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1
Brigham, Christopher R. "Common Tips for IMEs: Musculoskeletal Conversions: Musculoskeletal Conversions." Guides Newsletter 7, no. 6 (November 1, 2002): 13–15. http://dx.doi.org/10.1001/amaguidesnewsletters.2002.novdec03.
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Abstract Most impairments are expressed ultimately as a whole person impairment, and the musculoskeletal chapters of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include instructions for converting regional impairments to whole person impairments using a percentage relationship. This article presents an extensive table that incorporates the conversion factors for extremity and spinal impairments. Occasionally evaluators need to convert spinal impairments from whole person to impairment of the spine, a process that is explained in the AMA Guides, Section 15.13. The conversion factors differ depending on whether the impairment was obtained using the Diagnosis-related estimate (DRE) method or the range-of-motion (ROM) method. For example, a 5% whole person impairment is an 8% upper extremity impairment, a 9% hand impairment, 23% thumb impairment, 46% index/middle finger impairment, or 93% ring/little finger impairment. The same 5% whole person impairment would convert to a cervical spine impairment of 14% cervical spine if the DRE method were used and 6% if the ROM method were used. For the lumbar spine, this would convert to 7% lumbar spine impairment if the DRE method were used and 6% if the ROM method were used. The table in this article provides values for converting foot to lower extremity impairment and for converting whole person impairment to regional spinal impairment.
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Brigham, Christopher R. "Combining Values Chart." Guides Newsletter 17, no. 2 (March 1, 2012): 7–9. http://dx.doi.org/10.1001/amaguidesnewsletters.2012.marapr03.
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Abstract Evaluating physicians may need to account for the effects of multiple impairments using a summary value. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the Combined Values Chart provides a method to combine two or more impairment percentages based on the formula A + B(1 – A) = the combined value of A and B. Using the Combined Values Chart and this formula, physicians can combine multiple impairments so that the whole person impairment is equal to or less than the sum of all the individual impairment values. The AMA Guides, Sixth Edition, specifies that “impairments are successively combined by first combining the largest number with the next largest remaining number, and then further combining it with the next largest remaining number … until all given impairment numbers are combined.” Impairment values within a region generally are combined and converted to whole person permanent impairment before being combined with values from other regions. The article reviews the AMA Guides, Sixth Edition, approach to combining upper extremity impairments, lower extremity impairments, and combining spinal impairments.
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Subin, Kenneth, and Christopher R. Brigham. "Impairment Tutorial: Headache Impairment." Guides Newsletter 13, no. 5 (September 1, 2008): 11. http://dx.doi.org/10.1001/amaguidesnewsletters.2008.sepoct04.
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Abstract The approach to assessing impairment for headaches differs among the fourth, fifth, and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In summary, the fourth edition provides only a qualitative, nonnumeric rating. In the fifth edition, an examiner can give up to 3% whole person permanent impairment. Using the sixth edition of the AMA Guides, an examiner may determine up to 5% whole person permanent impairment for migraine headaches for Chapter 13 and up to 3% whole person impairment for other headaches according to Chapter 3. With respect to the AMA Guides, Fourth Edition, unless other objective features can be rated according to specific organ dysfunction, headache impairment is a qualitative, nonnumeric rating, and “The vast majority of patients with headache[s] will not have permanent impairments.” In some defined cases, the fifth edition facilitates calculation of a pain related impairment score (that specifically is not an impairment rating) that is used to describe the severity of the pain, for which up to 3% whole person impairment may be provided. The sixth edition of the AMA Guides provides a quantitative whole person impairment rating up to 5% whole person impairment for migrainous headaches and 3% whole person impairment for nonmigrainous headaches.
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Cai, Yurun, Yuri Agrawal, Jennifer Schrack, Alden Gross, Nicole Armstrong, Eleanor Simonsick, and Susan Resnick. "Sensory Impairment and Algorithmic Classification of Early Cognitive Impairment in Middle-Aged and Older Adults." Innovation in Aging 5, Supplement_1 (December 1, 2021): 436–37. http://dx.doi.org/10.1093/geroni/igab046.1697.
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Abstract Sensory function has been linked to cognitive impairment and dementia, but the link between multiple sensory impairments and early cognitive impairment (ECI) is unclear. Sensory function (vision, hearing, vestibular, proprioception, and olfaction) was measured in 390 BLSA participants (age=75±8 years; 57% women; 69% white) from 2012 to 2018 over a mean 3.6 years. ECI was defined based on 1 standard deviation below age-and race-specific means in Card Rotations or California Verbal Learning Test immediate recall. Cox proportional hazard models examined the risk of ECI for each sensory impairment and across categories of impairments. Vision impairment (vs. no vision impairment) was associated with a 70% greater risk of ECI (HR=1.70, p=0.05). Participants with 1 or ≥2 sensory impairments had triple the risk of ECI (HR=3.74 and 3.44, p=0.008 and 0.02, respectively) compared to those without impairment. Future studies are needed to examine whether treatment for sensory impairments can modify these risks.
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Borg, Johan, Natasha Layton, Per-Olof Östergren, and Stig Larsson. "Do Assistive Products Enhance or Equalize Opportunities? A Comparison of Capability across Persons with Impairments Using and Not Using Assistive Products and Persons without Impairments in Bangladesh." Societies 12, no. 5 (October 8, 2022): 141. http://dx.doi.org/10.3390/soc12050141.
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Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids and persons without impairments (N = 572); and (ii) data from persons with ambulatory impairment not using manual wheelchairs, persons with ambulatory impairment using manual wheelchairs and persons without impairments (N = 598). Kruskal–Wallis tests were used to compare levels of capability across the three groups in each data set. Results showed that, for all functionings in both data sets, the levels of capability were statistically significantly highest for persons without impairments. Compared to persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids scored higher in all functionings, with statistical significance at the .05 level for 12 of them. Persons with ambulatory impairment using manual wheelchairs scored higher than persons with ambulatory impairment not using manual wheelchairs for 11 of the functionings, but none of the comparisons between the two groups were significant at the .05 level. Assistive products—hearing aids more than manual wheelchairs—enhance capabilities but do not fully equalize opportunities between people with and without impairments.
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Fuller-Thomson, Esme, Aliya Nowaczynski, and Andie MacNeil. "The Association Between Hearing Impairment, Vision Impairment, Dual Sensory Impairment, and Serious Cognitive Impairment: Findings from a Population-Based Study of 5.4 million Older Adults." Journal of Alzheimer's Disease Reports 6, no. 1 (May 2, 2022): 211–22. http://dx.doi.org/10.3233/adr-220005.
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Background: Sensory impairments and cognitive impairment are increasing in scope due to the aging population. Objective: To investigate the association between hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment among older adults. Methods: Secondary analysis of a combination of ten consecutive waves (2008–2017) of the nationally representative American Community Survey. The sample included 5.4 million community-dwelling and institutionalized older adults aged 65 and older. Bivariate and logistic regression models were conducted to examine the association hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment. Results: After controlling for age, race, education, and income, older adults with only hearing impairment had more than double the odds of cognitive impairment (OR = 2.66, 95% CI = 2.64, 2.68), while older adults with only vision impairment had more than triple the odds of cognitive impairment (OR = 3.63; 95% CI = 3.59, 3.67). For older adults with dual sensory impairment, the odds of cognitive impairment were eight-fold (OR = 8.16; 95% CI = 8.07, 8.25). Similar trends were apparent in each sex and age cohort. Conclusion: Hearing and vision impairment are both independently associated with cognitive impairment. However, dual sensory impairment is associated with substantially higher odds of cognitive impairment, even after controlling for sociodemographic characteristics. Practitioners working with older adults may consider treatment for sensory impairments and cognitive impairment concurrently. Future research is needed to determine if the association is causal, and to investigate the effectiveness of common methods of treatment for sensory impairment for reducing the prevalence of cognitive impairment.
