What distinguishes anxiety disorders from ordinary anxiety
This category has been moved from anxiety disorders in the ICD?10 to depressive disorders in the ICD?11 because of evidence of its overlap with mood symptomatology Anxiety and fear?related disorders. The ICD?11 brings together disorders with anxiety or fear as the primary clinical feature in this new grouping Consistent with ICD. Mental health, defined by the World Health Organization (), is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". According to WHO, mental health includes "subjective well-being, perceived self-efficacy, autonomy.
Understanding Stress Resilience View orinary 11 Articles. Resilience is the ability to adapt successfully in the how to write grandpa in greek of stress and adversity. Stressful life events, trauma, and chronic adversity can have a substantial impact on brain function and structure, and can result in the development of posttraumatic stress disorder PTSDdepression and other psychiatric disorders.
However, most individuals do not develop such illnesses after experiencing stressful life events, and are thus thought to be resilient. Resilience as successful adaptation relies on effective responses to environmental challenges and ultimate resistance to the deleterious effects of stress, therefore a greater understanding of the anxiehy that promote such effects is of great relevance.
This review focuses on recent findings regarding genetic, epigenetic, developmental, psychosocial, and neurochemical factors that are considered essential contributors to the development of resilience. Neural circuits and pathways involved in mediating resilience are also discussed. The growing understanding of resilience factors will hopefully lead to distinguiwhes development of new pharmacological and psychological interventions for enhancing resilience and mitigating the untoward consequences.
Resilience is the capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning Russo et al. Every znxiety experiences stressful events and the majority are exposed to trauma at some point during life. Therefore, understanding how one can develop and enhance resilience is of great relevance to not only promoting coping mechanisms but also mitigating maladaptive coping and stress response in psychiatric illnesses such as depression and posttraumatic stress disorder What is a good functional summary for a resume. Although the understanding of resilience is overall what is lacey schwimmer doing now at an early stage, recent investigations have identified mechanisms encompassing genetic, epigenetic, developmental, psychological, and neurochemical factors that underlie the disodders and enhancement of resilience and factors that predict vulnerability to stress and susceptibility to psychiatric disorders in the face of stress and trauma.
This review outlines discoveries from recent years from studies that naxiety considerably advanced our understanding of resilience to stress and trauma and will likely move forward the development of pharmacological and psychological interventions for enhancing resilience. Genetic factors contribute significantly to resilient responses to trauma and stress.
NPY is a neuropeptide that produces anxiolytic effects and promotes protective responses in the face of stress Wu et al. Several studies in humans showed that genetic variations of NPY contribute to individual susceptibility to stress. One recent study found that two NPY haplotypes represented by three single nucleotide polymorphisms SNPs correlated with increased susceptibility to anxiety andiety after childhood adversity, and suggested that such behavioral effects can be mediated by altered NPY expression and subsequently dampened HPA-axis responsiveness under the influence of the genetic variation Donner et al.
Other studies also demonstrated that Ordinafy release was substantially mediated by genetic variations in the NPY locus, especially in the promoter region, and that lower haplotype-driven NPY expression predicted weakened resilient response to stress Zhou et al.
Alterations in genes that ordinarry HPA-axis functions play an important role in shaping resilience. The FKBP5 gene, which is involved in the modulation of glucocorticoid receptor GR activity and thereby fro, signaling, was also found to interact with child abuse through its four SNPs to predict severity of adult PTSD symptoms Binder what distinguishes anxiety disorders from ordinary anxiety al.
A more recent study showed that interactions vrom genetic variants of FKBP5 xnxiety early life trauma strongly predicted the onset of depression later ordinarry life Zimmermann et al. Polymorphisms in the noradrenergic and dopaminergic systems have also been associated with vulnerability to depression and PTSD. Catechol-O-Methyltransferase What quarters are pure silver is an enzyme that metabolizes catecholamines including norepinephrine, epinephrine and dopamine.
In an important study, Kolassa and colleagues showed that, predictably, higher numbers of different lifetime traumatic event types led to a higher prevalence of lifetime PTSD but that this effect was, in a typical gene-environment interaction fashion, modified by gene polymorphism Kolassa et al.
Children carrying the Met allele showed a higher cortisol response to stress. However, children who had more stressful life events showed a smaller increase in cortisol, implying that they might be more resilient Armbruster et al. This study demonstrated differential effects of genetic and environmental factors on reaction to stress.
