Cutting Edge Techniques Cutting Edge Techniques For For Functional Capacity Functional Capacity Evaluation Evaluation Utilizing Utilizing Ariel Performance Ariel Performance Analysis Systems Analysis Systems By Robert Wainwright, P.T. By Robert Wainwright, P.T. President, Kinematic Consultants, President, Kinematic Consultants, Inc Inc Point Pleasant, NJ Point Pleasant, NJ
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Cutting Edge Techniques For Functional Capacity Evaluation Utilizing Ariel Performance Analysis Systems By Robert Wainwright, P.T. President, Kinematic.
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Cutting Edge Techniques Cutting Edge Techniques For For
Utilizing “State of the Art” Technology (APAS) to Utilizing “State of the Art” Technology (APAS) to Measure Function in Work, ADL and Recreation Measure Function in Work, ADL and Recreation
Test Protocols Designed Test Protocols Designed and and
Administered byAdministered by Licensed Physical TherapistsLicensed Physical Therapists
Biomedical EngineersBiomedical Engineers
Medical and Workers Medical and Workers Compensation Issues Compensation Issues
ConsideredConsidered
Safe Return to WorkSafe Return to Work Altered Duty Capacity RecommendationAltered Duty Capacity Recommendation Residual Dysfunction %Residual Dysfunction % Examinee ReliabilityExaminee Reliability Case ClosureCase Closure Legal SupportLegal Support
Providing Support in Medical Providing Support in Medical Decision Making To:Decision Making To:
Treating PhysicianTreating Physician Independent Medical Evaluation PhysicianIndependent Medical Evaluation Physician Case Manager Case Manager Rehabilitation NurseRehabilitation Nurse Insurance and Risk Management PersonnelInsurance and Risk Management Personnel EmployerEmployer
What To Expect From An What To Expect From An FCE?FCE?
EXAMINEE RELIABILITYEXAMINEE RELIABILITY during the FCE (% Effort Level during the FCE (% Effort Level and Coefficient of Variation).and Coefficient of Variation).
RESIDUAL DEFICIT OR DYSFUNCTIONRESIDUAL DEFICIT OR DYSFUNCTION (body part (body part specific.)specific.)
GENERAL FUNCTIONAL ABILITYGENERAL FUNCTIONAL ABILITY (activities of daily living: (activities of daily living: walking, balancing, bending, climbing, squat, reach, etc.).walking, balancing, bending, climbing, squat, reach, etc.).
SPECIFIC STRENGTH CAPABILITYSPECIFIC STRENGTH CAPABILITY (push, pull, lift). (push, pull, lift). SPECIFIC WORK CAPACITYSPECIFIC WORK CAPACITY category (Examinee’s specific category (Examinee’s specific
and current qualification: sedentary thru very heavy).and current qualification: sedentary thru very heavy). JOB REQUIREMENTSJOB REQUIREMENTS (Job description from Employer and (Job description from Employer and
Dictionary of Occupational Titles).Dictionary of Occupational Titles). Definitive Statement of Examinee’s capacity to return to Definitive Statement of Examinee’s capacity to return to FULL FULL
DUTY, ALTERED DUTY OR NOT AT ALL.DUTY, ALTERED DUTY OR NOT AT ALL.
In Summary, A Kinematic FCE In Summary, A Kinematic FCE Answers The Following:Answers The Following:
Is the ExamineeIs the Examinee:: Demonstrating maximum effort Demonstrating maximum effort
and cooperation during the FCE?and cooperation during the FCE? Suffering residual dysfunction?Suffering residual dysfunction? Capable of safe return to work for Capable of safe return to work for
or altered duty?”or altered duty?”
How Do We Get The Answers How Do We Get The Answers You Need?You Need?
