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Updated and enhanced: Guides sixth offers the most current guidelines for correct impairment evaluation The newly revised Guides to the Evaluation of Permanent Impairment, sixth edition, from the American Medical Association, emphasizes the fundamental skills physicians need to evaluate and communicate patient impairments. Standardized methodology is applied to each chapter to enhance the relevancy of impairment ratings, improve internal consistency and promote ease of application to the rating process. This ordered method enables busy physicians to become proficient with the ratings for multiple organ systems and anticipate how each chapter is organized and assimilates information. The sixth edition applies both terminology from and an analytical framework based on the International Classification of Functioning, Disability and Health (ICF), to generate five impairment classes which permit the rating of the patient from no impairment to most severe. A diagnosis-based grid has been developed for each organ system. The grid arranges commonly used ICD-9 diagnoses within the five classes of impairment severity, according to the consensus-based dominant criterion. Functionally based histories, physical findings and broadly accepted objective clinical test results are integrated where applicable to help physicians determine the grade within the impairment class. The result is a decision that is both transparent and reproducible. Using the latest evidence in diagnosis and clinical tests, the new sixth edition offers the following key features: -Standardized approach across organ systems and chapters -Expanded use of diagnostic approach to help physicians consider relevant clinical tests and patient outcomes in performing the rating -Required clinical information needed to rate a given condition -Clear step-by-step grading instructions in each chapter to promote consistent scoring of impairment ratings and to improve physician consistency -Simplified methodology presented between chapters -Contemporary, evidence-based concepts and terminology of disablement from the ICF -The latest scientific research and evolving medical opinion provided by nationally and internationally recognized experts -More comprehensive and expanded diagnostic approach -Transparent process to allow the evaluator to document functional assessment, clinical tests and physical findings -Uniform grids to help physicians calculate impairment ratings

-도서목차-

Chapter 1 Philosophy, Purpose, and Appropriate Use of the Guides 1
1.1 History 1
1.2 Impairment, Disability, and Handicap 2
1.3 The Organ System and Whole Body Approach to Impairment 9
1.4 Philosophy and Use of the Combined Values Chart 9
1.5 Incorporating Science With Clinical Judgment 10
1.6 Causation, Apportionment Analysis, and Aggravation 11
1.7 Use of the Guides 12
1.8 Impairment Evaluations in Workers' Compensation 13
1.9 Employability Determinations 13
1.10 Railroad and Maritime Workers 14
1.11 The Physician's Role Based on the Americans with Disabilities Act (ADA) 14
1.12 Summary 15

Chapter 2 Practical Application of the Guides 17
2.1 Defining Impairment Evaluations 18
2.2 Who Performs Impairment Evaluations? 18
2.3 Examiners' Roles and Responsibilities 18
2.4 When Are Impairment Ratings Performed? 19
2.5 Rules for Evaluation 19
2.6 Preparing Reports 21

Chapter 3 The Cardiovascular System: Heart and Aorta 25
3.1 Principles of Assessment 26
3.2 Vavular Heart Disease 29
3.3 Coronary Heart Disease 35
3.4 Congenital Heart Disease 42
3.5 Cardiomyopathies 47
3.6 Pericardial Heart Disease 52
3.7 Arrhythmias 56
3.8 Cardiovascular Impairment Evaluation Summary 60

Chapter 4 The Cardiovascular System: Systemic and Pulmonary Arteries 65
4.1 Hypertensive Cardiovascular Disease 66
4.2 Disease of the Aorta 70
4.3 Vascular Diseases Affecting the Extremities 73
4.4 Diseases of the Pulmonary Arteries 79
4.5 Cardiovascular Impairment Evaluation Summary 82

Chapter 5 The Respiratory System 87
5.1 Principles of Assessment 88
5.2 Symptoms Associated With Respiratory Disease 89
5.3 Tobacco Use and Environment Exposure Associated With Respiratory Disease
5.4 Examinations, Clinical Studies, and Other Tests for Evaluating Respiratory Disease 91
5.5 Asthma 102
5.6 Obstructive Sleep Apnea 105
5.7 Hypersensitivity Pneumonitis 105
5.8 Penumoconiosis 106
5.9 Lung Cancer 106
5.10 Permanent Impairment Due to Respiratory Disorders 107
5.11 Respiratory Impairment Evaluation Summary 112

Chapter 6 The Digestive System 117
6.1 Principles of Assessment 118
6.2 Upper Digestive Tract 120
6.3 Colon, Rectum, and Anus 128
6.4 Enterocutaneous Fistulas 132
6.5 Liver and Biliary Tract 133
6.6 Hernias 136
6.7 Digestive System Impairment Evaluation Summary 138

Chapter 7 The Urinary and Reproductive Systems 143
7.1 Principles of Assessment 144
7.2 The Urinary System 144
7.3 Upper Urinary Tract 145
7.4 Urinary Diversion 150
7.5 Bladder 151
7.6 Urethra 153
7.7 Male Reproductive Organs 157
7.8 Female Reproductive Organs 163
7.9 Urinary and Reproductive Systems Impairment Evaluation Summary 170