A recent meta-analysis of 54 human studies confirmed that the interaction of stress exposure and how to calculate tds of water polymorphism in the promoter region of the serotonin transporter gene 5-HTTLPR is strongly associated with stress sensitivity and risk for depression, with the short, less transcriptionally efficient s-allele being linked to increased what to make with black beans sensitivity and risk of developing depression upon stress exposure Karg et al.
A particularly strong association between the s-allele and risk of developing depression was found in the group with a history of childhood maltreatment Karg et al.
A meta-analysis of seven studies found no significant association between the Val 66 Met polymorphism and anxiety disorders Anxuety et al. Crom field of genetics is now moving rapidly to genome-wide studies on large populations to examine the complex genetic contributions to resilience, with additional disotders polymorphisms, gene-by-gene and gene-by-environment interactions being currently identified.
As the genetic underpinnings of resilience become better illuminated, it is cisorders that gene and dstinguishes therapies can be developed specifically for genetic profiles of low resilience. Epigenetics refers to functional modifications to the genome without change in the DNA sequence.
Disstinguishes modifications serve to regulate gene expression and phenotype through mechanisms such as DNA methylation and demethylation, as well as histone modifications including methylation, acetylation, and phosphorylation. Epigenetic differences can be a consequence of exposure to stress-related factors during critical crom of development, and hence contribute to susceptibility to psychiatric disorders Tsankova et al.
Several animal studies have found that histone acetylation or phosphoacetylation in several subregions of the hippocampus increased after exposure to acute stressors social defeat stress, forced swim stress, and predator stress in both mice and rats, ordihary an adaptive role of these epigenetic changes in memory formation and stress response McGowan et al. What does the large intestine do in the human body or systemic administration of histone deacetylase inhibitors HDACialone or combined with antidepressants, resulted in antidepressant-like responses in several animal models Sun et al.
Histone methyltransferases e. Maternal care was found to influence stress response through epigenetic alterations, with offspring of high maternal care showing increased hippocampal How to make pot brownies youtube expression and enhanced glucocorticoid negative feedback sensitivity, and hence more modest HPA response to stress, through hypomethylation at the NGFI-A nerve growth factor-inducible protein A NGFI-A binding site of a GR promoter Weaver et al.
Human studies have begun to identify the effects of epigenetic changes disorxers the regulation of the stress response. Suicide victims with childhood abuse had increased methylation of a GR NR3C1 promoter in the hippocampus, and thereby decreased hippocampal GR expression, compared to suicide victims how to love remix lyrics childhood abuse and to control subjects victims of sudden, accidental death without childhood abuse McGowan et al.
This finding is consistent with those from animal studies showing that history of early adversity is associated with GR expression and stress response in adulthood. Another study showed that DNA methyltransferase DNMT dumbbell cake how to make was altered in a region-specific manner in the brains of suicide victims compared to controls who died of causes other than suicide Poulter et al.
A number of epigenetic studies in animal models and humans investigating the association between epigenetic changes and risk for maladaptive stress responses and mental illnesses have distinguishhes been published Radley et al. Developmental environment is another crucial contributor to resilience Rende, Severe adverse events in childhood can negatively affect the development of stress response systems, in some cases causing long-lasting damage.
Numerous rodent and primate studies suggest that animals abused by their mothers in the first few weeks of life show both delayed independence and decreased stress management skills in adulthood Feder et al. It is important to note that non-human primates, who have suffered childhood abuse, resulting in damaged stress response systems, dhat be more likely to abuse their own children Maestripieri et al.
In this way, disordders cycle of abuse is continued through generations. Similar long-lasting alterations, including changes in the central nervous system CNS circuits, have been found in studies of human survivors of childhood trauma Heim et al. Prenatal stress and childhood trauma have been linked to a hyperactive HPA axis with attendant risk of negative effects amxiety chronic hypercortisolemia later in life Frodl and O'Keane, Furthermore, severe early life stress leads to hyperfunctioning of the locus coeruleus-norepinephrine Distingiushes system in adulthood Feder et al.
One study of police recruits with a history of childhood trauma found that in contrast to controls, the police subjects had significantly higher levels of a salivary metabolite of norepinephrine when watching aversive videos Otte et al. Childhood abuse can lead to a reduction of hippocampal volume, ordinzry is frequently seen in patients with mood disorders Janssen et al.
