Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bell's Palsy


Related Terms

  • Bell's Paralysis
  • Cranial Mononeuropathy VII
  • Idiopathic Facial Palsy
  • Idiopathic Facial Paralysis
  • Peripheral Facial Palsy
  • Unilateral Facial Paralysis

Differential Diagnosis

Specialists

  • Family Physician
  • Neurologist
  • Ophthalmologist

Factors Influencing Duration

Factors that may influence the length of disability include the severity of symptoms, the duration of symptoms, and whether surgery is needed.

Medical Codes

ICD-9-CM:
351.0 - Bells Palsy; Facial Palsy

Overview

Bell's palsy is paralysis or weakness on one side of the face because of damage to the seventh (facial) cranial nerve, which is responsible for motor innervation of the muscles of the face. Paralysis occurs in some or all of the muscles on the affected side. Other symptoms of the condition include an inability to close the eye on the affected side of the face, a hypersensitivity to sound in the affected ear, pain, headache, tearing, drooling, and impairment of taste.

The condition comes on abruptly and can range from mild to severe, with total paralysis on one side of the face within 48 hours after symptoms first appear. Symptoms usually peak within 3 to 5 days. Symptoms develop over a period of hours, and since onset is usually first noted in the morning, the onset is believed to be during sleeping hours. The cause of Bell's palsy is not known. Idiopathic facial paralysis is the diagnosis in 60% to 75% of cases (Zalvan). One prevalent theory suggests that the facial nerve becomes swollen and injured when a viral infection, especially herpes simplex virus (HSV) infection, is reactivated. Other suggested causes include autoimmune disease, vascular problems, allergies, and infectious agents. Cranial neuritis caused by herpes simplex virus has been demonstrated in many studies, supporting the idea of a viral cause for Bell's palsy. It has also been linked to intranasal administration of an influenza vaccine, but the causative mechanism has not been described (Zalvan).

A symptomatic grading system developed for Bell's palsy describes grades I and II as having good outcomes, grades III and IV as producing moderate facial dysfunction, and grades V and VI as having poor outcomes, ranging from only slight facial motion to complete facial paralysis.

Incidence and Prevalence: Approximately 40,000 cases of Bell's palsy are reported each year in the United States ("Bell’s Palsy"). It affects 20 to 30 individuals per 100,000 people (Zalvan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with herpes simplex or other herpes viruses infection, diabetes, upper respiratory ailments (such as the flu or a cold), and compromised immune systems are at higher risk for Bell's palsy. The condition occurs primarily in individuals over age 15, with a mean onset of early to mid-40s and increased onset over age 65 (Zalvan), but it can occur at any age. Pregnant women appear to have an increased risk for developing the condition since incidence is higher in this group (Zalvan). Individuals with a family history of the condition are also at greater risk. It affects males and females equally until middle age and over age 65 predominates in males (Zalvan).

Source: Medical Disability Advisor



Diagnosis

History: The most obvious symptom of Bell's palsy is an unexplained episode of unilateral facial weakness or paralysis. Individuals may report other symptoms, including a headache, tearing, changes in the amount of saliva and tears, drooling, difficulty eating and drinking, change in facial appearance, impairment of taste, and hearing loss. Some individuals report having a mild cold, influenza, or other upper respiratory tract infection within a week prior to the onset of Bell's palsy. The individual may report a history of diabetes or prior herpes infection with a recent outbreak. A complete history of current and prior illnesses is usually obtained.

Physical exam: The exam reveals facial asymmetry, drooling, increased distance between the top and bottom eyelids (palpebral fissure width), a smooth forehead, and a flattened crease between the nose and the upper lip (nasolabial fold). No other evidence of central nervous system signs is usually noted. The ear and neck will be examined fully for any conditions contributing to the symptoms. If the face is paralyzed except for the forehead, a central nervous system cause is sometimes suspected. The extent of facial dysfunction will be graded (grades I through VI) according to standard definitions.

Tests: No specific test confirms Bell’s palsy; the initial diagnosis is made through observation. Laboratory testing may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein, antinuclear antibodies, and blood chemistries to rule out underlying illness such as autoimmune or other immunologic disease, diabetes, neoplastic disease, or infectious disease. Serological laboratory tests may be done to rule out Lyme disease. An antineutrophil cytoplasmic antibody (cANCA) test may be performed if Wegener granulomatosis is a possible underlying diagnosis.

A careful cranial nerve examination is typically performed, including a tuning fork examination to test hearing and testing for corneal sensation. A simple test of taste should be performed. Audiometry may also be used to evaluate hearing. Nerve excitability testing may also be performed through the use of electromyography (EMG) for assessing facial paralysis by measuring voluntary motor activity, and electroneuronography for determining the extent of nerve fiber degeneration. EMG usually is not thought to be reliable sooner than 18 days after onset of the paralysis. Blepharokymographic analysis may be used to evaluate eyelid motion, which can confirm the diagnosis and help predict the prognosis. Imaging (x-ray, MRI, or CT) may be performed to evaluate other possible pressure sources such as infection, tumor, or skull fracture (“Bell’s Palsy”).

