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.

Subarachnoid Hemorrhage (Non-traumatic)


Related Terms

  • Ruptured Arteriovenous Malformation
  • Ruptured Cerebral Aneurysm
  • Spontaneous Atraumatic Intracranial Hemorrhage

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)

Comorbid Conditions

Factors Influencing Duration

Disability factors include the location and extent of hemorrhage within the brain, underlying cause of the hemorrhage, age and general health of the individual, job requirements, severity of residual brain damage, and success of treatment measures directed at eliminating the cause of the hemorrhage.

Medical Codes

ICD-9-CM:
430 - Subarachnoid Hemorrhage

Overview

© Reed Group
A subarachnoid hemorrhage (SAH) refers to the leakage of blood into the subarachnoid space containing the cerebrospinal fluid. The subarachnoid space is located under the middle of three membranes (meninges) that surround the brain and spinal cord. The middle membrane is called the arachnoid.

SAH may result from head trauma, rupture of a dilated blood vessel (cerebral aneurysm), or leakage from a complex cluster of thin-walled arteries and veins called arteriovenous malformation (AVM). Cerebral aneurysms are also referred to as "berry" aneurysms because of their shape. They may be congenital (present at birth) and later rupture when a person is in their 30's or 40's. Other possible causes of SAH are bleeding disorders such as hemophilia or reduced ability to clot (altered hemostasis) from excessive use of anti-coagulant medications.

About 80% of cases of SAHs without trauma are caused by aneurysms (Gershon). Individuals with a history of high blood pressure (hypertension), an infection in the heart (endocarditis), and fluid-filled cysts within the kidneys (polycystic disease of the kidneys) are also at an increased risk for developing SAH. About one-fifth of strokes are caused by intracranial hemorrhage, and 50% of nontraumatic intracranial bleeding is caused by SAH (Newton).

Incidence and Prevalence: SAH not caused by trauma occurs annually in about 10 out of 100,000 people (Gershon). Incidence rates vary worldwide, with the smallest incidence rates in China and the greatest in Denmark.

Source: Medical Disability Advisor



Causation and Known Risk Factors

SAH is more frequent in women, with a 3 to 2 female-to-male ratio (Newton). The age group most affected is between 40 and 70. In individuals under 40, spontaneous SAHs typically result from an arteriovenous malformation.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report the abrupt onset of a severe, throbbing headache that is localized initially before spreading to other areas. Additional symptoms include dizziness, stiff neck, nausea, vomiting, drowsiness, sweating, sensitivity to light (photophobia), double vision, weakness on one side of the body (hemiparesis), chills, and decreased consciousness.

Physical exam: The individual's level of consciousness may vary from alert to comatose. Partial paralysis, dilation of one or both pupils, and / or a rigid (stiff) neck may be present. Blood pressure is often elevated.

Tests: Blood tests such as complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (aPTT), electrolytes, cardiac enzymes, arterial blood gas (ABG), and type and screen (T&S) can help in the initial evaluation of the patient. Transcranial doppler, chest x-ray (CXR), and electrocardiogram (ECG) are also indicated. The most frequently used diagnostic test involves the use of a CT to visualize the area affected by the bleeding, as well as the source of hemorrhage. CT is better than MRI because MRI may not detect SAH early on. However, CT is not always positive in an individual with SAH. If results are negative and the history is compelling, a spinal tap is done to look for blood in the CSF. This procedure involves inserting a needle into the subarachnoid space in the lower spinal column and removing a small amount of CSF. Intracranial pressure (ICP) is then measured using a screw-type device or catheter with a sensor tip inserted through a burr hole in the skull. Sometimes cerebral angiography is done to identify the exact source of hemorrhage (e.g., AVM or aneurysm).

Source: Medical Disability Advisor



Treatment

Treatment focuses on first locating the source of hemorrhage and, if possible, surgically repairing the aneurysm or AVM to stop the bleeding. The best time to perform surgery remains controversial. Early surgery (within the first 3 days) reduces the chances of rebleeding, but delayed surgery (after 14 days) avoids the time between 3 and 14 days when abnormal contraction of arteries (vasospasm) and its consequences are greatest. In general, individuals who are conscious with a minimal neurologic deficit on arrival do best with early surgery, whereas obtunded individuals do better with delayed surgery.

Ruptured cerebral aneurysms are corrected surgically using one of three procedures: aligning the edges of the ruptured aneurysm to stop the bleeding with stainless steel or cobalt alloy clips (clipping), tying off the bleeding blood vessel with suture (ligation), or wrapping the aneurysm with muscle. The best way to prevent SAH from rupture of a cerebral aneurysm is to diagnose and surgically correct the aneurysm before it ruptures.