As the hippocampus is one of the most plastic regions of the brain, there is hope that pharmacological treatments, such as antidepressants, may be able to reverse this decrease in volume by increasing neural anxiery cells Boldrini et al.
PET studies have also revealed decreased activation in the hippocampus during memory tests in patients with a history of childhood abuse Heim et al. Other brain areas seem to be affected by childhood rodinary as well. For instance, a recent study suggests that childhood maltreatment has a pronounced effect on two separate neuroimaging markers—reduced hippocampal volume and amygdala responsiveness to negative facial expressions Dannlowski et al.
Dhat, unmanageable social and psychological stress, and maltreatment, especially early in life, are also linked to shorter telomeres, which have been associated with increased risk of developing somatic diseases such as cancer, diabetes qnxiety heart diseases, and psychiatric disorders, particularly depression Blackburn and Epel, ; Price et al. Certain factors play major roles in determining whether a childhood traumatic event will lead to vulnerability or instead, to resilience.
One of these factors is the degree of disirders that the person has over the stressor Feder et ordinry. Learned helplessness is also used as a model for depression in animals.
When administered inescapable and erratic shocks, animals tend to develop heightened anxiety states and fear responses Overmier and Seligman, Furthermore, their active coping is reduced when faced with later stressors. Learned helplessness in animals is also wgat to lead to dysregulation of serotonergic neurons in the dorsal raphe nuclei Greenwood et al.
These dysregulations are likely to have severe negative repercussions on both cognition and mood. On the other distinguisyes, when animals are administered shocks that are avoidable by behavioral modification, learned helplessness does not seem to develop Seligman and Maier, In this same way, humans that have been able to successfully master distingusihes mild or moderate stressor for example, the end of a friendship or illness of a parent appear to be resilient distingiushes a variety of other later stressors Feder et al.
Stress oedinary is a form of immunity against later stressors, much in the same way that vaccines induce immunity against disease Rutter, Research in rodents supports the stress inoculation hypothesis and has suggested that this protection against some of the later negative effects may be due to neuroplasticity in the PFC induced by stress inoculation Southwick and Charney, In one study, young monkeys were presented with diosrders controllable stressor periodic short maternal separations over a course of 10 weeks Parker et al.
These monkeys experienced acute stress during the separation periods, illustrated by agitation as well as temporary increased levels of cortisol. Yet, at disordders months of age, they experienced less anxiety and lower basal stress hormone levels than monkeys who did not undergo the separations.
Additionally, at later time points, the group of stress-inoculated monkeys showed higher cognitive control, higher curiosity in a stress-free situation and larger ventromedial PFC volume Parker et al. It is important ordinar note that although research has outlined numerous ways in which developmental environment can negatively impact a person, resilience is in fact a common trait, following even the most severe adversities. Other studies have found that neural circuits involved in resilience can be froom for many years after adversity.
The fact that not all animals or humans exposed to uncontrollable traumatic experiences develop stress-related disorders clearly implies that environmental factors interact with genetic endowment and together, affect resilience. In fact, resilient genes may be sufficient to help a person overcome the most traumatic developmental events in some cases Feder et al. The findings that the developmental environment has significant effects on building and enhancing resilience from a young age impart clear messages for child rearing.
Several ordinay longitudinal studies have investigated resilience in participants from childhood or adolescence through the transition to adulthood. Results from these studies strongly indicated that key factors including positive family functioning and peer relationships, connections to supportive adults and prosocial romantic partners, planfulness, self-discipline, and cognitive ability, all contribute to a more successful transition to adulthood and more resilient functioning Burt and Paysnick, Interventional paradigms in the form of foster care, adoption, and parent training can improve the quality of parenting, family function, and attachment relationship, and in turn promote adaptive functioning and resilience in children and youth Sapienza and Masten, Children with a history of maltreatment showed lower resilient functioning than those without maltreatment Cicchetti and Rogosch, Children with exposure to war and related traumatic experiences e.
Protective factors against deleterious impact of war-related adversities in children include a strong, positive bond between the primary caregiver and the child, the social support from teachers and peers, anxiefy shared sense of values, religious beliefs that find meaning in suffering, and humor and altruism as defense mechanisms Werner, Besides children from an abusive and life-threatening environment, a ordniary identified group at risk is youth from affluent families, who may face higher risk of adjustment problems e.
