Cutting Edge Techniques For Functional Capacity Evaluation Utilizing

Cutting Edge Techniques Cutting Edge Techniques For For

Functional Capacity EvaluationFunctional Capacity EvaluationUtilizingUtilizing

Ariel Performance Analysis SystemsAriel Performance Analysis Systems

By Robert Wainwright, P.T.By Robert Wainwright, P.T.

President, Kinematic Consultants, IncPresident, Kinematic Consultants, Inc

Point Pleasant, NJPoint Pleasant, NJ

Kinematic ConsultantsKinematic Consultants

Test and Measurement ServicesTest and Measurement Servicesfor for

Workers Compensation IssuesWorkers Compensation IssuesSpecializing InSpecializing In

KinematicKinematic Functional Capacity Functional Capacity EvaluationsEvaluations

Utilizing “State of the Art” Technology (APAS) to Utilizing “State of the Art” Technology (APAS) to Measure Function in Work, ADL and Recreation Measure Function in Work, ADL and Recreation

Activities.Activities.

Kinematic Consultants LocationsKinematic Consultants Locations

Test Protocols Designed Test Protocols Designed and and

Administered byAdministered by Licensed Physical TherapistsLicensed Physical Therapists

Biomedical EngineersBiomedical Engineers

Medical and Workers Medical and Workers Compensation Issues Compensation Issues

ConsideredConsidered

Safe Return to WorkSafe Return to Work Altered Duty Capacity RecommendationAltered Duty Capacity Recommendation Residual Dysfunction %Residual Dysfunction % Examinee ReliabilityExaminee Reliability Case ClosureCase Closure Legal SupportLegal Support

Providing Support in Medical Providing Support in Medical Decision Making To:Decision Making To:

Treating PhysicianTreating Physician Independent Medical Evaluation PhysicianIndependent Medical Evaluation Physician Case Manager Case Manager Rehabilitation NurseRehabilitation Nurse Insurance and Risk Management PersonnelInsurance and Risk Management Personnel EmployerEmployer

What To Expect From An What To Expect From An FCE?FCE?

EXAMINEE RELIABILITYEXAMINEE RELIABILITY during the FCE (% Effort Level during the FCE (% Effort Level and Coefficient of Variation).and Coefficient of Variation).

RESIDUAL DEFICIT OR DYSFUNCTIONRESIDUAL DEFICIT OR DYSFUNCTION (body part (body part specific.)specific.)

GENERAL FUNCTIONAL ABILITYGENERAL FUNCTIONAL ABILITY (activities of daily living: (activities of daily living: walking, balancing, bending, climbing, squat, reach, etc.).walking, balancing, bending, climbing, squat, reach, etc.).

SPECIFIC STRENGTH CAPABILITYSPECIFIC STRENGTH CAPABILITY (push, pull, lift). (push, pull, lift). SPECIFIC WORK CAPACITYSPECIFIC WORK CAPACITY category (Examinee’s specific category (Examinee’s specific

and current qualification: sedentary thru very heavy).and current qualification: sedentary thru very heavy). JOB REQUIREMENTSJOB REQUIREMENTS (Job description from Employer and (Job description from Employer and

Dictionary of Occupational Titles).Dictionary of Occupational Titles). Definitive Statement of Examinee’s capacity to return to Definitive Statement of Examinee’s capacity to return to FULL FULL

DUTY, ALTERED DUTY OR NOT AT ALL.DUTY, ALTERED DUTY OR NOT AT ALL.

In Summary, A Kinematic FCE In Summary, A Kinematic FCE Answers The Following:Answers The Following:

Is the ExamineeIs the Examinee:: Demonstrating maximum effort Demonstrating maximum effort

and cooperation during the FCE?and cooperation during the FCE? Suffering residual dysfunction?Suffering residual dysfunction? Capable of safe return to work for Capable of safe return to work for

or altered duty?”or altered duty?”

How Do We Get The Answers How Do We Get The Answers You Need?You Need?

Standard “Low Technology” Functional Standard “Low Technology” Functional Capacity EvaluationCapacity Evaluation

VersesVerses

““High Technology” (APAS) Kinematic High Technology” (APAS) Kinematic Functional Capacity EvaluationFunctional Capacity Evaluation

LOW TECHNOLOGY FCE

Traditional ToolboxEyesHandsVideoTape measureGoniometry

HIGH TECHNOLOGY FCEHIGH TECHNOLOGY FCE

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

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

Click on the picture to see the animation

KINEMATIC ASSESSMENTKINEMATIC ASSESSMENT::

““THREE DIMENSION THREE DIMENSION MOVEMENT ANALYSIS”MOVEMENT ANALYSIS”