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McDonnall, Michele C., and Zhen S. McKnight. "The Association Between Presenting Visual Impairment, Health, and Employment Status." Journal of Visual Impairment & Blindness 115, no. 3 (May 2021): 204–14. http://dx.doi.org/10.1177/0145482x211016570.
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Introduction: The purpose of this study was to investigate the effect of visual impairment and correctable visual impairment (i.e., uncorrected refractive errors) on being out of the labor force and on unemployment. The effect of health on labor force status was also investigated. Method: National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2008 ( N = 15,650) was used for this study. Participants were classified into three vision status groups: normal, correctable visual impairment, and visual impairment. Statistical analyses utilized were chi-square and logistic regression. Results: Having a visual impairment was significantly associated with being out of the labor force, while having a correctable visual impairment was not. Conversely, having a correctable visual impairment was associated with unemployment, while having a visual impairment was not. Being out of the labor force was not significantly associated with health for those with a visual impairment, although it was for those with correctable visual impairments and normal vision. Discussion: Given previous research, it was surprising to find that health was not associated with being out of the labor force for those with visual impairments. Perhaps other disadvantages for the people with visual impairments identified in this study contributed to their higher out-of-the-labor-force rates regardless of health. Implications for practitioners: Researchers utilizing national data sets that rely on self-reports to identify visual impairments should realize that some of those who self-identify as being visually impaired may actually have correctable visual impairments. Current research is needed to understand why a majority of people with visual impairments are not seeking employment and have removed themselves from the labor force.
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Brigham, Christopher R. "Erroneous Impairment Ratings." Guides Newsletter 11, no. 4 (July 1, 2006): 1–3. http://dx.doi.org/10.1001/amaguidesnewsletters.2006.julaug01.
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Abstract This article continues a discussion of the results of a nationwide study that reviewed 2100 impairment ratings and found a large number of errors (see the May/June issue of The Guides Newsletter). Spinal impairment ratings, for example, often are erroneous. Although the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) clearly specifies use of the Diagnosis related estimates (DRE) method, evaluators sometimes incorrectly use the range-of-motion (ROM) method, which is fraught with potential error and typically results in higher impairment ratings. The most common problem associated with rating the lower extremities is combining multiple duplicative impairments. Multiple impairments typically are combined rather than added because the latter usually results in overrating impairments. A sidebar highlights red flags to erroneous AMA Guides ratings, and evaluators can take a number of steps to ensure accurate ratings. The first of these is to ensure an unbiased rating, preferably by a board-certified physician who, ideally, also has certification in the performance of independent medical and impairment examinations. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation, and the evaluator's report should comply with standards defined in the AMA Guides. All submitted reports should be reviewed by a physician experienced in the use of the AMA Guides; this cannot be accomplished by a nonphysician reviewer.
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Brigham, Christopher R. "Combining Values." Guides Newsletter 7, no. 2 (March 1, 2002): 1–4. http://dx.doi.org/10.1001/amaguidesnewsletters.2002.marapr01.
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Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.
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West, Jessica, and Scott Lynch. "Hearing and Cognitively Impaired Life Expectancies in the United States." Innovation in Aging 4, Supplement_1 (December 1, 2020): 484. http://dx.doi.org/10.1093/geroni/igaa057.1565.
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Abstract As the population ages, increased prevalence of cognitive and sensory impairments may pose growing public health challenges. Among the nine modifiable risk factors for dementia, the highest percentage (9%) of dementia cases are attributed to hearing impairment. While much research has examined the relationship between hearing impairment and cognition, almost none has translated these relationships into a meaningful, life course metric: how many years of life individuals can expect to live with both impairments and how hearing impairment affects years lived with cognitive impairment. Our study fills this gap by using Bayesian multistate life table methods applied to nine waves of the Health and Retirement Study (1998-2014) to estimate years of life to be spent (1) with/without hearing and cognitive impairment, and (2) with/without cognitive impairment, conditional on having versus not having hearing impairment. Preliminary results for aim 1 reveal that at age 50, individuals will live 18.9 (18.7-19.2) years healthy, 4.3 (4.2-4.5) years hearing impaired but cognitively intact, 4.2 (4.0-4.3) years hearing unimpaired but cognitively impaired, and 2.3 (2.2-2.6) years with both impairments. Women will spend more years healthy, hearing unimpaired but cognitively impaired, or with both impairments; men will spend more years hearing impaired but cognitively intact. People with more education will spend more years hearing impaired but cognitively intact; people with less education will spend more years hearing unimpaired but cognitively impaired or with both impairments. Our study is one of the first to investigate the implications of hearing impairment for years of cognitively impaired life.
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West, Jessica S., and Scott Lynch. "COGNITIVE AND HEARING IMPAIRMENTS IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY." Innovation in Aging 3, Supplement_1 (November 2019): S77. http://dx.doi.org/10.1093/geroni/igz038.300.
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Abstract As the number of older adults increases, increased prevalence of cognitive and sensory impairments pose growing public health challenges. Research on the relationship between hearing impairment and cognition, however, is minimal and has yielded mixed results, with some studies finding that hearing impairment is associated with cognitive decline, and others reporting that the association is weak or non-existent. Most of this research has been conducted outside of the U.S., and the few U.S.-based longitudinal studies have relied mostly on small, non-representative samples involving short follow-up periods. Further, despite known gendered patterns in cognitive and hearing impairments, no studies to date have examined whether the relationship between the two varies by gender. Our study addresses these weaknesses in the literature by utilizing nine waves of the Health and Retirement Study (1998-2014; n=14,169), a large, nationally representative, longitudinal study that facilitates examination of long-term interrelationships between hearing and cognitive impairments. In this study, we use autoregressive latent trajectory (ALT) methods to model: 1) the relationship between hearing impairment and cognitive decline, and 2) sex differences in the relationship. ALT models enable us to determine whether hearing impairment and cognitive impairment are associated, net of their common tendency simply to co-trend with age. Results indicate that hearing and cognitive impairments are strongly interrelated processes that trend together over time. Moreover, hearing impairment has an increasing impact on cognitive impairment across age while the effect of cognitive impairment on hearing impairment levels out over time. Sex differences in these patterns are discussed.
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Mastro, James V., Allen W. Burton, Marjorie Rosendahl, and Claudine Sherrill. "Attitudes of Elite Athletes with Impairments Toward One Another: A Hierarchy of Preference." Adapted Physical Activity Quarterly 13, no. 2 (April 1996): 197–210. http://dx.doi.org/10.1123/apaq.13.2.197.
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Hierarchies of preference by elite athletes with impairments toward other athletes with impairments were examined by administering the Athletes With Impairments Attitude Survey (AWIAS) to 138 members of the United States Disabled Sports Team as they were traveling to the 1992 Paralympic Games. The AWIAS uses 12 statements concerning social and sport relationships to measure social distance from a particular impairment group. Five groups of athletes participated—athletes with amputations, cerebral palsy, dwarfism or les autres, paraplegia or quadriplegia, and visual impairment—with each participant filling out a separate survey for the four impairment groups other than his or her own. For all groups combined, the participants’ responses toward other impairment groups, ordered from most to least favorable attitudes, were amputations, les autres, para/quadriplegia, visual impairment, and cerebral palsy. The preference hierarchies for individual groups were very similar to this overall pattern.
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Aich, T. K., A. Mahato, and S. Subedi. "Cognitive Impairment in Schizophrenia: Current Perspective." Journal of Psychiatrists' Association of Nepal 5, no. 1 (September 29, 2017): 5–13. http://dx.doi.org/10.3126/jpan.v5i1.18324.
