35773 Airport Rd. Hamilton, MT 59840 John Fiore, PTThe table below reflects the job demands...

FUNCTIONAL CAPACITY EVALUATION

OF

Mr. John Doe

REQUESTED BY

RANDY SMITH, MD

BITTEROOT VALLEY HEALTH CLINIC

35773 Airport Rd.

Hamilton, MT 59840

PREPARED BY

John Fiore, PT

SAPPHIRE PHYSICAL THERAPY

2207 S. THIRD ST. W

MISSOULA, MT 59801

ASSESSED

10/11/2008 - 10/12/2008

10/13/10 Mr. John Doe Page 2

TABLE OF CONTENTS

Client Profile ................................................................................................................... 3 Job Demands ................................................................................................................... 8 Dexterity ....................................................................................................................... 10 Grip Strength ................................................................................................................. 12 Handling ....................................................................................................................... 13 Fitness ........................................................................................................................... 14 Mobility ........................................................................................................................ 15 Material Handling ......................................................................................................... 18 Musculoskeletal Evaluation – Upper Extremities ........................................................... 20 Musculoskeletal Evaluation – Lower Extremities .......................................................... 24 Musculoskeletal Evaluation – Cervical Spine ................................................................ 27 Musculoskeletal Evaluation – Thoracic Spine ................................................................ 29 Musculoskeletal Evaluation – Lumbar Spine ................................................................. 31 Timer Analysis .............................................................................................................. 35 Physical Effort Findings ................................................................................................ 36 Reliability Of Client Reports ......................................................................................... 40 Summary of Findings .................................................................................................... 45 Recommendations ......................................................................................................... 46 Next Day Follow-up ...................................................................................................... 47


CLIENT PROFILE

Client: Mr. John Doe

Date of service: 10/11/2008 Diagnosis: Mr. Doe reports he was riding his motorcycle on Hwy 12 in Idaho

along the Lochsa River when he lost control of the motorcycle and went off the road and embankment. He laid by his bike for 4 days before crawling up to the Hwy to flag down help. He sustained a segmental left tibia fracture which required ORIF, a left fibula fracture, c/o right ulnar neuritis, he fractured his left scapula, and the proximal phalanx of his left index finger which required pin fixation.

Job at time of injury: Deck Hand Date of injury: 08/27/2007

Date last worked: 10/11/2008 Worked Since: 10/11/2008

Work Status: Yes Referred by: Randy Smith, MD

Reasons for Referral Mr. Doe was referred to this facility to answer the following questions about his current work/functional ability: 1. Did John Doe provide evidence of consistently full effort during two days of FCE testing? 2. What are John Doe‟s present functional physical abilities related to occupational demands? 3. What are John Doe‟s present functional physical limitations related to occupational demands? 4. What category of job (based on occupational requirements of tolerance and frequency) is John Doe presently capable of performing? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Prior to beginning the evaluation, an intake interview was performed. During the interview Mr. Doe signed a “Consent to Evaluate and Treat” release. Present at the interview were evaluator and evaluee. The following information was obtained during the interview:


Previous Problems Mr. Doe has a prior history of a distal left tibia fracture that was casted.

Reportedly forced into early retirement two years ago due to a commercial fishing accident resulting in throat and neck surgery.

Precautions/Contradictions Mr. Doe continues to have left lower leg pain which limits his mobilty. Mr. Doe did not have any physical therapy treatment due to lack of insurance per report.

Hand Dominance Right Date of Birth 12/10/1958 Height 71 Inches Weight 160 Pounds Social Security Number 568-13-5790 Additional Comments: None Mr. Doe‟s resting heart rate was 72 beats per minute.

Previous Treatment Mr. Doe reports having attended the following treatments in an attempt to rehabilitate his condition:

Treatment Results/Comments No treatment outside of initial surgical and follow-up care.

Investigations Mr. Doe reports having had the following investigations:

Investigation Date Results/Comments X-Ray 9/2007-present Confirmed left tib/fib fracture; Healing continues in the

tibia

Medical History Mr. Doe indicates the following medical history:

Medical History Checklist Memory Loss Numbness/Tingling Noise In Ears Balance Problems Change In Voice Hoarseness Difficulty Swallowing Swollen Ankles Varicose Veins


Back Injury Joint Injury/Pain Arthritis Broken Bones Change In Wart Or Mole Trouble Sleeping Stress Depression Prior Drug/Alcohol Treatment Pneumonia Persistent Cough Smoked For 20 Years Smokes 1 Packs of Cigarettes Per Day Exposed To Second-Hand Smoke Mr. Doe also provides the following medical history and medication information:

Area Description Surgeries Feb. 2008 surgical removal of tibial plates and rod placement; Sept. 2007 left

tib/fib fx and ORIF; July 1, 2005 throat/neck surgery following commercial fishing accident; 1987 bladder surgery to remove stone; 1985 hernia repair.

Prescription Medications Celebrex Non-Prescription Medications

Ibuprofen; multi-vitamin

Medication Allergies Morphine Medical Devices -na- Additional Medical History

-na-

Mr. Doe reports the following family illnesses:

Family Illness Diabetes Cancer Mr. Doe reports the following about members of his immediate family:

Member

Age(s)

Cause of Death (If Deceased)

Other Major Health Problems

Work Related

Father CA Mother 68 Sisters 49 Spouse 53 Smoker; Hernia -na- Mr. Doe provides the following work history:

Area Comments/Specifics Work Environment Construction Site


Fiber Mill/Foundry Paper / Lumbar Mill Dusty Jobs

Chemical Exposure Asbestos Extreme Changes In Temperature Chromates Large Amounts Of Dust Loud Noises Spray Paints Lasers Repetitive Motion/Vibration Solvents /Degreasers Welding/Soldering Radioactive Materials

Work History Comments Mr. Doe reports he has remained steadily employed throughout his work history.

Mr. Doe reports the following job injuries:

Description Approx. Date Results Throat/neck injury resulting in surgical intervention while working for commercial fishing co.

