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.

Encephalopathy


Related Terms

  • Dementia
  • Neurologic Disease

Differential Diagnosis

  • Absence seizures
  • Absence status epilepticus
  • Alzheimer's disease
  • Anterior circulation stroke
  • Aphasia due to stroke
  • Aseptic meningitis
  • Bacterial meningitis
  • Carotid disease and stroke
  • Chronic meningitis
  • Complex partial seizures
  • Cortical basal ganglionic degeneration
  • Cryptococcal meningitis
  • Delirium tremens
  • Dementia with Lewy bodies (DLB)
  • Focal disorder due to right parietal, thalamic, or caudate disease
  • Focal disorder due to surgical damage to basal forebrain
  • Frontal and temporal lobe dementia
  • Frontal lobe epilepsy
  • Frontal lobe syndromes
  • Hepatic encephalopathy
  • Herpes simplex encephalomyelitis
  • HIV-1 associated CNS complications
  • Hyperglycemia
  • Hypernatremia
  • Hypoglycemia
  • Hypomagnesemia
  • Hyponatremia
  • ICU psychosis
  • Neglect syndrome due to stroke
  • Paraneoplastic encephalomyelitis
  • Pick's disease
  • Posterior cerebral artery stroke
  • Renal disease
  • Seizure disorders
  • Spike-wave stupor
  • Staphylococcal meningitis
  • Status epilepticus
  • Toxicity from prescribed or unprescribed medications
  • Transient global amnesia
  • Trauma (contusions or subdural or epidural hematomas)
  • Tuberculosis meningitis

Specialists

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

Comorbid Conditions

  • Hypoglycemia
  • Metabolic brain disease
  • Severe liver disease
  • Viral and bacterial infections

Factors Influencing Duration

The length of disability is influenced by the severity of the underlying disease and the residual outcome of the disease process.

Medical Codes

ICD-9-CM:
348.30 - Encephalopathy, Unspecified
348.31 - Metabolic Encephalopathy; Septic Encephalopathy
348.39 - Encephalopathy, Other
349.82 - Toxic Encephalopathy
437.2 - Cerebrovascular Disease, Other and Ill Defined; Hypertensive Encephalopathy

Overview

Encephalopathy refers to an abnormal condition of the structure or function of brain tissues (specifically degenerative conditions) that can result in inflammation and hemorrhaging. Encephalopathy may be caused by chronic conditions such as liver disease, viral or bacterial infections, high blood pressure, metabolic or nutritional diseases, or hereditary diseases. Some destructive conditions resulting in encephalopathy include long-term exposure to chemotherapeutic drugs or toxic chemicals and radiation therapy. It can also be caused by repeated head trauma during boxing (boxer's encephalopathy) or develop during the final stage of a terminal illness. Encephalopathy may also resolve without treatment and without any lasting effects.

Incidence and Prevalence: The incidence of encephalopathy is difficult to assess because of its association with other conditions.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Encephalopathy can occur at any age and may or may not be easily detected.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report associated symptoms of the various disease states associated with encephalopathy. If encephalopathy occurs independent of a pre-existing illness, symptoms may include seizures, decreased mental function, double vision, lack of muscular coordination, and tremors.

Physical exam: Findings include sensory impairment, loss of muscle tone, abnormal reflexes, failure of muscle coordination (ataxia), and involuntary movements.

Tests: Specific tests depend on the underlying condition causing inflammation of the brain (encephalitis). Blood tests and cultures can identify viral and bacterial infections, metabolic or nutritional deficiencies, and liver disease. CT scan, EEG, and MRI can identify brain lesions, tumors, or other causes of brain dysfunction.

Source: Medical Disability Advisor



Treatment

Treatment depends on the cause of the encephalopathy. If it is due to nutritional deficiency such as lack of a B vitamin (thiamine), then vitamin supplementation and an alteration in diet may be indicated. In the case of bacterial or viral infections, administering antibiotics may reduce toxins in the brain (cerebrotoxins). If encephalopathy results from repeated head trauma (chronic or boxer's traumatic encephalopathy), no therapy is effective. In the presence of chronic disease such as that associated with alcoholism (cirrhosis), treating the underlying illness and administering antibiotics will decrease the amount of cerebrotoxins and ammonia in the brain. A synthetic sugar (lactulose) can also be used in conjunction with antibiotics to help the body get rid of ammonia. Anticonvulsant medication may also be necessary if seizures are implicated.

Source: Medical Disability Advisor



Prognosis

In most cases, in the absence of a specific diagnosis, the outcome is unpredictable and related to the extent and progression or course of the underlying disease state. Serious encephalopathies may lead to necrosis of nerve cells in the brain, causing retardation, cerebral palsy, or death. In advanced liver disease, hepatic encephalopathy may progress to deep coma (hepatic coma). Treating bacterial and viral infections with antibiotics can reduce cerebrotoxins and symptoms. In cases in which treatment is started early, progression of the condition and damage to the brain may be minimized.

