...Christopher R. Brigham, MD; William T. Grant, MD; Waqas Ahmad, MBBS, MHA, BSc Jurisdictions use impairment ratings differently, and physicians must understand the specific requirements in each jurisdiction. This article discusses a case of severe spinal cord injury for a jurisdiction that only...

...Richard T. Katz, MD This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury...

...Christopher R. Brigham, MD Spinal cord injuries can affect many functions, interfere with the activities of daily living, and result in significant impairment. This article reviews cauda equina and conus medullaris syndromes, examines the process of rating corticospinal tract damage, and provides...

... a spinal cord injury to demonstrate how an LCP can be constructed. © 2016 American Medical Association. All Rights Reserved. 2016 American Medical Association Physicians interested in medical–legal consultation are often asked to perform independent, comprehensive medical examinations...

... on the patient's age and specific conditions. For example, excellent data are available regarding life expectancy for individuals with spinal cord injury (SCI) and are sorted in various ways, eg conditional life expectancy calculated for persons who have survived the first year after an SCI. Major depressive...

... in outcomes. The term differentiator was abandoned and replaced with clinical findings . Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition. © 2001 American Medical Association. All Rights...

... significant spinal cord injury. The final differentiator is bladder studies, measured using a cystometrogram and showing unequivocal neurologic compromise of the bladder with resulting incontinence. © 1999 American Medical Association. All Rights Reserved. 1999 American Medical Association...

...Lorne K. Direnfeld, MD, FRCP(C) Lower urinary tract dysfunction may result from a variety of neurologic disorders, including traumatic spinal cord injury, head injury, a cauda equina syndrome, or trauma to the peripheral lumbosacral nerves. Urinary incontinence can be divided into five categories...

... need some assistance in understanding how to rate a spinal cord injury. My patient is a 34-year-old former professional hang glider. When coming in for a landing in a national competition, he misjudged his height, struck the top of a tree, and fell to the ground. He experienced the immediate onset...

... the interpretation of these tests must be correlated with a detailed neurologic evaluation. The primary application of this chapter in previous Editions has been for the rating of traumatic brain injuries and spinal cord injuries. This Edition comments that “in contrast to previously held belief, the symptoms...

...Marjorie Eskay-Auerbach, MD, JD; Charles N. Brooks, MD Myelopathy literally indicates any pathology of the spinal cord, but the term most commonly is used when the cord pathology results from degenerative disease. Specific names usually are used if the disorder is traumatic (spinal cord injury...

... with spinal stenosis. CES is rated a bit differently from spinal cord injury due to cervical or thoracic pathology. In spinal cord pathology, probably implied from the Spine chapter is the Guides , Fifth Edition concept of rating both the lower motor neuron (nerve root) injury and the upper motor neuron...

..., suggests significant spinal cord injury. Bladder studies . The last differentiator listed is a cystometrogram showing “…unequivocal neurologic compromise of the bladder with resulting incontinence.” (4th ed., 109) However, some patients with no cord pathology evident on imaging studies do have abnormal...

...Steven Mandel, MD; Christopher R. Brigham, MD © 2000 American Medical Association. All Rights Reserved. 2000 American Medical Association Lower urinary tract dysfunction may result from a variety of neurologic disorders, including traumatic spinal cord injury, head injury, a cauda...

... to spastic paraplegia, and injuries to the lumbar spine can result in varying degrees of flaccid lower extremity paralysis. These clinical findings are dictated by neuroanatomical considerations. The corticospinal tract and its related motor pathways synapse in the spinal cord, prior to exiting the cord...

... is unreliable. 1 Therefore, the individual's statements or the physician's opinions of reduction in pre-injury capacity are speculative. Katz 2 showed that the typical patient with paraplegia from a thoracic spinal cord injury rates at 58%-60% whole person impairment for the multiple consequences...

...James B. Talmage, MD; Jay Blaisdell Injuries that affect the central nervous system (CNS) can be catastrophic because they involve the brain or spinal cord, and determining the underlying clinical cause of impairment is essential in using the AMA Guides to the Evaluation of Permanent Impairment...

.... Table 13-6, Criteria for Rating Impairment due to Sleep and Arousal Disorders on page 329, lists reduced daytime alertness with “cannot drive” as criteria for Class 2 impairment, which is a 6%-10% WPI. Impairments associated with C4 complete spinal cord injury typically include all...

... to reach MMI, often about a year, with a range of six months to two years. Serious head, spinal cord, and other catastrophic injuries commonly take two or more years to reach MMI. These more severe injuries and illnesses understandably are more likely to result in permanent impairment. However, various...

... of sensory function following nerve injury but rather is a complex interaction between nerve recovery and modulation of central nervous system function in spinal cord, subcortical, and cortical structures. The authors ask if the value of 2PD in the clinical assessment of impairment has been overrated within...