Introduction Book 1 Flashcards
Ergonomics
The study of work performance with an emphasis on worker safety and productivity.
Occupational therapy.
Skilled treatment that helps individuals achieve independence in all facets of their lives
Physical therapy.
The assessment, prevention, and treatment of movement dysfunction and physical dis- ability, with the overall goal of enhancing human movement and function.
ergonomics
- provides brief histories of the fields of occupational therapy (OT), physical therapy, and ergonomics.
- also describes the relationships between thera- pists and ergonomists in three areas of practice: (1) workplace analysis, (2) environment and product design and redesign, and (3) research.
- Principles of therapy and ergonomics are consid- ered in relation to persons with permanent dis- abilities; persons with temporary injuries, such as work-related musculoskeletal disorders; and per- sons without disabilities.
- also pro- files considerations for joint ventures between therapists and ergonomists.
HISTORICAL BACKGROUND
Occupational Therapy
OT is predicated on the belief that eradication of disease alone is insufficient for complete recovery.
Before the advent of OT, individuals who had been injured or ill were hospitalized, treated, and discharged, only to find themselves unable to function sufficiently because of physical and mental exhaustion.
George Barton
- an originator of OT, spent extensive time as a client in a tuber- culosis hospital and recognized the need for addi- tional therapy.
- Trained as an architect, he formed his own rehabilitation program after leaving the hospital by working with the tools of his profes-
sion to strengthen himself physically and men- tally. - In 1914 he opened Consolation House to provide similar services for others.
Other founders of the field of OT held similar beliefs that occupy- ing one’s time and doing something of purpose serve both as evaluative tests and as tools for “strength, reserve force, nerve and mental poise, and of the several elements that we take together as character.”
What was important for the founders of OT was that the individual have pursuits that were important to him or her.
The purposeful involve- ment helped reduce weaknesses caused by illness or injury by building on personal strengths, allow- ing people to return as productive members of their families and society.
Dr. Adolph Meyer,
- another of the founders of OT, asked his col- leagues at the Chicago Pathological Society in 1893 for their opinions on the types of occupa- tions that could best be used during patient treat- ment.
- Gardening, ward, and shop work were mentioned, including raffia and basket work, weaving, bookbinding, carpentry, and metal and leather working.
- These crafts were not consid- ered leisure activities as they are today; instead, the practice of a craft was an assignment that provided rehabilitation for the client and could be used as full-time employment to support the client and client’s family after discharge.
- Thus, the OT rehabilitation process focused on improving phys- ical and mental functioning, as well as returning the patient to a functional status in society.
- Indeed, these activities were often used to train patients for specific jobs, and it was with great alarm that therapists first realized their patients did not always enter the craft field for which they had been trained.
- Questions arose regarding whether time, effort, and funds had been wasted in train- ing if the clients did not enter the field for which they had been trained.
- It was noted, however, that with just a few carefully chosen, occupationally based crafts, the habits and skills needed for reha- bilitation and employment could be learned and transferred to numerous jobs.
Crafts were cate- gorized according to the physical movements (upper and lower extremity, torso, head and neck), balance, and coordination required, as well as according to complexity, pace, stimulation level provided (monotonous or stimulating), the level of problem-solving skills required, initial cost, final product use, level of concentration needed, initiative required, noise created, amount of mental capacity required, and type of client for which it might be appropriate.
Thus, the need for simulating the job each client wanted to return to, or undergoing specific new training for a particu- lar occupation, was eliminated.
The question of whether using a few well- chosen activities for rehabilitation is more effec- tive than individual job simulation has still not been clearly answered through outcome research.
Work hardening, or the simulation of the work environment as a means for recovery of ability, has revived the idea that each job and its com- mensurate job tasks need to be recreated to provide the best possible rehabilitation and return- to-work programs for the industrial worker, but no proof for either argument exists, except anec- dotally.
The intent is clear, however, that actively engaging the patient in carefully guided physical and mental activities enhances the chances for a more successful return to work.
The fundamental goal of OT is to enhance “the capacity [of the client] throughout the life span, to perform with satisfaction to self and others those tasks and roles essential to productive living and to the mastery of self and the environment.”
