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.

Atrophy, Muscular


Related Terms

  • Atrophy of the Muscles
  • Muscle Atrophy
  • Muscle Wasting
  • Wasting

Differential Diagnosis

Specialists

  • Neurologist
  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The severity of muscular atrophy, the muscle(s) affected, and underlying cause of the atrophy influence the disability period. The individual's ability and willingness to participate in rehabilitation will also be a factor in the length of disability.

Medical Codes

ICD-9-CM:
335.10 - Spinal Muscular Atrophy, Unspecified
335.19 - Spinal Muscular Atrophy, Other; Adult Spinal Muscular Atrophy
356.1 - Peroneal Muscular Atrophy; Charcot-Marie-Tooth Disease; Neuropathic Muscular Atrophy
728.2 - Muscular Wasting and Disuse Atrophy, Not Elsewhere Classified; Myofibrosis, Amyotrophia NOS

Rehabilitation

Physical therapy for muscular atrophy depends on the underlying cause, extent, and location of the atrophy. For example, if the individual has sustained an injury that severed the nerves supplying the muscles of the foot, a different protocol is warranted than for someone experiencing a progressive muscular disease (e.g., muscular dystrophy). Muscular atrophy that results from immobility of the affected area from casting or another form of fixation is the easiest and most straightforward to treat.

Overlapping therapeutic strategies are used in all three cases but have common goals. They include increasing or maintaining range of motion for all joints, increasing or maintaining overall muscle integrity and strength, improving muscular efficiency (i.e., decreasing muscular effort when performing activities of daily living), and educating the individual on injury prevention. These goals are met through a progressive exercise routine directed by the physical therapist, which also may include the assistance of an occupational therapist or a vocational specialist.

The effectiveness of microcurrent electrical neuromuscular stimulation (MENS) and low energy laser (LEL) have been challenged (American College of Occupational and Environment Medicine); these forms of therapy must result in objective improvement to warrant their use. Neuromuscular stimulation of intact motor nerves may be used to maintain range of motion and start the re-education process for the muscle; this type of muscle stimulation can be used while performing movements that pattern appropriate biomechanics for that limb. Low-voltage electromuscular stimulation (EMS) helps stimulate denervated muscles where peripheral nerve damage has occurred. Transcutaneous electrical nerve stimulation (TENS) therapy uses electrodes placed on the skin over the muscle area of interest. By changing the intensity, frequency, and pulse of the current, a sensory effect (decreased pain) or muscular effect (maximal recruitment of muscle fibers) can be noninvasively elicited in the individual.

As the individual gains increased range of motion and stamina, more challenging resistive exercises may be added. The appropriate time for including resistive exercises depends on the type of underlying injury. For example, muscular atrophy related to a fracture can be addressed only after the fracture heals. Regardless of injury type, various methods of water therapy (aquatic rehabilitation) can be used to increase range of motion and facilitate weight bearing without imposing maximal forces of gravity. Once the individual can bear his or her full weight, the routine may be split between aquatic and standard exercises. Bracing may be required to protect the muscle or joint in some individuals during the strengthening process.

Depending on the injury, core trunk strength exercises help improve muscle efficiency and stabilization. An example of a core strength task is to sit or stand on an unstable surface while reaching for an object. If paralysis is involved, recreational therapy using games such as balloon volleyball or billiards can help build functional balance and manual dexterity. Muscle strength is gained through progressive resistive exercises (PREs) with gradual increases in resistance.

An occupational therapist may evaluate the individual's home and work environment, since some individuals may still be fatigued when performing repetitive or labor-intensive tasks such as hammering. Additional support from a vocational rehabilitation specialist may be needed if paralysis or other permanent and debilitating injury is involved. The vocational rehabilitation specialist also is able to help with job placement or job accommodations to meet the individual’s restrictions and limitations.

Individuals who experience muscle atrophy from disuse usually recover within 8 to 12 weeks and should have minimal, if any, problems after return to work. These individuals should continue with a home exercise routine once physical therapy ends. The course of recovery from muscular atrophy that results from other causes is hard to predict and may require up to a year to determine functional outcomes; in some cases, muscular atrophy may be progressive.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical or Surgical
SpecialistAtrophy, Muscular
Physical or Occupational TherapistUp to 6 visits with establishment of home education program
Surgical is rare for muscle atrophy but may be appropriate for a condition causing atrophy or to correct a contracture (see specific conditions for details).

Source: Medical Disability Advisor






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