• Impairment Ratings and Disability Issues of the Upper Extremity
• Coordinating Rehabilitation Efforts and the Disability Evaluating Process
• Evaluation of the Peripheral Nervous System in Disability Management: Practical Aspects in Lower Back Pain
• The Evolution and Mechanics of the Midfoot and Hindfoot

1997;8(1):9-17

Impairment Ratings and Disability Issues of the Upper Extremity

Frank E. Jones Richard E. Johns Jr.

Determination of a fair and consistent permanent impairment rating is a very important part of the injured worker's care. This rating is a medical determination and is based on objective and consistent physical findings. Conversion of these findings into a percent of impairment is greatly facilitated by the use of guidelines which enable different examiners to be consistent in their determinations. The most widely used guide is the Guides to the Evaluation of Permanent Impairment, published by the American Medical Association. Disability is a legal determination which attempts to quantitate how the impairment will affect the injured person. Disability takes into account the worker's age, education, experience, and other social and economic factors. In the United States, disability is usually determined by the courts, while in other parts of the English-speaking world, the physician who does the impairment rating may be expected to estimate the disability as well as the impairment. This article will discuss some aspects of determination of impairment of the upper extremity, using the AMA Guides as the primary guideline.

Keywords: Disability evaluation; Extremity, upper; Amputation; Range of motion; Neurologic evaluation

1997;8(1):19-43

Coordinating Rehabilitation Efforts and the Disability Evaluating Process

Anthony J. Dorto & John M. Williams

Treating industrial injuries/dysfunctions present greater challenges for the treating physician and rehabilitation team. The treatment and documentation needs of injured workers require a coordinated effort of the entire rehabilitation team in order to bring the disability evaluating process to an efficient and final conclusion. This manuscript presents the authors' personal clinical approaches to industrial injuries, focusing on the rehabilitation process; what to do, when to do it, and when to stop and proceed along a different plan. This paper will also address issues of completing the disability evaluating process while meeting the needs of the patient, employer, case manager, and payor source. The importance of the multi-disciplinary rehabilitation team and communication with the employer through the case manager, patient and family will be described. The use of Functional Capacity Evaluation, Job Analysis and other return to work and disability assessment modalities will be discussed as related to coordination with other rehabilitation efforts.

Keywords: Disability evaluating process; Rehabilitation; Return to work; Passive/active modalities; Multi-disciplinary treatment team; Treatment outcome; Vocational rehabilitation

1997;8(1):45-56

Evaluation of the Peripheral Nervous System in Disability Management: Practical Aspects in Lower Back Pain

Steven Mandel and Robert A. Carabelli

Lower back pain (LBP) is a common condition with profound economic and social consequences. A conservative, symptomatic, goal-oriented management program is advocated by most, emphasizing pain relief and restoration of functional capacity. Still, LBP is recurrent in approximately 50% of patients and up to 5-10% experience chronic intractable pain. This article describes how to evaluate and rehabilitate the patient with spinal impairment (SI). All is summarized in a diagnostic/treatment algorithm as used in the spine rehabilitation center. Causes of LBP, components of the patient history and physical, diagnostic test usage and management options are summarized in tables for future reference. Lastly, preventative measures are discussed which, when implemented within a treatment program, may prevent future reoccurrences.

Keywords: Disability; Low back pain; Peripheral nervous system

1997;8(1):57-64

The Evolution and Mechanics of the Midfoot and Hindfoot

Robert Donatelli

The foot and ankle have been an important part in the development of human gait and the erect posture of man. This paper presents several important evolutionary and biomechanical insights to the function of the midfoot and rearfoot. The bony architecture of the foot and ankle has enhanced the ability of man to walk in an upright posture. The complex movements of supination and pronation was established as a result of positional changes of the talus and calcaneus. The human foot has adapted to a bipedal striding gait by forming a compact structure that can absorb high ground reaction forces and provide a lever for push off. Certain mechanical disorders of the foot and ankle may result from alterations of several evolutionary features. Excessive pronation and supination are the two major categories of mechanical disorders of the foot and ankle. The restoration of normal foot mechanics offers an important treatment approach to mechanical dysfunction of the foot and ankle.

Keywords: Pronation; Supination; Pes cavus; Pes planus