Standard “Low Technology” Functional Standard “Low Technology” Functional Capacity EvaluationCapacity Evaluation
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
Click on the picture to see the animation
KINEMATIC ASSESSMENTKINEMATIC ASSESSMENT::
““THREE DIMENSION THREE DIMENSION MOVEMENT ANALYSIS”MOVEMENT ANALYSIS”
TECHNICAL ADVANCES FROM THE TECHNICAL ADVANCES FROM THE SCIENCE OF SPORT ANALYSIS *SCIENCE OF SPORT ANALYSIS *
•Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.•Click on the picture to see the animation
CALIBRATION (VOLUME) CUBE FOR GAITCALIBRATION (VOLUME) CUBE FOR GAIT
OPEN LOOP STRENGTH TESTINGOPEN LOOP STRENGTH TESTING
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
CLOSED LOOP LIFT TESTINGCLOSED LOOP LIFT TESTING
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
DYNAMIC DYNAMIC ELECTROMYOGRAPHYELECTROMYOGRAPHY
“Monitoring the electrical activity of muscle groups during work
activities.”
EMG POST KNEE INJURY AND SURGERYEMG POST KNEE INJURY AND SURGERY
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
ELECTROMYOGRAPHY MONITORING OF TEST PROTOCOLELECTROMYOGRAPHY MONITORING OF TEST PROTOCOL
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
WORK SITE JOB ANALYSISWORK SITE JOB ANALYSIS Determine if the job is a Determine if the job is a
contributing factor to injury.contributing factor to injury. Determine if Examinee work Determine if Examinee work
technique is a contributing factor technique is a contributing factor to un-successful return to work.to un-successful return to work.
Job Title: FishermanJob Title: Fisherman
Sewage processing plant. Job of Sewage processing plant. Job of “Fisherman.”“Fisherman.”
General Employer Problem: multiple cases General Employer Problem: multiple cases ofof rotator cuff and low back problems.
OutcomeOutcome
Work technique contributes to shoulder and Work technique contributes to shoulder and low back stress.low back stress.
Researched plant construction and found Researched plant construction and found this aeration system to be outdated.this aeration system to be outdated.
Reconstruction not feasible.Reconstruction not feasible. Changed work biomechanics technique to Changed work biomechanics technique to
de-stress shoulder and low back.de-stress shoulder and low back.
Office Worker: Chronic Neck Office Worker: Chronic Neck and Back Painand Back Pain
Worker suffers chronic neck and back pain Worker suffers chronic neck and back pain resulting from multiple automobile resulting from multiple automobile accidents.accidents.
Job requires 90% computer terminal work.Job requires 90% computer terminal work. Is ergonomic workstation or work technique Is ergonomic workstation or work technique
a contributing factor?a contributing factor?
Ergonomic Work Station AnalysisErgonomic Work Station Analysis
OutcomeOutcome
Modifications Suggested Include:1. New, sturdy chair with ergonomic adjustments.2. Take Monitor off elevated platform.3. Back seat adjusted to more upright position.4. Seat raised to decrease shoulder stress.5. Adjustable foot rest added to decrease low back
tension.
Employee performs job in a relaxed posture, relieving chronic neck and back strain.
Case StudiesCase Studies
Case #1 Case #1 No Light At The End of the No Light At The End of the
Carpal TunnelCarpal Tunnel
A 32 year old road laborer A 32 year old road laborer who developed Carpal Tunnel who developed Carpal Tunnel from repetitive stress trauma.from repetitive stress trauma.
Patient diagnosed with EMG and NCV.Patient diagnosed with EMG and NCV. Surgical release performed 16 months prior to Surgical release performed 16 months prior to
analysis.analysis. Patient returning to court for upgraded impairment Patient returning to court for upgraded impairment
rating for continued pain and dysfunction.rating for continued pain and dysfunction. FCE ordered by the County for accurate FCE ordered by the County for accurate
assessment and verification of complaints.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.* 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.
FinancialFinancialJudge originally awarded a 12.5% for the
operated right carpal tunnel.
Outcome FCE results reveal no current dysfunction FCE results reveal no current dysfunction
of right wrist. of right wrist. Right wrist functioning better than left.Right wrist functioning better than left. No increase in impairment rating.No increase in impairment rating.