Source: Medical Disability Advisor



Treatment

In many cases, no treatment is recommended. Although there is no specific treatment available for Bell's palsy, corticosteroids are commonly prescribed to reduce inflammation and swelling, relieving pressure on the affected nerve. When treatment is necessary, the goal is to relieve the symptoms. If an individual is unable to close the affected eye, lubricating eye drops may be used during the day, and lubricating ointment, an eye patch, or moist chamber lenses at night. Analgesics may be used for pain. Antiviral medication may reduce or limit damage to the nerves from viral causes. Some success in treatment has been achieved using electromyographic rehabilitation (EMGR), botulinum toxin injections to control involuntary facial contractions that may develop, and facial massage. Acupuncture and relaxation techniques have resulted in improvement in some cases.
Surgical decompression of the facial nerve may be attempted by opening the bony passage through which the nerve passes to relieve pressure on the swollen nerve. This reduction in pressure allows blood vessels to supply the nerve with oxygen and nutrients. However, surgeons consider the procedure of limited value for incomplete paralysis and seldom perform it except when complete paralysis is present.
Surgical reanimation procedures typically involve surgical connection (anastomosis) of a peripheral branch of the spinal accessory (eleventh) cranial nerve to the affected facial nerve to restore innervation to the facial muscles. This procedure likely would be considered much later in the process and would contribute significantly to length of disability.

Source: Medical Disability Advisor



Prognosis

Bell's palsy is not life-threatening; approximately 80% of individuals experience a complete resolution of symptoms within a few weeks to a few months after onset (Zalvan). Some cases result in residual side effects, and in rare instances, an individual may never recover. Recurrence of signs and symptoms is found in 7% to 9% of individuals who have had a complete recovery (Zalvan); it sometimes recurs on the opposite side (“Bell’s Palsy”).

Source: Medical Disability Advisor



Rehabilitation

The priorities of rehabilitation in Bell's palsy are pain control, preservation of vision, improved facial function, and restoration of outward appearance. When addressing pain from Bell's palsy, the physical therapist may utilize electrostimulation combined with heat or cold treatment to relax painful facial muscles affected by the condition. Other therapies that may help control pain are iontophoresis, a technique that uses a small electric current to drive anti-inflammatory medication into the painful muscle tissues, and biofeedback, a method that employs a special machine to teach the individual how to control certain body responses that reduce pain. The use of simple pain relievers (analgesics) may be necessary.
Once pain is brought under control, therapy then focuses on re-education of the facial muscles affected by the condition. Direct electrical stimulation of muscles innervated by the facial nerve is a common technique used in rehabilitation of Bell's palsy.
Modifications may need to be made in the rehabilitation program, depending on the extent of muscle paralysis and whether surgical techniques were required to restore function to the face.

Source: Medical Disability Advisor



Complications

Complications of Bell's palsy may include disfigurement or permanent contracture from irreversible facial nerve damage, eye damage (corneal ulcers and infections), chronic spasm of facial muscles and / or eyelids, and chronic taste abnormalities. Involuntary contraction of certain muscles may result from misdirected regrowth of nerve fibers. Psychological trauma may accompany facial disfigurement in some individuals.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with jobs that require them to be exposed to harsh lighting, wind, or dust may require glasses, goggles, or lubricants to protect the affected eye.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have an unexplained episode of unilateral facial weakness or paralysis?
  • Does individual have a headache, tearing, drooling, difficulty eating and drinking, change in facial appearance, impairment of taste, or hearing loss?
  • Did individual report a mild cold, influenza, or other upper respiratory tract infection within a week prior to the onset of Bell's palsy?
  • Does individual have diabetes?
  • Is individual pregnant?
  • Does individual have a history of herpes virus infection?
  • Did the physical exam reveal facial asymmetry, drooling, increased distance between the top and bottom eyelids, a smooth forehead, a flattened crease between the nose and the upper lip, and loss of sensation to the affected area of the face?
  • Was facial dysfunction graded?
  • Was hearing evaluated? Was eyelid motion analyzed?
  • Were laboratory tests performed to rule out underlying illness with similar symptoms?
  • Was a thorough cranial nerve examination, skull x-ray, or EMG performed?

Regarding treatment:

  • Is individual receiving symptomatic treatment such as lubrication for the eyes? Corticosteroids? Analgesics?
  • Does individual have residual, debilitating facial dysfunction?
  • Was surgical nerve decompression performed?
  • Were EMGR, botulinum toxin injections, or surgical reanimation considered?

Regarding prognosis:

  • Is individual active in physical therapy? Is a home exercise program in place?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed, such as disfigurement from irreversible damage to the facial nerve, corneal ulcers and infections, chronic spasm of facial muscles and / or eyelids, or chronic taste abnormalities?

Source: Medical Disability Advisor



References

Cited

"Bell's Palsy." MayoClinic.com. 24 Sep. 2004. Mayo Foundation for Medical Education and Research. 1 Jul. 2009 <http://www.mayoclinic.com/invoke.cfm?objectid=2B73952A-337E-4AB7-95368E5C254B2D65&dsection=1>.

Zalvan, Craig H. "Otolaryngology and Facial Plastic Surgery." eMedicine. Eds. B. Viswanatha, et al. 21 Nov. 2007. Medscape. 1 Jul. 2009 <http://emedicine.medscape.com/article/880959-overview>.

Source: Medical Disability Advisor






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