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.

Subdural Hemorrhage


Related Terms

  • Subdural Hematoma

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Emergency Medicine Physician
  • Endocrinologist
  • Internal Medicine Physician
  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Radiologist
  • Speech Therapist

Comorbid Conditions

  • Alcohol abuse
  • Bleeding disorders
  • Chronic heart disease
  • Chronic obstructive lung disease
  • Cigarette smoking
  • Diabetes
  • Drug abuse
  • Epilepsy
  • Immune system disorders
  • Obesity

Factors Influencing Duration

Factors influencing the length of disability include the number and severity of postoperative complications (i.e., wound infection and adverse reaction to a general anesthetic), the extent of brain injury, the individual's mental and emotional stability and pre-injury intellect, a history of substance abuse and/or psychiatric problems, the individual's access to rehabilitation facilities, and the strength of the individual's support system. Individuals who experience a SDH as the result of a traumatic head injury often have other major internal and orthopedic injuries that may be life-threatening and affect their ability to recover. In some cases, the individual may recover fully from the head injury but be disabled by traumatic injuries to some other body system.

Medical Codes

ICD-9-CM:
432.1 - Subdural Hemorrhage; Subdural Hematoma, Nontraumatic
852.20 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, Unspecified State of Consciousness, Unspecified Loss of Consciousness
852.21 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with No Loss of Consciousness
852.22 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Brief (Less than 1 Hour) Loss of Consciousness with Brief (Less than One Hour) Loss of Consciousness
852.23 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Moderate (1-24 hours) Loss of Consciousness with Moderate (1-24 Hours) Loss of Consciousness
852.24 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness and Return to Pre-existing Conscious Level
852.25 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Prolonged (More than 24 Hours) Loss of Consciousness without Return to Pre-existing Conscious Level
852.26 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Loss of Consciousness of Unspecified Duration
852.29 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound, with Concussion, Unspecified

Overview

© Reed Group
Subdural hemorrhage (SDH) is bleeding, usually due to trauma, that occurs between the outer and middle membranes (meninges) covering the brain. The outer meningeal membrane is called the dura mater, the middle is called the arachnoid membrane, and the inner membrane is known as the pia mater. SDH, therefore, is bleeding beneath (below) the dura mater and above the arachnoid membrane. This type of hemorrhage can result from blunt head trauma as minimal as a mild bump.

Acute SDH is a life-threatening condition caused by rapid bleeding that requires immediate evaluation and treatment. Subacute and chronic SDHs are characterized by slower bleeding. The collection of blood (hematoma) expands for days or weeks before the pool of blood is large enough to compress the brain sufficiently to cause symptoms.

Incidence and Prevalence: The incidence of SDH is about 13.5 persons per 100,000 population per year. This figure may increase to as much as 58.1 persons per 100,000 population per year among those 65 and older (Almenawer).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include chronic use of aspirin, treatment with blood thinners (anticoagulant therapy), and epilepsy associated with falls from seizures. The condition occurs most frequently in individuals with some degree of brain shrinkage (atrophy), such as chronic alcoholics, individuals over the age of 60, and those with Alzheimer's disease and other degenerative neurologic diseases.

SDH has been diagnosed in 12% to 29% of individuals with severe traumatic brain injury (Bullock). As diagnostic techniques improve, the diagnosis of SDH increases (Almenawer). Most SDHs are caused by motor vehicle accidents, falls, and assaults (Bullock), but other risk factors may include the use of antiplatelet and anticoagulant medications (Almenwer), aneurysm rupture, arteriovenous malformations and dural arteriovenous fistulae, tumors or metastatic disease, coagulation deficiencies, acquired immunodeficiency syndrome (AIDS), cocaine abuse, and moyamoya disease (Depreitere).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with SDH may present with an unexplained increasing headache, nausea and vomiting, drowsiness, confusion, impaired vision, slurred speech, personality changes, weakness or paralysis on one side of the body, and/or a decreased level of consciousness, usually following a traumatic head injury. As the SDH grows, seizures, lethargy, and unconsciousness (coma) may occur. The individual may remember sustaining some head trauma within the recent past. However there is a small but important subgroup of individuals with no history of head trauma (Chhiber). Individuals with suspected SDH may have a history of alcoholism, bleeding disorders, or recent anticoagulant therapy.

Physical exam: An individual's level of consciousness with SDH may range from drowsy and/or confused to comatose. Evidence of trauma to the head may be present. Weakness or paralysis may exist on one side. Abnormal breathing patterns may be present. Speech may be disturbed. The pupils may be unequal in size (anisocoria) and react sluggishly to light.

Tests: Computed tomography (CT) is the standard diagnostic tool used to determine the presence or absence of a skull fracture and/or bleeding within the skull under the dura. Magnetic resonance imaging (MRI) is not as useful as CT imaging in the acute phase of injury but is useful after the initial 48 hours to assess the extent of injury to the brain. Additional diagnostic tests may include an electrocardiogram (ECG), chest x-ray, urinalysis, and blood studies (complete blood count [CBC], coagulation testing [including prothrombin time], erythrocyte sedimentation rate [ESR], blood glucose, electrolytes, blood type, and cross-matching).

