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Abnormal illness behavior

Exaggeration or fabrication of symptoms and/or physical findings to psychological, social, financial, or other reasons. Abnormal pain behavior is more specific, meaning there are verbal and/or physical manifestations of discomfort in excess of, or unsupported by, physical injury or illness.


Any modification of the work-place or a specific job that allows a person with a disability to perform essential functions of a job and or able to be gainfully employed.


The quality of being correct or near to the truth, especially the degree to whi ch a measurement, calculation, or estimate conforms to the true value. Examples include, the patient presented an accurate history; when lower limb length is measured, radiographic measurements are more accurate than measurements with a tape measure; magnetic resonance imaging supported an accurate diagnosis.


Denoting an abnormality, disease, or predisposition that developed after birth. Not hereditary or congenital.


The execution of a task or action by an individual. (This term along with “activity limitations” replaces “disability” according to ICF)

Activities of Daily Living (ADLs)

Basic self-care activities performed in one's personal sphere (eg, feeding, bathing, hygiene, dressing). Instrumental Activities of Daily Living (IADLs) are complex self-care activities that may be delegated to others (eg, financial management, medications, meal preparation). ADLs do not include highly individualized work duties.


Permanent worsening of a pre-existing condition. A physical, chemical, biological, or other factor results in an increase in symptoms, signs, and/or impairment that never returns to baseline, or what it would have been except for the aggravation (the level pre-determined by the natural history of the antecedent injury or illness).


Pain in response to a normally nonpainful stimulus (eg, light touch).


Movement of one's body from one point in space to another (eg, walking, stair climbing, wheelchair locomotion).

Americans with Disabilities Act (ADA)

A civil rights law, signed in 1990, that protects individuals with disabilities against discrimination in such diverse areas as employment (hiring, firing, advancement, compensation, job training, etc), government service entitlement, and access to transportation, communications, public accommodations, and businesses.


Immobilization of a joint in a specific position due to disease, injury, or surgery. When surgically created, the goal is to fuse the joint in the most functional position.


The extent to which each of 2 or more probable causes are found responsible for an effect (injury, disease, impairment, etc). Only probable causes (at least more probable than not) are included. Hence, the first step in apportionment is scientifically based causation analysis. Second, one must allocate responsibility among the probable causes and select apportionment percentages consistent with the medical literature and facts of the case in question. Arbitary, merely opinion based unscientific apportionment estimates which are nothing more than speculations must be avoided. When appropriate current impairment can also be apportioned to more than one cause.

p. 651 Arm

That portion of the upper extremity between the shoulder and elbow joints.

Assistive device

Any item made or adapted to help a person with a functional loss perform a particular task. Examples include magnifying glasses, hearing aids, telephone amplifiers, reachers, shower chairs, walking aids (canes, crutches, walkers), and wheelchairs.


The absence of vision; also called no light perception (NLP).

Body Mass Index (BMI)

A measure comparing body weight to height used to determine if a person's weight is too low, normal, or too high. The BMI is calculated by dividing the individual's weight in kilograms by his or her height in meters squared (kg/m2). Using English weights and measures, the formula is weight in pounds multiplied by 705 divided by height in inches squared (lb × 705/in2). According to the National Institutes of Health, a BMI below 18.5 is underweight; 18.5 to 24.9, normal; 25 to 29.9, overweight; 30 to 39.9, obese; and 40 or higher, morbidly obese. BMI differs from percent body fat or lean mass calculations because it considers only weight and height.

Burden of Treatment Compliance (BOTC)

The impairment (impact on ADLs) that results from adhering to a complex evaluation and treatment regimen including diagnostic testing, prescription (not over-the-counter) medications, therapy, and/or procedures, to achieve objectively measurable clinical improvement that would not occur, or could be reversed, without compliance.


See complex regional pain syndrome.


