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Glossary of WPI terms and definitions of clinical findings

Abduction:

Movement of a limb away from the midline of the body

ABI:

Acquired brain injury

Active motion:

How far a joint can be actively moved by the individual (compare to passive motion)

Activities of Daily Living (ADLs):

ADLs refer to the activities of life, for example self-care. A table listing ADLs with examples can be found on page 317 of the AMA4 Guides

Adduction:

Movement of a limb towards the midline of the body

AMA4 Guides:

American Medical Association Publication: Guides to the Evaluation of Permanent Impairment, 4th Edition, 3rd Printing (1995)

Amputation:

Traumatic or surgical removal of part or all of a limb

Ankylosis:

Fusion of a joint, in a position such that it cannot be moved or bent in another way

Anosmia:

Absence or the loss of the sense of smell

Anterior:

Towards the front

Arthritis:

An inflammatory condition involving joints

Arrhythmia:

Irregular heartbeat

Atrophy:

Wasting of an organ e.g. muscle

Bilateral:

On both sides

Bone scan:

This is a test that is performed to detect areas of increased or decreased bone metabolism, which is an indication of abnormal bone process such as fracture, infection and tumours. The test normally involves an intravenous injection of radioactive material and a series of photographs are taken using a specialised camera.

Causation:

A physical, chemical or biological factor contributed to the occurrence of a medical condition. To determine this it is necessary to verify that the factor could have caused or contributed to the impairment and that factor did cause or contribute to the impairment (page 316, AMA4)

Clinical dementia rating (CDR):

A tool used to assess impairment due to disturbances of the nervous system, specifically mental status and integrative functioning

Combining:

Separate impairment percentages for different injuries are generally not added but combined using the Combined Values Chart (pages 322 – 354 AMA4)

Complex regional pain syndrome (CRPS):

A chronic pain condition in which high levels of nerve impulses are sent to an affected site. For a diagnosis to be made, at least 8 of 11 criteria must be met (refer to the current guidelines on the assessment of permanent impairment issued by the State Insurance Regulatory Authority) being:

  • skin colour that is mottled or cyanotic
  • cool skin temperature
  • oedema
  • skin dry or overly moist
  • skin texture that is smooth and non-elastic
  • soft tissue atrophy (especially fingertips)
  • joint stiffness and decreased passive motion
  • nail changes with blemished, curved or talon like nails
  • hair growth changes with hair falling out, longer or finer
  • x-rays showing trophic bone changes or osteoporosis, and
  • bone scan showing findings consistent with CRPS.

Contralateral:

The opposite side

Crepitus:

A crackling sensation when bony surfaces rub against each other

Computerised tomography (CT) scan:

A radiographic technique that uses a computer to assimilate multiple x-ray images into a two dimensional cross sectional image

Deglutition:

Swallowing

Dermatome:

An area of skin supplied by a single spinal nerve for sensation. If a particular nerve is injured, altered sensation is experienced by all people in approximately the same area of skin

Disability:

Consequence of impairment

Distal:

Away or distant from the centre of the body

Diagnosis related estimate (DRE):

The method used for evaluation of impairment of the spine

Diagnosis based estimate (DBE):

Certain impairment estimates of the lower extremity are assigned more appropriately on the basis of their diagnosis. These can be found on pages 85-86 of AMA4

DSM :

Diagnostic Statistics Manual of Mental Disorders describes various diagnostic criteria for mental disorders.

Dysaesthesia:

Disturbed sensation (often painful or uncomfortable)

Dysmetria:

Non-uniform loss of motion in any one of the three planes of movement in the spine

Electrocardiography (ECG):

Procedure by which a doctor obtains a tracing of the electrical activity of the heart

Epistaxis:

Excessive nose bleeds

Extension:

A movement that increases the angle, or the distance, between two bones or parts of the body

External rotation:

Rotation occurring away from midline

Flexion:

A movement that decreases the angle of a joint and brings two bones closer together

Fracture:

Break in a bone

Glasgow coma scale (GCS):

A scale used to evaluate a patient's level of awareness that indirectly indicates the extent of neurological injury. The lowest possible GCS is 3 (coma) whilst the highest is 15 (fully awake). The scale is comprised of three tests with the points for each test added:

Eye opening - spontaneous (4 points), to command (3 points), to pain (2 points) and none (1 point)

Verbal oriented - (5 points), confused (4 points), inappropriate, (3 points) incomprehensible (2 points) and none (1 point)

Motor responses - obeys commands (6 points), localises pain (5 points), withdraws to pain (4 points), flexion to pain (3 points), extension to pain (2 points) and none (1 point)

Goniometer:

Apparatus for measuring range of motion of a joint

Internal rotation:

Rotation of a body part towards the midline

ICD:

International statistical classification of diseases and related health problems

Impairment:

An alteration to a person’s health status, a deviation from normal in a body or organ system and its functioning

Impingement:

Intrusion by one part of anatomy on another, e.g. nerve root impinged upon by protruding disc

Leg Length Discrepancy:

