Functional Assessment Systems, Inc.
Functional Capacity Evaluation
Sample Report

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FUNCTIONAL ASSESSMENT SYSTEMS 
2127 Northpoint Blvd.
Hixson,TN 37343 
423-280-7885

FUNCTIONAL
CAPACITY
EVALUATION

December 18, 2001

RE: Client               [Evaluated: December 17, 2001 ]

PURPOSE OF ASSESSMENT

Client was referred for a Functional Capacity Evaluation to assess his current functional abilities to determine his ability to return to work as a Brick/Block/Stone Mason.

RELIABILITY AND CONSISTENCY OF EFFORT

The results of this evaluation suggest that client gave a reliable effort, with 39 of 41 consistency measures within expected limits.

Functional Abilities Summary

Client’s demonstrated abilities in this evaluation (FCE) are summarized below.

Activities Rated by Strength Level

Activity

FCE Performance

(PDC Category)

Equivalent Strength Level

Job Demand

(PDC Category)

Deficit

Occasional

0 to 2.6 hours/day

Frequent

2.7 to 5.3 hours/day

Constant

5.4 to 8 hours/day

Low Lift (floor to knuckle)

Medium

(50#occ/

35#freq)

21 - 50 lb

11 - 25 lb

1 - 10 lb

Heavy

Yes

Carry

Medium

(50#occ/

35#freq/

20#const)

51 - 100 lb

26 - 50 lb

11 - 20 lb

Heavy

Yes

Push (static)

Heavy

51 - 100 lb

26 - 50 lb

11 - 20 lb

 

 

Pull (static)

Medium

21 - 50 lb

11 - 25 lb

1 - 10 lb

 

 

Overall Strength Category

Medium

21 - 50 lb

11 - 25 lb

1 - 10 lb

Heavy

Yes

Activities Rated by Frequency and Duration

Activity

FCE Performance

Job Demand

Deficit

Walk

Frequent, slightly antalgic gait with left LE

Occasional

No

Climb Stairs

3 min CAFT Step Test with adequate LE strength and balance

 

 

Stoop

Occasional, difficulty extending from a flexed position

Constant

Yes

Kneel

Constant, adequate LE strength to stand up from kneeling

Frequent

No

Crouch

Constant, adequate LE strength to stand up from crouching

Frequent

No

Sitting

55 minutes with difficulty noted with frequent weight shifting

 

 

Standing

85 minutes with adequate ability

Frequent

No

Other Activities

Grip Strength (position 2)

Left: 88.4 lb

Right: 86.7 lb

 

 

Cardiovascular Fitness

Below average

 

 

               
LUMBAR RANGE OF MOTION was measured with dual spinal inclinometers with extension and lateral flexion right giving him the most discomfort: Flexion – 57 degrees/95% of Normative Values, Extension – 11 degrees/44%, Lateral Flexion Right – 22 degrees/88%, Lateral Flexion Left – 27 degrees/108%, SLR Right – 93 degrees, SLR Left – 95 degrees.

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