Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Topics in PT > Industrial Rehabilitation > Flashcards

Industrial Rehabilitation Flashcards

1
Q

What makes treating an injured worker
different than a Medicare patient or
group health patient (with the same diagnosis)?

A

They are more likely to do heavy lifting/ have larger requirements to meet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Role of a Claims Adjuster

A
  • Handles all Worker’s Comp cases
  • 1st report of injury
  • Sets Reserves based on ICD-10 code
  • Authorizes/Denies all medical and clinical
    treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Role of Case Manager

A
  • Only assigned to cases that are complicated,
    catastrophic, or with Hx of work-related injuries.
  • Manages the individual case to insure the claimant moves through the various phases of medical treatment and rehabilitation smoothly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Main goal of a case manager

A

To ensure the claimant receives optimum
treatment, and follows through with all treatment recommendations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definition of case management

A

A collaborative process which assesses,
plans, implements, coordinates, monitors
and evaluates the options and services
required to meet an individual’s health
needs, using communication and available
resources to promote quality, cost- effective outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Role of vocational evaluator

A
  • Only brought into the case when it appears that the injured worker will be unable to return to the previous job.
  • Determine a claimant’s employability, job placement and wage earning capacity.
  • Identifies appropriate job objectives based on education level, transferable skills, etc.
  • Helps with returning injured worker back to work as quickly and safely as possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The purpose of administering a complete and thorough vocational assessment is to determine a person’s

A
  • aptitude levels
  • achievement levels
  • vocational skills
  • temperaments
  • work values
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Industrial Rehabilitation Services

A
  • FCE (baseline, job specific, UE)
  • Work Conditioning/Hardening
  • On-Site Work Hardening
  • Job Analysis
  • On-Site RTW Consultation
  • Job Coaching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FCE Defintion

A

The FCE is a generic term used in the medical
and vocational rehabilitation communities to
denote a form of functional evaluation that
consists of a battery of tests focusing on selected work tolerance areas, consistency of effort and reliability of pain reports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an FCE for?

A
  • Provides objective information about the client’s ability to perform the essential functions of their job over an 8 hr. day
  • Provides concrete data on Consistency of Effort testing
  • Evaluates Reliability of Pain Reports
  • Identifies the need for job modification and/or an On-site RTW Consultation
  • Rules out need for surgical intervention
  • Aides in appropriate work placement/case resolution (only 40% of FCE referrals require Work Conditioning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Do you need an MD script for FCE?

A

not at direct access sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 Indicators for FCE

A

Medical, Legal, Behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medical considerations for FCE

A

– Job history of injury/re-injury
– Job involves repetitive work tasks
– Job involves Medium to Heavy work
– Complaints of pain with no substantiated
clinical findings
– Plateau in PT/OT/Medical (MTI/MMI), yet
functional difficulties evident
– Decreased work tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Behavioral Considerations

A

– Off work for more than 3 months
– Negative attitude about returning to work
– Fear of re-injury
– Suspected sub-maximal effort/compliance
issues
– Questionable legitimacy of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Legal Considerations

A
  • Objective documentation needed to RTW
  • Conflict of medical opinion about worker’s
    status (ie. Ortho MD & Occ. Med MD)
  • RTW will require job modification
  • Attorney resists work release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Different FCE Philosophies

A
  • Standardized: KEY Method, Matherson
  • Non Standardized: Hybrid, Developed In-House
  • Psychophysical: patient is in charge, based on pain and subjective complaints
  • Kinesiophysical: based on biomechanical changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

FCE Admission Criteria

A
  • Client is medically stable (i.e. resting BP <
    160/100, pulse < 100)
  • Pain has stabilized
  • Inflammation and/or swelling has stabilized
  • Soft tissue dysfunctions have been
    addressed
  • Passive mobility has plateaued over a 2 week period
  • Client can tolerate 2 hrs. exercise/activity
  • Client should demonstrate absence of major psychiatric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the admission requirements for patients with lumbo-sacral injuries?

A

– Pelvic symmetry or status plateaued
– Trunk strengthening addressed
– 45° hamstring length
– 30 second static partial sit up
– 75% squat for 45 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

before doing an FCE for a patient with cervical and shoulder injuries what should you assess?

