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.

Post-concussion Syndrome


Related Terms

  • Closed Head Injury Syndrome
  • Mild Brain Injury
  • Postconcussional Syndrome
  • Postconcussive Syndrome

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Family Physician
  • Neurologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Psychiatrist

Comorbid Conditions

  • Depressive disorders
  • Post-traumatic cognitive impairment
  • Post-traumatic headache
  • Post-traumatic seizures
  • Post-traumatic stress disorder
  • Substance abuse

Factors Influencing Duration

The length of disability is highly variable and dependent upon the nature of the head trauma and associated symptoms. Factors influencing the length of disability include the individual's response to medications and psychotherapy; the presence of substance abuse or other psychiatric disorders; the individual's access to a supportive emotional network; and any secondary gain, such as financial gain related to litigation, increased attention from friends and family, and avoidance of work or other responsibilities. Some orthopedic and neurological complications may be present, depending upon the severity and circumstances of the trauma.

Medical Codes

ICD-9-CM:
310.2 - Postconcussion Syndrome

Overview

Postconcussion or postconcussive syndrome, first described by Strauss and Savitsky in 1934, is characterized by impairments in memory, attention, and concentration (cognition); emotional state (affect); and behavior following a closed head injury. In a closed head injury, there is no penetration of the skull, but trauma results in the brain knocking against the hard inner surface of the skull. The closed head injury itself may be accompanied by loss of consciousness, loss of memory of the trauma and events immediately following (post-traumatic amnesia), and possibly post-traumatic seizure disorder. Postconcussive syndrome usually follows mild head injury, in which loss or alteration in consciousness lasts less than 20 minutes. Cognitive symptoms include poor concentration, attention deficits, and impaired memory. Affective symptoms may include irritability, anxiety, depression, or fluctuation in mood (emotional lability). Physical symptoms can include fatigue, headaches, vertigo, or an intolerance of noise (phonophobia) and bright lights (photophobia). Occasionally, there will be visual or hearing impairments or a loss of the sense of smell (anosmia), which may affect appetite. Its definition as a syndrome reflects a lack of consensus as to the defining factors and validity of the entity as a discrete entity. Rather, it represents a pattern of signs and symptoms that have been given the name.

Incidence and Prevalence: Of the 2,000,000 individuals in the US who suffer mild head injuries every year, 20% to 90% have a symptom of postconcussive syndrome 30 days after their injury; after 90 days, 40% of individuals have three symptoms or more of postconcussive syndrome (Legome).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women are more likely than men to develop postconcussive syndrome (Legome).

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis of postconcussion disorder is based on research criteria, meaning that this is a proposed idea for a new diagnosis to be listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) in the future after more research studies are performed. The individual will have trouble paying attention, concentrating, changing focus from one activity to another, performing more than one mental activity at the same time, remembering information, and learning new information. Three or more of the following symptoms occur after the trauma and last at least 3 months: fatigue; insomnia; headache; vertigo or dizziness; anger that occurs without a good reason; anxiety, depression, or mood swings; and personality changes such as inappropriate behavior, apathy, or lack of spontaneity. The impairment represents a significant decline from pre-trauma functioning and causes significant difficulty with school or workplace performance. Postconcussion disorder is not considered to be the diagnosis if the individual has dementia following trauma to the head.

Physical exam: A general physical and neurological examination will determine if other disorders are causing the symptoms. Physical impairments that may be observed include loss of sense of smell (anosmia), slowed movement or speech (psychomotor retardation), impaired gait on specialized tests such as standing with feet together and eyes closed (Romberg) or walking a straight line (tandem gait), or other subtle neurological findings.

Tests: Skull x-rays, brain CT scan or MRI, and psychological tests may all be performed. Regarding psychological testing, typically a full-scale neuropsychological battery of tests are completed, such as the Wechsler Adult Intelligence Scale III (WAIS-III), Neuropsychological Assessment Battery (NAB) and other related neuropsychological tests specific to the noted deficits. These tests can also then be utilized to determine not only premorbid level of functioning according to age group, but also current deficits so that appropriate treatment plans can be developed to help the individual regain different levels of cognitive functioning. Electroencephalogram (EEG) may be indicated if seizures are suspected.

Source: Medical Disability Advisor



Treatment

Treatment options vary according to the nature of the trauma and associated symptoms. Medication therapy may be helpful for specific areas of concern such as sleep disturbances, depression, anxiety, headaches, or seizures. Psychotherapy, specifically the behavioral approaches, is helpful, depending upon the individual's level of cognitive impairment. Substance abuse treatment may also be indicated.

