Functional Capacity Evaluation
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Repetitive Gripping - Performed using 10 lb gripper
Not Met
Upper Body Endurance - Performed Upper body ergometer unilaterally
Not Met
Torquing - Performed in seated position with elbow in flexed position and repetitive pronation/supination completed.
Not Met
Essential Job Demand Status
Date of Injury 07/11/1991
Body Part/System Hand
Total FCE Time 4 hours - testing/reporting
Ref. Physician N/A
Occupation N/A
Name Sample Upper Extremity FCE
Job Req. PDC N/A
Employer N/A
Mr. Sample was referred to CORA Rehabilitation for an FCE to define his return to work ability.
Sincerity of EffortThe 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 SummaryMr. Sample's occasional lifting capabilities are at a Medium physical demand category (PDC). According to the US Department of Labor guidelines, Medium work is defined as lifting 20-50 pounds 0-33% of the workday.
Functional Restrictions & LimitationsMr. Sample arrived on time and was driven by his wife to the evaluation. He ambulated independently into facility with KAFO brace on L foot and L arm in "retracted" position. He answered questions appropriately and his musculoskeletal screen was consistent with his diagnosis. He demonstrated decreased sensation in both volar and dorsum of L thumb compared to R side and grip strength is less than half of the force produced by the R hand. He also demonstrated decreased endurance in the L UE compared to the R UE as well. He did NOT demonstrate self limiting pain behavior. His sincerity of effort testing indicated he was providing a consistent maximal effort and physiological responses throughout were consistent with maximal efforts. Based on these findings, this evaluation should be considered his safe and tolerable abilities at this time.
- Avoid repetitive gripping and torquing for greater than on an occasional basis (up to 20 non-consecutive minutes in agiven hour or up to 2.5 hours per day)
- Avoid lifting and carrying greater than 20 lbs with L hand at this time
Recommendations & AccommodationsMr. Sample should follow up with his medical team to review results of FCE and discuss any further plan of care considerations.
Mike Ligmanowski, PTA, ATC, CEASI, cWCHP
Evaluator 1 01/07/2019
SampleJanuary 7, 2019
FCE
Page 1
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Sara Torbett, OT
Evaluator 2 01/07/2019
SampleJanuary 7, 2019
FCE
Patient Demographics
Name:
SS#:
Referring Physician:
Date of Onset/Injury:
Surgery Date:
Gender:
Age:
Height:
Weight:
Hand Dominance:
Sample
N/A
N/A
July 11, 1991
May 2, 2016
Male
50
6 ft. 0 in.
187 lbs.
Left
Employment Information
Employer:
Occupation:
Claim #:
Insurance/Payer:
Job Req. PDC:
DOT Code:
Work Status:
N/A
N/A
Not Working
N/A
N/A
N/A
Self Pay
Diagnosis
S622 Fracture of first metacarpal bone
ICD-10 Description Code Description
History & Mechanism of Injury
Mr. Sample reports that he was injured on July 11, 1991.
Patient's Report of Injury:Initially injured in the war in 1991, he took up Paralympic cycling and had been training since 2013. On April 26, 2016 he was completing a training ride and crossing an intersection and a car turned into him. Emergency was called and he was taken to Flagler hospital and was diagnosed with a 1st metacarpal fracture in his left hand. Orthopedics was called and an ORIF was performed by Dr. Physician on 5/2/2016. No therapy was prescribed at that time. He reports he is left hand dominant and can no longer extend his left thumb and reports "clawing" in his Left pinky finger.
Past Medical History
He did attend therapy for this diagnosis. He did have surgery for this injury on May 2, 2016.
Traumatic Brain Injury 1991, 10 surgeries on L hand, tendon transfer and releases
MedicationMr. Sample is not taking any medication at this time. Mr. Sample reports that he did not take pain medication prior to the evaluation.
