In the Sixth Edition, there is a paradigm shift which adopts a contemporary model of disablement; it is simplified, functionally based, and internally consistent to the fullest extent possible.

The visition embodied by this paradigm shift is articulated in terms of 5 specific new axioms. These axioms provide direction and define priorities:

  1. The Guides adopts the terminology and conceptual framework of disablement as put forward by the International Classification of Functioning, Disability, and Health (ICF).
  2. The Guides becomes more diagnosis based with these diagnoses being evidence-based when possible.
  3. Simplicity, ease-of-application, and following precedent, where applicable, are given high priority, with the goal of optimizing interrater and intrarater reliability.
  4. Rating percentages derived according to the Guides are functionally based, to the fullest practical extent possible.
  5. The Guides stresses conceptual and methodological congruity within and between organ system ratings.