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Impairments in a variety of cognitive functions are found in patients with schizophrenia. These impairments affect a wide array of different cognitive abilities and are often of moderate to severe degree. Cognitive impairments appear to present across lifespan, detectable at the time of first episode of illness, probably predate the illness and manifest a generally stable course over time.Though cognitive impairment does not form a part of diagnostic criteria, it has been included in DSM-V and proposed to be included in ICD-11 as a schizophrenia course specifier. This review attempts to provide a broad overview of the domains, onset, severity and course of cognitive impairments in schizophrenia, with a focus on functional relevance and treatment possibilities. There is strong evidence for a relationship between cognitive impairment and vocational and functional impairment in individuals with schizophrenia.
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Mueller, Kathryn, and Christopher R. Brigham. "Impairment Tutorial: Impairment Evaluation of Ear, Nose, Throat, and Related Structures: Fifth Edition Revisions." Guides Newsletter 7, no. 2 (March 1, 2002): 5–6. http://dx.doi.org/10.1001/amaguidesnewsletters.2002.marapr02.
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Abstract Chapter 11, Ear, Nose, Throat, and Related Structures of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, includes a new section on voice impairment, a new table on vestibular disorders, and information regarding combined facial disorders and disfigurements. Impairments are based on anatomic, physiological, and functional approaches and involve the assessment of subjective information (eg, statements provided by the patient) and objective factors determined by clinical examination or functional tests. The rating of hearing loss is unchanged from the Fourth Edition in the AMA Guides, Fifth Edition, and tables guide the conversion of monoauricular and binaural hearing impairments into whole person impairments. A tinnitus rating can be combined with the binaural hearing impairment loss before conversion to a whole person permanent impairment. Total disfigurement of the face can be graded between 16% and 50%; a table guides evaluators in rating facial disorders or disfigurement. Impairments of the nose, throat, and related structures include respiration, mastication, deglutition, olfaction and taste, speech, and voice. Although hearing loss is measured using anatomic, physiological, and functional approaches, many other assessments in Chapter 11 are based on interference in the activities of daily living, and the examiner must perform a careful assessment and apply the criteria in the AMA Guides.
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Ranavaya, Mohammed I., and Robert Rondinelli. "To Combine or Not to Combine." Guides Newsletter 18, no. 6 (November 1, 2013): 9. http://dx.doi.org/10.1001/amaguidesnewsletters.2013.novdec02.
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Abstract Physicians must account for the effects of multiple impairments using a summary value. Sometimes, when dealing with multiple impairments in a single case, the evaluating physician may be confused about whether specific impairments are added or combined, particularly during the assessment of hand or limb injuries. Combining is accomplished by using the Combined Values Chart presented in the Appendix of each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). With a few exceptions, the general rule is that all impairments should be combined. The combining must occur at the same hierarchal level (eg, upper extremity impairment can be combined only with another upper extremity impairment from the same limb), and whole person impairment (WPI) can be combined only with another WPI impairment. In case of impairments from a different limb (either from both upper or lower limbs) even though they may be expressed at the same hierarchal limb (eg, upper extremity or lower extremity), they should be combined at the WPI level only after the individual limb is fully rated and the final impairment for that limb is expressed at the WPI level. Evaluators should remember that impairing factors (sensory, motor, vascular, and so on) are combined at the smallest common unit (ie, digit < hand < upper extremity < whole person).
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Brigham, Christopher R. "Impairment Tutorial: Lower Extremities Impairment Evaluation: Overview of Sixth Edition Approaches." Guides Newsletter 13, no. 5 (September 1, 2008): 7–8. http://dx.doi.org/10.1001/amaguidesnewsletters.2008.sepoct02.
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Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, takes approaches to the lower extremities that are consistent with Chapter 15, Upper Extremities (reviewed in the March/April 2008 issue of The Guides Newsletter). Because there is a comparatively smaller spectrum of diagnoses in the lower extremities, Chapter 16 is less complex and is shorter than Chapter 15. The purposes of the lower extremity are transfer and mobility, and, in comparison to the upper extremity, the lower extremity provides greater stability than flexibility. This chapter's principles of assessment define the standards for interpreting symptoms and signs, functional history, physical examination, and clinical studies. Examiners may use the Lower Limb Instrument developed by the American Academy of Orthopaedic Surgery as an adjunct to defining functional ability, but values are not provided to define a specific grade modifier. Most lower extremity impairments are based on Diagnosis-related impairments, and an impairment example case demonstrates the use of the Knee Regional Grid to asses a partial meniscus repair. An associated table illustrates the resulting whole person impairment values associated with these examples and gives the probable impairments based on the fifth edition. The article also discusses impairments of the peripheral nerves, amputation, and range of motion. Mastery of one chapter of the AMA Guides facilitates performing ratings using other chapters.
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Shaw, William S., and Charles N. Brooks. "Lower Extremity Impairments—Knee and Hip." Guides Newsletter 4, no. 1 (January 1, 1999): 1–3. http://dx.doi.org/10.1001/amaguidesnewsletters.1999.janfeb01.
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Abstract The process of assessing lower extremity impairment described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, differs from that in previous editions. This article addresses common questions that arise in knee and hip impairment rating according to the new edition. Anatomic, diagnostic, or functional methods can be used to estimate lower extremity impairments. Functional methods include ratings based on diminished range of motion, weakness, or gait derangement. In general, only one method should be used to rate impairment associated with an injury or illness. Section 3.2i, Diagnosis-related Estimates, in the AMA Guides lists impairment ratings for many knee conditions and operative procedures. Decreased range of motion, ankylosis, diminished muscle function, and joint space narrowing are some rating methods for the knee. Similar anatomic, diagnostic, and functional methods may be used to rate impairment due to hip pathology, but most hip impairments are estimated by range-of-motion deficits. Assessing lower extremity impairments requires a thorough medical evaluation, careful analysis, experience, and clear judgment; evaluators must determine the applicable rating methods, use the methods to rate the impairment, and then decide which method or combination best describes the impairment, without overlooking or duplicating ratings. [A related Lower Extremity Impairment Checklist and Worksheet appears on page 4 of this issue of The Guides Newsletter. A related Quick Reference, Motion at the Wrist, Elbow, and Shoulder, appears on page 5.]
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Fries, Ian Blair, and Charles N. Brooks. "Impairment Tutorial: Convert, Add, or Combine?" Guides Newsletter 9, no. 1 (January 1, 2004): 4–12. http://dx.doi.org/10.1001/amaguidesnewsletters.2004.janfeb02.
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Abstract The presence of multiple ratable entities, including symptoms, physical findings, test results, diagnoses, and/or procedures, complicates impairment evaluation; further, patients may have several findings in the same anatomic area and/or findings unrelated to the condition being rated. In complex cases involving a final extremity or whole person impairment (WPI), the examining physician must consider all possible ratable impairments, discarding duplicative or mutually exclusive ratings and converting, adding, or combining to obtain the final rating. Failure to follow the instructions detailed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is a common source of error in impairment rating. The AMA Guides provides multipliers and, for the upper extremity, tables to convert a body part impairment to an extremity and then to a whole person rating. Jurisdictional requirements vary, but rating physicians commonly are asked to provide a single impairment percentage for the limb or whole person; when two or more impairments are involved, the rater must add or combine the percentages, carefully following the specific instructions in the AMA Guides. Adding two ratings is no different than deriving any other arithmetic sum, but impairment percentages much more commonly are combined than added to ensure that, no matter how many impairments are present, the total is never greater than 100% loss of an extremity or 100% WPI.
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Mueller, Kathryn, and Christopher R. Brigham. "Impairment Tutorial: Hearing Impairment." Guides Newsletter 8, no. 2 (March 1, 2003): 11. http://dx.doi.org/10.1001/amaguidesnewsletters.2003.marapr03.
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Abstract A 1999 study of adults showed hearing loss was the fifth most common disability in the US population, and almost 50% of workers in carpentry, plumbing, and mining had hearing impairment. Determining hearing impairment according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 11.2a, Criteria for Rating Impairment Due to Hearing Loss, is straightforward, if limited. Examiners should be aware that hearing can be temporarily impaired by recent exposure to loud noise and should test only after an extended period without such exposure. Audiometers should be properly calibrated, and technicians must be appropriately trained to obtain accurate measurements. The evaluator should separately test both of the individual's ears at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz (the representative or test frequencies) and then identify the total worst ear decibel level using the AMA Guides Table 11-1 or 11-2. The evaluator can use Tale 11-3 to convert hearing impairment to whole person loss. Tinnitus also can be rated if a hearing loss in that ear affects speech discrimination; in such instances, the tinnitus rating is limited to a 5% loss. The article includes a Hearing Impairment Rating Sheet that can be used to record data from the hearing impairment evaluation.
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Deal, Jennifer, Pei-Lun Kuo, Alison Huang, Joshua Ehrlich, Judith Kasper, Nicholas Reed, Frank Lin, and Bonnielin Swenor. "Prevalence of Concurrent Functional Vision and Hearing Impairment and Its Association with Dementia." Innovation in Aging 5, Supplement_1 (December 1, 2021): 434. http://dx.doi.org/10.1093/geroni/igab046.1688.
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Abstract Vision and hearing impairment are common and independently linked to dementia risk. Adults with concurrent vision and hearing impairment (dual sensory impairment, DSI) may be particularly at-risk. Data were from the National Health and Aging Trends Study (NHATS) (2011–2018, N=7,562). Functional sensory impairments were self-reported (no impairment, vision only, hearing only, and DSI). We calculated age-specific prevalence of sensory impairments. Discrete time proportional hazards model with a complementary log-log link were used to assess 7-year dementia risk. Of 7,562 participants, overall prevalence of functional vision, hearing and DSI was 5.4%, 18.9% and 3.1%, respectively. DSI prevalence increased with age, impacting 1 in 7 adults ≥90 years. DSI was associated with a 50% increased 7-year dementia risk (adjusted hazard ratio 1.50; 95% confidence interval, 1.12–2.02) compared to no impairment. Sensory rehabilitative interventions for multiple impairments may be an avenue for consideration in efforts to reduce dementia risk.
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Shaw, William S. "Impairment Tutorial: Impairment of the Lower Extremity." Guides Newsletter 2, no. 1 (January 1, 1997): 2–4. http://dx.doi.org/10.1001/amaguidesnewsletters.1997.janfeb02.
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Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, introduces a new system of rating lower extremity impairments that allows use of more than one method for arriving at a rating. Such flexibility allows the rater greater leeway to assess each patient's unique status but requires the clinician to clearly understand the diagnosis, pathoanatomy, and expected sequelae of a condition. For example, diminished muscle function can be evaluated in four ways (gait, atrophy, weakness, and peripheral nerve injury), but impairments should be estimated under only one of these criteria. Tables in the AMA Guides give impairment values for the whole person, as well as for the lower extremity and the part, where applicable. Impairments can be calculated in several broad categories, including the following: limb length discrepancy; gait derangement; unilateral atrophy; manual muscle testing; range of motion measurements and ankylosis; arthritis; amputations; skin loss; diagnosis-based estimates; peripheral nerve; vascular disorders; and causalgia and reflex sympathetic dystrophy. Each category includes general guidelines that help raters decide when to use that specific section. In addition to clarifying and discussing the categories, the article provides references to specific sections and tables in the AMA Guides, Fourth Edition.
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Khurana, Maitri, Natalie Shoham, Claudia Cooper, and Alexandra Laura Pitman. "Association between sensory impairment and suicidal ideation and attempt: a cross-sectional analysis of nationally representative English household data." BMJ Open 11, no. 2 (February 2021): e043179. http://dx.doi.org/10.1136/bmjopen-2020-043179.
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ObjectivesSensory impairments are associated with worse mental health and poorer quality of life, but few studies have investigated whether sensory impairment is associated with suicidal behaviour in a population sample. We investigated whether visual and hearing impairments were associated with suicidal ideation and attempt.DesignNational cross-sectional study.SettingHouseholds in England.ParticipantsWe analysed data for 7546 household residents in England, aged 16 and over from the 2014 Adult Psychiatric Morbidity Survey.ExposuresSensory impairment (either visual or hearing), Dual sensory impairment (visual and hearing), visual impairment, hearing impairment.Primary outcomeSuicidal ideation and suicide attempt in the past year.ResultsPeople with visual or hearing sensory impairments had twice the odds of past-year suicidal ideation (OR 2.06; 95% CI 1.17 to 2.73; p<0.001), and over three times the odds of reporting past-year suicide attempt (OR 3.12; 95% CI 1.57 to 6.20; p=0.001) compared with people without these impairments. Similar results were found for hearing and visual impairments separately and co-occurring.ConclusionsWe found evidence that individuals with sensory impairments are more likely to have thought about or attempted suicide in the past year than individuals without.
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Blaisdell, Jay, and James B. Talmage. "Amputation Evaluation: Sixth Edition Approaches." Guides Newsletter 24, no. 2 (March 1, 2019): 6–11. http://dx.doi.org/10.1001/amaguidesnewsletters.2019.marapr02.
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Abstract Upper extremity amputations are rated in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 15.6, Amputation Impairment, where text, tables, and figures guide evaluators in combining proximal diagnosis-based impairments (DBIs) and proximal range-of-motion impairments. The AMA Guides provides impairment grids for lower and upper extremity amputations, which are divided into five impairment classes (0 through 4), and each impairment class is further divided (except class 0) into five grades (A through E), each with its respective impairment rating that is expressed as a percentage of the extremity. Determining impairment class, and thus the default value of impairment, is straightforward if the amputation occurred directly at one of the points in the relevant grid; if the amputation occurred at another point, the evaluator should consult the appropriate figure to assess how the specific level of amputation corresponds with impairment percentages. An individual's proximal problems may lead to an increase in the impairment value because of the application of grade modifiers. Except in rare instances of bilateral upper extremity amputation or when the patient is unable to wear a prosthesis for a lower extremity amputation, the evaluator usually uses the default rating value within the selected impairment class as the final percentage rating. Evaluators are advised to re-read the amputation section in the AMA Guides before conducting an amputation evaluation.
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Talmage, James B., and Jay Blaisdell. "Cardiovascular Impairment Evaluation: Sixth Edition." Guides Newsletter 20, no. 5 (September 1, 2015): 12–14. http://dx.doi.org/10.1001/amaguidesnewsletters.2015.sepoct02.
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Abstract To assess medical impairments, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) divides cardiovascular diseases into the following eight groups, each of which has its own grid: valvular heart disease; coronary artery disease; cardiomyopathies, pericardial heart disease, dysrhythmias, hypertensive cardiovascular disease, vascular diseases affecting the extremities, and diseases of the pulmonary artery. An accompanying table shows the criteria for rating permanent impairment due to valvular heart disease. Within the grids, the rows are divided into three main impairment variables: history, physical findings, and objective test results. The latter are essential in assigning cardiovascular impairment ratings. The AMA Guides names the objective test results variable as the key factor to underscore its role in assigning the impairment class in the cardiovascular chapter. For cardiovascular impairments, objective test results are always used to place the injury in its impairment class; therefore, objective test results are never used to modify the rating once the evaluator chooses the impairment class. Not all internal medicine chapters designate objective test results as the key factor, but all use one key factor that is clearly indicated in a footnote and one or two non-key factors. This rating scheme emphasizes objective test results, history, and physical findings and avoids incorporating variables twice.
