Spine Impairment Research Articles

α-Synuclein triggers cofilin pathology and dendritic spine impairment via a PrPC-CCR5 dependent pathway

Cognitive dysfunction and dementia are critical symptoms of Lewy Body dementias (LBD). Specifically, alpha-synuclein (αSyn) accumulation in the hippocampus leading to synaptic dysfunction is linked to cognitive deficits in LBD. Here, we investigated the pathological impact of αSyn on hippocampal neurons. We report that either αSyn overexpression or αSyn pre-formed fibrils (PFFs) treatment triggers the formation of cofilin-actin rods, synapse disruptors, in cultured hippocampal neurons and in the hippocampus of synucleinopathy mouse models and of LBD patients. In vivo, cofilin pathology is present concomitantly with synaptic impairment and cognitive dysfunction. Rods generation prompted by αSyn involves the co-action of the cellular prion protein (PrPC) and the chemokine receptor 5 (CCR5). Importantly, we show that CCR5 inhibition, with a clinically relevant peptide antagonist, reverts dendritic spine impairment promoted by αSyn. Collectively, we detail the cellular and molecular mechanism through which αSyn disrupts hippocampal synaptic structure and we identify CCR5 as a novel therapeutic target to prevent synaptic impairment and cognitive dysfunction in LBD.

PKCε inhibition prevents ischemia‑induced dendritic spine impairment in cultured primary neurons.

Brain ischemia is an independent risk factor for Alzheimer's disease (AD); however, the mechanisms underlining ischemic stroke and AD remain unclear. The present study aimed to investigate the function of the ε isoform of protein kinase C (PKCε) in brain ischemia-induced dendritic spine dysfunction to elucidate how brain ischemia causes AD. In the present study, primary hippocampus and cortical neurons were cultured while an oxygen-glucose deprivation (OGD) model was used to simulate brain ischemia. In the OGD cell model, in vitro kinase activity assay was performed to investigate whether the PKCε kinase activity changed after OGD treatment. Confocal microscopy was performed to investigate whether inhibiting PKCε kinase activity protects dendritic spine morphology and function. G-LISA was used to investigate whether small GTPases worked downstream of PKCε. The results showed that PKCε kinase activity was significantly increased following OGD treatment in primary neurons, leading to dendritic spine dysfunction. Pre-treatment with PKCε-inhibiting peptide, which blocks PKCε activity, significantly rescued dendritic spine function following OGD treatment. Furthermore, PKCε could activate Ras homolog gene family member A (RhoA) as a downstream molecule, which mediated OGD-induced dendritic spine morphology changes and caused dendritic spine dysfunction. In conclusion, the present study demonstrated that the PKCε/RhoA signalling pathway is a novel mechanism mediating brain ischemia-induced dendritic spine dysfunction. Developing therapeutic targets for this pathway may protect against and prevent brain ischemia-induced cognitive impairment and AD.

Paliperidone alleviates MK-801-induced damage to prefrontal cortical neurons via the PP2A/PTEN pathway

BackgroundThe putative mechanisms underlying the efficacy of the US Food and Drug Administration-approved antipsychotic drug paliperidone for the treatment of schizophrenia deserve additional investigation, which is the aim of the present animal study. MethodsThe behavioral activities of mice were recorded in the open field test and light-dark box test. The effects of paliperidone on MK-801-induced neuronal damage in the prefrontal cortex were tested by flow cytometry, TUNEL staining assays, and ROS staining assays. The neuroprotective effects of paliperidone on neural dendrites and synapses were evaluated using Golgi staining and Sholl analysis. An adenovirus vector containing a Ca2+ indicator was used to monitor the calcium ion concentration in the prefrontal cortex. The expression levels of protein phosphatase 2A (PP2A) and phosphatase and tensin homolog (PTEN) were investigated using Western blotting. ResultsThe data showed that MK-801 caused stereotyped behavior in mice and induced synaptic damage and dendritic spine impairment compared with the control, whereas paliperidone ameliorated these changes. Moreover, paliperidone reversed MK-801-induced decreases in PP2A and PTEN levels in prefrontal cortical neurons. Furthermore, in primary cultured cortical neurons and HT-22 cells, paliperidone inhibited cell apoptosis caused by MK-801. In particular, pretreatment with the PP2A inhibitor LB-100 significantly restrained the protective effects of paliperidone on MK-801-treated neurons and on locomotor activity and stereotypical behavior of mice. LimitationsWhether other proteins are involved in this pathway and how the pathway works have not been revealed. ConclusionOur data show that paliperidone alleviates neuronal damage induced by MK-801 via the PP2A/PTEN pathway.

