Greathouse Chiropractic & Physical Therapy

When it comes to personal injury you want a healthcare provider that not only provides quality care but one that also documents and supports your case appropriately.

Level of Expertise & Experience

• Diplomate, American Chiropractic Rehabilitation Board (DACRB), (inactive).
• Working knowledge of AMA Guides
• 30+ years of practice experience.
• Experience with live testimony, video testimony, depositions and IMEs.

Reputation

We have a good working relationship with area allopaths and routinely incorporate interdisciplinary care with general practitioners, neurologists, orthopedics, neurosurgeons and other rehab specialists.

Medical Necessity

Medical necessity issues are obviously important for the patient, employers, third party payers and attending physicians. This includes frequency and duration of care, appropriate and timely diagnostic intervention as well as clinically indicated care management. The chiropractic profession has set forth guidelines for case management and our office adheres to these algorithmic standards of care.

Effects on Function & Physical Capacity

It's axiomatic that a joint joint will result in some degree of permanency by virtue of the fact that dense connective tissue heals by scar formation, however, it's the effect on function that determines impairment.

As a rehab specialist, I am trained to evaluate the patient for loss of basic elements of physical performance and set up a rehabilitation program of care to address deficits found. The doctor and patient going through this process, demonstrating goal oriented sincerity, further validates impairment when it occurs.

With the use of valid & reliable objective outcome assessment procedures called physical capacity evaluations, we are better able to document loss in physical performance ability, and translate to functional loss, all of which ultimately determine impairment and assists with disability determination.

Subjective Outcome Assessment Tools

The reliability and validity data published regarding these tools for gathering outcome information is regarded as exceptional and many times out-performs the physical performance tests. These tools provide good insight to a patients activity intolerance, pain level and preliminary psychometric barriers. They also serve as excellent patient progress tracking tools.

Inappropriate Illness Behavior

Malingering is rare, but patients may have complicating psychosocial issues that are many times enhanced by injury. Many of the subjective outcome assessment questionnaires double as early indicators of inappropriate illness behavior, as does Waddell's. Inappropriate or disproportionate illness behaviors should be identified early, if present, and managed accordingly.

Pre-existing Issues (Causation & Apportionment Analysis)

Objective data antedating new injury, compared to post injury objective data plays the strongest role in determining the ultimate cause of final impairment associated with the most recent injury in question. This includes MRI, electrodiagnostic studies, x-rays, valid range of motion assessment, strength assessment and documented effects on ADL. It also includes professional opinion of likelihood (reasonable degree of medical probability) of >50% in the opinion of the attending physician. We attempt to obtain all of the documentation and data necessary for apportionment.

Maximum Medical Improvement

An impairment is considered permanent when it has reached MMI, meaning it is well stabilized and unlikely to change substantially in the next year with or without medical treatment.

ImpairmentLoss, loss of use, or derangement implies a change from a normal or "pre-existing" state. Normal is a range or zone representing healthy functioning and varies with age, gender, and other factors such as environmental conditions. Normal values are defined from an individual or population perspective.

Offering Contemporary & Professional Care

(for non-surgical spinal and extremity disorders)

This Includes:

• Differential Diagnostic Work-up
• Timely Reports
• Realistic Functional Goals & End Points of Care
• Patient Education
• Valid & Reliable Subjective and Objective Outcome Assessment Tools
• Pain Modulation Modalities
• Remedial Therapeutic Care
• Physical Performance Evaluations
• Rehabilitative Care
• Return to Work Coordination with Human Resource Personnel
• Interdisciplinary Care Coordination
• Additional Diagnostics (MRI, CT scan, electrodiagnostic studies, lab work etc.)

From a medico-legal perspective, valid outcome assessment procedures help take the guess-work out of rationale for care and patient status reporting. This makes expert opinion testimony more substantial and much less contentious.

"Impairment and disability are the conceptual linchpins for the specialty of the physical medicine and rehabilitation and provide the major focus for virtually all of rehabilitation problem solving".

(Rondinelli & Katz,Impairment Rating and Disability Evaluation, W.B. Saunders Co., 2000)