ALBERTA PERMANENT CLINICAL IMPAIRMENT GUIDE - Workers ...

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THE UPPER EXTREMITIESC. Denervation1. The schedule provides ratings for complete denervations of specificnerves. Where the Alberta Guides do not provide a value for a specificnerve refer to the AMA Guides.2. Rating partial loss of motor and/or sensory function is made using theprinciples of the AMA Guides. Refer to the AMA Guides table forspecific unilateral spinal nerve impairment affecting the upper extremityto obtain the specific percentage loss of function. This figure should beapplied to the appropriate rating for complete loss found in theschedule on page 25 of this document, using the following formula:% functional loss Scheduled rating for(AMA Guides) X complete loss = Rating (%)3. Brachial plexus, spinal cord and brain injuries are capable of producingimpairments of varying degree and type to parts of the body beyondthe primary site of injury. Upper extremity effects from these causesare assessed and rated using the procedures and rules describedabove.D. Repetitive Strain Injury (RSI)1. PCI is assessed only on an exceptional basis where there ismeasurable clinical impairment.E. Reflex Sympathetic Dystrophy (RSD)1. Impairment rating for RSD is made, on a judgement basis, by applyingthe principles of the AMA Guides table for assessment of impairmentof the upper extremity, due to peripheral nerve disorders, to the AlbertaGuide rating of the whole limb or portion as deemed appropriate.Refer to the Grading Scheme table for pain or loss of sensation.Page 24COPYRIGHT 2008 All Rights Reserved April 1, 2008
THE UPPER EXTREMITIESRATING SCHEDULE1. Amputations Whole PersonRating (%)a. Disarticulation at the shoulder or amputation withinthe proximal third of the humerusEach 70b. Amputation within the middle third of the humerusc. Amputation within the distal third of the humerus or ofthe forearm proximal to the biceps insertiond. Amputation of the forearm between biceps insertionand wrist*This rating depends on the amount of leverage affordedthe arm by the length of the stump. The lower theleverage (i.e., the shorter the stump), the higher therating2. Complete Immobility of Jointsa. Complete loss of shoulder movementi) flexion/extensionii) abduction/adductioniii) internal/external rotationb. Ankylosed elbowc. Ankylosed wrist3. Partial Immobility of Jointsa. Forearm unable to supinate from neutral positionb. Forearm unable to pronate from neutral positionEachEachEachEachEachEachEach656050 - 60*181162012.553Page 25COPYRIGHT 2008 All Rights Reserved April 1, 2008
Page 1 and 2: ALBERTAPERMANENT CLINICALIMPAIRMENT
Page 3 and 4: Table of ContentsFingers/Hands(cont
Page 5 and 6: Table of Contents8 CardiovascularSy
Page 7 and 8: I. IntroductionDETERMINING PERMANEN
Page 9 and 10: Figure 1: DETERMINING PERMANENT DIS
Page 11 and 12: Figure 2: THE PERMANENT CLINICAL IM
Page 13 and 14: Rating Permanent Clinical Impairmen
Page 15 and 16: 3. For combinations of accidents po
Page 17 and 18: FINGERS/HANDSFINGERS/HANDSI. Introd
Page 19 and 20: FINGERS/HANDS7. To obtain the PCI t
Page 21 and 22: FINGERS/HANDS7. To calculate the ra
Page 23 and 24: FINGERS/HANDSCHART 1 - THUMB AND/OR
Page 25 and 26: FINGERS/HANDSCHART 2 - TWO FINGERSP
Page 27 and 28: FINGERS/HANDSCHART 3 - THREE FINGER
Page 29 and 30: FINGERS/HANDSCHART 4 - FOUR FINGERS
Page 31 and 32: FINGERS/HANDSStep Two:Rate the dist
Page 33 and 34: EXAMPLE 2Situation:FINGERS/HANDSLef
Page 35 and 36: FINGERS/HANDSStep Six:Adjust the to
Page 37 and 38: FINGERS/HANDSStep Twelve: Rate the
Page 39: THE UPPER EXTREMITIESIII.Specific R
Page 43 and 44: THE LOWER EXTREMITIESTHE LOWER EXTR
Page 45 and 46: THE LOWER EXTREMITIESC. Denervation
Page 47 and 48: THE LOWER EXTREMITIES3. Replacement
Page 49 and 50: THE SPINEAn increase greater than 1
Page 51 and 52: THE SPINEThoracic and Lumbar Spine1
Page 53 and 54: HEARING LOSSD. The calculated PCI r
Page 55 and 56: HEARING LOSSHEARING LOSS TABLE 1 -
Page 57 and 58: VISIONE. Combine the impairments in
Page 59 and 60: VISIONEXAMPLESEXAMPLE 1:IMPAIRMENTS
Page 61 and 62: VISIONRATING SCHEDULE IIWHOLE PERSO
Page 63 and 64: SKINSKINI. IntroductionA. The skin
Page 65 and 66: SKINTABLE I - FUNCTIONAL IMPAIRMENT
Page 67 and 68: THE CARDIOVASCULAR SYSTEMTHE CARDIO
Page 69 and 70: THE CARDIOVASCULAR SYSTEMb) laborat
Page 71 and 72: THE RESPIRATORY SYSTEMTHE RESPIRATO
Page 73 and 74: THE RESPIRATORY SYSTEMi. chronic in
Page 75 and 76: THE RESPIRATORY SYSTEMSCHEDULE II -
Page 77 and 78: THE RESPIRATORY SYSTEMClass IV SEVE
Page 79 and 80: THE BRAINTHE BRAINI. IntroductionA.
Page 81 and 82: THE BRAINiv. for disturbances of co
Page 83 and 84: MENTAL IMPAIRMENTloss as well as gi
Page 85 and 86: MENTAL IMPAIRMENTCLASS II MINIMAL I
Page 87 and 88: MENTAL IMPAIRMENTCLASS IV MODERATE
Page 89 and 90: MISCELLANEOUS CONDITIONSMISCELLANEO
Page 91 and 92:
APPENDIXCOMBINED VALUES CHARTAPPEND
Page 93 and 94:
APPENDIXCOMBINED VALUES CHARTPart 2
Page 95 and 96:
APPENDIXCOMBINED VALUES CHARTPart 4
Page 97 and 98:
Part 6 - Range: 75 - 99 x 76 - 99AP
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ALBERTA PERMANENT CLINICAL IMPAIRMENT GUIDE - Workers ...

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