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Functional Capacity Evaluation

Mr. Sample was referred to CORA Rehabilitation for an FCE to define his functional ability.

Sincerity of Effort The results of this evaluation show that Mr. Sample demonstrated consistent and maximal effort. The test results and the referral diagnosis correlate. Therefore this FCE is a reliable indication of his true functional abilities at this time.

Lifting Ability Summary Mr. Sample's occasional lifting capabilities are at a Light physical demand category (PDC). According to the US Department of Labor guidelines, Light work is defined as lifting 0-20 pounds 0-33% of the workday.

Tarping load. - Client is required to place Not Met ~100 lb tarp overhead to cover load on an

occasional basis.

Very Heavy

Heavy

Medium

Light

Sedentary Winding gear. - Client is required to wind up/down landing gear on an occasional

basis.

Met with Restrictions

Binding down load. - Client is required to utilize ~100 lbs of downward force to utilize "cheater bar" to bind down chains to secure load.

Not Met

Functional Restrictions & Limitations Mr. Sample put forth great and sincere effort with today's FCE; however, due to functional deficits of right hand/fingers, was unable to function safely above the Light PDC level. Noted decreased right grasp/pinch strength on static strength testing, below functional AROM of 2nd-4th digits, gross 4-/5 strength, as well as hypersensitivity of 2nd -4th DIPs. Material handling activities were either terminated or modified by clinician when an unsafe decline in right grip along with increased body substitutions/decline in body mechanics were noted. The below material handling activities were performed slow and controlled with excellent body mechanics. Mr. Sample can safely lift/carry 11# above waist height bilaterally with larger wooden box; however, to lift to the full Light PDC level (20#) requires modification of lifting smaller non handled objects. Due to hypersensitivity of of 2nd-4th digits, noted consistent compensatory techniques (utilizing thenar/hypothenar eminence for weight bearing as well as utilizing 1st and 5th digits for grasping) to increase functionality of R UE.

Shift through 10-13 gears manually w/R hand along with pulling up transfer axel button. - Client is required to utilize right hand to shift through 10-13 gears on a frequent basis, along with pressing transfer axel button (with 3-4th digits) to reach higher gears on truck.

Not Met

Chain load down. - Client is required to carry/place ~100 lbs chains on flatbed to secure load on an occasional basis.

Not Met

Name Sample

Occupation Flatbed Truck Driver

Employer Action Inc.

Job Req. PDC Heavy

Body Part/System Hand

Date of Injury 05/20/2018

Ref. Physician Dr. Sample

Total FCE Time 4 hours - testing/reporting

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108 Palmetto Park Lexington, SC 29072 • Ph: 803-359-2323 • Fx: 803-359-2331 • [email protected] • www.corahealth.com

- Floor to Waist: 21 lbs Occasional

- Chest to Overhead: 11 lbs Occasional for Box and 20 lbs Occasional for smaller/easier to grasp objects (kettlebell)

- Bilateral Carry: 11 lbs Occasional for Box and 20 lbs Occasional for smaller/easier to grasp objects (kettlebell)

- L Unilateral 12in to Knuckle: 50 lbs Occasional

- Waist to Shoulder: 11 lbs Occasional for Box and 20 lbs Occasional for smaller/easier to grasp objects (kettlebell)

- Push/Pull: 100 lbs Occasional

Recommendations & Accommodations Mr. Sample can work at the Light PDC level with the following modifications/accommodations:

- Larger items/box lifts are limited to 11 lbs above waist height.

- To lift to the full Light PDC (11-20 lbs) above waist and carrying; client is limited to lifting smaller non-handled objects only.

- For performing winding up/down landing gear- modified to L UE only.

- Client can grasp/handle on a constant basis with L UE without modification; however, with R UE requires the ability to utilize compensatory techniques on R UE (consistent with decreased AROM and hypersensitivity).

Evaluator 1

Carrie Manges, PTA

Evaluator 2

Randi Scherer, DPT

Physician

Dr. ______

mailto:[email protected]

http://www.corahealth.com/

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Patient Demographics

Name:

SS#:

Referring Physician:

Date of Onset/Injury:

Surgery Date:

Sample Sample

XXX-XX-0000

Dr. Sample

May 20, 2018

September 1, 2018

Gender:

Age:

Height:

Weight:

Hand Dominance:

Male

28

6 ft. 2 in.