Source: Medical Disability Advisor



Treatment

Immediate medical treatment for acute SDH includes establishing a patent airway and maintaining an adequate blood oxygen level and blood pressure. As soon as a definitive diagnosis of SDH is made, the brain is decompressed by opening the skull (burr holes or craniotomy) to remove any blood or blood clots beneath the dura. Any active bleeding is stopped and the brain examined. Once the individual's condition stabilizes, treatment becomes supportive and focuses on treating any underlying medical conditions. Many individuals with small or chronic SDHs can be monitored by CT scan and their hematomas may spontaneously resolve without surgery.

Source: Medical Disability Advisor



Prognosis

Individuals who have an urgent craniotomy performed to evacuate an acute SDH have higher rates of morbidity compared to those who have less invasive procedures (Almenawer).

The mortality rate is related to the time interval between injury and surgery. The death rate is related to the severity of the injury. Overall, about 75% to 85% of all individuals will recover after appropriate medical intervention (Almenawer).

Source: Medical Disability Advisor



Rehabilitation

Individuals who sustain a SDH may present with a variety of physical and cognitive disabilities, depending on when the hemorrhage is detected. Individuals with early detection will suffer less severe deficits due to surgical intervention that minimizes brain injury. Since SDH usually is a secondary injury resulting from an initial brain injury such as a contusion, individuals need to be treated by physical, occupational, and speech therapists, as well as neuropsychologists, vocational counselors, and social workers. Individuals with poor motor control of the facial muscles may require speech therapy to improve clarity of speech and increase their safety in swallowing. Rehabilitation on an inpatient and outpatient basis continues until maximum restoration of function or adjustment to loss of function is attained.

Source: Medical Disability Advisor



Complications

Herniation of the brain may occur, leading to coma or death. Seizures may be a long-term complication. Weakness and/or paralysis of one side of the body can occur. Mild traumatic brain injury is also a concern, and can lead to chronic headaches, dizziness, lethargy, memory loss, irritability, personality changes, and cognitive and perceptual changes.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Some individuals recovering from SDH may have a permanent decrease in their thinking and reasoning abilities or a personality change that prevents them from returning to the job they performed before the injury. These individuals may be retrained in other positions. Following evacuation of a chronic SDH, there may be gradual significant improvement in an individual's neurologic status, allowing him or her to resume ordinary or modified work activities.

Visual impairment is likely to require major work restrictions and accommodations or a classification of permanent disability. Large computer screens and Braille keyboards may be useful for these individuals. Individuals with hearing loss may require the use of hearing aids and specially equipped telephones.

Risk: Jobs with high risk of head injury should be avoided; however, individuals with SDH are not at risk of harm when performing work activities for which they have appropriate intellectual and motor skills. There is no basis for work restrictions, unless post-traumatic seizures or visual deficits are present.

Capacity: After SDH, individuals may lack the cognitive or motor skills needed to perform essential work functions, which may preclude a return to their prior level of employment. Functional testing or a trial of supervised work activity may be helpful in determining work ability.

Tolerance: Tolerance for symptoms like headache, malaise, and fatigue may be reasons cited by individuals for choosing not to work. These symptoms may be satisfactorily addressed by work autonomy, in which the pace and rate of work are modified. Personality changes found in acute SDH following severe traumatic brain injury may become significant obstacles to return to work because of changes in motivation and effort.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 to 270 days (wide range reflecting size of the hemorrhage).

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 individual had any blunt head trauma?
  • Is individual a chronic aspirin user? On anticoagulant therapy? Does individual have brain atrophy?
  • Does individual present with an unexplained increasing headache, nausea and vomiting, drowsiness, confusion, impaired vision, slurred speech, personality changes, weakness or paralysis on one side of the body, and/or a decreased level of consciousness, usually following a traumatic head injury?
  • Does individual have a history of alcoholism? An altered mental status?
  • Is there weakness or paralysis on one side? Is speech disturbed?
  • Are individual's pupils unequal in size? Do they react sluggishly to light?
  • Was a CT done? A lumbar puncture? Has individual had an ECG, chest x-ray, urinalysis and CBC, coagulation testing (including prothrombin time), ESR, blood glucose, electrolytes, blood type, and cross-matching? Was an MRI done later?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Did individual have a craniotomy with blood or clot extraction?
  • Is individual receiving supportive treatment?
  • Are any underlying conditions being treated?

Regarding prognosis:

  • Is individual active in rehabilitation? Is a home exercise program in place?
  • Can individual's employer accommodate any necessary restrictions?
  • Have any complications developed, such as herniation of the brain or prolonged coma? Does individual have seizures?

Source: Medical Disability Advisor



References

Cited

Almenawer, S. W., et al. "Chronic Subdural Hematoma Management: A Systematic Review and Meta-Analysis of 34829 Patients." Annuals of Surgery (2013):

Bullock, M. R., et al. "Surgical Management of Acute Subdural Hematomas." Neurosurgery 38 (2006): S16-24, Si-iv.

Chhiber, S. S., and J. P. Singh. "Acute Spontaneous Subdural Hematoma of Arterial Origin: A Report of Four Cases and Review of Literature." Neurology India 58 (2010): 654-658.

Depreitere, B., et al. "A Clinical Comparison of Non-Traumatic Acute Subdural Haematomas Either Related to Coagulopathy or of Arterial Origin without Coagulopathy." Acta Neurochirurgica (2003): 145, 541-546.

Source: Medical Disability Advisor






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