In general, anything that produces an effect. In medicine, cause refers to an identifiable factor (eg, genetic abnormality, toxic or infectious exposure, trauma) that results in injury or illness. The cause or causes must be scientifically probable following causation analysis.

Chronic pain

Pain that extends beyond the expected healing period of the injury or illness that initiated it, or is caused by a progressive incurable disease such as arthritis or cancer, and has outlived its usefulness as a warning. Chronic pain is sometimes defined as pain lasting more than 3 months for nociceptive pain, as most conditions affecting the musculoskeletal and other organ systems will heal by this time. However, the nervous system is an exception.

Combined Values Chart

A method used to combine 2 or more impairment percentages, derived from the formula A + B (1 − A) = Combined Values of A and B. Combining, as opposed to adding, ensures that the total value will not exceed 100% whole person impairment and takes into account the impact of impairment from one body part on impairment of another body part.

Complex regional pain syndrome (CRPS)

An uncommon, chronic condition characterized by burning pain that usually involves an upper or lower extremity, and rarely other body parts. Physical findings include hypersensitivity to touch plus vasomotor, sudomotor, and later trophic changes. Two types have been described: CRPS I, formerly known as reflex sympathetic dystrophy, and CRPS II, formerly known as causalgia. CRPS II follows an injury to or other lesion of a peripheral nerve, while CRPS I may complicate an injury or illness, or occur spontaneously.


Existing at birth; referring to conditions, traits, defects, etc. which are hereditary or acquired during development in utero.


Referring to something, commonly an occupational activity, that occurs 67% to 100% of the time or workday.


Chronic and sometimes permanent shortening of soft tissues such as muscle, tendon, ligament, joint capsule, and/or skin. The contracture often results in loss of joint motion or in deformity.

Contrast sensitivity

The ability to perceive larger objects with low contrast, important for tasks such as facial recognition.


Complete recovery from a disease or condition.


Failure of the body's ability to compensate for a disease, causing a previously stable state to become unstable, with onset or worsening of symptoms (eg, decompensated cirrhosis or heart or lung disease). In psychiatry, it refers to deterioration of or inability to maintain defense mechanisms in response to stress, leading to pathological behavior or worsening thereof.

Desirable weight

A range of weight determined to be healthful, and depending on an individual's sex, age, height, and habitus (physique or body build). Body mass index is currently the most widely used measure of desirable weight.

p. 652 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)

A book published by the American Psychiatric Association in 2013, that lists and describes the criteria necessary to make psychiatric diagnoses.


An umbrella term for activity limitations and/or participation restrictions in an individual with a health condition, disorder or disease.


Abnormal appearance of a body part, including alteration in color, shape, and/or texture, especially scarring of the skin in commonly exposed areas such as head, face, neck, or hands. It may be congenital or caused by injury or disease; it is generally permanent. Disfigurement may cause social rejection, diminished self-image, alteration of lifestyle, and other adverse mental and behavioral effects.


A sensation of unsteadiness, imbalance, lightheadedness, and/or movement, typically spinning or falling.

Dominant extremity

The limb, usually upper (more commonly right than left) having more dexterity with motor skills and hence more effective and preferentially used for single limb activities. See Handedness.


Distortion of a sense, especially touch, such that an unpleasant sensation (eg, burning or itching) is produced by ordinary stimuli (evoked) or occurs in the absence of stimulation (spontaneous).


Temporary worsening of a pre-existing condition. Following a transient increase in symptoms, signs, disability, and/or impairment, the person recovers to his or her baseline status, or what it would have been had the exacerbation never occurred. Given a condition whose natural history is one of progressive worsening, following a prolonged but still temporary worsening, return to pre-exacerbation status would not be expected, despite the absence of permanent residuals from the new cause.


Proximity to and/or contact with a potential disease-producing agent (eg, chemical, ionizing radiation, or microorganism) or mechanical forces (eg, prolonged vibration or repetitive tensile, compressive, or shear stresses).

False negative, False positive

See Negative, Positive, respectively.


