functional capacity evaluation...sincerity of effort the results of this evaluation show that mr....

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


Sara Torbett, OT

Evaluator 2 01/07/2019


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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FCE

Page 3


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


Static Strength Test Knuckle Left 0.0% ≤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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FCE

Page 5


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


FCE

Page 6


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.


FCE

Page 7


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


FCE

Page 8


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


(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


Material Handling


FCE

Page 9


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


FCE

Page 10


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


FCE

Page 11


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


FCE

Page 12


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

Page 13


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.

functional capacity evaluation...sincerity of effort the results of this evaluation show that mr....

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