In AMA 4 , seven differentiators are presented in table 71, DRE Impairment category Differentiators(AMA 4 P 109), including guarding, loss of reflexes, atrophy etc.The rating was based SOLELY on the injury and NOT improvement(or worsening) with treatment.This was a difficult exercise as patients have usually been treated for a cervical strain by the time they present for Pi assessment!
AMA 5 carried significant changes so that evaluators could now take into account the tretment results.As a result, the DRE rating is based on the objective findings at the eventual time of PI evaluation.THE OBJECTIVE FINDINGS are : muscle spasm, muscle guarding, asymmetric spinal motion(previously called dysmetria), non-verifiable radicular pain, reflexes, neurologic changes such as wasting or loss of sensation, atrophy, radiculopathy etc.imaging studies may assist the evaluator.
SUMMARY: AMA 4: Section 3.3 pp 103-105, Table 71 p 109.Determine if injury occurred, assess ADL, examination, assess differentiators, select category, based on HISTORICAL FINDINGS( hence my repeated calls for all GP, physic records!).
AMA 5: As per AMA 4 without differentiators and select appropriate category based on CURRENT FINDINGS ( not trying to determine findings at TOI and without treatment!).
As per AMA 4 issues discussed above, with AMA5 , the impairment is no longer based on prior (someone elses') findings and treatment effects are allowed into the assessment.
ASSISTANT PROFESSOR MICHAEL CORONEOS CIME
SENIOR NEUROSURGEON & PI ASSESSOR
NATIONAL RACS EXAMINER & RACS SENIOR MORTALITY ASSESSOR (QASM)
FAIM MASE CIME FACS FRACS FRCSI FRCS(EDIN)SN MB BS(1ST CLASS HONOURS) MAPS MNSA MNSQ MANZSOM