July 1, 2005 Took early retirement from commercial fishing

Back strain approximately once per year Resumed full-time work as a laborer Mr. Doe also provides the following job history: From To Position/Job Duties Company 2004 July,

2005 Deck Hand Pacific Fisheries, INC

1998 2003 Carpenter Moderman Construction 1997 1998 Deck Hand Patience Fisheries, INC Mr. Doe‟s home environment is as follows: Resides With Husband/Wife with 5 children Type of Residence Single Level Mobile Home Activity Level Moderate Education Completed High School diploma; Associate Degree in computers at Riverside, CA

(High School); Newport, OR (AA degree) Mr. Doe enjoys the following hobbies:

Hobbies Gardening/Yard Work Bicycling/Motorcycling Woodwork/Carpentry/Home Repair Use Chainsaw/Power Tools/Jack Hammer Wrist/Type/Computer Hunt/Fish/Shoot Mr. Doe has not been able to ride motorcycles


since his 2007 accident; Light weight power tool use only

Reported Functional Tolerances Mr. Doe reports his functional tolerances as follows:

Client‟s Estimate of Maximum Tolerance Strength Lifting 1/2 sheet 4x8 plywood tolerated Lifting Approximately 20 lbs. to head level Carrying Approximately 40 to 50 lbs. for 30 to 40 feet Pushing Tolerates up to 10 or 20 minutes of lawn mowing Pulling Hand truck pulling and garbage can with wheels tolerated Mobility Sitting 15 to 20 minutes tolerated Static Standing 15 to 20 minutes tolerated Dynamic Standing 15 to 20 minutes tolerated Walking 30 minutes tolerated with subsequent seated rest needed Agility Stairs/Ladders Capable carrying light object only due to left leg limitation Balancing Some limitation balancing on left leg Bending/Stooping Greater difficulty than prior to MVA due to low back strain and right

leg Crouching/Squatting Squatting to floor difficult due to left tib/fib ORIF and rod presence Crawling Not tolerated due to knee pain bilaterally left > right Twisting/Spinal Rotation

Guarded but tolerated due to low back "being out"

Above-Shoulder Work Tolerated with limited concomitant lifting only Low-Level Work Some back and left leg aching with kneeling avoided Prolonged Neck Positioning

15 minutes max reading without altering neck position; Does not tolerate prolonged cervical side flexion

Impact/Jarring Tolerates landing on right leg off step only s/p left tib/fib fracture Dexterity Fine Finger Limited motion left index finger; parasthesia digits 4 & 5 right hand Grasping - Light Limited motion left index finger; parasthesia digits 4 & 5 right hand Grasping – Firm Limited motion left index finger; parasthesia digits 4 & 5 right hand Writing Less legible than prior to MVA Vision/Hearing Hearing ringing in the ears

Client’s Work-Related Goals Mr. Doe states that his current vocational goals are: Mr. Doe is presently applying for SSI Disability.


JOB DEMANDS

The table below reflects the job demands considered in this functional capacity evaluation. These values were determined by reference to The Dictionary of Occupational Titles. Mr. Doe‟s target job is Electric-Meter Reader (DOT Code 209.567-010) in the “Utilities (Light, Heat, And Power)” industry classification (Industry Code 6131). The DOT describes the target job as: Reads electric, gas, water, or steam consumption meters and records volume used by residential and commercial consumers: Walks or drives truck over established route and takes readings of meter dials. Inspects meters and connections for defects, damage, and unauthorized connections. Indicates irregularities on forms for necessary action by servicing department. Verifies readings to locate abnormal consumption and records reasons for fluctuations. Turns service off for nonpayment of charges in vacant premises, or on for new occupants. Collects bills in arrears. Returns route book to business office for billing purposes. May be designated according to type of meter read as Electric-Meter Reader (utilities); Gas-Meter Reader (utilities); Steam-Meter Reader (utilities); Water-Meter Reader (waterworks). The Industry Description is: This designation includes occupations concerned with generating electricity in steam and hydroelectric power plants; transmitting and distributing electricity; distributing manufactured and natural heating and illuminating gas; producing and distributing steam heat and power; and the activities related to such functions. Occupations concerned with transporting petroleum and gas products are included in the PIPE LINES INDUSTRY (pipe lines). The typical work day is 540 minutes long with 60 minutes of lunch and other breaks resulting in a net time worked of 480 minutes.

Job Demand Client Concerns Strength Lifting Light. 20 lbs. Occasional (Up to 1/3 Day). Carrying Light. 20 lbs. for feet. Occasional (Up to 1/3 Day). Pushing Light. 20 lbs. for feet. Occasional (Up to 1/3 Day). Pulling Light. 20 lbs. for feet. Occasional (Up to 1/3 Day). Mobility Sitting Occasional (Up to 1/3 Day). Static Standing Occasional (Up to 1/3 Day). Dynamic Standing Occasional (Up to 1/3 Day). Walking Occasional (Up to 1/3 Day). Agility


Bending/Stooping Occasional (Up to 1/3 Day). Crouching/Squatting Occasional (Up to 1/3 Day). Above-Shoulder Work

Frequent (1/3 to 2/3 Day).

Low-Level Work Occasional (Up to 1/3 Day). Dexterity Grasping - Light Occasional (Up to 1/3 Day). Grasping - Firm Frequent (1/3 to 2/3 Day). Pinching Occasional (Up to 1/3 Day). Reaching Forward Frequent (1/3 to 2/3 Day). Writing Frequent (1/3 to 2/3 Day). Vision/Hearing Near Acuity (<20 in.) Frequent (1/3 to 2/3 Day). Color Vision Occasional (Up to 1/3 Day). Depth Perception Occasional (Up to 1/3 Day).


DEXTERITY

Purdue Pegboard Test(-na-)

Valpar 9 Whole Body Range of Motion Test Sustained Above Eye Level Reaching The Valpar 9 Whole Body Range of Motion Test was used to evaluate Mr. Doe‟s tolerance to sustained above-eye-level reaching.

Time (sec)

MTM Ranking

(%)

Worker Qualification

Profile

Pegs Dropped

Comments

Right Left 517 105% Meets Industrial

Standard 1 0

Topic Observation

Signs of Physical Discomfort Increased neuro complaints Mild numbness reported in right hand fingers

Bending The Valpar 9 Whole Body Range of Motion Test was used to help evaluate Mr. Doe‟s tolerance to both sustained and repetitive bending.

Time (sec)

MTM Ranking

(%)


Profile

Pegs Dropped

Comments


Standard 0 0 pt. had difficulty moving from standing

position to seated position.

Topic Observation Signs of Physical Discomfort Increased neuro complaints

Performed second part of transfer while seated. Sustained Low-Level Work The Valpar 9 Whole Body Range of Motion Test was used to help evaluate Mr. Doe‟s tolerance to prolonged low-level work.

Time (sec)

MTM Ranking

(%)


Profile

Pegs Dropped

Comments


Standard 0 0 performed transfer in seated position



Numbness reported in right hand fingers Recovery from Low-Level Work (Floor to Eye Level) The Valpar 9 Whole Body Range of Motion Test was used to help evaluate Mr. Doe‟s tolerance to low-level work recovery to eye-level work, requiring continuous reaching between floor and eye levels.

Time (sec)

MTM Ranking

(%)


Profile

Pegs Dropped

Comments

Right Left 482 117% Meets May Exceed

Industrial Standard 0 0 performed transfer in seated and

standing position


Numbness reported in right hand fingers Comments Mr. Doe reported numbness in his right hand fingers throughout the test. Mr. Doe sat on crate in order to perform low level transfers. Mr. Doe had difficulty moving from standing to seated/kneeling position during transfer 2. No difficulty noted from seated to standing position in transfer 4. Very good finger/hand dexterity despite reported right ulnar neuritis symptoms and left second digit PIP flexion contracture.


