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.

General Paresis


Related Terms

  • Brain Syphilis
  • Dementia Paralytica
  • General Paralysis of the Insane
  • Paralytic Dementia
  • Parenchymatous neurosyphilis
  • Paresis
  • Syphilitic Meningoencephalitis

Specialists

  • Infectious Disease Internist
  • Internal Medicine Physician
  • Neurologist
  • Physical Therapist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

The timeliness and accuracy of the diagnosis, the nature and severity of symptoms, the individual's response to treatment, any other forms of neurosyphilis such as tabes dorsalis, or any complications may influence the length of disability. Treatment may stop the progression in some cases but will not reverse the disability.

Medical Codes

ICD-9-CM:
094.0 - Neurosyphilis, Tabes Dorsalis; Locomotor Ataxia, Progressive; Syphilitic Posterior Spinal Sclerosis
094.1 - Neurosyphilis; General Paresis; Paretic Neurosyphilis, Dementia Paralytica, General Paralysis (of the Insane) (Progressive), Taboparesis
095.8 - Syphilis, Other Specified Forms of Late Symptomatic
095.9 - Syphilis, Late Symptomatic, Unspecified
096 - Syphilis, Late, Latent; Syphilis without Clinical Manifestations, with Positive Serological Reaction and Negative Spinal Fluid Test, Two Years or More after Infection

Overview

General paresis is a chronic inflammation of the brain and its lining (meningoencephalitis) that occurs in the late stages of syphilis (tertiary syphilis). The infection causes gradual, widespread damage to the nerves of the brain, resulting in a variety of physical and psychological changes such as generalized paralysis and progressive dementia.

General paresis is a progressive, disabling, and life-threatening condition. Since it is a complication of untreated syphilis, the primary risk factor is previous syphilis infection. Previous infection with another sexually transmitted disease (STD) such as gonorrhea or HIV/AIDS is also a risk factor as such diseases can hide the symptoms of a syphilis infection. General paresis usually does not occur until 20 to 30 years after the primary infection (Knudsen).

Incidence and Prevalence: The incidence of general paresis is difficult to determine, because the disease develops up to 15 or more years after the initial infection. A rise in primary syphilis occurred during the 1970s and 1980s, especially among homosexual men, followed by a substantial decline in the 1990s. This suggests that the incidence of general paresis will follow that trend. General paresis is uncommon.

Source: Medical Disability Advisor



Causation and Known Risk Factors

General paresis is a complication of untreated syphilis. Since humans are the only host to Treponema pallidum, the organism that causes syphilis, the main risks of contracting syphilis are sexual activity with an infected individual or sharing needles during intravenous drug abuse. Whites are 2-3 times more likely to contract neurosyphilis than blacks, and men are twice as much at risk as women (Knudsen).

Source: Medical Disability Advisor



Diagnosis

History: The mnemonic "paresis" has been used to describe the manifestations of general paresis: personality changes, affect, reflexes (hyperactive), eyes (Argyll Robertson pupils), sensorium (illusions, delusions, hallucinations), intellect (both long-term and short-term memory loss, and defective orientation, judgment, calculations, and insight), and speech (decreased language ability [aphasia]). The individual or his or her family may also report irritability, impaired concentration, carelessness, fatigue, lethargy, headache, and insomnia. In the later stages of this condition, symptoms include muscle weakness, defective judgment, depression, psychosis, dementia, confusion, disorientation, paranoia, and seizures. The final stage of the disease may include frequent seizures, incontinence, and recurrent strokes. The individual may voluntarily report prior syphilis infection, but since the initial infection may have occurred many years earlier, the individual may not make the association between the current symptoms and the previous infection.

Physical exam: Individuals may present with tremors of the lips, tongue, and fingers; slurred speech; difficulty writing; unsteadiness; decreased muscle tone; muscle weakness; lack of facial expressions; and small, nonreactive pupils (Argyll Robertson pupils). Other conditions associated with late-stage syphilis infection may also be present, such as tabes dorsalis, another disease that affects the nervous system. Individuals may also exhibit psychological instability that mimics schizophrenia, mania, paranoia, or depression.