Typically, family counseling is also important to help family members adjust to changes and to educate the family on how to support the individual in facilitating a gradual return to everyday activities.

Source: Medical Disability Advisor



Prognosis

In most cases of mild to moderate head injury, the symptoms clear up in 6 to 12 months. However, some individuals may experience symptoms for several years and may never return to normal. Residual impairment and changes in mood (excitement or depression) are common. Depending on the severity of the injury, there may be residual cognitive impairment or seizures.

Source: Medical Disability Advisor



Rehabilitation

In addition to psychotherapy and pharmacotherapy treatments, occupational therapy may be helpful. Occupational therapy may help the individual develop communication skills, identify and match personal skills and work habits to the workplace, and learn how participation in leisure activities contributes to overall health and well being. In the first weeks or months after the head trauma, physical therapy may be useful to increase balance and coordination that may have been affected by the injury. Cognitive rehabilitation may help the individual cope with memory or concentration problems through strategies such as making lists or learning new information presented in writing as well as verbally.

In addition to occupational therapy, physical therapy is a typical part of the rehabilitation process. The treatment team is comprised of the physiatrist, physical therapist, occupational therapist, speech pathologist (if necessary), psychologist specializing in rehabilitation/neuropsychology, and perhaps, in-home care assistance in the beginning, once the individual returns home.

Source: Medical Disability Advisor



Complications

Complications may be caused by psychosocial factors. Substance abuse and major depression may occur and require treatment in their own right. Impairments in memory, vision, hearing, and sense of smell that may have resulted from the head trauma can also complicate recovery. Seizures (post-traumatic epilepsy), persistent headaches (post-traumatic headache), or specific neurological impairments may also occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations may include modifying the work space to decrease noise and visual distractions; introducing the individual to new or stressful situations gradually under appropriate supervision and support; providing written instructions and new information in small steps; allowing break time according to individual needs rather than a fixed schedule; limiting physical tasks that involve stooping, physical exertion, noise, and that cause sneezing and excitement; adjusting or eliminating highly stressful activities; providing sensitivity training for coworkers; and providing praise and positive reinforcement. Individuals with seizures should not work at heights, drive, or operate heavy machinery. Persistent memory problems may require reassignment of job duties or even result in total disability. Avoiding work environments with loud noise or bright lights may help decrease headaches.

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:

  • Have well defined neurological, metabolic or anatomic abnormalities been ruled out?
  • Has postconcussive syndrome been confirmed?
  • Is there evidence of neurological problems following head trauma, such as seizures or memory problems?
  • Is additional testing warranted?
  • Does the individual have a coexisting medical or psychological condition that may affect recovery?
  • Have changes in physical and cognitive functioning resulted in a depressive disorder?

Regarding treatment:

  • Has drug therapy been effective for specific areas of concern, such as sleep disturbances, depression, anxiety, headaches, or seizures?
  • Is individual taking medication as prescribed? Are side effects interfering with use or benefit from that particular medication? Are too many medications, excessive doses, or substance abuse resulting in cognitive impairment?
  • Could other medication options be used instead?
  • Are post-traumatic seizures and / or post-traumatic headaches being properly addressed?
  • Depending on the level of cognitive impairment, would individual benefit from more frequent sessions or a different type of therapy?
  • Because coexisting substance abuse may complicate treatment and delay recovery, would individual benefit from enrollment in a substance abuse treatment program?

Regarding prognosis:

  • Do symptoms persist despite treatment?
  • Does cognitive impairment persist?
  • Would cognitive or vocational rehabilitation be beneficial?
  • Would individual benefit from additional psychotherapy or enrollment in a support group?
  • Are other factors prolonging disability, such as financial gain related to litigation, or secondary gain related to increased attention from family and friends?
  • Did the individual have a pre-existing psychological disorder prior to the injury? If so, what was the diagnosis?
  • What type of treatment was provided?
  • How did the individual respond to past psychological treatment?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, Harold Alan Pincus, and Michael B. First, eds. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association, 1994.

Legome, Eric. "Postconcussive Syndrome." eMedicine. Eds. Jerry Balentine, et al. 18 Aug. 2004. Medscape. 7 Jan. 2005 <http://emedicine.com/emerg/topic865.htm>.

Source: Medical Disability Advisor






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