A New Potential Indicator in Differentiating Patients with Lumbar Spinal Stenosis and Lumbar Intervertebral Disc Degeneration

Background: Center of pressure (CoP) trajectory is one of the gait parameters that is widely used for clinical assessments. Moreover, the CoP trajectory could be adversely affected by anatomic and mechanical factors that involve foot function, which was shown to be correlated with musculoskeletal diseases. The aim of this study is to compare angle-associated parameters of gait in patients with different lumbar spinal disorders. Methods: The subjects suffered from the same levels of spine impairment, including patients with lumbar spinal stenosis (LSS) and lumbar intervertebral disc degeneration (LIDD) were recruited in this study. The spatio-temporal angular parameters associated with the CoP of the subjects during their gait were collected and examined. The measurements were used to calculate the CoP angle and symmetry angle (SA). Then the butterfly diagram (BD) intersection angle was introduced as a new potential parameter in gait assessment. Results: The results of the current study showed that CoPs and SAs did not vary between the two groups (P > 0.05). The BD intersection angle, however, indicated some variations between patients with LSS and LIDD (P < 0.05). Conclusion: While the results showed that CoP angles and SAs did not differ between the LSS and LIDD groups, it is hypothesized that such disorders that affect the gait could be reflected in the BD intersection angle. Therefore, the BD intersection angle is suggested as a clinical indicator in clarifying patients with lumbar spinal disorders.

Spine impairment in mice high-expressing neuregulin 1 due to LIMK1 activation

The genes encoding for neuregulin1 (NRG1), a growth factor, and its receptor ErbB4 are both risk factors of major depression disorder and schizophrenia (SZ). They have been implicated in neural development and synaptic plasticity. However, exactly how NRG1 variations lead to SZ remains unclear. Indeed, NRG1 levels are increased in postmortem brain tissues of patients with brain disorders. Here, we studied the effects of high-level NRG1 on dendritic spine development and function. We showed that spine density in the prefrontal cortex and hippocampus was reduced in mice (ctoNrg1) that overexpressed NRG1 in neurons. The frequency of miniature excitatory postsynaptic currents (mEPSCs) was reduced in both brain regions of ctoNrg1 mice. High expression of NRG1 activated LIMK1 and increased cofilin phosphorylation in postsynaptic densities. Spine reduction was attenuated by inhibiting LIMK1 or blocking the NRG1–LIMK1 interaction, or by restoring NRG1 protein level. These results indicate that a normal NRG1 protein level is necessary for spine homeostasis and suggest a pathophysiological mechanism of abnormal spines in relevant brain disorders.

Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.

Q&A: Converting Cervical Spine Rating to Back Rating

QUESTION: I practice in South Carolina and have been asked to convert an impairment rating (IR) of the cervical spine to a percentage loss of the back. South Carolina Title 42-Workers’ Compensation, Section 42-9-30, provides a listing “for the loss of use of the back.” However, it does not provide one for the cervical spine. How do I make that conversion?ANSWER: The spine is comprised of three segments: the cervical spine (neck), the thoracic spine (upper and mid back), and the lumbar spine (lower back). The AMA Guides’ cervical spine IR was never intended to be converted to “a percentage loss of the back.” To do so is medically nonsensical because the neck (cervical spine) and back (thoracolumbar spine) are two anatomically different entities. Similarly, being asked to convert a cervical spine impairment to a “head” impairment makes no sense, as no edition of the AMA Guides has ever used a concept of “head” impairment.If a law or regulation requires such a nonsensical conversion, it is far preferable to have some justifiable and defensible method for doing so rather than pulling a number out of thin air. South Carolina has a state schedule of disabilities; unscheduled disabilities may be determined using the AMA Guides (edition unspecified) or other accepted medical authority. However, many physicians in South Carolina use the AMA Guides, and the ratings based thereon are generally accepted.Regarding the diagnosis-related estimate (DRE) and range of motion (ROM) methods for rating spinal impairments, the AMA Guides, Fifth Edition, Section 15.13, Criteria for Converting Whole Person Impairment to Regional Spine Impairment (5th ed, 427), states: “Under the DRE method, a whole person estimate being converted to a regional estimate would be divided by 0.35 for the cervical spine, 0.20 for the thoracic spine, and 0.75 for the lumbar and sacral spines. Under the ROM method, a whole person estimate being converted to a regional estimate should be divided by 0.80 for the cervical spine, 0.40 for the thoracic spine, or 0.90 for the lumbosacral spine (Figure 15-19).”Regarding diagnosis-based impairment (DBI), the subsection on regional impairment in the AMA Guides, Sixth Edition (6th ed, 583) states that the “conversion factors used in the DBI method are the same as those used for the DRE method in the Fifth Edition…0.35 for the cervical spine, 0.20 for the thoracic spine, and 0.75 for the lumbar spine.”Assume you used the DRE method from the Fifth Edition or a DBI from the Sixth Edition and came up with 10% whole person impairment (WPI) due to the cervical spine pathology. To convert this to a back rating, does one divide by 0.20, 0.75, or an average of the two numbers? Because both thoracic and lumbar spine comprise the back, rather than picking one or the other, it seems more defensible to average the two numbers, ie, the mean being 0.475: 10% ÷ 0.475 = 21%. Hence, while medically very dubious, if such a conversion is required by law or regulation, 10% WPI for cervical spine pathology could be converted to 21% “loss of the back.”While the aforementioned method provides a percentage in an attempt to comply with state law or regulation, the adjudicator will ultimately decide what the law intended with the requirement to convert a cervical spine rating to a “percentage loss of the back.”