240 lbs.

Left

Employment Information

Employer:

Occupation:

Claim #:

Insurance/Payer:

Drive Inc.

Flatbed Truck Driver

0000000

.

Job Req. PDC:

DOT Code:

Work Status:

Heavy

905.663-014

Not Working

Diagnosis

ICD-10 Description Code Description

M79641 Pain in right hand

History & Mechanism of Injury

Mr. Sample reports that he was injured on May 20, 2018 while working as a Flatbed Truck Driver for Action Inc.

Patient's Report of Injury:

Mr. Sample reports that he injured his right 2-4th digits when a "2.5 ton stump rake" was dropped on his 2-4th digits. Client reports constant hypersensitivity in 3-4th digits as well as numbness along ulnar nerve path of 3-4th DIPs. Client reports weakness in his "whole hand." Client reports that he is independent with ADLs; however, due to hypersensitivity requires significant modification (shampooing hair with L UE only and overall disuse of left 2-4th digits).

Past Medical History

He did attend therapy for this diagnosis. He did have surgery for this injury on September 1, 2018.

Mr. Sample does not have any significant medical history.

Medication

Mr. Sample is currently taking the following medications: BP Meds, Gabapentin, Neurotin, 800 mg Ibuprofen, and Percocet PRN. Mr. Sample reports that he did not take pain medication prior to the evaluation.



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Sincerity of Effort Sincerity of Effort

Hand grip, pinch grip and static testing were used to determine if Mr. Sample's performance is consistent and reliable.

Test Result Expected Measure Reliable

Jamar Hand Test MVE Pos 1 Right 7.5% :511% COV Yes

Jamar Hand Test MVE Pos 1 Left 1.3% :511% COV Yes









Pinch Grip Test Palmar Right 7.9% :511% COV Yes

Pinch Grip Test Palmar Left 3.1% :511% COV Yes

Pinch Grip Test Key Right 4.2% :511% COV Yes

Pinch Grip Test Key Left 0.0% :511% COV Yes

Pinch Grip Test Tip to Tip Right 6.2% :511% COV Yes

Pinch Grip Test Tip to Tip Left 5.9% :511% COV Yes

Pinch Grip Test Pinch Comparison - Right Key>Tip Key>Tip MVE Yes

Pinch Grip Test Pinch Comparison - Left Key>Tip Key>Tip MVE Yes

Jamar Hand Test Rapid Exchange - Right REG<MVE REG<MVE REG Yes

Jamar Hand Test Rapid Exchange - Left REG<MVE REG<MVE REG Yes

The results of the sincerity of efforts testing show that Mr. Sample demonstrated consistent and maximal effort during the evaluation.

In addition to the sincerity of effort testing results, Mr. Sample was observed throughout the FCE using distraction based testing, a technique used to detect insincere effort. Distraction based testing is a clinical testing situation in which the client is unaware of all information being gathered by the tester making it difficult if not impossible to consciously control performance.

There were no inconsistencies noted during the test.



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JAMAR Hand Tests

The JAMAR hand dynamometer was used to quantify grip strength and determine whether Mr. Sample exerted consistent effort during grip strength testing. Mr. Sample was tested using the maximum voluntary effort (MVE) and rapid exchange hand grip (REG) protocols.

Maximum Voluntary Effort

The MVE protocol tests strength over a range of five positions on the hand dynamometer. With maximal effort, the strength graphs obtained will result in a bell-shaped curve. Research has shown that both normal and injured hand strength should be strongest in positions 2, 3 and 4 and weaker in positions 1 and 5. The average and standard deviation is analyzed for coefficient of variation (COV) at each test position. Any COV > 20% indicates inconsistent effort. Any COV <11% indicates consistent effort. Anything between 11% and 20% does not indicate either consistent or inconsistent effort and is therefore not relevant for determining consistency of effort.

