Cutting Edge Techniques in Functional Capacity Examinations

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Cutting Edge Techniques For Functional Capacity
Evaluation Utilizing Ariel Performance Analysis
Systems
By Robert Wainwright, P.T. President, Kinematic
Consultants, Inc Point Pleasant, NJ
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Kinematic Consultants Test and Measurement
Servicesfor Workers Compensation
IssuesSpecializing InKinematic Functional
Capacity Evaluations

• Utilizing State of the Art Technology (APAS) to
  Measure Function in Work, ADL and Recreation
  Activities.

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Kinematic Consultants Locations
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Test Protocols Designed and Administered by

• Licensed Physical Therapists
• Biomedical Engineers

Kinematics
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Medical and Workers Compensation Issues
Considered

• Safe Return to Work
• Altered Duty Capacity Recommendation
• Residual Dysfunction
• Examinee Reliability
• Case Closure
• Legal Support

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Providing Support in Medical Decision Making To

• Treating Physician
• Independent Medical Evaluation Physician
• Case Manager
• Rehabilitation Nurse
• Insurance and Risk Management Personnel
• Employer

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What To Expect From An FCE?

• EXAMINEE RELIABILITY during the FCE ( Effort
  Level and Coefficient of Variation).
• RESIDUAL DEFICIT OR DYSFUNCTION (body part
  specific.)
• GENERAL FUNCTIONAL ABILITY (activities of daily
  living walking, balancing, bending, climbing,
  squat, reach, etc.).
• SPECIFIC STRENGTH CAPABILITY (push, pull, lift).
• SPECIFIC WORK CAPACITY category (Examinees
  specific and current qualification sedentary
  thru very heavy).
• JOB REQUIREMENTS (Job description from Employer
  and Dictionary of Occupational Titles).
• Definitive Statement of Examinees capacity to
  return to FULL DUTY, ALTERED DUTY OR NOT AT ALL.

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In Summary, A Kinematic FCE Answers The
Following

• Is the Examinee
• Demonstrating maximum effort and cooperation
  during the FCE?
• Suffering residual dysfunction?
• Capable of safe return to work for or altered
  duty?

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How Do We Get The Answers You Need?

• Standard Low Technology Functional Capacity
  Evaluation
• Verses
• High Technology (APAS) Kinematic Functional
  Capacity Evaluation

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LOW TECHNOLOGY FCE
Traditional Toolbox
Eyes
Hands
SUBJECTIVE
Video
Tape measure
Goniometry
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HIGH TECHNOLOGY FCE
OBJECTIVE
Click on the picture to see the animation

• 3D Kinematic Computer Analysis of Motion (APAS)
• Kinetic Ground Reaction Forces / Balance (APAS)
• Computerized Strength Analysis Equipment(CES)
• Dynamic EMG electromyography (APAS)

Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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KINEMATIC ASSESSMENTTHREE DIMENSION MOVEMENT
ANALYSIS
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TECHNICAL ADVANCES FROM THE SCIENCE OF SPORT
ANALYSIS

• Technology Courtesy of Ariel Dynamics Inc, San
  Diego, CA.
• Click on the picture to see the animation

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CALIBRATION (VOLUME) CUBE FOR GAIT
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GAIT RIGHT CAMERA VIEW
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GAIT LEFT CAMERA VIEW
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AUTOMATIC DIGITIZING GAIT VIEW
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CONVERSION TO STICK FIGURE AND GRAPH
Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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FULL SKELETON ANIMATION
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Diego, CA.
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DIGITIZING A DELTA LIFT TASK ANALYSIS
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Diego, CA.
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Analyzing Technique
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Diego, CA.
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Good Lift
Poor Lift
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Diego, CA.
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DELTA LIFT TASK ANALYSIS
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Diego, CA.
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DELTA WITH 125 POUND LOAD
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Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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How Do We Interpret The Data?
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GRAPHING DATA
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Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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KINETIC FORCE PLATE Ground Reaction forces

• Newtons Law of Physics
• Every Action Creates an Equal and Opposite
  Reaction

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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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POSTERIOR LEANING CENTER OF GRAVITY STANCE
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Diego, CA.
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EXTREME FORWARD LEANING C.G. POST LUMBAR SURGERY
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Diego, CA.
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BALANCE TEST PROTOCOL
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Diego, CA.
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BALANCE AND CENTER OF PRESSURE SWAY
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Diego, CA.
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LIFT TASK ANALYSIS MAXIMUM SAFE LIFT
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Diego, CA.
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COMPUTERIZED EXERCISE DIAGNOSTIC ANALYSIS
EQUIPMENT
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OPEN LOOP STRENGTH TESTING
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Diego, CA.
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CLOSED LOOP LIFT TESTING
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Diego, CA.
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DYNAMIC ELECTROMYOGRAPHY

• Monitoring the electrical activity of muscle
  groups during work activities.

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EMG POST KNEE INJURY AND SURGERY
Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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ELECTROMYOGRAPHY MONITORING OF TEST PROTOCOL
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Diego, CA.
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WORK SITE JOB ANALYSIS

• Determine if the job is a contributing factor to
  injury.
• Determine if Examinee work technique is a
  contributing factor to un-successful return to
  work.

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Job Title Fisherman

• Sewage processing plant. Job of Fisherman.
• General Employer Problem multiple cases of
  rotator cuff and low back problems.