GRIP STRENGTH

As a function of Jamar Hand Dynamometer testing, information about the client‟s grip strength was collected. Using the five scores from his strongest grip span, he compares to a normative group using a six-grip test as:

Dominant (Right) Hand Grip Strength

Non-Dominant (Left) Hand Grip Strength

Client

Norm Group

Client

Norm Group

48.33 109.9 60.67 100.8 Results are in pounds. As can be seen from this table, the client demonstrates the dominant hand as being weaker than the normative group. His non-dominant hand demonstrates as being weaker than the normative group. Jamar serial number 11195923 was used for this portion of the test. During the grip strength test, the client was noted to show no signs of physical discomfort. Mr. Doe was observed to demonstrate no signs of competitive test performance during grip strength testing.


HANDLING

Valpar 202 Light Strength Handling Test The Valpar 202 Light Strength Handling Test was used to further evaluate Mr. Doe‟s dexterity, tolerance for work involving sustained neck flexion, tolerance for prolonged light-strength work, tolerance for prolonged standing in one place, and general ability to use wrenches and hammers. Mr. Doe‟s scores for the Valpar 202 Test are presented as follows:

Total Score MTM Ranking Worker Qualification Profile Assembly 507 50 to 55 Does Not Meet (B) Disassembly 490 65 to 70 Does Not Meet (A) * The Worker Qualification Profile is used to describe the typical worker functions tested by the apparatus. The WQP for the Valpar equipment indicates the various areas of work the evaluee has qualified for according to the guidelines set forth in the US Department of Labor‟s “Dictionary of Occupational Titles” 4th Edition (Revised)(DOL, 1991), and “The Revised Handbook for Analyzing Jobs” (DOL, 1991)(RHAJ). The client therefore either Meets or Does Not Meet the industrial time standard for the test. The accuracy requirement was within acceptable limits required to qualify for the industrial time standard. Mr. Doe exhibited no signs of physical discomfort during the Valpar 202 Test. The client demonstrated no signs of competitive test performance during the Valpar 202 Test. The Valpar 202 Test was terminated as it was successfully completed. Mr Doe reported numbness in his right hand fingers throughout the test. He also reported mild mid back soreness but did not increase his reported pain level.


FITNESS

Walking Mr. Doe was observed to walk over a primarily level terrain a distance of approximately 5280 feet. This activity took place over a 46 minute period. His heart rate prior to testing was 78 beats per minute, at the end was 86 beats per minute, and the maximum was 99 beats per minute. Antalgia was present on the left leg and was noted to increase on the left side. Mr. Doe was noted to demonstrate the following signs of physical discomfort: pausing intermittently and facial wince. The client demonstrated no signs of competitive test performance during the cardiovascular tests. Max HR= 99 bpm. Required 3 standing rest breaks due to fatigue and report of left medial ankle pain. Increase in left antalgia. Poor tolerance to prolonged walking. Very slow walking pace of 46 minutes for 1 mile distance. Poor aerobic capacity due to poor tolerance to walking due to injury history and gross lower extremity debilitation (see Musculoskeletal Evaluation portion of FCE testing).


MOBILITY

Trunk Flexibility The National Back Fitness Test was used to evaluate Trunk Flexibility. Forward bending was completed 1 out of 3 times to 11 inches from the floor. Right side bending was completed 1 out of 3 times to 18 inches from the floor. Left side bending was completed 1 of 3 times 19 inches from the floor. Mr. Doe demonstrated no signs of physical discomfort during this test. He demonstrated no signs of competitive test performance. Moved slowly into forward and lateral trunk flexion.

Balance Mr. Doe was observed to partake in both upper- and lower-level balance testing using a 10-foot-long, 3.5-inch-wide beam. The client passed the basic balance test, but failed the upper level balance test: he should therefore avoid work on slippery, wet, narrow, elevated or erratically moving surfaces. Mr. Doe demonstrated the following signs of competitive test performance: voiced frustration at poor performance and holding breath.

Crouching/Squatting Mr. Doe was observed to assume a position of sustained crouching for 15 seconds. Repetitive crouching was completed for 5 out of five trials. Crouching was completed smoothly with no support required to rise. He demonstrated the following sign of competitive test performance: holding breath. HR= 100 bpm. Mr. Doe reported left ankle soreness with prolonged crouching. Fair tolerance. The client was observed to squat (i.e., with a straight back) for 15 seconds in succession. Squatting was completed smoothly with no support required to rise. Mr. Doe demonstrated the following sign of competitive test performance: compensatory body postures. HR= 95 bpm post squatting. Difficulty with balance due to decreased weight bearing left lower extremity. Mr. Thompsom reported left ankle pain of 1. Fair tolerance.


Kneeling/Floor Mobility Mr. Doe was observed to perform kneeling/floor mobility as follows: Result (Seconds) Right Knee 15 Left Knee 15 Both Knees Unable Sitting Back on Calves and Heels Unable Mr. Doe was able to move into a seated position on the floor. He was observed to prefer a floor position of sit knee-chest. The client was noted to rise slowly with no the need of adjacent support. He demonstrated the following signs of competitive test performance: compensatory body postures and HR= 102 bpm. HR= 102 bpm. Unable to kneel on both knees or sit back on calves due to limited left knee range of motion and pain. Poor kneeling tolerance.

Climbing and Descending Stairs Mr. Doe was observed to climb and descend 1 floor of 26 steps. He completed this without a break. Antalgia was noted at the onset of the test on the left. Antalgia was noted to increase on the left as the test progressed. The client demonstrated no signs of physical discomfort during the stairs test. Mr. Doe demonstrated no signs of competitive test performance. HR= 102 bpm with left ankle pain.

Ladder Mobility Mr. Doe was observed to climb and descend 3 rungs of an A-frame step ladder (8‟) for 5 repetitions. His pace was noted to be slightly slowed with slowing at top of ladder. The client demonstrated no signs of physical discomfort during the ladder test. Mr. Doe demonstrated the following sign of competitive test performance: voiced frustration at poor performance. HR= 106 bpm post ladder climbing. Pain reported as a 2 post ladder climbing.


Comments John Doe‟s Mobility tolerance is as follows: GOOD: Low level balance (eyes open) activities. FAIR: Crouching, Squatting, Stair ascending/descending, Ladder ascending/descending. POOR: Trunk forward and side bending, kneeling, crawling, bending/stooping, spinal twisting/rotation.


