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.

Ultrasound, Therapeutic


Specialists

  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Factors that may influence disability are the individual's response to ultrasound treatment, degree of pain and inflammation present, and the individual's compliance with the physical therapy program.

Medical Codes

ICD-9-CM:
00.01 - Therapeutic Ultrasound of Vessels of Head and Neck; Anti-restenotic Ultrasound; Intravascular Non-ablative Ultrasound
00.02 - Therapeutic Ultrasound of Heart; Anti-restenotic Ultrasound; Intravascular Non-ablative Ultrasound
00.03 - Therapeutic Ultrasound of Peripheral Vascular Vessels; Anti-restenotic Ultrasound; Intravascular Non-ablative Ultrasound
00.09 - Therapeutic Ultrasound, Other
93.39 - Physical Therapy, Other

Overview

In addition to its use as a diagnostic tool, ultrasound can be used therapeutically. Therapeutic ultrasound is the use of ultrasound sound wave technology to penetrate tissue. In many medical circles, therapeutic ultrasound is considered an alternative for healing to be used only when traditional treatment methods fail.

Therapeutic ultrasound has gained wide acceptance among sports-medicine specialists as an effective method for generating "deep" heat to treat musculoskeletal injuries and ailments such as back pain, muscle spasms, bursitis, and tendinitis. The same principle of heat generation makes therapeutic ultrasound one suggested method for treating hypothermia.

It has also been suggested that ultrasound may be helpful in speeding wound and bone healing as it stimulates cell activity and the production of fibroblasts (cells in connective tissue that produce collagen and aid in healing). Therapeutic ultrasound is also used to treat plantar warts and to aid in the delivery of anti-inflammatory drugs and thrombolytics. Research is being conducted on its efficacy in forming clots, which can stop internal bleeding (noninvasively).

The use of therapeutic ultrasound with metal implants is controversial. There is published research confirming arguments both for and against its use. Ultrasound should not be done over bony growth centers (growth plates) of young children; near pacemakers; over the heart, eyes, head, or spinal cord; or when cancer or infection is present.

Source: Medical Disability Advisor



Reason for Procedure

Ultrasound is capable of sending penetrating heat deeper than any other heating method (e.g., hot packs). Ultrasound can penetrate up to 5 cm below the skin's surface, and heats structures that contain the most protein, such as muscle. Ultrasound increases blood flow to an injured area, provides temporary pain relief, reduces muscle spasms, and helps promote healing. It can also increase the flexibility of connective tissue such as ligaments and tendons and allow the return of a joint's normal range of motion.

Ultrasound can deliver medicine locally without using invasive procedures such as injections. This technique is known as phonophoresis. Because ultrasound increases the permeability of membranes, anti-inflammatory medications such as hydrocortisone or dexamethasone and local anesthetics such as lidocaine can be introduced through the skin. This can help decrease pain and inflammation due to injury.

Source: Medical Disability Advisor



How Procedure is Performed

During the procedure, the patient should experience a comfortable heat; if the heat becomes too much at any time, the individual should immediately alert the healthcare professional. The frequency of the ultrasound is then selected based on treatment goals and may be increased based on the patient's tolerance to heat. If the area being treated is close to the surface of the skin, such as an ankle ligament, the frequency might be 3 MHz. If the area is deeper, such as low back muscles, a frequency of 1 MHz might be selected (waves of 3 MHz are absorbed faster and do not penetrate as deeply as 1 MHz waves, so are more appropriate for superficial targets). A coupling medium such as ultrasound gel is used to allow the transmission of ultrasound waves through the skin and the ultrasound head is moved continuously over the treatment site. In phonophoresis, a nonsteroidal cream or gel is used as the coupling medium.

For irregularly shaped body parts like fingers, the body part and the ultrasound head can be submerged in water to make the individual more comfortable during treatment. The dosage of the ultrasound is then determined. For more superficial areas, 0.5 Watts/cm2 may be appropriate, and for deeper tissues, 1.5 Watts/cm2 is often used. The ultrasound head is then moved in a circular manner over the treatment site. The treatment time is approximately 5 to 10 minutes taking into account the patient's comfort level and heat tolerance.

Source: Medical Disability Advisor



Prognosis

The healing outcome depends on the nature of the condition treated and the individual's motivation to participate in therapy. Individuals can expect some increase in healing and flexibility in the treated area; however, if the condition is severe or chronic, such as a frozen shoulder, intensive rehabilitation will be needed as an adjunct to ultrasound.

Source: Medical Disability Advisor



Complications

Increased inflammation may be observed in the area being treated. If this occurs, a pulsed mode may be appropriate where the dosage is alternately turned off and on. Individuals may feel pain or irritation over the site of the ultrasound if the technique is applied directly onto the skin. Individuals may experience redness or irritation in response to the anti-inflammatory agent used in phonophoresis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Any work restrictions are necessitated by the underlying condition and not the ultrasound treatments.

Source: Medical Disability Advisor



References

General

Busse, Jason W., et al. "The Effect of Low-intensity Pulsed Ultrasound Therapy on Time to Fracture Healing: a Meta-Analysis." PubMed. 22 May 2005 <http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=11873920>.

Source: Medical Disability Advisor






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