Right Hand Avg. SD COV Left Hand Avg. SD COV

1 66.0 60.0 57.0 61.0 4.6 7.5% 1 117.0 118.0 115.0 116.7 1.5 1.3%

2 80.0 76.0 72.0 76.0 4.0 5.3% 2 120.0 116.0 120.0 118.7 2.3 1.9%

3 60.0 63.0 58.0 60.3 2.5 4.2% 3 107.0 99.0 105.0 103.7 4.2 4.0%

4 60.0 55.0 53.0 56.0 3.6 6.4% 4 98.0 93.0 92.0 94.3 3.2 3.4%

5 44.0 47.0 40.0 43.7 3.5 8.0% 5 87.0 82.0 78.0 82.3 4.5 5.5%



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Rapid Exchange Grip

The REG test protocol is used as a means to assess the reliability of effort in the maximum voluntary effort test. Research shows that REG strength exceeding max grip strength is an indication of sub maximal or unreliable effort. REG testing is performed using the position in which the client produces the greatest force during the MVE test.

Mr. Sample demonstrated the highest MVE on position 2 on the left hand, therefore position 2 was used for REG testing. REG values were compared to MVE values for both right and left sides at position 2.

Position 2 REG MVE Results

Right 52 lbs 80 lbs Pass

Left 110 lbs 120 lbs Pass

Results

The results of these tests show that Mr. Sample demonstrated consistent and maximal effort.

The data obtained for Mr. Sample did not demonstrate a bell shaped curve which indicates sub maximal effort. The coefficients of variation measured during the MVE are less than the 11% acceptable limit showing Mr. Sample performed the test with consistent effort. Mr. Sample demonstrated a negative rapid exchange grip which indicates maximal effort. Mr. Sample's grip strength is below normal when compared to published norms.



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Normative Data Comparison

Normative data was compiled for grip strength to establish clinical norms for adults. In this test, normative data for grip strength at position 2 was used as a baseline to compare with evaluation data collected on Mr. Sample.

Mr. Sample's average hand grip on position 2 bilaterally was compared to normative data for men his age.

Task Name Actual Normative Value % Difference

Grip Pos 2 (R) 76.0 120.8 37.1%

Grip Pos 2 (L) 118.7 110.5 7.4%

Task Name Right Left % Difference

Grip Pos 2 76.0 118.7 36.0%

Mr. Sample's grip strength was compared to age and gender matched normative data. The published normal grip strength range for the left hand is between 77 and 139 pounds. Mr. Sample produced an average force of 118 pounds which is considered within the normal range. The published normal grip strength range for the right hand is between 78 and 158 pounds. Mr. Sample produced an average force of 76 pounds which is considered below the normal range. Mr. Sample is left hand dominant and his average strength on position 2 for his left hand was 36.0% stronger than his right side which demonstrates an abnormal relationship. Right hand dominant subjects are assumed to be approximately 10% stronger on the right side, while left hand dominant subjects are assumed to have approximately equal strength on both sides.



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Pinch Grip Strength Test

The pinch dynamometer is used to quantify an individual’s pinch strength, to determine reliability of effort and to compare these measures to recognized population normative data. Mr. Sample was asked to perform the following three pinch grip strength tests: standard key, tip and palmar. Each position is tested three times and the COV is calculated to determine if the client is giving reliable effort as evidenced by consistent results. Any COV >20% indicates inconsistent effort. Any COV <11% indicates consistent effort. Anything between 11% and 20% does not indicate either consistent or inconsistent effort and is therefore not relevant for determining consistency of effort. A comparison of the key and tip test was used to determine if maximal effort was given; full effort would result in a key pinch that is greater than the tip pinch.

Left 23.0 23.0 23.0 23.0 0.0 0.0% Left 17.0 18.0 16.0 17.0 1.0 5.9%

Palmar Grip Avg. SD CV

Right 8.0 7.0 7.0 7.3 0.6 7.9%

Left 18.0 18.0 19.0 18.3 0.6 3.1%

Results

The coefficients of variation measured during the pinch grip strength testing are less than the 11% acceptable limit showing Mr. Sample performed the test with consistent effort. Mr. Sample's maximum key pinch was greater than his maximum tip to tip pinch implying maximal effort during his test. Mr. Sample's pinch grip is below normal when compared to published norms.

Key Grip Avg. SD CV

Right 14.0 13.0 14.0 13.7 0.6 4.2%

Tip Grip Avg. SD CV

Right 10.0 9.0 9.0 9.3 0.6 6.2%



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Normative Data

Normative data was compiled for pinch strength to establish clinical norms for adults. In this test, normative data for pinch strength at the key, tip, and palmar positions were used as a baseline to compare with evaluation data collected on Mr. Sample. Mr. Sample's average pinch grip for key, tip and palmar bilaterally were compared to normative data for men his age.