MATERIAL HANDLING

Maximum Isoinertial Lifting Evaluation Mr. Doe completed the Maximum Isoinertial Lifting Evaluation during the evaluation process. Prior to testing, the client‟s heart rate was found to be 84 bpm and his blood pressure was 156/98 mm Hg. His functional pain rating was 2/10. The results for the 19 inch width (center of body to hands) of this evaluation are as follows:

Test

Max. Weight

Final Weight

Heart Rate

Pain

%ile

Comments

Floor-Knuckle 37 35 108 3 10 Compensatory posture to lower to floor in order to decrease left knee flexion; Favored left leg

12"-Knuckle 41 39 108 3 Left knee pain and right gluteal muscle soreness

Knuckle-Shoulder 24 22 110 3 < 10 low tightness and left shoulder soreness

Shoulder-Overhead 19 17 107 2 < 10 low back tightness, right elbow pn, and left shoulder soreness

Carry 30 feet 22 20 119 3 < 10 light headedness and LBP pain and left shoulder soreness

Push 30 feet 102 95 108 3 > 90 HAND TRUCK; Increased low back soreness and left knee pain and lower left leg soreness

Pull 30 feet 102 95 108 3 > 90 HAND TRUCK; Increased low back soreness and left knee pain and lower left leg soreness

The client‟s post-test heart rate was 90 bpm, his post-test blood pressure was 144/90 mm Hg and his post-test pain rating was 2/10. The client demonstrated the following sign of physical discomfort during the test: Compensatory posture to decrease left leg weight bearing. The client exhibited the following sign of competitive test performance during the test: requesting to continue when advised to stop. The test was terminated as it was successfully completed.

Comments Mr. Doe‟s lifting tolerance is SEDENTARY to LIGHT based on the height of the lifting. Mr. Doe is rated as SEDENTARY when lifting from floor height and when lifting overhead. He is rated as LIGHT when lifting from 12” < >waist height, waist< >shoulder


height. Mr. Doe is rated as LIGHT when carrying up to 30 feet, and when pushing/pulling WITH HAND TRUCK ONLY.


MUSCULOSKELETAL EVALUATION – UPPER EXTREMITIES

A musculoskeletal evaluation was performed on Mr. Doe prior to any functional testing. The client‟s pre-test pain level was 0/10. The evaluation results are as follows:

Posture Mr. Doe‟s posture and the upper limbs were observed and found to appear as follows: Neck: Decreased lordosis Shoulder: Protracted, depressed L>R Elbow: Normal Wrist: Normal

Tests Active and passive ranges of motion and muscle power are presented below in the various upper extremity joints tested:

Shoulder Movement

Active Range Passive Range Muscle Power Right Left Right Left Right Left

Flexion 160º 150º 0º 0º 4/5 4/5 Abduction 129º 111º 0º 0º 4/5 4/5 Medial Rotation 45º 48º 0º 0º 5/5 4/5 Lateral Rotation 80º 73º 0º 0º 5/5 5/5 Horizontal Flexion 45º 45º 0º 0º 5/5 5/5 Horizontal Extension 90º 90º 0º 0º 5/5 5/5

Elbow Movement


Flexion 150º 150º 0º 0º 4/5 4/5 Extension 0º 0º 0º 0º 5/5 5/5 Pronation 80º 80º 0º 0º 5/5 5/5 Supination 80º 80º 0º 0º 5/5 5/5

Wrist Movement


Flexion 80º 80º 0º 0º 4/5 4/5 Extension 70º 70º 0º 0º 5/5 5/5 Radial Deviation 20º 20º 0º 0º 5/5 5/5 Ulna Deviation 30º 30º 0º 0º 5/5 5/5

Index Finger Movement


MCP Flexion 90º 90º 0º 0º 5/5 5/5 MCP Extension 45º 45º 0º 0º 5/5 5/5 PIP Flexion 90º 100º 0º 0º 5/5 5/5


PIP Extension -11º 0º 0º 0º 5/5 5/5 DIP Flexion 90º 90º 0º 0º 5/5 5/5 DIP Extension 0º 0º 0º 0º /5 /5

Middle Finger Movement


MCP Flexion 90º 90º 0º 0º 5/5 5/5 MCP Extension 45º 45º 0º 0º 5/5 5/5 PIP Flexion 100º 100º 0º 0º 5/5 5/5 PIP Extension 0º 0º 0º 0º 5/5 5/5 DIP Flexion 90º 90º 0º 0º 5/5 5/5 DIP Extension 0º 0º 0º 0º 5/5 5/5

Ring Finger Movement



Little Finger Movement



Thumb Movement


CMC Flexion 0º 0º 0º 0º 5/5 5/5 CMC Extension 0º 0º 0º 0º 5/5 5/5 MP Flexion 50º 50º 0º 0º 5/5 5/5 MP Extension 0º 0º 0º 0º 5/5 5/5 IP Flexion 80º 80º 0º 0º 5/5 5/5 IP Extension 0º 0º 0º 0º 5/5 5/5

Special Tests

Test Comments Shoulder Instability - Anterior Negative on both sides. Shoulder Instability - Posterior Negative on both sides. Elbow - Medial Collateral Ligament Negative on both sides. This indicates that there is no tear in the medial

collateral ligament of both elbows. Elbow - Later Collateral Ligament Negative on both sides. This indicates that there is no tear in the lateral

collateral ligament of both elbows. Tinel - Elbow Positive on the right side. This indicates that there is a cubital tunnel


compression on the right elbow.

Circumferential Measurement Circumferential measurements were taken at various anatomical regions pre- and post-testing and the results are presented below:

Anatomical Region Pre-Test (cm) Post-Test (cm) Difference (cm) -na- 0cm 0cm 0cm

Volumetric Measurement Volumetric measurement based on Archimedes‟ Principle was used to determine whether swelling occurred during the evaluation. The results are tabled below:

Anatomical Region Pre-Test (ml) Post-Test (ml) Difference (ml) -na- 0ml 0ml 0ml

Abnormal Illness Behavior Mr. Doe‟s movement patterns were noted to improve by distraction and his pain was not proportional to his movement patterns.

Palpation Thorough palpation of the upper extremities was performed on Mr. Doe with the following results:

Area Result Shoulder Bilateral shoulder atrophy Fingers -11 degree left second digit PIP joint flexion contracture

Post-Evaluation Pain Level Mr. Doe reported a post-test pain level of 0/10.

Assessment Gross upper extremity (shoudler girdle) weakness. Flexion contracture second digit PIP joint limites mobility and grip per report.

Recommendations


Address bilateral rotator cuff and wrist weakness. Work on left scapular mobiltiy to improve function and decrease pain.


MUSCULOSKELETAL EVALUATION – LOWER EXTREMITIES

A musculoskeletal evaluation was performed on Mr. Doe prior to functional testing. The client‟s pre-test pain level was 2/10. The evaluation was performed on the lower extremities and the results are as follows:

Posture Mr. Doe‟s posture and the lower limbs were observed and found to appear as follows: Back: Decreased lordosis Hip: Normal Posture Knee: IM rod incisional scar Ankle: IM rod incisional scar

Tests The active and passive ranges of motion and muscle power are presented below in the various lower extremity joints tested:

Hip Movement


Flexion 99º 85º 0º 0º 3/5 3/5 Extension 22º 18º 0º 0º 4/5 4/5 Abduction 40º 43º 0º 0º 5/5 4/5 Adduction 30º 30º 0º 0º 5/5 4/5 Medial Rotation 20º 21º 0º 0º 5/5 4/5 Lateral Rotation 48º 48º 0º 0º 5/5 4/5

Knee Movement


Flexion 128º 122º 0º 0º 5/5 4/5 Extension 1º 0º 0º 0º 4/5 4/5

Ankle Movement


Dorsi-Flexion 12º 5º 0º 0º 5/5 4/5 Plantar-Flexion 58º 52º 0º 0º 5/5 4/5 Inversion 60º 43º 0º 0º 5/5 4/5 Eversion 15º 15º 0º 0º 5/5 4/5

Special Tests

Test Comments Hip - Thomas Positive. This indicates abnormal hip flexor muscle length on both sides. Hip - Ober Positive. This indicates abnormal ilio-tibial-band length on both sides.


