Questionnaire Text

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11. Physical or mental handicap
[] 1 blind
[] 2 deaf
[] 3 paralysis on one or both sides
[] 4 paralysis of the legs
[] 5 total paralysis
[] 6 missing extremities or parts thereof
[] 7 mental deficiency
[] 8 more than one
[] 0 none listed

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Question 11 - Physical or mental handicap
Mark:
1 - Blindness - for persons who have been totally blind since birth or who lost their sight later due to disease or accident. A person who sees with difficulty is not considered blind;
2 - Deafness - for persons who have been totally deaf since birth (deafness and dumbness) or who lost their hearing later [p. 61] due to disease or accident. A person who hears with difficulty is not considered deaf;
3 - Paralysis of one side - for hemiplegic persons, that is, persons who are paralyzed or handicapped with motor deficiency on one side due to injury of the nervous system;
4 - Paralysis of the legs - for paraplegic persons, that is, persons with the lower members paralyzed;
5 - Total paralysis - for quadriplegic persons, that is, persons with both the upper members (arms) and lower members (legs) paralyzed;
6 - Is missing one or more limbs or part of a limb:

a) Is missing one upper limb or part of an upper limb - for persons who are missing one or both upper limbs since birth or from later amputation due to disease or accident. Consider as missing an upper member the loss of an arm, forearm or hand. Do not consider the lack of fingers;
b) Is missing one lower limb or part of a lower limb - for persons who are missing one or both lower limbs since the birth or from later amputation due to disease or accident. Consider as missing a lower limb the loss of an entire leg, part of a leg or a foot. Do not consider lack of toes;

7 - Mental deficiency - for persons with mental retardation due to irreversible lesion or syndrome which was first determined during childhood and which is characterized by great difficulty in learning and social adaptation. Do not consider as such those persons who present a mental disturbance or disorder such as neurotics, psychotics or schizophrenics, vulgarly known as mad or crazy;
8 - More than one - for persons with more than one of the listed handicaps; and
0 - None of the above - for persons who do not have any of the deficiencies described above or for those who are not handicapped.