ANKLE PAIN CARPAL TUNNEL SYNDROME CHRONIC PAIN ELBOW PAIN HIP PAIN IMPAIRMENT & DISABILITY KNEE PAIN MUSCLE WEAKNESS MYOFASCIAL PAIN NECK & LOW BACK PAIN NUMBNESS SHOULDER PAIN WRIST PAIN Spence Rehabilitation Center 9305 Calumet Ave. Suite C-1 Munster, IN 46321 Phone : (219) 513-2267 Fax      : (219) 836-1276         How is impairment and disability determined? Guidelines are published by the American Medical Association’s Guides to the Evaluation of Permanent Impairment. What is impairment? Loss of function. For example, a person who has their arm amputated, is unable to write. What is disability? The alteration of the ability to interact in a particular environment. For example, a man who had his arm amputated is having difficulty performing his duties as a mechanic. What is causation? The factor that led to the medical problem. For example, a machinist who had his arm amputated while operating a machine at work. The amputation was caused by the machine trauma. What is aggravation? A factor that worsens a medical condition. For example, a worker with a prior history of disc herniation in his back who injures his back again while lifting a heavy object. What is apportionment? To determine the relative weight of each factor when multiple factors are involved. For example, a person with back arthritis who fractures a vertebrae after a fall. How much of the weight is attributed to the back arthritis and how much is due to the vertebral fracture. What is an Impairment rating? A measure of functional loss due an injury in the workers anatomy. For example, an above knee amputation carries an impairment rating of 100% to the lower extremity   What are some types of impairment?   1. Temporary, partial impairment: Common after minor injuries on the job. 2. Permanent, partial impairment: For example, after an arthroscopic meniscectomy, the patient will have a PPI rating of 5% to the affected extremity. The anatomy was permanently altered due to the surgery but the patient is not totally impaired. 3. Temporary, total impairment: For example, a severe cervical strain after a motor vehicle accident. The person will likely make a full recovery and there is no permanent problem with the anatomy. 4. Permanent, Total Impairment: The patient will likely never return to work   What is a maximum medical improvement date? The individual is unlikely to improve further medically on this date. The impairment ratings should be performed at this time. How is the impairment rating determined? Different parts of the body are examined and given an impairment score. The scores are then used to determine the Whole Person Impairment score.   1. Left upper extremity 7. Lumbar Spine 2. Right upper extremity 8. Pelvis 3. Left lower extremity 9. Skin 4. Right Lower extremity 5. Cervical Spine 6. Thoracic Spine           What are the components of the upper extremity impairment rating?   1. Diagnosis- Based Estimates (DBE): impairment ratings for common medical procedures 2. Amputation: percent depends on amputation level 3. Nerve injury: percent depends on the nerves injured and whether there is motor involvement, sensory or pain involvement, or both 4. Range-of-motion: depends on which and how many joints of the arm are involved and the amount of range-of-motion that is lost. 5. Weakness: usually tested by a physical therapist with a machine that measures strength   What are the components of the lower extremity impairment rating? 1. Diagnosis- Based Estimates (DBE): impairment ratings for common medical procedures 2. Amputation: percent depends on amputation level 3. Nerve injury: percent depends on the nerves injured and whether there is motor involvement, sensory or pain involvement, or both 4. Leg length discrepancy: depends on how many centimeters different the two legs are 5. Range-of-motion: depends on which and how many joints of the arm are involved and the amount of range-of-motion that is lost. 6. Weakness: usually tested by a physical therapist with a machine that measures strength 7. Gait disturbance: how severe is the patients walking affected and what sort of assistive devices are needed for mobility such as cane, walker, or wheelchair 8. Muscle Atrophy: measures the diameter of the calf in both legs. If there is a difference, by how many centimeters. 9. Skin Loss: percent of impairment depends on how severe the activities of daily living are affected. 10. Vascular Impairment: percent of impairment depends on how far the individual can walk before muscle cramping during walking. Other factors include the presence of pulses, whether leg swelling is present, whether there are leg ulcers and if so, how deep are they, and whether there is a leg amputation.   What factors are used to evaluate the spine?   1. Spasm: In the back or neck muscles 2. Range of motion: Limits in the spine 3. If there are compression fractures present and if so how bad 4. If there is evidence of a radiculopathy (aka pinched nerve) on EMG 5. If there is a neurologic deficit present such as weakness, loss of reflexes, etc.   What factors are used to evaluate the pelvis?   1. If there is a pelvic deformity present 2. What part of the pelvis is affected: the pubic rami, the illium, the ichium, the sacrum, or the Sacroilliac joint. 3. Is there displacement of the joint What factors are used to evaluate impairment due to pain in the upper extremity?   1. Whether it affects the dominant or nondominant extremity 2. Does it limit hand dexterity 3. Does it limit self care? What factors are used to evaluate impairment due to pain in the lower extremity?   1. Whether it affects climbing stairs 2. Whether it affects walking 3. Whether the individual needs assistive devices such as canes or walkers to walk. How are Impairment Ratings Used ?   1. The amount of payment is determine based on the degree of permanent impairment 2. Payment is determined by a Board who follow regulations made by the Workers' Compensation Act. 3. The Impairment ratings are classified ranging from Class 1 to Class 5. a. Class 1: No impairment, impairment rating 0%. b. Class 2: Mild impairment and able to perform. most useful functioning, impairment rating 10-20%. c. Class 3: Moderate Impairment and able to perform some but not all useful functioning, impairment rating 25-50%. d. Class 4: Marked Impairment that significantly impedes useful functioning, impairment rating 55-75%. e. Class 5: Extreme Impairment and unable to perform useful functioning, impairment rating >75%.

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