Hip - Patrick (FABERE) Positive. This indicates that sacroiliac joint pathology is evident. Knee - MCL Negative. Knee - ACL Positive.

Circumferential Measurement Circumferential measurements were taken at various anatomical regions pre- and post-testing. The results are presented below:

Anatomical Region Pre-Testing (cm) Post-Testing (cm) Difference (cm) visible left quad atrophy 0cm 0cm 0cm visible left gastroc atrophy 0cm 0cm 0cm

Volumetric Measurement Volumetric measurement based on Archimedes‟ Principle was used to determine whether swelling occurred during the evaluation. The results are tabled below:

Anatomical Region Pre-Testing (ml) Post-Testing (ml) Difference (ml) -na- 0ml 0ml 0ml

Abnormal Illness Behavior Mr. Doe‟s movement patterns were not noted to improve by distraction and his pain was not proportional to his movement patterns.

Gait Mr. Doe‟s gait was observed. A limp was observed on the left side. The gait was consistent and found to be normal.

Palpation Thorough palpation of the lower extremities was performed on Mr. Doe with the following results:

Area Result Hip Anteriolateral left hip pain to palpation. Knee Pain to light palpation inferior and lateral aspects of left knee. Ankle Pain to light palpation lateral left ankle.



Assessment John Doe has significant hip range of motion and strength limitations. He also has significant bilateral (left > right) quad atrophy as evidenced by manual muscle testing and difficulty with active SLR against gravity.

Recommendations Establish a low extremity strengthening program as Mr. Doe has not had any formal physical therapy treatment and lacks a home exercise program.


MUSCULOSKELETAL EVALUATION – CERVICAL SPINE

A musculoskeletal evaluation was performed on Mr. Doe prior to any functional testing. The client‟s pre-test pain level was 0/10. The evaluation was performed on cervical spine and the results are as follows:

Posture Mr. Doe‟s posture was observed: Cervical Lordosis: Decrease Thoracic Kyphosis: Normal Scoliosis: Normal Scapulae: Downwardly rotated left

Resisted Movement

Movement Strength Pain Comments Flexion /5 /10 Resisted cervical motion not assessed Extension /5 /10 Side Flexion Right /5 /10 Side Flexion Left /5 /10 Rotation Right /5 /10 Rotation Left /5 /10

Special Tests

Test

Result Comments Right Left

Tinel (Elbow) Positive Negative This suggests that Cubital Tunnel Compression is present.

Neurology

Test


Sensation All Dermatomes Normal

All Dermatomes Normal

Sensation was tested by neither pin prick nor light touch.

Power All Myotomes Normal All Myotomes Normal Reflexes-Biceps (C5) -na- -na- Reflexes-Brachioradialis (C6)

-na- -na-

Reflexes-Triceps (C7) -na- -na- Babinski Negative Negative Clonus Negative Negative


Other Tests

Test Comments Right Shoulder Normal A capsular pattern does not exist which suggests that internal derangement, such

as arthritis, is not present. Right ACJ Normal Right SCJ Normal Right Elbow Ulnar neuritis Right Wrist Normal Left Shoulder S/p left scapula fracture A capsular pattern does not exist which suggests that internal

derangement, such as arthritis, is not present. Left ACJ Normal Left SCJ Normal Left Elbow Normal Left Wrist Normal Lumbar Spine Degenerative changes

Palpation Thorough palpation of soft tissues and joint structures was performed on Mr. Doe with the following results:

Area Result Superficial -na- Spinal (PAIVM) -na- Muscular WNL Other -na- Sweating None Temperature Normal


Assessment Cervical motion and function WNL.

Recommendations -na-


MUSCULOSKELETAL EVALUATION – THORACIC SPINE

A musculoskeletal evaluation was performed on Mr. Doe prior to any functional testing. The client‟s pre-test pain level was 0/10. The evaluation was performed on the thoracic spine and the results are as follows:

Posture Mr. Doe‟s posture was observed: Kyphosis: Normal Scoliosis: None Weight Bearing: Right The client‟s body alignment was observed to be as follows: Iliac Crests: Yes Posterior Superior Iliac Spines:

Yes

Gluteal Folds: No Popliteal Creases: No

Gait Mr. Doe‟s gait was observed. A limp was observed on the left side. The gait was consistent and guarding was not observed. Left antalgic gait, toe out gait left > right, decreased loading at heelstrike.

Active Range of Motion

Movement Range Pain Deviation Comments Flexion 50º 0/10 None Extension 0º /10 Side Flexion Right 0º /10 Side Flexion Left 0º /10 Rotation Right 0º /10 Rotation Left 0º /10

Resisted Movement

Movement Strength Pain Comments Flexion /5 /10 Resisted thoracic motion not assessed. Extension /5 /10 Side Flexion Right /5 /10 Side Flexion Left /5 /10


Rotation Right /5 /10 Rotation Left /5 /10

Special Tests

Test Result Comments


Area Result Superficial WNL Muscular WNL Intervertebrae -na- Intercostal -na- Sweating None Temperature Normal


Assessment Decreased thoracic segmental motion/excursion with trunk forward flexion and side bending.

Recommendations Home program to address segmental thoracic motion.


MUSCULOSKELETAL EVALUATION – LUMBAR SPINE

A musculoskeletal evaluation was performed on Mr. Doe prior to any functional testing. The client‟s pre-test pain level was 4/10. The evaluation was performed on the lumbar spine and the results are as follows:

Posture Mr. Doe‟s posture was observed: Lumbar Lordosis: Decrease Thoracic Kyphosis: Increase Scoliosis: -na- Weight Bearing: Right The client‟s body alignment was observed to be as follows: Iliac Crests: Yes Posterior Superior Iliac Spines:

Yes

Gluteal Folds: No Popliteal Creases: No Reportedly seeing chiropractor for “malalignment” issues.

Gait Mr. Doe‟s gait was observed. A limp was observed on the left side. The gait was consistent and guarding was not observed.