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Cao, Tongyu, Hasnah Shaari, and Ray Donnelly. "Impairment reversals: unbiased reporting or earnings management." International Journal of Accounting & Information Management 26, no. 2 (May 8, 2018): 245–71. http://dx.doi.org/10.1108/ijaim-08-2016-0084.
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Purpose This paper aims to provide evidence that will inform the convergence debate regarding accounting standards. The authors assess the ability of impairment reversals allowed under International Accounting Standard 36 but disallowed by the Financial Accounting Standards Board to provide useful information about a company. Design/methodology/approach The authors use a sample of 182 Malaysian firms that reversed impairment charges and a matched sample of firms which chose not to reverse their impairments. Further analysis examines if reversing an impairment charge is associated with motivations for and evidence of earnings management. Findings The authors find no evidence that the reversal of an impairment charge marks a company out as managing contemporaneous earnings. However, they document evidence that firms with high levels of abnormal accruals and weak corporate governance avoid earnings decline by reversing previously recognized impairments. In addition, companies that have engaged in big baths as evidenced by high accumulated impairment balances and prior changes in top management, use impairment reversals to avoid earnings declines. Research limitations/implications The results of this study support both the informative and opportunistic hypotheses of impairment reversal reporting using Financial Reporting Standard 136. Practical implications The results also demonstrate how companies that use impairment reversals opportunistically can be identified. Originality/value The results support IASB’s approach to the reversal of impairments. They also provide novel evidence as to how companies exploit a cookie-jar reserve created by a prior big bath opportunistically.
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Morales, Emmanuel Garcia, and Nicholas Reed. "Early Retirement and Sensory Impairments: The Modifying Effect of Total Assets." Innovation in Aging 5, Supplement_1 (December 1, 2021): 441. http://dx.doi.org/10.1093/geroni/igab046.1712.
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Abstract Sensory impairments are common among older adults. Little is known on the association between sensory impairments, which impact labor productivity, and the effect modification of wealth. We used the 2006-2018 rounds of the Health and Retirement Study. Hearing (HI) and vision (VI) impairments (self-report) at baseline, and working status throughout the study period was observed. Logistic regression models, adjusted for demographic, socioeconomic, and health characteristics, were used to characterize the association of sensory impairment and early retirement (i.e., before age 65). Secondary analysis stratified by assets. Among 1,688 adults ages 53-64, 1,350 had no impairment, 140 had HI only, 141 VI only, and 57 had dual sensory impairment (DSI). Only adults with HI had higher odds of early retirement (Odds Ratio [OR]: 1.6; 95% Confidence Interval [CI]: 1.0,2.5) relative to those without sensory impairment. Among those with large assets, those with HI had higher odds (OR:2.6, 95% CI: 1.4,5.2) and those with VI had lower odds (OR. 0.37; 95% CI: 0.2,0.8) of early retirement. Among the low asset group, we found no differences across impairment groups for the odds of retirement. In sample of older adults, we provide evidence that the presence of hearing impairment is associated early retirement. Secondary analyses suggest wealth may modify this association which highlights the wealth disparities faced by people with sensory impairments.
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Park, Hyangjeong, Heejeong Kim, Sisook Kim, and Hyegyeong Cha. "The Association between Olfactory Function and Cognitive Impairment in Older Persons with Cognitive Impairments: A Cross-Sectional Study." Healthcare 9, no. 4 (April 1, 2021): 399. http://dx.doi.org/10.3390/healthcare9040399.
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Olfactory function is an emerging topic of research in the fields of cognitive impairment and neurodegenerative diseases. We aimed to confirm the association between olfactory function and cognitive impairment by assessing the olfactory function of older persons with cognitive impairment and identify whether olfactory function is associated with cognitive impairment. For this study, we recruited 117 older people aged ≥65 years with cognitive impairments from a public hospital in Korea. We used the Korean version of the expanded clinical dementia rating scale to evaluate participants’ cognitive impairments, and the University of Pennsylvania’s smell identification test to assess their olfactory function. Our results indicate a significant negative correlation between olfactory function and all domains of cognitive impairment (memory, orientation, judgement and problem-solving, community affairs, home and hobbies, and personal care). In addition, olfactory function was a factor associated with cognitive impairment in older persons. Therefore, we expect that our results to provide useful data for the development of interventions using olfactory stimulation to improve cognitive function in older persons with cognitive impairment.
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Horber, Veronka, Asma Fares, Mary Jane Platt, Catherine Arnaud, Ingeborg Krägeloh-Mann, and Elodie Sellier. "Severity of Cerebral Palsy—The Impact of Associated Impairments." Neuropediatrics 51, no. 02 (March 2, 2020): 120–28. http://dx.doi.org/10.1055/s-0040-1701669.
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Abstract Objective This article describes associated impairments in children with cerebral palsy (CP) and its subtypes. Method Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An “impairment index” characterized severity of impairments and their combinations. Results Amongst the 11,015 children analyzed, 56% (n = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient ≥ 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% (n = 1,637) in unilateral spastic, 24% (n = 79) in ataxic, 18% (n = 913) in bilateral spastic, and 7% (n = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment ± additional impairments)—highest in dyskinetic (77%, n = 549) and bilateral spastic CP (54%, n = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group ≤ 1,000 g or gestational age group ≤ 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%). Conclusion Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.
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Brigham, Christopher R., Kathryn Mueller, Douglas Van Zet, Debra J. Northrup, Edward B. Whitney, and Martha M. McReynolds. "Comparative Analysis: The State of Colorado Study, Part II." Guides Newsletter 9, no. 2 (March 1, 2004): 1–16. http://dx.doi.org/10.1001/amaguidesnewsletters.2004.marapr01.
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Abstract [Continued from the January/February 2004 issue of The Guides Newsletter.] To understand discrepancies in reviewers’ ratings of impairments based on different editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), users can usefully study the history of the revisions as successive editions attempted to provide a comprehensive, valid, reliable, unbiased, and evidence-based system. Some shortcomings of earlier editions have been addressed in the AMA Guides, Fifth Edition, but problems remain with each edition, largely because of the limited scientific evidence available. In the context of the history of the different editions of the AMA Guides and their development, the authors discuss and contextualize a number of key terms and principles including the following: definitions of impairment and normal; activities of daily living; maximum medical improvement; impairment percentages; conversion of regional impairments; combining impairments; pain and other subjective complaints; physician judgment; and causation analysis; finally, the authors note that impairment is not synonymous with disability or work interference. The AMA Guides, Fifth Edition, contrasts impairment evaluations and independent medical evaluations (this was not done in previous editions) and discusses impairment evaluations, rules for evaluations, and report standards. Upper extremity and lower extremity impairment evaluations are discussed in terms of clinical assessments and rating processes, analyzing important changes between editions and problematic areas (eg, complex regional pain syndrome).
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Blaisdell, Jay, and James B. Talmage. "Impairment of Face-, Nose-, and Throat-related Structures Sixth Edition Approaches." Guides Newsletter 24, no. 2 (March 1, 2019): 12–14. http://dx.doi.org/10.1001/amaguidesnewsletters.2019.marapr03.
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Abstract Facial disfigurements, including those caused by burns (thermal, chemical, or electrical) or trauma, are rated in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Chapter 11, which also discusses occupational overexposure to sunlight, airborne chemicals, heavy metals, and allergens that may lead to head and neck cancers and degraded ability to breathe, chew, swallow, smell, or speak. Additional relevant impairments include those of olfaction and taste, chewing and swallowing, voice and speech, and of the upper respiratory passages. For upper air passage defects and voice and speech impairments, the evaluator assigns an impairment rating by selecting the relevant table or grid in Chapter 11 and then assigning the appropriate impairment class, as determined by the key factor. The patient's history is the key factor for upper air passage deficits, and the performance measures of audibility, intelligibility, and functional efficiency collectively act as the key factor for voice and speech impairments. Once they select an impairment class, evaluators can modify the rating within the impairment class by considering remaining variables. When rating the patient's ability to smell and taste or chew and swallow, raters do not use impairment classes or modifiers. Rather, they assign impairment within an allowable range largely based on professional judgment complemented by objective findings and a well-documented rationale.
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Berkman, John, and Robyn Boeré. "St. Thomas Aquinas on Impairment, Natural Goods, and Human Flourishing." National Catholic Bioethics Quarterly 20, no. 2 (2020): 311–28. http://dx.doi.org/10.5840/ncbq202020229.
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This essay examines St. Thomas Aquinas’s views on different types of impairment. Aquinas situates physical and moral impairments in a teleological account of the human species, and these impairments are made relative in light of our ultimate flourishing in God. For Aquinas, moral and spiritual impairments are of primary significance. Drawing on Philippa Foot’s account of natural goods, we describe what constitutes an impairment for Aquinas. In the Thomistic sense, an impairment is a lack or privation in relation to that which is appropriate to the human being, known by our nature and ultimate perfection. For Aquinas, perfection lies in the transformation necessary for union with God.
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Richardson, Stephanie, Corinna Tanner, and Jeremy Yorgason. "Sensory Impairment and Social Isolation: Implications for the Hispanic Population." Innovation in Aging 4, Supplement_1 (December 1, 2020): 617. http://dx.doi.org/10.1093/geroni/igaa057.2096.
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Abstract Although the likelihood of developing a disability increases with age among all demographics, older adults of hispanic origin are more likely to experience vision and hearing impairment than both their white and black non-hispanic counterparts. Both hearing impairment and vision impairment are known risk factors for social isolation, yet little research has examined this association in Hispanic populations. Using data from 472 Hispanic and 5,186 White participants of the NHATS study, we examined 8-year trajectories of social isolation, along with how sensory impairment was associated with initial levels and change over time. Findings suggest that sensory impairments are linked with steeper increases over time among White participants. Among Hispanics vision and hearing impairments were linked with higher initial levels of social isolation, yet no associations were found across time. It may be that Hispanic older adults maintain social connections across time despite potentially isolating sensory impairments.
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Johnson, E., and J. Suhr. "C-42 Is “Clinical Impairment” Normative in College Populations? Identifying Base Rates of Self-Reported Impairment in a Non-Treatment Seeking Population." Archives of Clinical Neuropsychology 34, no. 6 (July 25, 2019): 1071. http://dx.doi.org/10.1093/arclin/acz034.204.
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Abstract Objective Individuals presenting with concerns of Attention Deficit Hyperactivity Disorder (ADHD) report impairment and may seek academic or disability accommodations related to perceived impairment. Problematically, the legal definition of impairment remains poorly understood by clinicians, and there is little consensus regarding credibility of self-reported impairment. Furthermore, many impairments reported by individuals seeking evaluation for ADHD appear to be general and non-specific, but base rates of reports of these impairments in non-treatment seeking populations remain unclear. We examined base rates of impairment associated with ADHD in a sample of non-treatment seeking college students. Method Participants were undergraduate students who completed online surveys (N = 175). Participants who failed measures of validity, reported a past diagnosis of ADHD, or endorsed clinically significant symptoms of ADHD were excluded from analyses (final N = 89). Participants largely identified as white (88.8%) and female (85.4). Participants completed measures of impairment (Barkley Functional Impairment Scale) and ADHD symptoms (Conners’ Adult Attention Rating Scale). Base rates of clinically significant impairment among this sample were analyzed. Results Clinically significant levels of impairment were reported at high levels within the following categories; at home (15.1%), interacting with strangers (13.5%) and friends (20.2%), performing daily self-care (7.9%), and managing health (12.4%). Conclusions Base rates of clinically significant self-reported impairment are high among a non-clinical, non-treatment seeking sample of college students without ADHD symptoms. Results raise questions about the validity of self-reported impairment in diagnostic decision making, suggesting that experiences of difficulty in these areas may be normative among college populations and not specific to ADHD.
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Xue, Qianli, Brian Buta, Lina Ma, Meiling Ge, and Michelle carlson. "INTEGRATING FRAILTY AND COGNITIVE PHENOTYPES: THEORY, MEASUREMENT, APPLICATIONS." Innovation in Aging 3, Supplement_1 (November 2019): S396. http://dx.doi.org/10.1093/geroni/igz038.1464.
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Abstract The fact that frailty and cognitive impairment are associated and often coexist in older adults has led to the popular view of expanding the definition of frailty to include cognitive impairment. However, there is great variability in approaches to and assumptions regarding the integrated phenotypes of physical frailty and cognitive impairment. By reviewing the theoretical underpinnings of three integrated phenotypes of physical and cognitive impairments, this talk advocates the incorporation of biological theories in phenotype development that helps determine shared and distinct pathways in the progression to physical and cognitive impairments.
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Brigham, Christopher R. "Impairment Tutorial: The Combined Values Chart." Guides Newsletter 3, no. 6 (December 1, 1998): 7. http://dx.doi.org/10.1001/amaguidesnewsletters.1998.novdec03.
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Abstract Impairment values are more often combined than added, and the Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment can be used to calculate the combined value of two numbers. The values are derived from the formula A + B(1 – A) = the combined value of A and B, where A and B are the decimal equivalents of the impairment ratings. This mathematically prevents an estimate of impairment greater than 100%. With smaller numbers, the combined value may equal the arithmetic sum of the 2 numbers. Impairments of different organ systems are converted to whole person impairment ratings before combining. In most lower extremity impairment cases only one evaluation method is used, but certain circumstances justify combining impairments. Examples in the lower extremity include diagnosis-based estimates with short leg, degenerative joint disease (in the case of fractures in and about joints), and neurologic loss. Combining vs adding can be confusing, but one can nearly always combine, with the following exceptions for the musculoskeletal system: range of motion (ROM) deficits within an upper extremity; ROM deficits of the thumb; total hand impairment; rating hip or knee replacement results; and ROM deficits of the spine at a specific level.
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Welch, Laura. "Impairment Tutorial: Dermatological Impairment Assessment." Guides Newsletter 3, no. 5 (September 1, 1998): 6–7. http://dx.doi.org/10.1001/amaguidesnewsletters.1998.sepoct03.
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Abstract The main function of the skin is to protect the body that it encloses. Anatomically and physiologically, the skin's regions differ to the extent that skin is not one organ but a combination of multiple systems. The skin has a limited range of reaction patterns, but these may express a wide range of clinical syndromes. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states that the morphology of the lesion and the pattern of distribution suggest the differential diagnosis. Skin lesions can be characterized as macule, papule, change in pigmentation, plaque, erythema, or eczema. The evaluating physician should consider relevant characteristics, including: Is the condition localized or generalized? Does in involve the face or spare it? Does the condition involve or spare the palms and soles? Approximately 95% of occupational skin disease involves contact dermatitis from irritation, contact allergy, or both. The remaining instances usually arise from biological, physical, mechanical, or other miscellaneous causes. The AMA Guides directs the evaluating physician to complete a detailed work description and conduct a physical examination with biopsy or patch testing as needed. Because most cases of occupational contact dermatitis involve irritants, a systematic approach to examination of the skin and use of good dermatology tests can pinpoint the diagnosis in the majority of cases.
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Talmage, James B., and Mohammed Ranavaya. "Impairment Tutorial: Spinal Impairment Apportionment." Guides Newsletter 4, no. 1 (January 1, 1999): 7–8. http://dx.doi.org/10.1001/amaguidesnewsletters.1999.janfeb05.