Parents' lax repercussions on discovering substance use was shown to be a major vulnerability factor. Moreover, the levels of teens' symptoms rule breaking, anxious-depressed, and somatic ddisorders were found to correlate more strongly with the teens' relationships with mothers than with fathers, which may in part reflect greater amount of time spent with mothers, who are generally the primary caregivers of their children.
Therefore, positive changes in parenting for affluent youth are of critical importance, including adopting a strict zero-tolerance policy regarding students' law breaking, remaining vigilant about their children's activities outside school, and engaging in talks and workshops for families in distress and holding support groups particularly for mothers Luthar and Barkin, A review of efficacy of different interventions for children and adolescents with a history of trauma distinguisjes indicates that cognitive-behavioral treatment, in both individual and group formats, is effective in reducing psychological harm such as anxiety and depressive disorders and symptoms Wethington et al.
Stress inoculation training SITa preventive and interventional cognitive-behavioral paradigm, has been shown to be distingkishes in reducing anxiety and stress-related symptoms in adolescents Maag and Kotlash, School-based interventions, including SIT, can improve adaptive coping skills and decrease the likelihood of developing PTSD symptoms in children exposed to war Werner, Education on successful parenting should be able to help to foster children in a resilience-promoting environment and to minimize occurrence of impaired stress response through generations.
Moreover, training programs for children that focus on constructing and maintaining supportive social networks, enhancing prosocial behavior and disorderz reappraisal, and promoting coping self-efficacy and self-esteem, can all contribute to resilience building from an early age Figure 1. Significant research has been done on the psychosocial factors of stress tolerance and resilience anxitey Duryea et al.
Cognitive processes, personality traits, and active coping mechanisms, wat others, contribute to resilience. These qualities also interact with biological factors to enhance adaptation in the face and aftermath of traumatic events, and confer resilience Charney, Characteristics such as high level of intellectual functioning, efficient self-regulation, active coping styles, optimism, and secure attachment were observed in youth who had distinguihes adverse situations and settings, yet did not succumb to the adverse impact of extreme stress Richardson, Positive affect has been found to be protective in the face of stress in numerous studies.
May 09, · Depression, Diabetes and Obesity This is a case study on a year-old male, Mr. H.Y. who worked at a supermarket and is now retired. He has a supportive wife who works full time and children who are all tiktoklovehere.com has a history of smoking, . Resilience is the ability to adapt successfully in the face of stress and adversity. Stressful life events, trauma, and chronic adversity can have a substantial impact on brain function and structure, and can result in the development of posttraumatic stress disorder (PTSD), depression and other psychiatric disorders. However, most individuals do not develop such illnesses after experiencing. Apr 08, · Determining why a child acts unusually can be a difficult process. Reactive Attachment Disorder (RAD) and autism can look similar on the surface, but they work very differently and involve different therapies. Here is how to start distinguishing between the two. This article focuses on children.
The body system listings in parts A and B of the Listing of Impairments will no longer be effective on the following dates unless extended by the Commissioner or revised and promulgated again. Criteria applicable to individuals age 18 and over and to children under age 18 where criteria are appropriate.
Which musculoskeletal disorders do we evaluate under these listings? We evaluate disorders of the skeletal spine vertebral column or of the upper or lower extremities that affect musculoskeletal functioning under these listings. The skeletal spine refers to the bony structures, ligaments, and discs making up the spine. We refer to the skeletal spine in some musculoskeletal listings to differentiate it from the neurological spin e see 1.
Musculoskeletal disorders may be congenital or acquired, and may include deformities, amputations, or other abnormalities. These disorders may involve the bones or major joints; or the tendons, ligaments, muscles, or other soft tissues. We evaluate soft tissue injuries including burns or abnormalities that are under continuing surgical management see 1.
The injuries or abnormalities may affect any part of the body, including the face and skull. We evaluate curvatures of the skeletal spine that affect musculoskeletal functioning under 1. If a curvature of the skeletal spine is under continuing surgical management see 1. We evaluate a disorder or injury of the skeletal spine that results in damage to, and neurological dysfunction of, the spinal cord and its associated nerves for example, paraplegia or quadriplegia under the listings in We evaluate inflammatory arthritis for example, rheumatoid arthritis under the listings in We evaluate curvatures of the skeletal spine that interfere with your ability to breathe under the listings in 3.
We evaluate non-healing or pathological fractures due to cancer, whether it is a primary site or metastases, under the listings in We evaluate the leg pain associated with peripheral vascular claudication and foot ulceration associated with peripheral arterial disease under the listings in 4.
We evaluate burns that do not require continuing surgical management under the listings in 8. We need objective medical evidence from an acceptable medical source to establish that you have a medically determinable musculoskeletal disorder. We also need evidence from both medical and nonmedical sources, who can describe how you function, to assess the severity and duration of your musculoskeletal disorder. We will determine the extent and kinds of evidence we need from medical and nonmedical sources based on the individual facts about your disorder.
Physical examination report s. In the report s of your physical examination, we require a medical source's detailed description of the orthopedic, neurologic, or other objective clinical findings appropriate to your specific musculoskeletal disorder from his or her direct observations during your physical examination. We will not accept a report of your statements about your symptoms and limitations in place of the medical source's report of objective clinical findings. We will not use findings on imaging or other diagnostic tests see 1.
When the medical source reports that a clinical test sign s is positive, unless we have evidence to the contrary, we will assume that he or she performed the test properly and accept the medical source's interpretation of the test. For example, we will assume a straight-leg raising test was conducted properly that is, in sitting and supine positions , even if the medical source does not specify the positions in which the test was performed.
If you use an assistive device see 1. If your musculoskeletal disorder causes a reduction in muscle strength, the report must document measurement of the strength of the muscle s in question. The measurement should be based on a muscle strength grading system that is considered medically acceptable based on your age and impairments. For example, a grading system of 0 to 5, with 0 indicating complete loss of strength and 5 indicating maximum strength or equivalent medically acceptable scale see Table 1.
Reduction in muscle strength is demonstrated by evidence that your muscle strength is less than active range of motion ROM against gravity with maximum resistance. If the reduction in muscle strength involves one or both of your hands, the report must also document measurements of grip and pinch strength.
Imaging refers to medical imaging techniques, such as x-ray, computed tomography CT , magnetic resonance imaging MRI , and radionuclide scanning. For the purpose of these listings, the imaging must be consistent with the prevailing state of medical knowledge and clinical practice as the proper technique to support the evaluation of the disorder. Findings on imaging must have lasted, or be expected to last, for a continuous period of at least 12 months.
Imaging and other diagnostic tests can provide evidence of physical abnormalities; however, these abnormalities may correlate poorly with your symptoms, including pain, or with your musculoskeletal functioning. Accordingly, we will not use findings on imaging or other diagnostic tests as a substitute for findings on physical examination about your ability to function, nor can we infer severity or functional limitations based solely on such tests. Operative reports. If you have had a surgical procedure, we need a copy of the operative report, including details of the findings at surgery and information about any medical complications that may have occurred.
If we do not have the operative report, we need confirmatory evidence of the surgical procedure from a medical source for example, detailed follow-up reports or notations in the medical records concerning the surgical procedure in your medical history. Treatments for musculoskeletal disorders may have beneficial or adverse effects, and responses to treatment vary from person to person. We will evaluate all of the effects of treatment including surgical treatment, medications, and therapy on the symptoms, signs, and laboratory findings of your musculoskeletal disorder, and on your musculoskeletal functioning.
Response to treatment. To evaluate your musculoskeletal functioning in response to treatment, we need the following: A description, including the frequency of the administration, of your medications; the type and frequency of therapy you receive; and a description of your response to treatment and any complications you experience related to your musculoskeletal disorder.
The effects of treatment may be temporary or long-term. We need information over a sufficient period to determine the effects of treatment on your current musculoskeletal functioning and permit reasonable projections about your future functioning.
We will determine the amount of time that constitutes a sufficient period in consultation with a medical consultant on a case-by-case basis. In some cases, we will need additional evidence to make an assessment about your response to treatment. Your musculoskeletal disorder may meet or medically equal one of these listings regardless of whether you were prescribed opioid medication, or whether you were prescribed opioid medication and did not follow this prescribed treatment.
An assistive device, for the purposes of these listings, is any device that you use to improve your stability, dexterity, or mobility.
An assistive device can be worn see 1. This evidence must describe any limitation s in your upper or lower extremity functioning and the circumstances for which you need to use the assistive device. We do not require that you have a specific prescription for the assistive device. Prosthesis es. A prosthesis is a wearable device, such as an artificial limb, that takes the place of an absent body part.
