated in the

9th revision of the International

Classification of Diseases (ICD–9).

Auditory Function (Table 8)—

Auditory function is described by

degree of difficulty hearing under

everyday listening conditions and by

the average of hearing threshold levels

at four standard frequencies.

Speech (Table 9)—Limitations of

speech include difficulties in voice

production and articulation and in use

of age appropriate vocabulary.

Cognitive Function (Table 10)—

Cognitive function is described by the

capacity of the individual to perform

age appropriate activities, demonstrate

age appropriate learning memory

abilities, and for school age children

having age appropriate academic

progress.

Applying the Definitions to the AIS 90

Dictionary

The attribute and severity levels will

be applied to each injury listed in the
45910 Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices

AIS 90 Dictionary by an expert panel

based upon their clinical judgment.

These judgements will then be validated

by interviewing a sample of people who

experienced the injuries.

Developing a Numerical Scale

The final step in the development of

the FCI is to translate the sets of

qualitative statements applicable to each

injury into numerical values. The

approach taken for the PFCI follows that

of the adult version. Values are assigned

to each severity level within an attribute

on a scale of 0 to 100. Each number on

this scale represents a degree of severity

such that 50 is ten degrees higher than

40, 90 is ten degrees higher than 80 and

so forth. The number 0 reflects the

lowest degree of severity (no limitation

in functional capacity), and 100 reflects

the highest degree of severity (maximum

limitation in functional capacity). The

numbers reflect the rater’s judgment of

the relative severity of the limitation in

terms of its likely impact on overall

function in everyday living. The major

aspects of life for children are intended

to include social interaction and major

usual activity such as play, school or for

older children, work. A separate chart is

used for each of the attributes. In these

charts the end points are preprinted and

the rater places the remaining

intermediate levels of function on the

scale such that the relative spacing

between levels reflects their judgments

of the expected degree of severity.

Once the within-attribute scaling has

been completed, the second step is to

rate the relative weights of the attributes

with respect to each other. This step is

more complex than the rating within

attributes because it must consider the

possibility that the attributes may not be

completely independent. Also, some

combined states are added to assist in

the final step of combining into the

whole body factor and to cover

situations not included in the single

state listing, for example, total blindness

in one eye and both eyes, profound or

total loss of auditory function in one or

both ears, quadriplegia, deaf-blind, and

simultaneously being at the most severe

level on all 10 dimensions. Death is also

scaled to provide an anchor point.

In this step, the rater first considers

the most severe level for each of the

attributes and identifies which has the

greatest impact on everyday living by

placing a mark on a scale of 0 to 100.

The rater then places the remaining

most severe states for the remaining

nine attributes on the scale relative to

the one judged to have the greatest

impact. Death is scaled next. A scale

value greater than 100 is acceptable.

Next, the rater assigns a numerical value

to the state representing the state of

being at the most severe of all of the

dimensions, and to some combined

states not included in the list of

attributes, such as quadriplegia and

deaf-blind. These will be placed at scale

values less than the value assigned to

death.

Following these two steps, the values

and weights will be normalized to a 0

to 100 scale with death as 100 and the

remaining states relative to that. These

values will then be combined using an

appropriate model.

As part of this work the judgments of

parents, teachers, both special education

and mainstream education, and children

will be obtained. In addition, an effort

will be made to determine if value

judgements vary with cultural

background.

Limitations

Although every attempt has been

made to make the PFCI as broadly

applicable as possible, certain

limitations are acknowledged. Some of

these are topics that could be

considered for further development.

1. With a few exceptions, the index in

its present state of development is

applicable to single injuries.

Methodologies to estimate the change in

functional capacity resulting from any

synergistic effects of more than one

injury, particularly injuries to different

body regions, remain to be developed.

2. Changes in functional capacity

from pre-existing conditions are not

included, as this would require

knowledge of differences in the

consequences of injuries to different

sub-populations. An average healthy

child prior to injury is assumed in the

current development.

3. The present effort to develop a PFCI

will be limited to the injury definitions

in the 1990 version of the Abbreviated

Injury Scale. Although the International

Classification of Disease injury

descriptions are widely used, they

generally do not contain sufficient detail

for the agency’s countermeasure

development purposes.

Comments

NHTSA requests comments on the

proposed PFCI. General and detailed

comments on this proposal are welcome

in order to benefit from the opinions

that interested parties and the public

may wish to forward. All comments

submitted in response to this notice will

be considered by the agency.

Comments are specifically solicited

on the following issues with respect to

the material shown in Tables 1 through

10 of this Notice.

1. Do the 10 attributes reasonably

cover the range of functions found in

people age 1 and older?

2. Do the levels of functional capacity

shown in Tables 1 through 10

reasonably cover the range for the

individual functions?

3. Are the definitions of the functional

capacity levels shown in Tables 1

through 10 unambiguous?

4. Are the definitions shown in Tables

1 through 10 comprehensible to a lay

person?

Written comments should be

submitted to:NHTSA Docket

Section,Room 5109, Nassif Building,

400 Seventh Street S.W., Washington,

D.C. 20590.

Comments should refer to Docket

#91–33, Notice 03.

It is requested, but not required, of

interested persons that ten copies of

each comment be submitted. All

comments must not exceed fifteen pages

in length. (49 CFR 553.21). Necessary

attachments may be appended to these

suggestions without regard to the fifteen

page limit. This limitation is intended to

encourage commenters to present their

views in a concise fashion.

All comments received before the

close of business on the comment

closing date listed above will be

considered and will be available for

examination in the docket at the above

address both before and after that date.

To the extent possible, comments filed

after the closing date will be considered.

However, this action may proceed at

any time after that date. The agency will

continue to file relevant information as

it becomes available. It is recommended

that interested persons continue to

examine the docket for new material.

Those persons desiring to be notified

upon receipt of their comments by the

docket should include a self-addressed,

stamped postcard in the envelope with

their comments. Upon receiving the

comments, the docket supervisor will

return the postcard by mail.

Issued on: August 22, 1997.

