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.

Cerebral Contusion, Closed


Related Terms

  • Brain Bruise
  • Cerebral Bruise

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Physical Therapist
  • Speech Therapist

Comorbid Conditions

Factors Influencing Duration

Prolonged coma, residual disturbances of memory, dizziness, inability to concentrate, behavioral problems, other diseases or injuries, and poor response to psychotherapy increase the length of disability.

Medical Codes

ICD-9-CM:
851.00 - Cortex (Cerebral) Contusion without Mention of Open Intracranial Wound, Unspecified State of Consciousness
851.01 - Cortex (Cerebral) Contusion without Mention of Open Intracranial Wound, with No Loss of Consciousness
851.02 - Cortex (Cerebral) Contusion, without Mention of Open Intracranial Wound, with Brief (Less than One Hour) Loss of Consciousness
851.03 - Cortex (Cerebral) Contusion, without Mention of Open Intracranial Wound, with Moderate (1-24 Hours) Loss of Consciousness
851.04 - Cortex (Cerebral) Contusion, without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness and Return to Pre-existing Conscious Level
851.05 - Cortex (Cerebral) Contusion, without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness without Return to Pre-existing Conscious Level
851.06 - Cortex (Cerebral) Contusion, without Mention of Open Intracranial Wound, with Loss of Consciousness of Unspecified Duration
851.09 - Cortex (Cerebral) Contusion without Mention of Open Intracranial Wound with Concussion, Unspecified
851.40 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, Unspecified State of Consciousness
851.41 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with no Loss of Consciousness
851.42 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with Brief (Less than One Hour) Loss of Consciousness
851.43 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with Moderate (1-24 Hours) Loss of Consciousness
851.44 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness and Return to Pre-existing Conscious Level
851.45 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness without Return to Pre-existing Conscious Level
851.46 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound, with Loss of Consciousness of Unspecified Duration
851.49 - Cerebellar or Brain Stem Contusion without Mention of Open Intracranial Wound with Concussion, Unspecified

Overview

A cerebral contusion is a bruising of the brain resulting from blunt impact to the head or an acceleration/deceleration injury. The individual usually suffers prolonged unconsciousness. Increased intracranial pressure (ICP) due to swelling of the brain (cerebral edema) may result in brain herniation that can be fatal. A closed cerebral contusion indicates that the individual's brain was not penetrated.

Incidence and Prevalence: Each year an estimated 1.7 million Americans sustain a traumatic brain injury (TBI); of these, 1,365,000 are treated in emergency rooms, 275,000 are hospitalized, and about 52,000 of them die. In the US at least 5.3 million individuals have experienced at least one TBI, and at least 3.2 million of them require help to perform activities of daily living due to head injury. Nearly 500,000 of the emergency room visits are for children aged 14 years and younger. Adults 75 and older are the most likely to be hospitalized for TBI and to die from their injuries. TBI occurs in all age groups but more so in those aged 0 to 4, 15 to 19, and those over the age of 64 (CDC, Faul).

Males are three times as likely as females to die of a TBI (Coronado). More than 200,000 head injuries are reported each year as a result of sports injuries (MMWR).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The leading causes of TBI are falls (35.2%), motor vehicle accidents (17.3%), being struck by or colliding with stationary or moving objects (16.5%), and assaults, including assaults with firearms (10%). Activities such as sports and other recreational activities, and professions that involve the potential for injury or violence are often associated with TBI, especially mild TBI (Faul). Alcohol often plays a role in the leading causes of TBI (Chen). Motor vehicle accidents occur most frequently in the 15 to 24 year-old age group (Coronado).

Among individuals 65 years and older, falls are the most common cause of TBI (Faul). The risk of fall-related TBI dramatically increases with age. Compared to individuals aged 55 to 65, those aged 65 to 74, 75 to 84, and those older than age 84 are 2.2, 7.1, and 17.8 times as likely to die of TBI, respectively (Coronado).

Sports-related head injuries are common among cyclists, football players, and basketball players. Dozens of other sports also produce large numbers of head injuries per year (MMWR).