Chapter 8 The Skin 173
8.1 Principles of Assessment 174
8.2 Disfigurement 175
8.3 Scars and Skin Grafts 176
8.4 Contact Dermatitis 176
8.5 Natural Rubber Latex Allergy 177
8.6 Skin Cancer 177
8.7 Criteria for Rating Permanent Impairment Due to Skin Disorders 178
8.8 Skin Impairment Evaluation Summary 188

Chapter 9 The Hematopoietic System 191
9.1 Principles of Assessment 192
9.2 Anemia 192
9.3 Polycythemia and Myelofibrosis 196
9.4 White Blood Cell Disease or Abnormalities 197
9.5 Hemorrhagic and Platelet Disorders 203
9.6 Thrombotic Disorders 206
9.7 Hematologic Impairment Evaluation Summary 208

Chapter 10 The Endocrine System 211
10.1 Principles of Assessment 212
10.2 Hypothalamic. Pituitary Axis 212
10.3 Thyroid 217
10.4 Parathyroids 219
10.5 Adrenal Cortex 222
10.6 Adrenal Medulla 228
10.7 Pancreas (Islets of Langerhans) 230
10.8 Gonads 237
10.9 Mammary Glands 239
10.10 Metabolic Bone Disease 240
10.11 Endocrine System Impairment Evaluation Summary 241

Chapter 11 Ear, Nose, Throat, and Related Structures 245
11.1 Principles of Assessment 246
11.2 The Ear 246
11.3 The Face 255
11.4 The Nose, Throat, and Related Structures 259
11.5 Ear, Nose, Throat, and Related Structures Impairment Evaluation Summary

Chapter 12 The Visual System 277
12.1 Principles of Assessment 278
12.2 Impairment of Visual Acuity 281
12.3 Impairment of the Visual Field 287
12.4 Impairment of the Visual System 296
12.5 Visual Acuity Measurement at Near (Reading Acuity) 300

Chapter 13 The Central and Peripheral Nervous System 305
13.1 Principles of Assessment 305
13.2 Criteria for Rating Impairment Due to Central Nervous System Disorders 308
13.3 Criteria for Rating Cerebral Impairments 309
13.4 Criteria for Rating Impairments of the Cranial Nerves 327
13.5 Criteria for Rating Impairments of Station, Gait, and Movement Disorders 336
13.6 Criteria for Rating Impairments of Upper Extremities Related to Central Impairment 338
13.7 Criteria for Rating Spinal Cord and Related Impairments 340
13.8 Criteria for Rating Impairments Related to Chronic Pain 343
13.9 Criteria for Rating Impairments of the Peripheral Nervous System, Neuromuscular Junction, and Muscular System 344
13.10 Nervous System Impairment Evaluation Summary 352

Chapter 14 Mental and Behavioral Disorders 357
14.1 Principles of Assessment 358
14.2 Psychiatric Diagnosis and Impairment 359
14.3 A Method of Evaluating Psychiatric Impairment 361
14.4 Assessing Impairment Severity 364
14.5 Examples of Impairment Due to Mental and Behavioral Disorders 367
14.6 Format of the Impairment Report 370

Chapter 15 The Spine 373
15.1 Principles of Assessment 374
15.2 Determining the Appropriate Method for Assessment 379
15.3 Diagnosis-Related Estimates Method 381
15.4 DRE: Lumbar Spine 384
15.5 DRE: Thoracic Spine 388
15.6 DRE: Cervical Spine 392
15.7 Rating Corticospinal Tract Damage 395
15.8 Range-of-Motion Method 398
15.9 ROM: Lumbar Spine 405
15.10 ROM: Thoracic Spine 411
15.11 ROM: Cervical Spine 417
15.12 Nerve Root and/or Spinal Cord 423
15.13 Criteria for Converting Whole Person Impairment to Regional Spine Impairment 427
15.14 The Pelvis 427
15.15 Spine Evaluation Summary 429

Chapter 16 The Upper Extremities 433
16.1 Principles of Assessment 434
16.2 Amputations 441
16.3 Sensory Impairment Due to Digital Nerve Lesions 445
16.4 Evaluating Abnormal Motion 450
16.5 Impairment of the Upper Extremities Due to Peripheral Nerve Disorders 480
16.6 Impairment of the Upper Extremities Due to Vascular Disorders 497
16.7 Impairment of the Upper Extremities Due to Other Disorders 498
16.8 Strength Evaluation 507
16.9 Summary of Steps for Evaluating Impairments of the Upper Extremity 511
16.10 Clinical Examples 512

Chapter 17 The Lower Extremities 523
17.1 Principles of Assessment 524
17.2 Methods of Assessment 525
17.3 Lower Extremity Impairment Evaluation Procedure Summary and Examples 5
Chapter 18 Pain 565
18.1 Principles of Assessment 566
18.2 Overview of Pain 566
18.3 Integrating Pain-Related Impairment Into the Conventional Impairment Rating System 569
18.4 Behavioral Confounders 581
18.5 How to Rate Pain-Related Impairment: A Sample Protocol 583
18.6 Psychogenic Pain 585
18.7 Malingering 585
18.8 Conclusion 586
18.9 Case Examples 586
Appendix Recording Range-of-Motion Measurements 593
 Glossary 599
 Combined Values Chart 604
 Index 607

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