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 Palsy


Related Terms

  • Dyskinetic Cerebral Palsy
  • Spastic Cerebral Palsy

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Otolaryngologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Psychiatrist

Comorbid Conditions

  • Deformities of the limbs
  • Epilepsy
  • Obesity

Factors Influencing Duration

The type and severity of cerebral palsy, the individual's emotional adjustment to the disability, and the availability of work accommodations will all influence the individual's ability to work.

Medical Codes

ICD-9-CM:
343.9 - Cerebral Palsy, Unspecified; Cerebral Palsy NOS

Overview

Cerebral palsy refers to a group of chronic disorders impairing motor function (control and coordination of movement, muscle tone, balance, and posture) due to brain injury occurring before, during, or shortly after birth. The disorder is nonprogressive (static) and generally does not worsen over time. The manifestations of the illness are the same from childhood to adulthood.

There are three major types of cerebral palsy: spastic, dyskinetic, and ataxic. Combinations of two types or, rarely, all three types may occur. Spastic cerebral palsy, the most common and less severe form of the disease, accounts for an estimated 80% of all cerebral palsy cases. Individuals in this group display varying degrees of paralysis/weakness of the limbs on one side of the body (hemiplegia/hemiparesis), of all four limbs and trunk (quadriplegia/quadriparesis), or of all four limbs but with the legs and feet more severely affected than the arms and hands (diplegia/diparesis). Dyskinetic cerebral palsy is characterized by abnormal involuntary movements, such as slow, twisting, writhing movements (athetosis) or quick, jerky movements. Ataxic cerebral palsy, a rare form of the condition, is characterized by tremors, unsteadiness, and lack of coordination, especially when making quick movements ("Cerebral Palsy").

The vast majority of children who have cerebral palsy develop it before birth (congenital cerebral palsy), and the rest develop it after birth (acquired cerebral palsy), usually as a result of brain damage in the first few months of life, a brain infection such as bacterial meningitis or viral encephalitis, or a head injury ("Cerebral Palsy").

Some individuals with cerebral palsy are also affected by other disorders, including seizures and mental impairment, but cerebral palsy does not always cause a profound handicap, and the severity of the disorder can vary.

Incidence and Prevalence: It is estimated that some 764,000 children and adults in the US manifest one or more of the symptoms of cerebral palsy ("How Common"). Currently, about 1 in 300 children (less than 1%) have cerebral palsy ("Cerebral Palsy").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause is not fully known, but it is believed that cerebral palsy can be caused by abnormalities resulting from abnormal implantation of the ovum or fetus, maternal diseases, external toxins, or metabolic disorders. Lack of oxygen (hypoxia) during the birth process causes only a small number of cerebral palsy cases.

Certain infections, including German measles (rubella), cytomegalovirus, and toxoplasmosis in an expecting mother, can cause brain damage and result in cerebral palsy. Recent studies suggest that maternal infections involving the placental membranes (chorioamnionitis) may contribute to cerebral palsy in full-term and preterm babies (those born before 37 completed weeks of pregnancy). Urinary tract infections may also increase the risk of preterm labor, which is a risk factor for the disease.

Other risk factors include insufficient oxygen reaching the fetus, premature birth (babies who weigh less than 3 1/3 pounds are up to 30 times more likely to develop cerebral palsy) ("Cerebral Palsy"); asphyxia during the birthing process; Rh incompatibility between the blood of a mother and her infant; blood clotting disorders; severe jaundice; and other birth defects.

Source: Medical Disability Advisor



Diagnosis

History: Cerebral palsy is difficult to recognize and diagnose in early infancy but is easy to recognize in children and adults. Early signs of cerebral palsy usually appear before the age of three. A careful history of possible prenatal, perinatal, or postnatal injuries to the developing nervous system should be obtained from the family. Symptoms include difficulty with fine motor skills, such as writing, difficulty with balance and walking, and involuntary movements.

Physical exam: Motor abnormalities that have their onset early in life and continue through adulthood are numerous and diverse. The individual usually has slow motor development, overactive or overresponsive reflexes (hyperreflexia), and altered muscle tone (hypertonia and/or hypotonia). Individuals with hemiparesis have increased tone in the limbs and develop a characteristic gait and posture. Walking may seem normal, but the abnormality is apparent when the individual runs. Tendon reflexes are increased on the affected side, and spasticity and clonus may be present. In quadriparesis, both cerebral hemispheres are involved, and speech impairment, drooling, and difficulty swallowing (dysphagia) develop. Fine motor skills, including rapid hand movements and asymmetric forearm function, and reflexes should be tested. In dyskinetic cerebral palsy, there is enlargement (hypertrophy) of the continually moving muscles, especially of the neck and shoulders.

Tests: Computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) are often used in the diagnosis. Laboratory testing of blood and cerebrospinal fluid will help distinguish cerebral palsy from meningitis and metabolic disorders causing similar symptoms.

Source: Medical Disability Advisor



Treatment

The goals of therapy are to improve function, control seizures, and help the individual establish an emotional life that approaches normal. Drugs to control seizures and muscle spasms and special braces that compensate for muscle imbalance may be used. Other treatments that can be employed include physical, occupational, speech, and behavioral therapy. Mechanical devices that help correct, support, align, or prevent deformities (orthoses) and orthopedic surgery (if appropriate) can improve function of the legs. Counseling for emotional and psychological needs may also be provided. Therapy should be tailored to individual needs at a particular time and age.

