Transcript Cutting Edge Techniques in Functional Capacity Examinations

Cutting Edge Techniques
For
Functional Capacity Evaluation
Utilizing
Ariel Performance Analysis Systems
By Robert Wainwright, P.T.
President, Kinematic Consultants, Inc
Point Pleasant, NJ
Kinematic Consultants
Test and Measurement Services
for
Workers Compensation Issues
Specializing In
Kinematic Functional Capacity
Evaluations
Utilizing “State of the Art” Technology (APAS) to
Measure Function in Work, ADL and Recreation
Activities.
Kinematic Consultants Locations
Test Protocols Designed
and
Administered by
 Licensed
Physical Therapists
 Biomedical Engineers
Medical and Workers
Compensation Issues
Considered
 Safe
Return to Work
 Altered Duty Capacity Recommendation
 Residual Dysfunction %
 Examinee Reliability
 Case Closure
 Legal Support
Providing Support in Medical
Decision Making To:
 Treating Physician
 Independent Medical
 Case
Evaluation Physician
Manager
 Rehabilitation Nurse
 Insurance and Risk Management Personnel
 Employer
What To Expect From An
FCE?
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



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
EXAMINEE RELIABILITY during the FCE (% Effort
Level and Coefficient of Variation).
RESIDUAL DEFICIT OR DYSFUNCTION (body part
specific.)
GENERAL FUNCTIONAL ABILITY (activities of daily
living: walking, balancing, bending, climbing, squat, reach,
etc.).
SPECIFIC STRENGTH CAPABILITY (push, pull, lift).
SPECIFIC WORK CAPACITY category (Examinee’s
specific and current qualification: sedentary thru very heavy).
JOB REQUIREMENTS (Job description from Employer
and Dictionary of Occupational Titles).
Definitive Statement of Examinee’s capacity to return to
FULL DUTY, ALTERED DUTY OR NOT AT ALL.
In Summary, A Kinematic FCE
Answers The Following:
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Is the Examinee:
Demonstrating maximum effort
and cooperation during the FCE?
Suffering residual dysfunction?
Capable of safe return to work for
or altered duty?”
How Do We Get The Answers
You Need?

Standard “Low Technology” Functional
Capacity Evaluation
Verses

“High Technology” (APAS) Kinematic
Functional Capacity Evaluation
LOW TECHNOLOGY FCE
Traditional Toolbox
Eyes
Hands
Video
Tape measure
Goniometry
HIGH TECHNOLOGY FCE
Click on the picture to see the animation

3D Kinematic Computer Analysis of Motion (APAS)*
 Kinetic Ground Reaction Forces / Balance (APAS)*
 Computerized Strength Analysis Equipment(CES)*
 Dynamic EMG [electromyography] (APAS)*
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
KINEMATIC ASSESSMENT:
“THREE DIMENSION
MOVEMENT ANALYSIS”
TECHNICAL ADVANCES FROM THE
SCIENCE OF SPORT ANALYSIS *
•Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
•Click on the picture to see the animation
CALIBRATION (VOLUME) CUBE FOR GAIT
GAIT RIGHT CAMERA VIEW
GAIT LEFT CAMERA VIEW
AUTOMATIC DIGITIZING GAIT VIEW
CONVERSION TO STICK FIGURE AND GRAPH*
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
FULL SKELETON ANIMATION*
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
DIGITIZING A DELTA LIFT TASK ANALYSIS
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
DELTA LIFT TASK ANALYSIS*
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
DELTA WITH 125 POUND LOAD
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
How Do We Interpret The
Data?
GRAPHING DATA
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
KINETIC FORCE PLATE
Ground Reaction forces
Newton’s Law of Physics
“Every Action Creates an Equal and
Opposite Reaction”
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
POSTERIOR LEANING CENTER OF GRAVITY STANCE
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
EXTREME FORWARD LEANING C.G.
POST LUMBAR SURGERY
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
BALANCE TEST PROTOCOL
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
BALANCE AND
CENTER OF PRESSURE SWAY
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
LIFT TASK ANALYSIS: MAXIMUM SAFE LIFT
LIFT TASK
ANALYSIS
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
COMPUTERIZED EXERCISE
DIAGNOSTIC ANALYSIS
EQUIPMENT
OPEN LOOP STRENGTH TESTING
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
CLOSED LOOP LIFT TESTING
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
DYNAMIC
ELECTROMYOGRAPHY
“Monitoring the electrical activity of
muscle groups during work
activities.”
EMG POST KNEE INJURY AND SURGERY
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
ELECTROMYOGRAPHY MONITORING OF TEST PROTOCOL
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
WORK SITE JOB ANALYSIS
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Determine if the job is a
contributing factor to injury.
Determine if Examinee work
technique is a contributing factor
to un-successful return to work.
Job Title: Fisherman
 Sewage
processing plant. Job of
“Fisherman.”
 General Employer Problem: multiple cases
of rotator cuff and low back problems.
Outcome
 Work
technique contributes to shoulder and
low back stress.
 Researched plant construction and found
this aeration system to be outdated.
 Reconstruction not feasible.
 Changed work biomechanics technique to
de-stress shoulder and low back.
Office Worker: Chronic Neck
and Back Pain
 Worker
suffers chronic neck and back pain
resulting from multiple automobile
accidents.
 Job requires 90% computer terminal work.
 Is ergonomic workstation or work technique
a contributing factor?
Ergonomic Work Station Analysis
Outcome
 Modifications Suggested Include:
1.
2.
3.
4.
5.
New, sturdy chair with ergonomic adjustments.
Take Monitor off elevated platform.
Back seat adjusted to more upright position.
Seat raised to decrease shoulder stress.
Adjustable foot rest added to decrease low back
tension.
 Employee performs job in a relaxed posture,
relieving chronic neck and back strain.
Case Studies
Case #1
No Light At The End of the
Carpal Tunnel
A 32 year old road laborer
who developed Carpal Tunnel
from repetitive stress trauma.

