Rating Lower Extremity Impairments Handout

Rating Lower Extremity Impairments

2017 DWC Conference

Disability Evaluation Unit

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Thirteen Methods For Rating Lower Extremity Impairment

1) Limb Length 2) Amputation 3) Muscle Atrophy 4) Arthritis 5) Range of Motion 6) Ankylosis 7) Peripheral nerve

8) Muscle Strength 9) Gait 10) CRPS 11) Skin Loss 12) Vascular 13) Diagnosed Based

Impairments

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Lower Extremity Methods

? Typically one method will adequately characterize the impairment

? In some cases more than one method will be used to assess all features of the impairment

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Cross-usage chart (Table 17-2, pg. 526)

? Guide for avoiding duplication for the same body part

? Shows which combinations of methods are allowable

? Note that X doesn't mark the spot!

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Combining Impairments

(Table 17-2 Condensed)

Gait

Atrophy Muscle ROM DJD

Strength

Gait

X

X

X

X

Can range of motion and arthritis be combined?

Atrophy X

X

X

X

DBE X X

Muscle X

X

X

X

X

Strength

ROM

X

X

X

X

X

DJD

X

X

X

X

DBE

X

X

X

X

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Combining Lower Extremity Impairments

? Common sense must be applied to Table 17-2 ? For example a knee meniscectomy (DBE) may be

combined with decreased hip range of motion ? Even though there is an "X" for this combination,

these impairments are for different regions

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3

Regions of the Lower Extremity

? Hip ? Knee ? Ankle ? Foot

17.01 Impairments ? Limb length ? Amputation ? Gait ? Skin loss ? Peripheral nerve ? Vascular ? CRPS

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Lower Extremity Indices

? Lower Extremity Index ? Abbreviation = LE ? Used for all impairments from ankle to hip ? Lower Extremity Index x .4 = Whole Person Index

? Foot Index ? Abbreviation = FT ? Used only for impairments of foot and toes ? Foot index x .7 = Lower Extremity Index

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Limb Length (Table 17-4, pg. 528)

? Based on limb length difference ? X-rays are the preferred method of measurement ? Interpolate between values ? Minimum ratable difference is 2 cm. ? Use lower extremity (LE) index

Limb Length Discrepancy Impairment

0-1.9 cm

0

2-2.9 cm 3-3.9 cm

2-3 (5-9) 4-5 (10-14)

4-4.9 cm 5+ cm

6-7 (15-19) 8 (20)

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Limb Length (Table 17-4, pg. 528)

? In cases when shortening is due to malalignment or fracture deformities

? Use chart beneath Table 17-4

? Look for accompanying fracture/deformity DBE impairments

Limb Length Discrepancy Impairment

0-1.25 cm

5 LE

1.25-2.5 cm

10 LE

2.5-3.75 cm

15 LE

3.75-5 cm

20 LE

10

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