The measured difference between the lengths of two legs

L.E.I:

Lower extremity impairment

Mastication:

Chewing

Motor Accident Guidelines 2017:

Guidelines issued by the Authority in December 2017 pursuant to the Motor Accident Injuries Act 2017

Muscle atrophy:

Muscle wasting (see Atrophy)

Muscle guarding:

Spasm (contraction) of a muscle or group of muscles to minimise motion of the injured site

Muscle spasm:

A sudden involuntary contraction (shortening) of a muscle or group of muscles

MRI:

Magnetic resonance imaging - a special imaging technique, particularly useful for the soft tissues. It uses a large magnet to polarise hydrogen atoms in the tissues and then monitors the summation of the spinning energies within living cells

Nerve root tension signs:

Indicators of irritation of nerve roots. The most commonly used test is the straight leg raising test. Sciatic nerve tension signs are indicators of irritation of the lumbosacral nerve roots

Non-verifiable radicular complaints:

Symptoms in the distribution of a nerve root but no objective physical findings of nerve root dysfunction

Olfaction:

The sense of smell

ORIF:

Open reduction, internal fixation

Passive motion:

How far the examiner/assessor can move the person’s injured joint (see active motion)

Paraesthesia:

Numbness or tingling associated with nerve damage

Peripheral nerves:

Nerves (motor and sensory) running through upper and lower extremities

Permanent impairment:

An impairment is permanent if it has been present for a prolonged period of time, is static, well-stabilised, and unlikely to change substantially regardless of treatment (that is, by more than 3% WPI in the next year with or without medical treatment)

PIRS:

Psychiatric impairment rating scale

Pronation:

Facing downwards, as with palm of the hand

Post-traumatic amnesia (PTA):

An early stage in the recovery process from a traumatic brain injury. A transitory state, intermediate between coma and return of full consciousness, the patient is confused, disoriented and unable to lay down new memories. Duration of PTA is variable from a few minutes to many months.

A daily assessment is carried out using a PTA scale. When the person can answer all the questions correctly on three consecutive days they are considered to have emerged from PTA on the first of these three days.

Some patients are unable to achieve a perfect score on the PTA scale and this usually occurs because the patient is left with a severe memory impairment after the injury.

Severity of injury is determined as follows:

  • PTA less than one hour = a mild injury
  • PTA of 1 - 24 hours = a moderate injury
  • PTA of 1 - 7 days = a severe injury
  • PTA 1 - 4 weeks = a very severe injury
  • PTA more than 4 weeks = an extremely severe   injury

Posterior:

Towards the back of the body

Prosthesis:

Artificial replacement for part of the body

Proximal:

Nearer to the centre of the body

Radial deviation:

Bending the wrist toward the thumb side

Radiculopathy:

Malfunction of a spinal nerve, at the nerve root. Radiculopathy is present when a claimant has two or more of the following objective physical findings:

  • loss or asymmetry of reflexes
  • positive sciatic nerve root tension signs
  • muscle atrophy/decreased limb circumference
  • muscle weakness which is anatomically localised to an appropriate spinal nerve root distribution
  • reproducible sensory loss which is anatomically localised to an appropriate spinal nerve root distribution.

Range of motion (ROM):

The range, measured in degrees, through which a joint may be moved

Reflexes:

An involuntary response elicited by a defined stimulus. Reflexes may be normal, increased, absent or reduced. In muscles, this motor response is best demonstrated by the knee jerk

Scheurmanns disease:

Spinal disease that occurs mainly in children, usually apparent by school age. Some deformity of spine, back curve becomes more exaggerated. Backache and stiffness is aggravated by sitting

Spinous process:

Part of the vertebrae. A spinous process protrudes from each vertebra. The spinous processes create the palpable ‘bumps’ up and down the spine

Splenectomy:

Removal of the spleen

Spondylolisthesis:

The forward slipping of one vertebra upon another. This is normally due to a defect of the joints that normally bind the vertebrae together (facet/zygapophyseal joints). It is often congenital but can occur following a very large traumatic force

Spondylosis:

Refers to degeneration of the vertebrae and discs. Spondylosis produces a characteristic appearance on x-ray including a narrowing of the disc space and the presence of osteophytes (bony outgrowth)

Sprain:

An injury to a ligament, caused by sudden over stretching

SIRA:

State Insurance Regulatory Authority

Strain:

An injury to a muscle that has been abnormally stretched or torn

Supination:

Facing upwards (as with palm of hand)

TBI:

Traumatic brain injury

Tinnitus:

Ringing in the ears, due to nerve damage

Transverse process:

Part of the vertebra. Protrusions (wings) on each side of a vertebra to which muscles and ligaments attach

Ulnar deviation:

Bending the wrist towards the little finger

UEI:

Upper extremity impairment

Unilateral:

On one side only

Vertebral fracture:

Any break of the vertebral body, or of the posterior elements forming the ring of the spinal canal (e.g. lamina, pedicle, transverse processes or spinous process)

WAD:

Whiplash associated disorder