William H. Walsh,

Associate Administrator, Plans and Policy.
Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices 45911

EATING

Function Level A: No limitations

Level B: No dietary modifications. Requires supervision,

compensatory strategies and/or

adaptive equipment

Level C: Requiring dietary

modifications. May require supervision, compensatory strategies and/or adaptive equipmentLevel D: Limited P.O. intake

supplemented by tube feeding Level E: Tube feeding only

Swallowing Liquids 12

mo+.

Drinks liquids primarily from

cup, however may occasionally use bottle or breast.

Coughing and choking are

rare.

Requires grading amount of liquid, or compensatory strategies (i.e., jaw support, etc.).

Requires use of thickening

agent or rice cereal to safely

tolerate liquids.

Tolerates small amount of liquid following safety precautions however, child is

unable to meet nutritional

needs P.O. requiring tube

feeding.

All nutritional needs met via

tube feeding as child is unable to safely take any liquids P.O. secondary to impaired oral motor skills and/

or risk for aspiration.

Swallowing Solids 12–

18 mo.

Effectively chews and swallows

ground, mashed, or chopped

table foods. May lose minimal amounts of food/saliva

during chewing and swallowing.

Requires adaptive positioning

techniques, adaptive placement of food in mouth (i.e.

flat-based spoon) or smaller

sized bolus to tolerate solids.

Requires pureed diet (i.e. baby

food) secondary to difficulty

chewing, swallowing or digesting.

Tolerates small amount of solids following safety precautions however, child is

unable to meet nutritional

needs P.O. requiring tube

feeding.

All nutritional needs met via

tube feeding as child is unable to safely take any solids

P.O. secondary to impaired

oral motor skills and/or risk

for aspiration.

18 mo+ ........................ Effectively chews and swallows

all solids well with good lip

closure. No loss of food/saliva during swallowing.

Requires adaptive positioning

techniques, adaptive placement of food in mouth (i.e.

flat-based spoon) or smaller

sized bolus to tolerate solids.

Requires pureed diet (i.e. baby

food) secondary to difficulty

chewing, swallowing or digesting.

Tolerates limited amount of solids following safety precautions however, child is

unable to meet nutritional

needs P.O. requiring tube

feeding.

All nutritional needs met via

tube feeding as child is unable to safely take any solids

P.O. secondary to impaired

oral motor skills and/or risk

for aspiration.

Reference: Pre-Feeding skills—Suzanne Evans Morris, PhD and Marsha Dunn Klein, M.Ed, OTR, Therapy Skill Builders, 1987, P.O. (Per Os)=By Mouth.

EXCRETORY FUNCTION

Function Level A: No limitation Level B: Controllable excretory

difficulty

Level C: Moderate excretory difficultyLevel D: Severe excretory difficulty

1yr–<2yrs (12–23

mnths).

No significant difficulty eliminating urine or fecal matter (into

diaper); No constipation or urinary retention.

No retention problems. Dependent, but controlled use of catheterization device +/or ostomy

or controlled with medication

+/or diet.

Moderate retention. Difficulty

eliminating urine or fecal matter (into diaper) despite use of

catheterization device +/or

ostomy or controlled with

medication +/or diet.

Severe difficulty eliminating urine

or fecal matter (into diaper)

despite use of catheterization

device +/or ostomy or medication +/or ostomy or medication

+/or diet.

2yrs–31⁄2yrs (24–42

mnths).

No significant difficulty eliminating urine or fecal matter (into

diaper); No constipation or urinary retention.

No retention problems. Dependent, but controlled use of catheterization device +/or ostomy

or controlled with medication

+/or diet.

Moderate retention. Difficulty

eliminating urine or fecal matter (into diaper) despite use of

catheterization device +/or

ostomy or controlled with

medication +/or diet.

Severe difficulty eliminating urine

or fecal matter (into diaper)

despite use of catheterization

device +/or ostomy or medication +/or diet.

>31⁄2yrs–10yrs (≤42–

≥120 mnths).

No significant difficulty controlling

the elimination of urine or fecal

matter. No incontinence day/

night; No constipation or urinary retention.

No incontinence. Controlled use

of catheterization device +/or

ostomy with 1 person assistance or controlled with medication +/or diet. No retention

problems. Dependent, but controlled use of catheterization

device +/or ostomy or controlled with medication +/or

diet.

Moderate incontinence (urinary

+/or fecal); frequency greater

than 2x/wk by night and by

day despite use of catheterization device +/or ostomy with 1

person assistance or controlled with medication +/or

diet. Moderate retention difficulty despite use of catheterization device +/or ostomy or

medication +/or diet.

Severe incontinence (urinary +/or

fecal); frequency everyday &

night despite use of catheterization device +/or ostomy with

1 person assistance or controlled with medication +/or dietary influence. Severe retention difficulty despite use of

catheterization device +/or

ostomy or medication +/or diet.

SEXUAL INTERCOURSE FUNCTIONING (PREDICTION OF ADULT SEXUAL FUNCTION)

Function Leval A: No limitation Level B: Moderate difficulty Level C: Severe limitation (or no sexual function possible)

1yr + (12+ mnths) ... Sexual function will be possible without

difficulty.

Sexual function will be possible but

with varying degrees of difficulty due

to physical impairment(s).

Sexual function will not be possible or

there will be severely impaired difficulty.

AMBULATION (STAIR CLIMBING)

Function Level A: No limitations Level B: Minor limitations

Level C: Independent, requires device, takes more than reasonable timeLevel D: Minimally

dependent; requires assistance

Level E: Moderately

dependent

Level F: Completely

dependent

Stair climbing 12–17

months.

Crawls up or down stairs,

may walk up stairs with

one hand held.

......................................... May require extra time

and/or an assisted device.

......................................... ......................................... Severe limitation, no ability to climb stairs.

18–23 months ............... Walks up and down holding rail. May need one

hand held walking

down stairs.

Walks up w/one hand

held, may crawl up or

down stairs.

......................................... Crawls on stomach and

elbows (not quadruped)

up stairs.

......................................... Severe limitation, no ability to climb stairs.

