APPROPRIATENESS CRITERIA TO PERFORM AOMSI ANALYSIS
X-Ray Digitizing Necessity
Ray Wiegand, D.C.
Many doctors have asked when is it an appropriate time to perform the examination. Here is my interpretation from a medical legal standpoint.
Two examinations need to be performed.
1. Initial AOMSI testing: A reasonable time after the accident when the patient can perform a realistic ROM without guarding or spasm. Approximately two weeks following the accident is usual and customary, although you have to decide clinically.
a. This identifies findings that would change or modify your clinical management including spinal manipulation.
b. It establishes a causal relationship of the sudden impact injury to the clinical findings.
c. The longer you wait to test for AOMSI the more the insurance carrier will argue that the findings are not due to the accident for a plethora of reasons. One that I’ve heard is “how do we know that you the doctor, did not cause this finding”
2. Final AOMSI testing: The AMA Guides describes that testing for an impairment should be performed when the patient has reached maximum medical improvement (MMI) AND is stationary and permanent.
a. MMI is described when after a reasonable course of treatment, the patient is not expected to improve further.
b. Stationary and Permanent. This occurs after MMI and earlier editions of the Guides describes this time period as anywhere from six to eighteen months.
I have performed AOMSI testing for over 20 years at a frequency of every twenty treatments. These are the documented statistics:
1. Approximately 70% of patients demonstrate AOMSI for at least on motion segment level.
a. 40% demonstrate two or more levels.
2. Approximately 30% of patients with AOMSI on the initial examination no longer demonstrate AOMSI on the final examination.
The fact that AOMSI is not demonstrated on the final testing established two things:
1. The patient had serious ligament damage and it will never function at 100%.
a. You need to know the physiology of ligament tissue, the effects of abnormal motion and the sequella of abnormal loading over time. I strongly suggest you take a course n Spinal Trauma Pathology (CLICK HERE)
2. Your treatment intervention was successful.
Of the two groups that initially demonstrated AOMSI and those that later did not demonstrate AOMSI, 100% had dysfunctional motion segment ROM with continued abnormal loading. This indicates that during the testing moment, the joint was now within normal limits, however if you stress or load the joint and image it, which is not considered usual and customary 100% will continue to show failure. Ligament laxity is permanent.
Successful use of this information by an attorney is incumbent on their understanding of the underlying anatomy, physiology and spinal biomechanics, which is purely dependent upon your understanding of the physiology. This is what the Academy of Chiropractic teaches you. They give the doctor the tools to create and accurate diagnosis, prognosis and treatment plan and the lawyer the tools to successfully help the patient to be compensated for the serious injury AOMSI is.