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Colledge, Alan, Bradley Hunter, Larry D. Bunkall, and Edward B. Holmes. "Impairment Rating Ambiguity in the United States: The Utah Impairment Guides for Calculating Workers' Compensation Impairments." Journal of Korean Medical Science 24, Suppl 2 (2009): S232. http://dx.doi.org/10.3346/jkms.2009.24.s2.s232.
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Gopinath, Bamini, Gerald Liew, George Burlutsky, and Paul Mitchell. "Associations Between Vision, Hearing, and Olfactory Impairment With Handgrip Strength." Journal of Aging and Health 32, no. 7-8 (April 15, 2019): 654–59. http://dx.doi.org/10.1177/0898264319843724.
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Objectives: We aimed to assess the cross-sectional associations between sensory impairments (vision, hearing, and/or olfactory loss) and handgrip strength. Method: In the Blue Mountains Eye Study, 947 participants aged 65+ years had handgrip strength measured using a dynamometer. Visual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4,000 Hz). Olfaction was measured using the San Diego Odor Identification Test. Results: Marginally significant associations between sensory impairment and handgrip strength were observed after multivariable adjustment. For example, women with two or three sensory impairments had lower adjusted mean handgrip strength (17.47 ± 0.5 kg) versus women who had no sensory loss (18.59 ± 0.3 kg; p = .06) or only one sensory impairment (18.58 ± 0.3 kg; p = .05), respectively. No significant associations were observed in men. Discussion: Women who had multiple sensory impairments had reduced muscle strength as indicated by ~1.1 kg lower mean handgrip strength.
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Zandvliet, Sarah B., Gert Kwakkel, Rinske H. M. Nijland, Erwin E. H. van Wegen, and Carel G. M. Meskers. "Is Recovery of Somatosensory Impairment Conditional for Upper-Limb Motor Recovery Early After Stroke?" Neurorehabilitation and Neural Repair 34, no. 5 (May 2020): 403–16. http://dx.doi.org/10.1177/1545968320907075.
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Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recovery influences motor recovery. Methods. Motor (Fugl-Meyer upper-extremity [FM-UE]) and somatosensory impairments (Erasmus modification of the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks and at 5, 12, and 26 weeks after a first-ever ischemic stroke. The longitudinal association between FM-UE and EmNSA-UE was examined in patients with motor and somatosensory impairments (FM-UE ≤ 60 and EmNSA-UE ≤ 37) at baseline. Results. A total of 94 patients were included in the longitudinal analysis. EmNSA-UE increased significantly up to 12 weeks poststroke. The longitudinal association between motor and somatosensory impairment disappeared when correcting for progress of time and was not significantly different for patients with severe baseline somatosensory impairment. Patients with a FM-UE score ≥18 at 26 weeks (n = 55) showed a significant positive association between motor and somatosensory impairments, irrespective of progress of time. Conclusions. Progress of time, as a reflection of spontaneous neurobiological recovery, is an important factor that drives recovery of upper-limb motor as well as somatosensory impairments in the first 12 weeks poststroke. Severe somatosensory impairment at baseline does not directly compromise motor recovery. The study rather suggests that spontaneous recovery of somatosensory impairment is a prerequisite for full motor recovery of the upper paretic limb.
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Watts, Christopher R., and Yan Zhang. "Progression of Self-Perceived Speech and Swallowing Impairment in Early Stage Parkinson's Disease: Longitudinal Analysis of the Unified Parkinson's Disease Rating Scale." Journal of Speech, Language, and Hearing Research 65, no. 1 (January 12, 2022): 146–58. http://dx.doi.org/10.1044/2021_jslhr-21-00216.
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Purpose: The purpose of this study was to investigate the presence and progression of self-perceived speech and swallowing impairments in newly diagnosed people with Parkinson's disease (PD) longitudinally across 6 years. Method: Longitudinal data from the Parkinson's Progression Markers Initiative were analyzed across six consecutive years in a cohort of 269 newly diagnosed people with PD, and a subset of those ( n = 211) who were assessed at every time point across the 6 years. Dependent variables included self-perceived ratings of speech and swallowing impairment severity from the Unified Parkinson's Disease Rating Scale. Patient-centered factors of age at diagnosis and motor phenotype were also assessed to determine if they were related to the change in self-perceived speech and swallowing impairments. Results: Overall, self-perceived speech and swallowing impairments were present in newly diagnosed people with PD, although over time, the degree of severity for both remained in the mild range. However, the rate of change over time was significant for perceived speech impairment, F (5.5, 1158.8) = 21.1, p < .001), and perceived swallowing impairment, F (5.2, 1082.6) = 8.6, p < .001. Changes for speech and swallowing impairment were both in the direction of progressive severity. There were no effects of age at diagnosis or motor phenotype on the degree of change for either speech or swallowing. Conclusions: Self-perceptions of speech and swallowing impairment changed significantly over time in newly diagnosed people with PD (PWPD). Consistent with existing literature, self-perceptions of speech impairment were rated as more severe than those of swallowing impairment. These findings reveal that even in the early years postdiagnoses, PWPD are experiencing changes to speech and swallowing function, albeit within the mildly severe range. The presence of self-perceived mild speech and swallowing impairments in the initial years postdiagnosis may support the need for intervention to improve and or sustain function over time.
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Abbasi Jondani, Javad. "Locus of Control in College Students with and Without Visual Impairments, and the Visual Characteristics that Affect It." Journal of Visual Impairment & Blindness 115, no. 1 (January 2021): 42–54. http://dx.doi.org/10.1177/0145482x20987019.
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Introduction: According to previous research, locus of control (LOC) has a crucial role in an individual’s psychological well-being. The purpose of this study was 3-fold: (1) comparing LOC of college students with and without visual impairments while controlling for gender, educational level, and age; (2) investigating the relationship between LOC and visual characteristics in college students with visual impairments; and (3) predicting LOC of these students using their visual characteristics. Methods: The design of this study was causal-comparative. The statistical population included a sample of college students with and without visual impairments who were enrolled at the University of Isfahan, Iran. Fifteen of the 20 college students with visual impairments were selected through convenience sampling and amongst sighted students, 15 individuals were selected in a way that they were matched with college students with visual impairment regarding gender, educational level, and age. The Rotter Locus of Control Scale was used to measure LOC. Also, visual impairment characteristics and demographic data were collected. The results were analyzed by t-test and stepwise regression analysis. Results: Results indicated no significant difference between LOC of college students with and without visual impairments ( p > .05), and both groups tended to have internal LOC on average. The results indicated that adjustment to visual impairment and the recent status of visual impairment might predict the LOC of a college student who is visually impaired and explained 59.2% of its variance with this sample ( p < .005). Discussion: LOC of college students with visual impairments was similar to their sighted counterparts. The better adjusted the person was to his or her visual impairment and the less worsening the status of visual impairment was, the higher internal LOC he or she had. Implications for practitioners: Families and society can help individuals with visual impairments build their internal LOC, by teaching them how to adjust to their disability and providing them the conditions to increase their independence. At the same time, preparing them for entering university may also help them develop their sense of internal LOC.
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Deardorff, William, Phillip liu, Richard Sloane, Courtney Van Houtven, Susan N. Hastings, Harvey J. Cohen, and Heather E. Whitson. "ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES." Innovation in Aging 3, Supplement_1 (November 2019): S44. http://dx.doi.org/10.1093/geroni/igz038.170.
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Abstract The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.
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Foley, Jennifer A., Reiner Kaschel, and Sergio Della Sala. "Dual tasking in Alzheimer’s disease and depression." Zeitschrift für Neuropsychologie 24, no. 1 (January 2013): 25–33. http://dx.doi.org/10.1024/1016-264x/a000089.