That portion of the upper extremity between the elbow and wrist joints.


Referring to something, commonly an occupational activity, that occurs 34% to 66% of the time or workday.

Functional limitation

Restriction in or lack of ability to perform a task due to an impairment. In some instances, functional limitations may be overcome through personal or environmental accommodations.


Any behavior that diminishes or prevents pain. Guarding may include voluntarily limiting joint motion, muscle contraction to splint or protect an injured or ill part such as abdominal guarding in appendicitis, avoidance of contraction of an injured muscle, flinching or withdrawal upon palpation of a tender area, maintaining a limb in a protected posture such as holding the anterior forearm across the abdomen following shoulder injury, a limp (antalgic gait), or applying a brace or splint to the involved body part.


The unequal distribution of fine motor skills between left and right hands and digits, prompting the individual to preferentially use and generally acquire greater strength and dexterity on the dominant side. Almost 90% of persons are right handed, and about 10% are left handed. The 1% or so of persons who are equally skilled with both hands are labeled ambidextrous. See Dominant extremity.


Protrusion of an organ or tissue through the wall of the cavity in which it is normally contained, or through a natural or surgically created opening where it normally would not go, due to a pressure gradient.

Human immunodeficiency virus (HIV)

Any of a group of retroviruses, and especially HIV-1, that infect and destroy helper T cells of the immune system, causing a marked reduction in their numbers. It is one of the diagnostic criteria of AIDS and is also called the AIDS virus.


An exaggerated pain response to a noxious stimulus.


Increased sensitivity to pain, touch, or other sensory stimuli. Allodynia, hyperalgesia, and hyperpathia (see entries for those terms) are types of hyperesthesia.


An exaggerated subjective reaction to a painful stimulus.

Hypesthesia (Hypoesthesia)

Decreased sensitivity to pain, touch, or other sensory stimuli.


A significant deviation, loss, or loss of use of any body structure or function in an individual with a health condition, disorder, or disease.

Impairment evaluation

Acquisition, recording, assessment, and reporting of medical evidence, using a standard method such as described in the p. 653 Guides, to determine permanent impairment associated with a physical or mental condition.

Impairment rating

Consensus-derived percentage estimate of loss of activity, which reflects severity of impairment for a given health condition, and the degree of associated limitations in term of Activities of Daily Living (ADLs).

Independent medical examination (IME)

A usually one-time evaluation performed by an independent medical examiner who is not treating the patient or claimant, to answer questions posed by the party requesting the IME.


Derived by genetic transmission from a parent or ancestor.


A sudden traumatic event producing immediate or prompt symptoms and/or signs due to physical and/or psychological pathology.

Instrumental Activities of Daily Living

See Activities of Daily Living.


Marked by intervals during which the symptoms and signs of an injury or illness, or manifestations of another process or state, are absent; repeatedly starting and stopping; not continuous.


That portion of the lower extremity between the knee and ankle joints.

Maximum Medical Improvement (MMI)

The point at which a condition has stabilized and is unlikely to change (improve or worsen) substantially in the next year, with or without treatment. While symptoms and signs of the condition may wax and wane over time, further overall recovery or deterioration is not anticipated. However, both the name given to and exact definition of this status vary depending on the jurisdiction. Among the numerous synonyms for MMI are (in alphabetical order): ascertainable loss, end of healing, fixed and stable, maximum cure, maximum degree of medical improvement, maximum medical healing, maximum medical recovery, maximum medical rehabilitation, maximum medical stability, medical end result, medical stability, medical stabilization, medically stable, medically stationary, permanent and stationary, and stable and ratable.


See metabolic equivalent.

Metabolic equivalent (MET)

The unit used to measure the intensity of physical activity, and express the results of stress testing. One MET equals 3.5 mL of oxygen consumed per kilogram of body weight per minute, the amount normally used by the body at rest (eg, sitting quietly). Activity involving less than 3 METs is considered light; 3 to 6 METs, moderate; and over 6 METs, vigorous. Walking and jogging are examples of moderate and vigorous activity, respectively. Oxygen consumption during intensive exercise may increase to 12 or more METs.


