The AMA Guides to the Evaluation of Permanent Impairment 6th Edition (hereafter referred to as the “Guides”) is generally a well-considered and carefully compiled book with what seems to be a mostly good, sound method for evaluating permanent impairment. It is easy to follow and apply and is currently a necessary reference book to have for the psychologist doing neuropsychological assessments for RAF cases.
History of the Guides:
The Guides was published by the American Medical Association (AMA) in 2008. It started in 1958 with the publication of an article by the AMA titled, “A Guide to Permanent Impairment of the Extremities and Back” and was followed by 12 additional guides that were published in JAMA. In 1971 a compendium of these 13 guides became the First Edition of the Guides. Over several years, the Guides was updated and several other editions were released. The 6th edition, the newest edition to date, has been designed to be easy to apply, to optimise inter-rater reliability and stresses conceptual and methodological congruity within and between organ system ratings.
Use of the Guides for psychologists:
The Guides consists of 12 chapters. The first two chapters are important introductory chapters that explain the history of the Guides, the philosophy behind it and some principles of practical application. Parts of Chapter 13 are of relevance to psychologists practicing in the field of neuropsychology. Chapter 14 (on the assessment of “Mental and Behavioural Disorders”) is relevant for a psychiatrist or a psychologist with no training in neuropsychology necessary.
Chapter 13, titled, “The Central and Peripheral Nervous System”, guides the psychologist in how to calculate an impairment rating for a person who has suffered traumatic brain injury. Not all of the chapter is of relevance to neuropsychology because it includes the rating of other aspects of the central and peripheral nervous system such as neurogenic respiratory dysfunction and neuromuscular junction disorders.
The parts of Chapter 13 that are relevant to psychologists practicing in the field of neuropsychology are the ratings of “Episodic Loss of Consciousness or Awareness”, “Sleep and Arousal Disorders”, “Impairment due to Alteration of Mental status, Cognition, and Highest Integrative Function (MSCHIF)”, “Aphasia or Dysphasia” and “Station and Gait Disorders”.
Recognition of Neuropsychological Assessment:
The Guides indicates that a neuropsychological assessment is unnecessary where persons have severe cognitive deficits. Regarding “symptoms of mild traumatic brain injury”, it indicates that they “generally resolve in days to weeks, and leaves the patient with no impairment” (Pg. 330), implying that a neuropsychological assessment is not necessary for that matter either. It does, however, recognise that a neuropsychological assessment can be very valuable in moderate traumatic brain injuries.
Unfortunately for psychologists doing neuropsychology, while the Guide recognises the value of a neuropsychological assessment for persons with moderate TBI, it gives two other assessment methods equal significance: medical doctors using an extended mental status exam (as provided in the Guides) and the opinion of an untrained person who knows the patient well and can comment on the person’s ability to perform Activities of Daily Living (ADLs) (pg. 330).
Future with the Guides:
Hopefully, the legal fraternity will recognise that the full complexity of a brain injury cannot be measured using an extended mental status exam only nor collateral information but that a thorough neuropsychological assessment is more likely to give the true picture of the degree to which a person is impaired.
Purchasing the Guides:
The AMA Guides to the Evaluation of Permanent Impairment 6th Edition can be attained from the AMA itself and when one of its authors, Dr Ranavaya comes to South Africa to give training in using the Guides, he often brings a few copies with him that can be purchased. It is also available through Amazon.com.
Book review by: Sharon Truter
 American Medical Association. A guide to the evaluation of permanent impairment of the extremities and back. JAMA. 1958; 166(suppl):1 – 122.