AMA Guides® Newsletter - Issue Archive

Articles

1. Assessing Mild Traumatic Brain Injury

   Nathan D. Zasler, Michael F. Martelli

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.1998.NovDec01

   Abstract

   Mild traumatic brain injury (MTBI) accounts for approximately 80% of the estimated 373000 traumatic brain injuries that occur annually in the United States. MTBI typically occurs in males 15 to 24 years of age, and postconcussional sequelae may impede physical, emotional, social, marital, vocational, and avocational functioning. Usually the severity of the initial neurologic injury is defined according to the Glasgow Coma Score, the presence and duration of amnesia (retrograde and anterograde), and the alteration of loss of consciousness and its duration. MTBI is a traumatically induced physiological disruption of cerebral function manifested by at least one of the following: loss of consciousness no longer than 20 minutes; any loss of memory; any alteration in mental status at the time of the accident; physical symptoms that potentially are related to the brain; and development of posttraumatic cognitive deficits not accounted for by emotional factors. When a patient presents with multisystem trauma, impairments may involve several parts of the body, including the nervous system. Individual impairments of other systems should be calculated separately and their whole person values combined using the Combined Values Chart in AMA Guides to the Evaluation of Permanent Impairment. At present, no ideal system can rate impairment following MTBI, and physicians must thoroughly understand both the underlying disease process and the associated injuries.
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2. Clinical Update: Tinnitus

   Robert Thayer Sataloff, Joseph Sataloff, Steven Mandel

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.1998.NovDec02

   Abstract

   Momentary or intermittent tinnitus—perceived sounds that originate within a person's head rather than in the outside world—is common; continuous tinnitus is abnormal but not unusual. According to the National Center for Health Statistics, 32% of US adults acknowledge having experienced tinnitus at some time; 6.4% characterize the condition as debilitating or severe; and prevalence increases with age to approximately 70 years and declines thereafter. A patient with tinnitus is assessed initially using a comprehensive otologic and neurotologic history, a physical examination, and selected tests of otologic function. Current tests can evaluate hearing and balance, but no good, comprehensive, objective methods exist to determine the presence of tinnitus, quantify the symptoms, or assess its severity. For these reasons, there are no scientific data on which to base a judgment regarding impairment or disability, and tinnitus alone generally is not considered compensable. The AMA Guides to the Evaluation of Permanent Impairment allows some adjustment for unilateral, but not bilateral, tinnitus that may impair speech discrimination. No scientific justification supports this policy, and there is no defensible basis for this disparity. Thus, additional research is necessary before this subjective symptom can be used reliably in impairment and disability determinations.
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3. Impairment Tutorial: The Combined Values Chart

   Christopher R. Brigham

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1998.NovDec03

   Abstract

   Impairment values are more often combined than added, and the Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment can be used to calculate the combined value of two numbers. The values are derived from the formula A + B(1 – A) = the combined value of A and B, where A and B are the decimal equivalents of the impairment ratings. This mathematically prevents an estimate of impairment greater than 100%. With smaller numbers, the combined value may equal the arithmetic sum of the 2 numbers. Impairments of different organ systems are converted to whole person impairment ratings before combining. In most lower extremity impairment cases only one evaluation method is used, but certain circumstances justify combining impairments. Examples in the lower extremity include diagnosis-based estimates with short leg, degenerative joint disease (in the case of fractures in and about joints), and neurologic loss. Combining vs adding can be confusing, but one can nearly always combine, with the following exceptions for the musculoskeletal system: range of motion (ROM) deficits within an upper extremity; ROM deficits of the thumb; total hand impairment; rating hip or knee replacement results; and ROM deficits of the spine at a specific level.
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4. Literature Review

   Mohammed Ranavaya

   Pages 12–12

   DOI: 10.1001/amaguidesnewsletters.1998.NovDec04