Of low severity, force, degree, or effect (eg, a mild fever, collision, burn, or analgesic, respectively).


Of medium or average severity, force, degree, or effect; not excessive or extreme.


A desire, goal, intention, and/or need that causes a person to act or behave in a certain manner.


Indicating the absence of a condition, pathogen, or response (eg, a negative pregnancy test, streptococcal throat culture, or Trendelenberg's sign, respectively). False negative is when the test result is negative but the condition is actually present. True negative is when the test result is negative and the condition is actually absent.

Neuropathic pain

Pain due to abnormal function of the peripheral and/or central nervous system resulting from disease, injury, sensitization, or other changes. Although neuropathic pain is perceived as orginating in a body part, the responsible pathology lies in the nervous system, such as pain felt in the posterior thigh and leg due to compression of a lumbar nerve root (sciatica).


The neurophysiologic process whereby noxious chemical, mechanical, or thermal stimuli are transduced by sensory receptors into electrical signals (action potentials), transmitted along afferent neurons through peripheral nerves to the spinal cord and brain, modulated along the way, and ultimately perceived as pain. Nociceptive pain resolves once the noxious stimulus is removed and tissue has healed.


A range that represents healthy functioning and varies with age, sex/gender, environmental conditions, and other factors.


In healthcare, objective refers to something, usually a physical finding or diagnostic test result, that can be perceived by an examiner using one or more senses without patient input. For example, one might see a scar, hear a heart murmur, smell alcohol on a patient's breath, feel a subcutaneous mass, or read an X ray or lab report. Objective data can often be measured. In general usage as an adjective, objective means based on observation or other data, and uninfluenced by one's attitudes, beliefs, biases, emotions, and/or prejudices (eg, an objective medical opinion or judicial decision). Compare with Subjective.

p. 654 Occasional

Referring to something, commonly an occupational activity, that occurs 10% to 33% of the time or workday.

Occupational history

Acquisition, organization, and assessment of information about an individual's prior and current work, including activities and exposures, duration thereof, and their possible relationship to illness and injury. An occupational history can provide information important in causation analysis and apportionment, specifically whether work caused or contributed to the condition or conditions, and it that may assist in treatment and/or prevention or minimization of further illness or injury.


An externally applied device, such as a brace or splint, used to stabilize and/or support a body part, most commonly a portion of the spine or upper or lower limb, to facilitate healing, align it and prevent or correct deformity, assist motion of an adjacent joint or joints, unload body weight, and/or otherwise improve function.


According to the International Association for the Study of Pain, an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

Pain behavior

Verbal and/or nonverbal manifestations of discomfort, and perhaps distress and suffering. The behavior or behaviors may be audible complaints—actions such as a grimace or other facial expression, abnormal posture, guarding or rubbing a body part, a limp, or use of a walking aid, brace, or other device—or inaction such as activity avoidance, even bedrest. Pain behaviors reflect the way persons think, feel, and act in response to their discomfort, and the way they communicate the symptom to others. The behaviors may be adaptive (eg, when diminished stress on an injured part is necessary for healing) or pathological (when disproportionate to physical pathology).

Pain disorder

A type of somatoform disorder in which pain is the predominant focus of clinical attention; and psychological factors are judged to have an important role in the onset, severity, exacerbation, and maintenance of the pain.


An abnormal sensation, most commonly tingling or pricking (“pins and needles”), but sometimes burning, tickling, or creeping on the skin, usually associated with injury or irritation of a sensory nerve or nerve root.


Involvement in a life situation (This term along with “participation restrictions” replaces “handicap” according to ICF)


Synonymous with maximum medical improvement.

Permanent impairment

An impairment extant at the point of maximum medical improvement.


