FCE test

Discussion in 'Fibromyalgia Main Forum' started by 2thFairyIsBroke, Oct 31, 2002.

  1. 2thFairyIsBroke

    2thFairyIsBroke New Member

    Hi, I am new to this board and just was wondering if any of you here has gone for a Functional Capability Evaluation (FCE)
    I received a letter from my attorney, and he said I would greatly benefit from it, but the cost is 500.00 and then it has to be validated by another person which costs from 300.00 to 500.00. Just wondering if anyone else has done this?If I had 5-700.00 and where he thinks I can come up with that kind of money is beyond me.Jeepers, if I had that money I would be able to get groceries and get couple bill collectors off my butt.
    [This Message was Edited on 11/01/2002]
  2. 2thFairyIsBroke

    2thFairyIsBroke New Member

    Hi, I am new to this board and just was wondering if any of you here has gone for a Functional Capability Evaluation (FCE)
    I received a letter from my attorney, and he said I would greatly benefit from it, but the cost is 500.00 and then it has to be validated by another person which costs from 300.00 to 500.00. Just wondering if anyone else has done this?If I had 5-700.00 and where he thinks I can come up with that kind of money is beyond me.Jeepers, if I had that money I would be able to get groceries and get couple bill collectors off my butt.
    [This Message was Edited on 11/01/2002]
  3. Cactuslil

    Cactuslil New Member

    Yes. While in the last stages of my SS battle "they" had the occupational specialist present; she ironically fought together with "their" own physician that I could not work in any job designated as "gainful employment".

    This after 5 years of steadfast efforts, all of which were rejected. The occupational therapist fought like a trojan with a judge that was finding it hard to understand the medical situation.

    I paid for no special tests. Good luck! CactusLil'
  4. pamj

    pamj New Member

    My LTD insurance required me to take this test, but my HMO insurance paid for it since they had my doctor order it. I'm very suprised that your attorney wants you to take this exam. Most advocates for CFS/FM are against the way this test determines what you may be capable of.

    The problem is that many of us w/CFS/FM can get ourselves dressed, maybe prepare meals, and get ourselves around the house. This does NOT mean that by doing these things, that we could perform a full-time job, and we may not even be able to do these minimal things every day. Also, many of us can sometimes push ourselves to get things done when we have to, but we feel extremely sick afterwards and may end up in bed for days.

    During the test they wanted to see if I could do the following: crawl, walk 20 feet, reach over my head, reach behind my back, etc... activities included: putting pegs into holes, squeezing a grip strength tester, using tweezers, etc...
    Of course I could do these things, I'm not claiming to be paralyzed!!!

    What the test did not show is that I was so dizzy/lightheaded, I had to lie down every 15-20 minutes for breaks, I had a blinding headache during the testing, and I fell asleep in the car on the way home & stayed in bed till the test the next day. After the second day of testing, I was in bed with high fever & worsened symptoms for the week. The testing was only 1 1/2 hours each of the 2 consecutive days, and according to the occupational therapist - she said I was ABLE to perform FULL TIME work!!! This was when my LTD insurance company denied me.

    The FCE test DOES NOT show why a person with CFS/FM is not able to perform a full-time position.

    After being denied, a friend in the legal field suggested that I get a neuro-psych exam. Even though I had to pay out of pocket ($2300) for this 3-day testing, it was the additional proof that I needed to show that I could not perform my job. It showed the memory loss, slow processing, and cognitive difficulties. It also mentioned depression & anxiety which were due to the illness. The report also noted the amount of rest required during testing, and the severe headaches while trying to focus.

    Unless your illness has you completely unable to move, I would be very hesitant about getting a FCE. Especially if you have to pay out of pocket. The reason I finally got approved was due to psychologist's report, along with the support of my other doctors validating my explanations of how this illness affects my life, and why I am unable to work.