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Alzheimer’s disease (AD) is associated with a marked impairment in the ability to do two things at once, or ‘dual task’. Several studies have reported that depression is also associated with impairments in cognitive functioning, particularly executive functioning, but it remains unclear if depression also leads to impairments in dual tasking ability. Therefore, this paper describes two experiments, assessing (1) dual tasking ability in 50 people with AD and 50 healthy controls, and (2) dual tasking and planning ability, as assessed using the Tower of Hanoi task, in 24 people with depression and 21 healthy controls. The AD group showed marked impairment in dual tasking ability, but the depressed group showed impairment on the Tower of Hanoi task, but preserved performance on the measure of dual tasking. This shows that shows that whereas AD is associated with gross impairment in dual tasking ability, depression is associated with a patchy pattern of impairment across the different cognitive functions, but, importantly, preserved dual tasking ability.
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Sherman, Victoria, Rosemary Martino, Ishvinder Bhathal, Gabrielle DeVeber, Nomazulu Dlamini, Daune MacGregor, Elizabeth Pulcine, Deryk S. Beal, Kevin E. Thorpe, and Mahendranath Moharir. "Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke." Stroke 52, no. 4 (April 2021): 1309–18. http://dx.doi.org/10.1161/strokeaha.120.031893.
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Background and Purpose: Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke. Methods: Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, preexisting conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression. Results: A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients. Conclusions: For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.
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Talmage, James B., and Jay Blaisdell. "Central Nerve System Impairment, AMA Guides, Sixth Edition: An Overview." Guides Newsletter 23, no. 1 (January 1, 2018): 10–13. http://dx.doi.org/10.1001/amaguidesnewsletters.2018.janfeb03.
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Abstract Injuries that affect the central nervous system (CNS) can be catastrophic because they involve the brain or spinal cord, and determining the underlying clinical cause of impairment is essential in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), in part because the AMA Guides addresses neurological impairment in several chapters. Unlike the musculoskeletal chapters, Chapter 13, The Central and Peripheral Nervous System, does not use grades, grade modifiers, and a net adjustment formula; rather the chapter uses an approach that is similar to that in prior editions of the AMA Guides. The following steps can be used to perform a CNS rating: 1) evaluate all four major categories of cerebral impairment, and choose the one that is most severe; 2) rate the single most severe cerebral impairment of the four major categories; 3) rate all other impairments that are due to neurogenic problems; and 4) combine the rating of the single most severe category of cerebral impairment with the ratings of all other impairments. Because some neurological dysfunctions are rated elsewhere in the AMA Guides, Sixth Edition, the evaluator may consult Table 13-1 to verify the appropriate chapter to use.
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Thomas, Alvin G., Jessica M. Ruck, Nadia M. Chu, Dayawa Agoons, Ashton A. Shaffer, Christine E. Haugen, Bonnielin Swenor, et al. "Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study." Nephrology Dialysis Transplantation 35, no. 7 (August 14, 2019): 1262–70. http://dx.doi.org/10.1093/ndt/gfz164.
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Abstract Background Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes. Methods In our prospective cohort study (June 2013–June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registry-augmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N = 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality]. Results In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17–9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78–9.82)], physical [0.67 (95% CI 0.08–3.35)] and walking [0.50 (95% CI 0.06–3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32–7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48–2.98)], hearing [1.01 (95% CI 0.29–3.47)] and physical [1.16 (95% CI 0.34–3.94)] impairments were not. Conclusions Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KT monitoring.
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Hirvensalo, Mirja Hannele, Jiska Cohen-Mansfield, Shlomit Rind, and Jack Guralnik. "Assessment of Impairments That Limit Exercise and Use of Impairment Information to Generate an Exercise." Journal of Aging and Physical Activity 15, no. 4 (October 2007): 459–79. http://dx.doi.org/10.1123/japa.15.4.459.
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Prescribing the correct exercise program is a challenge for older adults with multiple physiological impairments. The authors evaluated an assessment instrument that incorporates results of multiple categories of impairment, including strength, balance, gait, vision, and cognitive function. The physical therapist made judgments on the relative impact of 9 different impairments on specific exercises and on the total impact of all impairments on particular exercises. In a cohort age 75–85 y, functional limitations, impaired balance, pain, and low physical endurance were estimated to have the largest impact on the ability to carry out exercise activities, primarily walking, stair climbing, balance exercises, and stationary bicycling. The assessments revealed that the ability to exercise was related to objective measures of function, indicating that the therapist incorporated such objective measures into the impairment-impact rating. The impairment-impact assessment facilitates creating individualized exercise prescriptions for individuals with impairments.
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Schubert, Carla R., Karen J. Cruickshanks, Mary E. Fischer, A. Alex Pinto, Yanjun Chen, Guan-Hua Huang, Barbara E. K. Klein, et al. "Sensorineural Impairments, Cardiovascular Risk Factors, and 10-Year Incidence of Cognitive Impairment and Decline in Midlife: The Beaver Dam Offspring Study." Journals of Gerontology: Series A 74, no. 11 (January 9, 2019): 1786–92. http://dx.doi.org/10.1093/gerona/glz011.
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Abstract Background Sensorineural impairments and cardiovascular risk factors (CVRF) and disease (CVD) in midlife may be important predictors of future cognitive health, but longitudinal studies that include multiple sensorineural measures in middle-aged adults are lacking. Methods Hearing, vision, and olfaction, and CVRF and CVD were measured at the Beaver Dam Offspring Study baseline (2005–2008) examination. The Mini-Mental State Examination and Trail Making Tests A and B were administered at all phases and additional cognitive function measures were obtained at 5 (2010–2013) and 10 years (2015–2017). Cox proportional hazards models were used to evaluate associations between baseline sensorineural impairments, CVRF, CVD, and 10-year cumulative incidence of cognitive impairment and decline. Results There were 2,556 participants (22–84 years) without cognitive impairment at baseline and data from at least one follow-up. In a multivariable model including age, sex, education, and head injury, visual impairment (hazard ratio = 2.59, 95% confidence interval = 1.34, 5.02), olfactory impairment (hazard ratio = 3.18, 95% confidence interval = 1.53, 6.59), CVD (hazard ratio = 2.37, 95% confidence interval = 1.24, 4.52), and not consuming alcohol in the past year (hazard ratio = 2.21, 95% confidence interval = 1.16, 4.19) were associated with the 10-year cumulative incidence of cognitive impairment. Current smoking and diabetes were associated with increased risk, and exercise with decreased risk, of 10-year decline in cognitive function. Conclusions Visual and olfactory impairments, CVRF, and CVD were associated with the 10-year cumulative incidence of cognitive impairment and decline in middle-aged adults. Identifying modifiable factors associated with cognitive decline and impairment in midlife may provide opportunities for prevention or treatment and improve cognitive health later in life.
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Rubinsztein, Judy S., Barbara J. Sahakian, and John T. O'Brien. "Understanding and managing cognitive impairment in bipolar disorder in older people." BJPsych Advances 25, no. 3 (February 11, 2019): 150–56. http://dx.doi.org/10.1192/bja.2018.74.
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SUMMARYBipolar disorder is less prevalent in older people but accounts for 8–10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with ‘late-onset’ bipolar disorder than in those with ‘early-onset’ disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand that cognitive impairment in euthymic older people with bipolar disorder is similar to that in working-age adults with the disorder, affecting attention, memory and executive function/processing speeds•recognise that cognitive impairment in older people is likely to be a major determinant of functional outcomes•Implement approaches to treat cognitive impairment in bipolar disorder.DECLARATION OF INTERESTB.J.S. consults for Cambridge Cognition, PEAK (www.peak.net) and Mundipharma.