Source: Medical Disability Advisor



Rehabilitation

If only minimal damage to the brain has occurred, the overall objective of rehabilitation is to quickly return the individual to normal activities. Rehabilitation may involve physical, occupational, and speech therapy and/or cognitive retraining to help the individual achieve functional recovery and cope with any remaining disabilities.

Setting goals is a common practice in rehabilitation of diseases affecting the brain. It maximizes the effective use of time and resources and aids the team of healthcare professionals in creating an organized treatment plan. Rehabilitation varies, however, for each individual because of the variation in problems that result from damage to different areas of the brain.

Individuals who have lost voluntary motion of the limbs begin with passive range of motion exercises. While unconscious, individuals may progress from becoming less comatose or sleepy to more wakeful, but they may still be confused and easily distracted. If memory is affected, exercises are initiated that promote memory return and instruct the individual in carrying out simple tasks. Such exercises can be as simple as motivating individuals to receive an object in his or her hand.

The rehabilitation program sequences activities that progress from easy to more difficult. Once individuals regain their thinking processes, rehabilitation focuses on the needs of muscular strength, endurance, and flexibility. Muscle imbalance is corrected by using physical therapy techniques that help make the muscle and nervous system work together. Group activities may occur in mat classes or in other activities.

When appropriate, the final phase of rehabilitation following an episode of encephalopathy involves the individual's reinstatement to work. Both physical and mental exercises are directed toward work requirements. The physical therapist may need to modify the program, depending on the severity of the individual's encephalopathy.

Source: Medical Disability Advisor



Complications

Complications are directly related to the disease causing the encephalopathy. Loss of nerve cells (neurons) in the brain can occur in some cases.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If treatment of the underlying condition is successful and there is minimal brain damage from the encephalopathy, the individual may perform light work in a limited capacity if accommodations are made available. For example, an individual who recovers from hepatic encephalopathy and has only mild mental dullness and confusion may be able to perform light work that requires simple mental ability. In these cases, the work environment should be quiet, safe, and accepting of individuals with a disability.

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 a history of liver disease, viral or bacterial infections, high blood pressure (hypertension), or metabolic or nutritional diseases?
  • Has individual had long-term exposure to chemotherapeutic drugs, toxic chemicals, or radiation therapy?
  • Has individual experienced repeated head trauma, such as with boxing?
  • Is individual in the final stage of a terminal illness?
  • Does individual report symptoms associated with any of the above disease states?
  • If not, does individual complain of seizures, decreased mental function, double vision, lack of muscular coordination, and tremors?
  • Were blood tests and cultures done to identify viral and bacterial infections, metabolic or nutritional deficiencies, or liver disease?
  • Were computed tomography (CT scan) and magnetic resonance imaging (MRI) done to identify brain lesions, tumors, or other causes of brain dysfunction?
  • Was the underlying disease diagnosed? If so, what is the underlying disease?
  • Has the diagnosis of encephalopathy been confirmed?

Regarding treatment:

  • If the disorder is caused by nutritional deficiency, were vitamin supplementation and an alteration in diet given?
  • Was bacterial infection treated with antibiotics?
  • Was drug treatment successful?
  • Does individual understand that if encephalopathy is due to repeated head trauma (chronic or boxer's traumatic encephalopathy), no therapy is effective?
  • If alcoholism with liver disease (cirrhosis) is present, were antibiotics administered to decrease the amount of cerebrotoxins and ammonia in the brain?
  • Was lactulose also used in conjunction with antibiotics to enhance either the excretion or formation of ammonia?
  • What was the response to treatment?

Regarding prognosis:

  • What is the extent of the underlying disease, and how far has it progressed?
  • Has the underlying condition responded to treatment? If not, what options are available?
  • Was encephalopathy diagnosed and treated in its early stages?
  • If antibiotics were used to treat infection, were they specific for the causative organism?
  • Has serious encephalopathy led to necrosis of nerve cells in the brain, causing retardation or cerebral palsy?
  • Has hepatic encephalopathy progressed to deep coma (hepatic coma)?

Source: Medical Disability Advisor



References

General

Ford, Marsha D., et al., eds. Clinical Toxicology. 1st ed. Philadelphia: W.B. Saunders, 2001.

Jacobs, Daniel H. "Confusional States and Acute Memory Disorders." eMedicine. Eds. Robert A. Hauser, et al. 13 Oct. 2004. Medscape. 20 May 2005 <http://emedicine.com/neuro/topic435.htm>.

Source: Medical Disability Advisor






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