Tests: Blood (serologic) tests are first conducted to identify the cause of infection. If syphilis is detected, then a lumbar puncture procedure is performed to obtain a small amount of cerebrospinal fluid (CSF). Study of the CSF fluid can confirm diagnosis and provide a baseline to gauge the effectiveness of future treatment.

Source: Medical Disability Advisor



Treatment

The goals of treatment are to cure the underlying infection with antibiotic medication such as penicillin, and reduce progression of the disorder. Treatment of the infection reduces new nerve damage but will not reverse damage that has already occurred. Individuals treated for general paresis need periodic tests of the CSF to ensure that the infection is responding. If the CSF fails to return to normal after 6 months, the individual should be treated again. Individuals with neurosyphilis may need to be retested up to 2 years after treatment.

Damage already done to body organs cannot be reversed but can be treated symptomatically. Antipsychotic drugs may help to control paresis. Emergency treatment of seizures may be required. Antiseizure medicine may be prescribed for controlling seizures. Assistance or supervision with activities such as eating and dressing may be required if individuals can no longer care for themselves. Physical or occupational therapy may be required for those with muscle weakness.

Source: Medical Disability Advisor



Prognosis

General paresis can take away individuals' ability to care for themselves and communicate or interact with others. Progressive disability is likely, although treatment can reduce (but not necessarily stop) the progression of nerve damage. As mentioned above, damage already done to organs cannot be reversed. If untreated, this condition is fatal, with death typically occurring within 5 to 6 years following the development of symptoms.

Source: Medical Disability Advisor



Rehabilitation

Physical and/or occupational therapy may help individuals with muscle weakness. The duration and frequency of such therapy vary considerably, depending on the extent and severity of symptoms and the individual's response to treatment. In general, therapy focuses on maintaining range of motion; increasing strength; and improving coordination, balance, and functional abilities such as gait.

Individuals with weakness and decreased function in their arms and/or legs require a comprehensive program to maintain the maximum possible range of motion in the joints. A strengthening program helps maintain or improve functional abilities of the arms and legs. Individuals may have impaired coordination. An occupational therapist instructs individuals in performing fine motor coordination exercises that promote self-care skills. Physical and occupational therapists also help individuals with their sitting and standing balance. The focus of physical and occupational therapy is to maximize functional capabilities.

Source: Medical Disability Advisor



Complications

Complications include injuries incurred from falls or during seizures.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended sick leave for hospitalization and treatment may be needed. Other accommodations vary, depending on the extent and severity of symptoms and any underlying conditions. Work responsibilities may need to be restricted to duties requiring minimal intellectual and/or physical activity.

Risk: Individuals with late-stage general paresis who experience seizures should be removed from safety-sensitive work tasks and conditions in which significant injury to the self or others could occur during a seizure. Impaired cognitive abilities may also be a concern.

Capacity: Individuals with general paresis may have significantly reduced capacity secondary to permanent neurological impairment, muscle weakness, and psychological instability. Reassignment to simple, sedentary job duties may be necessary. Most patients will not be able to return to work.

Tolerance: Tolerance is dependent on the stage of the general paresis. Contact physician for details.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 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:

  • Has diagnosis of general paresis been confirmed?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual taken antibiotics as prescribed?
  • Since individuals with neurosyphilis may need to be retested for up to 2 years following treatment, was individual compliant with CSF testing regimen?
  • If CSF failed to return to normal after 6 months, was individual retreated?
  • Has individual followed physician's instructions regarding the use of antipsychotic and/or antiseizure medications?
  • Does individual have muscle weakness?
  • Does individual have an underlying condition that may complicate treatment or prolong recovery?

Regarding prognosis:

  • Is individual able to care for him- or herself? Does individual need assistance with daily activities such as eating and dressing?
  • Has individual received appropriate physical and/or occupational therapy?
  • Has treatment been effective in reducing nerve damage progression? If not, is it because the infection has not responded to antibiotic therapy?
  • Has individual received a second course of treatment?
  • Has individual experienced any complications associated with the general paresis?
  • Is individual compliant with CSF testing regimen? If not, what can be done to increase compliance?

Source: Medical Disability Advisor



References

Cited

Knudsen, Richard P., et al. "Neurosyphilis." eMedicine. 7 Oct. 2014. Medscape. 22 Apr. 2015 <http://emedicine.medscape.com/article/1169231-overview>.

Source: Medical Disability Advisor






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