Industrial work rehab and return to work involve the ______, __________, _________, ___________, ____________
Client, employer, human resources department, safety personnel, case managers
OTAs have the role as ________
educators
Americans with Disabilities Act
Legislation governing employment practices and public accommodations for people with disabilities
Occupational Safety and Health Administration (OSHA)
Ensure safe and healthful working conditions by setting and enforcing standards and by providing training, outreach, education, and assistance.
Workplace safety, lifting ergonomics, ergonomics to reduce workplace injury
The National Institute of Occupational Safety and Health (NIOSH)
Federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness.
Provides workplace safety, injury, hazards, prevention, ergonomics
Occupational Information Network (O*NET)
an online job description database developed by the Labor Department
Work-related musculoskeletal disorders (WSMDs)
-those affecting the muscles, tendons, and nerve
-slow and insidious onset: result of microtrauma
-1/3 of all occupational injuries and illnesses in US
-injury sustained in a fall is not considered a musculoskeletal disorder per the U.S. Department of Lab
Back and neck rehabilitation provides..
Strategies focused on improving fitness, job comfort, and workplace safety for workers to prevent injury or retrain clients after injury
Back & Neck Rehab:
____are one form of rating scales that may be used to asses a clients body mechanics but are not useful in determining the clients actual body movements
Checklists
True or False:
Body mechanics instruments have established reliability and validity and are sensitive to change in task performance
False
The OTA assesses for ergonomic risk factors including:
Forceful exertions, repetition, awkward posture, contact stress, excessive vibration, cold temperatures
In what ways does the OTA provide strategies to maintain ergonomic principles?
-body mechanic and postural alignment strategies
- keep spine in alignment
- hold objects close to center of gravity
- avoid twisting through spine by facing object string any on
- use both sides of body equally, maintain wide base of support
Environmental fit:
Work environment redesign through workstation modification, proper tool access and fit, proper materials handling, and environmental adjustments such as temperature and lighting
Symptom Magnification
Manipulating society with display of symptoms
Unconscious and conscious behavior
Malingering
Deliberate faking of symptoms to avoid work or responsibility to achieve personal gain
Four types of symptom magnification are unconscious:
Refugee
Symptom misinterpreted
Game player
Identified patient
The refugee
Uses symptoms to escape undeliverable conflict
The symptom misinterpreter
Responds to changes in body in extreme manner bc of difficulty processing sensory and kinesthetic input or unrealistic belief systems about manner in which body works
The Game player
consciously attempts to convince those working with him or her of the reality of symptoms for positive gain
The identified patient
assumes the patient role as a lifestyle
The symptom minimizer
client who keeps symptoms hidden so he or she can return to normal activity or avoid appearing weak
Identification of symptom magnification is required as part of _____
FCE (functional capacity evaluation)
The clinician should screen for behaviors, symptoms, and signs that are inconsistent clients medical history
A common assessment used to assist clinician in determining maximum efforts is the _____
5 level grip test:
Client instructed to grasp dynamometerat each setting handle on dynamometer. Strongest grip expected on second and third settings. Results expected to fall in bell shaped curve.
Injury prevention program:
Primary intervention goal-
Identify and reduce risk factors early before injuries occur to promote healthy work habits and lifestyles
Injury prevention program:
Secondary prevention goal-
Early identification of symptom related risk factors, ultimately to reduce duration, severity, and cost of work related injuries
Injury prevention program
Tertiary prevention goal-
Occurs after an injury or illness has been diagnosed, interventions for us on medically treating the work related injury and restoring work role
Job demands analysis involves use of...
Questionnaires, interviews, observations, formal assessments completed in real work environment
The DOT
Defines physical demands of work using standardized classification system and defined occupations in the United States.
DOT specifications of physical demands of work:
-Lifting
-Standing
-Walking
-Sitting
-Carrying
-Pushing
-Pulling
-Climbing
-Balancing
-Stooping
-Kneeling
-Crouching
-Crawling
-Reaching
-Handling
-Fingering
-Feeling
-Talking
-Hearing
-Seeing
sedentary work
exerting as much as 10# of force occasionally, using negligible amount of force frequently to move objects, and involves sitting most of time
Light work
exerting as much as 20# of force occasionally, 10# frequently, or negligible amount constantly to move objects; may require walking/standing to significant degree or maintaining a production rate pace
Medium work
exerting 20-50# of force occasionally, 10-25# frequently, <10# constantly to move objects
heavy work
50-100 lb force occasionally, 25-50 lb of force frequently, 10-20 lb of force constantly to move objects
Very heavy work
100 lb occasionally, in excess of 50 lb force frequently, or in excess of 20 lb of force constantly to move objects
_____________________screening is used to assess clients physical and cognitive abilities to meet general or specific demands of essential function of job.
Work tolerance screening
Documentation of work tolerance screening should specify...
Weight limits
Activity tolerance in time
Restrictions within environment
Report of pain
OT observations
common ergonomic risk factors
- repetitive movement
- forceful/prolonged exertion of hands
- frequent or heavy lifting, pushing, pulling, carrying
- awkward or static postures
- excessive vibration
- excessive temperatures
- poor body mechanics
Identify work station and environmental setup
Workstation height
Seat height
Monitor height
Keyboard/ mouse height
Position of commonly used items
Tools
Work Readiness
provide individuals with a process to help them identify goals for work and identify a plan for returning to work
Work conditioning/work hardening
outcome focused, individualized, interdisciplinary program that addresses:
-medical
-physical
-psychological
-behavioral
-physical
-functional
-vocational components of employment
**task replication
-can participate once high levels of stress no longer po
Work hardening May include...
Warm up, cool down exercises, conditioning exercises, practice body mechanics, use of job modifications
hierarchy of functional return
gradation from gross to fine motor, from less to more resistive, from skill to speed focused, and from simple to complex
Work conditioning is specifically designed to restore....
Clients systematic, neuromuscular skeletal function. Focus is on limited work tasks with more emphasis on exercise, aerobic conditioning, education
Worksite evaluations are ____ assessments to determine whether an individual can return to work after onset of disability or can benefit from reasonable accommodations.
On the job
Light or modified duty programming
allows a worker to temporarily perform job duties with less physical demand
Functional Capacity Evaluation (FCE)
Objective assessment of persons in ability to preform work related tasks and is core of all return to work programs.
True or false:
Most job accommodations are very expensive
False.
Most cost nothing.
Reasonable Accommodation
A change in the work environment or the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.
Qualified individual with a disability
an individual with a disability who is able to perform, with reasonable accommodation, the requirements of the job in question, despite the disability
Reasonable accommodations may include
-changes to environment
-job restructuring
-modified schedules
-job reassignment
- modification time equipment
- training manuals
- adjustment of examinations
- readers/interpreters
Vocational Evaluation
provides information about a person's capacities and interests for work in situations when he or she has not worked before or is looking for a new job after injury or illness
Job coaching is necessary when
A client is unable to return to work because injury or illness prevents him from fulfilling job requirements.
Work programs require _____ documentation than acute therapy
More.
Use of progress notes, daily notes, daily schedule & circuits sheets