Two-Point Discrimination in the Use of Upper Extremity Nerve Function in the AMA Guides

Abstract This article presents a case report regarding a 34-year-old obese male who works as a chipper and grinder at a steel manufacturing mill and uses high-frequency vibratory power tools. He presents with typical complaints of carpal tunnel syndrome, including numbness in all five digits, wrist pain, nocturnal awakening/numbness, and others. Two-point discrimination (2PD) using a caliper was tested in the digits of the upper extremities and was 5 mm throughout. 2PD first appeared in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, and the Sixth Edition states, “sensory deficits can be challenging to grade, since the clinical examination is based on subjective reports by the patient. Grading is based on the results of sensibility testing and two-point discrimination, to improve inter-rater reliability.” The discussion of “sensibility” involves a concept of sensory perception that is more appropriate in surgery literature than neurological literature, and the discussion of the case report in this article reflects the recent literature regarding 2PD as a measure of sensibility. The authors report that sensibility is not a simple recovery of sensory function following nerve injury but rather is a complex interaction between nerve recovery and modulation of central nervous system function in spinal cord, subcortical, and cortical structures. The authors ask if the value of 2PD in the clinical assessment of impairment has been overrated within the AMA Guides, as was range of motion in the assessment of spine impairment.

Upper cervical range of motion is impaired in patients with temporomandibular disorders

Aims:Clinicians increasingly suggest assessment and treatment of the cervical spine in patients with temporomandibular dysfunction (TMD); however, few studies have investigated upper cervical spine mobility in people who suffer from TMD. The purpose of this study was to investigate whether patients with TMD pain (with or without headache) present with upper cervical spine impairment when compared with asymptomatic subjects.Methodology:A single blind examiner evaluated cervical range of motion (ROM) measures including axial rotation during the flexion–rotation test (FRT) and sagittal plane ROM. Twenty asymptomatic subjects were compared with 37 subjects with pain attributed to TMD, confirmed by the Revised Research Diagnostic Criteria. Subjects with TMD were divided according to the presence of headache (26 without headache TMDNHA, 11 with headache TMDHA). One-way analysis of variance and planned orthogonal comparisons were used to determine differences in cervical mobility between groups. All subjects with TMD were positive on the FRT with restricted ROM, while none were in the control group.Results:The analysis of variance revealed significant differences between groups for the FRT F(2,54) = 57·96, P<0·001) and for sagittal ROM [F(2,54) = 5·69, P = 0·006]. Findings show that the TMDHA group had less axial rotation than group TMDNHA, and both TMD groups had less ROM than controls. For sagittal ROM, the only difference was between group TMDHA and controls.Conclusions:Subjects with TMD had signs of upper cervical spine movement impairment, greater in those with headache. Only subjects with TMD and headache had impairment of cervical spine sagittal plane mobility. This study provides evidence for the importance of examination of upper cervical mobility determined by the FRT in patients who suffer from TMD.

Whole-Person Impairment in Younger Retired NFL Players: The Orthopaedic Toll of a Professional Football Career.

