Industrial Rehabilitation Flashcards
1
Q
What is the most commonly sighted risk factor for occupational injury?
A
Sitting
2
Q
Other than sitting, what are commonly sighted risk factors for occupational injury?
A
Physically demanding work
Pushing/pulling
Whole body vibration
Twisting and flexion
3
Q
T/f: reports of hand/wrist, shoulder, elbow/forearm, and LBP and them causing missed work is decreasing
A
False, they are increasing
4
Q
What body segment makes up 50% of all MSK disorder cases?
A
Lumbar
5
Q
With lumbar injuries, what is the median days to return to work?
A
7
6
Q
T/f: about 100 million days are lost from work per year bc of LBP in the US
A
True
7
Q
When is acute pain typically present?
A
In the first month
8
Q
When is chronic pain usually present?
A
Longer than 3 months
9
Q
What is a major cause of work absenteeism that accounts for a high proportion of occupational disability costs?
A
Work related LBP
10
Q
What injury makes up 70% of works comp cases?
A
Work related LBP
11
Q
Work related LBP makes up what percent of all LBP?
A
7%
12
Q
T/f: the longer someone is off work, the less likely they are to return to work
A
True
13
Q
What psychosocial factors in people with acute WRLBP predicts who would be off work for 4 weeks after the onset?
A
The individuals opinion of whether or not they would return to work
14
Q
LBP disability is highly associated with what 7 variables?
A
Work that involves heavy physical demand
Inability to modify work
Stressful work demands
Lack of workplace social support
Job dissatisfaction
Poor expectation of recovery and return to work
Fear of re injury
15
Q
What heavy physical demands can make it hard to get pts motivated to go back to work?
A
Bending, lifting, pushing, or pulling heavy objects for a long period of time at work
16
Q
What stressful work demands make it hard to get pts motivated to go back to work?
A
Time pressure
Productivity demands
Inability to control the speed of work
17
Q
What is piece rate and how is it related to workplace disability?
A
Piece rate is having to produce a certain number of products per day and getting bonuses when exceeded
It makes it hard to get pts to go easy at work when they know they’ll get paid more for doing more
18
Q
What factors contribute to lack of workplace social support?
A
Isolated work environment
Unusual work hours
New place of employment
Recent departmental transfer
Past conflicts with coworkers/supervisors
Difficulty developing social ties in the workplace
19
Q
What factors contribute to job dissatisfaction?
A
Unrewarding job
Few prospects for transfer or advancement
Overall discontent for the job
20
Q
Who is involved in caring for work injuries?
A
The pt
Employer
Insurance carrier
Physician
PT
nurse case manager
Lawyer
21
Q
Who is typically involved in normal pt cases?
A
Physician
PT
The pt
22
Q
T/f: in workers comp cases, we should ONLY be working on the work related injury
A
True
23
Q
What is the works comp panel?
A
Pre approved providers in various medical domains who are approved to treat an injured work from a particular company
24
Q
What practitioners for works comp pts do they have to go to in their first 90 days of care?
A
To practitioners workers comp panel
25
The complex environment of works comp involves interaction between what factors?
Work demands
Worker capacity
Work environment
Work benefits
26
T/f: workers capacity changes with age and changing health status
True
27
Where do PTs fit in to works comp?
First and foremost, we treat pain and other impairments along with the fxnal deficits with an eye on regaining fxn
28
The natural focus of PT in workers comp is on work activity, but it is good to inquire about what else?
ADLs and hobbies to take into account the whole person
29
T/f: in workers comp cases we are serving the pt but we are also serving the company
True
30
Who are we examining in workers comp?
Individuals with work related impairments, activity limitation, or participation restrictions
Or individuals with other health related conditions which prevent them from performing their occupational pursuits
31
What is included in the works comp exam?
All that we typically do like a history, systems review and review of systems, and tests and measures typical for other pt populations
Managing stages of healing
Moving towards fxnal progression
Plus other work related adaptations, training, equipment, and education
32
What are the challenges of the injured worker?
The employee-employer relationship
Secondary gain
Employer
33
What secondary gains should we be aware of with works comp pts?
Financial gain
Time off
Disgruntled employee
34
Is light duty job options always available? What tends to prevent light duty work options?
Light duty is not always available and unions tend to prevent light duty
35
What is involved in fxnal progression?