Task Name Actual Normative

Value % Difference

Key (R) 13.7 26.7 48.8%

Key (L) 23.0 25.0 8.0%

Palmar (R) 7.3 26.0 71.8%

Palmar (L) 18.3 25.1 27.0%

Tip (R) 9.3 18.3 49.0%

Tip (L) 17.0 17.5 2.9%

Task Name Right Left % Difference

Key 13.7 23.0 40.6%

Palmar 7.3 18.3 60.0%

Tip 9.3 17.0 45.1%



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Results

Mr. Sample's key grip strength was compared to age and gender matched normative data. The published normal pinch strength range for the left hand is from 19 to 39 pounds. Mr. Sample demonstrated an average force of 23.0 pounds which is within the normal range for the left pinch strength. The published normal grip strength range for the right hand is from 19 to 41 pounds. Mr. Sample demonstrated an average force of 13.7 pounds which is below the normal range for the right pinch strength.

Mr. Sample's palmar strength was compared to age and gender matched normative data. The published normal pinch strength range for the left hand is from 19 to 36 pounds. Mr. Sample demonstrated an average force of 18.3 pounds which is below the normal range for left pinch strength. The published normal grip strength range for the right hand is from 19 to 35 pounds. Mr. Sample demonstrated an average force of 7.3 pounds which is below the normal range for right pinch strength.

Mr. Sample's tip strength was compared to age and gender matched normative data. The published normal pinch strength range for the left hand is from 12 to 36 pounds. Mr. Sample displayed an average force of 17.0 pounds which is within the normal range left pinch strength. The published normal grip strength range for the right hand is from 10 to 34 pounds. Mr. Sample displayed an average force of 9.3 pounds which is considered in the below the normal range for right pinch strength.



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Pain Assessment

Pre-FCE Post-FCE

4/10 6/10



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Job Demand Analysis

A detailed job demand analysis compares Mr. Sample's abilities to his required demands for overall physical capacity, material handling, non-material handling and essential job demands. Mr. Sample's employer did not provide a job description outlining the functional demands needed to perform his job as a Flatbed Truck Driver for Action Inc. According to the Dictionary of Occupational Titles TRUCK DRIVER, HEAVY (any industry) with code 905.663-014 is classified as a Heavy PDC.

Activity Job Requirement Demonstrated Ability Meets Job Requirement

Physical Demand Category Heavy Light Not Met

Lifting Floor to Waist 100 lbs/Occasional 20 lbs/Occasional Not Met

Lifting Waist to Shoulder 100 lbs/Occasional 20 lbs/Occasional Not Met

Lifting Chest to Overhead 100 lbs/Occasional 20 lbs/Occasional Not Met

(L) Unilateral Lifting Floor to Waist

100 lbs/Occasional 50 lbs/Occasional Not Met

Carrying 100 lbs/Occasional 20 lbs/Occasional Not Met

Pushing 100 lbs/Occasional 100 lbs/Occasional Met

Pulling 100 lbs/Occasional 100 lbs/Occasional Met

Sitting Frequent Constant Met

Standing Frequent Constant Met

Walking Frequent Frequent Met

Reaching Constant Constant Met

Crawling Occasional Occasional Met

Kneeling Occasional Occasional Met

Stooping Occasional Frequent Met

Crouching Occasional Occasional Met

Climbing Occasional Occasional Met

Balancing Occasional Occasional Met

Twisting Occasional Occasional Met

Handling Constant Constant Met with Restrictions

Essential Job Demand Meets Job Requirement

Client is required to place ~100 lb tarp overhead to cover load on an occasional basis. Not Met

Client is required to carry/place ~100 lbs chains on flatbed to secure load on an occasional basis.

Not Met

Client is required to utilize ~100 lbs of downward force to utilize "cheater bar" to bind Not Met down chains to secure load.

Client is required to wind up/down landing gear on an occasional basis. Met with Restrictions



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Client is required to utilize right hand to shift through 10-13 gears on a frequent basis, along with pressing transfer axel button (with 3-4th digits) to reach higher gears on truck.