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6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
SampleJanuary 7, 2019
FCE
Page 3
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Pinch Grip Test Palmar Right 7.4% ≤11% COV Yes
Pinch Grip Test Palmar Left 6.0% ≤11% COV Yes
Static Strength Test Arm Lift 2.6% ≤11% COV Yes
Static Strength Test Pull 0.0% ≤11% COV Yes
Static Strength Test Push 5.1% ≤11% COV Yes
Pinch Grip Test Key Right 2.7% ≤11% 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 Bell Curve - MVE - Left Bell Curve Bell Curve MVE Yes
Pinch Grip Test Tip to Tip Right 4.2% ≤11% COV Yes
Jamar Hand Test Bell Curve - MVE - Right Bell Curve Bell Curve MVE Yes
Static Strength Test Static Comparison Knuckle>Arm Knuckle>Arm MVE Yes
Jamar Hand Test MVE Pos 2 Right 2.1% ≤11% COV Yes
Jamar Hand Test MVE Pos 2 Left 4.6% ≤11% COV Yes
Jamar Hand Test MVE Pos 1 Left 0.0% ≤11% COV Yes
Static Strength Test Knuckle Left 0.0% ≤11% COV Yes
Jamar Hand Test MVE Pos 1 Right 2.8% ≤11% COV Yes
Jamar Hand Test MVE Pos 3 Right 2.9% ≤11% COV Yes
Jamar Hand Test MVE Pos 5 Right 2.7% ≤11% COV Yes
Jamar Hand Test MVE Pos 5 Left 4.9% ≤11% COV Yes
Jamar Hand Test MVE Pos 4 Left 4.0% ≤11% COV Yes
Jamar Hand Test MVE Pos 3 Left 3.7% ≤11% COV Yes
Jamar Hand Test MVE Pos 4 Right 3.5% ≤11% COV Yes
Test Result Expected Measure Reliable
Sincerity of Effort
Hand grip, pinch grip and static testing were used to determine if Mr. Sample's performance is consistent and reliable.
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.
SampleFCE
January 7, 2019
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
3 145.0 140.0 137.0 140.7 4.0 2.9%4 135.0 130.0 126.0 130.3 4.5 3.5%5 110.0 110.0 105.0 108.3 2.9 2.7%
2 140.0 135.0 140.0 138.3 2.9 2.1%1 100.0 105.0 100.0 101.7 2.9 2.8%
Right Hand Avg. SD COV
3 70.0 68.0 65.0 67.7 2.5 3.7%4 75.0 70.0 70.0 71.7 2.9 4.0%5 60.0 60.0 55.0 58.3 2.9 4.9%
2 65.0 65.0 60.0 63.3 2.9 4.6%1 40.0 40.0 40.0 40.0 0.0 0.0%
Left Hand Avg. SD COV
Rapid Exchange Grip
Left 0 lbs 70 lbs PassRight 0 lbs 145 lbs PassPosition 3 REG MVE Results
Comments: unable to properly assess rapid exchange due to L hand ROM deficits
Results
The results of these tests show that Mr. Sample demonstrated consistent and maximal effort.
The data obtained for Mr. Sample did demonstrate a bell shaped curve which indicates 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 positive rapid exchange grip which indicates submaximal effort. Mr. Sample's grip strength is within the normal range when compared to published norms.
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6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
SampleJanuary 7, 2019
FCE
Page 5
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Left 16.0 17.0 20.0 17.7 2.1 11.8%Right 22.0 21.0 21.0 21.3 0.6 2.7%
Key Grip Avg. SD CV
Left 10.0 10.0 8.0 9.3 1.2 12.4%Right 14.0 14.0 13.0 13.7 0.6 4.2%
Tip Grip Avg. SD CV
Left 10.0 9.0 10.0 9.7 0.6 6.0%Right 15.0 17.0 15.0 15.7 1.2 7.4%
Palmar Grip Avg. SD CV
Comments: Middle phalanyx on L hand non functional in palmar gripping
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 maximal key grip was greater than his maximal tip grip which indicates maximal effort. Mr. Sample's pinch grip is below normal when compared to published norms.
Static Strength Test
Bilat 110.0 115.0 110.0 111.7 2.9 2.6%Arm Test Avg. SD CV
Bilat 70.0 70.0 70.0 70.0 0.0 0.0%Pull Test Avg. SD CV
Bilat 55.0 60.0 55.0 56.7 2.9 5.1%Push Test Avg. SD CV
Bilat 125.0 125.0 125.0 125.0 0.0 0.0%Knuckle Test Avg. SD CV
Results
Mr. Sample's static strength testing showed an average force of 111.7 pounds for arm curl, 56.7 pounds for pushing at chest height, 70.0 pounds for pulling at chest height, and 125.0 pounds for upright pull at knuckle height. The coefficient of variations measured during the static strength testing are less than the 11% acceptable limit showing Mr. Sampleperformed the test with consistent effort. Mr. Sample's maximal knuckle lift was greater than his max arm lift which indicates maximal effort.