24–29 months ............... Walks up and down holding rail.Needs 1 hand held walking down stairs.Crawls up or down stairs,

may walk up with one

hand held and/or use

assisted device.

......................................... Crawls on stomach and

elbows (not quadruped)

upstairs.

Severe limitation no ability to climb stairs.

30–35 months ............... Alternates feet going up

and down stairs.

Alternates feet going

down stairs.

Walks up and down holding rail, may need 1

hand held and/or assisted device.

Crawls up or down stairs ......................................... Severe limitation, crawls

on stomach up stairs,

no ability to stair climb.
45912 Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices

AMBULATION (STAIR CLIMBING)—Continued

Function Level A: No limitations Level B: Minor limitations

Level C: Independent, requires device, takes more

than reasonable time

Level D: Minimally

dependent; requires

assistance

Level E: Moderately

dependent

Level F: Completely

dependent

36 months and older .... No limitation. Climbs up

and down 12 steps

without difficulty.

Minimal limitation, may

have deviations in gait

pattern.

Climbing 12 stairs without

assistance takes more

than a reasonable time,

requires device or

handrail.

Can climb minimum of 12

steps with or without

assistance and/or device.

Stair climbing less than

12 steps with or without assistance and/or

device.

Severe limitation, cannot

walk up minimum of 12

steps.

AMBULATION (STANDING, WALKING, RUNNING)

Function Level A: No limitations Level B: Minor limitations

Level C: Independent, requires device, takes more

than reasonable amount

of time

Level D: Minimally dependent; requires assistance

Level E: Moderately dependentLevel F: Completely dependent

Standing/Walking/Running 12–17 Months.Walks alone seldom falls

(may be wide based

gait) may only walk

several steps independently.

Walks with 1 hand held .. Walks with 2 hands held

may require assisted

device (orthotics, walker, etc.).

Cruises with 1 hand (may

need assisted device).

Cruises with 2 hands

(may need assisted device).

Completely dependent,

crawl and/or stands at

rail, including no crawling or standing or pull

to standing position.

18–23 Months ............... Walks alone without falling, runs.Walks alone seldom falls Walks with 1 hand held

may require some device.

Walks with 2 hands held

may require device.

Cruises with 1 hand (may

need device).

Completely dependent;

crawls, stands, cruises

with 2 hands; may not

crawl or pull to stand.

24 Months and Older ... No limitations, able to

walk at least 150′, no

deviations in gait pattern.

Some limitation, can walk

150′ without assistance

but with increasing

problems over increased distances; may

have minimal deviation;

does not require device.

Can walk 150′ without

assistance, but takes

more than a reasonable amount of time

and requires some device.

Can walk minimum of

150′ with assistance

may or may not require

device.

Walking limited to 50–

150′ with/or without assistance and/or device.

Difficulty standing for long

periods of time or walk

minimum of 50′ including unable to walk at

all.

Note: Cruising: ‘‘Sidewards walking, holding rail for support, shifting hands.’’ Taken from Manual of Developmental Diagnosis by Knobloch, Stevens and Malone (p. 68).

PEDIATRIC BETTER HAND AND ARM FUNCTION

Function Level A: No limitation

Level B: Minor limitation

in hand function: No limitation in arm function

Level C: Major limitation

in hand function: No limitation in arm function

Level D: No limitation in

hand function: Min to

moderate limitation in

arm function

Level E: Moderate limitation in hand and arm

function

Level F: Complete or

near paralysis or loss of

both limbs

Grasp and release of

small and large objects (12 mos. +).

Grasps tiny objects using

tips of thumb and index

finger. No difficulty with

large objects in relation

to the child’s hand. Releases objects in a

controlled manner.

Uses immature grasp

(scissor grasp) of tiny

object with increased

time. No difficulty with

large objects. Requires

increased time for controlled release.

Uses immature grasp

(palmer grasp) with

max difficulty with tiny

and large objects (including not being able

to do it at all). Release

is uncontrolled.

No difficulty grasping pellet or large objects. Release is controlled.

Moderate difficulty grasping small and large objects using immature

grasp patterns (raking).

May require increased

time. Release is clumsy but purposeful.

Max difficulty or inability

to grasp small and

large objects. Release

is uncontrolled.

Writing (15–23 mos.) .... Holds crayon in palm and

scribbles spontaneously. Writes using

whole arm movement.

Minor difficulty to grasp

crayon in palm and

write using whole arm

movement. Imitates

scribble with increased

time.

Max difficulty grasping

crayon including inability to grasp crayon effectively for scribble.

No difficulty grasping

crayon in palm. May

require increased time

to scribble using whole

arm movements.

Moderate difficulty to

grasp crayon in palm

and write using whole

arm movement. Requires increased time

to scribble.

Max difficulty grasping

crayon including inability to grasp crayon or

scribble.

(24–30 mos.) ................ Holds crayon in palm and

writes using forearm

movement. Imitates

vertical stroke and circular scribble.

Holds crayon in palm and

writes using forearm

movement. Demonstrates vertical

stroke and circular

scribble with increased

time.

Max difficulty grasping

crayon including inability to grasp crayon effectively for scribble.

No difficulty grasping

crayon in palm. Writes

using whole arm movements. Demonstrates

age-appropriate strokes.

Moderate difficulty to

grasp crayon in palm

and write using whole

arm movements. Requires increased time

to grossly imitate vertical and circular strokes.

Max difficulty grasping

crayon; including inability to grasp crayon or

scribble.

(31–59 mos.) ................ Holds crayon with fingers

and writes using whole

hand and wrist movement. Imitates horizontal stroke, V+H

strokes.

Holds crayon with fingers

and writes using whole

hand and wrist movement. Imitates horizontal, V+H strokes

with increased time.

Max difficulty grasping

crayon. Uses immature

grasp patterns (palmer). Writes using forearm movement.

No difficulty grasping

crayon with fingers.

Writes using whole

hand or wrist movement with forearm supported. Demonstrates

age-appropriate strokes.

Uses immature grasp

(palmer) to hold crayon

and writes using forearm or arm movement.

