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.

Spinal Cord Injury


Related Terms

  • Vertebral Injury

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Neurologist
  • Neurosurgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Psychiatrist

Comorbid Conditions

  • Cardiovascular disease
  • Morbid obesity
  • Pulmonary disease

Factors Influencing Duration

Disability is highly variable as each spinal cord injury is unique. Disability will depend on the site and extent of injury, severity of symptoms, and whether the symptoms are temporary or permanent. The degree of dysfunction and disability varies relative to the level of injury and how much of the cord is spared from trauma. Psychological adjustment to the injury and disability often contributes to the length of disability. Contact physician for additional information to determine disability duration.

Medical Codes

ICD-9-CM:
952.00 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 Level with Unspecified Spinal Cord Injury
952.01 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 Level with Complete Lesion of Spinal Cord
952.02 - Spinal Cord Injury, Cervical Spine with Anterior Cord Syndrome
952.03 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 level with Central Cord Syndrome
952.04 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 level with Other Specified Spinal Cord Injury
952.05 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Unspecified Spinal Cord Injury
952.06 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Complete Lesion Of Spinal Cord
952.07 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Anterior Cord Syndrome
952.08 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Central Cord Syndrome
952.09 - Spinal Cord Injury, without Evidence of Spinal Bone Injury;C5-C7 level with Other Specified Spinal Cord Injury
952.10 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Unspecified Spinal Cord Injury
952.11 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Complete Lesion of Spinal Cord
952.12 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Anterior Cord Syndrome
952.13 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Central Cord Syndrome
952.14 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Other Specified Spinal Cord Injury
952.15 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Unspecified Spinal Cord Injury
952.16 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Complete Lesion of Spinal Cord
952.17 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Anterior Cord Syndrome
952.18 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Central Cord Syndrome
952.19 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Other Specified Spinal Cord Injury
952.2 - Lumbar Spinal Cord Injury without Evidence of Spinal Bone Injury
952.3 - Sacral Spinal Cord Injury without Evidence of Spinal Bone Injury
952.8 - Spinal Cord Injury without Evidence of Spinal Bone Injury, Multiple Sites
952.9 - Spinal Cord Injury, Unspecified

Overview

The spinal cord carries all motor and sensory functions between the brain and the rest of the body. Injuries to it may be either complete or incomplete. In complete spinal cord injuries, permanent interruption of the transmission of motor and sensory impulses occurs, causing quadriplegia or paraplegia. This is the most severe form of injury and is associated with severe disabilities. Incomplete injuries damage some parts of the spinal cord; however, the cord remains partially functional.

Injury to the spine is usually caused by compression, bending or shearing forces that can dislocate or fracture the vertebrae and injure the spinal cord. Accumulation of blood, or a displaced vertebra can press on the spinal cord, impairing function. The cord may even be torn or severed, destroying sensation and / or motor function below the site of the injury. Collectively these are called traumatic spinal cord injuries. Alcohol intoxication is involved in up to 49% of traumatic spinal cord injuries (Dawodu). Injury can also be caused by tumor, vascular disorders, or infections. These injuries are considered nontraumatic spinal cord injuries. Spinal cord injury can be fatal.

Incidence and Prevalence: In the US there are about 8 cases per 10,000 population per year. Motor vehicle accidents account for 45% of all spinal cord injuries, followed by falls (18%), acts of violence (17%), and sports injuries (12%) (Dawodu).

Source: Medical Disability Advisor



Causation and Known Risk Factors

More than half of all traumatic spinal cord injuries occur to individuals between the ages of 16 and 30. Men are 4 times more likely to be affected than women. Nontraumatic spinal cord injury is more common in individuals over age 40.

In the US, more whites than blacks or Hispanics experience spinal cord injury, and single individuals are more likely to sustain spinal cord injury than married individuals. More spinal cord injuries occur in July than any in other month (Dawodu).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report feelings of numbness, pain, tingling, burning, or other neurological symptoms experienced immediately following the injury. The individual, family member, or others who witness the accident may report what type of injury occurred (fall, flexion, twisting, penetrating).

Physical exam: The exam focuses first on vital functions. These include adequacy of respirations, blood pressure, pulse, examination of level of consciousness and appropriateness of verbal responses to questions. This is followed by an assessment of motor and sensory function in the arms and legs, and reflexes. Presence of back or neck pain or tenderness is evaluated. There are several classification systems to describe the extent of the injury including the International Standards for Neurological and Functional Classification of Spinal Cord Injury and the American Spinal Injury Association (ASIA) Impairment Scale.

