Sample PDA

Online.Sample PDA

Published on Saturday, October 4, 1997 by Gideon Ariel

Table of Contents

1. General Information

Examinee
Name: 
Address: 
City, State, ZIP: 
Social Security Number: 
Employer: 
Occupation: 
Current Evaluation
Date of Evaluation: 
Evaluated by: 
Site of Evaluation:Site 1: Kinematic Consultants
Comments: 
Referral Source: 
Insurance Administrator: 
Case Number: 
Claim Number:

Picture 1: The Examinee

2. Case History

Physician: 
Diagnosis: 
Date of Incident (Injury): 
Complaints: 
Height: 
Weight: 
Type of incident: 
Required assistance: 
Continued to work: 
Initially evaluated
By: 
Test and Tx: 
Result: 
Specialty Referral 1
By: 
Test and Tx: 
Result: 
Specialty Referral 2
By: 
Test and Tx: 
Result: 
Surgery 1
Date: 
By: 
Type: 
Surgery 2
Date: 
By: 
Type: 
Surgery 3
Date: 
By: 
Type: 
Return to work: 
Status:[Select status]
Comments:

3. Job Information

This data is usually obtained from the referring case manager or directly from the Examinee’s employer. If no job description is available a description is obtained from the Dictionary of Occupational Titles (DOT).

Job Description: 
Provided by: 
DOT Number: 
Work Level Category – DOT:Sedentary
Work Level Category – Employer:Sedentary

4. Kinematic Neck Assessment

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 video taped 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 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.

Picture 2: Cervical Flexion

Picture 3: Cervical Extension

Chart 1: Cervical Flexion/Extension
Table 1: Cervical Flexion/Extension [ Help ]
Range of Motion
[degrees]
FlexionExtension
Norm (mean)45-45
Examinee Sample (mean)21.5-43.9
Standard Deviation (sd)3.063.23
Range of Motion (rom)65.465.4
Trial Consistency (sd/rom)4.7%4.9%
Degrees of Freedom (df)88
H0: Examinee = NormRejectAccept
Probability (p0)0.000000.17026
Level of Confidence99%99%
H1: Side = Opposing SideRejectAccept
Probability (p1)0.000000.00000

Picture 4: Cervical Lateral Flexion – Left

Picture 5: Cervical Lateral Flexion – Right

Chart 2: Cervical Lateral Flexion

Table 2: Cervical Lateral Flexion [ Help ]
Range of Motion
[degrees]
LeftRight
Norm (mean)45-45
Examinee Sample (mean)32.9-32.1
Standard Deviation (sd)2.416.12
Range of Motion (rom)6565
Trial Consistency (sd/rom)3.7%9.4%
Degrees of Freedom (df)88
H0: Examinee = NormRejectReject
Probability (p0)0.000000.00011
Level of Confidence99%99%
H1: Side = Opposing SideAcceptAccept
Probability (p1)0.355690.35569

Picture 6: Cervical Rotation – Left

Picture 7: Cervical Rotation –
Right Chart 3: Cervical Rotation
Table 3: Cervical Rotation [ Help ]
Range of Motion
[degrees]
LeftRight
Norm (mean)60-60
Examinee Sample (mean)32.9-29.5
Standard Deviation (sd)2.511.79
Range of Motion (rom)62.362.3
Trial Consistency (sd/rom)4%2.9%
Degrees of Freedom (df)910
H0: Examinee = NormRejectReject
Probability (p0)0.000000.00000
Level of Confidence99%99%
H1: Side = Opposing SideAcceptReject
Probability (p1)0.001000.00100
  • Number of tests where Examinee performed subnormal: 5 of 6
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 2 of 6
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 0 of 0
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 0 of 0

Significant Findings Kinematic Neck Assessment:

5. Kinematic Shoulder Assessment

A computer kinematic assessment is performed for shoulder flexion/extension, abduction/adduction, internal and external rotation. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events were video taped 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 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.