    Good luck,
    Pam
  5. klutzo

    klutzo New Member

    An FCE will not show our almost total lack of endurance. Sure I can reach over my head, a couple of times. Ask me to do it repeatedly though, and I'll be writhing on the floor in pain and tears and my arms will go numb and be unusable for two days. DUH! They just don't get it.
    The Neuro-psych exam is what you need. I have never known anyone with FMS, and esp. CFS to not have very abnormal results on this exam. It is many tests (usuallyabout 6 hrs.) of how your brain functions, and my test results showed my brain was only functioning at 45% of normal, and I have FMS. The Neuropsychologist who examined me told me that CFS has such a distinctive pattern on the tests that he feels he can dx CFS patients sight unseen, just by looking at their Neuro-psych test results.
    Maybe you should print this thread out and take it to your attorney. He is barking up the wrong tree and it is more likely to hurt than help you.
    Klutzo
  6. Shirl

    Shirl New Member

    Hi, just stopped to welcome you to the board. I see you have received answers to your question already.


    Hope we get to hear from you often , and again welcome.


    Shalom, Shirl
  7. allhart

    allhart New Member


    this artical might help good luck,

    Fibrofog, Fibromyalgia and Dissociation
    Understanding why some memory-impaired patients with fibromyalgia score normally on neuropsychological testing.

    Frank Leavitt, Ph.D.


    Cognitive difficulties characterized by memory lapses and mental confusion frequently disable patients with fibromyalgia from carrying out their responsibilities in the work situation, but are a challenge to prove in a disability claim. Part of the problem is that the methods of disability evaluation pertaining to cognitive complaints typically involve a referral to neuropsychologists because this group is widely considered to have specialty skills in assessing cognitive functioning. Yet, many neuropsychologists are not well versed in either the limitations of neuropsychological tests or in dissociation. Probably even fewer are cognizant of the connection between FMS, dissociation and cognitive dysfunction. More often then not, neuropsychological testing will show cognitive functioning to be normal. Normal findings shift the weight of available evidence upon entering the arena of disability determination, creating an imbalance that often enables the disability claim to be denied. However, the denial may be based on a false premise.

    Our clinical and research experience suggests a way of unraveling the mysterious discrepancy between patient conviction and neuropsychological findings. Instead of the flaw residing in the patient complaint, it may well be that these patients as a group are being held to the wrong standards. Testing logic often takes the following form: if memory deficits fail to be demonstrated by scores on standard measures of memory that operationally define level of impairment, then fibromyalgia patients are overestimating or overplaying the severity of their memory decline. The logic is flawed because it does not account fully for the many ways memory failures arise and overlooks shortcomings in the testing process.

    A process prominently linked to memory impairment is dissociation. Dissociation is a failure to integrate experiences that normally go together. Short-term memory complaints of dissociatives are well known to mimic the complaints of patients with fibromyalgia that we now refer to as fibrofog . Level of dissociation fluctuates in intensity throughout the day. Variation is likely to be influenced by daily stress. With rising intensity, sensory experience is transformed into haze like sensations leaving the patients feeling as if enveloped in a fog. At more severe intensity, lapses in memory are likely to occur leaving the individual unable to remember what was said, done or planned. But cognitive testing at levels of dissociative intensity (low) that are less apt to affect memory should yield normal performance.

    Normal scores on standard cognitive tests traditionally employed in neuropsychological testing can be expected among individuals experiencing dissociation for other reasons.

    a. Cognitive tests provide indirect information about brain function. When performance is poor, brain dysfunction is inferred.
    b. Memory failure for day to day events is a well-established finding with dissociation.
    c. Dissociation is low in patients with medically established brain damage.
    d. Dissociation and conditions (brain damage) wherein impaired performance is routinely observed on cognitive tests of memory are not linked or interconnected. Therefore, there is no logical reason to expect memory difficulties arising from dissociation to be associated with impaired performance on cognitive tests. Tests of dissociation are the appropriate measure for detecting memory failures arising from dissociation.

    Poor memory is frequently traceable to compromised attention. Impaired sensory processing of tasks involving complex stimulus sources is common in patients with fibromyalgia. The deficiencies come into play when environmental stimuli require the individual to simultaneously process information from multiple channels, activity common to real life situations, but not detectable by commonly administered measures of short-term memory. Currently available cognitive measures of short-term memory rely on selective attention to a finite set of information and are therefore suitable for assessing difficulties in only a small portion of the attention spectrum. They provide a snapshot of short term memory functioning at one point in time on tasks limited to highly focalized attention. They do not provide measures of memory under heavier processing loads requiring attention to be allocated to competing stimulus sources.

    The standard cognitive measures are not sensitive to complex attentional deficits and therefore can not detect or assess difficulties related to complex information processing. They can not provide a true estimate of memory when failures are secondary to impairments in processing the multiple stimuli impinging on experience at any point in time. Because of their test structure, poor attention for simple and complex stimuli will have different consequences. Poor attention for simple stimuli will adversely affect performance scores, whereas poor attention for complex stimuli will not.

    In sum, cognitive tests do not inform us in the same way about adults with deficits in focal attention and those with deficits in divided attention. If an individual can not focus, or frequently looses their focus, cognitive performance generally falters. By contrast, when deficits are in the area of divided attention, memory in the natural setting is readily affected by distraction, but performance does not falter on cognitive tests as long as focal attention remains intact.

    Thus, shortcomings inherent in the cognitive tests obscure the very problems that are salient to complaints of people with fibrofog. Collectively, findings of 3 research studies indicate that individuals with FMS are impaired for complex attention (divided attention) and normal for focal attention. Due to insensitivity to compromised attention for complex stimuli, cognitive test scores will seriously underestimate the severity of memory problems in patients whose problems arise when they must deal with many facets of a situation simultaneously.

    Though the combination of memory complaints and normal cognitive performance may appear paradoxical, clinicians should be cautious in their interpretations of test results. Normal performance on cognitive tests does not rule out the presence of severe and disabling memory deficits in fibromyalgia patients with fibrofog.

    Our research indicates that fibrofog is a subtype of fibromyalgia connected to dissociation, wherein problems with memory and mental confusion are prominent and superimposed on the primary symptoms of FMS. Individuals presenting with fibrofog exhibit a subtype of the Fibromyalgia Syndrome of a more severe form.

    The public perception that dissociative symptoms arise solely from psychological causation is unfounded, particularly in the case of milder forms of dissociation. Causation in many of these cases may be tied to abnormalities in N-methyl-D-aspartate receptor activity. The symptomatic difficulties that unify the fibrofog syndrome are known to be produced by sleep deprivation and certain classes of drugs that affect N-methyl-D-aspartate receptor activity. By way of illustration, Ketamine is known to induce dissociative like states in psychologically healthy individuals characterized by sensations of time slowing, alterations in sensory processing, tunnel vision, feelings of being in a fog, loss of control of thought processes and poor memory. Since Ketamine is a drug known to be mediated by the blockage of N-methyl-D-aspartate receptor activity, it is conceivable that any medical disease process that interferes with NMDA activity might induce symptoms of fibrofog in otherwise psychologically healthy individuals.

    For individuals with fibrofog basing a disability claim on memory decline, the dilemma posed by non-substantiating results from supposedly "objective measures of actual memory functioning" is obvious. Hopefully, the foregoing places competing claims in a better perspective for all parties participating in the disability decision. Tests covering dissociation and complex attention should come into general use in assessing these complaints.

    Fibrofog Reference:
    Cognitive and Dissociative Manifestations in Fibromyalgia

    Journal of Clinical Rheumatology, 2002, Volume 8.
    Number 2, pp:77-84.

  8. klutzo

    klutzo New Member

    If this article is true, I must have lucked out and gotten one of the good Neuropsychologists, because he knew all about CFS and FMS and explained the differences in the way the test scores typically turn out for both groups and why. I had a head injury in the accident which triggered my FMS, so that may have made my tests worse also. But, I know someone with FMS and no injury whose test scores were worse than mine, and she went to a different Neuropsychologist.
    I still think the FCE would be a disaster though, since it does not address the inability to do a task over and over all day long like on a job.
    Klutzo