Active Range of Motion

Movement Range Pain Deviation Comments Flexion 52º 2/10 None Extension 14º 2/10 None Side Flexion Right 22º 2/10 None Side Flexion Left 19º 2/10 None Rotation Right 24º 2/10 None Rotation Left 28º 2/10 None

Resisted Movement

Movement Strength Pain Comments Flexion /5 /10 Resisted lumbar motion not assessed. Extension /5 /10 Side Flexion Right /5 /10


Side Flexion Left /5 /10 Rotation Right /5 /10 Rotation Left /5 /10

Waddell Non-Organic Signs Waddell non-organic sign testing was revised in 1998 in Gordon Waddell‟s book “The Back Pain Revolution”. Waddell testing was completed to help better gauge the reliability of Mr. Doe‟s subjective reports. Revised 1998 testing produced a final group of seven behavioral signs. Positive signs are suggestive of non-organic presentation. Mr. Doe presented with 1 positive signs out of 7 signs. The results of the examination are as follows:

Test Results 1. Tenderness – Superficial Negative 2. Tenderness – Non-Anatomic Negative 3. Simulation – Axial Loading Negative 4. Simulation – Simulated Rotation Negative 5. Distraction – Straight Leg Raise Negative 6. Regional Weakness Positive 7. Sensory Disturbance Negative Total Score 1 of 7

Somatic Amplification Rating Scale (Korbon, et al., 1987) Mr. Doe was assessed using the protocol described by Korbon in “The Development of the Somatic Amplification Rating Scale for Low Back Pain” as published in Spine in 1987. The results of the examination are as follows:

Test and Rating Score I. Sensory A. No deficit or deficit well localized to dermatome. 0 I. Sensory B. Amount of body involved (Burn Chart): < 15% 0 II. Motor A. No deficit or deficit well localized to myotome. 0 II. Motor B. Amount of body involved (Burn Chart): < 15% 0 III.Tenderness A. No tenderness or tenderness localized to discrete anatomically sensible structure.

0

III.Tenderness B. Amount of body involved (Burn Chart): < 15%. 0 IV. Distraction Distraction - Straight Leg Raise (SLR), compare supine and seated SLR. Difference: 20° - 45°.

1

Total Score (of 21). The result is negative. 1 Somatic Amplification is not present.


Special Tests

Test Result Comments Straight Leg Raise Supine Back pain bilateral 45º right, 47º left. Straight Leg Raise Sitting Back pain bilateral 80º right, 85º left. The difference between the seated and sitting

straight leg raise of 35º on the right and 38º on the left indicates that abnormal illness behavior is present.

Hoover Test Negative This suggests that abnormal illness behavior is not present. Ankle Dorsi-Flexion Negative This suggests that abnormal illness behavior is not present. Femoral Nerve Stretch Negative

Neurological Examination

Test


Sensation All Dermatomes Normal

All Dermatomes Normal

Sensation was tested by neither pin prick nor light touch.

Power All Myotomes Normal All Myotomes Normal Reflexes-Patella (L3/4) -na- -na- Reflexes-Achilles (L5/S1) -na- -na- Babinski Negative Negative Clonus Negative Negative

Other Tests

Test Comments Right Hip Limited motion, weakness Right SIJ Normal Right Knee Normal Left Hip Limited motion, weakness; Mole in need of inspection by dermatologist Left SIJ Normal Left Knee S/p IM nail left tibia Thoracic Spine Decreased mobility Cervical Spine Normal


Area Result Superficial Mole left hip to be examined by dermatologist Spinal (PAIVM) -na- Muscular Paraspinal muscle guarding Other -na- Sweating None Temperature Normal



Assessment Lumbar core strength lacking. Muscle guarding and limited proximal lumbar mobility.

Recommendations Mr. Doe would benefit from the establishment of a core/lumbar strengthening exercise program as he has had no formal physcial therapy or instruction in an independent exercise program. I referred Mr. Doe to Partnership Health Service for examination of mole on left hip.


TIMER ANALYSIS

During the functional capacity evaluation, Mr. Doe‟s total sitting, standing, walking, and other position and combinations of positions time was recorded. His results from this continuous observation and recording is presented as follows:

Total Time (Hrs. and Min.) Longest Duration Kneeling 00:04 00:02 Lying 00:35 00:35 Mild Stooping 00:24 00:16 Sitting 02:17 00:45 Standing 02:52 01:30 Walking 01:18 00:46 Total Time for Evaluation 07:30 Preferred Position On Breaks Sitting, Standing


PHYSICAL EFFORT FINDINGS

Physical Effort testing is used to evaluate whether or not attained physical data truly represents a client‟s physical maximums. If a client does not partake in his testing day with full physical effort, an evaluator cannot be certain that observed performances truly represent maximal abilities.

Maximum Voluntary Effort (MVE) Testing Jamar Five-Position Grip Mr. Doe underwent a formal screening procedure to query maximum voluntary effort during testing. This test uses the Jamar Hand Dynamometer (serial number 11195923) to measure isometric force generated by the hand. The Jamar is used to present ten maximum gripping measurements, each repeated three times. Studies indicate that out of 10 coefficients of variation calculated, no more than two will exceed experimentally derived “cut-points” if the individual is demonstrating maximum voluntary effort. The results (in pounds) of Mr. Doe‟s Jamar testing is presented below:

Grip Span

Test 1 Test 2 Test 3 Comments Dom Non Dom Non Dom Non

1 1/4” 35 50 38 44 34 41 1 3/4” 57 55 44 43 41 47 2 1/4” 52 63 49 60 44 59 2 3/4” 45 60 50 57 37 48 3 1/4” 39 50 39 47 39 46

Grip Span

Coefficient of Variation Exceed Cut Point? Dom Non Dom Non

1 1/4” 4.77 8.31 No No 1 3/4” 14.67 10.32 Yes Yes 2 1/4” 6.83 2.8 No No 2 3/4” 12.17 9.27 Yes No 3 1/4” 0 3.57 No No

0

5

10

15

0

5

10

15

1 1/4 1 3/4 2 1/4 2 3/4 3 1/4

Grip Span (Inches)

C.V.

Cut Point

Un-Impaired Dominant Upper Extremity


0

5

10

15

20

0

5

10

15

20

1 1/4 1 3/4 2 1/4 2 3/4 3 1/4

Grip Span (Inches)

C.V.

Cut Point

Un-Impaired Non-Dominant Upper Extremity

Analysis of the client‟s scores demonstrates 3 coefficients of variation above the permissible cut-points. As a total of two scores are allowed above the cut-point, this is suggestive of less than full effort during testing. Grip Curve Analysis A second method of screening for the presence of maximal voluntary effort relates to the analysis of score distribution. If an evaluee is providing maximum effort on the Jamar, a bell curve pattern of score distribution is expected.

0

20

40

60

80

0

20

40

60

80

1 1/4 1 3/4 2 1/4 2 3/4 3 1/4

Grip Span (Inches)

Left

Right

Score Distribution

Such a bell curve pattern was observed in Mr. Doe‟s case for his right hand and was present for his left hand, suggestive of maximum voluntary effort on the right and of maximum voluntary effort on the left. Jamar serial number 11195923 was used for this portion of the test. A second method of using bell curve analysis to gauge a client's level of physical effort relates to analysis of standard deviation. Clinical studies indicate that if a person is partaking in testing with full physical effort, a specific pattern of score distribution is expected. Right Upper Extremity: Mr. Doe‟s right hand grip scores, produced a flat line variance (S.D. = 4.86). Clinical studies suggest this standard deviation to be indicative of low effort. Left Upper Extremity: Mr. Doe‟s left hand grip scores, produced a flat line variance (S.D. = 5.71). Clinical studies suggest this standard deviation to be indicative of low effort.