Background:Professional American football is a physically demanding, high-impact sport with an elevated risk of injury. Orthopaedic injuries may impose acute, short-term or cumulative consequences throughout a player’s lifetime. Several studies have addressed health and psychosocial concerns of an older, retired population of players in the National Football League (NFL); however, minimal research has examined the orthopaedic toll on younger, retired players.Purpose:This study reports total whole-person impairment (WPI) percentages in a cohort of younger, retired NFL players who presented for disability evaluations based on the use of standardized American Medical Association (AMA) impairment guidelines.Study Design:Case series; Level of evidence, 4.Methods:During the study period of February 2011 to August 2013, 65 younger retired NFL players presented for impairment evaluations. The mean time between retirement and impairment evaluation was 3.1 years (range, 0.3-16.4 years). A complete history and physical examination was performed on all symptomatic joints. A retrospective chart review was conducted on 100% of presenting players to assess orthopaedic burden. Body-part impairment (BPI) percentage for each affected joint was generated. The impairment data for each extremity were then combined with spine impairment data to create WPI percentage. Player demographics, including age, position, and playing time, were also recorded.Results:The average WPI percentage was 37% (range, 19%-53%). Players participating in >30 games (n = 54) had a higher mean WPI percentage (38%) than those playing in <30 games (31%; n = 11) (P = .004). Players competing in >5 seasons (n = 46) were 2.4 times more likely to have a WPI of at least 37% (P = .007). The most common joints players reported as symptomatic were lumbar (n = 63; 97%) and cervical spine (n = 58; 89%). The mean age at evaluation was 33.5 years (range, 27-42 years), and the mean number of seasons played was 7.5 (range, 3-14 seasons). The mean number of games played was 98.4 (range, 2-236 games).Conclusion:This study demonstrated high WPI percentages related to symptomatic joints in a cohort of younger, retired NFL players. Further research is warranted to study potential cumulative physical and quality of life factors related to high impairment percentages in younger, retired NFL players.

A Correlative Study of the Spine Impairment Rating, The Pain Disability Status, and The Physical Performance Status of Individuals with Poly-Trauma History and with a Spine Impairment: Impact on Life Care Planning

PM&RVolume 5, Issue 9S p. S298-S298 Pain and Spine Medicine A Correlative Study of the Spine Impairment Rating, The Pain Disability Status, and The Physical Performance Status of Individuals with Poly-Trauma History and with a Spine Impairment: Impact on Life Care Planning Armando Miciano MD, Armando Miciano MD Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this author Armando Miciano MD, Armando Miciano MD Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.538Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S298-S298 RelatedInformation

A correlative study of the spine impairment rating, the pain disability status, and the physical performance status of individuals with poly-trauma history over two years and with a spine impairment

A correlative study of the spine impairment rating, the pain disability status, and the physical performance status of individuals with poly-trauma history over two years and with a spine impairment

Poster 477 The Functional Status Due to Pain-Related Impairments, According to the AMA Guides 6th Ed., and the Physical Performance Status of Subjects With a > 2-Year Poly-Trauma History and With a Spine Impairment: A Descriptive Case Study

PM&RVolume 4, Issue 10S p. S353-S353 2012 AAPM&R Annual Assembly Abstract Poster 477 The Functional Status Due to Pain-Related Impairments, According to the AMA Guides 6th Ed., and the Physical Performance Status of Subjects With a > 2-Year Poly-Trauma History and With a Spine Impairment: A Descriptive Case Study Armando S. Miciano MD, Armando S. Miciano MD Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this authorChad Cross PhD, PStat(R), Chad Cross PhD, PStat(R) Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this author Armando S. Miciano MD, Armando S. Miciano MD Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this authorChad Cross PhD, PStat(R), Chad Cross PhD, PStat(R) Nevada Rehabilitation Institute, Las Vegas, NV, United StatesSearch for more papers by this author First published: 23 October 2012 https://doi.org/10.1016/j.pmrj.2012.09.1081Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume4, Issue10SOctober 2012Pages S353-S353 RelatedInformation

The Prevalence and Severity of Lumbar Spine Motion Impairment in Normal Subjects

Crosssectional. To assess the prevalence and severity of lumbar spine motion impairment in normal subjects. A prior study of cervical and lumbar spine impairment indicated that a high percentage of normal subjects had impairment. A total of 579 normal subjects were assessed for lumbar spine motion impairment using 3 editions (Third Edition Revised, Fourth Edition, and Fifth Edition) of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides). Eighty percent to 86% of normal subjects had impairment due to loss of lumbar motion. A high percentage of normal subjects will have lumbar spine impairment due to loss of lumbar motion using the AMA Guides.

