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.

Tics


Related Terms

  • Chronic Motor Tic Disorder
  • Chronic Vocal Tic Disorder
  • Habit Spasm
  • Tic Disorder
  • Transient Tic Disorder

Differential Diagnosis

  • Akathisia
  • Athetoid movements
  • Autism
  • Carbon monoxide toxicity
  • Chorea gravidarum
  • Chorea in adults
  • Chorea in children
  • Chronic motor or vocal tic disorder
  • Cocaine
  • Complex partial seizures
  • Drug-induced tardive dyskinesia
  • Dystonias
  • Encephalitis lethargica
  • Essential myoclonus
  • Frontal lobe syndromes
  • Hallervorden-Spatz disease
  • Hemiballisimic movements
  • Hemifacial spasm
  • Huntington disease
  • Hyperekplexia and other startle syndromes
  • Inherited metabolic disorders
  • Mannerisms
  • Medication induced movement disorder not otherwise specified
  • Mental retardation
  • Monoamine oxidase a deficiency
  • Movement disorders in individuals with developmental disabilities
  • Myoclonus
  • Neuroacanthocytosis
  • Neuronal ceroid lipofuscinosis
  • Neurosyphilis
  • Obsessive-compulsive disorder
  • Paroxysmal dyskinesia
  • Periodic limb movement disorder
  • Restless legs syndrome
  • Rett syndrome
  • Schizophrenia
  • Seizures
  • Spasm
  • Stereotypic movement disorder
  • Stimulants
  • Stroke (infarction)
  • Synkinesis
  • Tardive dyskinesia
  • Tic disorder not otherwise specified
  • Tic douloureux
  • Transient tic disorder
  • Tremor
  • Tuberous sclerosis
  • Wilson's disease

Specialists

  • Clinical Psychologist
  • Neurologist
  • Occupational Therapist
  • Psychiatrist

Comorbid Conditions

  • ADHD
  • Neurologic conditions
  • Obsessive-compulsive disorder
  • Orthopedic problems
  • Skin conditions
  • Substance abuse

Factors Influencing Duration

The severity of the disorder, effectiveness of treatment, and interference with job requirements influence the length of disability. Medications used to treat tics or ADHD can have side effects that may lengthen disability.

Medical Codes

ICD-9-CM:
307 - Special Symptoms or Syndromes, Not Elsewhere Classified
307.2 - Special Symptoms or Syndromes, Not Elsewhere Classified; Tics
307.20 - Special Symptoms or Syndromes, Not Elsewhere Classified; Tic Disorder, Unspecified
307.22 - Special Symptoms or Syndromes, Not Elsewhere Classified; Chronic Motor or Vocal Tic Disorder
307.23 - Special Symptoms or Syndromes, Not Elsewhere Classified; Gilles De La Tourettes Disorder; Motor-verbal Tic Disorder

Overview

A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization that may be simple and involve only a few muscle groups or complex and involve multiple muscle groups. Many individuals report a sensation of rising tension or a sensation in a part of the body that precedes the motor or vocal tic, and a feeling of relief or tension reduction following the involuntary movement. Although tics are experienced as irresistible, they can be suppressed for varying lengths of time. An individual may feel the need to perform a complex tic until tension is relieved.

Tics occur in bouts of varying frequencies, generally decrease or disappear during sleep, and can change in location, number, frequency, and duration over time. The movements may be simple and resemble shock-like contractions of muscles or muscle groups (myoclonic jerks).

Tics often develop in childhood but also appear in adulthood. Vulnerability to tic disorders is transmitted within families and appears genetic. The specific gene(s) involved are those that affect the ability of the brain to break down chemicals (neurotransmitters) used by nerve cells to communicate with each other, especially the neurotransmitters dopamine, serotonin, and norepinephrine. Not everyone who inherits the genetic vulnerability expresses symptoms. The precise type or severity of tic may be different from one generation to another and can be modified by nongenetic factors. In some cases, tics may follow strep throat, which suggests that autoimmune factors may be involved.

Tics may occur alone or as part of Tourette's syndrome, an inherited neurological disorder characterized by tics and often associated with attention-deficit/hyperactive disorder (ADHD), obsessive-compulsive disorder, or tics. The symptoms of Tourette's syndrome usually appear before age 18.

Incidence and Prevalence: One in 1000 people in the US develop Tourette's syndrome based on research estimates (Black). In young people Transient tic disorder has a prevalence of 3% to 15%; 2% to 5% roughly is the prevalence of chronic motor tic disorder (Black).