Requires increased

time to grossly imitate

horizontal and vertical

strokes.

Max difficulty grasping

crayon including inability to grasp crayon or

scribble.

(60 mos. +) ................... Holds crayon with fingers

and writes using fine

finger movement.

Prints own name.

Holds crayon with fingers

and writes using wrist

and finger movement.

Prints own name with

increased time.

Max difficulty grasping

crayon. Uses whole

hand or forearm movement to write. Imitates

immature stroke patterns grossly.

No difficulty grasping

crayon. Writes using

fine finger movements

with forearm supported.

Demonstrates age- appropriate strokes.

Requires increased time

to grasp crayon with

fingers and write using

forearm movement.

Grossly prints own

name.

Max difficulty grasping

crayon including inability to grasp crayon or

scribble.

Hand Movement to

mouth(12 mos. +).

No difficulty moving

hands to mouth at least

5 times.

No difficulty moving

hands to mouth at least

5 times.

No difficulty moving

hands to mouth at least

5 times.

Minimal to mod difficulty

moving hands to mouth

at least 5 times.

Requires increased time

to take hand to mouth.

Cannot move either hand

to mouth at least 5

times.

Arm Movement over

head(12 mos. +).

No difficulty reaching for

toys over head with

both arms.

No difficulty reaching for

toys over head with

both arms.

No difficulty reaching for

toys over head with

both arms.

Min to mod difficulty

reaching over head for

toys with one or both

arms.

Requires increased time

or assistance to reach

above head.

Cannot reach over head

with either arm.

Bilateral UE skills (12–

15 mos.).

No difficulty using both

hands to manipulate

different objects simultaneously.

Min difficulty using both

hands to manipulate

different objects simultaneously. May require

increased time.

Max difficulty or inability

to use both hands to

manipulate different objects simultaneously.

No difficulty using both

hands to manipulate

different objects simultaneously.

Uses uncoordinated

movement patterns to

manipulate different objects simultaneously in

both hands. May drop

objects frequently during task.

Max difficulty or inability

to use both hands to

manipulate different objects simultaneously.
Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices 45913

PEDIATRIC BETTER HAND AND ARM FUNCTION—Continued

Function Level A: No limitation

Level B: Minor limitation

in hand function: No limitation in arm function

Level C: Major limitation

in hand function: No limitation in arm function

Level D: No limitation in

hand function: Min to

moderate limitation in

arm function

Level E: Moderate limitation in hand and arm

function

Level F: Complete or

near paralysis or loss of

both limbs

16–23 mos.) ................. No difficulty stabilizing

object with one hand

while manipulating object with the other hand.

Min difficulty stabilizing

object with one hand

while manipulating object with the other

hand. May use forearm

rather than hand to stabilize.

Min to mod difficulty stabilizing object with one

hand while manipulating with the other hand.

Uses forearm rather

than hand to stabilize.

Min to mod difficulty stabilizing object with

hand while manipulating with the other hand.

Uses forearm rather

than hand to stabilize.

Moderate difficulty to stabilize object with hand

while manipulating object with other hand.

May use trunk or leg to

assist to stabilize object.

Max difficulty or inability

to stabilize object with

one hand while manipulating object with

other hand.

(24 mos. +) ................... No difficulty completing

bilateral opposing UE

movements (i.e., tearing paper).

Min difficulty completing

bilateral opposing UE

movements. May require increased time.

Max difficulty or inability

to complete bilateral

opposing UE movements.

Min to Mod difficulty completing bilateral opposing UE movements.

May require increased

time.

Requires increased time

to complete bilateral

opposing UE movements. May require

several attempts to

successfully complete

task.

Max difficulty or inability

to complete bilateral

opposing UE movements.

BENDING AND LIFTING

Function Level A: No limitation Level B: Minor limitation Level C: Major limitation Level D: Cannot bend or lift

Bending from

Sitting Position (1 yr. +).

No difficulty bending over

from sitting position in appropriate sized chair to

touch hand to foot and return to sitting at least 5

times.

Minimal difficulty bending

over from sitting position in

appropriate sized chair to

touch hand to foot and return to sitting 5 times. May

require increased amount

of time.

Can bend over from sitting

position in an appropriate

sized chair, touch hand to

foot and return to sitting at

least 2 times. Requires

maximum increased time

or use of adaptive techniques, i.e., assisting with

upper extremities to push

self up into sitting.

Cannot with controlled motion

bend over from sitting position, touch hand to foot

and return to sitting position.

Bending from

Standing Position (12–18

mos).

Holds supporting surface to

bend from standing position and return to upright

position at least 3 times.

May lose balance occasionally.

Holds supporting surface to

bend from standing position and return to upright

position at least 3 times.

Requires repeated attempts secondary to frequent loss of balance.

................................................ Cannot bend from standing

to pick up object from floor

and return to upright.

Bending from

Standing Position (18 mos

+).

No difficulty bending over

from standing position to

pick up object from floor

and return to upright position at least 5 times.

Minimal difficulty bending

over from standing position

to pick up object from floor

and return to upright position at least 5 times. May

require increased time or

adaptive techniques, i.e.

holding onto stable surface.

Maximal difficulty bending

over from standing position

to pick up object from floor

and return to upright position. Requires increased

time and may use adaptive

techniques, i.e. holding

onto stable surface.

Cannot bend over from

standing position to pick up

object from floor and return

to upright position for a

minimum of 2 times. Includes not being able to

bend in a controlled manner from standing at all.

Lifting from

Standing * (1

yr. +).

No difficulty lifting amounts

appropriate for age and

body weight.

Minimal difficulty lifting

amounts appropriate for

age.

Major difficulty or inability to

lift amounts appropriate for

age; but able to lift a lesser

amount.

Inability to lift any weight.

* Norms are needed for ‘‘appropriate’’ amount and minimal amount of weight to age for a pediatric population.

VISION

Function Level A: No limitations Level B: No loss in VA but with Diplopia

Level C: Near-normal visionLevel D: Moderate-low vision

Level E: Severe low

vision (legal blindness

in USA)

Level F: Preferred low visionLevel G: Total blind- ness

1yr–<2yrs (12–23

mnths).