OT should also help clients obtain their highest functional performance in all areas of life, includ- ing work, recreational activities, and life at home.
Clearly, though, the main focus of OT is working with clients (as opposed to the global workforce population).
That is, OT focuses on those indi- viduals who need assistance in order to achieve independent and satisfying lives. According to the American Occupational Therapy Association’s website (www.aota.org), OT is skilled treatment that helps individuals achieve independence in all facets of their lives.
OT assists people in develop- ing the “skills for the job of living” necessary for independent and satisfying lives.
Services typi- cally include the following:
• Customized treatment programs to improve one’s ability to perform daily activities
• Comprehensive home and job site evalua- tions with adaptation recommendations
• Performance skills assessments and treat- ment
• Adaptive equipment recommendations and usage training
• Guidance for family members and care- givers
Both occupational therapists and ergonomists are trained to be aware of normal human abilities.
Therapists must be aware of clients’ current physical, cognitive, and psychologic limitations and capabilities; their potential abilities and dis- abilities; and the physiologic and psychologic demands of the clients’ activities (including work).
Therapists must also be aware of the per- formance competencies and limitations of people without injuries to be able to assess whether a client is functioning within normal range.
Maximal functional performance has been the goal of OT since the inception of the profession in 1917 (beginning with the founding of the National Society for the Promotion of Occupational Therapy).
The use of purposeful activities (e.g., work simulation) as treatment modalities was integral to the development of the profession, as suggested by its name: occupational therapy.
It must be noted, however, that work or activity used in a therapeutic manner is not ergonomics, nor is work hardening necessarily a part of ergonomics.
The first articles appearing in OT literature to use ergonomic principles were published by Haas in the late 1920s and early 1930s.
The first article involved what has been termed ergonomics-for– special populations.64 Haas designed and con- structed a weaving frame that could be used for those who were bedridden.
The second article described the combination of the principles of OT (therapeutic activity) with the needs of the hospi- tal (increasing work efficiency): the clients were assigned to build a folding conveying chair for the hospital.
As described in a subsequent article, the building of an adjustable stool that encour- aged “good” posture helped hasten recovery, maintain health, and increase productivity through the principles of anatomy.
None of the early articles applied to the general population; instead, the articles were designs for special client populations.
HISTORICAL BACKGROUND
Physical Therapy
The American Women’s Physical Therapeutic Association was founded in 1921, becoming the American Physiotherapy Association in the 1930s, and the American Physical Therapy Association in the 1940s.
HISTORICAL BACKGROUND
Ergonomics
Although the concept of ergonomics (also called human factors) existed during the Stone Age (humans constructed tools to fit their own hands for hunting and gathering needs), the first docu- mented mention of the field came in 1857, when Wojciech Jastrzebowski published An Outline of Ergonomics, or The Science of Work Based upon the Truths Drawn from the Science of Nature34:
“Hail, Thou great unbounded idea of work! God, Who, as the Bible teaches us, cursed mankind and subjected him to work, cursed him with a father’s heart; for the punishment was also a consolation.
He who complains against his work knoweth not life; work is an uplifting force by which all things may be moved. Repose is death, and work is life!”
Jastrzebowski felt the ideas of work should be studied and preached with the same rigor applied to the more philosophical studies of his time, for he believed that “affections (i.e., beliefs, emo- tions) are nothing else, but accessories to deeds.”
According to Jastrzebowski, the study of work, or ergonomics, should involve all aspects of useful work, the four main components of which are physical, aesthetic, rational, and moral.
Jastrzebowski taught that applying each of the four components of work to whatever endeav- ors one is involved with increases the benefits of those activities exponentially.
For example, whereas pure physical work applied to planting might yield a two-for-one harvest, applying aes- thetic or sensory forces would increase the yield fourfold.
Additional application of intellectual forces would then yield an eightfold gain at harvest time, and so on.