Patient diagnosed with EMG and NCV.
 Surgical release performed 16 months prior to
analysis.
 Patient returning to court for upgraded impairment
rating for continued pain and dysfunction.
 FCE ordered by the County for accurate
assessment and verification of complaints.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
Financial

Judge originally awarded a 12.5% for the
operated right carpal tunnel.
Outcome
 FCE results reveal no current dysfunction of
right wrist.
 Right wrist functioning better than left.
 No increase in impairment rating.
Case #2
The Chronic Cervical Sprain
Chronic Cervical Sprain
 Drug
Counselor [clerical job] with a
diagnosis of whiplash cervical sprain.
 Date of Incident, 1 1/2 years prior to
analysis.
 Complaints of constant pain, severe spasm
in Sterno Cleido Mastoid Muscle (right).
 In and out of work multiple times since
incident.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
Outcome
 FCE negative for objective evidence in
support of her complaints of ROM
distress.
 Dynamic EMG demonstrates SCM
symmetry, negative for spasm.
 Recommendations:
 No active treatment.
Case #3
The Remote Kinematic FCE
Remote Functional Capacity
Evaluation
 31
year old male.
 Struck by an automobile while working.
 Resulted in a Fractured Pelvis and Low
Back Sprain.
 Treated for 2 years and declared to be
totally disabled for life by his Orthopedic
Surgeon.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
Outcome
 Report
was presented to the opposing
Attorney by the Insurance Company
Attorney.
 Two days after receiving the report, the case
was settled.
Case #4
The “FALL”
The Fall

47 year old laborer, Home Improvement Center.
 Incident involving lifting of stock, fell backwards,
injuring his low back. No hard diagnostic
evidence.
 1 1/2 years after incident, he continues to be out of
work and seeking medical opinions. Complaints
include severe back pain, right and left legs give
out and collapse.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
Outcome
 Examinee
was returned to work
without protest.
 Case closed.
How To Read A Kinematic
Functional Capacity Report
BACK TO WORK RECOMMENDATION
LAST PAGE
EXAMINEE RELIABILITY (VALIDITY)
MEASURE OF
COOPERATION AND EFFORT
RESIDUAL DEFICIT OR DYSFUNCTION
DETAILS OF THE ANALYSIS
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
CLOSING THOUGHTS!
What can a Kinematic FCE Do For
You as Employer or Risk Manager?

Kinematic FCE cannot determine the diagnosis.
 It can confirm whether the Examinee is moving, lifting,
push/ pulling, bending, posturing, and or demonstrating
muscular imbalance in a dysfunctional manner that is
compatible with diagnosis and or complaints.
 It can determine Examinee’s Reliability to perform with
maximum effort during the FCE (correlate with symptom
magnification and or malingering).
 It can match Examinee’s current ability with essential job
demands.
 It can determine safe return to work.
 It can provide objective evidence for case closure, case
settlement and “fitness for duty (employee termination)”.
When should an FCE be
CONSIDERED?
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At 4-5 week, post injury, when soft tissue injury patient is
not responding as expected to treatment and or is not back to
work, full duty (results can help you decide if there are nonmedical issues, symptom magnifying , malingering issues or
real functional issues that may need further diagnostic or
medical consideration.
When the treating physician has concluded the patient has
reached MMI and there is a question of work capability.
When multiple body parts are involved and, or the patient is
recovering from lumbar, cervical, shoulder, hip, knee or ankle
surgery.
Anytime the treating physician or case manager has reached a
roadblock in getting an injured employee back to work.
Additional Considerations

When objective residual disability information is
needed for case settlement.
 To supplement and strengthen an Independent
Medical Evaluation.
 When objective information is needed to
strengthen a case position for settlement and or
legal disposition.
 To assist with case closure in the case of a
problem Examinee.
Do Kinematic FCE’s Help the
Bottom Line Of Your
Business?
County of Ocean, NJ: 3 Year History
LOST WORK DAYS
1837
2000
1161
1000
1994
575
1995
1996
0
YEARS