Once an aneurysm is treated, follow-up focuses on preventing complications such as rebleeding, cerebral vasospasm, abnormal amounts of CSF collecting around the brain (hydrocephalus), and the effects of elevated intracranial pressure. Large amounts of intravenous fluid (IV) are administered to treat vasospasm by increasing blood pressure to enhance blood flow to the brain. This increased blood flow ensures an adequate oxygen level to the brain and minimizes damage to the surrounding brain tissue.

Draining excess cerebrospinal fluid (CSF) though a shunt into the abdominal or chest cavity or into the heart typically treats an abnormal amount of CSF surrounding the brain. If hydrocephalus is not controlled, brain tissue damage can occur as a result of compression of the brain from the excess fluid. Anti-inflammatory medications called steroids and medications to rid the body of excess fluid (diuretics) may also be used in an effort to temporarily control increased intracranial pressure.

Source: Medical Disability Advisor



Prognosis

The prognosis associated with a SAH is grave. SAH causes death in 10% to 30% of people who cannot make it to the hospital in time to be treated; even those individuals with nontraumatic SAH who make it to the hospital in time have a 30% to 60% chance of dying (Gershon). Among those individuals who survive SAH, significant neurological deficits are common. If the aneurysm is successfully treated surgically, 55% of individuals have a positive result after 3 months, as few as 30% of individuals return to their premorbid functional level (Gershon).

Source: Medical Disability Advisor



Rehabilitation

Individuals who sustain nontraumatic subarachnoid hemorrhage may require a wide array of rehabilitation services. The type and length of rehabilitation depend on the severity of residual brain damage as a result of the hemorrhage. Individuals may present with a variety of physical and cognitive disabilities, depending on the severity of the injury. They may need to be treated by physical, occupational, and speech therapists, as well as neuropsychologists, vocational counselors, and social workers.

Individuals may demonstrate motor control deficits. Physical and occupational therapists treat any balance and coordination disorders. Individuals with impaired coordination perform fine motor coordination exercises in occupational therapy and work on gross motor coordination in physical therapy. Individuals with impaired balance engage in physical and occupational therapy. For example, occupational therapists may work on dynamic sitting balance to promote dressing and grooming abilities. Physical therapists may focus on standing balance to preserve the individual's ability to walk. Since individuals with motor control deficits may also have difficulty planning out movements (apraxia), therapists may need to provide cues.

The main focus of physical and occupational therapy in the area of motor control is to maximize functional capabilities. Occupational therapists teach individuals skills to help them with the activities of daily living and may order equipment to make these tasks easier. Physical therapists teach skills such as getting in and out of bed, walking, or using a wheelchair and may order adaptive equipment. Physical therapists may also refer an individual to an orthotist, if leg braces are deemed appropriate.

Individuals with poor motor control of the facial muscles may require speech therapy to improve their clarity of speech and ensure their safety in swallowing. Speech therapy teaches individuals to learn or relearn to pronounce certain speech sounds. Individuals also learn to change speech patterns, such as decreasing the speed of speech or changing the volume of speech. Individuals learn to speak with greater volume through activities such as sustained vocal expressions, for example, saying "ah." Speech therapy can also strengthen the muscles of the face for improved speech and swallowing. Individuals learn to move the facial muscles in a balanced manner, using both manual assistance and visual cueing. Individuals perform tongue exercises to allow for better speech and eating. Individuals who cannot talk because of motor deficits may require adaptive devices such as communication boards or computers that "talk" for the individual when words are entered into it.

Individuals may also suffer from perceptual deficits. Occupational and physical therapists provide methods to increase safety, such as teaching the use of a cane to compensate for decreased balance due to double vision. Individuals may require an occupational or physical therapist to assess their homes to remove tripping hazards. Individuals may present with difficulty speaking or understanding speech (aphasia) due to brain injury. Speech therapy may focus on skills such as word finding and sentence completion. Individuals with hearing loss also may require speech therapy. Speech therapists can teach lip reading or sign language for communication and can provide suggestions for coping with hearing loss. Speech therapists can also assist individuals in obtaining equipment to compensate for hearing loss that uses flashing lights instead of sound as a signal.

Individuals may present with persistent fatigue after a subarachnoid hemorrhage. Occupational therapists may teach energy conservation techniques, in which activities of daily living are broken up into smaller components, thereby making tasks more manageable. Physical therapy addresses decreased endurance by teaching stretching and strengthening exercises of the arms and legs to improve overall endurance. Individuals may also perform aerobic activity to further increase endurance. For individuals in a persistent vegetative state as a result of subarachnoid hemorrhage, physical and occupational therapists teach family members stretching exercises and positioning techniques to prevent pressure sores and joint contractures.

Individuals may also present with cognitive deficits. Occupational therapists evaluate and treat any deficits that are present. Individuals may learn to compensate for cognitive deficits by making lists.

Treatment by a neuropsychologist may be necessary for individuals with more severe deficits. Individuals are assessed in areas such as planning, perception, concentration, attention span, orientation, memory, problem solving, and social judgment. Neuropsychologists apprise the therapy disciplines of changes in these areas and help to guide the course of rehabilitation. Neuropsychologists also help individuals and their families make long-range decisions.

Social workers coordinate the care of individuals in areas ranging from discharge planning to obtaining different services. Social workers may obtain any adaptive equipment that is necessary. Individuals may learn of support groups for people with similar disabilities.

Vocational counselors work with occupational, physical, and speech therapists to replicate job task requirements in therapy. These counselors may help individuals keep future career plans realistic and ease the transition back to work. Vocational counselors may also focus individuals on new careers that may be more appropriate under their current level of disability.

Source: Medical Disability Advisor



Complications

Complications include seizures, infection after surgery, long-lasting neurologic deficits, recurrent bleeding (19%), and hydrocephalus (Newton). Some SAHs are associated with extension of bleeding into the brain itself, thereby complicating treatment and worsening the prognosis. Another complication of SAH is a low sodium concentration in the blood (hyponatremia) due to the inappropriate release of a hormone called antidiuretic hormone from the pituitary gland. This complication is known as the syndrome of inappropriate antidiuretic hormone (SIADH) secretion.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Significant work restrictions and accommodations are often required. If the individual was working before the SAH, he or she may require transfer to a more sedentary and less physically and emotionally demanding position. In addition, loss of some cognitive function and / or residual partial paralysis may dictate the need for reassignment or may mandate medical retirement.

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:

  • Did subarachnoid hemorrhage (SAH) occur as the result of a ruptured blood vessel in the brain, AVM, bleeding disorder, or head trauma?
  • Does individual have a history of high blood pressure (hypertension), an infection in the heart (endocarditis), or fluid-filled cysts within the kidneys (polycystic disease of the kidneys)?
  • Did individual exhibit symptoms such as an abrupt onset of a severe, throbbing headache, dizziness, neck stiffness, vomiting, drowsiness, sweating, facial droop, weakness, sensitivity to light (photophobia), chills, and decreased level of consciousness?
  • Were the presenting symptoms and clinical history consistent with the diagnosis of subarachnoid hemorrhage?
  • Was the diagnosis confirmed with CT, spinal tap, and / or cerebral angiogram?
  • If the diagnosis was uncertain, were other conditions, such as brain tumor, infection, abscess, intracerebral hemorrhage, meningitis, or acute migraine headache, ruled out?
  • Would individual benefit from consultation with a neurosurgeon?

Regarding treatment:

  • Was individual given appropriate stabilization and supportive care (intensive monitoring, bed rest, avoidance of bright lights and noises, blood pressure stabilization)?
  • Did individual suffer any deterioration of neurological status or bleeding or vasospasm?
  • Were appropriate medications administered to reduce bleeding and vasospasm?
  • Was surgery performed within 3 to 14 days following the initial hemorrhage?

Regarding prognosis:

  • Does individual have any persistent or permanent neurological deficits?
  • Is the individual involved in rehabilitative therapy?
  • What is individual's age and general state of health at time of onset?
  • Were there any complications, such as seizures, infection after surgery, long-lasting neurologic deficits, recurrent bleeding, hydrocephalus, or syndrome of inappropriate antidiuretic hormone (SIADH), that may have influenced prognosis?
  • What was the expected outcome?

Source: Medical Disability Advisor



References

Cited

Gershon, Abner, and Robert Feld. "Subarachnoid Hemorrhage." eMedicine. Eds. Hugh J. Robertson, et al. 11 Jun. 2004. Medscape. 3 Nov. 2004 <http://emedicine.com/radio/topic661.htm>.

Newton, Todd, and Jennifer Krawczyk. "Subarachnoid Hemorrhage." eMedicine. Eds. Paul L. Penar, et al. 26 Jun. 2004. Medscape. 3 Nov. 2004 <http://emedicine.com/med/topic2883.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.