Pinch Grip Strength Test
SampleJanuary 7, 2019
FCE
Page 6
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Pain Assessment
7/10 8/10Pre-FCE Post-FCE
Symptom Magnification
McGill 15 <31 NegativeTest Result Expected Symptom Magnification
The results of this evaluation show that Mr. Sample demonstrated negative symptom magnification.
McGill Pain IndexResults
Mr. Sample scored 15 on the McGill Pain Index which shows a low pain focus.
SampleJanuary 7, 2019
FCE
Page 7
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Job Demand AnalysisA detailed job demand analysis shows Mr. Sample's ability for overall physical capacity, material handling, non-material handing and essential functions.
Reaching Waist to Overhead N/A Occasional N/AForward Reaching N/A Occasional N/A
Physical Demand Category N/A Medium N/A
Activity Job Requirement Demonstrated Ability Meets Job Requirement
Performed using 10 lb gripper Not MetPerformed Upper body ergometer unilaterally Not Met
Performed in seated position with elbow in flexed position and repetitive pronation/supination completed.
Not Met
Essential Job Demand Meets Job Requirement
> 20 lbs.> 50 lbs.> 100 lbs.
10-20 lbs.25-50 lbs.50-100 lbs.
0-10 lbs.10-25 lbs.20-50 lbs.
Negligible0-10 lbs.0-20 lbs.
N/ANegligible0-10 lbs.
Very Heavy
Heavy
Medium
Light
Sedentary
67-100% or 500+ Reps34-66% or 100-500 Reps0-33% or 1-100 Reps
ConstantFrequentOccasionalPhysical Demand Category
SampleJanuary 7, 2019
FCE
Page 8
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Lifting Floor to Waist
N/A lbs. 50 lbs. N/A Demonstrated ability to safely lift 50 lbs from floor to waist on an occasional basis.
N/A
Job Req. Demonstrated Frequency & Duration ROM/Position/Parameter Comments
(R) Unilateral Carry
N/A lbs. 30 lbs. N/A Demonstrated ability to lift and carry 30 lbs with RUE a distance of 50 feet
N/A
Job Req. Demonstrated Frequency & Duration ROM/Position/Parameter Comments
(L) Unilateral Carry
N/A lbs. 20 lbs. N/A Demonstrated ability to lift and carry 20 lbs with LUE a distacne of 50 feet.
N/A
Job Req. Demonstrated Frequency & Duration ROM/Position/Parameter Comments
Material Handling
SampleJanuary 7, 2019
FCE
Page 9
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Reaching Waist to Overhead
N/A Occasional Performed in standing position with pegs located directly in front at chest height and above
Completed 7:35 and reported fatigue in bilateral upper extremities and unable to continue.
Job Req. Demonstrated ROM/Position/Parameter Comments
Forward Reaching
N/A Occasional Performed in seated position with cones located directly in front at chest height
Completed 4:17 and reported fatigue and discomfort in L hand
Job Req. Demonstrated ROM/Position/Parameter Comments
Non-Material Handling
SampleJanuary 7, 2019
FCE
Page 10
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Performed Upper body ergometer unilaterally
Completed L: 5:23 and R: 10:00 respectively and completed on the R side but noted fatigue with the L side and unable to continue
Job Req. Comments
Upper Body Endurance - Not Met
Performed using 10 lb gripper Completed L: 1:45 and R:6:04 respectively and reported fatigue and unable to continue.
Job Req. Comments
Repetitive Gripping - Not Met
Performed in seated position with elbow in flexed position and repetitive pronation/supination completed.