If you have a prosthesis es , we need evidence from a medical source documenting your ability to walk, or perform fine and gross movements see 1. When amputation s involves one or both lower extremities, it is not necessary for the medical source to evaluate your ability to walk without the prosthesis es in place. If you cannot use your prosthesis es due to complications affecting your residual limb s , we need evidence from a medical source documenting the condition of your residual limb s and the medical basis for your inability to use the device s.
Orthosis es. An orthosis is a wearable device, such as a brace, that prevents or corrects a dysfunction or deformity by aligning or supporting the affected body part. If you have an orthosis es , we need evidence from a medical source documenting your ability to walk, or perform fine and gross movements see 1.
If you cannot use your orthosis es , we need evidence from a medical source documenting the medical basis for your inability to use the device s. Hand-held assistive devices.
Hand-held assistive devices include walkers, canes, or crutches, which you hold onto with your hand s to support or aid you in walking. When you use a one-handed, hand-held assistive device such as a cane with one upper extremity to walk and you cannot use your other upper extremity for fine or gross movements see 1. If you use a hand-held assistive device, we need evidence from a medical source describing how you walk with the device.
Wheeled and seated mobility devices. Wheeled and seated mobility devices are assistive devices that you use in a seated position, such as manual wheelchairs, motorized wheelchairs, rollators, and power operated vehicles. If you use a wheeled and seated mobility device, we need evidence from a medical source describing the type of wheeled and seated mobility device that you use and how you use the assistive device including any customizations or modifications to the assistive device itself or for your use of the assistive device.
For example, if you use a wheelchair that typically requires the use of both hands but has been customized for your use with one hand, then we will evaluate your use of the assistive device using the criteria in 1.
Some wheeled and seated mobility devices involve the use of both hands to use the assistive device for example, most manual wheelchairs. If you use a wheeled and seated mobility device that involves the use of both hands, then the need for the assistive device limits the use of both upper extremities.
Some wheeled and seated mobility devices involve the use of one hand to use the assistive device for example, most motorized wheelchairs. If you use a wheeled and seated mobility device that involves the use of one upper extremity and you cannot use your other upper extremity for fine or gross movements see 1. We generally need a longitudinal medical record to assess the severity and duration of your musculoskeletal disorder because the severity of symptoms, signs, and laboratory findings related to most musculoskeletal disorders may improve over time or respond to treatment.
Evidence over an extended period will show whether your musculoskeletal functioning is improving, worsening, or unchanging. For 1. When the criterion is imaging, we mean that we could reasonably expect the findings on imaging to have been present at the date of impairment or date of onset.
Once this level of severity is established, the medical record must also show that this level of severity has continued, or is expected to continue, for a continuous period of at least 12 months. Surgical treatment and physical therapy. For some musculoskeletal disorders, a medical source may recommend surgery or physical therapy PT.
If you have not yet had the recommended surgery or PT, we will not assume that these interventions will resolve your disorder or improve your functioning. We will assess each case on an individual basis. Depending on your response to treatment, or your medical sources' treatment plans, we may defer our findings regarding the effect of surgery or PT, until a sufficient period has passed to permit proper consideration or judgment about your future functioning.
Musculoskeletal disorders may cause pain or other symptoms; however, your statements about your pain or other symptoms will not alone establish that you are disabled. We will not substitute an alleged or a reported increase in the intensity of a symptom, such as pain, no matter how severe, for a medical sign or diagnostic finding present in the listing criteria. Pain is included as just one consideration in 1. To consider your symptom s , we require objective medical evidence from an acceptable medical source showing the existence of a medically determinable musculoskeletal impairment that we could reasonably expect to produce the symptom s.
How do we use the functional criteria to evaluate your musculoskeletal disorder under these listings? The functional criteria are based on impairment-related physical limitations in your ability to use both upper extremities, one or both lower extremities, or a combination of one upper and one lower extremity.
The required impairment-related physical limitation of musculoskeletal functioning must have lasted, or be expected to last, for a continuous period of at least 12 months.
We do not use the functional criteria in 1. Work environment. We use the relevant evidence that we have to evaluate your musculoskeletal functioning with respect to the work environment rather than the home environment. For example, an ability to walk independently at home without an assistive device does not, in and of itself, indicate an ability to walk without an assistive device in a work environment. Functional criteria. A musculoskeletal disorder satisfies the functional criteria of a listing when the medical documentation shows the presence of at least one of the impairment-related limitations cited in the listing.
The required impairment-related limitation of musculoskeletal functioning must be medically documented by one of the following:.
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