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.

Wilson's Disease


Related Terms

  • Copper Metabolism Disorder
  • Hepatolenticular Degeneration
  • Westphal-Struempel Pseudosclerosis
  • Westphal-Strümpell Pseudosclerosis
  • Westphal-Strümpell Syndrome

Differential Diagnosis

Specialists

  • Clinical Geneticist
  • Gastroenterologist
  • Neurologist
  • Ophthalmologist
  • Psychiatrist
  • Urologist

Comorbid Conditions

  • Psychiatric disorders

Factors Influencing Duration

Length of disability may be influenced by the extent of the disease when diagnosed and the response to treatment. The individual usually presents to the clinician after the onset of physical and neurological symptoms. Therefore, it may take several months before improvement in the clinical condition allows the individual to return to work. The other factor that will influence disability is whether the individual has any side effects from the therapeutic drugs.

Medical Codes

ICD-9-CM:
275.1 - Disorder of Copper Metabolism; Hepatolenticular Degeneration; Wilsons Disease

Overview

Wilson's disease is an inherited disorder in which copper is not properly metabolized and abnormally accumulates in the brain, liver, kidneys, and corneas of the eyes.

Copper is a naturally occurring mineral that the body needs in small amounts to stay healthy. Normally, the liver excretes excess copper through the intestines (gastrointestinal tract) into the feces. In Wilson's disease, the liver is impaired and cannot excrete copper. As a result, copper accumulates in the liver, causing irreversible damage (cirrhosis). Eventually the damage causes the liver to slowly release copper into the bloodstream, where it travels to other parts of the body. In time, the liver, kidneys, brain, and eyes are significantly impaired.

Because this disease is hereditary, the accumulation of copper begins at birth. Symptoms usually appear between the ages of 6 and 20, but can appear as late as age 40. However, individuals with a family history should be tested before symptoms develop. If the disease is detected before copper has built up to toxic levels, treatment may prevent symptoms from developing.

Incidence and Prevalence: A rare disorder, only 1 in 30,000 to 40,000 individuals are afflicted with Wilson's disease in the US (Carter; Goldman 1130). The gene causing this condition is an autosomal recessive. It is estimated that 1 in 90 individuals carry the gene (Carter). Wilson's disease is found worldwide.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The only risk factor is a family history of the disorder. Men and women of all races are equally affected.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may include a vague feeling of discomfort or illness (malaise), lack of appetite (anorexia), yellowing of the skin (jaundice), vomiting blood, tremor, loss of fine motor skills, rigidity, drooling, difficulty with speech, staggering gait (titubation), early intellectual deterioration, personality changes, and a disorder resembling schizophrenia (schizophreniform disorder).

Physical exam: An eye examination will reveal a golden brown to greenish-looking ring around the individual's cornea (Kayser-Fleischer ring). This ring is a characteristic sign on which the diagnosis of Wilson's disease can be based (a pathognomonic sign). Physical examination findings may include tenderness and swelling of the liver and spleen, fluid buildup in the lining of the abdomen, lack of muscle tone in the face (dystonic facies), and lack of muscle tone in the body (dystonic posture).

Tests: Wilson's disease is usually diagnosed upon definitive lab results. Individuals with this disease have elevated liver and urinary copper levels, along with a low serum ceruloplasmin. Although these three results in combination give the diagnosis, removal of a small amount of liver tissue for microscopic analysis (liver biopsy) may also be done to assess the amount of copper accumulation. Genetic testing may also be done.

Source: Medical Disability Advisor



Treatment

Wilson's disease requires treatment with a drug (penicillamine) that binds with the copper, enabling it to be excreted from the body. If started soon after symptoms appear, treatment can sometimes improve liver and brain function. Individuals may respond quite slowly to this treatment, as it sometimes takes up to a year to resolve excess copper buildup. The individual must be monitored every 2 months during the first year and then every 6 months thereafter. Monitoring consists of acquiring urinary copper levels, serum ceruloplasmin, and serum non-ceruloplasmin levels. Lifetime maintenance therapy is usually required.