Doctor of Medicine, Doctor of Osteopathic Medicine, or a recognized equivalent physician degree eligible for an Accreditation Council for Graduate Medical Education (ACGME) residency.


Indicating the presence of a condition, pathogen, or response (eg, a positive pregnancy test, blood culture, or Tinel's sign, respectively). False positive is when the test result is positive and the condition is actually absent. True positive is when the test result is positive and the condition is actually present.


In general, precision refers to the quality of being sharply defined, stated, estimated, or measured. In statistics, it means the inverse of the variance of an estimate or measurement. As used in the AMA Guides, precision means the smallest unit of change a measuring instrument can distinguish, or the number of digits used to express the measurement. For example, the more precise computerized inclinometer showed that shoulder flexion was 91.5 degrees, whereas the same motion was read as 90 degrees on a goniometer.


An artificial device to replace a missing body part.


Inflammation of a nerve root. As commonly used, radiculitis implies symptoms such as pain, numbness, tingling, and/or weakness in the distribution of a nerve root; but without physical findings of radiculopathy.


Any pathological condition of a spinal nerve root, most commonly compression with or without inflammation, or less frequently another disorder such as traction, tumor, or infection. Radicular symptoms may include pain, numbness, tingling, and/or weakness in distribution of the nerve root, usually involving an upper or lower extremity. Physical findings are weakness of the involved myotome (muscles innervated by the nerve root), diminution in or loss of the corresponding muscle stretch reflex (if any), diminished sensation in the appropriate dermatome (area of skin supplied by the nerve root), and/or positive root tension signs. As commonly used, and for purposes of the AMA Guides, radiculopathy requires the presence of radicular physical findings, not just symptoms.

p. 655 Raynaud's phenomenon

A vascular disorder marked by recurrent, temporary spasm of cutaneous arterioles, especially those of the fingers and toes, most commonly upon exposure to cold, and generally characterized by pallor, cyanosis, and rubor (white, blue, and red discoloration) in succession. The digits often feel cold and numb during the initial ischemic phase (when blood supply is diminished), then tingle and/or throb for a time after resolution of the vasospasm and restoration of normal blood flow.


Reappearance of the symptoms and/or signs of a disease after a remission (period during which the manifestations were absent or significantly diminished).

Reflex sympathetic dystrophy (RSD)

See Complex regional pain syndrome.


Synonymous with recurrence.


The extent to which a test or measurement yields consistent results when repeated. Synonymous with reproducibility.


A decrease in or disappearance of the symptoms and/or signs of a disease (partial and complete remission, respectively).

Replacement medication or therapy

Treatment that involves the supply of something (an element, compound, or hormone) lacking in the body. Although the person may be fully functional while taking replacement medication, he or she may be unable to adequately respond to stresses such as trauma or infection.


Synonymous with reliability.


Pain along the course of the sciatic nerve and its branches, usually caused by lumbar nerve root impingement and/or inflammation, or less commonly compression of the lumbar plexus or sciatic nerve. The pain usually radiates distally from the low back through the buttock into the posterior thigh, then anterior, lateral, or posterior leg. However, the distribution may be as narrow as the posterior thigh.


Referring to something, commonly an occupational activity, that occurs less than 1% of the time of workday.


The state or quality of being sensitive to light, sound, touch, temperature changes, chemicals, and/or other stimuli. In statistics, the ability of a diagnostic test to detect a condition when present. It is a proportion or percentage obtained by the number of true-positive test results divided by the sum of true positives and false negatives. A test with 90% sensitivity will identify 9 of 10 persons having the condition. See Specificity and Predictive value.

Sensitization (pain)

Increased perception of chemical, mechanical, and thermal stimuli, due to nociception-induced changes in the peripheral and/or central nervous system, with resultant hyperalgesia and/or allodynia. It may be localized (eg, involve only the low back) or generalized, with most or all of the body affected. In immunology, it refers to abnormally increased response to a chemical, biological or physical agent such as air sensitization to chemicals leading to airway hyper-responsiveness causing an asthmatic response.