.................................... .................................... Able to I.D. favorite

toy 5cm in size from

across room with

nystagmus.

Recognizes relative

across room without

voice.

With possible nystagmus.

.................................... Everything close to

face.

without recognition of

faces or objects

without cues.

with nystagmus possible.

Without visual response even to

light.

2yrs–<5yrs (24–

59 mnths).

.................................... .................................... Near-normal vision;

VA is 20/30–20/60.

Look out window and

ID objects i.e. birds.

Not on top of TV.

Recognizes relative

across room without

voice.

Moderate low vision;

VA is 20/70–20/160.

Without recognition of

people without stimuli.

Without seeing small

objects out the window

With possible nystagmus.

.................................... Profound low vision;

VA is <5/200 (count

fingers at less than

3 mo) but with light

perception.

Near TV, loses interest if not close.

Everything close to

face.

Without recognition of

faces or objects

without stimuli with

possible nystagmus.

Total visual impairment; black blind;

no light perception.
45914 Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices

VISION—Continued

Function Level A: No limitations Level B: No loss in VA

but with Diplopia

Level C: Near-normal

vision

Level D: Moderate-low

vision

Level E: Severe low

vision (legal blindness

in USA)

Level F: Preferred low

vision

Level G: Total blindness

5yrs–<10yrs (60–

119 mnths).

Normal vision; no significant loss of VA;

VA is 20/25 or better; no functional

diplopia.

No significant loss of

VA; VA is 20/25 or

better but functional

diplopia is present.

Near-normal vision;

VA is 20/30–20/60.

Moderate low vision;

VA is 20/70–20/160.

Face close to page

Up close to blackboard or front of

room.

.................................... Profound low vision;

VA is <5/200 (count

fingers at less than

3mo) but with light

perception.

Total visual impairment; black blind;

no light perception.

>10 yrs≤120

months.

Normal vision; no significant loss of VA;

VA is 20/25 or better; no functional

diplopia.

No significant loss of

VA; VA is 20/25 or

better but functional

diplopia is present.

Near-normal vision;

VA is 20/30–20/60.

Moderate low vision;

VA is 20/70–20/160.

Severe low vision; legally blind in USA;

VA is 20/200–5/200.

Profound low vision;

VA is <5/200 (count

fingers at less than

3 mo) but with light

perception.

Total visual impairment; black blind;

no light perception.

Best Eye—Remember most Pedi Injuries unilateral and until 8–10 years old children will have only transient diplopia and then suppression of the poorer eye.

School Age—can ask regarding school eye screen.

Without visual field.

AUDITORY FUNCTION IN ONE EAR

Function Level A: No limitations Level B: Minor loss Level C: Moderate loss Level D: Severe loss Level E: Profound or total loss

1yr–<2yrs (12–23

mnths).

No significant loss able to hear

under everyday listening

conditions; average hearing

level at 500, 1000, 2000 and

3000 Hz ≤25 with understanding of simple phrases.

................................................... Moderate to moderately severe

loss; average hearing level at

500, 1000, 2000 and 3000

Hz is 41–70 Difficulty with

conversation beyond 3–5 ft.,

classroom or group discussion with significant difficulty

understanding simple

phrases.

................................................... Profound to total loss; non-correctable; average hearing

level at 500, 1000, 2000 and

3000 is Hz >91 Difficulty

hearing all but some loud

sounds Failure to respond,

awaken, or move to loud environmental sounds.

2yrs–>10yrs

(24mnths—≥120

mnths).

No significant loss able to hear

under everyday listening

conditions; average hearing

level at 500, 1000, 2000 and

3000 Hz≤25.

Minor loss correctable with

readily available hearing aid;

average hearing level at 500,

1000, 2000 and 3000 Hz is

26–40 Difficulty with faint or

distant speech.

Moderate to moderately severe

loss; average hearing level at

500, 1000, 2000 and 3000

Hz is 41–70 Difficulty with

conversation beyond 3–5 ft.,

classroom or group discussion.

Severe loss; average hearing

level at 500, 1000, 2000 and

3000 Hz is 71–91 Difficulty

with anything but shouted or

amplified speech.

Profound to total loss; non-correctable; average hearing

level at 500, 1000, 2000 and

3000 Hz is >91 Difficulty

hearing all but some loud

sounds.

Reference

* Goodman, A.C. and Chasin, W.D.: In Gellis, SS and Kagan B.M. (Eds): Current Pediatric Therapy 7th Ed W.B. Saunders Co. Phila, 1976 p.518 (or whole Pedi Catalog Vol 1 p.15).

SPEECH/LANGUAGE

Function Level A: No limitations Level B: Mild limitations Level C: Moderate–severe limitations Level D: Global limitations

12–14 mos ......... Vocabulary of 4–6 words; recognizes

own name; mixes words with jargon;

follows simple motor instructions (esp.

if accompanied by visual cue).

Vocabulary of 1–2 words; imitates

sounds of adults inconsistently; minimal language comprehension; smiles

in response to presence of caregiver or

familiar person; listens at least momentarily when spoken to by a caregiver.

Sparse output mainly jargon; does not

recognize name or follow motor instructions.

Maximum difficulty; no speech; minimal

comprehension of commands.

15–18 mos ......... Vocabulary of 8–20 words; uses words

and jargon in conversation; identifies

some body parts; sings spontaneously.

Vocabulary of 4–6 words; recognizes

own name, but does not follow motor

instructions; smiles in response to

presence of caregiver or other familiar

person; mild articulation defect without

compromise of intelligibility.

Vocabulary of 1–2 words; recognizes

own name, but does not follow motor

instructions; intelligibility of speech

compromised by articulation defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

19–23 mos ......... Vocabulary of 30–300 words; uses ‘‘I’’

and ‘‘mine’’; tries to tell experiences;

uses short, incomplete sentences;

uses prepositions and regular verb

endings; follows 1–2 step commands.

