Online. Sample 001 Page Published on Thursday, October 2, 1997 by Gideon Ariel 1. General Information Examinee Name: Jane Doe Address: N/A City, State, ZIP: N/A Social Security Number: N/A Employer: Johnson Occupation: Staffing Coordinator / Central Supply Current Evaluation Date of Evaluation: 12/19/2002 12:06:48 Evaluated by: John Chimney Site of Evaluation: Site 1: Kinematic Consultants Comments: Report generated by APAS/Wizard 0.5 Referral Source: John Doe, M.D. Insurance Administrator: Johnson Insurance Case Number: N/A/ Claim Number: 2138709123897 2. Case History Physician: Diagnosis: Herniated Disk Date of Incident: 12/19/2002 12:08:17 Complaints: 1. Constant Pain in cervical spine and lower back with radiating pain into B. LE's to toes 2. Frequent shicking pain from back to neck. Pain increasing with activity 3. Difficuly sleeping. Difficulty performing ADL's, cleaning, cooking 4. Currently pain 6/10 Height: 5'2" Weight: 225 Date of injury: 12/5/2003 12:08:17 Type of incident: M.V.A. Required assistance: True Continued to work: Initially evaluated By: John Chimney, M.D. Test and Tx:: MRI, X-rays Result: Specialty Referral 1 By: Test and Tx:: Result: Specialty Referral 2 By: Test and Tx:: Result: Surgery 1 Date: 12/19/2003 12:08:17 By: Type: Surgery 2 Date: By: Type: Surgery 3 Date: By: Type: Return to work: Status: Comments: 3. Job Information Job Description: Provided by: DOT Number: Work Level Category - DOT: Sedentary Work Level Category - Employer: Sedentary 4. Physical Evaluations Normal values reflected herein are from the AMA Guides to the Evaluation of Permanent Impairment, 4th EditionPosture: 5. Cervical Spine Analysis A computer kinematic assessment is performed for cervical flexion/ extension, lateral flexion and rotation. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are videotaped in a precisely calibrated field for computer analysis. Each event is analyzed for total dynamic range of motion and peak velocity quantity and quality. Consistency of results [coefficient of variation] is considered for determining Examinee effort. After a thorough discussion of expectations, and agreement of understanding by the Examinee, the Examinee is asked to perform the movement events. More information... Figure 1: Cervical FlexionFigure 2: Cervical ExtensionChart 1: Cervical F/E DisplacementTable 1: Cervical F/E DisplacementResults in degreesAverageExaminee%DeficitFlexion45N/AExtension45N/ACoefficient of VariationChart 2: Cervical F/E VelocityTable 2: Cervical F/E VelocityResults in deg/secExamineeFlexion/ExtensionN/ACoefficient of VariationN/AFigure 3: Left Cervical Lateral FlexionFigure 4: Right Cervical Lateral FlexionChart 3: Cervical Lateral Flexion DisplacementTable 3: Cervical Lateral Flexion DisplacementResults in degreesAverageExaminee%DeficitRight Cervical Lateral Flexion45N/ALeft Cervical Lateral Flexion45N/ACoefficient of VariationChart 4: Cervical Lateral Flexion VelocityTable 4: Cervical Lateral Flexion VelocityResults in deg/secN/ARotationN/ACoefficient of VariationN/AFigure 5: Left Cervical RotationFigure 6: Right Cervical RotationChart 5: Cervical Rotation DisplacementTable 5: Cervical Rotation Dynamic Range of MotionResults in degreesAverageExaminee%DeficitRight Rotation60N/AN/ALeft Rotation60N/AN/ACoefficient of VariationN/AChart 6: Cervical Rotation VelocityTable 6: Cervical Rotation VelocityResults in deg/secN/ARotationN/ACoefficient of VariationN/ASummary Protocol 5: Kinematic Neck SummaryKinematic neck assessment indicated Examinee demonstrates residual cervical dysfunctionPercent average residual dysfunction vs normals is currentlyN/ACoefficient of variation averageN/AExaminee's effort during this FCE is considered maximum due to C.V. 10% 6. Shoulder Involvement Analysis A computer kinematic assessment is performed for shoulder flexion/extension, abduction/adduction, and internal/external rotation. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are videotaped in a precisely calibrated field for computer analysis. Each event is analyzed for total dynamic range of motion and peak velocity quantity and quality. Consistency of results [coefficient of variation] is considered for determining Examinee effort. After a thorough discussion of expectations, and agreement of understanding by the Examinee, the Examinee is asked to perform the movement events. More information... Chart 7: Shoulder F/E DisplacementChart 8: Shoulder F/E VelocityChart 9: Shoulder Abduction DisplacementChart 10: Shoulder Abduction VelocityChart 11: Shoulder Rotation DisplacementChart 12: Shoulder Rotation Velocity Reference: /wizard/product/reports/sample001