Shoulder Flexion/Extension

Picture 8: LeftShoulder Flexion –

Picture 9: LeftShoulder Extension –

Picture 10: RightShoulder Flexion –

Picture 11: RightShoulder Extension –
Chart 4: Shoulder Flexion/Extension

Table 4: Shoulder Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)180-50180-50
Examinee Sample (mean)124.2-21.9116.2-17.7
Standard Deviation (sd)5.774.643.762.94
Range of Motion (rom)146.1146.1133.9133.9
Trial Consistency (sd/rom)3.9%3.2%2.8%2.2%
Degrees of Freedom (df)10977
H0: Examinee = NormRejectRejectRejectReject
Probability (p0)0.000000.000000.000000.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectAccept
Probability (p1)0.001560.021220.001560.02122

Shoulder Abduction/Adduction

Picture 12: LeftShoulder Abduction –

Picture 13: RightShoulder Abduction –
Chart 5: Shoulder Abduction/Adduction

Table 5: Shoulder Abduction/Adduction [ Help ]
Range of Motion
[degrees]
Ab+
Left
Ad-
Left
Ab+
Right
Ad-
Right
Norm (mean)180-50180-50
Examinee Sample (mean)144.430.9143.124.6
Standard Deviation (sd)5.421.656.87.99
Range of Motion (rom)113.6113.6118.5118.5
Trial Consistency (sd/rom)4.8%1.5%5.8%.8%
Degrees of Freedom (df)12121111
H0: Examinee = NormRejectRejectRejectReject
Probability (p0)0.000000.000000.000000.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptRejectAcceptAccept
Probability (p1)0.291760.000000.291760.00000

Shoulder Internal/External Rotation

Picture 14: LeftShoulder Internal Rotation –

Picture 15: LeftShoulder External Rotation –

Picture 16: RightShoulder Internal Rotation –

Picture 17: RightShoulder External Rotation –
Chart 6: Shoulder Internal/External Rotation

Table 6: Shoulder Internal/External Rotation (I/R) [ Help ]
Range of Motion
[degrees]
I+
Left
E-
Left
I+
Right
E-
Right
Norm (mean)90-9090-90
Examinee Sample (mean)52.4-8756.3-92.7
Standard Deviation (sd)3.828.085.525.75
Range of Motion (rom)139.4139.4149.1149.1
Trial Consistency (sd/rom)2.7%5.8%3.7%3.9%
Degrees of Freedom (df)11111011
H0: Examinee = NormRejectAcceptRejectAccept
Probability (p0)0.000000.114610.000000.06460
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptAcceptAccept
Probability (p1)0.028160.029690.028160.02969
  • Number of tests where Examinee performed subnormal: 10 of 12
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 2 of 12
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 1 of 6
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 1 of 6

Significant Findings Kinematic Shoulder Assessment:

6. Kinematic Elbow Assessment

A computer kinematic assessment is performed for elbow flexion/extension, and forearm supination/pronation. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are video taped 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 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.

Picture 18: LeftElbow Flexion –

Picture 19: LeftElbow Extension –

Picture 20: RightElbow Flexion –

Picture 21: RightElbow Extension –
Chart 7: Elbow Flexion/Extension

Table 7: Elbow Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)14001400
Examinee Sample (mean)152.750.6146.710.6
Standard Deviation (sd)5.134.73.421.66
Range of Motion (rom)102.1102.1136.2136.2
Trial Consistency (sd/rom)5%4.6%2.5%1.2%
Degrees of Freedom (df)9888
H0: Examinee = NormAcceptRejectAcceptReject
Probability (p0)0.000010.000000.000180.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptRejectRejectAccept
Probability (p1)0.004590.000000.004590.00000
  • Number of tests where Examinee performed subnormal: 2 of 4
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 2 of 4
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 1 of 2
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 1 of 2

Significant Findings Kinematic Elbow Assessment:

7. Kinematic Wrist Assessment

A computer kinematic assessment is performed for wrist flexion/extension, ulnar/radial deviation and supination/pronation. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are video taped 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 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.

