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
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Radiologist

Comorbid Conditions

  • Alcohol abuse
  • Bleeding disorders
  • Chronic heart disease
  • Chronic obstructive lung disease
  • Cigarette abuse
  • 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 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 subdural hemorrhage as the result of a traumatic head injury often have other major internal and orthopedic injuries that are 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
852.2 - Subdural Hemorrhage Following Injury, without Mention of Open Intracranial Wound
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 is bleeding due to trauma that occurs between the outer and middle membranes (meninges) covering the brain. The outer membrane is called the dura, the middle is called the arachnoid, and the inner membrane is known as the pia mater. Subdural hemorrhage, therefore, is bleeding beneath (below) the dura and above the arachnoid. This type of hemorrhage can result from blunt head trauma as minimal as a mild bump.

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

Risk factors include chronic use of aspirin, treatment with blood thinners (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.

Incidence and Prevalence: Severe head injuries cause acute subdural hemorrhages about one-third of the time (Scaletta).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The elderly over age 60 or children who have been abused by their parents are at increased risk to develop this type of hemorrhage (Scaletta).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with subdural hemorrhage may present with an unexplained headache, drowsiness, confusion, impaired vision, slurred speech, personality changes, weakness or paralysis on one side of the body, and/or a decreased level of consciousness following a traumatic head injury. The individual may remember sustaining some head trauma within the recent past, but in the days before CT scans were available to help establish the diagnosis, 25% to 50% of individuals with suspected chronic subdural hemorrhage offered no history of head trauma (Meagher). Individuals with suspected subdural hemorrhage may have a history of alcoholism, bleeding disorders, or recent anticoagulation therapy.

Physical exam: An individual's level of consciousness with subdural hemorrhage 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. Speech may be disturbed. The pupils may be unequal in size and react sluggishly to light.

Tests: 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. If the CT is negative for blood, lumbar puncture is performed to see if blood occurs in the cerebrospinal fluid. 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, prothrombin time, erythrocyte sedimentation rate [ESR], blood glucose, electrolytes, and blood type).

Source: Medical Disability Advisor



Treatment

Immediate medical treatment for acute subdural hemorrhage includes establishing a patent airway and maintaining an adequate blood oxygen level and blood pressure. As soon as a definitive diagnosis of subdural hemorrhage 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 persons with chronic subdural hematomas can be monitored by CT scan and their hematomas spontaneously resolve without surgery.

Source: Medical Disability Advisor



Prognosis

Individuals who have an urgent craniotomy performed to evacuate a subdural hemorrhage often recover with minimal or no significant permanent brain damage. However, some individuals will have a persistent headache, memory loss, difficulty concentrating, and infection. Seizures occur in as many as 10% of individuals (Scaletta).

The mortality rate is related to the time interval between injury and surgery. The death rate is roughly 20% for acute subdural hematomas in which the brain is not injured, but with subdural hematomas in which the brain sustains a cut or contusion, roughly half of individuals die; half of patients with subdural hematoma have chronic subdural hematoma (Scaletta).

Source: Medical Disability Advisor



Rehabilitation

Individuals who sustain a subdural hematoma may present with a variety of physical and cognitive disabilities, depending on when the hematoma is detected. Individuals with early detection will suffer less severe deficits due to surgical intervention that minimizes brain injury. Since subdural hematoma 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.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Some individuals who survive a subdural hemorrhage may have a permanent decrease in their thinking and reasoning abilities that prevents them from returning to the job they performed before the injury. These individuals may be retrained in other positions. Individuals recovering from a subdural hemorrhage may also have a change in personality that prevents them from fulfilling the responsibilities of their former position. These individuals may need to be retrained in positions that better accommodate their new personalities. Following evacuation of a chronic subdural hematoma, 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.

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 headache, drowsiness, confusion, impaired vision, slurred speech, personality changes, weakness or paralysis on one side of the body, and/or a decreased level of consciousness 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, prothrombin time, erythrocyte sedimentation rate, blood glucose, electrolytes, blood type, and crossmatch? 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

Meagher, Richard J., and William Young. "Subdural Hematoma." eMedicine. Eds. Norman C. Reynolds, et al. 28 Dec. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/neuro/topic575.htm>.

Scaletta, Tom. "Subdural Hematoma." eMedicine. Eds. Richard S. Krause, et al. 18 Mar. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/emerg/topic560.htm>.

Source: Medical Disability Advisor






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