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FCE - PLEASE HELP

#1 User is offline   TWINKLE09 

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Posted 10 June 2011 - 01:54 PM

Hi all. My friend is having major issues with ACC - I know all groan now! She has been told she has to attend a Full FCE (standard) assessment.

Her case manager is Kelly McLeod - Hamilton (be warned this woman is a serious "toadie") Her obvious goal is to get my friend discharged - bonus time!

The diagnosis is a Prolapsed disc with radicularly - nerve damage I believe this to mean.

After advice taken from here my friend found out that the above case manager had not gained a docs approval for this assessment, had not told my friend about it - first she knew about it was a telephone call from Rob Neish alpha consultants. So she emailed her issues to her case manager. And surprise surprise her case manager has now gained her docs approval 3 days after my friend raised her issues, oh, and the auth. had been sent urgently to her docs!

She had declined to go to the assessment but they have re-arranged the assessment for early next week. Surprise telling her that if she does not go this time her claim will basically be suspended.

She is worried about any physical assessment causing her further damage so she declined attendance on those grounds.

Yep they have emailed her telling her the assessment is not a fitness test or includes independence assessment so basically the assessor will not be preforming a "fitness test" - ok yep! The doc has authorised a "objective standardised assessment" does any one here know exactly what the doc has authorised as she is lost.

Does she go for the assessment or not. I have tried to find info about the objective standardised assessment but can not find any info anywhere. My friend has requested a full written program description which should include a fully listed activity layout but (coincidentally) she has not received a reply as yet and time is running out.

The way the letter to the doc is worded I don't actually believe he fully understands what a Full FCE is. The letter states that the assessment will help acc produce further recommendations that will be helpful to her! Identify physical work tasks she can do and Identify employment possibilities.

Thanks for any help.

She is a long term claimant.
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#2 User is offline   not their victim 

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Posted 10 June 2011 - 03:22 PM

nerve damage is nerve damage...............

so evaluating nerve damage is a waste of time if she already has a specialist that has written radiculopathy...

also, you cannot reactivate dead nerves!

there is a huge drive on, to decrease the number of long term claimants by about 2000 by November, thats bonus time for the case managers!

and im sure someone with a bit more experience will tell you, they have to provide her a copy of what the evaluation will be like within 21 days???

good luck
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#3 User is offline   greg 

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Posted 10 June 2011 - 04:12 PM

Get you mate to pay for her own nerve conduction test on here back. This will
supply the exact spot if any injury has occured. they were about $300 approx.
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#4 User is offline   doppelganger 

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Posted 10 June 2011 - 04:17 PM

The object of the test is to gather information to be used in court which is incorrect and inaccurate.

Prolapse disc can have all other injuries associated with it. Nerve damage is just one of the problems.

Search and ger these articles from the internet.

Effective endurance and strength training for patients with cronic musculoskeletal discrders (it is about back injuries)

Long term effect of specific stabilizing exercises for first-episode low back pain

Clinical spinal instability and low back pain

endurance of trunk muscles in persons with chronic low back pain; assessment, performance, training.

Does strengthening the abdominal muscles prevent low back pain --

And also take section 6 & 7 of the health and saftey employment Act with you.

Make a document for the assessor to sign indicating he is aware of these document and just because you can do activity it does not mean employment can be gained.

You should also get ogg the ACC site

The role of employers in return to work of people with Musculoskeletal pain disorders. and New Zealand Acute low back pain guide. Read them and then have the documents added as the ACC document causes a reoccurrence and doesn't help with rehabilitation.

send the above documents to ACC to be added to any and all of the medical information on file. State the documents must be read in full by everyone making decision on entitlements and cover. The documents must be sent to the assessor so they know what causes deterioration and this will prevent any deterioration.
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#5 User is offline   greg 

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Posted 10 June 2011 - 04:24 PM

Just an additional point.. Nerve damage is not caused by degeneration.
Nerve damage comes from an injury area. no injury no nerve damage.
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#6 User is offline   doppelganger 

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Posted 10 June 2011 - 04:31 PM

Prolapse disc is not age related degeneration either is instability cause by degeneration.
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#7 User is offline   TWINKLE09 

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Posted 10 June 2011 - 07:40 PM

Hi all and thanks for all your info. This is what has been received back when asked to provide a detailed program description.

Blood Pressure check (sitting having cuff inflated and BP recorded)
Heart rate check. (sitting having HR recorded)
grip strength test (sitting using dynamometer 3 grips on each hand in each of 5 positions)
Postural tests with heart rate monitor fitted including:
Sitting for 3 minutes clipping pegs onto container
Standing for 3 minutes placing glass beads in/out of container
Standing 3 minutes doing up/undoing bolts overhead.
Standing 3 minutes and reaching forwards placing glass beads in/out of container
Standing and stooping 3 minutes doing up/undoing bolts
Walking approx 750 metres
Stair climbing 3 minutes set of 3 steps.
Typing test up to 10 minutes sitting.
Handwriting test 5 minutes sitting

So this is not a fitness test????? I googled some of the above and I can assure all this is what the FCE comprises of and is a fitness test. Also I can not confirm fully but from the research I have just done they are using the Ranking procedure and the scale to score your performance during such.
Now if I am correct the Ranking system is predominantly used for scoring the functional capacity of stroke victims.

HOW CAN ACC BE ALLOWED TO GET AWAY WITH THIS. The more I read and have my own personal experiences the more I can not believe that this is allowed to happen. How the heck can she get out of this test?
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#8 User is offline   TWINKLE09 

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Posted 10 June 2011 - 07:51 PM

[quote name='doppelganger' timestamp='1307679467' post='112881']
The object of the test is to gather information to be used in court which is incorrect and inaccurate.

Prolapse disc can have all other injuries associated with it. Nerve damage is just one of the problems.

Search and ger these articles from the internet.

Effective endurance and strength training for patients with cronic musculoskeletal discrders (it is about back injuries)

Long term effect of specific stabilizing exercises for first-episode low back pain

Clinical spinal instability and low back pain

endurance of trunk muscles in persons with chronic low back pain; assessment, performance, training.

Does strengthening the abdominal muscles prevent low back pain --

And also take section 6 & 7 of the health and saftey employment Act with you.

Make a document for the assessor to sign indicating he is aware of these document and just because you can do activity it does not mean employment can be gained.

You should also get ogg the ACC site

The role of employers in return to work of people with Musculoskeletal pain disorders. and New Zealand Acute low back pain guide. Read them and then have the documents added as the ACC document causes a reoccurrence and doesn't help with rehabilitation.

send the above documents to ACC to be added to any and all of the medical information on file. State the documents must be read in full by everyone making decision on entitlements and cover. The documents must be sent to the assessor so they know what causes deterioration and this will prevent any deterioration.
[/quoteSorry but what is ogg the acc site just been there but can not find anything
]
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#9 User is offline   Easyrider 

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Posted 10 June 2011 - 07:51 PM

View PostTWINKLE09, on 10 June 2011 - 07:40 PM, said:

Hi all and thanks for all your info. This is what has been received back when asked to provide a detailed program description.

Blood Pressure check (sitting having cuff inflated and BP recorded)
Heart rate check. (sitting having HR recorded)
grip strength test (sitting using dynamometer 3 grips on each hand in each of 5 positions)
Postural tests with heart rate monitor fitted including:
Sitting for 3 minutes clipping pegs onto container
Standing for 3 minutes placing glass beads in/out of container
Standing 3 minutes doing up/undoing bolts overhead.
Standing 3 minutes and reaching forwards placing glass beads in/out of container
Standing and stooping 3 minutes doing up/undoing bolts
Walking approx 750 metres
Stair climbing 3 minutes set of 3 steps.
Typing test up to 10 minutes sitting.
Handwriting test 5 minutes sitting

So this is not a fitness test????? I googled some of the above and I can assure all this is what the FCE comprises of and is a fitness test. Also I can not confirm fully but from the research I have just done they are using the Ranking procedure and the scale to score your performance during such.
Now if I am correct the Ranking system is predominantly used for scoring the functional capacity of stroke victims.

HOW CAN ACC BE ALLOWED TO GET AWAY WITH THIS. The more I read and have my own personal experiences the more I can not believe that this is allowed to happen. How the heck can she get out of this test?



What does her ARC 18 say in what restrictions she has.
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#10 User is offline   doppelganger 

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Posted 10 June 2011 - 09:15 PM

thisis what to get off the ACC site

The role of employers in return to work of people with Musculoskeletal pain disorders
and

New Zealand Acute low back pain guide
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#11 User is offline   Gloria Mitchell 

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Posted 10 June 2011 - 10:32 PM

View Postdoppelganger, on 10 June 2011 - 09:15 PM, said:




If your friend refuses to go the cm will suspend the erc.