A

scapular strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Baseline FCE

A
  • Assessment of the functional ability to perform the spectrum of work tolerances related to the physical demand factors of job tasks
  • Best suited when restricted duty is available or RTW to previous job is highly improbably
  • initiated with M-S eval
  • Addresses consistency of effort and reliability of pain testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Job Specific FCE/WCE

A

– Assessment of the match between the client’s functional capabilities and the critical demands of a specific job
– Answers the referral question: “Can the client return to work to the previous job?”
– Accomplished by evaluating work tolerances with specific parameters and the use of structured work simulations
– Initiated with M-S eval
– Addresses Consistency of Effort (COE) and Reliability of Pain (ROP) testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UE FCE

A
  • Initiated with M-S eval
  • Assessment of only the physical capabilities and tolerances that incorporate UE usage
  • Will NOT evaluate sitting, standing, stoop, squat, kneel, couch, stair climb
  • Address COE and ROP testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When answering the question “can the client return to work to the previous job?,” what should you test?

A

only the physical capabilities and tolerances specific to job

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When answering the question, “with restricted duty available, what can the client do now?” what should you test?

A
  • evaluate all the physical capabilities and tolerances
  • may be candidate for on-site work hardening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
when answering the question "with a catastrophic case, what can the client functionally do?" what should you test?
- Evaluate ALL physical capability and tolerances - determine employability - may be candidate for On-Site RTW Consultation to assist in work transition
26
Evaluation Process
* Varies: 3-5 hours; avg. 4 hrs. * Musculo-Skeletal Evaluation * Consistency of Effort (COE) testing * Reliability of Pain (ROP) testing * Objective Functional Tolerance testing * Repeat 1 & 2 hand lifting (reliability) * Functional Simulation Circuit
27
What determines the stopping point of the FCE?
- determined by the most limiting of the 3 domains (biomechanical, cardiovascular-metabolic, psycho-physical) - HR can go up 20 bpm
28
What is the most limiting domain?
Psychophysical – Governs expended effort in biomechanical and/or cardiovascular-metabolic domains – Good evaluator is skilled in the reliable evaluation of psychophysical domain.
29
What approach should be taken when pain behavior is believed to be questionable?
* Physical effort testing is particularly useful to rule-out fatigue, fear and biomechanical impairment which may lead to inconsistent performance
30
Reliability of Pain Reports
* Indication as to the extent to which one is able to rely on clients subjective reports (not a measure of effort) * Subject of client reported pain has been a dividing issue between various FCE systems
31
Tests for reliability of client reports
- intro/intake interview - Sorts (Spine Function Sort, Hand Function Sort) - Pain Questionnaires - Activity Questionnaires
32
Clients Behaviors, Observations, and Movements Which When Present, May Suggest Issues With ROP
- Medical inconsistencies - adjusting history - Client avoids answering direct question - Blaming others - Symptoms reports and functional limitations which are inconsistent with posture and movement patterns
33
Red Flags on Ransford Pain Drawing
- total body and non specific drawing - does not follow pain referral pattern - Combination of multiple systems - 0-2: more reliable - 3 or more: there's a problem
34
Red Flags with Symptoms Grading Scale
– Almost always 7 or above; often 10 when sitting or doing easy tasks. Should be in obvious distress. – May be reported as 15 - 20 on scale of 1-10 – No attempt to decrease symptoms with proper posture – Symptoms do not decrease with rest or medication
35
Other ROP Tools
- Visual analog scale (should be within 1.5 to numeric pain scale) - McGills Pain Questionnaire - Oswestry: LBP - NDI: Cervical - DASH: UE - LEFS - Pain disability index
36
Tests for Reliability of Pain Reports within MS Evaluation
- Repetitive movement tests - Waddell's Non-Organic Signs (LB pts) - Hoovers Test - Distractionary Testing
37
Purpose of consistency of effort testing
- Determine maximal vs. sub max effort - identify unresolved medical/rehab deficits - provide case direction/resolution ** to be statically significant, you need 20 to 30 things tested
38