Attempt to incorporate job tasks at some point
36
T/f: we may be limited in our ability to replicate specific job requirements
True
37
What is ergonomics?
Fitting the job to the worker
38
What are the goals of ergonomics?
Help prevent injury
Reduce fatigue and discomfort
Increase productivity
Improve quality of work
Improve job satisfaction
39
What is included in the ergonomic checklists?
Posture
Force
Reps
Vibration
Temp
40
If we can’t change a pts posture for their work task, what should we tell them to do?
Advise them to take frequent breaks and only do the task for a few minutes at a time
41
What are we doing in a work site analysis?
Assessing for job demands
Getting a job description from the pt and/or employer
Correcting ergonomics
Getting an idea of the specific job demands to understand the scope of the pts work
42
What specific job demands do we want to understand?
The physical demands, psychosocial demands, and ergonomics of the job
43
What aspects of the pts job do we need to gather from the job site analysis?
Work demands
Workers capability
Government rules and regulations
Production constraints
Economic factors of business necessity
44
Who can we talk to at the job site analysis to understand what goes on at the job?
Human Resources
Labor unions
Managers
Employees
45
What is involved in improved ergonomics?
Increased worker safety
Improved biomechanics
Reduced risks of injury
Increased worker efficiency
46
What is an OSHA citation?
When many employees complain or are injured, OSHA sends a warning and the employer has to remediate and follow through
47
What is the OSHA-300 logs?
The record of reported problems from an employer
48
What are the 4 factors involved in hazard prevention and control?
Engineering controls
Work practice/behavioral controls
PPE
Administrative controls
49
What are engineering controls?
Making the job fit the person with changed physical environment or equipment and workers techniques
50
What should we consider about grip?
What position the wrist is in and how we can make it more neutral
Adding padding to prevent hard edges
51
T/f: engineering controls may require physical plant changes, new equipment, or a totally new design
True
52
Repetitive reach objects should be within how many inches?
13-18 inches
53
Occasional reach objects should be within how many inches?
21-26 inches
54
What are behavioral controls/work practice controls in hazard prevention and controls?
Strategies under the employees control including proper technique, appropriate training, and practice time
55
Are correct lifting techniques a part of engineering or behavioral controls?
Behavioral controls
56
Is adjusting desk height a part of engineering controls or behavior controls?
Engineering controls
57
Is tool care a part of engineering controls or behavior/work practice controls?
Behavior/work practice controls
58
What is involved in PPE for hazard control?
Gloves to protect from sharp material and BBP (blood borne pathogens)
Protection from cold
Bracing, splints, lumbar supports/braces
Eyewear for protection or magnification
59
What are some administrative controls?
Reducing the duration, frequency, severity of stress
Decreasing production rates (reduced speed lines)
Providing rest periods
Stretching breaks
Limiting OT
Increasing the number of employees doing a job
Job rotations
Effective program for equipment and tool maintenance
Effective house keeping for minimizing slips and falls
60
Effective safety and health programs involve what things? (Long ass list)
Commitment by management
Written program
Employee involvement
Suggestion procedures
Prompt and accurate reporting of CTDs
Regular program reviews
Work site analysis and ergonomic checklist
Medical management
Training and education
Body mechanics, recognition of CTDs to prevent progression
61
What can we tell pts to do instead of twisting at the hips and spine?
Pivot when turning to the sides
62
How should shelves be arranged?
Most commonly used things in the middle
Light things on top
Heavy/less frequently used items below
63
What is an FCE?
Functional capacity evaluations
64
What is the purpose of an FCE?
To assess for safe max work capacity of our pts and to define their limitations
To attempt to assign pts to a safe and appropriate job classification
65
What are the job classifications we can put pts in with the FCE?
Sedentary
Light duty
Medium duty
Heavy duty
Very heavy duty
66
How is FCE used?
For assessment of safe return to work
For defining limitation and/max safe capacities for RTW
In litigation
In disability claims
In inference to appropriate surgical candidates
To assign job tasks in pre-employment screenings
67
With pre-employment screenings, is data compared to normative data?
Nope, it compared based on the pts fxnal abilities as they compare to their job situation
68
With pre-employment screenings, can we deny employment based on the results?
No, we can only assign to most appropriate positions
69
What pt populations are involved in industrial rehab?
Acute and chronic injuries
Injured workers
Litigation cases
Disability claims
Pre surgical
To assist with IME (independent medical exams)
70
What are IMEs?