Not Met

Physical Demand Category Occasional

0-33% or 1-100 Reps

Frequent

34-66% or 100-500 Reps

Constant

67-100% or 500+ Reps

Sedentary 0-10 lbs. Negligible N/A

Light 0-20 lbs. 0-10 lbs. Negligible

Medium 20-50 lbs. 10-25 lbs. 0-10 lbs.

Heavy 50-100 lbs. 25-50 lbs. 10-20 lbs.

Very Heavy > 100 lbs. > 50 lbs. > 20 lbs.



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Lifting Waist to Shoulder - Not Met

A box or crate is placed at waist height with the client lifting the weight from waist height to shoulder height.

Job Req. Demonstrated Frequency & Duration ROM/Position/Parameter Comments

100 lbs. 20 lbs. Occasional No limitations Client able to lift 11# box

safely with bilateral UEs; however, when weight increased in box- clinician terminated due to unsafe

decline in R UE grip as well as

unsafe decline in body

mechanics. Client able to utilize bilateral UEs to lift small 20# kettlebell safely with good body mechanics. Post test rpts 4/10 R hand/finger pain post

test.

Lifting Chest to Overhead - Not Met

A box or crate is placed at chest height with the client lifting the weight from chest height to overhead.


100 lbs. 20 lbs. Occasional No limitations Client able to lift 11# box safely with bilateral UEs;

however, when weight

increased in box- clinician terminated due to unsafe decline in R UE grip as well as


mechanics. Client able to

utilize bilateral UEs to lift small

20# kettlebell safely with good

body mechanics



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Carrying - Not Met

A weighted box is placed at waist height and the client carries it over a distance of 50 ft.


100 lbs. 20 lbs. Occasional No limitations Client able to carry 11# box

safely with bilateral UEs; however, when weight increased in box- clinician terminated due to unsafe

decline in R UE grip as well as


mechanics. Client able to utilize bilateral UEs to carry small 20# kettlebell safely with



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Non-Material Handling Mr. Sample is assessed for positional tolerance using static or repetitive testing while comparing test performance to the standards of time and repetitions according to the Physical Demand Categories of Work for the Department of Labor (Dictionary of Occupational Titles, Fourth Edition Supplement Appendix D pg 101-102, 1996). All below tests are stopped when job standard is met; if a significant breakdown or compensation in body mechanics is observed; or if the client self terminates the activity early for any reason.

Sitting - Met

Sitting tolerance and frequency is observed throughout the duration of the FCE while the client performs testing in a seated position. The client’s reported ability may also be referenced and compared to observed ability.

Job Req. Demonstrated ROM/Position/Parameter Comments

Frequent Constant No limitations Client demonstrated the ability to sit on a constant basis; no subjective reports or complaints.

Walking - Met

The client is asked to walk freely around the testing facility or on a treadmill using a normal pace for as long as possible.


Frequent Frequent No limitations Client demonstrated the ability to walk on a frequent basis; no subjective reports or complaints.

Reaching - Met

Using a pegboard, the client was asked to extend hand(s) and arm(s) in any direction.


Constant Constant No limitations Client demonstrated the ability to reach on a constant basis; no subjective reports or complaints.



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Crawling - Met

Crawling refers to moving about on hands and knees or hands and feet. The client is asked to crawl as far as can be safely demonstrated.


Occasional Occasional No limitations Client demonstrated the ability to crawl on an occasional basis; client utilizes hypothenar and thenar borders of palm for weight bearing. Not able to place palm flat

on floor due to decreased AROM and

hypersensitivity.

Kneeling - Met

Kneeling tolerance may be measured either statically or dynamically. The client is asked to kneel on one or both knees. For static tolerance the client maintains the kneeling position as long as able, while moving pegs up and down a peg board from chest to floor height. For dynamic tolerance, the client is asked to go from kneeling to standing and back to kneeling as many times as can be safely demonstrated.


Occasional Occasional No limitations Client demonstrated the ability to kneel on an occasional basis; no subjective reports or complaints.

Stooping - Met

Stooping tolerance may be measured either statically or dynamically. The client is asked to bend downward and forward by bending the spine at the waist. This motion requires the full use of the lower extremities and back muscles. For static tolerance the client maintains the stopping position as long as able, while moving pegs up and down a peg board from chest to floor height. For dynamic tolerance, the client is asked to go from stooping to standing and back to stooping as many times as can be safely demonstrated.


Occasional Frequent No limitations Client demonstrated the ability to stoop/bend on a frequent basis; no subjective reports or complaints.



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Standing - Met

Standing tolerance and frequency is observed throughout the duration of the FCE while the client performs testing in an upright position at a work station without moving about. The client's reported ability may also be referenced and compared to observed ability.


Frequent Constant No limitations Client demonstrated the ability to stand on a constant basis; no subjective reports or complaints.

Balancing - Met

Balancing refers to maintaining one’s body equilibrium to prevent falling when walking, standing, crouching, or running on various surfaces. The client is asked to perform tandem walking and a bilateral single leg stand with eyes open and closed to determine safe work ability.


Occasional Occasional No limitations Client demonstrated the ability to balance on an occasional basis; no subjective reports or complaints.

Crouching - Met

Crouching tolerance may be measured either statically or dynamically. The client is asked to bend downward and forward by bending the legs and spine. For static tolerance the client maintains the crouching position as long as able while moving pegs up and down a peg board from chest to floor height. For dynamic tolerance, the client is asked to go from crouching to standing and back to crouching as many times as can be safely demonstrated.


Occasional Occasional No limitations Client demonstrated the ability to crouch on an occasional basis; no subjective reports or complaints.

Climbing - Met

Climbing refers to a ladder climb and/or stair climb activity. The client is asked to ascend or descend ladders and/or stairs using their feet, legs, hands and arms. The client is presented with a ladder and/or 8 inch step and asked to perform climbing as many times as can be safely demonstrated.


Occasional Occasional ladder Client demonstrated the ability to climb on an occasional basis; client utilizes hypothenar and thenar eminence for support/balance when utilizing R UE support.



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Twisting - Met

Twisting refers to the ability to rotate through the spine. Ability is observed throughout the FCE and with ROM testing during the musculoskeletal screen. If client is expected to have job required twisting ability then client will be asked to move an empty crate across a horizontal plane back and forth from the right side of the body to the left side until frequency is met.


Occasional Occasional No limitations Client demonstrated the ability to twist/rotate on an occasional basis; no subjective reports or complaints.

Handling - Met with Restrictions

Grasping ability and frequency is observed throughout the duration of the FCE. The client is observed seizing, holding, grasping, turning, or otherwise working with one or both hands. Fingers are involved only to the extent that they are an extension of the hand.


Constant Constant No limitations Client can grasp/handle on a constant basis with L UE w/o restrictions; however, when

grasping/handling with R hand utilizes thenar

and hyopthenar eminence as well as thumb and pinky fingers due to decreased AROM

and hypersensitivity.



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Essential Job Demand Mr. Sample was asked to demonstrate the ability to perform the job specific activities which are required for his job as a Flatbed Truck Driver for Driver Inc..

Tarping load. - Not Met

Client is required to place ~100 lb tarp overhead to cover load on an occasional

Unable to safely lift > 10 lbs bilaterally due to decreased grasp, AROM, and hypersensitivity on R UE.

basis.

Winding gear. - Met with Restrictions

Client is required to wind up/down Able to perform with LUE only. landing gear on an occasional basis.

Chain load down. - Not Met

Client is required to carry/place ~100 lbs chains on flatbed to secure load on an


occasional basis.

Binding down load. - Not Met

Client is required to utilize ~100 lbs of downward force to utilize "cheater bar"


to bind down chains to secure load.

Shift through 10-13 gears manually w/R hand along with pulling up transfer axel button. - Not Met

Client is required to utilize right hand to shift through 10-13 gears on a frequent basis, along with pressing transfer axel button (with 3-4th digits) to reach higher

Due to decreased strength, AROM, dexterity, and hypersensitivity; client would be unable to tolerate vibration of gear shifter as well as pushing axel button.

gears on truck.

Job Req. Comments

Job Req. Comments

Job Req. Comments

Job Req. Comments

Job Req. Comments



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Sit/Stand Tolerance

Reported Demonstrated Duration Demonstrated Interval

Sitting Without limitation Without limitation Without limitation

Standing Without limitation Without limitation Without limitation

Mr. Sample's demonstrated tolerance to sitting matched his reported ability. Mr. Sample's demonstrated tolerance to standing matched his reported ability.

Cardiovascular Status According to the ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription , exercise should not be initiated if blood pressure is uncontrolled (>160/100 mm Hg). Individuals with hypertension should avoid very strenuous aerobic activity, very heavy loads, sustained contractions, isometric handgrip, and Valsalva maneuver during lifting. Due to these guidelines the FCE would not be a safe test for anyone who’s Pre-Testing BP is uncontrolled. The cut off for safe resting heart rate is <100 bpm. Individuals with high resting heart rates would require medical clearance prior to proceeding with the FCE.

Pre-Testing Post-Testing

Blood Pressure (BP) 158/90 160/100

Heart Rate (HR) 80 76



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Musculoskeletal Assessment

Musculoskeletal ROM Normal (degrees)

ROM Right (degrees)

ROM Left (degrees)

Strength Right Strength Left Non-Phys Response

Finger (2nd) - MP Flexion

�90 80 90 5/5 5/5 None

Finger (2nd) - MP Extension

�20 0 20 5/5 5/5 None

Finger (2nd) - PIP Flexion

�100 60 100 4/5 5/5 None

Finger (2nd) - PIP Extension

�0 0 0 4/5 5/5 None

Finger (2nd) - DIP Flexion

�70 30 70 5/5 5/5 None

Finger (2nd) - DIP Extension

�0 0 0 3+/5 5/5 None

Finger (3rd) - MP Flexion

�90 60 90 5/5 5/5 None

Finger (3rd) - MP Extension

�20 10 20 4/5 5/5 None

Finger (3rd) - PIP Flexion

�100 80 105 4/5 5/5 None

Finger (3rd) - PIP Extension

�0 -20 0 4/5 5/5 None

Finger (3rd) - DIP Flexion

�70 50 85 3/5 5/5 None

Finger (3rd) - DIP Extension

�0 0 0 3/5 5/5 None

Finger (4th) - MP Flexion

�90 60 90 4+/5 5/5 None

Finger (4th) - MP Extension

�20 10 25 4/5 5/5 None

Finger (4th) - PIP Flexion

�100 80 105 4/5 5/5 None

Finger (4th) - PIP Extension

�0 -20 0 4-/5 5/5 None

Finger (4th) - DIP Flexion

�70 50 70 3+/5 5/5 None

Finger (4th) - DIP Extension

�0 0 0 3+/5 5/5 None



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Results

AROM and MMT were performed to determine Mr. Sample's range of motion and strength respectively. AROM below 75% and strength below 4-/5 are considered below functional limits. During MMT, attention is paid to any non- physiologic responses such as cogwheeling or breakaway. Cogwheeling is a jerky movement pattern similar to a tremor and breakaway is a complete sudden release of manual resistance.

Mr. Sample demonstrated below functional AROM for right finger {2nd) mp extension, right finger {2nd) pip flexion, right finger {2nd) dip flexion, right finger {3rd) mp flexion, right finger {3rd) mp extension, right finger {3rd) pip extension, right finger {3rd) dip flexion, right finger {4th) mp flexion, right finger {4th) mp extension, right finger {4th) pip extension, and right finger {4th) dip flexion and below functional strength for right finger {2nd) dip extension, right finger {3rd) dip flexion, right finger {3rd) dip extension, right finger {4th) dip flexion, and right finger {4th) dip extension.

Mr. Sample did not exhibit non-physiological responses to manual muscle testing.

During material handling, Mr. Sample performed lifting with excellent body mechanics.



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References

Effort Analysis Testing

1. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M Rogers S. 1985. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66:69-74

2. Mathiowetz V, Wiemer D, Federman S. 1986. Grip and pinch strength: norms for 6 to 19 year olds. Am J Occup Ther 40 (10): 705-11

3. Stokes H 1983. The seriously uninjured hand-weakness of grip. J Occup Med 25(9):683-684.

4. Niebuhr B, Marion R 1990. Voluntary control of submaximal grip strength. Am. J Phys Med Rehabil 69(2):96- 101

5. Matheson L, Carlton R, Niemeyer L 1988. Grip strength in a disable sample: reliability and normative standards. Ind rehabil Q 1(3):9, 17-23