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The individual may complain of involuntary movements or vocalization and feeling compelled to make such movements or vocalizations in order to relieve perceived tension. These behaviors can be voluntarily suppressed for brief intervals. Transient tic disorder includes motor and/or vocal tics lasting for at least 4 weeks but for no longer than 12 consecutive months. Chronic motor or vocal tic disorder must have duration over 12 months. Tourette's syndrome lasts over 12 months and is further characterized by multiple motor tics and at least one vocal tic during the history of the disorder. During the year they cannot have a tic free period for more than 3 months back to back. Symptoms should appear prior to 18 years of age. Tic disorder cannot be diagnosed if the tics are caused by physiological side effects of a substance or drug, such as a stimulant, or are caused by a general medical condition, such as Huntington's disease.

Physical exam: The exam includes observing the involuntary movements. Simple tics may include head shaking, eye blinking, sniffing, or arm waving. Complex tics may include touching parts of the body, assuming and holding unusual positions, hair twisting, or making obscene gestures. Vocal tics may also be present such as barking, throat clearing, squealing, repetition of one's own sounds (palilalia) or the sounds of others (echolalia), and explosive, involuntary cursing (coprolalia).

Tests: Tests may include head MRI or CT, electroencephalogram (EEG), or blood tests to rule out other conditions possibly confused with tics. However, diagnosis of tics or Tourette's syndrome is based primarily on history and observation of abnormal movements. SPECT brain scan is a research tool that can show abnormal blood flow in the caudate nucleus, a part of the brain involved in controlling movement. Serum ceruloplasmin or slit-lamp examination for Kayser-Fleischer rings can be useful to rule out Wilson's disease as a possible etiology of tics.

Source: Medical Disability Advisor



Treatment

When tics are mild and not socially disabling, no treatment is required. Neuroleptic drugs in small doses help reduce the frequency and severity of tics although both short and long-term side effects may occur. Neuromuscular blockers, skeletal muscle relaxants and benzodiazepines have all been shown helpful in controlling tics.

The blood pressure medication clonidine is more effective in reducing motor tics than vocal tics. Relief of nervous tension by sedative or tranquilizing drugs and psychotherapy may be helpful. If the individual also has obsessive-compulsive disorder (common among those with tic disorders), cognitive-behavior therapy may be helpful. Group therapy could also be a useful and cost-effective way to provide cognitive behavioral treatment. Habit reversal therapy which involves relaxation therapy and helping patients have a "competing response" to tic urges causes a 75% drop in tic symptoms (Black).

Source: Medical Disability Advisor



Prognosis

There is no cure for Tourette's syndrome but many individuals with this condition or tic disorder show improvement when they get older. Tics tend to decrease with age, however, associated neuropsychiatric disorders such as depression, panic attacks, mood swings, and antisocial behavior may increase. The primary goal of treatment is not the complete elimination of tics but rather suppression of tics to the point where the individual can function normally. Even without treatment, symptoms can go into remission and then recur, but with treatment, many individuals can experience significant reductions in symptoms. There is a 50% to 80% reduction in tic frequency with antipsychotic medication; 50% of people treated have a 75% drop in tic frequency in research done on outcomes (Black).

Source: Medical Disability Advisor



Complications

Stressful situations can aggravate tics. Many individuals with tic disorder are also diagnosed with obsessive-compulsive disorder. Those with Tourette's syndrome may also have learning or sleep disorders. About half of those with Tourette's syndrome have a coexisting obsessive-compulsive disorder, however, only 5% of individuals with obsessive-compulsive disorders have Tourette's syndrome. Severe tics may lead to reactive depression, social withdrawal, or accidental self-injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Time-limited restrictions and work accommodations are necessary only infrequently, for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity. Depending on the type and severity of tic, it may not be safe for individuals with tics to drive, operate heavy machinery, or work at heights.

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:

  • Was a diagnosis of tics confirmed?
  • Have conditions with similar symptoms been ruled out?
  • Does the individual have a coexisting condition that may impact recovery?
  • Do stressful situations aggravate tics?

Regarding treatment:

  • Would neuroleptic or other medications be beneficial? If not effective, should dosage be modified? Do side effects prevent individual from using or benefiting from that particular medication?
  • Does the individual also have obsessive-compulsive disorder?
  • Would the individual benefit from more frequent cognitive-behavioral encounters or the addition of group therapy?

Regarding prognosis:

  • Do symptoms persist despite treatment?
  • Are coexisting disorders being effectively addressed?
  • Is the individual participating in appropriate cognitive-behavioral or group therapy?
  • Would the individual benefit from evaluation by a neurologist?
  • Can the individual continue in present position under appropriate work modifications and accommodations?

Source: Medical Disability Advisor



References

Cited

Black, Kevin J., and Heather Webb. "Tourette Syndrome and Other Tic Disorders." eMedicine. Eds. Raj D. Sheth, et al. 9 Nov. 2004. Medscape. 17 Dec. 2004 <http://emedicine.com/neuro/topic664.htm>.

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Source: Medical Disability Advisor






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