When the physician reviews records with little hands on which can frustrate the pt
71
When are IMEs often done?
When the pt is out of work for a while and the comp carrier is wanting to see where they are in their recovery
72
What is objectivity?
The measurement having a degree of reliability and being free from examiner bias
73
What is reliability?
The consistency of the measure
74
What is the interrater reliability?
Similar results can be achieved when the test is administer by different examiners
75
What is the intrarater reliability?
Consistent/stable results when the test is re-administered by the same examiner
76
What is validity?
Does the test measure what it’s supposed to measure?
77
What is content validity?
A representative sample of the components of the task in question are incorporated into the assessment
78
What is necessary to determine job demands?
Job analysis
79
What is criterion related validity?
Can the measure be used to make an inference to fxn?
Can the results predict an individuals performance in specified activities?
80
What is predictive validity?
Can the measure predict the future performance?
81
What are the components of the FCE data gathering?
Medical, social, and vocational history
82
What are the components of the FCE?
Physical exam
MSK and endurance
Body mechanics
Fxnal performance
Lifting test
83
What is involved in the physical exam in the FCE?
MSK exam/screening
Reproduction of pain or comparable sign
Distraction
Non organic signs (Waddel signs)
84
A screen for a pts high levels of pain behaviors should include what things?
The pain perception and description of pain
The behavior of the pt perceiving the pain
The pts effort to perform physical tests
Pts consistency of behavior
85
What do we normally expect to see when giving max effort?
Bulging of prime movers and accessory muscles
A very wide BOS
Substantial counterbalance posture
Substantial increase in HR and RR
Safe but unable to maintain control with addition of anymore weight
Very slow pace
86
What would we expect to see with heavy tasks?
Bulging of prime movers
Distinct recruitment of accessory muscles
Distinctly increased BOS
Distinctly increased counterbalance posture
Distinctly increased HR and RR
Increasingly controlled movt, might begin to use momentum
Execution with difficulty but not yet at limit
Distinctly slower pace and very deliberate movts
87
What would we expect to see with light to moderate tasks?
Normal recruitment of prime movers
No or slight recruitment of accessory muscles
Natural stance
No or slight counterbalance posture
No or minimal increase in HR and RR
Smooth movts
Moderate or comfortable pace
88
What posture characterizes a pt with no or slight problems?
Normal or slight deviation
89
What posture characterizes a pt with some fxnal problems?
Some deviations from normal
Occasional change in position
90
What posture characterizes a pt with substantial fxnal problems?
Substantial deviations from normal
Frequent change in position
91
What movt pattern characterizes a pt with no/slight problems?
Normal or slight deviation
Smooth movts Moderate
Normal to slight slowed performed
92
What movt pattern characterizes a pt with some fxnal problems?
Some deviation
Tense movts
Markedly slower performance
93
What movt pattern characterizes a pt with substantial fxnal problems?
Substantial deviation
Very tense movt
Very slow performance
94
What Ms recruitment characterizes a pt with no/slight problems?
Normal recruitment of prime movers
Minimal recruitment of accessory muscles
95
What Ms recruitment characterizes a pt with some fxnal problems?
Some accessory muscle recruitment
96
What Ms recruitment characterizes a pt with substantial fxnal problems?
Pronounced accessory muscle recruitment
97
What autonomic NS signs would we see in a pt with no/slight problems?
Minimal increase in HR
98
What autonomic NS signs would we see in a pt with some fxnal problems?
Moderate increase in HR and RR
99
What autonomic NS signs would we see in a pt with substantial fxnal problems?
Substantial increase in HR and RR
Substantial sweating
100
How can we improve reliability of observation of maximal effort?
Training, experience, and repetition
101
What is involved in the MSK and CV endurance portion of the FCE?
Observing HR as it correlates with effort
Monitoring throughout FCE
Correlating it with pain and observed effort
102
T/f: in the FCE we can suggest corrections in body mechanics but cannot force them, we have to let the pt lift as desired
True
103
What is involved in lifting testing?
Isometric testing
Isokinetic testing
Isoinertial testing
Psychophysical method or client self reported method
Movt pattern observation
104
When doing isokinetic and isometric lift testing, what should we be paying attention to?
Consistency of effort and correlating it to pain
105
What is the psychophysical/client self reported method of lift testing?
