By Robert Wainwright, P.T. President, Kinematic Consultants, Inc Cutting Edge Techniques For Functional Capacity Evaluation Utilizing Ariel Performance Analysis Systems By Robert Wainwright, P.T. President, Kinematic Consultants, Inc Point Pleasant, NJ

Kinematic Consultants Test and Measurement Services for Workers Compensation Issues Specializing In Kinematic Functional Capacity Evaluations Utilizing “State of the Art” Technology (APAS) to Measure Function in Work, ADL and Recreation Activities.

Kinematic Consultants Locations

Test Protocols Designed and Administered by Licensed Physical Therapists Biomedical Engineers Kinematics

Medical and Workers Compensation Issues Considered Safe Return to Work Altered Duty Capacity Recommendation Residual Dysfunction % Examinee Reliability Case Closure Legal Support

Providing Support in Medical Decision Making To: Treating Physician Independent Medical Evaluation Physician Case Manager Rehabilitation Nurse Insurance and Risk Management Personnel Employer

What To Expect From An FCE? EXAMINEE RELIABILITY during the FCE (% Effort Level and Coefficient of Variation). RESIDUAL DEFICIT OR DYSFUNCTION (body part specific.) GENERAL FUNCTIONAL ABILITY (activities of daily living: walking, balancing, bending, climbing, squat, reach, etc.). SPECIFIC STRENGTH CAPABILITY (push, pull, lift). SPECIFIC WORK CAPACITY category (Examinee’s specific and current qualification: sedentary thru very heavy). JOB REQUIREMENTS (Job description from Employer and Dictionary of Occupational Titles). Definitive Statement of Examinee’s capacity to return to FULL DUTY, ALTERED DUTY OR NOT AT ALL.

In Summary, A Kinematic FCE Answers The Following: Is the Examinee: Demonstrating maximum effort and cooperation during the FCE? Suffering residual dysfunction? Capable of safe return to work for or altered duty?” In Summary, A Kinematic FCE Answers The Following:

How Do We Get The Answers You Need? Standard “Low Technology” Functional Capacity Evaluation Verses “High Technology” (APAS) Kinematic Functional Capacity Evaluation

LOW TECHNOLOGY FCE SUBJECTIVE Traditional Toolbox Eyes Hands Video Tape measure Goniometry

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA. HIGH TECHNOLOGY FCE OBJECTIVE Click on the picture to see the animation 3D Kinematic Computer Analysis of Motion (APAS)* Kinetic Ground Reaction Forces / Balance (APAS)* Computerized Strength Analysis Equipment(CES)* Dynamic EMG [electromyography] (APAS)* * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

KINEMATIC ASSESSMENT: “THREE DIMENSION MOVEMENT ANALYSIS”

TECHNICAL ADVANCES FROM THE SCIENCE OF SPORT ANALYSIS * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA. Click on the picture to see the animation

CALIBRATION (VOLUME) CUBE FOR GAIT

GAIT RIGHT CAMERA VIEW

GAIT LEFT CAMERA VIEW

AUTOMATIC DIGITIZING GAIT VIEW

CONVERSION TO STICK FIGURE AND GRAPH* * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

FULL SKELETON ANIMATION* * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

DIGITIZING A DELTA LIFT TASK ANALYSIS * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Analyzing Technique * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Good Lift Poor Lift * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

DELTA LIFT TASK ANALYSIS* * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

DELTA WITH 125 POUND LOAD * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

How Do We Interpret The Data?

GRAPHING DATA * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

KINETIC FORCE PLATE Ground Reaction forces Newton’s Law of Physics “Every Action Creates an Equal and Opposite Reaction”

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

POSTERIOR LEANING CENTER OF GRAVITY STANCE * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

EXTREME FORWARD LEANING C.G. POST LUMBAR SURGERY * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

BALANCE TEST PROTOCOL * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

CENTER OF PRESSURE SWAY BALANCE AND CENTER OF PRESSURE SWAY * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

LIFT TASK ANALYSIS: MAXIMUM SAFE LIFT * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

COMPUTERIZED EXERCISE DIAGNOSTIC ANALYSIS EQUIPMENT

OPEN LOOP STRENGTH TESTING * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

CLOSED LOOP LIFT TESTING * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

DYNAMIC ELECTROMYOGRAPHY “Monitoring the electrical activity of muscle groups during work activities.”

EMG POST KNEE INJURY AND SURGERY * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

ELECTROMYOGRAPHY MONITORING OF TEST PROTOCOL * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

WORK SITE JOB ANALYSIS Determine if the job is a contributing factor to injury. Determine if Examinee work technique is a contributing factor to un-successful return to work.

Job Title: Fisherman Sewage processing plant. Job of “Fisherman.” General Employer Problem: multiple cases of rotator cuff and low back problems.

