In AMA 4 , seven differentiators are presented in table 71, DRE Impairment category Differentiators(AMA 4 P 109), including guarding, loss of reflexes, atrophy etc.The rating was based SOLELY on the injury and NOT improvement(or worsening) with treatment.This was a difficult exercise as patients have usually been treated for a cervical strain by the time they present for Pi assessment!
AMA 5 carried significant changes so that evaluators could now take into account the tretment results.As a result, the DRE rating is based on the objective findings at the eventual time of PI evaluation.THE OBJECTIVE FINDINGS are : muscle spasm, muscle guarding, asymmetric spinal motion(previously called dysmetria), non-verifiable radicular pain, reflexes, neurologic changes such as wasting or loss of sensation, atrophy, radiculopathy etc.imaging studies may assist the evaluator.
SUMMARY: AMA 4: Section 3.3 pp 103-105, Table 71 p 109.Determine if injury occurred, assess ADL, examination, assess differentiators, select category, based on HISTORICAL FINDINGS( hence my repeated calls for all GP, physic records!).
AMA 5: As per AMA 4 without differentiators and select appropriate category based on CURRENT FINDINGS ( not trying to determine findings at TOI and without treatment!).
As per AMA 4 issues discussed above, with AMA5 , the impairment is no longer based on prior (someone elses') findings and treatment effects are allowed into the assessment.
ASSISTANT PROFESSOR MICHAEL CORONEOS CIME
SENIOR NEUROSURGEON & PI ASSESSOR
NATIONAL RACS EXAMINER & RACS SENIOR MORTALITY ASSESSOR (QASM)
FAIM MASE CIME FACS FRACS FRCSI FRCS(EDIN)SN MB BS(1ST CLASS HONOURS) MAPS MNSA MNSQ MANZSOM
Always seek treatment from your own doctor.
For all appointments.
Booking details: Mon,Wed and Thur please call 07-38319511 Tuesday and Friday please call 07-33441440 Dr Coronoes consults BOTH in the city at Silverton Place, Suite 73, 101 Wickham Terrace, Brisbane SPRING HILL QLD