TECHNICAL ADVANCES FROM THE TECHNICAL ADVANCES FROM THE SCIENCE OF SPORT ANALYSIS *SCIENCE OF SPORT ANALYSIS *

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

CALIBRATION (VOLUME) CUBE FOR GAITCALIBRATION (VOLUME) CUBE FOR GAIT

GAIT RIGHT CAMERA VIEWGAIT RIGHT CAMERA VIEW

GAIT LEFT CAMERA VIEWGAIT LEFT CAMERA VIEW

AUTOMATIC DIGITIZING GAIT VIEWAUTOMATIC DIGITIZING GAIT VIEW

CONVERSION TO STICK FIGURE AND GRAPH*CONVERSION TO STICK FIGURE AND GRAPH*


FULL SKELETON ANIMATION*FULL SKELETON ANIMATION*


DIGITIZING A DELTA LIFT TASK ANALYSIS


DELTA LIFT TASK ANALYSIS*DELTA LIFT TASK ANALYSIS*


DELTA WITH 125 POUND LOADDELTA WITH 125 POUND LOAD


How Do We Interpret The How Do We Interpret The Data?Data?

GRAPHING DATA


KINETIC FORCE PLATE KINETIC FORCE PLATE Ground Reaction forcesGround Reaction forces

Newton’s Law of PhysicsNewton’s Law of Physics

““Every Action Creates an Equal and Every Action Creates an Equal and Opposite Reaction”Opposite Reaction”

POSTERIOR LEANING CENTER OF GRAVITY STANCEPOSTERIOR LEANING CENTER OF GRAVITY STANCE


EXTREME FORWARD LEANING C.G. EXTREME FORWARD LEANING C.G. POST LUMBAR SURGERYPOST LUMBAR SURGERY


BALANCE TEST PROTOCOLBALANCE TEST PROTOCOL


BALANCE ANDBALANCE ANDCENTER OF PRESSURE SWAYCENTER OF PRESSURE SWAY


LIFT TASK ANALYSIS

LIFT TASK ANALYSIS: MAXIMUM SAFE LIFTLIFT TASK ANALYSIS: MAXIMUM SAFE LIFT


COMPUTERIZED EXERCISE COMPUTERIZED EXERCISE DIAGNOSTIC ANALYSIS DIAGNOSTIC ANALYSIS

EQUIPMENTEQUIPMENT

OPEN LOOP STRENGTH TESTINGOPEN LOOP STRENGTH TESTING


CLOSED LOOP LIFT TESTINGCLOSED LOOP LIFT TESTING


DYNAMIC DYNAMIC ELECTROMYOGRAPHYELECTROMYOGRAPHY

“Monitoring the electrical activity of muscle groups during work

activities.”

EMG POST KNEE INJURY AND SURGERYEMG POST KNEE INJURY AND SURGERY


ELECTROMYOGRAPHY MONITORING OF TEST PROTOCOLELECTROMYOGRAPHY MONITORING OF TEST PROTOCOL


WORK SITE JOB ANALYSISWORK SITE JOB ANALYSIS Determine if the job is a Determine if the job is a

contributing factor to injury.contributing factor to injury. Determine if Examinee work Determine if Examinee work

technique is a contributing factor technique is a contributing factor to un-successful return to work.to un-successful return to work.

Job Title: FishermanJob Title: Fisherman

Sewage processing plant. Job of Sewage processing plant. Job of “Fisherman.”“Fisherman.”

General Employer Problem: multiple cases General Employer Problem: multiple cases ofof rotator cuff and low back problems.

OutcomeOutcome

Work technique contributes to shoulder and Work technique contributes to shoulder and low back stress.low back stress.

Researched plant construction and found Researched plant construction and found this aeration system to be outdated.this aeration system to be outdated.

Reconstruction not feasible.Reconstruction not feasible. Changed work biomechanics technique to Changed work biomechanics technique to

de-stress shoulder and low back.de-stress shoulder and low back.

Office Worker: Chronic Neck Office Worker: Chronic Neck and Back Painand Back Pain

Worker suffers chronic neck and back pain Worker suffers chronic neck and back pain resulting from multiple automobile resulting from multiple automobile accidents.accidents.

Job requires 90% computer terminal work.Job requires 90% computer terminal work. Is ergonomic workstation or work technique Is ergonomic workstation or work technique

a contributing factor?a contributing factor?

Ergonomic Work Station AnalysisErgonomic Work Station Analysis

OutcomeOutcome

Modifications Suggested Include:1. New, sturdy chair with ergonomic adjustments.2. Take Monitor off elevated platform.3. Back seat adjusted to more upright position.4. Seat raised to decrease shoulder stress.5. Adjustable foot rest added to decrease low back

tension.

Employee performs job in a relaxed posture, relieving chronic neck and back strain.

Case StudiesCase Studies

Case #1 Case #1 No Light At The End of the No Light At The End of the

Carpal TunnelCarpal Tunnel

A 32 year old road laborer A 32 year old road laborer who developed Carpal Tunnel who developed Carpal Tunnel from repetitive stress trauma.from repetitive stress trauma.

Patient diagnosed with EMG and NCV.Patient diagnosed with EMG and NCV. Surgical release performed 16 months prior to Surgical release performed 16 months prior to

analysis.analysis. Patient returning to court for upgraded impairment Patient returning to court for upgraded impairment

rating for continued pain and dysfunction.rating for continued pain and dysfunction. FCE ordered by the County for accurate FCE ordered by the County for accurate

assessment and verification of complaints.assessment and verification of complaints.

FinancialFinancialJudge originally awarded a 12.5% for the

operated right carpal tunnel.

Outcome FCE results reveal no current dysfunction FCE results reveal no current dysfunction

of right wrist. of right wrist. Right wrist functioning better than left.Right wrist functioning better than left. No increase in impairment rating.No increase in impairment rating.

Case #2Case #2The Chronic Cervical SprainThe Chronic Cervical Sprain

Chronic Cervical SprainChronic 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.

OutcomeOutcome

FCE negative for objective evidence in FCE negative for objective evidence in support of her complaints of ROM support of her complaints of ROM distress.distress.

Dynamic EMG demonstrates SCM Dynamic EMG demonstrates SCM symmetry, negative for spasm.symmetry, negative for spasm.

Recommendations: Recommendations: No active treatment.No active treatment.

Case #3Case #3The Remote Kinematic FCEThe Remote Kinematic FCE

Remote Functional Capacity Remote Functional Capacity EvaluationEvaluation

31 year old male.31 year old male. Struck by an automobile while working.Struck by an automobile while working. Resulted in a Fractured Pelvis and Low Resulted in a Fractured Pelvis and Low

Back Sprain.Back Sprain. Treated for 2 years and declared to be Treated for 2 years and declared to be

totally disabled for life by his Orthopedic totally disabled for life by his Orthopedic Surgeon.Surgeon.

OutcomeOutcome

Report was presented to the opposing Report was presented to the opposing Attorney by the Insurance Company Attorney by the Insurance Company Attorney.Attorney.

Two days after receiving the report, the Two days after receiving the report, the case was settled.case was settled.

Case #4Case #4The “FALL”The “FALL”

The FallThe Fall

47 year old laborer, Home Improvement Center.47 year old laborer, Home Improvement Center. Incident involving lifting of stock, fell backwards, Incident involving lifting of stock, fell backwards,

injuring his low back. No hard diagnostic injuring his low back. No hard diagnostic evidence.evidence.

1 1/2 years after incident, he continues to be out of 1 1/2 years after incident, he continues to be out of work and seeking medical opinions. Complaints work and seeking medical opinions. Complaints include severe back pain, right and left legs give include severe back pain, right and left legs give out and collapse.out and collapse.

OutcomeOutcome

Examinee was returned to work Examinee was returned to work without protest.without protest.

Case closed.Case closed.

How To Read A Kinematic How To Read A Kinematic Functional Capacity ReportFunctional Capacity Report

BACK TO WORK RECOMMENDATIONBACK TO WORK RECOMMENDATION

LAST PAGE

EXAMINEE RELIABILITY (VALIDITY) EXAMINEE RELIABILITY (VALIDITY) MEASURE OF MEASURE OF

COOPERATION AND EFFORTCOOPERATION AND EFFORT

RESIDUAL DEFICIT OR DYSFUNCTIONRESIDUAL DEFICIT OR DYSFUNCTION

DETAILS OF THE ANALYSISDETAILS OF THE ANALYSIS


CLOSING THOUGHTS!CLOSING THOUGHTS!

What can a Kinematic FCE Do For What can a Kinematic FCE Do For You as Employer or Risk Manager?You as Employer or Risk Manager?

Kinematic FCE cannot determine the diagnosis.Kinematic FCE cannot determine the diagnosis. It can confirm whether the Examinee is moving, lifting, push/ It can confirm whether the Examinee is moving, lifting, push/

pulling, bending, posturing, and or demonstrating muscular pulling, bending, posturing, and or demonstrating muscular imbalance in a dysfunctional manner that is compatible with imbalance in a dysfunctional manner that is compatible with diagnosis and or complaints. diagnosis and or complaints.

It can determine Examinee’s Reliability to perform with It can determine Examinee’s Reliability to perform with maximum effort during the FCE (correlate with symptom maximum effort during the FCE (correlate with symptom magnification and or malingering).magnification and or malingering).

It can match Examinee’s current ability with essential job It can match Examinee’s current ability with essential job demands.demands.

It can determine safe return to work.It can determine safe return to work. It can provide objective evidence for case closure, case settlement It can provide objective evidence for case closure, case settlement

and “fitness for duty (employee termination)”.and “fitness for duty (employee termination)”.

When should an FCE be When should an FCE be CONSIDERED?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.

Additional ConsiderationsAdditional 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.

Do Kinematic FCE’s Help the Do Kinematic FCE’s Help the Bottom Line Of Your Bottom Line Of Your

Business?Business?

1837

1161

575

0

1000

2000

YEARS

LOST WORK DAYS

1994

1995

1996

County of Ocean, NJ: 3 Year HistoryCounty of Ocean, NJ: 3 Year History

Cutting Edge Techniques For Functional Capacity Evaluation Utilizing

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