Vocabulary of 8–20 words; mixes words

with jargon; follows simple motor instructions and identifies some body

parts; mild articulation defect without

compromise of intelligibility.

Vocabulary of 4–6 words; mixes words

with jargon; follows simple motor instructions; intelligibility of speech compromised by articulation defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

24–36 mos ......... Uses a range of words which is normal

for age (vocabulary of 900–1000

words); sentences have 8 or more

words; uses ‘‘he’’ and ‘‘she’’ correctly;

recites rhymes, songs; follows 2–3

step commands; identifies 2 colors;

sentences have subject and verb; talks

about present.

Vocabulary of 30–300 words; uses words

and jargon in short, incomplete sentences; identifies some body parts;

sings spontaneously; mild articulation

defect without compromise of intelligibility.

Vocabulary of 8–20 words; mixes words

with jargon; follows simple motor instructions; intelligibility of speech compromised by articulation defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

37–47 mos ......... Uses a range of words which is normal

for age (Vocabulary of 1,000–1,500

words); talks about the present; states

number of siblings.

Uses a range of words slightly below

other children of same age (vocabulary

of 900–1000 words); sentences have 8

or more words; uses ‘‘he’’ and ‘‘she’’

correctly; recites rhymes, songs; follows 2–3 step commands; identifies 2

colors; sentences have subject and

verb; talks about present; mild articulation defect without compromise of intelligibility.

Vocabulary of 30–300 words; uses words

and jargon in short, incomplete sentences; identifies some body parts;

sings spontaneously; intelligibility of

speech compromised by articulation

defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

48–59 mos ......... Uses a range of words which is normal

for age (vocabulary of 1500–2200

words); increases complexity of sentences; recounts the past; asks many

questions; understands most questions

about the immediate environment; has

75%+ grammar acquisition; discusses

feelings; follows 3-step commands.

Uses a range of words slightly below

other children of same age (vocabulary

of 1000–1500 words); uses ‘‘I’’ and

‘‘mine’’; tries to tell experiences; uses

short sentences which range from

complete with subject and verb to incomplete sentences; follows 1–2 step

commands; mild articulation defect

without compromise of intelligibility.

Uses significantly fewer words than other

children of same age (vocabulary of

900–1000 words); uses words and jargon in conversation; identifies body

parts; intelligibility of speech compromised by articulation defect.

Maximum difficulty; no speech; minimal

comprehension of commands.
Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices 45915

SPEECH/LANGUAGE—Continued

Function Level A: No limitations Level B: Mild limitations Level C: Moderate–severe limitations Level D: Global limitations

5–<8 years ......... Uses a range of words which is normal

for age (vocabulary of 2,500+ words);

understands a range of words which is

normal for age (20,000–24,000 words);

uses all parts of speech to some degree; verbalizes ideas; talks a lot.

Uses a range of words slightly below

other children of same age (vocabulary

of 1500–2200 words); sentences have

8+ words; uses ‘‘he’’ and ‘‘she’’ correctly; follows 2 step commands; mild

articulation defect without compromise

of intelligibility.

Uses significantly fewer words than other

children of same age (vocabulary of

1000–1500 words); uses ‘‘I’’ and

‘‘mine’’; tries to tell experiences; uses

short, incomplete sentences; follows 1–

2 step commands; intelligibility of

speech compromised by articulation

defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

8–<10 years ....... Uses a range of words which is normal

for age (vocabulary of 5,000+ words);

understands a range of words which is

normal for age (25,000+ words); able

to write fluently either in cursive or in

printed characters; prints or writes sentences of 3 to 4 words; reads at or

above second grade level; gives complex directions to others.

Uses a range of words slightly below

other children of same age (vocabulary

of 2,500+ words); 75% grammar acquisition; follows 3 step commands; verbalizes ideas; mild articulation defect

without compromise of intelligibility.

Uses significantly fewer words than other

children of same age (vocabulary of

1500–2200 words); recites alphabet;

tells plot of a fairy tale; follows 2-step

commands; 25% grammar acquisition;

intelligibility of speech compromised by

articulation defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

>10 years ........... Uses a range of words which is normal

for age (vocabulary of 25,000+ words);

talks a lot; understands a range of

words which is normal for age (approximately 50,000 words).

Uses a range of words slightly below

other children of same age (vocabulary

of 5,000+ words); increases complexity

of sentences using all parts of speech

to some degree; understands a range

of words slightly below other children

of same age (20,000+ words); 75%

grammar acquisition; follows 3-step

commands; mild articulation defect

without compromise of intelligibility.

Uses significantly fewer words than children of same age (vocabulary of 2,500

words); sentences have 8+ words;

uses ‘‘he’’ and ‘‘she’’ correctly; follows

2 step commands; intelligibility of

speech compromised by articulation

defect.

Maximum difficulty; no speech; minimal

comprehension of commands.

COGNITION

Function Level A: No limitations Level B: Mild limitations Level C: Moderate–severe limitations Level D: Global limitations

12–14 mos ......... Uses common objects appropriately;

helps to turn pages; tries to pick up

cubes; builds tower of 2 blocks; spontaneously scribbles or imitates;

searches for objects; maintains attention for 2 minutes to an interactive toy

or picture.

Brings 2 blocks together, usually lifting

them and comparing them, but does

not build a tower; touches book but

does not turn page; picks up crayon

but fails to scribble; maintains attention

for one minute to an interactive toy/picture.

Inconsistent response to book; variable

response to blocks; no use of crayon;

inconsistently maintains attention.

No response to book; no response to

blocks; no use of crayon; fails to attend

to interactive toy or picture.

Learning/memory Searches in a location where an object

was last hidden.

Fails to consistently search for hidden

object.

No response to hidden object .................. Max difficulty; does not search.

15–18 mos ......... Imitates adult object use and motor acts;

turns 2–3 pgs at a time; initiates crayon stroke; builds 3 block tower;places

different shaped objects in different

sized holes; maintains attention for 2

minutes or more to an interactive toy

or picture.

