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Stephen L. Demeter

functional capacity assessment. They allow us to assess both the basal function of an organ or organ system as well as the capacity of that system when stressed physiologically. For muscles to move joints, a system must provide nutrients, remove waste products, and conduct nervous impulses. The cardiopulmonary exercise test (CP Ex test) incorporates many of these elements into one defining test of work capacity and addresses two primary issues necessary for muscle movement: the adequacy of the cardiac output for delivery of nutrients to muscles and removal of waste

in AMA Guides® Newsletter
Stephen L. Demeter

Cardiopulmonary exercise stress testing (CPET) provides objective data used to assess cardiac and pulmonary impairment. The Clinical Update section of the May/June 1997 edition of the AMA Guides Newsletter contains a one page article that briefly reviews CPET. This article provides an update. The 1997 article contains two tables, reprinted here, which summarize the variables measured during a CPET and the indications for performing this test during an impairment assessment. Since the last publication on this topic in the AMA Guides Newsletter in 1997

in AMA Guides® Newsletter
Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

Introduction Determining the factors contributing to the disease in evaluating pulmonary disease is critically important. In the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment ( AMA Guides) , Sixth Edition, Section 5.3, Environmental Exposures, Lifestyle Choices, and Pulmonary Disease (6th ed, 80), emphasizes the importance of obtaining a thorough history of tobacco use and occupational exposures. This history is mandatory in assessing impairment related to cardiopulmonary issues. It should be noted in all evaluations

in AMA Guides® Newsletter
Restricted access
James B. Talmage

Compendium of Physical Activities: Classification of Energy Costs of Human Physical Activities, Barbara Ainsworth, et al ( Medicine and Science in Sports and Exercise , 1993;71–80), American College of Sports Medicine. When assessing cardiopulmonary impairments, physicians are often asked about the individual's physical abilities and restrictions. If the impaired individual has completed a valid treadmill exercise test, then his work capacity (in METS) is known. This article lists the energy requirements or energy costs (in METS) of 477 physical

in AMA Guides® Newsletter
Stephen L. Demeter
,
Lorne Direnfeld
,
Richard Katz
,
James B. Talmage
, and
Christopher R. Brigham

System) or Chapter 13 (The Central and Peripheral Nervous System) in the AMA Guides, Fifth and Sixth Editions ? How is urinary or fecal incontinence rated following a CNS injury? A case involving a catastrophic accident in which an examinee's airway was completely obstructed, causing a cardiopulmonary arrest and subsequent hypoxic-ischemic encephalopathy, is presented that exemplifies many of the problems that can occur to the reader and/or rater. This article explains, in detail, the methodology for rating multiple impairments caused by central nervous system

in AMA Guides® Newsletter

Abstract

Accurate pulmonary impairment ratings depend on a valid and reliable lung function test and appropriate application of the criteria provided in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. The two lung function tests are dynamic and static; the principal dynamic test is the cardiopulmonary stress test [see sidebar, “Cardiopulmonary Exercise Testing,” in this issue of The Guides Newsletter]. To rate pulmonary impairment using Chapter 5 of the AMA Guides, Sixth Edition, a physician should obtain the spirometric results and the value for the diffusion of carbon monoxide across the alveolar capillary membrane of the lung (DLCO); the latter should be administered according to American Thoracic Society criteria. A six-minute walk test is a standard test of pulmonary reserve in lung disease patients and may be part of the individual's physical examination. Each diagnosis table in Chapter 5 is divided into variables or factors that determine the impairment rating. Each impairment class (except 0) has five grades (A through E). Once the evaluator uses objective test results to assign the impairment class, the non-key factors are considered to determine whether the impairment should be adjusted from the default value. To determine the adjustment, the evaluator subtracts the impairment class integer from each non-key factor integer, and the differences are summated for the net adjustment.

in AMA Guides® Newsletter
Stephen L. Demeter

imaging studies are recommended for patients who had infiltrates, had new or worsening pulmonary symptoms, or had abnormal findings on cardiopulmonary physical examination. For most individuals, a plain chest X ray is sufficient; however, if more severe illness is possible, a computed tomography (CT) scan is recommended. In general, the expectation of lung damage, as defined radiographically, resolves within 2 to 4 weeks, but full resolution may require 12 weeks or longer. There are studies suggesting that changes may occur within the first year, especially in

in AMA Guides® Newsletter
Jay Blaisdell
,
James B. Talmage
, and
Stephen Demeter

Accurate pulmonary impairment ratings are dependent on a valid and reliable lung function test and appropriate application of the criteria provided in the AMA Guides. There are 2 lung function tests: dynamic and static. The principal dynamic test is the cardiopulmonary stress test (see Sidebar ). Definitions Forced vital capacity (FVC) is the amount of air that an individual can forcibly exhale after taking the deepest breath possible and then blowing it out to completion. Forced expiratory volume (FEV) is measured as the amount of air exhaled

in AMA Guides® Newsletter
Laura Welch

great deal of objective data, but objective data itself may not be better than subjective assessment if it cannot be proven to correlate with work performance. Some measures of work capacity have been validated. An exercise stress test can determine at what level of work an individual develops ischemia. A more detailed evaluation with a cardiopulmonary stress test can measure VO 2 max and determine whether an exercise limitation is due to underlying heart or lung disease, or solely to reduced fitness. If the results of these tests are combined with a detailed job

in AMA Guides® Newsletter
Stephen L. Demeter

, on average, 121 days previously. CMR and a cardiopulmonary exercise stress test were performed in 36 patients based on clinical concerns. Of those individuals, 16 (44.4%) had pathological findings. The remainder had subjective complaints without objective abnormalities. These abnormalities occurred in individuals with asymptomatic disease, as well as those whose acute COVID-19 infection was of sufficient severity necessitating hospitalization. 44 Fatigue, shortness of breath, and exercise intolerance are frequent symptoms in long COVID patients. Tleyjeh et al 45

in AMA Guides® Newsletter