It could take months to get the erc reinstated.

You are required to work with them......you will have to negotiate with them. If you simply refuse you will be punatively exited or suspended until you comply.


None of these assessments are pleasant....if only because they are attended under duress with the knowledge they can generate documents which can be used against you. Then there s the way they push you past your comfort zone and can stir up symptoms and pain for some time after....most unpleasant.

Does your friend have an IRP with the assessments written into it?

Gloria



Y
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#12 User is offline   TWINKLE09 

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Posted 10 June 2011 - 11:31 PM

[quote name='Gloria Mitchell' timestamp='1307701953' post='112900']
If your friend refuses to go the cm will suspend the erc.

It could take months to get the erc reinstated.

You are required to work with them......you will have to negotiate with them. If you simply refuse you will be punatively exited or suspended until you comply.


None of these assessments are pleasant....if only because they are attended under duress with the knowledge they can generate documents which can be used against you. Then there s the way they push you past your comfort zone and can stir up symptoms and pain for some time after....most unpleasant.

Does your friend have an IRP with the assessments written into it?

Gloria



Y


Hi she refused to sign the IRP and sent it back with not illegal wrote on it. They have done all this to her within 7 working days. They did not notify her she found out she had to attend via the assessor. They never wrote to inform her that she had to attend. They did not seek a docs authorisation, they did after she emailed stating that it is illegal not to have the docs consent but the day the complaint was submitted to ACC hey presto they got consent. And oh boy you should see the wording on the docs letter they sent him - even I would sign it without question. Her consultant has told her damage permanent, work related injury by the way, and she must not stretch, bend or lift in any form of exersion as she could do furhter damage which is between neck and collar bone on her spine. If you read what she found out she will have to do I would say this is pretty serious stuff, especially as apparently she will be expected to sign some kind of waiver that if she further injures herself during the tests ACC will not be held responsible. This is totally outrageous. I personally think she should go public. This is pure and simple neglect of the code of the claimants rights.
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#13 User is offline   TWINKLE09 

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Posted 10 June 2011 - 11:32 PM

[quote name='TWINKLE09' timestamp='1307705467' post='112904']
[quote name='Gloria Mitchell' timestamp='1307701953' post='112900']
If your friend refuses to go the cm will suspend the erc.

It could take months to get the erc reinstated.

You are required to work with them......you will have to negotiate with them. If you simply refuse you will be punatively exited or suspended until you comply.


None of these assessments are pleasant....if only because they are attended under duress with the knowledge they can generate documents which can be used against you. Then there s the way they push you past your comfort zone and can stir up symptoms and pain for some time after....most unpleasant.

Does your friend have an IRP with the assessments written into it?

Gloria



Y


Hi she refused to sign the IRP and sent it back with not legal wrote on it. They have done all this to her within 7 working days. They did not notify her she found out she had to attend via the assessor. They never wrote to inform her that she had to attend. They did not seek a docs authorisation, they did after she emailed stating that it is illegal not to have the docs consent but the day the complaint was submitted to ACC hey presto they got consent. And oh boy you should see the wording on the docs letter they sent him - even I would sign it without question. Her consultant has told her damage permanent, work related injury by the way, and she must not stretch, bend or lift in any form of exersion as she could do furhter damage which is between neck and collar bone on her spine. If you read what she found out she will have to do I would say this is pretty serious stuff, especially as apparently she will be expected to sign some kind of waiver that if she further injures herself during the tests ACC will not be held responsible. This is totally outrageous. I personally think she should go public. This is pure and simple neglect of the code of the claimants rights.
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#14 User is offline   TWINKLE09 

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Posted 10 June 2011 - 11:35 PM

View PostEasyrider, on 10 June 2011 - 07:51 PM, said:

What does her ARC 18 say in what restrictions she has.



Hi I am too sure but def that she has pain.
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#15 User is offline   TWINKLE09 

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Posted 11 June 2011 - 01:00 AM

Hi all still researching this FCE - some info just found which may be useful to others in the list i posted above of the tests involved are all compents of physical and are made up of Isometric - Isokinetic - Isoinenertial. I am struggling to find the actual test types listed anywhere so if anyone comes across them please post.

The reason blood pressures are taken are because bascially Isometric exercise is a form of resistance training in which the participant uses the muscles of the body to exert a force either against an immovable object or to hold the muscle in a fixed position for a set duration of time. In this type of exercise, the muscle is contracted but does not change length during the exertion of force. Additionally the joint most closely associated with the effort remains static throughout the exercise.

Although isometric exercises may result in a great deal of benefit to the individual, there are some precautions that should be noted. Specifically those with high blood pressure should not engage in this type of activity because isometric exercises cause a spike in blood pressure. Although the blood pressure typically returns to normal rather quickly once the muscle is relaxed, the spike in blood pressure can be dangerous to those who already suffer from elevated blood pressure.
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#16 User is offline   Fighter for Justice 

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Posted 11 June 2011 - 06:56 AM

One of the above posts suggests getting Nerve Conduction Studies done. I am aware that Dr Grant Carroll in Christchurch (Drs section of phone book) does Nerve Conduction Studies privately.

I would possibly contact the Omnbudsman urgently complaining re being forced to do FCE with these injuries.
Also, get a letter from GP stating what activities claimant definately cannot do.
Claimant could take GP's letter to Assessment. Then when asked to do something unsuitable for their injury - produce GP's letter.

Fighter for justice
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#17 User is offline   doppelganger 

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Posted 11 June 2011 - 02:56 PM

can't refuse if the test is approximate. it is clearly the test are not going to acheive the goal. that is why the medical documentation should go with the test, read with any report and read before making such a decision.

Doing that will make the FCE a waist of time as it does not deal with the injury or incapacity. FCE for the back involves awork place monotering at say 30 second interviles. this is recorded electronically and done over a period of time of at least 6 months.
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#18 User is offline   me0 

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Posted 11 June 2011 - 11:49 PM

(quote)
Hi she refused to sign the IRP and sent it back with not legal wrote on it. They have done all this to her within 7 working days. They did not notify her she found out she had to attend via the assessor. They never wrote to inform her that she had to attend. They did not seek a docs authorisation, they did after she emailed stating that it is illegal not to have the docs consent but the day the complaint was submitted to ACC hey presto they got consent. And oh boy you should see the wording on the docs letter they sent him - even I would sign it without question. Her consultant has told her damage permanent, work related injury by the way, and she must not stretch, bend or lift in any form of exersion as she could do furhter damage which is between neck and collar bone on her spine. If you read what she found out she will have to do I would say this is pretty serious stuff, especially as apparently she will be expected to sign some kind of waiver that if she further injures herself during the tests ACC will not be held responsible. This is totally outrageous. I personally think she should go public. This is pure and simple neglect of the code of the claimants rights.
[/quote]


I cannot say specific to your injury but My personal experience when going for FCE's is I have:
Not refused to turn up, or they can suspend erc.
Turn up with a support person, not alone.
I have totally crossed out (then initial) the waiver before signing the forms, expressing my concerns/view that I think it is unreasonable that activities could cause new injury or further worsen my condition.
I request that no videos or photos be taken.
I do activities I am requested however do not do activities that my Medical Certificate sites I should avoid, giving them a copy of certificate.
I also do not do activities that my GP, professional treatment providers, surgeons or physio etc suggest should be avoided in my case/specific to my injury. If possible take anything in writing that supports this (as quite often ACC do not provided such reports).
I visit my GP in the days prior to and days after the FCE to have pain levels etc monitored and also provide GP & ACC with written record of how pain & condition, increased medication, sleep is affected during the week following, due to the assessment.
This supports what happens (with alot of people I am sure!) is just because I may be able to do a few things at the time, doesn't mean I can sustain them long term.
Good Luck!! They are not pleasant, stressful & cause me massive flare up. However I have found if seen to be reasonable & communicate expressing specific realistic reasons why I am not happy to do some activities.
Not to say the end report will be realistic - that is when I take report to GP, surgeon and treatment providers for comment/recommendation specific to my injury, before outcome is put on my IRP.

Keep us posted :)
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#19 User is offline   Easyrider 

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Posted 12 June 2011 - 10:06 AM

Her ARC 18 will show all restrictions her GP has said she cannot do.

What restrictions does the ARC 18 state.