Wrist Flexion/Extension

Picture 22: LeftWrist Flexion –

Picture 23: LeftWrist Extension 

Picture 24: RightWrist Flexion –

Picture 25: RightWrist Extension –
Chart 8: Wrist Flexion/Extension

Table 8: Wrist Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)60-6060-60
Examinee Sample (mean)78.1-44.957.3-21.6
Standard Deviation (sd)1.181.682.444.24
Range of Motion (rom)12312378.978.9
Trial Consistency (sd/rom)1%1.4%3.1%5.4%
Degrees of Freedom (df)7766
H0: Examinee = NormAcceptRejectAcceptReject
Probability (p0)0.000000.000000.013260.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.000000.000000.000000.00000

Wrist Ulnar/Radial Deviation

Picture 26: LeftWrist Ulnar Deviation –

Picture 27: LeftWrist Radial Deviation –

Picture 28: RightWrist Ulnar Deviation –

Picture 29: RightWrist Radial Deviation –
Chart 9: Wrist Ulnar/Radial Deviation

Table 9: Wrist Ulnar/Radial Deviation (U/R) [ Help ]
Range of Motion
[degrees]
U+
Left
R-
Left
U+
Right
R-
Right
Norm (mean)30-2030-20
Examinee Sample (mean)40.6-22.325.4-2.3
Standard Deviation (sd)3.43.562.542.94
Range of Motion (rom)62.962.927.627.6
Trial Consistency (sd/rom)5.4%5.7%9.2%10.6%
Degrees of Freedom (df)101198
H0: Examinee = NormAcceptAcceptRejectReject
Probability (p0)0.000000.021980.000140.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.000000.000000.000000.00000

Forearm Supination/Pronation

Picture 30: LeftForearm Supination –

Picture 31: RightForearm Supination –

Picture 32: LeftForearm Pronation –

Picture 33: RightForearm Pronation –
Chart 10: Forearm Supination/Pronation

Table 10: Forearm Supination/Pronation (S/P) [ Help ]
Range of Motion
[degrees]
S+
Left
P-
Left
S+
Right
P-
Right
Norm (mean)80-8080-80
Examinee Sample (mean)96.7-86.285.7-82.9
Standard Deviation (sd)8.471.668.862.54
Range of Motion (rom)182.9182.9168.6168.6
Trial Consistency (sd/rom)4.6%.9%5.3%1.5%
Degrees of Freedom (df)91088
H0: Examinee = NormAcceptAcceptAcceptAccept
Probability (p0)0.000080.000000.045770.00460
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.006390.001350.006390.00135
  • Number of tests where Examinee performed subnormal: 4 of 12
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 6 of 12
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 0 of 6
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 6 of 6

Significant Findings Kinematic Wrist Assessment:

8. Kinematic Finger Assessment

A computer kinematic assessment is performed for index finger flexion/extension. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are video taped 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 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.

Picture 34: LeftFinger Flexion –

Picture 35: LeftFinger Extension –

Picture 36: RightFinger Flexion –

Picture 37: RightFinger Extension –
Chart 11: Finger MP Flexion/Extension

Table 11: Finger MP Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)800800
Examinee Sample (mean)67.9-5.441.97.6
Standard Deviation (sd)1.552.2410.831.95
Range of Motion (rom)73.373.334.334.3
Trial Consistency (sd/rom)2.1%3.1%31.6%5.7%
Degrees of Freedom (df)9876
H0: Examinee = NormRejectAcceptRejectReject
Probability (p0)0.000000.000040.000010.00002
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.000000.000000.000000.00000