Jamar Rapid Exchange Grip Test (REG) The Rapid Exchange Grip test (REG) was used to further validate original maximum voluntary effort (static) test results. Studies indicate that if an evaluee is providing high effort, REG peaks usually fall short of maximum voluntary effort peaks, typically by about 15%. Based upon a 1995 study by Harold Stokes, a 12 pounds forgiveness window was provided. Research dictates that if a person is providing high effort, his REG scores will not exceed his MVE (static) scores by 12 pounds or more. Mr. Doe‟s results (in pounds) are presented below: MVE

Peak REG Peak

MVE vs REG Difference Pounds Percent

Dominant 52 62 +10 +19 Non-Dominant 63 70 +7 +11 Results of the REG testing identified high effort for Mr. Doe„s dominant hand and high effort for Mr. Doe‟s non-dominant hand. During the REG test, the client was noted to demonstrate no signs of physical discomfort. Mr. Doe was observed to demonstrate the following signs of competitive test performance: muscular recruitment and holding breath.

Competitive Test Performance© Matheson-trained functional capacity evaluators are trained to look for examples of competitive test performance (CTP) in persons who participate in tests which entail high levels of physical effort. Such examples may include (but are not exclusive to): starting tests prior to the uttered “START” command, continuing to work after the uttered “STOP” command, asking for extra practice time, asking to repeat a slow trial, postural accommodation to improve performance, etc. In Mr. Doe‟s case, such examples were sporadic throughout his testing day.

Physiological Analysis – Heart Rate Monitoring To further gauge Mr. Doe‟s overall level of physical effort, clinical heart rate analysis was used throughout his testing day. Matheson-trained functional capacity evaluators are trained to look for heart rate measures nearing or exceeding aerobic target levels in individuals providing high levels of effort on repetitive, large muscle group activity. Overall heart rate analysis suggest questionable effort on Mr. Doe„s behalf.


Clinical Consistency Matheson-trained functional capacity evaluators are trained to look for high levels of clinical consistency in clients who partake in testing which entails full physical effort. Persons providing full physical effort should remain consistent in functional presentation despite multi-hour tests under distraction-based clinical testing situations. During 7 hours and 30 minutes of constant distraction-based clinical testing, Mr. Doe‟s presented with multiple inconsistencies.

Summary of Physical Effort Findings Overall test findings, in combination with clinical observations, suggest the presence of variable levels of physical effort on Mr. Doe‟s behalf. In describing sub-maximal effort, this evaluator is by no means implying intent. Rather, it is simply stated that Mr. Doe can do more physically at times than was demonstrated during this testing day. Any final vocational or rehabilitation decisions for Mr. Doe should be made with this in mind.


RELIABILITY OF CLIENT REPORTS

Reliability of Client Report testing is comprised of a battery of tests designed to better assess the dependability and accuracy of the client‟s subjective reports of pain and/or disability. The battery includes tests which evaluate the presence or absence of non-organic findings (findings that have more to do with illness behavior than underlying physical disease) as well as tests which compare a client‟s subjective reports to what he is actually capable of doing through the use of distraction based testing and observations of ability/disability. Areas of testing, which fall under the Reliability of Client Reports umbrella, include: symptom magnification, inappropriate illness behavior, somatic amplification, and non-organic signs.

Waddell Non-Organic Signs Waddell non-organic sign testing was revised in 1998 in Gordon Waddell‟s book “The Back Pain Revolution”. Waddell testing was completed to help better gauge the reliability of Mr. Doe‟s subjective reports. Revised 1998 testing produced a final group of seven behavioral signs. Positive signs are suggestive of non-organic presentation, drawing question as to the reliability/accuracy of a client‟s subjective reports. Mr. Doe presented with 1 positive signs out of 7 signs.

Waddell Inappropriate Symptoms Questionnaire The Waddell Inappropriate Symptoms Questionnaire (Waddell) was used to further gauge the reliability of Mr. Doe‟s subjective reports of pain and limitation. Mr. Doe presented with 3 of 7 inappropriate (anatomically unreasonable) responses. This is suggestive of inappropriate illness behavior.

Somatic Amplification Rating Scale (Korbon) The Somatic Amplification Rating Scale was used to help better gauge the reliability of Mr. Doe‟s subjective reports of pain and limitation. Mr. Doe presented with 1 of 21 inappropriate (anatomically unreasonable) responses. This indicates the absence of somatic amplification.

Placebo Testing Various placebo pain tests were conducted to further evaluate the reliability of Mr. Doe‟s subjective (verbal) reports. He did not complain of inappropriate pain upon any placebo tests.


Pain Scales Various pain scales were implemented with Mr. Doe to evaluate both the consistency and reliability of his subjective (verbal) reports. Visual Analog Pain Scale ratings correlated well with Functional Pain Scale ratings. Subjective ratings of pain matched well with distraction-based clinical observations. Repetitive movement reports matched poorly with clinical observations.

Subjective Pain Levels Mr. Doe states that he is experiencing pain in the areas indicated in the following table (these are based on the 0-10+ Functional Pain Rating Scale where 0 represents no pain and 10+ represents emergency pain warranting immediate emergency department care or hospitalization):

Pre-Test Pain Post-Test Pain Next Day Pain (L) Lower Leg 4/10 2/10 3/10 (L) Knee 4/10 2/10 3/10 Low Back 4/10 2/10 3/10 (L) Scapula 0/10 0/10 0/10 Mr. Doe reported the following additional pain rating data:

Functional Pain Rating Present Rating 4/10 Best Rating Over Past 30 Days 2/10 Worst Rating Over Past 30 Days 6/10 The Visual Analog Pain Scale (Huskisson, 1973) was also used to evaluate the client‟s pain before and after the evaluation. The client‟s score at the beginning of the evaluation was 3 and the score at the end of the evaluation was 3. This indicates a difference of no points. These scores and their trend should be compared with the functional pain ratings recorded at the same time.

Pain Assessment/Questionnaires Mr. Doe completed a number of standard assessment questionnaires to assess the presence and impact of Chronic Pain Syndrome. These questionnaires have been published in peer-reviewed journals and are widely used in the industrial rehabilitation field.

