AMA Guides® Newsletter - Issue Archive

Articles

1. Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

   James B. Talmage, Jay Blaisdell

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2017.MarApr01

   Abstract

   Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.
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2. In the Literature

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.2017.MarApr02

   Abstract

   A method for determining the severity of a presentation of cognitive impairment has been developed and scientifically validated specifically for use with cases in which the causative diagnosis is traumatic brain injury. The method determines if the impairment, as demonstrated on neuropsychology testing, is consistent with the severity of the claimed cause. Such scientific linkage of an objective measurement of impairment severity and the severity of the cause is quite rare. The research related to this method did not consider methodology for impairment rating presented in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), so this article compares the new method to the impairment rating methodology from the AMA Guides, Sixth Edition, Section 13.3d, Mental Status, Cognition, and Highest Integrative Function. This article offers an example of how neuropsychology test results for an individual case can be applied to the classes of impairment that are included in Table 13-8, Criteria for Rating Neurologic Impairment Due to Alteration in Mental Status, Cognition, and Highest Integrative Function. This method has the advantages of standardization, objectivity, and being based on scientific findings that make the unique contribution of actually linking severity of impairment to severity of the causative factors. The authors caution that the method is only a subset of the methodology from Section 13.3d and does not justify abandonment of the remainder of this section of the AMA Guides.
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3. Rating Cognitive Impairment, Part 2: Objective and Evidence-Based Integration of Neuropsychology Testing

   Robert J. Barth, John E. Meyers

   Pages 6–12

   DOI: 10.1001/amaguidesnewsletters.2017.MarApr03

   Abstract

   Hearing impairment rating determination is described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 11.2a, Criteria for Rating Impairment Due to Hearing Loss. A hearing impairment evaluation for adults who have acquired language skills is derived from a pure-tone audiogram and always is based on the functioning of both ears even though hearing loss may be present in only one ear. Audiometers should be properly calibrated, and technicians should be appropriately trained to obtain accurate measurements. Audiograms typically are obtained at four frequencies (test frequencies): 500, 1000, 2000, and 3000 Hz, which are considered to be representative of everyday auditory speech ranges. The evaluator tests the individual's right and left ears at the test frequencies and adds the decibel levels for each of these frequencies for each ear separately; consults Table 11-2, Computation of Binaural Hearing Impairment; and finally consults Table 11-3, Relationship of Binaural Hearing Impairment to Impairment of the Whole Person. Tinnitus can be rated if the individual experiences hearing loss in the ear and this loss affects speech discrimination; loss is limited to a maximum of 5% loss. The AMA Guides provides no correction in the hearing section for age-related loss of hearing, although the latter may be apportionable. A table presents a model hearing impairment report.
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4. Hearing Impairment

   Kathryn Mueller, Christopher R. Brigham

   Pages 13–14

   DOI: 10.1001/amaguidesnewsletters.2017.MarApr04

5. Q&A: Multiple Lower Extremity Impairments and AMA Guides, Third Edition, Revised

   Christopher R. Brigham, Kathryn Mueller, Steven Demeter, Randolph Soo Hoo

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2017.MarApr05