Uses common objects appropriately;

helps to turn pages; tries to pick up

cubes; builds tower of two blocks;

spontaneously scribbles or imitates;

searches for objects; mild difficulty sustaining attention for more than 2 minutes, easily distracted.

Inconsistent response to toy or to book;

inconsistently uses crayon; no response to placing different shaped objects in different sized holes; fails to

maintain attention for 2 minutes to an

interactive toy or picture; brings 2

blocks together, usually lifting them

and comparing them, but does not

build a tower.

No response to book; no response to

blocks; no use of crayon; no response

to toy; no response to placing different

shaped objects in different sized holes;

max difficulty.

Learning/memory Remembers places where familiar objects are usually located (toys in

toybox).

Searches in a location where an object

was last hidden.

Fails to consistently search for hidden

object.

Max difficulty; no response.

19–23 mos ......... Builds tower of 5–7 blocks; imitates circular scribble and/or vertical stroke;

places different shaped objects in different sized holes even after rotation;

sits alone for short periods with book;

maintains attention for 3 to 4 minutes

or more to an interactive toy or picture.

Builds 3 block tower; turns 2–3 pages at

a time; initiates crayon stroke; places

different shaped objects in different

sized holes; mild difficulty sustaining

attention for more than 2 to 3 minutes,

easily distracted.

Builds tower of 2 blocks; inconsistently

uses crayon; inconsistently places different shaped objects in different sized

holes; inconsistent response to toy;

scribbles with crayon; inconsistently

maintains attention for 2 minutes.

No response to book; no response to

blocks; no use of crayon; no response

to toy; no response to placing different

shaped objects in different sized holes;

max difficulty.

Learning/memory Recognizes pictures in picture book ........ Remembers places where familiar objects are usually located (toys in

toybox).

Searches in a location where an object

was last hidden.

Max difficulty; minimal search.

24–30 mos ......... Matches familiar objects; builds tower of

8–9 blocks; makes circular strokes with

crayon; knows big and little concepts;maintains attention for 5 minutes

or longer on one interactive activity.

Builds 5–7 block tower; scribbles spontaneously with a crayon; places different

shaped objects in different sized holes

even after rotation; mild difficulty sustaining attention for more than 3–4

minutes, easily distracted.

Builds tower of 3 or fewer blocks; plays

with crayon but not without prompting/

imitation scribbles using crayon; tries

but usually unable to place different

shaped objects in different sized holes.

No response to book; no response to

blocks; no use of crayon; no response

to toy; no response to placing different

shaped objects in different sized holes;

max difficulty.

Learning/memory Remembers one item; repeats 2 items, 1

of 3 trials.

Recognizes pictures in picture book ........ Remembers places where familiar objects are usually located (toys in

toybox).

Max difficulty; minimal search.

31–36 mos ......... Creates representational art; matches primary colors; engages in make-believe

play unconstrained by objects; builds

tower of 10 cubes; imitates bridge;

copies circle; places 7 different shaped

objects in different sized holes; maintains attention for 6–7 minutes or

longer on one interactive activity.

Builds 8–9 block tower; imitates a circular

scribble; mild difficulty sustaining attention for more than 5 minutes; easily

distracted.

Builds 5–7 block tower; places different

shaped objects in different shaped

holes even after rotation; inconsistently

maintains attention for 3–4 minutes on

one toy or activity.

No response to book; no response to

blocks; no use of crayon; no response

to toy; no response to placing different

shaped objects in different sized holes;

max difficulty.

Learning/memory Remembers 2 items; repeats 3 items, 1

of 3 trials.

Remembers one item; repeats 2 items, 1

of 3 trials.

Recognizes pictures in picture book ........ Max difficulty; minimal search.

37–47 mos ......... Knows 4 actions; maintains attention for

10–11 min; can show use of 2 objects;

imitates a square or better; can build a

bridge with blocks.

Creates representational art; matches primary colors; engages in make-believe

play unconstrained by objects; builds

tower of 10 cubes; imitates bridge;

copies circle; places 7 different shaped

objects in different sized holes; maintains attention for 6–7 minutes or

longer on one activity.

Builds 8–9 block tower; imitates a circular

scribble; mild difficulty sustaining attention for more than 5 minutes; easily

distracted.

No response to book; no response to

blocks; no use of crayon; no response

to placing different shaped objects in

different sized holes; max difficulty.

Learning/memory Remembers 3 items; repeats 4 items, 1

of 3 trials.

Remembers 2 items; repeats 3 items; 1

of 3 trials.

Remembers one item; repeats 2 items, 1

of 3 trials.

Inconsistently recognizes picture Max difficulty; no response.
45916 Federal Register / Vol. 62, No. 168 / Friday, August 29, 1997 / Notices

1Pursuant to 49 CFR 1150.50(d)(2), the railroad

must file a verified notice with the Board at least

50 days before the abandonment or discontinuance

is to be consummated. The applicant in its verified

notice, indicated a proposed consummation date of

September 29, 1997. However, because the verified

notice was filed on August 11, 1997, consummation

should not have been proposed to take place prior

to September 30, 1997. Applicant’s representative

has been contacted and has confirmed that the

correct consummation date is on or after September

30, 1997.

COGNITION—Continued

Function Level A: No limitations Level B: Mild limitations Level C: Moderate–severe limitations Level D: Global limitations

48–59 mos ......... Knows own right and left; develops time

concepts; recognizes relationships of

parts to whole; categorizes types of

animals; counts rotely up to 13; can

show 3 objects; understands concepts

of 3; labels some coins; maintains attention for 11–13 minutes on one interactive activity.

Matches familiar objects; knows big and

little; builds bridge with blocks; imitates

a circle with a crayon; knows big and

little concepts; mild difficulty sustaining

attention for 10 minutes; easily distracted.

Builds 10 block tower; imitates a circle;

repeats 1 item, 1 of 3 trials, places 7

different shaped objects in different

sized holes; inconsistently maintains

attention for 7–8 minutes.

No response to book; no response to

blocks; no use of crayon; no response

to formboard or other toy; max difficulty.