Source: Medical Disability Advisor



Diagnosis

History: The conscious individual reports headache, dizziness, confusion, nausea, vomiting, seizures, and weakness of the extremities (paresis), and makes inappropriate responses to questions. The individual is possibly unconscious when examined by medical personnel. A common symptom is prolonged unconsciousness (coma).

Physical exam: The individual's level of consciousness is disturbed. A neurological examination may not reveal any localizing signs. The individual with no other serious injuries than cerebral contusion will not have a fractured skull or any signs of opening or penetration of the skull.

Tests: Skull x-rays check for a fracture. Computed tomography (CT) or magnetic resonance imaging (MRI) help to exclude major bleeding in the skull. The Glasgow Coma Scale (GCS) classifies the severity of brain injury, with a score of 15 being normal and progressively lower scores indicating greater neurologic injury to the brain.

Source: Medical Disability Advisor



Treatment

The treatment of cerebral contusions is supportive. Breathing and circulation are supported, if needed, and often the individual is restrained during treatment. Frequent assessment of neurological status is important in case changes occur that indicate the need for further treatment (i.e., medication to reduce swelling in the brain). Cerebral edema caused by the buildup of fluids as a result of the contusion is reduced by continuous infusion of high protein fluids (oncotic therapy with 25% bovine serum albumin), with frequent measurement of oncotic pressure and adjustment of fluids and electrolytes. Spreading ("blossoming") hemorrhagic contusions may require surgical intervention.

Source: Medical Disability Advisor



Prognosis

Each year about 52,000 of the 1.7 million Americans with head injuries die (Faul). Adults over age 50 do not recover as rapidly or as frequently as younger individuals. Individuals in a coma do not do as well, and the longer the coma, the greater the probability of death or permanent neurological damage. In general, individuals with oncotic therapy have a better chance of survival without permanent neurological damage.

Source: Medical Disability Advisor



Rehabilitation

Individuals with closed cerebral contusion may present with a variety of physical and cognitive disabilities, depending on the severity of the injury. Individuals may need treatment by physical, occupational, or speech therapists; neuropsychologists; vocational counselors; and / or social workers.

Individuals may present with motor control deficits such as coordination and balance disorders. The main goal of physical therapy and occupational therapy in the area of motor control is to maximize functional capabilities. Occupational and physical therapists teach individuals basic skills, such as getting in and out of bed or the shower, dressing, using a wheelchair, and preparing meals, and may also require individuals with impaired motor coordination to perform a wide range of proprioceptive and coordination exercises. Individuals with impaired balance are instructed to engage in activities that hone the skills needed to walk, stand, sit, and plan sequences of movements. Special equipment may be ordered to make these tasks easier.

Physical therapy will improve overall endurance by teaching stretching and strengthening exercises of the arms, legs, and trunk. Individuals may also perform aerobic activity such as walking on a treadmill or riding a stationary bicycle to further increase endurance.

Individuals with poor motor control of the facial muscles may require speech therapy to improve clarity of speech and increase safety in swallowing. The speech therapist teaches individuals how to pronounce certain sounds. Individuals also learn to change speech patterns, such as decreasing the speed of speech or changing the volume. Individuals learn to speak with greater volume through activities such as sustained vocal expressions (e.g., saying "ah"). For those individuals who have difficulty speaking or understanding speech (aphasia) due to brain injury, therapy focuses on skills such as word finding and sentence completion. Individuals unable to effectively engage in oral therapy may require adaptive devices to help them communicate.

Individuals with perceptual deficits may require occupational and physical therapy to learn how to live safely, such as using a cane to compensate for decreased balance from double vision (diplopia). Individuals with hearing loss may require help from speech therapists, who can teach lip reading and sign language and how to use equipment such as telecommunication devices for the deaf (TDD) telephones and doorbells.

Individuals may present with persistent fatigue due to deficits in the regulatory centers of the brain. Occupational therapists teach energy conservation techniques, in which activities of daily living such as meal preparation are broken into smaller components that make these tasks more manageable.

