Lower limb assessment method
Gait derangement after a motor accident
A limp is not an extra impairment percentage. Under clause 6.78, gait derangement is a last-resort method used only when another lower-limb method cannot be applied satisfactorily, and it cannot be combined with any other lower-limb evaluation.
Motor accident injury
How can this injury happen?
Car or passenger collision
Pelvic, hip, knee, ankle, foot or nerve injury may alter walking after a collision.
Motorcycle accident
Fracture, joint injury or nerve damage after a motorcycle fall can produce persistent gait change.
Pedestrian or cyclist impact
Multiple lower-limb injuries after pedestrian impact may prevent a single joint method from addressing the whole pattern.
Injuries that can occur
- antalgic gait from structural lower-limb injury
- Trendelenburg-type or abductor-related gait
- stiff-knee, foot-drop or shortened-limb gait
- multi-joint impairment not satisfactorily assessed by another valid method
Symptoms and functional problems
- limp and reduced walking distance
- need for a cane, crutch or brace
- difficulty stairs, slopes or uneven ground
- fatigue and slower community mobility
Seek urgent medical assessment
Sudden inability to walk, new foot drop, calf swelling, severe pain or neurological change requires prompt medical assessment.
Clinical evidence
What findings matter?
The assessor must first identify the cause of the altered gait and explain why a more specific joint, fracture, nerve, replacement, length or arthritis method cannot be applied satisfactorily. Aid use must be medically necessary and permanent.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Observed gait examination | Records pattern, consistency, distance, transfers and aid use. | A brief observed limp does not establish permanence or a Table 36 category. |
| Joint, nerve and length examination | Tests whether a more specific method can assess the impairment. | Gait cannot be chosen merely because it produces a convenient result. |
| Rehabilitation and aid prescription | Supports long-term walking limits and whether an aid is necessary. | Possessing or occasionally using an aid is insufficient. |
Movement in daily life
How movement affects real activities
Gait is the integrated result of hip, knee, ankle, foot, nerve and balance function. The method is reserved for cases where that overall pattern cannot be satisfactorily represented by a more specific method.
Stance phase
Accepting body weight and maintaining pelvic stability.
The cause must be linked to permanent accident-related impairment.
Swing phase
Clearing the foot and advancing the limb.
Joint movement or a named nerve method is preferred where it specifically explains the deficit.
Walking aid use
Safe support for community mobility.
Clause 6.79 requires the aid to be necessary and permanent for the relevant Table 36 item.
Threshold injury is a separate question: an altered gait is a consequence, not a threshold diagnosis. Threshold status depends on the underlying accident-related injury.
Part 6 permanent impairment
How is CTP WPI assessed?
Clauses 6.78 to 6.80 modify AMA4 Table 36. Gait is a last resort, reasons must be given, it cannot be combined with another lower-limb evaluation, any relied-on walking aid must be necessary and permanent, and Table 36 item b (Trendelenburg sign) is deleted.
Measurement rules that apply
- Clauses 6.69 and 6.70 require the method that most specifically addresses the lower-limb impairment. Gait should not replace a joint, nerve, fracture or replacement method that can be applied reliably.
- Clause 6.84 requires active range of motion, a goniometer where clinically indicated and consistent repetitions when reliability is uncertain. Passive movement may inform the examination but does not set the impairment value.
- Clause 6.85 says only the most severe deficit in one direction or axis from the same lower-limb ROM table is rated. Deficits from separate tables may be combined only as the Guidelines permit.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Gait derangement | Clause 6.78; AMA4 Table 36 | Only where another lower-limb method cannot be applied satisfactorily. | Cannot combine with any other lower-limb evaluation. |
| Walking-aid item | Clause 6.79; Table 36 | Where the aid is genuinely medically necessary and permanent. | Occasional or precautionary use is not enough. |
| Deleted item | Clause 6.80 | Table 36 item b is not available. | Trendelenburg sign cannot be rated under the deleted row. |
- Explain why every more specific method is unsuitable.
- Record a consistent permanent gait pattern.
- Do not combine the gait result with another lower-limb value.
What cannot be combined?
- gait with ROM, arthritis or diagnosis-based estimate
- gait with replacement, leg-length or nerve impairment
- gait with atrophy, strength or CRPS
What does not establish WPI by itself?
- limp observed once
- pain while walking
- self-purchased cane
- gait change without diagnosed cause
Motor accident examples
Knee injury measurable under Table 41
Gait should not be used because a more specific valid knee ROM method can address the impairment.
Complex multi-joint injury with permanent aid
Gait may be considered only if the assessor explains why no other method works satisfactorily and confirms the aid is necessary and permanent.
Claim file preparation
Evidence checklist
Assessment source
Gait derangement WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.78-6.80; modified AMA4 Table 36.
Threshold injury: Gait is a WPI assessment method, not a threshold injury diagnosis; classification follows the underlying injury.
What the assessor checks
- last-resort rule
- no combination
- necessary permanent aid
- Table 36 item b deleted
What does not establish the result by itself
- limp
- pain
- aid possession
- undiagnosed cause
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is every limp assessable under Table 36?
- No. Gait is a last resort and requires a permanent accident-related impairment.
- Can gait be added to knee or ankle WPI?
- No. Clause 6.78 prohibits combining gait with another lower-limb evaluation.
- Must a walking aid be permanent?
- Yes for a Table 36 item that depends on aid use; clause 6.79 requires it to be necessary and permanent.
- Is Trendelenburg sign rated?
- Not under Table 36 item b, because clause 6.80 deletes that item.
- Why is another method preferred?
- A joint, fracture, nerve or replacement method usually identifies the actual impairment more specifically.