His treatise is more complex than this chapter shows; he further subdivided all areas of work. He also sought to identify further areas of study including (1) the animals with which we share work categories, (2) the periods of our lives that are particularly suited to various types of work, (3) the manner of work, and (4) the benefits drawn from work for both the indi- vidual and the common good of society.
His views are remarkably similar to those of the founders of OT, although the latter applied the theories to individuals who were injured or ill, whereas Jastrzebowski primarily applied his theories to able-bodied persons, with the ultimate objective of bettering humankind.
Ergonomics as a specialty made gains as technologic developments emerged during the industrial revolution.
Time and motion studies, considered predecessors of our present day ergo- nomic discipline, focused on evaluation of work methods, workstation design, and equipment design.
They were conducted by numerous inves- tigators, including the Gilbreths, Taylor, Muen- sterberg, and Binet.17
The field of ergonomics received particular attention during World War II, when the complex- ity of military equipment frequently surpassed the abilities of human operators18: “Man had become the weak link.”19 As during World War I, the primary focus was selection and training of per- sonnel; however, even with extensive training, personnel could not always perform as needed.
Because selection and training were not providing an acceptable solution, the focus changed to fitting the task or equipment to the person by using human dimensions, capabilities, and limitations as factors in the design process.
After World War II, the Ergonomics Research Society (the current Ergonomics Society) was founded in England, and the first ergonomics text, Applied Experimental Psychology: Human Factors in Engineering Design by Chapanis, Garner, and Morgan, was published.16 In 1957, the Human Factors Society was formed in the United States,
and Ergonomics, the journal of the Ergonomics Research Society, began publication.
The Interna- tional Ergonomics Association was formed in 1959 to join ergonomics societies from several coun- tries.
Since that time, the field of ergonomics has had tremendous growth, and many areas of specialization have been developed.
The interface between humans and computers has given rise to new specializations in ergonomics, and the incident at Three Mile Island accelerated the study of the role of ergonomics in the nuclear power industry.
In addition, more attention to product liability has increased the number of ergonomics experts needed in forensics to address design defi- ciencies, instructions, and warning labels.
Other areas that are experiencing considerable growth in awareness of ergonomic issues involve design- ing for special populations including children (Figure 1-1),14,50 older adults,56 and persons with disabilities.
Ergonomics developed from the common inter- ests of a number of professions, particularly engi- neering, psychology, and medicine. It has remained a multidisciplinary field of study.
Ergonomists include professionals with degrees in psychology, engineering, ergonomics, industrial design, educa- tion, physiology, medicine, health and rehabilita- tion sciences, business administration, computer science, and industrial hygiene.
However, as the discipline evolved, specific areas of knowledge and practice have been identified, giving rise to bachelor’s, master’s, and doctoral degree pro- grams, specifically in ergonomics or human factors.
The Human Factors and Ergonomics Society (www.hfes.org) offers an accreditation process for these programs.
Individual certifica- tion is also offered through the Board of Certifica- tion in Professional Ergonomics
ERGONOMICS DEFINED
Ergonomics (Greek ergon [work] + nomos [law]) focuses on the study of work performance with an emphasis on worker safety and productivity.
Although several definitions have been proposed, one of the best was provided by Chapanis, who used the terms ergonomics and human factors interchangeably: “Human factors (ergonomics) is a body of knowledge about human abilities, human limitations, and other human characteristics that
are relevant to design.
Human factors engineering (ergonomics implementation) is the application of human factors information to the design of tools, machines, systems, tasks, jobs, and environments for safe, comfortable, and effective human use.”
According to the International Ergonomics Associ- ation (www.iea.cc), ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and other methods to design in order to optimize human well-being and overall system performance.
Ergon- omists contribute to the design and evaluation of tasks, jobs, products, environments, and systems in order to make them compatible with the needs, abilities, and limitations of people.
Considerable debate on the definitions of ergo- nomics and human factors has persisted.
The con- troversy has been especially fervent regarding the differentiation of the terms.
Proponents of differ- entiation argue that the term human factors was first used in psychology and refers primarily to the interface of humans with technology, whereas ergonomics originated in human physiology and biomechanics and therefore refers primarily to physically demanding work.
The differentiation is capricious at best, and both the classic and newer human factors and ergonomics texts encour- age use of the two terms interchangeably.
In their introduction, Sanders and McCormick state that “some people have tried to distinguish between the two, but we believe that any distinc- tions are arbitrary and that, for all practical pur- poses, the terms are synonymous.”
In this chapter, as well as throughout this book, the two terms are used interchangeably.
It is true that originally ergonomics was not as widely used in the United States and Canada as in other parts of the world.
In the United States, the terms human factors engineering, human engineering, engineering psychology, and human factors have all been used, although the current term of choice is human factors.
As noted by Chapanis, “whether we call ourselves human factors engineers or ergonomists is mostly an accident of where we happen to live and where we were trained.”
Ergonomics is the more recognized term among the general public, even in the United States.
Part I of this text establishes the context in which a therapist chooses to specialize in dealing with work-related issues such as occupational health and ergonomics.
It includes both a client- centered approach, as well as a broader macroer- gonomic perspective.
Ergonomics focuses on humans and their inter- actions with the environment.
It involves interac- tions with tools, equipment, consumer products, work methods, jobs, instruction books, facilities, and organizations.
Kantowitz and Sorkin noted that “the first commandment of human factors is ‘Honor Thy User’.”36 Ergonomists design environ- ments and products according to the physical (visual, auditory, tactile, strength, anthropomet- ric), cognitive (learning, information processing, retention), and psychosocial (cultural influences,
References troversy has been especially fervent regarding the differentiation of the terms. Proponents of differ- entiation argue that the term human factors was first used in psychology and refers primarily to the interface of humans with technology, whereas ergonomics originated in human physiology and biomechanics and therefore refers primarily to physically demanding work.21 The differentiation is capricious at best, and both the classic and newer human factors and ergonomics texts encour- age use of the two terms interchangeably. In their introduction, Sanders and McCormick state that “some people have tried to distinguish between the two, but we believe that any distinc- tions are arbitrary and that, for all practical pur- poses, the terms are synonymous.”66
In this chapter, as well as throughout this book, the two terms are used interchangeably. It is true that originally ergonomics was not as widely used in the United States and Canada as in other parts of the world. In the United States, the terms human factors engineering, human engineering, engineering psychology, and human factors have all been used, although the current term of choice is human factors. As noted by Chapanis, “whether we call ourselves human factors engineers or ergonomists is mostly an accident of where we happen to live and where we were trained.”15 Ergonomics is the more recognized term among the general public, even in the United States.
Part I of this text establishes the context in which a therapist chooses to specialize in dealing with work-related issues such as occupational health and ergonomics. It includes both a client- centered approach, as well as a broader macroer- gonomic perspective.
Ergonomics focuses on humans and their inter- actions with the environment. It involves interac- tions with tools, equipment, consumer products, work methods, jobs, instruction books, facilities, and organizations. Kantowitz and Sorkin noted that “the first commandment of human factors is ‘Honor Thy User’.”36 Ergonomists design environ- ments and products according to the physical (visual, auditory, tactile, strength, anthropomet- ric), cognitive (learning, information processing, retention), and psychosocial (cultural influences,
*References 21, 26, 32, 38, 46, 54, 72.
behavior, background) characteristics of humans. Accordingly, ergonomics is not solely confined to the workplace. Products and environments should match the abilities, needs, and perceptions of the people who use them. In self-care, ergonomically designed toothbrushes and spigots are found. These spigots conform to users’ expectations (e.g., water should emerge when the spigot is turned counterclockwise, and cold water should be controlled by the spigot on the user’s right). Bicycles and snow skis are designed with riders and skiers of differing abilities in mind and are designed differently for men and women. Numer- ous examples of proper and improper designs can be found throughout homes and offices. The concept of making the devices and systems “user- friendly” extends beyond the workplace.60
To attain the goal of designing user-friendly devices and systems, ergonomists conduct scien- tific investigations to identify the limitations, capabilities, and responses of humans in a variety of climates and circumstances. This information is used to produce designs that match human characteristics. Part II of this book, Knowledge, Tools, and Techniques, provides some necessary basic information, as well as examples of how physical and cognitive information can be applied in the workplace.
Part III, Special Considerations, demonstrates how human characteristics are applied to specific situations. Ergonomists evaluate equipment, jobs, work methods, and environments to ensure they meet their intended objectives. This section is more specific, using a microergonomic approach.
Ergonomics can be considered a design phi- losophy that focuses on supplying a product that ensures safety, ease of use, comfort, and effi- ciency. However, many distinguished human factors practitioners and ergonomists contend that ergonomics is a unitary, scholarly discipline with unique characteristics, just as OT and PT are unique disciplines characteristics of humans.
Accordingly, ergonomics is not solely confined to the workplace.
Products and environments should match the abilities, needs, and perceptions of the people who use them.
In self-care, ergonomically designed toothbrushes and spigots are found.
These spigots conform to users’ expectations (e.g., water should emerge when the spigot is turned counterclockwise, and cold water should be controlled by the spigot on the user’s right).
Bicycles and snow skis are designed with riders and skiers of differing abilities in mind and are designed differently for men and women.
Numer- ous examples of proper and improper designs can be found throughout homes and offices.
The concept of making the devices and systems “user- friendly” extends beyond the workplace.
To attain the goal of designing user-friendly devices and systems, ergonomists conduct scien- tific investigations to identify the limitations, capabilities, and responses of humans in a variety of climates and circumstances.
This information is used to produce designs that match human characteristics.
Part II of this book, Knowledge, Tools, and Techniques, provides some necessary basic information, as well as examples of how physical and cognitive information can be applied in the workplace.
Part III, Special Considerations, demonstrates how human characteristics are applied to specific situations.
Ergonomists evaluate equipment, jobs, work methods, and environments to ensure they meet their intended objectives.
This section is more specific, using a microergonomic approach.
Ergonomics can be considered a design phi- losophy that focuses on supplying a product that ensures safety, ease of use, comfort, and effi- ciency.
However, many distinguished human factors practitioners and ergonomists contend that ergonomics is a unitary, scholarly discipline with unique characteristics, just as OT and PT are unique disciplines.
WHY USE ERGONOMICS?
For the lay person, ergonomics is most noted when absent.
This is because the focus is to opti- mize the relationship between the environment and the person.
When an appropriate ergo nomic design is in use, the user should be unaware of environmental design deficiencies and should be able to concentrate on the task at hand.
For example, in a well-designed office workstation, a worker should not have to hold his or her neck in an awkward posture to use a visual display terminal and should not experience neck and shoulder discomfort.
According to Osborne, good ergonomic design in the workplace offers a means to “victory over the oppressive forces that con- tinue to make work less productive, less pleasant, less comfortable, and less safe.”
In the past, industry focused on product outcome, and the needs of workers took second place.
Humanistic and economic concerns and litigation, however, have convinced industry that consideration of the worker is good business.
The use of sound ergonomic principles has generated many examples of increased worker productivity and safety.
One older example demonstrated that less training is required if workers’ abilities are considered in the design of equipment.
In this example, the detection efficiency of machine parts inspectors was evaluated after either a 4-hour training program or the use of a set of visual aids and displays that assisted with the detection of defects.
A 32% increase in detected defects was found with the training, a 42% increase was found with the use of appropriate visual aids, and a 71% increase was found when training and visual aids were combined.
Although training was useful, a properly designed environment was needed for superior results.
In terms of the case study mentioned at the beginning of the chapter, asking to have ergo- nomic consultation for all of their facilities and services is a huge endeavor!
Ergonomists could start by evaluating the following:
• Safety practices, procedures, and records, including deaths, injuries, and near-miss occurrences in terms of patient safety
• Injuries, illnesses, turnover, and workers’ compensation cases among the employees • The health care practitioners’ perceptions
regarding the products they use and environ- ments they work in to determine if the designs are as complementary to their work as they should be
• Costs and revenues to see where they might have the most impact on a redesign effort
• Information flow throughout the facilities,
including client care, team interactions, and
data management
Any of these initial approaches would be within
the purview of ergonomics as they seek to design products and places to improve efficiency, effec- tiveness, and safety.
