Impairment Evaluation

1. See Also
   1. Disability
   2. Disability Management
2. Approach
   1. Determine third party requesting the evaluation (e.g. Employer, insurer, judge)
   2. Determine nature of the request (e.g. diagnosis, cause, treatment, work capacity)
   3. Determine physician's role (e.g. second opinion, independent medical examiner)
3. History
   1. Sensory deficits
      1. Hearing
      2. Vision
   2. Cognitive and perceptual history
      1. Addiction
      2. Planning
      3. Conscientiousness, honesty and trustworthiness
      4. Interpersonal functioning
      5. Motivation and Reliability
      6. Pace, persistence and stress tolerance
   3. Activities of Daily Living (ADL)
      1. Ambulation and Transfers
      2. Bathing and Toileting
      3. Dressing and Grooming
      4. Eating
   4. Instrumental Activities of Daily Living (IADL)
      1. Shopping
      2. Transportation
      3. Telephone
      4. Managing money and medication
      5. Cleaning house
      6. Cooking
   5. Mobility
      1. Balance and coordination
      2. Strength and endurance
   6. Environment
      1. Home (Family factors and expectations)
      2. Work or School
      3. Community
   7. Resources
      1. Communication
      2. Vocational status
         1. Work training and experience
         2. Opportunities
      3. Financial status
      4. Educational status
      5. Recreational needs
      6. Transportation needs
      7. Community interaction
4. Examination
   1. Mental Status
      1. Cognition
      2. Mood and Affect
   2. Sensory
      1. Vision
         1. Read newsprint or a child's book
         2. Snellen chart
      2. Hearing
         1. Whisper test
         2. Audioscope
      3. Special senses
         1. Proprioception
         2. Vibration sense
         3. Temperature sense
   3. Functional Range of Motion
      1. Hands behind head and back
      2. Squeeze or grip two fingers
      3. Pinch paper
      4. Touch toes while sitting
   4. Mobility, agility, and aerobic capacity
      1. "Get up and go" test
      2. Get up from floor
      3. Climb stairs
   5. Motor Function
      1. Strength
      2. Coordination
5. Grading: Severity
   1. Asymptomatic
   2. Mild
   3. Moderate
   4. Severe
   5. End-Stage
6. Evaluation: Scales
   1. Mental Status
      1. Mini-Mental Status Exam
      2. Geriatric Depression Scale
   2. Functional Status
      1. Katz ADL Scale
      2. Tinetti balance Test
      3. Gait evaluation Scale
   3. Other Tests
      1. Barthel Index
      2. Functional Independent Measure
7. References
   1. (1997) Can Med Assoc J 156:680A-C
   2. Barron (2001) Am Fam Physician 64(9): 1579-86
   3. Derebry (1983) J Occup Med 25:829-35
   4. McGrail (2001) Am Fam Physician 63(4):679-84