6. Hildreth D, Breidenbach W, Lisiter G, Hodges A. 1989. Detection of submaximal effort by use of the rapid exchange grip. J Hand surgery 14A (4): 742-745

7. Kilmek E, Strait J 1997. Volition an impairment rating: the validity of effort assessment. J Occup Med 6(2) 9-18

8. Domangue, B., Stokes, H., Landrieu, K., & Kunen, S. (1995). Identification of low-effort patients through dynamometry. J Hand Surg, Vol 20, pp 1047-56

9. Cuoto S., Hupli M., Alaranta H., Hurri . Scandinavian Journal of Rehabilitation Medicine- 1996 Dec: 28(4): 207-10

10. Virgil Mathiowetz, MS, OTR, Nancy Kashman, OTR, Gloria Volland, OTR, Karen Weber, OTR, Mary Dowe, OTS, Sandra Rogers, OTS, "Grip and Pinch Strength: Normative Data for Adults", Occupational Therapy Program, University of Wisconsin-Milwaukee, Milwaukee, WI, Arch Phys Med Rehabil 66:69-72, Feb, 1985

11. Waddell G: Non-organic Physical Signs in Low Back pain. Spine 5: 117-125, Mar/Apr 1980

12. Main CJ, Waddell G. Behavioral Responses to Examination: A Reappraisal of the Interpretation of "Non-Organic Signs". Spine, 1998; 23(21): 2367-2371

13. Oesch, PR, Hilfiker, R, Kool, JP, Bachmann, S, Hagen, KB. {2010). Perceived functional ability assessed with the spinal function sort: is it valid for European rehabilitation settings in patients with non-specific non-acute low back pain? Eur Spine J, 19:1527-1533

14. Matheson, L, Kaskutas V, Mada, D. (2001). Development and construct validation of the Hand Function Sort. Journal of Occupational Rehabilitation, 11(2): 75–86

Pain Assessment

1. Fairbank JC, Pynsent PB, "The Oswestry Disability Index." Spine 2000; 25(22):2940-2952

2. Fairbank JCT, Couper J, Davies JB. "The Oswestry low Back Pain Questionnaire." Physiotherapy 1980; 66: 271- 273.

3. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975; 1:277-299

4. Vernon H, Mior S. "The Neck Disability Index: a study of reliability and validity." J Manipulative Physiol Ther. 1991 Sep;14(7):409-15.

5. Lawlis GF, Cuencas R, Selby D, McCoy CE. The development of Dallas pain questionnaire. Spine 1989; 14:515-16



FCE Sample

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Range of Motion/Cardiovascual Assessment

1. American Medical Association. Guides to the Evaluation of Permanent Impairment, Fourth Edition, Revised 1999

2. American Medical Association. Guides to the Evaluation of Permanent Impairment, Sixth Edition,

3. Guidelines of American Heart Association and Prescription for Programs of Prevention and Rehabilitation

4. Ebbeling CB1, Ward A, Puleo EM, Widrick J, Rippe JM., Development of a single-stage treadmill walking test, Med Sci Sports Exercise, 1991, Aug; 23(8) 966-73

Physical Capacity Assessment

1. U.S. Dept of Labor Dictionary of Occupational Titles, Fourth Edition Supplement, Appendix D, 101-102, 1986

2. Waters, Thomas R., et.al., Revised NIOSH Equation for the Design and Evaluation of Manual Lifting Tasks. Ergonomics, Volume 36, No. 7: 749-776, 1993

3. Tanaka, H,., Monahan, K.D. & Seals, D.R. Age Predicted Macimal Heart Rate Revisited; Journal of the American College of Cardiology, Jan 2001, Volume 37(1), 153-156

4. Khalil, T.M., Goldberg M.L., Asfour, S.S., et.al., Acceptable Maximum Effort (AME): A Psychological Measure of Strength in Back Pain Patients. Spine, 12:372-376, 1987

5. Hart, Dennis L., et.al., Effect of Lumbar Posture on Lifting, Spine, Volume 12, Number 2, 1987 pp138-145

6. Work Practices Guide for Manual Lifting, U.S. Dept of Health and Human Services, P.B. 82-178948, 1981, pp 18- 19

7. Florida Worker’s Compensation Uniform Medical Treatment/Status Reporting Form DFS-F5-DWC-25 (revised 2/14/2006)



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