Chapter 16: Mastery of the Environment & Work Flashcards
Omnibus Budget Reconciliation Act (OBRA)
Mandates that physical restraints cannot be used without proper justification, agreement, and documentation
Principles of Universal Design
Equitable: design is useful and marketable to people with diverse abilities. Flexibility in use: design accommodates wide range of preference and abilities. Simple and intuitive use: easy to understand regardless of cognitive abilities or language. Perceptible information: variety of modes to communicate (uses picture, verbal, tactile), high contrast etc. Tolerance for Error: provide warnings, design minimizes hazards. Low Physical Effort: design can be used efficiently with a minimum of fatigue. Size & Space for Approach & Use.
Minimum doorway clearance width for w/c
minimum is 32 inches, ideal is 36 inches
Hallway width minimum
36 inches
360 w/c turning space requirement
60 inches x 60 inches
Pathway and walkway minimum width
48 inches
Ramps width and slope
width 36 inches, slope ratio 1:12 (for every 1 inch of vertical rise, 12 inches of ramp is required)
When are 4’x4’ landings (level platforms) indicated?
If the ramp is excessively long for resting, if the person using the ramp has limited UE strength or cardiopulmonary capacity, sharp turns.
When are 4’x4’ landings (level platforms) indicated?
If the ramp is excessively long for resting, if the person using the ramp has limited UE strength or cardiopulmonary capacity, sharp turns.
Lofstrand Crutches
Proximal arm has closure around it instead of support in axillary region.
Bed mobility post hip replacement
May not be permitted to roll onto non operated side. This may result in internal rotation of operated hip. May require abductor pillow between LEs.
Bed mobility post CVA
Side lying for sleeping: Humeral flexion and slight abduction, may require pillows between knees
Supplemental Transportation
Volunteer, nonprofit, or community-based transport for older adults and people with disabilites. Based on being available, acceptable, accessible, adaptable, and affordable.
SAFETEA-LU Act
The safe, accountable, flexible, efficient transportation equity act: A legacy for users. Established safe routes for walking and biking to schools.
Community mobility intervention: Systems-level intervention
Addressing community mobility by consultation with transportation systems on issues such as design and accessibility.
Primary programs
focus on protecting healthy workers against a targeted condition before the condition occurs.
Secondary programs
emphasize early detection and intervention with asymptomatic workers at risk for work-related medical problems or treatment of workers with mild medical symptoms or reversible stages of injury. Comprehensive injury prevention programs incorporate all three phases of prevention programs (primary, secondary, and tertiary) and may include worksite and ergonomic interventions.
tertiary prevention program
occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications.
Ergonomics Intervention: Engineering Controls
Modifications of the environment, the workstation, and setup. e.g. workstation checklist, workstation components such as the keyboard
Ergonomics Intervention: Work Practice Controls
Modification of work habits through adaptive devices or strategies. Implementing factorywide stretching exercises is an example of work practice controls.
Ergonomics Intervention: Administrative Controls
Changes in line speed, staffing, physical demands of job, enforcing rest breaks, worker education, etc.
Work Readiness Program
Identify goals for work and makes a plan for returning to work. Used only for RETURNING to work, not in transitional programs. Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities.
Work Hardening
interdisciplinary, real or simulated work, address productivity, safety, physical tolerance, and behaviors. CARF accreditation required.
Work Conditioning Program
One discipline provides services, real or simulated work, addresses flexibility, strength, and endurance.
Job Demand Analysis
Defines the actual demands of the job through questionnaires, interviews, observation, assessments, official job description, all at the workplace. It is essential to determine which parts of the job are essential vs marginal.
Work Tolerance Screening
Assesses a client’s physical and cognitive abilities to meet the demands of a job they got offered.
Worksite Evaluation
On the site assessment to determine whether a client can return to work after disability and if they need reasonable accomodations
Indications to perform a Functional Capacity Evaluation:
To identify worker restrictions and to determine whether the person has the capacity for a job. A means to confirm or rule out a diagnosis, to limit physicians liability, to determine whether a worker is a candidate for remedial/vocational rehab, to see if the worker has been abused by the system, to determine reasonable accommodations, to determine impairment and disability ratings.
Functional Capacity Evaluation (FCE)
provides information about a client’s physical abilities to complete a specific job activity. The core of all return to work programs. Assessment of a person’s ability to work through review of medical charts, interview, musculoskeletal screening, physical performance, formation of recommendations, and report generation. Not recommended for novice clinician to perform.
Indications to perform a Functional Capacity Evaluation:
To identify worker restrictions and to determine whether the person has the capacity for a job. A means to confirm or rule out a diagnosis, to limit physicians liability, to determine whether a worker is a candidate for remedial/vocational rehab, to see if the worker has been abused by the system, to determine reasonable accommodations, to determine impairment and disability ratings.
Vocational Evaluation
may be conducted for a person who has not worked previously, who has been injured and is preparing to return to work, or is unable to return to a previous job. Vocational evaluation may be general or specific addressing a person’s potential for work or readiness to return to a specific occupation.Assesses person’s capacities and interests for work in new work settings.
Workbench Heights
Precision work: above the elbow, light work: just below the elbow, Heavy work: 4-6 inches below elbow.
transition-related evaluation
uses situational observation, interview, and activity analysis to determine a match between the client’s abilities and expected occupational performance.
disability rating
considers the worker’s impairment and the impact of the impairment on the client’s ability to perform preinjury for any job and considers the unique characteristics of the job. (Impairment rating does not take into account the unique factors relating to worker vocation.)
impairment rating
relates to the percentage of whole-body function and translates to a final monetary settlement for an injured worker. Impairment rating focuses on permanent quantifiable physical loss related to injury when the client is considered to be at the maximum medical endpoint (after all therapy)
Fitness-for-duty tests
completed by occupational medicine physicians after injury
Job coaching
provides vocational evaluation to identify a client’s vocational interests and abilities along with physical and mental tolerances for general job activities
Work tolerance screenings
Usually done after someone has a job offer. Assesses physical and cognitive abilities to meet demands of job. identifies limitations in the worker’s ability to meet the activity demands of essential job functions, such as weights, distances, forces, angles, repetitions, and tools. .
hierarchy of functional return
gradual gradation of tasks from gross to fine motor movements, increased resistance, and repetition from simple to complex tasks with postural changes to promote neuromuscular reeducation. E.g.: Manipulation of small objects, performance of reaching tasks, lifting objects with increasing speed and resistance from floor to waist
Four characteristics of successful implementation of a successful work injury prevention program
ongoing management support, supervisory support, employee participation, and ongoing support and reinforcement of program
Work therapy
work tasks to improve function during the acute rehabilitation phase of recovery.
