4/28/2015 DR. TRACY W. PRICE, D.C. PPI due to injury or illness AMA GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT 5 TH EDITION

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1 DR. TRACY W. PRICE, D.C CHAPEL HILL CHIROPRACTIC CENTER, INC HOME AVE. AKRON, OH PH : FAX WEB: AKRONCHHIRO.COM AMA GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT 5 TH EDITION Chapter 15: The Spine DRE Range of Motion SPINE IMPAIRMENT EVALUATION PROCESS PAGE 380 FIG IW at MMI NO Await MMI Yes Injury PPI due to injury or illness Illness 1

2 Injury Illness Single Level No ROM Method First injury or repeat injury, Different regions NO 1. Diagnosis 2. Measure ROM 3. Determine neurologic deficit 1 st injury Diagnosis 1,2,3 DRE Method Place in category Combine areas 1 3 with Combined Values Chart Deteriorated; repeat injury PAGE A SUMMARY OF SPECIFIC PROCEDURES AND DIRECTIONS Take a careful history: structural abnormalities, motion segment integrity, nerve root or cord involvement Consider permanency of impairment. Select region primarily involved and identify most serious objective findings Determine multilevel involvement: ROM if a) Fx at more than one spinal region b) Radiculopathy c) multilevel motion segment altercation d) Recurrent disc herniation, stenosis 2

3 If IW does not have multiple levels involvement or multiple recurrences/occasions DRE I,II or III can be used. A corticospinal tact injury is evaluated according to Section If IW has been treated with surgery or other modality evaluate the results, extent of improvement, and impact on ADL If more than one spinal region involved use combined values chart Page 604. Determine if there was preexisting impairment, congenital, developmental and other preexisting conditions. If requested apportion the findings ideally utilizing the same method. Corticospinal tract involvement refer to Table 15 6 DRE METHOD Lumbar Spine Page 384 Table 15.4 Thoracic Spine Page Table 15 4 Cervical Spine Page 392 Table

4 PAGE RANGE OF MOTION METHOD Range of Motion Method has three elements that need to be assessed 1) the range of motion of the impaired spine region 2) Accompanying diagnoses (Table 15 7) 3) Any spinal nerve deficit Chapter 13 (Central and Peripheral nervous system) and Chapter 15 4

5 PAGE ROM METHOD Range of motion method should be used only if 1) the DRE method is not applicable 2) if after obtaining a history and performing the examination the physician cannot place the IW within a multilevel DRE category. 3) if multilevel involvement and/or altercation of motion segment integrity has occurred in the same spinal region ROM CONTINUED 4) there is recurrent radiculopathy caused by a new (recurrent) disc herniation or a recurrent injury in the same spinal region. 5) if there are multiple l episodes of other pathology producing altercation ti of motion segment integrity and/or radiculopathy 6) If statutorily mandated PAGE D 1) Determine the IW is at MMI 2) Selectimpaired region 3) Use table 15 7 to determine the percentage of impairment for the part of the ROM diagnosis based estimate. 4) measure ROM in relevant frontal, sagittal and transverse planes 5

6 ROM CONTINUED 5) Perform at least 3 measurements on each ROM the average of each 6) Maximum of 6 measurements. 7) Use the maximal motion from a reproducible set of measurements. 8) Determine impairments due to neurological deficits. 9) Combine the diagnosis based (table 15 7) mobility and neurological using combined values chart. PAGE 403 ROM CONTINUED 10) Repeat steps 1 9 for either of the other two spinal regions. 11) Combine theregion impairments into a single WPIusing the Combined Values Chart page ) Combine the WPI to any other organ system using the Combined Values Chart page ) Record the results PAGE 403 ROM AND TABLE ) Use Table 15 7 only when ROM method is used. 2) Identify the most significant (impairing) diagnosis of the primarily involved region ( lumbar, thoracic, cervical). 3) The diagnosis based impairment should be combined with range of motion impairment estimates and WPI estimates involving sensation, weakness, and other conditions of the musculoskeletal, nervous, or other organ system. 4) Combine the diagnosis based, range of motion, and other whole person estimates. 5) Repeat for other spinal regions. 6

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11 PAGE RATING CORTICOSPINAL TRACT DAMAGE The neurological level of involvement is determined by identifying the level of cord involvement, not necessarily the same level of fracture, because the root function at the fracture level returns with time. The level of cord involvement is determined by identifying the lowest functioning nerve root. Identifying the level of nerve root function helps determine the level of residual function. 11

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