By refusing to carry out the assessment she will be cut off.
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#20 User is offline   TWINKLE09 

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Posted 12 June 2011 - 02:25 PM

View PostEasyrider, on 12 June 2011 - 10:06 AM, said:

Her ARC 18 will show all restrictions her GP has said she cannot do.

What restrictions does the ARC 18 state.

By refusing to carry out the assessment she will be cut off.



Hi she says she has never heard of a ARC 18. I know this is mad but she has had a very reasonable time with ACC up till now and has never had reason to mis-trust their recommendations. She has complied all the way - last two years. I got her to request her whole complete case file.

SOME MORE USEFUL INFO FOR ALL ATTENDING FCE's

I believe from the research I have done that ACC are following the procedures set out by MATHESON (Snook 1978, Ciriello et al 1993, Leggs & Myles 1985) If it is not exactly the same it is very very close.

The broad spectrum of Physical effort tests/tasks will and have to include Isometric/biomechanical/cardiovascular and behavioural.

Some of the components that must be included are activities in some type of the following format:-

Stooping
Crouching
Kneeling
Crawling
Stair climbing - I can confirm that this is def a physical test
Carrying

Even on the "Low" assessment, there are different levels they will request the FCE to be done for individual assessment needs (yep right!)

If any of your referral documents, paper work of any type to do with a FCE state "Standardized" the assessment must include the following forms of liftng (If they are not included and the word "Standardized" has been used then the assessment is not really valid as the assessment type score would be false.

LIFTS AND MAY BE WORDED IN DIFFERENT WAYS = "Postural" yep to me that means just showing how you stand or sit

= Isoinertial Lifting
= Progressive Isoinertial Lifting (Known as PILE and this is were they get you pick up a empty box then start adding weights) - This is a repetitive physical type and you are required to do this at a frequent pace.
=EPIC lift capacity

There are 4 various to lifting heights

= Floor to knuckle (Leg lift)
= 12" to knuckle (knee lift)
= Waist to shoulder
= Shoulder to overhead

Just be aware that there are various ways/formats that they could gain assessment records from. EG The bolt tasks - as listed above - is stated as screwing a bolt and then you replace it in a different position. So maybe they can cover (waist to shoulder - shoulder to overhead) with this task too. So simply just because you are not using a "weight" you are using your muscles - think of maybe "yoga" which is exercise (physical)and uses all your muscles - so if you have weakened muscles from your injury type there is cause for concern that you may further damage yourself.

Also always ask the assessor or case manager the duration of the FCE as the time the FCE takes is relevant to what they can actually assess you on - this is the scoring timed system

Disability rating should take only 1-2 hours
Job Matching should take 3-6 hours
Occupation Matching should take 5-8 hours
Work Capacity Evaluation should take 3-8 DAYS

This info may be useful for those who have been said they are fit for work under the FCE. If your assessment was only 1-2 hours then realistically you have only been assessed on your "disability" and should only therefore be assessed for such - I am no legal expert but I would be questioning any report that says you are fit for work if you have only been assessed for 1-2 hours - it must be illegal for ACC to Job and Occupational match if you have only ever had a 1-2 hours. I have not been through a FCE so this info would need to be confirmed and it may be possible that your FRP covers the last 3 - if it does then again I would have thought that there are some kind of legal issues around this as for a FCE to be valid it must be preformed methodically. So if you have had say Job matching - then a work capacity evaluation then they send you for a FCE it has been done in the wrong order so the results can not realistically be "valid".

If your FCE includes "Postural Poses" of any type they include you to balance, balancing your body uses physical muscle strength to do, without using any muscles at all you would simply fall over, therefore the Postural is a physical/dynamic task - So if you decide to try and refuse on the grounds of further injury and they tell you that you are not doing any "fitness tests" - if Postural is included in your program - you actually are - Just another way to get you to go for FCE.

BY THE WAY FOLKS I MAY NOT HAVE ANY LEGAL QUALIFICATIONS BUT I DO HAVE OVER 25 YEARS IN A COMMUNITY HEALTH/MENTAL HEALTH SETTING. THIS DOES INCLUDE WORKING WITH SPINAL INJURED PERSONS, ACQUIRED BRAIN INJURED PERSONS ETC WHICH I DO HAVE QUALIFICATIONS IN SO IF I CAN HELP ANYONE AT ALL JUST ASK.
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