Case #2Case #2The Chronic Cervical SprainThe Chronic Cervical Sprain
Chronic Cervical SprainChronic 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.
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
OutcomeOutcome
FCE negative for objective evidence in FCE negative for objective evidence in support of her complaints of ROM support of her complaints of ROM distress.distress.
Dynamic EMG demonstrates SCM Dynamic EMG demonstrates SCM symmetry, negative for spasm.symmetry, negative for spasm.
Recommendations: Recommendations: No active treatment.No active treatment.
Case #3Case #3The Remote Kinematic FCEThe Remote Kinematic FCE
31 year old male.31 year old male. Struck by an automobile while working.Struck by an automobile while working. Resulted in a Fractured Pelvis and Low Resulted in a Fractured Pelvis and Low
Back Sprain.Back Sprain. Treated for 2 years and declared to be Treated for 2 years and declared to be
totally disabled for life by his Orthopedic totally disabled for life by his Orthopedic Surgeon.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.
* 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.
OutcomeOutcome
Report was presented to the opposing Report was presented to the opposing Attorney by the Insurance Company Attorney by the Insurance Company Attorney.Attorney.
Two days after receiving the report, the Two days after receiving the report, the case was settled.case was settled.
Case #4Case #4The “FALL”The “FALL”
The FallThe Fall
47 year old laborer, Home Improvement Center.47 year old laborer, Home Improvement Center. Incident involving lifting of stock, fell backwards, Incident involving lifting of stock, fell backwards,
injuring his low back. No hard diagnostic injuring his low back. No hard diagnostic evidence.evidence.
1 1/2 years after incident, he continues to be out of 1 1/2 years after incident, he continues to be out of work and seeking medical opinions. Complaints work and seeking medical opinions. Complaints include severe back pain, right and left legs give include severe back pain, right and left legs give out and collapse.out and collapse.
* 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.
OutcomeOutcome
Examinee was returned to work Examinee was returned to work without protest.without protest.
Case closed.Case closed.
How To Read A Kinematic How To Read A Kinematic Functional Capacity ReportFunctional Capacity Report
BACK TO WORK RECOMMENDATIONBACK TO WORK RECOMMENDATION
LAST PAGE
EXAMINEE RELIABILITY (VALIDITY) EXAMINEE RELIABILITY (VALIDITY) MEASURE OF MEASURE OF
COOPERATION AND EFFORTCOOPERATION AND EFFORT
RESIDUAL DEFICIT OR DYSFUNCTIONRESIDUAL DEFICIT OR DYSFUNCTION
DETAILS OF THE ANALYSISDETAILS OF THE ANALYSIS
* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.
CLOSING THOUGHTS!CLOSING THOUGHTS!
What can a Kinematic FCE Do For What can a Kinematic FCE Do For You as Employer or Risk Manager?You as Employer or Risk Manager?
Kinematic FCE cannot determine the diagnosis.Kinematic FCE cannot determine the diagnosis. It can confirm whether the Examinee is moving, lifting, push/ It can confirm whether the Examinee is moving, lifting, push/
pulling, bending, posturing, and or demonstrating muscular pulling, bending, posturing, and or demonstrating muscular imbalance in a dysfunctional manner that is compatible with imbalance in a dysfunctional manner that is compatible with diagnosis and or complaints. diagnosis and or complaints.
It can determine Examinee’s Reliability to perform with It can determine Examinee’s Reliability to perform with maximum effort during the FCE (correlate with symptom maximum effort during the FCE (correlate with symptom magnification and or malingering).magnification and or malingering).
It can match Examinee’s current ability with essential job It can match Examinee’s current ability with essential job demands.demands.
It can determine safe return to work.It can determine safe return to work. It can provide objective evidence for case closure, case settlement It can provide objective evidence for case closure, case settlement
and “fitness for duty (employee termination)”.and “fitness for duty (employee termination)”.
When should an FCE be When should an FCE be CONSIDERED?CONSIDERED?
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 non-medical 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.