Impairment Tutorial: Rating Permanent Impairment for Artificial Disc Replacements

2006 ◽  
Vol 11 (3) ◽  
pp. 6-8
Author(s):  
James B. Talmage ◽  
Charles N. Brooks ◽  
Christopher R. Brigham
Keyword(s):  
Lumbar Spine ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Drug Administration ◽  
Daily Living ◽  
Lumbar Spine Surgery ◽  
Artificial Disc ◽  
Sixth Edition ◽  
Spinal Region ◽  
Loss Of Motion

Abstract In 2005, the Food and Drug Administration (FDA) approved an artificial disc replacement (ADR), and physicians likely will be called on to evaluate permanent impairment in some patients who have been treated using an ADR. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, was published in 2000, before the approval of ADRs, and thus is silent about evaluating ADR-associated impairment. FDA based its approval on the results of a study in which the indications were tightly limited and for which the list of relative contraindications was quite long. One review of 100 consecutive lumbar spine surgery patients found that 95% had at least 1 contraindication to ADR. The AMA Guides recommends using the Diagnosis-related estimates (DRE) method, but some situations (eg, multilevel involvement in the same spinal region) warrant use of the range-of-motion (ROM) method. Assuming a single injury and one level of loss of the activities of daily living, the DRE is the correct method to rate the permanent impairment, and the authors recommend that ADR be accepted as the equivalent to loss of motion segment integrity, warranting a rating from CRE Category IV. ADR is in its infancy, and until the AMA Guides, Sixth Edition, is available, evaluators can rate one level ADR from DRE Category IV.

Range of Motion: AMA Guides, Sixth Edition

2015 ◽  
Vol 20 (3) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living ◽  
Lower Extremities ◽  
Upper Extremities ◽  
Sixth Edition

Abstract In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range of motion (ROM) is used to calculate the physical examination modifier when the diagnosis-based impairment (DBI) method is used, ie, Table 15-8, Physical Examination Adjustment: Upper Extremities, and Table 16-7, Physical Examination Adjustment: Lower Extremities. The DBI method is preferable for calculating upper and lower extremity ratings, but in instances specified by the regional grid, the evaluator may choose to use the ROM method, typically because it yields a higher impairment rating. The article outlines the steps for measuring ROM. Invalid results on the day of testing are declared after three consecutive efforts if the three measurements for a given plane of motion vary by more than 10 degrees from the average (mean) of these three measurements. The process can be tried again another day, or the DBI method can be used. All ROM measurements should be rounded to the nearest number ending in zero, and a figure provides examples of suitable annotations. Adjustments for functional history can be made if ROM is the only method used for rating, if results are deemed reliable and consistent with results from an activities of daily living questionnaire or other valid functional report, and if the current ROM impairment does not adequately capture the full impairment.

Normal Functional Range of Motion of the Lumbar Spine During 15 Activities of Daily Living

2010 ◽  
Vol 23 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Jesse E. Bible ◽  
Debdut Biswas ◽  
Christopher P. Miller ◽  
Peter G. Whang ◽  
Jonathan N. Grauer
Keyword(s):  
Lumbar Spine ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living ◽  
Normal Functional

P167. The Effects of Lumbar Orthoses on the Range of Motion of the Lumbar Spine During Fifteen Activities of Daily Living

2009 ◽  
Vol 9 (10) ◽  
pp. 200S
Author(s):  
Christopher Miller ◽  
Jesse Bible ◽  
Debdut Biswas ◽  
Peter Whang ◽  
Jonathan Grauer
Keyword(s):  
Lumbar Spine ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living

The Effects of Three Different Types of Orthoses on the Range of Motion of the Lumbar Spine During 15 Activities of Daily Living

Spine ◽  
2011 ◽  
Vol 36 (26) ◽  
pp. 2346-2353 ◽  
Author(s):  
Kolawole A. Jegede ◽  
Christopher P. Miller ◽  
Jesse E. Bible ◽  
Peter G. Whang ◽  
Jonathan N. Grauer
Keyword(s):  
Lumbar Spine ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living ◽  
Different Types

Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

2002 ◽  
Vol 7 (4) ◽  
pp. 8-10
Author(s):  
Christopher R. Brigham ◽  
Leon H. Ensalada
Keyword(s):  
Lumbar Spine ◽  
Range Of Motion ◽  
Disk Herniation ◽  
Fourth Edition ◽  
Recurrent Injury ◽  
Injury Model ◽  
Whole Person ◽  
Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

The functional range of motion of the finger joints

2014 ◽  
Vol 40 (4) ◽  
pp. 406-411 ◽  
Author(s):  
G. I. Bain ◽  
N. Polites ◽  
B. G. Higgs ◽  
R. J. Heptinstall ◽  
A. M. McGrath
Keyword(s):  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living ◽  
Indications For Surgery ◽  
Active Motion ◽  
Finger Joints ◽  
Hand Grip ◽  
Significant Difference ◽  
Function Test ◽  
Distal Interphalangeal

The purpose of this study was to measure the functional range of motion of the finger joints needed to perform activities of daily living. Using the Sollerman hand grip function test, 20 activities were assessed in ten volunteers. The active and passive range of motion was measured with a computerized electric goniometer. The position of each finger joint was evaluated in the pre-grasp and grasp positions. The functional range of motion was defined as the range required to perform 90% of the activities, utilizing the pre-grasp and grasp measurements. The functional range of motion was 19°–71°, 23°–87°, and 10°–64° at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively. This represents 48%, 59%, and 60% of the active motion of these joints, respectively. There was a significant difference in the functional range of motion between the joints of the fingers, with the ulnar digits having greater active and functional range. The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment.

INFLUENCE OF VARIOUS DAILY TASKS ON SEGMENTED TRUNK KINEMATICS

2015 ◽  
Vol 27 (06) ◽  
pp. 1550058 ◽  
Author(s):  
Scott P. Breloff ◽  
Li-Shan Chou
Keyword(s):  
Back Pain ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Daily Living ◽  
Random Order ◽  
Obstacle Crossing ◽  
Trunk Motion ◽  
Stair Ascent ◽  
Level Walking ◽  
Lower Lumbar

Back pain can affect up to 65% of the American population and cost the health care system approximately fifty billion dollars each year. Due to the difficulty with recording spine/trunk movement, several methods and models exist. The myriad of methods and the need for understanding of spine/trunk motion has led to a lack in a ‘gold-standard’ of treatment for individuals with back pain. Therefore, the purpose of this study was to examine the effect of different activities of daily living on the kinematics of individual trunk segments in young adults to determine how common ambulatory tasks will alter trunk motion compared to level walking. Young healthy adults completed, in a random order, four activities of daily living: level walking, obstacle crossing, stair ascent and descent using a previously validated model. Subjects were outfitted with a full body marker set which included a segmented trunk. Multi-segmented trunk angles between the three inferior segments, sacrum to lower lumbar [SLL], lower lumbar to upper lumbar [LLUL] and upper lumbar to lower thorax [ULLT], were calculated and compared between tasks. Peak flexion angles, instance of peak angle and range of motion were analyzed. The overall hypothesis that different spine levels will have altered kinematics during various activities of daily living was supported. Stair descent had smaller peak flexion angles than obstacle crossing and stair ascent. The instance of peak angle were different depending on trunk angle and daily task. The most inferior trunk angle — Sacrum-to-Lower Lumbar — had the largest range of motion during all four tasks in all three (sagittal, frontal and transverse) planes of motion. This study was able to show how various activities of daily living produce different motions in the three inferior segments of a multi-segmented trunk method. The results of this study are the first steps in understanding how the trunk responds on a daily basis and how those responses could lead to back pain.

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