Lifts Heavy Material Well Over Shoulder Level

Extreme Bend Back and Knees

Outcome Work technique contributes to shoulder and low back stress. Researched plant construction and found this aeration system to be outdated. Reconstruction not feasible. Changed work biomechanics technique to de-stress shoulder and low back.

Office Worker: Chronic Neck and Back Pain Worker suffers chronic neck and back pain resulting from multiple automobile accidents. Job requires 90% computer terminal work. Is ergonomic workstation or work technique a contributing factor?

Ergonomic Work Station Analysis Head Tilted Back Monitor Too High Upper Back Tension Feet Flat On Ground Chair Back Inclined

Outcome Modifications Suggested Include: New, sturdy chair with ergonomic adjustments. Take Monitor off elevated platform. Back seat adjusted to more upright position. Seat raised to decrease shoulder stress. Adjustable foot rest added to decrease low back tension. Employee performs job in a relaxed posture, relieving chronic neck and back strain.

Case Studies

Case #1 No Light At The End of the Carpal Tunnel

A 32 year old road laborer who developed Carpal Tunnel from repetitive stress trauma. Patient diagnosed with EMG and NCV. Surgical release performed 16 months prior to analysis. Patient returning to court for upgraded impairment rating for continued pain and dysfunction. FCE ordered by the County for accurate assessment and verification of complaints.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Financial Judge originally awarded a 12.5% for the operated right carpal tunnel. Outcome FCE results reveal no current dysfunction of right wrist. Right wrist functioning better than left. No increase in impairment rating.

Case #2 The Chronic Cervical Sprain

Chronic Cervical Sprain Drug Counselor [clerical job] with a diagnosis of whiplash cervical sprain. Date of Incident, 1 1/2 years prior to analysis. Complaints of constant pain, severe spasm in Sterno Cleido Mastoid Muscle (right). In and out of work multiple times since incident.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Outcome FCE negative for objective evidence in support of her complaints of ROM distress. Dynamic EMG demonstrates SCM symmetry, negative for spasm. Recommendations: No active treatment.

Case #3 The Remote Kinematic FCE

Remote Functional Capacity Evaluation 31 year old male. Struck by an automobile while working. Resulted in a Fractured Pelvis and Low Back Sprain. Treated for 2 years and declared to be totally disabled for life by his Orthopedic Surgeon.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Outcome Report was presented to the opposing Attorney by the Insurance Company Attorney. Two days after receiving the report, the case was settled.

Case #4 The “FALL”

The Fall 47 year old laborer, Home Improvement Center. Incident involving lifting of stock, fell backwards, injuring his low back. No hard diagnostic evidence. 1 1/2 years after incident, he continues to be out of work and seeking medical opinions. Complaints include severe back pain, right and left legs give out and collapse.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

* Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

Outcome Examinee was returned to work without protest. Case closed.

How To Read A Kinematic Functional Capacity Report

BACK TO WORK RECOMMENDATION LAST PAGE

EXAMINEE RELIABILITY (VALIDITY) COOPERATION AND EFFORT MEASURE OF COOPERATION AND EFFORT

RESIDUAL DEFICIT OR DYSFUNCTION

DETAILS OF THE ANALYSIS * Technology Courtesy of Ariel Dynamics Inc, San Diego, CA.

CLOSING THOUGHTS!

What can a Kinematic FCE Do For You as Employer or Risk Manager? Kinematic FCE cannot determine the diagnosis. It can confirm whether the Examinee is moving, lifting, push/ pulling, bending, posturing, and or demonstrating muscular imbalance in a dysfunctional manner that is compatible with diagnosis and or complaints. It can determine Examinee’s Reliability to perform with maximum effort during the FCE (correlate with symptom magnification and or malingering). It can match Examinee’s current ability with essential job demands. It can determine safe return to work. It can provide objective evidence for case closure, case settlement and “fitness for duty (employee termination)”.

When should an FCE be CONSIDERED? At 4-5 week, post injury, when soft tissue injury patient is not responding as expected to treatment and or is not back to work, full duty (results can help you decide if there are non-medical issues, symptom magnifying , malingering issues or real functional issues that may need further diagnostic or medical consideration. When the treating physician has concluded the patient has reached MMI and there is a question of work capability. When multiple body parts are involved and, or the patient is recovering from lumbar, cervical, shoulder, hip, knee or ankle surgery. Anytime the treating physician or case manager has reached a roadblock in getting an injured employee back to work.

Additional Considerations When objective residual disability information is needed for case settlement. To supplement and strengthen an Independent Medical Evaluation. When objective information is needed to strengthen a case position for settlement and or legal disposition. To assist with case closure in the case of a problem Examinee.

Do Kinematic FCE’s Help the Bottom Line Of Your Business?

County of Ocean, NJ: 3 Year History

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