Chart 12: Finger PIP Flexion/Extension

Table 12: Finger PIP Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)800800
Examinee Sample (mean)101.8-8.5102.7-.5
Standard Deviation (sd)9.81.371.091.27
Range of Motion (rom)110.4110.4103.2103.2
Trial Consistency (sd/rom)8.9%1.2%1.1%1.2%
Degrees of Freedom (df)9978
H0: Examinee = NormAcceptAcceptAcceptAccept
Probability (p0)0.000030.000000.000000.12502
Level of Confidence95%95%95%95%
H1: Side = Opposing SideAcceptAcceptAcceptReject
Probability (p1)0.404170.000000.404170.00000

Chart 13: Finger DIP Flexion/Extension

Table 13: Finger DIP Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)800800
Examinee Sample (mean)67.86.759.810.3
Standard Deviation (sd)4.061.751.771.19
Range of Motion (rom)61.161.149.649.6
Trial Consistency (sd/rom)6.6%2.9%3.6%2.4%
Degrees of Freedom (df)9978
H0: Examinee = NormRejectRejectRejectReject
Probability (p0)0.000000.000000.000000.00000
Level of Confidence95%95%95%95%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.000050.000040.000050.00004
  • Number of tests where Examinee performed subnormal: 7 of 12
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 5 of 12
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 0 of 6
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 5 of 6

Significant Findings Kinematic Finger Assessment:

9. Thumb Flexion/Extension

A computer kinematic assessment is performed for thumb flexion/extension. The Examinee is asked to perform each maneuver 8-10 repetitions to full range and as quickly as possible. The events are video taped 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 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.

Picture 38: LeftThumb Flexion –

Picture 39: LeftThumb Extension –

Picture 40: RightThumb Flexion –

Picture 41: RightThumb Extension –
Chart 14: Thumb MP Flexion/Extension
Table 14: Thumb MP Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)700700
Examinee Sample (mean)72-5.347.931.2
Standard Deviation (sd)1.863.52.852.54
Range of Motion (rom)77.377.316.716.7
Trial Consistency (sd/rom)2.4%4.6%5.1%15.2%
Degrees of Freedom (df)111165
H0: Examinee = NormAcceptAcceptRejectReject
Probability (p0)0.001580.000150.000000.00000
Level of Confidence99%99%99%99%
H1: Side = Opposing SideAcceptAcceptRejectReject
Probability (p1)0.000000.000000.000000.00000

Chart 15: Thumb IP Flexion/Extension

Table 15: Thumb IP Flexion/Extension (F/E) [ Help ]
Range of Motion
[degrees]
F+
Left
E-
Left
F+
Right
E-
Right
Norm (mean)800800
Examinee Sample (mean)44.7-14.135.9-13.4
Standard Deviation (sd)12.422.152.963.71
Range of Motion (rom)58.858.849.349.3
Trial Consistency (sd/rom)21.1%3.7%6%7.5%
Degrees of Freedom (df)111165
H0: Examinee = NormRejectAcceptRejectAccept
Probability (p0)0.000000.000000.000000.00015
Level of Confidence95%95%95%95%
H1: Side = Opposing SideAcceptAcceptRejectAccept
Probability (p1)0.043210.305230.043210.30523
  • Number of tests where Examinee performed subnormal: 4 of 8
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 3 of 8
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 0 of 4
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 3 of 4

Significant Findings Thumb Flexion/Extension:

  • Number of tests where Examinee performed subnormal: 32 of 54
  • Number of tests where Examinee performed asymmetrically (one side worse than the other): 20 of 54
  • Number of tests where Examinee performed worse on Left Side than on Right Side: 2 of 24
  • Number of tests where Examinee performed worse on Right Side than on Left Side: 16 of 24

Significant Findings Ariel Kinematics Functional Capacity Evaluation:

10. Conclusions and Recommendations

Conclusions
Date: 
Name: 
Title: 
Reference: 
Conclusions: 
Recommendations: 
Independently verified by
Date: 
Name: 
Title: 
Reference: 
Comments: