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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.

Craniectomy


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Medical Codes | References

Medical Codes

ICD-9-CM:
01.25 - Craniectomy, Other; Debridement of Skull NOS; Sequestrectomy of Skull
02.01 - Cranioplasty; Opening of Cranial Suture; Linear Craniectomy; Strip Craniectomy

Related Terms

  • Brain Surgery

Overview

Craniectomy is the surgical removal of a portion of skull (cranium), leaving an opening in the skull that may be left open or covered with synthetic material. This procedure is often used to remove tumors in the rear of the brain (cerebellum) and to relieve brain swelling. A craniectomy also allows surgical treatment of diseases that affect the cranial nerves supplying sensation and movement to the structures of the head and neck. The procedure is classified as an emergency if pressure within the skull (intracranial pressure), usually from bleeding within the brain or its coverings, has increased to a dangerous level.

A craniectomy is performed in a major operating room under general anesthesia.

Source: Medical Disability Advisor



Reason for Procedure

Craniectomy is most commonly performed to remove a tumor or hematoma, a collection of blood and blood clots, from beneath the skull. A hematoma beneath the skull takes up space, compresses the brain, and decreases the flow of blood and oxygen to brain tissue. If not removed promptly, hematomas often cause permanent brain damage. Hematomas found between the skull and outer covering of the brain (dura mater) are called epidural hematomas and are often arterial in origin. When found between the outer and middle coverings of the brain, they are called subdural hematomas and are often venous in origin.

Craniectomy performed at the base of the skull is called suboccipital craniectomy. This approach allows exploration of the lower back portion of the brain (posterior fossa) and surgical treatment of diseases affecting certain cranial nerves. Through a suboccipital craniectomy, the fifth cranial nerve (trigeminal nerve) can be decompressed or deliberately cut in order to treat severe facial pain (trigeminal neuralgia). The ninth cranial nerve (glossopharyngeal nerve) can be cut to treat severe pain originating in the throat and spreading to the ear (glossopharyngeal neuralgia). A suboccipital craniectomy may also be used to remove tumors (acoustic neuromas) from the hearing (auditory) canal, or to cut a portion of the eighth cranial nerve (the vestibular branch of the vestibulocochlear nerve) when surgically treating Ménière's disease, a chronic condition of the inner ear.

Source: Medical Disability Advisor



How Procedure is Performed

Craniectomy is done in the operating room under general anesthesia. An incision is made in the scalp above the location of the hematoma, abscess, or other condition to be treated while the tissues are held open with small retractors. A bone flap is not turned. Instead, one or more small holes (burr holes) are drilled into the skull with a special drill. The edges of the burr holes are chipped away (rongeur) to enlarge the opening. If a larger opening is needed, a circular saw or a router blade craniotome may be used to connect the burr holes. The circular piece of bone is then removed, exposing a larger work surface for the surgeon.

The collection of blood, clots, or bloody fluid is suctioned out. To control vascular bleeding, the blood vessel is burned (cauterized) or clamped with clips. The brain is irrigated with saline irrigating solution until the return runs clear. A drain may be placed under the skull or dura mater and brought to the outside through a puncture hole in the scalp. The bone is not replaced, although under some circumstances, the long gap is filled with an acrylic material molded in the shape of the skull. The incision is closed and the wound is covered with a sterile dressing.

Source: Medical Disability Advisor



Prognosis

Predicted outcome after a craniectomy depends upon the underlying condition, the success of the surgical procedure performed through this approach, and the number and severity of postoperative complications. Individuals who suffer permanent brain damage from bleeding, infection, or increased intracranial pressure may have decreased cognitive ability. They may not be able to perform tasks they could before surgery. In some cases, the impairment can be severe enough to require permanent disability. Individuals with acoustic neuromas removed through a suboccipital craniectomy may experience permanent hearing loss and incapacitating balance problems.

Source: Medical Disability Advisor



Specialists

  • Neurosurgeon

Source: Medical Disability Advisor



Rehabilitation

Rehabilitative therapy for individuals who have undergone a craniectomy is aimed at restoring the functions required for activities of daily living. Therapy may range in intensity from minimal to long-term chronic rehabilitative care depending on the nature and severity of the injury or disease that necessitated treatment through a craniectomy approach.

Individuals undergoing craniectomy to treat disorders of the cranial nerves have outpatient rehabilitation plans geared toward the effects of injury to the cranial nerves, such as difficulties in hearing, swallowing, maintaining balance, and using the muscles of facial expression. Such therapy continues until maximum restoration of function or adjustment to loss of function is attained and could take several weeks to several months.

Certain individuals may require psychological counseling to help them adjust to chronic pain or the loss of mental or physical function.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of surgery performed through a craniectomy approach include bleeding, swelling of brain tissue resulting in nerve cell damage, wound infection, cranial nerve damage, leakage of the fluid covering the brain (cerebrospinal fluid), and postoperative headache. Air that enters a vein (venous air embolism) can form an air bubble, block off a small vessel, and cause a stroke. Complications of general anesthesia include allergic reaction to the anesthetic agent (anaphylaxis), decreased respiratory rate or effort, airway obstruction, and partial or complete collapse of the lung (atelectasis). A rare but often fatal complication of general anesthesia is a rapid rise in body temperature (malignant hyperthermia).

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the length of disability include the specific reason for the craniectomy, success or lack of success in treating the condition, complications, coexisting diseases affecting any of the major body systems, the individual's mental and emotional stability, access to rehabilitation facilities, and the strength of the individual's support system.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who have undergone a craniectomy have portions of their brains unprotected by bone. These individuals risk severe injury if assigned to work in an environment that contains moving equipment, falling objects, or similar hazards.

Those who have undergone surgery on their cranial nerves may have decreased sensation and movement in their mouths and the structures of the face and require certain restrictions and accommodations. For example, individuals with decreased sensation of the facial skin may have difficulty judging the severity of temperatures and be at risk for frostbite or severe sunburn if working outdoors. Individuals experiencing chronic pain as a result of damage to the cranial nerves during neurological surgery may have difficulty maintaining the level of concentration required of their pre-surgery assignment. Individuals with damage to the facial nerve during removal of an acoustic neuroma may not be able to completely close their eyes on the affected side and would be ill suited for environments that involve dust and other irritating particles or fumes. Individuals left with balance problems after surgical removal of an acoustic neuroma may require transfer to a sedentary job.

Individuals with surgery on the glossopharyngeal nerve may have a decreased gag reflex and difficulty swallowing (dysphagia). This situation requires a well-developed safety program with an emphasis on emergency care for a choking individual. Individuals may also have trouble making certain sounds and being easily understood over the telephone.

Source: Medical Disability Advisor



References

General

"Brain Tumor Glossary." Johns Hopkins Medicine. 20 May 2005 <http://www.hopkinsmedicine.org/radiosurgery/resources/glossary.cfm>.

Rakel, Robert E., and Edward T. Bope, eds. Conn's Current Therapy 2004. 56th ed. Philadelphia: W.B. Saunders, 2004.

Source: Medical Disability Advisor