When the client self adjusts the load during 20-25 minute period until tolerable load is achieved that the pt feels that can lift repetitively during an 8 hour work shift
106
What is isointertial testing?
Lifting progressively heavier weights at a set frequency over a specific vertical range
107
What is involved in movt pattern observation?
When the pt lifts progressively heavier weights until the examiner decides to stop the test as signaled by form fatigue
Observing for form fatigue and observed exertion
Comparing observed exertion to HR and pain rating
RPE
108
What are signs of exertion?
Facial expressions
Lifting technique
White knuckle gripping
109
What are the general guidelines for lift testing?
Start with low weights and increase while monitoring the pts response
Avoid exacerbating injury
Obtain medical consent
110
What are the types of lifts in lift testing?
Torso lift (bending at hips)
Leg lift (bending with knees)
12” lift to knuckle (floor to waist)
Shoulder lift
OH lift
Carrying weight
Pushing force
Pulling force
111
What basic things should we also test in the FCE?
Baseline vitals
ROM
Strength
Grip
Endurance
112
How do we measure strength in the FCE?
3-5 position grip dynamometer
Rapid alternating grip
Looking at coefficient of variation/consistency of effort
113
How do we test endurance in the FCE?
6MWT
Queens college step test
Platform step test
114
How do we assess dexterity in the FCE?
Purdue peg board
Minnesota manual dexterity test
Lafayette hand tool dexterity test
115
What is the length of the FCE?
Can be anywhere from a miniFCE to a 2 day FCE
116
T/f: a shorter FCE doesn’t likely include a comprehensive look at the 20 physical demand items outlined in the DOT
True
117
117
When is the short/mini FCE recommended?
When re-testing certain components of the FCE that may have been below message RTW levels
When you are familiar with the pt and there have been no “red flags” during their tx
118
How long is a typical FCE?
3-5 hours
119
What job classification involves lifting no more than 10 lbs, occasional lifting or carrying articles like files, ledgers, and small tools, a lot of sitting, and a certain amount of walking and standing?
Sedentary work
120
What job classification involves lifting no more than 20lbs at a time, frequent lifting/carrying objects up to 10lbs, a good deal of walking/standing or sitting most the time with some pushing/pulling of arm/leg controls?
Light work
121
If someone can do light work, can they do sedentary work?
Yes, unless they are limited by dexterity or inability to sit for long periods of time
122
What work classification involves lifting no more than 50 lbs at a time, frequent lifting/carrying up to 25 lbs?
Medium work
123
What other classifications of work can someone fit to do medium work do?
Sedentary and light work
124
What job classification involves lifting no more than 100 lbs, frequent lifting/carrying up to 50 lbs?
Heavy work
125
If someone can do heavy work, what other job classifications can they do?
Medium, light, and sedentary work
126
What job classification involves lifting over 100 lbs at a time, and frequent lifting/carrying 50 lbs or more?
Very heavy work
127
If someone can do very heavy work, what other job classifications can they do?
Heavy, medium, light, and sedentary work
128
What should be included in the FCE reporting?
Clear and easy to read report
Source of info in the job demands
Client cooperation
Consistency of effort
Body mechanics
RTW recommendations
129
What are the 20 physical demands per the DOT? (Do not memorize)
Walking
Climbing
Balance
Feeling
Sitting
Kneeling
Crouching
Crawling
Reaching
Handling
Fingering
Feeling
Sitting
Standing
Lifting high
Lifting mid
Lifting low
Carrying
Pushing
Pulling
130
What is constant activity?
67-100% of workday
131
What is frequent activity?
34-66% of the workday
132
What is occasional activity?
0-33% of the workday
133
What is high lifting?
Above shoulder
134
What is mid lifting?
Knuckle to shoulder
135
What is low lifting?
Floor to knuckle
136
What job classification involves occasional lifting 1-10 lbs?
Sedentary
137
What job classification involves occasional lifting 11-20 lbs and frequent lifting 1-10lbs?
Light work
138
What job classification involves occasional lifting 21-50 lbs, frequent lifting 11-25 lbs, and constant lifting 1-10lbs?
Medium work
139
What job classification involves occasional lifting 51-100 lbs, frequent lifting 26-50 lbs, and constant lifting 11-20 lbs?
Heavy work
140
What job classification involves occasional lifting >100lbs, frequent lifting >50 lbs, and constant lifting >20 lbs?
Very heavy work