Tests: Laboratory tests would include general baseline tests such as complete blood count (CBC), blood glucose (to rule out hypoglycemia or insulin shock), arterial blood gases (to assess adequacy of respiration), electrolytes, and toxicology screen. X-rays of the spine may detect fractures or bony abnormalities that may be responsible for spinal injury.

Source: Medical Disability Advisor



Treatment

Spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the outcome.

The basic goals of spinal cord injury management are relief of any spinal cord pressure and realignment and stabilization of any fractures or dislocations. This may be accomplished by using traction and / or surgical intervention. The individual must be stabilized before any surgical intervention is done.

Fractures or dislocations to the neck (cervical) vertebrae may be treated initially with skeletal traction. A tight fitting tong (Crutchfield tong) may be placed on the head as a means to apply weighted traction to realign the neck vertebrae. Special beds (Stryker frame, Kinetic therapy bed), which help to maintain spinal alignment, are used until the vertebrae are stabilized. These beds permit safe turning from side to side without disrupting proper alignment of the injured spine. Corticosteroid medications may be administered to reduce swelling in the spinal cord.

Injuries to the spine are either stable or unstable. An unstable injury is one in which it is possible that the vertebrae will shift and cause further damage to the cord, possibly even severing it. Once the individual is physically stable, surgical stabilization, which fastens bones using metal plates, wires, or bone pieces, is often a priority. This may be done by fusing the unstable vertebrae (spinal fusion) or by placing wire or metal stabilizing rods (placement of Harrington or Luque rods). Blood clots or bone fragments may be removed (evacuation of hematoma and / or bone fragments) if they are creating excess pressure on the spinal cord. If the bones are dislocated, the surgeon will attempt reduction putting them back into position under general anesthesia.

Initially, the individual will require close monitoring and intervention for life-threatening complications associated with spinal cord injuries. The individual may need respiratory support, blood pressure support, and careful management of fluids and nutrition. Once stable, the individual will receive continued care in a medical or neurological unit. In most instances, the individual will need some form of spinal cord rehabilitation.

Treatment is focused on preventing complications that can be caused by loss of sensation and mobility. Physical therapy can help prevent joints from locking and muscles from becoming permanently contracted. Urinary catheterization and enemas relieve urinary retention and constipation. Diligent skin care and frequent position changes prevent skin breakdown and bedsores.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the location and the extent of the injury to the spinal cord. Actual damage to the spinal cord can result in loss of sensation and / or mobility below the site of the injury. Paralysis and loss of sensation of part of the body are common outcomes. This may include total paralysis and / or numbness and varying degrees of movement or sensation loss. Between 10% and 20% of individuals with traumatic spinal cord injury die before being hospitalized. After hospitalization, death is still possible, particularly if there is paralysis of the breathing muscles.

Surgical stabilization is aimed at preventing any additional injury to the spinal cord. In some cases, surgical intervention relieves excess pressure on the spinal cord, and may result in some improvement of neurological function. Surgical intervention to the spine carries a small additional risk (1% to 4%) of further cord injury.

Recovery of movement or sensation within 1 week usually indicates eventual recovery of most function, although this may take 6 months or more. Losses that remain after 6 months are likely to be permanent.

Serious cord injury often reduces life expectancy. Pneumonia is the leading cause of death in individuals with spinal cord injury. Psychological adjustment to disability can be slow. The suicide rate in individuals under age 25 with spinal cord injury is higher than average.

Source: Medical Disability Advisor



Rehabilitation

Some form of rehabilitation is needed for nearly all individuals with spinal cord injury. This may include respiratory therapy, physical therapy, occupational therapy, speech therapy, and psychological therapy. The overall goal of rehabilitation is to maximize independence with mobility and self-care, and to facilitate successful living at home with return to gainful employment. The duration and frequency of the rehabilitative process is dictated by degree of injury and disability. Often, psychological rehabilitation takes longer than physical rehabilitation from spinal cord injury.

Therapy goals in the hospital focus on prevention of further illness. Respiratory therapists routinely assess individuals on ventilators to determine continued need for assisted breathing. For individuals no longer requiring assisted ventilation, respiratory therapists teach breathing exercises and perform chest percussions to keep the lungs clear of mucus. Physical therapists instruct in assisted bed mobility to prevent bedsores, and teach the individual's family members to comply with a repositioning schedule. Therapists also initiate a program to maintain joint flexibility and begin strengthening muscles that may have movement.