Completed L: 2:37 and R: 4:02 respectively and noted fatigue and unable to continue
Job Req. Comments
Torquing - Not Met
Essential Job Demand
SampleJanuary 7, 2019
FCE
Page 11
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Cardiovascular Status
Heart Rate (HR) 51 50Blood Pressure (BP) 107/75 116/74
Pre-Testing Post-Testing
Musculoskeletal Assessment
Thumb - MCP Flexion ≥60 75 45 N/T N/T N/TWrist - Radial Deviation ≥20 30 36 5/5 5/5 None
Thumb - IP Flexion ≥80 80 85 N/T N/T N/TThumb - MP Extension ≥0 0 0 N/T N/T N/T
Wrist - Flexion ≥60 65 44 5/5 5/5 None
Wrist - Ulnar Deviation ≥30 40 36 5/5 5/5 NoneWrist - Extension ≥60 66 70 5/5 5/5 None
Finger (2nd) - PIP Extension
≥0 0 0 N/T N/T N/T
Finger (2nd) - PIP Flexion
≥100 100 110 N/T N/T N/T
Finger (2nd) - DIP Flexion
≥70 70 75 N/T N/T N/T
Thumb - CMC Radial Abduction
≥50 60 34 N/T N/T N/TThumb - IP Extension ≥10 +25 +30 N/T N/T N/T
Finger (2nd) - MP Extension
≥20 0 0 N/T N/T N/T
Finger (2nd) - MP Flexion
≥90 90 0 N/T N/T N/T
Musculoskeletal ROM Normal (degrees)
ROM Right (degrees)
ROM Left (degrees)
Strength Right Strength Left Non-Phys Response
Sit/Stand Tolerance
Standing Without limitation Without limitation Without limitation
Sitting Without limitation Without limitation Without limitation
Reported Demonstrated Duration Demonstrated Interval
SampleJanuary 7, 2019
FCE
Page 12
6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
Finger (4th) - DIP Extension
≥0 0 90 N/T N/T N/T
Finger (5th) - MP Flexion
≥90 90 0 N/T N/T N/T
Finger (4th) - PIP Extension
≥0 0 +45 N/T N/T N/T
Finger (4th) - DIP Flexion
≥70 82.5 90 N/T N/T N/T
Finger (5th) - MP Extension
≥20 0 0 N/T N/T N/T
Finger (5th) - DIP Flexion
≥70 70 85 N/T N/T N/T
Finger (5th) - DIP Extension
≥0 0 +50 N/T N/T N/T
Finger (5th) - PIP Flexion
≥100 85 90 N/T N/T N/T
Finger (5th) - PIP Extension
≥0 0 +35 N/T N/T N/T
Finger (4th) - PIP Flexion
≥100 110 100 N/T N/T N/T
Finger (3rd) - MP Extension
≥20 0 0 N/T N/T N/T
Finger (3rd) - PIP Flexion
≥100 100 110 N/T N/T N/T
Finger (2nd) - DIP Extension
≥0 0 0 N/T N/T N/T
Finger (3rd) - MP Flexion
≥90 90 0 N/T N/T N/T
Finger (3rd) - PIP Extension
≥0 0 0 N/T N/T N/T
Finger (4th) - MP Flexion
≥90 85 0 N/T N/T N/T
Finger (4th) - MP Extension
≥20 0 0 N/T N/T N/T
Finger (3rd) - DIP Flexion
≥70 85 70 N/T N/T N/T
Finger (3rd) - DIP Extension
≥0 0 70 N/T N/T N/T
Comments: Semmes-Weinstein: Dorsum: Thumb: L: 6.65 R: 3.61 Index: L: 4.31 R: 3.61 Middle: L: 4.31 R: 4.31 Ring: L: 4.56 R: 4.31 Pinky: L: 3.61 R: 4.31 Volar: Thumb: L: 4.56 R: 3.61 Index: L: 5.07 R: 3.61 Middle: L: NT R: 3.61 Ring: L: NT R: 3.61 Pinky: L: NT R: 3.61. Was unable to test last three digits on left hand due to contracture. Purdue Peg Board: R: 9 L: 2 B: 2 Asseembly: 1
Results
SampleFCE
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6248 103rd Street Jacksonville, FL 32210 • Ph: 904-573-0046 • Fx: 904-573-0772 • [email protected] • www.corahealth.com
January 7, 2019
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 left thumb cmc radial abduction, left finger (2nd) mp flexion, bilateral finger (2nd) mp extension, left finger (3rd) mp flexion, bilateral finger (3rd) mp extension, left finger (4th) mp flexion, bilateral finger (4th) mp extension, left finger (5th) mp flexion, bilateral finger (5th) mp extension, and left wrist flexion.
Mr. Sample did not exhibit non-physiological responses to manual muscle testing.
During material handling, Mr. Sample performed lifting with � body mechanics.