Learning/memory Remembers 4 items;repeats 5 items, 1 of

3 trials; learns sequences such as

days of the week; recalls gist of a short

story; recognizes series of pictures.

Remembers 3 items; remembers places

where familiar objects are usually located; repeats 4 items, 1 of 3 trials.

Remembers 2 items; repeats 3 items, 1

of 3 trials.

Max difficulty; may recall 1 item.

5–<8 years ......... Longer attention span for 15 minutes or

more on one activity; knows left and

right of others; understands conversation; knows differences and similarities;

reads spontaneously.

Builds tower of 6–7 blocks; creates representational art; matches primary colors; engages in make-believe play unconstrained by objects; mild difficulty

sustaining attention for more than 10

minutes, easily distracted.

Builds tower of 4–5 blocks; imitates a circle; inconsistently maintains attention

for 9–10 minutes.

No response to book; no response to

blocks; no use of crayon; no response

to placing different shaped objects in

different sized holes; max difficulty.

Learning/memory Remembers and repeats 5 items; learns

a list of 6–8 words.

Remembers 4 items; learns sequences

such as months of the year; recalls gist

of a short story; recognizes a series of

pictures; repeats 5 items, 1 of 3 trials.

Remembers 1–2 items; partial recall of a

short story; repeats 1–2 items, 1 of 3

trials Remembers 3 items; remembers

places where familiar objects are usually located; repeats 4 items, 1 of 3

trials.

Max difficulty.

Academic

progress.

No change from preinjury ......................... Some decline in grades since injury but

remains in similar classes (e.g. mainstream).

Some or all classes are resources (special education), but attends school full

time.

Homebound or institutionalized.

8–<10 years ....... Reads books at second to fourth grade

level; writes neatly most of the time;

can give complex directions to others,

i.e. how to use key to unlock door;

knows right and left of others; understands conversation; maintains attention for 30 minutes or more on one activity.

Knows own right from left; develops time

concepts; recognizes relationships of

specific parts to whole; counts rotely

up to 13; prints/writes at least 10

words from memory states month and

day of birthday; recites alphabet; reads

at least 3 common signs; mild difficulty

sustaining attention for 15 minutes or

more; easily distracted.

Builds tower of 6–7 blocks; creates representational art; matches primary colors; engages in make-believe play; inconsistently maintains attention for 10–

15 minutes.

Max difficulty; no response to book or

blocks.

Learning/memory Remembers and repeats 6 items; recalls

events, actions of a short story; learns

a list of 8–10 words.

Remembers and repeats 5 items; learns

a list of 6–8 words; recalls gist of story

but not specific events and actions.

Remembers 4 items; learns sequences

such as months of the year; recalls gist

of a short story; recognizes a series of

pictures; repeats 5 items, 1 of 3 trials.

Max difficulty; minimal recall or recognition of 1–2 items.

Academic

progress.

No change from preinjury ......................... Some decline in grades since injury but

remains in similar classes (e.g. mainstream).

Some or all classes are resource (special

education), but attends school full time.

Homebound or institutionalized.

≥10 years ........... Plans future actions; engages in abstract

thought; i.e. can interpret proverb providing more than a concrete explanation; solves problems with only minimal physical input; writes in cursive,

maintains attention for 60 minutes or

more on one activity.

Knows left and right; understands conversation; knows differences and

similarities; reads spontaneously; mild

difficulty sustaining attention for more

than 30 minutes, easily distracted.

Knows own right and left; develops time

concepts; recognizes relationships of

parts to whole; categorizes; counts

rotely up to 13; can show 3 objects;

understands concept of 3; labels some

coins; inconsistently maintains attention for more than 15 minutes.

No response to book; no response to

blocks; no use of crayon; no response

to form board or other toy; max difficulty.

Learning/memory Remembers and repeats 7 items; repeats

details of short story; learns a list of

11–12 words; recognizes series of

100+ pictures; memory approaches the

level in adolescents and young adults

(e.g., recognizes faces of 100+ classmates, friends, relatives).

Remembers and repeats 6 items; learns

a list of 8–10 words.

Remembers and repeats 5 items; learns

a list of 6–8 words.

Max difficulty; may recall or recognize 1–

3 items.

Academic

progress.

No change from preinjury ......................... Some decline in grades since injury but

remains in similar classes (e.g. mainstream).

Some or all classes are resource (special

education), but attends school full time.

Homebound or institutionalized.

[FR Doc. 97–22795 Filed 8–28–97; 8:45 am]

BILLING CODE 4910–59–P

DEPARTMENT OF TRANSPORTATION

Surface Transportation Board

[STB Docket No. AB–32 (Sub–No. 57X)]

Boston and Maine Corporation—

Abandonment Exemption—in

Rockingham County, NH

Boston and Maine Corporation (B&M)

has filed a notice of exemption under 49

CFR part 1152 Subpart F—Exempt

Abandonments and Discontinuances to

abandon an approximately 3.30-mile

line of railroad on the Hampton Branch

between milepost 42.70 and milepost

46.00 in Hampton, Hampton Falls and

Seabrook, Rockingham County, NH.1

The line traverses United States Postal

Service Zip Codes 03842, 03844 and

03874.

B&M has certified that: (1) No local

traffic has moved over the line for at

least 2 years; (2) overhead traffic has

been rerouted over other lines; (3) no

formal complaint filed by a user of rail

service on the line (or by a state or local

government entity acting on behalf of

such user) regarding cessation of service

over the line either is pending with the

Surface Transportation Board (Board) or

with any U.S. District Court or has been

decided in favor of complainant within

the 2-year period; and (4) the

requirements at 49 CFR 1105.7

(environmental reports), 49 CFR 1105.8

(historic reports), 49 CFR 1105.11

(transmittal letter), 49 CFR 1105.12

(newspaper publication), and 49 CFR

1152.50(d)(1) (notice to governmental

agencies) have been met.

As a condition to this exemption, any

employee adversely affected by the

abandonment shall be protected under

Oregon Short Line R. Co.—

Abandonment—Goshen, 360 I.C.C. 91

(1979). To address whether this

condition adequately protects affected