Occupational therapists assess an individual's potential for self-care and initiate positioning strategies to enhance sitting tolerance. Speech therapists evaluate the individual for safe swallowing strategies and communication needs. Psychologists and psychiatrists are a crucial link in the rehabilitation process, helping to focus individuals on attainable goals and treating the depression that often occurs after spinal cord injury.

Once individuals are medically stable, they are transferred to a rehabilitation hospital for a few weeks where they are introduced to techniques to help increase independence. Physical therapists instruct individuals and family members in bed mobility; transferring to and from the bed, wheelchair, shower, and car; and wheelchair mobility. Individuals are also taught exercises to improve strength, flexibility, balance, and posture. Some individuals may learn to walk with assistive devices. For these individuals, therapists work on safe ambulation in the community.

Achieving independence in self-care is the primary goal of occupational therapists, who teach self-care strategies including dressing, grooming, and food preparation techniques. They instruct in the use of adaptive equipment and make suggestions for modifying the home environment to enhance self-care. Both occupational and physical therapists help individuals improve sitting tolerance, wheelchair positioning, and sitting balance. In addition, speech therapists focus on communication strategies for those who are ventilator-dependent, and on increasing the volume of speech for all individuals.

Some individuals with spinal cord injury may only suffer from weakness (paresis). In this case, individuals undergo rehabilitation to strengthen the arms and legs, increase proprioception and balance responses, learn functional mobility such as walking and transfers, and improve self-care.

Outpatient rehabilitation may be warranted to maximize functional gains and to reinforce the mobility and self-care techniques learned in the hospital. Also, individuals cleared by their physicians to drive can be assessed for car adaptations and driving school during outpatient physical therapy. Vocational rehabilitation may be necessary to help individuals learn new workplace skills.

Source: Medical Disability Advisor



Complications

Complications of spinal cord injury include paralysis below the level of injury, loss of sensation, infections, loss of sexual function, deep vein thrombosis, shock, paralysis of breathing muscles, and death. Individuals with permanently limited mobility are more susceptible to pneumonia and bedsores. Depression and other psychiatric disorders are common among the permanently disabled.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work requirements may need to be adapted if the individual has motor or sensory deficits, such as paraplegia or quadriplegia. See specific diagnosis.

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 been confirmed?
  • Have presence of abscess or tumor been ruled out?
  • Has individual experienced any complications from the spinal cord injury such as paralysis below the level of injury, loss of sensation, infections, loss of sexual function, deep vein thrombosis, shock, or paralysis of breathing muscles?
  • Does individual have an underlying condition, such as obesity and pre-existing pulmonary or cardiovascular disease that may impact recovery?

Regarding treatment:

  • Did individual receive prompt, appropriate treatment immediately following injury?
  • Has injury responded appropriately to realignment and stabilization?
  • Have corticosteroid medications been administered to reduce swelling and was swelling effectively relieved?
  • If originally unstable, has individual's spinal injury now been surgically stabilized?
  • If stabilization has been postponed due to individual's health, what is the estimated time frame before stabilization? Based on what criteria?
  • Has individual been provided respiratory support, blood pressure support, and careful management of fluids and nutrition?
  • Has individual received spinal cord rehabilitation?
  • Does individual have the necessary physical assistive devices (i.e., wheelchair, walker, eating utensils) to maximize independence?
  • Is individual receiving physical therapy?
  • Does individual have symptoms of bowel or bladder dysfunction, such as abdominal distention or urinary or fecal incontinence?
  • Is family or hired caregiver meticulous in skin care? In position changes?
  • Has skin broken down despite prevention?
  • What other treatment options or prevention products might be tried?

Regarding prognosis:

  • Does individual have evidence of muscle spasticity or muscle contractures that can interfere with mobility and coordination?
  • Did individual experience any improvement of neurological function following surgery?
  • Did individual recover movement or sensation within the first week after injury?
  • Has it been over 6 months since injury?
  • How much dysfunction remains?
  • Is individual realistic about prognosis?
  • Does the individual demonstrate signs of depression, such as powerlessness, hopelessness, or poor self-image?
  • Would individual benefit from psychological counseling?

Source: Medical Disability Advisor



References

Cited

Dawodu, Segun T. "Spinal Cord Injury: Definition, Epidemiology, Pathophysiology." eMedicine. Eds. Milton J. Klein, et al. 24 Aug. 2001. Medscape. 18 Oct. 2004 <http://emedicine.com/pmr/topic182.htm>.

Source: Medical Disability Advisor






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