Impairment rating for the person with an amputation requires a total body assessment in addition to the amputated extremity. In particular, those systems essential for prosthetic wear and function, skin coverage, sensation and motor function, and proximal joint range-of-motion should be included. Spinal function, pain, and psychological impairment frequently are involved as secondary issues related to the amputation. All of these systems must be assessed, and a determination must be made whether permanent impairment is present. The final calculation of the impairment rating uses the appropriate body systems and worksheets. Most people with an amputation will have some appropriate work restrictions applied, and all will have future medical needs.