However, it is doubtful that most therapists would be comfortable handling any of these approaches based solely on their entry-level education.
With advanced education in the area of work, perhaps they would be most comfortable handling the second approach, espe- cially if the target subset of injuries involved musculoskeletal overuse injuries.
THE INTERRELATIONSHIP BETWEEN THERAPISTS AND ERGONOMISTS
The interrelationship between rehabilitation and ergonomics has received a great deal of atten- tion.
More recent efforts by ergonomists are focusing on design issues.
In fact, ergonomic practice within the field of health care is burgeon- ing, with research being conducted in areas as varied as teamwork,client safety, informa- tion transfer, cognitive strategies used by clini- cians, and the design of equipment, client care areas, and protocol workflow.
Therapists and ergonomists share some com- mon interests, and therapists can contribute their unique strengths to the practice of ergonomics in five principal areas: ergonomics-for-one (individu- als who have a disability); ergonomics for special populations; prevention of musculoskeletal inju- ries; equipment design; and the application of the ADA.
These five areas can be simplified into three major practice application arenas, in addi- tion to integrating ergonomic principles into thera- peutic clinical practice: (1) workplace analysis aimed at prevention of work-related musculoskel- etal trauma; (2) workplace and tool design for individuals with disabilities; and (3) research through the development and use of databases.
Work-Site Analysis
Therapists should be familiar with the field of ergonomics as a whole to understand terminology being used, know how to best describe their own expertise, and recognize when an ergonomist with specialized training should be consulted.
A review of introductory ergonomics texts (as well as university accreditation requirements for OTs, PTs, and ergonomics) produced the following observations about the knowledge base of thera- pists compared with that of ergonomists.
Some areas of ergonomics with which thera- pists are familiar are sensory nervous system considerations, anthropometry, kinesiology, hu- man development, anatomy and physiology, work capability analysis, and basic research.
Areas familiar to occupational therapists (less so to physical therapists, based on their required train- ing) include communication, learning, motiva- tion, normal and abnormal psychology (including the effects of stress), job and task analysis, and measures of job satisfaction.
Workplace design, seating and posture, and safety may or may not be included in the knowledge of entry-level thera- pists.
Topics in ergonomics with which entry-level therapists may be unfamiliar include person- machine communication (displays and controls), workstation design, vibration, noise, temperature, illumination, training, inspection and mainte- nance, error and reliability, signal detection theory, visual displays, legal aspects of product liability, physics as applied to machinery as well as human motion, and advanced statistical research methods.
Although therapists may con- sider themselves educated in safety, they may be unfamiliar with safety as it is taught in ergonomics curricula. In these classes, safety includes acci- dent losses; the Occupational Safety and Health Act; standards, codes, and safety documents; designing, planning, and production errors; ha- zards; acceleration, falls, and other impacts; pressure and electrical hazards; explosions and explosives; toxic materials; radiation; vibration and noise; slip, trip, and fall (traction and physical materials, as well as biomechanics and physiol- ogy); and methods of safety analysis.
Therapists are well educated in the procedures of problem identification, interviewing, observa- tion, and record review. Their considerable knowl
edge of anatomy and physiology, neuroanatomy and neurophysiology, kinesiology, and the mecha- nism and treatment of injuries makes therapists excellent allies for ergonomists.
Knowledge of ergonomics allows therapists to apply their expertise by specializing in the field of work- related musculoskeletal ergonomics and injury prevention.
The application of ergonomics for therapists primarily implies workplace consultation directed at preventing musculoskeletal injuries.
Therefore, in the case study presented at the beginning of the chapter, therapists’ goals would be to promote safety and to decrease the financial costs associ- ated with lost work time, medical treatment, and retraining of hospital employees.
Consultative ser- vices could be combined with direct services (client treatment) or offered alone. When provid- ing consultative services in addition to direct ser- vices, therapists could offer functional capacity testing, work hardening, and graded return-to- work placements along with workplace evalua- tions.