Individuals may also present with cognitive deficits due to brain injury. Occupational and speech therapists can demonstrate how to compensate for cognitive deficits with written reminder notes and instructions. Consultations with a neuropsychologist may be necessary for individuals with more severe deficits. Individuals are assessed in areas such as planning, perception, concentration, attention span, orientation, memory, problem solving, and social judgment. Neuropsychologists apprise the therapy disciplines of changes in these areas and help guide the course of rehabilitation. Neuropsychologists also help individuals and their families make long-range decisions.

Social workers coordinate the care of individuals in areas such as discharge planning or obtaining different services. Social workers may obtain any necessary adaptive equipment. Individuals may learn of support groups for people with similar disabilities.

Vocational counselors work with occupational, physical, and speech therapists to replicate job task requirements in therapy. These counselors help individuals keep future career plans realistic and ease the transition back to work.

Source: Medical Disability Advisor



Complications

Possible complications include poor general health, inability to reduce the cerebral edema, skull fracture, a large amount of bleeding into the brain (large intracerebral hematoma), low oxygen concentration in the blood (hypoxia), fever or low body temperature, and acute renal failure.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who fully recover should be able to return to work without restrictions. The only accommodation may be follow-up physician visits. Individuals with permanent brain damage may be on permanent disability.

For more information, refer to "Work Ability and Return to Work," pages 326–328.

Risk: Individuals with closed cerebral contusion are not at risk of harm from work activities. Temporary reassignment of tasks may be necessary if the individual is experiencing seizures.

Capacity: Capacity may be limited if cognitive or motor impairment is present. Functional testing may be needed to determine work ability. Contact physician for details.

Tolerance: Tolerance is dependent on the individual's complaints of headache and fatigue, which may be mitigated by modification of work tasks. With severe TBI, personality changes may affect the individual's motivation at work.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

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:

  • Was individual in a motor vehicle accident or other accident?
  • Was individual conscious or unconscious when examined?
  • Does individual report headache, dizziness, nausea, vomiting, or weakness of the extremities or make inappropriate responses to questions?
  • Has individual had skull x-rays, CT or MRI? What was individual's initial GCS score?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Is individual receiving supportive treatment?
  • Was a respirator necessary?
  • Was individual treated with medication to reduce brain swelling?

Regarding prognosis:

  • Is individual active in occupational and physical therapy? Is a home exercise program in place? Was speech therapy needed?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any complications such as poor general health, inability to reduce the cerebral edema, skull fracture, large intracerebral hematoma, hypoxia, fever or low body temperature, or acute renal failure?

Source: Medical Disability Advisor



References

Cited

"Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities." Morbidity and Mortality Weekly Report 60 39 (2011): 1337-1342.

"Traumatic Brain Injury." CDC. 6 Mar. 2014. Centers for Disease Control and Prevention. 8 May 2014 <http://www.cdc.gov/TraumaticBrainInjury/index.html>.

Chen, C. M. , et al. "Alcohol Use at Time of Injury and Survival Following Traumatic Brain Injury: Results from the National Trauma Data Bank." Journal of Studies on Alcohol and Drugs 73 (2012): 531-541.

Coronado, V. G. , et al. "Surveillance for Traumatic Brain Injury-Related Deaths--United States, 1997-2007." Morbidity and Mortality Weekly Report 60 (2011): 1-32.

Dawodu, Segun T. "Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology." eMedicine. Eds. Denise I. Campagnolo, et al. 6 Mar. 2013. Medscape. 8 May 2014 <http://emedicine.medscape.com/article/326510-overview>.

Faul, Mark. "Traumatic Brain Injury in the United States: : Emergency Department Visits, Hospitalizations and Deaths 2002-2006." CDC. 7 Jan. 2013. Centers for Disease Control and Prevention. 8 May 2014 <http://www.cdc.gov/traumaticbraininjury/tbi_ed.html>.

Morales, Denise, et al. "Brain Contusion Imaging." eMedicine. Eds. James Smirniotopoulos, et al. 28 Oct. 2013. Medscape. 8 May 2014 <http://emedicine.medscape.com/article/337782-overview>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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