Section 343 - Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 - The assessor should: | Zoe
Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
343The assessor should:
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a) obtain a comprehensive, accurate medical history and review all relevant available records;
b) include in the assessment report a comprehensive description of current symptoms and their relationship to daily activities, detailed findings on physical examination, and all findings of relevant diagnostic and ancillary tests; and
c) indicate how the impairment assessment was calculated by reference to the relevant tables.
345 However, the special procedure set out below applies where there is spinal cord injury with neurological sequelae (that is, corticospinal tract involvement).
PART III – DEFINITIONS OF CLINICAL FINDINGS FOR DIAGNOSIS-RELATED ESTIMATES IN ASSESSING SPINAL IMPAIRMENT
350 These definitions, which are taken from the AMA5, apply to corresponding terms appearing in Part III – The spine of this Chapter.
351 Alteration of motion segment integrity – motion segment alteration can be either loss of motion segment integrity (increased translational or angular motion), or decreased motion secondary to developmental fusion, fracture healing, healed infection, or surgical arthrodesis. An attempt at arthrodesis may not necessarily result in a solid fusion but may significantly limit motion at a motion segment. Motion of the individual spine segments cannot be determined by a physical examination but is evaluated with flexion and extension roentgenograms. When routine x-rays are normal and severe trauma is absent, motion segment alteration is rare, and flexion and extension roentgenograms are indicated only if motion segment alteration is suspected from the individual’s history or routine x-rays.
352 Asymmetry of spinal motion in one of the three principal planes is sometimes caused by muscle spasm or guarding. That is, if an individual attempts to flex the spine, they are unable to do so moving symmetrically: rather, the head or trunk leans to one side. To qualify as true asymmetric motion, the finding must be reproducible and consistent, and the assessor must be convinced that the individual is co-operative and giving full effort.
353 Atrophy is measured with a tape measure at identical levels on both limbs. For reasons of reproducibility, the difference in circumference should be 2cm or greater in the thigh, and 1cm or greater in the arm, forearm, or leg.
354 Cauda equina syndrome is manifested by bowel or bladder dysfunction, saddle anaesthesia and variable loss of motor and sensory function in the lower extremities. Individuals with cauda equina syndrome usually have loss of sphincter tone on rectal examination and diminished or absent bladder, bowel, and lower limb reflexes.
355 Electrodiagnostic verification of radiculopathy – unequivocal electrodiagnostic evidence of acute nerve root pathology includes the presence of multiple positive sharp waves or fibrillation potentials in muscles innervated by one nerve root. However, the quality of the person performing and interpreting the study is critical. Electromyography should be performed only by a physician qualified through education, training, and experience in these procedures. Electromyography does not detect all compressive radiculopathies and cannot determine the cause of the nerve root pathology. On the other hand, electromyography can detect non-compressive radiculopathies which are not identified by imaging studies.
356 Loss of motion segment integrity is defined as an anteroposterior motion of one vertebra over another that is greater than 3.5mm in the cervical spine, greater than 2.5mm in the thoracic spine, and greater than 4.5mm in the lumbar spine. Alternatively, it is defined as a difference in the angular motion of two adjacent motion segments greater than 15° at L1-2, L2-3 and L3-4, greater than 20° at L4-5 and greater than 25° at L5-S1. In the cervical spine, it is also defined as motion at one level that is more than 11° greater than at either adjacent level.
357 Muscle guarding is a contraction of muscle to minimise motion or agitation of the injured or diseased tissue. It is not true muscle spasm because the contraction can be relaxed. In the lumbar spine, the contraction frequently results in loss of the normal lumbar lordosis, and it may be associated with reproducible loss of spinal motion.
358 Muscle spasm is a sudden, involuntary contraction of a muscle or group of muscles. Paravertebral muscle spasm is common after acute spinal injury but is rare in chronic back pain. It is occasionally visible as a contracted paraspinal muscle but is more often diagnosed by palpation (a hard muscle).
359 To differentiate true muscle spasm from voluntary muscle contraction, the individual should not be able to relax the contractions. The spasm should be present standing, as well as in the supine position, and frequently causes a scoliosis. The physician can sometimes differentiate spasm from voluntary contraction by asking the individual to place all their weight first on one foot, and then the other, while the physician gently palpates the paraspinous muscles. With this manoeuvre, the individual normally relaxes the paraspinal muscles on the weight-bearing side. If the assessor witnesses this relaxation, it usually means that true muscle spasm is not present.
360 Non-verifiable radicular root pain is pain that is in the distribution of a nerve root but has no identifiable origin (that is, there are no objective physical, imaging, or electromyographic abnormal findings).
361 Radiculopathy is significant alteration in the function of a nerve root or nerve roots, and is usually caused by pressure on one or several nerve roots. The diagnosis requires a dermatomal distribution of pain, numbness, and/ or paraesthesia. A root tension sign is usually positive. A diagnosis of herniated disc must be substantiated by an appropriate finding on an imaging study. The presence of findings on an imaging study is insufficient to make the diagnosis of radiculopathy. There must also be clinical evidence as described above.
362 Reflexes may be normal, increased, reduced, or absent. For reflex abnormalities to be considered valid, the involved and normal limb(s) should show marked asymmetry between arms or legs on repeated testing. Once lost because of previous radiculopathy, a reflex rarely returns. Abnormal reflexes such as Babinski signs or clonus may be signs of corticospinal tract involvement.
363 Urodynamic tests – cystometrograms are useful in individuals where a cauda equina syndrome is possible but not certain. A normal cystometrogram makes the presence of a nerve-related bladder dysfunction unlikely. Occasionally, more extensive urodynamic testing is necessary.
364 Weakness and loss of sensation – to be valid, the sensory findings must be in a strict anatomical distribution (that is, follow dermatomal patterns). Motor findings should also be consistent with the affected nerve structure(s). Significant, long-standing weakness is usually accompanied by atrophy.
PART III – MULTI-LEVEL FRACTURES INVOLVING THE SPINAL CANAL
a) where there are multi-level fractures but no associated neurological compromise: increase the assessment under Table 9.15, Table 9.16 or Table 9.17 by one level;
b) where there are multi-level fractures with neurological compromise: increase the assessment under Table 9.15, Table 9.16 or Table 9.17 by two levels.