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
BIOGRAPHY
REFERALS
Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
 
     
 
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%.
Disclaimer
"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only.
Please consult a physician for medical advice regarding any medical condition."
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