The Functional Status Due to Pain-Related Impairments, According to the AMA Guides 6th Ed., and the Physical Performance Status of Subjects with a >Two-Year Poly-Trauma History and with a Spine Impairment: a Descriptive Case Study

The Functional Status Due to Pain-Related Impairments, According to the AMA Guides 6th Ed., and the Physical Performance Status of Subjects with a >Two-Year Poly-Trauma History and with a Spine Impairment: a Descriptive Case Study

The Relationship between Cervicogenic Headache and Impairment Determined by the Flexion-Rotation Test

Objective This study evaluates the association between probable cervicogenic headache (CGH) and associated headache symptoms and cervical spine impairment identified by the flexion-rotation test (FRT). Methods This was an observational study. Ninety-two subjects were evaluated, 72 with probable CGH and 20 who were asymptomatic. Headache symptoms were evaluated by questionnaire. A single blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion (ROM). Fifteen subjects reported headache during testing and were subsequently retested when pain-free. A paired t test was used to determine whether FRT mobility to the most restricted side differed when the subject was experiencing headache. Univariate linear regression analysis and multiple regression analysis were used to examine the relationship between subject and headache characteristics, and range of motion during the FRT. Logistic regression analysis was used to examine relationships between subject and headache characteristics and whether the FRT was positive or negative. Results Mean ROM was significantly reduced ( P < .01) by 6° in the presence of headache, but this did not influence test interpretation. Regression analysis revealed that half the variance in FRT ROM was explained by an index of headache severity or component parts but not by other headache characteristics. Conclusions These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.

Spine Impairment Evaluation: Sixth Edition Approaches

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

Impairment Tutorial: No Double Dipping for Pain

Impairment Tutorial: No Double Dipping for Pain

Lumbar Posture—Should It, and Can It, Be Modified? A Study of Passive Tissue Stiffness and Lumbar Position During Activities of Daily Living

Physical therapists commonly attempt to reduce and prevent low back pain by "improving" individuals' lumbar posture. To investigate the physical therapy clinical practice of attempting to "improve" lumbar posture, measures of passive tissue stiffness and angular deformation during activities of daily living were used. The lumbar spine posture of 150 university students was measured as the inclinometer angle difference between L1 and S1. Eighteen female participants (6 with hypolordosis, 6 with hyperlordosis, and 6 controls without lumbar spine impairment) were recruited from this lumbar posture database. Hypolordosis and hyperlordosis were clinically classified by physical therapists. Lumbar passive tissue stiffness was measured during sitting, standing, and walking before and after a 12-week exercise program, and estimates of lumbar passive tissue strain were calculated from those measurements. The neutral zone (NZ), a range of lumbar positions of low passive tissue stiffness, was identified. Prior to training, the subjects with hypolordosis had more passive tissue strain during sitting than the subjects with hyperlordosis, and the subjects with hyperlordosis stood in extension relative to their NZs while the control subjects and subjects with hypolordosis stood within their NZs. Before and after training, subjects in all 3 groups walked with lumbar spine positions within their NZs. After training, the lumbar posture of the subjects with hypolordosis and the subjects with hyperlordosis changed toward a "mean" (mid-range) lumbar posture. After the exercise program, subjects in all 3 groups stood and walked with their lumbar spines in positions within their NZs, and they sat with their lumbar spines flexed relative to their NZs. Knowing that tissue failure can be related to passive tissue strain, the results of this study support the clinical practice of attempting to change individuals' posture-related lumbar spine positions during activities of daily living. Lumbar passive tissue strain, as estimated from the NZ and angular deformation during activities of daily living, can be decreased, but can also be increased, by an exercise program.

Common Tips for IMEs: Musculoskeletal Conversions: Musculoskeletal Conversions

Abstract Most impairments are expressed ultimately as a whole person impairment, and the musculoskeletal chapters of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include instructions for converting regional impairments to whole person impairments using a percentage relationship. This article presents an extensive table that incorporates the conversion factors for extremity and spinal impairments. Occasionally evaluators need to convert spinal impairments from whole person to impairment of the spine, a process that is explained in the AMA Guides, Section 15.13. The conversion factors differ depending on whether the impairment was obtained using the Diagnosis-related estimate (DRE) method or the range-of-motion (ROM) method. For example, a 5% whole person impairment is an 8% upper extremity impairment, a 9% hand impairment, 23% thumb impairment, 46% index/middle finger impairment, or 93% ring/little finger impairment. The same 5% whole person impairment would convert to a cervical spine impairment of 14% cervical spine if the DRE method were used and 6% if the ROM method were used. For the lumbar spine, this would convert to 7% lumbar spine impairment if the DRE method were used and 6% if the ROM method were used. The table in this article provides values for converting foot to lower extremity impairment and for converting whole person impairment to regional spinal impairment.