Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

and rehabilitation therapy for a period of time sufficient to permitregeneration and other physiologic recovery. In order to evaluateimpairment resulting from the effects of peripheral spinal nerve lesions, itis necessary to determine the extent of loss of function due to (a) sensorydeficit, pain or discomfort; and (b) loss of muscle strength and altered finemotor control of muscles of the part. Although atrophy, vasomotor andtrophic changes, reflex changes, and certain characteristic deformities arealso effects of peripheral nerve lesions, it is not necessary to evaluate all ofthese separately, because they would be reflected in the sensorydisturbance, loss of muscle strength, or altered fine motor control.Note: Restrictions of motion and ankyloses may result from peripheralspinal nerve impairments. Consideration was given to such impairmentswhen the percentage values set forth in this section were derived.Therefore, if an impairment results strictly from a peripheral nerve lesion,the evaluator should not apply the impairment values from both Sections3. 1a through 3. 1g and this section, because this would result in aduplication and a multiplying of the impairment rating. However, whenrestricted motion or ankylosis exists but cannot be attributed to sensoryinvolvement or muscle weakness, then values from Sections 3. 1a through3. 1g may be combined with values of this section using the CombinedValues Chart.It is necessary for the physician to establish as accurately as possiblethe anatomic distribution of sensory and/or motor loss and verify that thedistribution relates to a specific peripheral spinal nerve or nerves beforedetermining the percentage of permanent impairment. The diagnosis isbased firmly on the patient's signs and symptoms. With a carefully