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Replying to Thread: ROM method & foot drop
Created On Wednesday 6, August, 2008 12:01 PM by voiceofreason

voiceofreason
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Posts: 91
Joined: Jan 2004

Wednesday August 06, 2008 12:01 PM

I'm reviewing a medical report in which applicant underwent multilevel low back surgery. Physician elected to use the Range of Motion method. We'll assume this method is appropriate. Physician assigned impairment from the ROM & Specific Disorders elements, but did not address the Nerve Deficit element. Instead, he assigned 20% WPI due to a "drop foot", citing Gait Derangement per chapter 17.
As the "drop foot" clearly resulted from the surgery and implies nerve deficit, I am inclined to argue that this issue should have been addressed via the nerve deficit element (page 424) and not via the lower extremity chapter. Rather, Gait Derangement (table 17-5) is a stand alone impairment used for specific lower extremity injuries when no other impairments are present. Your thoughts.

Posts: 45
Joined: Mar 2006

Friday August 08, 2008 10:09 AM

You are correct. Table 17-5 is for lower extremity impairment and should not be used for spine injury. Since in your case there is multi-level involvement the ROM method applies. A foot drop will most likely be due to a significant motor impairment of the L5 nerve root. The impairment due to foot drop can be captured using the nerve deficit component of the ROM method via Tables 15-18 and 15-16 . An exception would be if there was spinal cord involvement as evidenced by the physician's clinical findings. Then the DRE method would apply and the foot drop could be combined with this disability using Table 15-6 (c) Station and Gait disorders.

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voiceofreason
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Posts: 91
Joined: Jan 2004

Friday August 08, 2008 6:20 PM

Thank you.

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