When should you perform consistency of effort testing?
throughout the FCE
39
COE Tests
- HR Monitoring - Spinal Inclinometer - Jamar Hand Grip Testing - Rapid Exchange Grip Test - Pinch Testing (or distal UE diagnoses) - Static Strength Testing (arm, push, leg)
40
Types of Physical Effort
1. Maximal effort: consistent performance (70% or above) 2. Questionable Effort: concern is raised (60-69;99%) 3. Sub maximal effort: inconsistent performance (<60%) **With 2 & 3 client is capable of greater functional abilities than those demonstrated or client is capable of functioning at a higher category of work
41
learn the strength chart for sedentary, light, medium, etc
42
defining physical demand level
2 hand lifting 2 hand carrying 2 hand push/pull walking MET level
43
lifting levels
floor to waist waist to shoulder shoulder to overhead
44
fitness testing
- metabolic endurance testing - according to Dictionary of Occupational Titles - can also use client's MET level to identify physical demand level classification
45
Medium dexterity tests
– Valpar #9 – Whole Body ROM – Bennett Hand Tool Dexterity – Minnesota Rate of Manipulation – 9 Hole Peg Test
46
Fine motor dexterity tests
― Purdue Pegboard Test ― Various Valpar work samples available
47
Definition of work conditioning
– An intensive, work-related, goal oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions and cardiopulmonary functions
48
what is the objective of work conditioning
restore physical capacity and function to enable the patient/client to return to work
49
how often/long is work conditioning
- up to 4 hr/day - 3-5 times/week - 3-4 weeks
50
what format is work conditioning
circuit - utilizes physical conditioning functional activities related to work
51
short term work conditioning program
- strength - flexibility - endurance - coordination - return to work goal
52
Entry criteria for work conditioning
- no longer in acute phase of therapy --> don't need hands on - unable to safely return to work due to weakness or deconditioning - client needs to increase functional tolerance or endurance - program approved by insurance - should be requesting finite duration based on clients needs
53
does work conditioning require a doctors prescription?
yes
54
3 phases of APTA work conditioning guidelines
- aerobic phase - strengthening phase - functional phase
55
definition of work hardening
– A highly structured, goal-oriented conditioning program designed specifically to return the client to work - Often interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions. - Addresses issues of productivity, safety, physical tolerances, and worker behaviors
56
is work hardening a prevalent service in most states?
nope
57
How often is work hardening?
- Up to 8 hr/day - 5 times/week - 4-6 weeks
58
aspects of work hardening
- utilizes simulated work action - interdisciplinary model - behavioral and vocational dysfunction - productivity - safety - physical tolerances - work behaviors
59
Entry criteria for work hardening
* Full ambulation * Unable to safely return to full duty * Non-related medical problem stabilized * Able to tolerate more than 3-4 hrs/day * Able to tolerate more than 3 days/week * No need for therapy * Doctor prescription * Program approved by insurance * Should be preceded with functional testing (in acute PT/OT or a Work Conditioning Eval
60
do you need an FCE after work conditioning/work hardening?
nope
61
Will work conditioning be successful if the client demonstrates an inconsistent effort or issues with ROP during FCE?
probs not
62
what happens if a client exhibits a consistent performance (COE & ROP) during the FCE and there is more than a 30# disparity between the current and required physical demand level?
there is a high probability that the client will have difficulty returning to full work duty
63
Ergonomics definition
– The relationship among the worker; the work that is done; the actions, tasks, or activities inherent in the work and the environment in which the work is performed
64
what is the primary goal of ergonomics
to improve worker safety and performance
65
OSHA
Occupational Safety and Health Administration – OSHA has regulations which address musculoskeletal disorders (MSD’s). – These regulations define workplace musculoskeletal disorders (WMSD’s). – By defining WMSD’s, one can determine the presence of liability and the likelihood of benefits
66
risk factors for ergonomic problems
- repetition - awkward postures - force - contact stress - vibration
67
NIOSH
National Institute of Occupational Safety and Health * NIOSH develops standards for safety in the workplace

Topics in PT (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions