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Treatment > Industrial Rehab > Flashcards

Industrial Rehab Flashcards

1
Q

Role of OT

A

Evaluation (specific or consultation)
- Individual, job, body part
Intervention (specific or consultation)
- Preventative
- Restorative
- Compensatory

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2
Q

Other names for industrial rehab

A

Occupational Rehabilitation
Work Training
“Always Working”
“Work Start”
“The Industrial Athlete”
Others

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3
Q

Industrial rehab includes

A

Functional (or Physical) Capacity Evaluations (FCE or PCE)
Vocational Evaluation
Job Demand Analysis (Job Description Development) (JDA)
Worksite evaluation and treatment
Pre-employment screening
Work hardening or conditioning
Modified/transitional employment
Education
Ergonomics
Wellness and prevention programs

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4
Q

Typical diagnoses seen

A

Can run from CHI to spinal cord
Work related musculoskeletal disorders
Repetitive stress injury

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5
Q

Functional (physical) capacity evaluations

A

Objective assessment of a client’s ability to safely complete a job- or work-related activity
Heavy on task analysis
Must be valid!
Used to:
- Be the “initial evaluation” to set goals for rehab
- Assess current work capacity
- Determine disability status/ close a case
- Screen for new hire

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6
Q

Components of the FCE

A

FCE’s can be very different (just like initial evaluations)-2-8 hours
Typical Components:
- Interview with client
*Comparison of job duties
*Goals and desires
*All that psych comes into play here!
- Physical exam: AROM, MMT, sensation, cardiac screen (MET levels) balance scale, pain, etc.
- Functional performance
* What you saw them do
* Must be safe to count
* Can be basic or computer driven
* Work tolerance and effort or cooperation
- Psychological screen
* Depression Index
* Indicators of consistency
* Ransford pain diagram
- Formation of recommendations
* Acute therapy
* Work hardening
* Discharge to return to work
* Other referral
- Formal report
* Expect to go to court!
* Be careful what you say or write, it will be true forever!

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7
Q

Referral (reimbursement for FCE) or other aspects

A

Can come from:
- Physicians
- Insurance companies
- Case managers
- Employers
Medicare and Blue Cross are not usually involved in this area.
Need to know state law in regard to requirements

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8
Q

Components commonly tested

A

Lifting (materials handling): often a separate section
- Static: can be used to get a baseline or start portion
- Dynamic: always preferred
- Various Levels – floor to waist, waist to shoulder, shoulder to overhead
- Various times: occasional, frequent, constant
Positioning

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9
Q

Positional testing

A

Kneeling
Standing
Walking
Sitting
Carrying
Pushing
Pulling
Balancing
Stooping
Materials handling
Crouching
Crawling
Reaching
Handling
Feeling
Climbing
Hearing
Seeing
Other

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10
Q

The DOT

A

GOE: 06.04.15 STRENGTH: M GED: R2 M2 L2 SVP: 3 DLU: 77
What does it mean??
GOE: Guide for Occupational Exploration
- 06=industry, 04= the work group (similar ed levels), .15= work group- interests, aptitudes and adaptability
Strength: based on level of work required (see chart in next slide).
M= Medium
GED=General Education Development-Ed level required (formal and informal)-1= commonsense and one and two step instructions, basic add and sub, two and three syllibul words,
- R= reasoning
- M=math
- L= language
* 6 is the highest, scientific process and logic, advanced calculus, literature, scientific and technical journals
SPV= Specific Vocational Training
1-9, length of “on the job training”
1- short demonstration only
9= 10 year or more
DLU- Date last updated
77=1977

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11
Q

Most common way to characterize work loads

A
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12
Q

Definition of demand frequency

A

Never: activity does not occur as part of the job
Occasionally: up to 1/3 of the day
Frequently: 1/3 - 2/3 of the day
Constantly: 2/3 - full day

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13
Q

Job Demands Analysis

A

Formally called Job Description
Details the:
- Essential elements of the job
- Physical requirements
- Cognitive requirements
- Educational requirements
- Equipment operated
- Environmental exposure
Developed based on:
- Observations
- Formal reports
- Interviews
- Questionnaires
- Often involves pictures
Usually the basis for the FCE

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14
Q

FCE vs. vocational evaluation

A

The Voc Eval is typically done by a Vocational Evaluator
- Sometimes that is an OT or PT
The FCE might be a part of the Voc Eval, but there will be more:
- Education evaluation
- Aptitude and interests
- FCE results
- Cognitive results
- Skills
- Emotional stability
- Work habits and tolerance

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15
Q

Two types of Voc Evals

A
  • General
  • Looks at a clients potential to do any type of work
  • People who have never worked, don’t have a job to go back to, or are not able to go back to a previous job
  • Specific
  • For someone who wants to return to a specific type of job
  • Includes elements of that job
  • Accommodations
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16
Q

Work hardening/conditioning

A

Thousands of different names:
- “Work Start”, “Re-Work”, “Always Working”
What they have in common:
- Based on job analysis
- Components of conditioning (cardio) and work simulation
- Multidisciplinary-OT, PT, ATC, Exercise Science
* New Rules as they apply to billing ect
Differences:
- Time- 2hours to 8 hours, 3 x week vs 5x week
- Onsite vs off site/transition programs
- Specific to employment market
* Forestry vs factory

17
Q

Issues in work hardening

A

Motivational issues
- Fear
- Malingering
- Secondary Gain
- Fraud
- Employer attitude
* Willingness to make accommodations
* Only come back at 100%
Can’t leave your psych behind
Time is of the essence!!
- With therapy in the first 3 months: 50% RTW
- Those 12 months off the job only: 18% RTW

18
Q

Basic rules of ergonomics

A

Plan the lift or motion before you do it – what is the best way for your back, not necessarily the most automatic motion. Make sure the lift is within your capability.
Stand close to the load and face it.
Keep the weight close to your body.
Get a firm footing. Keep your feet apart for a more stable base of support.
Bend at the knees and hips, not from the waist.
Don’t twist from the waist – pivot on your feet or take a small step to turn instead of twisting.
Use the largest muscles to do the job – leg muscles are much stronger than arm
Tighten your abdominal muscles when moving objects. These muscles are nature’s corset, and keeping them firm will help protect your back. Core Strength
Lift smoothly with a single fluid motion – avoid jerking.
Keep your spine in a balanced (neutral) position. You should not be hunched over or swaybacked – both extremes are hard on your spine.
Stay in shape
Push instead of Pull

19
Q

Others who get involved

A

Attorney’s
Families
OSHA - Occupational Safety and Health Administration
- Developing and enforcing workplace safety and health regulations
- Investigates and can fine, or shut down
NIOSH - The National Institute for Occupational Safety and Health
- Conducts research and makes recommendations for preventing work place injury and illness.

20
Q

Injury prevention programs

A

Primary: healthy individuals to keep then from getting hurt
- Hard hat
- Stretching program
Secondary: early stages of the disease to prevent it from getting worse or progressing
- Ergonomics after a flare up
Tertiary: deals with people after there is a problems
- Industrial rehab

21
Q

Pre-employment/ post-offer testing

A

Variety of Tests to see if an individual is able to complete the essential elements of a job
EEOC mandates that the Pre-Employment testing not have an adverse effect on any group-race, color, religion, sex, or national origin.
The process must be:
- Valid
- Of business necessity
- Bona fide occupational requirements
- Based on job description
- Test only essential function
- Dynamic testing is highly recommended
- Can be onsite or off site
- Use equipment associated with the job when possible

22
Q

Pre-employment testing

A

Typically completed after an offer is made
EEOC forbids:
- Monitoring of BP or heart rate
- Questions regarding medical history
Results are pass or fail
Don’t have to test all jobs (usually the high risk)
Don’t have to test all elements (usually high risk)
Do have to test all that apply for that job
If they pass, they are typically hired.

23
Q

What if they fail a pre-employment test?

A

It varies
The employer can rescind the offer
Can allow the employee to improve and retake
Have to see if it is due to a disability
- ADA and reasonable accommodation comes into play

24
Q

Future and emerging areas

A

Work Readiness Programs and Training Centers
- After non work related injury
- Special populations
- High school graduates
- Drop outs
Homeless shelter programs
Prison Programs
Welfare to work
Ticket to Work-SSI and SSDI
Roles for OT:
- Run the programs, therapist
- Advisory panels
- Support services

25
Q

What is joint protection?

A

Term commonly associated with RA and OA, but applies to all joints
Joint “warranty” is about 35 years
Should start at 18, effects are cumulative!
The goal with joint protection is:
- Prevent deformity (often further deformity)
- Prevent or mediate Pain
- Maintain Function

26
Q

Common principles of joint protection

A

Respect pain
Maintain normal muscle strength and joint ROM
Use joints in their most stable anatomical position
Avoid positions of common deformity
- Ulnar drift
Use larger, stronger joints first
Use correct patterns of movement and avoid “odd” positions or positions of stress
Avoid tasks that cannot be stopped
Reduce force
- Other joints
- Help
- Tools
Balance rest and work

27
Q

Other things to protect our joints

A

Deal with the issues ASAP
Pain, inflammation, instability
Forget “no pain, no gain”
Splint as needed
Modify the environment
- Light weight, durable, attractive
- Simply to operate
- Reduces stress, doesn’t cause new stresses
- In accord with self image

28
Q

Sex and joints

A

Very important ADL
Keep it simple
Medication planning
Time of day
ROM exercises and staying active, pain free
Warm bed with electric blankets

29
Q

Energy conservation/work simplification

A

Breaking up physically active periods with rest, resulting in an increased amount of physical activity
Finding a way to lower the required MET level of a task, complete the task with less effort and energy
Tasks identified that require large energy consumption:
- Speed or increased rate
- Increased resistance
- Increasing the use of large muscles
- Increasing need for trunk stability
- Raising arms over head or unsupported
- Isometric work or straining

30
Q

Other things with energy conservation

A

Check vitals as appropriate
Humidity level/ context
- Fans in bathroom
- Cooler baths or showers
- Moving to the guest room if it is closer to the kitchen and on the first floor
Adaptive equipment
- Shower chairs
- Rolling carts in kitchen or laundry
Changing the task
- Sending laundry out
- Hiring someone
- Not making up the bed
Planning tasks ahead of time and breaking them down
- Laundry on Monday, iron on Tuesday
- Prep meal in the morning, cook in the evening

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