Questionnaire/Assessment Score Interpretation Ransford Pain Drawing 3 Pts Poor psychodynamics McGill Pain Questionnaire 26 Pts Normal The Visual Analog Scale (Today) 3 cm The Pain Rating Scale 4 /10


Waddell's Inappropriate Symptoms Questionnaire 3 /7 Inappropriate illness behavior Beck Depression Inventory 21 Pts Moderate depression Oswestry Low Back Disability Questionnaire 44 % Severe disability Neck Disability Index 34 % Moderate disability Dallas Pain Questionnaire Factor I 72 % Dallas Pain Questionnaire Factor II 60 % Dallas Pain Questionnaire Factor III 55 % Dallas Pain Questionnaire Factor IV 40 %

Comments During the intake interview process, the client was noted to show the following sign of physical discomfort: shifting within chair. Severe to Moderate Disability subjectively reported via answers to the Oswestery Low Back Disability Questionnaire and the Neck Disability Index. Chronic pain symptoms in the form of Symptom Magnification may warrant a referral to a Chronic Pain Clinic.

PACT Spinal Function Sort The PACT Spinal Function Sort is used to quantify an individual‟s perception of his ability to perform work tasks. The responses on this instrument can be used to test reliability. Mr. Doe‟s ratings on the Spinal Function Sort were as follows: Rating of Perceived Capacity (RPC) 151 Perceived DOL Rating Light Norm vs. Healthy Employed At the 20th percentile, rated below average. Norm vs. Injured Unemployed At the 80th percentile, rated above average. Results of reliability check testing indicated a reliable profile. The client perceives himself as meeting the physical requirements for light strength work, according to Department of Labor standards. Subsequent clinical testing indicated that Mr. Doe‟s subjective reports matched well with distraction-based objective findings. The client was noted to show the following signs of physical discomfort during the administration of the Spinal Function Sort: shifting within chair and brief rise (< 1 minute). The Spinal Function Sort was terminated as it was successfully completed.


EPIC Hand Function Sort The EPIC Hand Function Sort is used to quantify an individual‟s perception of his ability to perform work tasks. The responses on this instrument can be used to test reliability. Results of reliability check testing indicated a marginally reliable profile. The client perceives himself as meeting the physical requirements for light-strength work, according to Department of Labor standards.

Rating of Perceived Capacity (RPC Total) 163 Perceived DOT Rating (Overall) Light Sedentary Incremental Rating of Perceived Capacity (RPC-I) Meets required RPC Light Incremental Rating of Perceived Capacity (RPC-I) Meets required RPC Medium Incremental Rating of Perceived Capacity (RPC-I) Does not meet required RPC Heavy Incremental Rating of Perceived Capacity (RPC-I) Does not meet required RPC Norm. vs. Healthy Employed 20 Norm. vs. Injured Unemployed 45

The client was noted to show the following signs of physical discomfort during the administration of the Hand Function Sort: shifting within chair and brief rise (< 1 minute). The Hand Function Sort was terminated as it was successfully completed.

Comments Sort Testing is used to determine a Rating of Perceived Capacity (RPC). A percentile ranking is given and the reliability of the scores based on question type and respones is given. John Doe‟s Spinal Function Sort RPC was that of LIGHT in occupational ability with RELIABLE scores. He scored 20% (Below Average) when comparing the Norm to Healthy Employed workers, and 80% (Above Average) when comparing the Norm to Injured Unemployed workers. John Doe‟s Hand Function Sort RPC was that of LIGHT in occupational ability as well, but with MARGINALLY RELIABLE scores. He scored 20% when comparing the Norm to Healthy workers, and 45% when comparing the Norm to Injured workers.

Summary of Reliability of Client Reports Overall test findings, in combination with clinical observations, suggest some minor inconsistency to the reliability/accuracy of Mr. Doe‟s subjective reports of pain/limitation. Overall inconsistencies were considered minor, with his subjective reports generally matching well with distraction-based clinical observations.


In describing such findings, this evaluator is by no means implying intent. Rather, it is simply stated that Mr. Doe may be able to do more at times than he currently states or perceives. While his subjective reports should not be disregarded, they should be considered within the context of such RCR findings.


SUMMARY OF FINDINGS

1. Did John Doe provide evidence of consistently full effort during two days of FCE testing? 2. What are John Doe‟s present functional physical abilities related to occupational demands? 3. What are John Doe‟s present functional physical limitations related to occupational demands? 4. What category of job (based on occupational requirements of tolerance and frequency) is John Doe presently capable of performing? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1. John Doe demonstrated signs of variable effort during two-day FCE testing as evidenced by his JAMAR scores (MVE vs REG), Spinal Function Sort vs Hand Function Sort scores, Valpar 9 (Dexterity) scores vs Valpar 202 (Small Tool Handling) scores, and sporatic Competetive Test Performance. 2. John Doe‟s present functional physical abilities include: Good tolerance to low level (eyes open) balance, dynamic standing up to 90 minutes, above-shoulder work; Fair tolerance to crouching, squatting, stair ascending/descending, ladder ascending/descending (with <10 lbs.), sitting up to 45 minutes duration; Fair tolerance to LIGHT lifting floor< >waist 35 lbs, 12”< >waist 39 lbs, waist< >shoulder 22 lbs, shoulder< >overhead 17 lbs, carrying 20 lbs. for 30 feet, pushing-pulling 95 lbs. with Hand Truck. 3. John Doe‟s present functional physical limitations include: Poor tolerance to kneeling, crawling, trunk forward flexion, trunk side flexion, bending/stooping, spinal twisting/rotation, sustained low-level work, and lifting/carrying/pushing-pulling beyond above stated tolerance, walking greater than 300 feet, and upper level (eyes closed) balance. 4. John Doe is presently capable of performing the occupational demands of a SEDENTARY TO LIGHT job depending on the possible job modifications (mobility limitations). The job example of Utility Reader (electric) has been used for comparison in the PHYSICAL ABILIITES AND JOB MATCH portion of the FCE Summary.


RECOMMENDATIONS

1. John Doe is should pursue an occupation rated as Sedentary to Light in physical demand with his present mobility restrictions in mind. 2. Because he has not had any physical therapy treatment following his 2007 MVA, John Doe would benefit form a home exercise program to address his gross lower extremtiy and trunk weakness. Periodic follow-up with the physcial therapist prescribing the home program is appropriate. 3. Due to the extensive and chronic nature of Mr. Doe‟s left scapula, left lower leg, left knee, left ankle, left second digit PIP joint pain, right ulnar neuritis symptoms, and Pain Questionnaire responses, he would benefit from a chronic pain consultation


NEXT DAY FOLLOW-UP

Mr. Doe states that he is experiencing pain in the areas indicated in the following table (these are based on the 0-10+ Functional Pain Rating scale where 0 represents no pain and 10+ represents emergency pain warranting immediate emergency department care or hospitalization):

Pre-Test Pain Post-Test Pain Next Day Pain (L) Lower Leg 4/10 2/10 3/10 (L) Knee 4/10 2/10 3/10 Low Back 4/10 2/10 3/10 (L) Scapula 0/10 0/10 0/10 John Doe called the day following FCE testing to report that he was “sore” but not as sore as he had anticipated. He described his pain as a 3 on a functional pain scale in his left lower leg, left knee, and low back regions.


--- End Of Functional Capacity Evaluation Report for Mr. John Doe ---

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