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Lifts Heavy Material Well Over Shoulder Level
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Extreme Bend Back and Knees
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Outcome

• Work technique contributes to shoulder and low
  back stress.
• Researched plant construction and found this
  aeration system to be outdated.
• Reconstruction not feasible.
• Changed work biomechanics technique to de-stress
  shoulder and low back.

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Office Worker Chronic Neck and Back Pain

• Worker suffers chronic neck and back pain
  resulting from multiple automobile accidents.
• Job requires 90 computer terminal work.
• Is ergonomic workstation or work technique a
  contributing factor?

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Ergonomic Work Station Analysis
Head Tilted Back
Monitor Too High
Upper Back Tension
Feet Flat On Ground
Chair Back Inclined
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Outcome

• Modifications Suggested Include
• New, sturdy chair with ergonomic adjustments.
• Take Monitor off elevated platform.
• Back seat adjusted to more upright position.
• Seat raised to decrease shoulder stress.
• Adjustable foot rest added to decrease low back
  tension.
• Employee performs job in a relaxed posture,
  relieving chronic neck and back strain.

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Case Studies
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Case 1 No Light At The End of the Carpal Tunnel
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A 32 year old road laborer who developed Carpal
Tunnel from repetitive stress trauma.

• Patient diagnosed with EMG and NCV.
• Surgical release performed 16 months prior to
  analysis.
• Patient returning to court for upgraded
  impairment rating for continued pain and
  dysfunction.
• FCE ordered by the County for accurate assessment
  and verification of complaints.

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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Diego, CA.
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Financial

• Judge originally awarded a 12.5 for the operated
  right carpal tunnel.
• Outcome
• FCE results reveal no current dysfunction of
  right wrist.
• Right wrist functioning better than left.
• No increase in impairment rating.

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Case 2The Chronic Cervical Sprain
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Chronic Cervical Sprain

• Drug Counselor clerical job with a diagnosis of
  whiplash cervical sprain.
• Date of Incident, 1 1/2 years prior to analysis.
  
• Complaints of constant pain, severe spasm in
  Sterno Cleido Mastoid Muscle (right).
• In and out of work multiple times since incident.

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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Outcome

• FCE negative for objective evidence in support of
  her complaints of ROM distress.
• Dynamic EMG demonstrates SCM symmetry, negative
  for spasm.
• Recommendations
• No active treatment.

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Case 3The Remote Kinematic FCE
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Remote Functional Capacity Evaluation

• 31 year old male.
• Struck by an automobile while working.
• Resulted in a Fractured Pelvis and Low Back
  Sprain.
• Treated for 2 years and declared to be totally
  disabled for life by his Orthopedic Surgeon.

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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Diego, CA.
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Diego, CA.
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Diego, CA.
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Outcome

• Report was presented to the opposing Attorney by
  the Insurance Company Attorney.
• Two days after receiving the report, the case was
  settled.

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Case 4The FALL
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The Fall

• 47 year old laborer, Home Improvement Center.
• Incident involving lifting of stock, fell
  backwards, injuring his low back. No hard
  diagnostic evidence.
• 1 1/2 years after incident, he continues to be
  out of work and seeking medical opinions.
  Complaints include severe back pain, right and
  left legs give out and collapse.

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Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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Diego, CA.
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Outcome

• Examinee was returned to work without protest.
• Case closed.

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How To Read A Kinematic Functional Capacity Report
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BACK TO WORK RECOMMENDATION
LAST PAGE
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EXAMINEE RELIABILITY (VALIDITY) MEASURE OF
COOPERATION AND EFFORT
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RESIDUAL DEFICIT OR DYSFUNCTION
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DETAILS OF THE ANALYSIS
Technology Courtesy of Ariel Dynamics Inc, San
Diego, CA.
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CLOSING THOUGHTS!
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What can a Kinematic FCE Do For You as Employer
or Risk Manager?

• Kinematic FCE cannot determine the diagnosis.
• It can confirm whether the Examinee is moving,
  lifting, push/ pulling, bending, posturing, and
  or demonstrating muscular imbalance in a
  dysfunctional manner that is compatible with
  diagnosis and or complaints.
• It can determine Examinees Reliability to
  perform with maximum effort during the FCE
  (correlate with symptom magnification and or
  malingering).
• It can match Examinees current ability with
  essential job demands.
• It can determine safe return to work.
• It can provide objective evidence for case
  closure, case settlement and fitness for duty
  (employee termination).

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When should an FCE be CONSIDERED?

• At 4-5 week, post injury, when soft tissue injury
  patient is not responding as expected to
  treatment and or is not back to work, full duty
  (results can help you decide if there are
  non-medical issues, symptom magnifying ,
  malingering issues or real functional issues that
  may need further diagnostic or medical
  consideration.
• When the treating physician has concluded the
  patient has reached MMI and there is a question
  of work capability.
• When multiple body parts are involved and, or the
  patient is recovering from lumbar, cervical,
  shoulder, hip, knee or ankle surgery.
• Anytime the treating physician or case manager
  has reached a roadblock in getting an injured
  employee back to work.

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Additional Considerations

• When objective residual disability information is
  needed for case settlement.
• To supplement and strengthen an Independent
  Medical Evaluation.
• When objective information is needed to
  strengthen a case position for settlement and or
  legal disposition.
• To assist with case closure in the case of a
  problem Examinee.

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Do Kinematic FCEs Help the Bottom Line Of Your
Business?
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County of Ocean, NJ 3 Year History
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THANK YOU