Having high severity, force, degree, or effect; very bad, extreme.

Social functioning

An individual's ability to interact appropriately, negotiate and compromise, and communicate effectively with other persons.


A tendency to experience and report somatic complaints (physical symptoms) in response to psychosocial stressors and seek health care services for them.


The ability of a diagnostic test to correctly identify those individuals without a condition when it is not present. It is a proportion or percentage obtained by the number of true-negative test results divided by the sum of true negatives and false positives. A test with 90% specificity will incorrectly identify 1 of 10 healthy persons as having the condition. See Sensitivity and Predictive value.


Measurement by means of a spirometer of the forced vital capacity and its subdivisions, as well as measurement of the speed of airflow achieved in performance of this maneuver. Spirometry is also known as ventilatory studies.

Spontaneous pain

Discomfort that occurs without sensory stimulus.

Stress testing

An electrocardiographic test of heart function before, during, and after a controlled period of increasingly strenuous exercise (as on a treadmill).


In health care, refers to that which is perceived, reported, and/or demonstrated by a patient but cannot be verified by an examiner on physical examination or via diagnostic tests. The adjective is most commonly used in the context of symptoms such as pain, but many physical findings are also subjective, including tenderness, range of motion, and strength. Tenderness or the absence thereof p. 656 depends on verbal or nonverbal input from the patient,. Subjective complaints such as pain may be quantified, for instance, on a 0 to 10 scale, but are not measured. In general usage, subjective means colored by one's attitudes, beliefs, biases, emotions, and/or prejudices. Subjectivity may influence medical, judicial, and other opinions. Compare with Objective.


Production of pain by palpation.


That portion of the lower extremity between the hip and knee joints.


Noises (ringing, whistling, roaring, booming, etc) in the ears, generally in the absence of corresponding external sounds. Tinnitus may be audible (objective) or inaudible (subjective). Audible tinnitus is usually associated with a muscular tic or vascular bruit. The more common inaudible tinnitus can be heard only by the person affected and may be associated with an obstruction of the external auditory canal or a disturbance of the auditory nerve and/or the central nervous system.


Movement of one's body position while remaining at the same point in space (eg, supine to side lying, supine to sit, or sit to stand).

True negative, True positive

See Negative, Positive, respectively.


The extent to which an instrument or test actually measures what it is intended to measure.


A false sensation of motion, especially spinning or whirling, either the external world revolving around the individual or the person revolving in space; or an exaggerated sense of motion in response to body movement.

Vision, low

Visual acuity less than 20/63 (20/60 if rounded) down to 20/1000.

Visual acuity

The ability to recognize small objects with high contrast, such as letters on a page, important for reading.

Visual Acuity Score (VAS), Visual Field Score (VFS)

Scales used to assign a numeric value to visual acuity and visual field measurements for each eye. Higher values indicate better vision.

Visual field

The ability to detect objects in the periphery of one's visual environment, important for orientation and mobility.

Visual impairment rating

A rating calculated as 100 − FVS. Higher values indicate poorer vision.

Whole person impairment

Percentages that estimate the impact of the impairment on the individual's overall ability to perform Activities of Daily Living, excluding work.

Workers' compensation

A statutorily mandated insurance program in North America mainly by various state jurisdictions and in some cases by federal statutes to provide medical and indemnity benefits to workers for injuries and illnesses arising out of and in the course and scope of employment. Similar statutes are also enacted by other parts of the industrialized world. Generally, workers' compensation statutes are “no fault,” obviating the need for an employee to prove negligence on the part of the employer or a coworker, but specify that the benefits provided are usually the “sole remedy” for the injury or illness. The exact provisions of a workers' compensation statute regarding eligibility, benefits, and obligations vary with each jurisdiction. p. 657 Page intentionally left blank. p. 658