Individuals will also need to take vitamin B6 supplements and follow a low-copper diet (avoiding mushrooms, chocolate, nuts, dried fruit, liver, and shellfish). Taking extra zinc may help block absorption of copper by the intestines.

A liver transplant may be indicated if Wilson's disease progresses to severe, irreversible impairment of the liver.

Source: Medical Disability Advisor



Prognosis

The prognosis is good in individuals who are treated with copper-binding medicine, a low-copper diet, and vitamin B6 and zinc supplements before liver or brain damage occurs. Such individuals have a normal life expectancy. If therapy is started soon after symptoms appear, treatment can sometimes improve liver and brain function. If untreated, Wilson's disease is generally fatal, usually by the age 30.

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation for Wilson's disease is designing a physical conditioning program for the individual that maintains the body's mobility and strength while improving overall stamina. The proper amount and intensity of rehabilitative exercise is determined by the physical therapist, who takes into consideration the individual's medication regimen. The rehabilitation professional focuses on establishing an independent program, because such treatment must be continued for life to keep the disease under control. The frequency and duration of the rehabilitation program will vary among individuals with Wilson's disease. Intensity and progression of the exercise will depend on the extent of the disease, which organs are most involved, and the individual's overall health. Rehabilitation professionals, along with other healthcare professionals, take a role in educating the individual about Wilson's disease throughout the course of direct rehabilitation. This includes making sure that the individual understands it is an inherited disorder and that relatives of a person with that diagnosis should be screened. This screening allows early treatment to prevent or minimize organ damage.

Source: Medical Disability Advisor



Complications

The toxic effects of copper on the liver can progress from inflammation (hepatitis) to permanent scarring, structural damage, and loss of function (cirrhosis). In the brain, accumulations of copper can cause progressive problems ranging from mild intellectual impairment to crippling rigidity, tremor, dementia, and death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Due to possible neurologic impairment with increased risk of falls, a safe environment is essential. Physical condition may require a sedentary position. Intellectual impairment may necessitate a change in job responsibilities. Individuals with advanced liver or brain damage may be permanently disabled and unable to work.

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 family history of Wilson's disease?
  • Has copper abnormally accumulated in individual's brain, liver, kidneys, and corneas?
  • Does individual complain of malaise, anorexia, jaundice, and vomiting blood?
  • Is there a tremor, loss of fine motor skills, or rigidity? Does individual drool and have difficulty with speech?
  • Does individual have a staggering gait, early intellectual deterioration, personality changes, and a disorder resembling schizophrenia?
  • On exam, is there a golden brown to greenish ring around individual's cornea? Was there tenderness and swelling of the liver and spleen? Fluid buildup in the lining of the abdomen? Lack of muscle tone in the face and body?
  • Has individual had blood and urine tests for copper level? Was a serum ceruloplasmin done? Was a liver biopsy done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with penicillamine? Being monitored frequently?
  • Was lifetime maintenance therapy prescribed?
  • Is individual following a low-copper diet?
  • Is individual compliant with treatment regime?
  • Is a liver transplant indicated?

Regarding prognosis:

  • Is individual active in rehabilitation? Is a home exercise program in place?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Have any complications occurred, such as permanent liver damage and loss of function? Intellectual impairment, crippling rigidity, tremor, or dementia?

Source: Medical Disability Advisor



References

Cited

Carter, Beth A. "Wilson Disease." eMedicine. Eds. Erawati Bawle, et al. 17 Jun. 2004. Medscape. 4 Jan. 2005 <http//emedicine.com/ped/topic2441.htm>.

Goldman, Lee, and J. Claude Bennett, eds. Cecil Textbook of Medicine. 21st ed. Philadelphia: W.B. Saunders, 2000.

Source: Medical Disability Advisor






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