Source: Medical Disability Advisor



Prognosis

Cerebral palsy cannot be cured, but function can be improved in almost all cases, especially with early treatment and management of neurological problems such as seizures. Although cerebral palsy is not progressive, most individuals will develop some form of motor abnormality or seizures (epilepsy), and most will reach adult years.

The severity of cerebral palsy depends on the degree of damage to the nervous system. In some cases, an individual may exhibit normal intelligence despite motor abnormalities. Individuals with less severe impairment can lead productive lives and are able to perform light work. In severe forms of the disease, special care may be required, and the individual may be limited in work capacity. For example, if the individual requires a wheelchair and also has mental impairment, then even light work may not be possible.

Source: Medical Disability Advisor



Rehabilitation

Because cerebral palsy is a diagnosis that incorporates a variety of different symptoms, individuals with this diagnosis will have varied rehabilitation needs. Physical, occupational, and speech therapists all may play a role in the care of an individual with cerebral palsy, with the frequency and duration of rehabilitation dependent upon the needs of the individual. Individuals typically require therapy in the following areas: communication, range of motion, strength, balance, coordination, and functional activities such as mobility. The use of a wheelchair, crutches, braces or splints, or adaptive equipment may be helpful in maximizing functional ability.

Because individuals with cerebral palsy typically have spasticity, which can create imbalances in strength that affect balance and functional mobility, physical and occupational therapists address increased muscle tone by aggressively stretching any affected muscle groups. Individuals and their caregivers learn to carry out these stretching techniques to further improve range of motion. Individuals also learn to strengthen any weak muscles to maximize their functional abilities. Physical and occupational therapists may consult with an orthotist to provide braces for the arms or legs for individuals with persistent muscle weakness. Both occupational and physical therapists should instruct individuals in safe mobility.

Source: Medical Disability Advisor



Complications

Although cerebral palsy is not progressive, individuals may develop other neurological problems, including seizures (epilepsy), mental retardation, attention deficit disorder, hyperactivity, visual impairment, difficulty swallowing, dental problems, speech impairment (dysarthria), and hearing loss. Some individuals who can walk may become unable to walk if they gain too much weight. Other potential problems that affect the muscles and joints include scoliosis, hip dislocation, muscle and joint stiffness, and unequal leg length.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations depend upon the type of cerebral palsy the individual has and the severity of motor abnormalities, seizures (epilepsy), and mental impairment. Each case would require individual evaluation to determine work limitations. For example, if an individual's neurological problems and difficulty with motor functions are addressed and no severe mental impairment exists, then performance of work in a limited capacity, such as from a wheelchair or with the use of mechanical walking devices or braces, may be possible.

Risk: No job causes this condition. There is no risk to the individual when working with cerebral palsy as long as safety factors are adequately taken into consideration. Individuals with cerebral palsy who have seizures or involuntary movements should be restricted from safety-sensitive work tasks in which significant injury to the self or others could occur. Drowsiness from medications to control seizures and muscle spasms may be an additional issue of risk.

Capacity: Capacity in individuals with cerebral palsy is variable and depends upon the type and severity of the disorder. Those with impaired motor function and balance may need to be restricted to sedentary job duties. An individual with mental impairment may not be able to perform even simple, repetitive work tasks.

Tolerance: Some individuals with cerebral palsy may dislike working, fearing that a potentially embarrassing seizure may occur in the workplace. Individuals with athetosis, drooling, or speech impairments may prefer to work in situations that do not require public interaction. In this case, tolerance becomes an issue of choice (to work or not to work) and is not a reason for reduced capacity or disability.

Accommodations: Accommodations should be decided upon on a case-by-case basis.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 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:

  • Did the mother have a urinary tract infection?
  • Did the mother have toxoplasmosis, German measles, or cytomegalovirus?
  • Was there Rh incompatibility between the mother and fetus?
  • Was individual's birth weight below 3 1/3 pounds?
  • Does individual have spastic, dyskinetic, or ataxic cerebral palsy?
  • Does individual have trouble with fine motor skills? Difficulty with walking or balance?
  • At what age did the symptoms appear?
  • Were CT, MRI, and EEG done? Blood tests? Lumbar puncture?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Does individual have seizures? Are they controlled?
  • Is individual on medications for muscle spasms?
  • Was individual fitted with orthoses?
  • Was orthopedic surgery necessary?

Regarding prognosis:

  • Is individual active in a rehabilitation program?
  • If obese, is individual in a weight management program?
  • Can individual's employer accommodate any necessary restrictions?

Source: Medical Disability Advisor



References

Cited

"Cerebral Palsy." March of Dimes. Jul. 2014. 22 Apr. 2014 <http://www.marchofdimes.org/baby/cerebral-palsy.aspx>.

"How Common Is Cerebral Palsy?" CerebralPalsy.org. Stern Law Group. 22 Apr. 2015 <http://cerebralpalsy.org/about-cerebral-palsy/prevalence-and-incidence/>.

Source: Medical Disability Advisor






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