They could also conduct ergonomics workplace evaluations specifically to identify situ- ations that might contribute to musculoskeletal injuries such as task analysis, videotaping, mea- surement and analysis of equipment and worksta- tions, and workspace analysis (see Lopez49 and Sanders65 for technique suggestions in addition to this text).
The consultations may be primarily based on physical considerations or may involve psychosocial factors.
The last part of this book addresses the ergonomics intervention process from the beginning (program development and marketing) through problem identification, analy- sis, and implementation to the final product (eval- uation and report of results).
Design for Individuals with Disabilities
More than 51 million Americans have a physical or mental disability, and 32.5 million have a severe disability.
This means that between 11.5% and 18.1% of the total population in the United States has a disability. Individuals who have a disability are less likely to finish high school or to attend college and are more likely to live in poverty.
Many of these individuals either do not work or have difficulty finding a job
Ergonomic intervention could do much to enhance quality of life, at work and home, for these people.
Cannon, an ergonomics consultant in Colorado who has designed equipment for persons with visual impairments, stated, “No segment of the population suffers more from neglect of human factors requirements in product design than the severely handicapped.”
Unfortunately, that state- ment remains true 20 years later.
Opportunities abound within the areas of overlap between ergo- nomics and health care.
For example, modifica- tions and design features of buildings, vehicles, and appliances could improve independent living prospects for those with physical, cognitive, and emotional disabilities.
In the hospital case study running throughout this chapter, therapists might also contribute by evaluating hiring and place- ment practices with special consideration for those who have disabilities and how the company is meeting ADA compliance.
Yet much remains to be done. Many factors contribute to the lapse of infor- mation: seeming unavailability of appropriate resources, lack of data, scarcity of ergonomic concept application in health care and rehabilita- tion, financial expense, lack of public support for funding, and insufficient databases on which to base designs for special populations.
Although the enactment of the ADA in 1990 encouraged both public and private entities to consider individuals with disabilities in the initial designs of work- places, accommodations, transportation systems, and communication services, the achievements have not been as great as some hoped.
Databases are available on hardware and software for persons with disabilities who use computers, and the increase in the geriatric population has increased spending and research on the needs of older Americans.
By designing specifically for the older population, their independence and ability to be active and engaged in life improves. Many even learn advanced technologies.
Few data exist, however, on the anthropomet- ric characteristics, capabilities, and limitations of individuals with disabilities and elderly popula- tions in varying climates and conditions.
The argument that has prevented the collection of such information is that the capabilities and limi- tations differ with each disease process and each person.
This argument contends that all of the individual differences that exist within an able- bodied population also exist within a population of persons with disabilities; however, the differ- ences are compounded because of the additional contrasts in residual capabilities of individuals with disabilities.
Until the abilities and restrictions of individuals with disabilities and elderly popula- tions are identified, however, suitable products for their use will not be developed on a consistent basis.
As noted, the expansion of the older popu- lation has resulted in an increased interest and generation of research in geriatrics. A com- mensurate increase in research for individuals with disabilities has not occurred, however.
The resistance, location, and shape of hand and foot controls; workplace design for people who must sit; and seat pan depth and width requirements differ for people with disabilities and vary accord- ing to the disabling condition.
Therapists have the skills and are in the settings to gather information for a database on various populations with dis- abilities.
Cases of good research exist, however, and one notable exception to the paucity of infor- mation is the research conducted by Das20 on paraplegic workers.
Das has carefully researched anthropometric information used in design guide- lines for paraplegics, annotated measurements of his own, and developed isometric strength profiles for male and female paraplegics.
Another noteworthy epidemiologic research project identi- fied injuries of wheelchair users and design and selection criteria to assist in injury prevention.
Technologic aids for individuals with disabili- ties are expensive because small-scale production is not cost-effective.
Although this situation may continue for high-level technologic equipment, the concept that assistive equipment designed for individuals with disabilities could also be attrac- tive and useful for the able-bodied population could be further examined.
This would entail greater attention to universal design—that is, design that is useful for all persons, regardless of age or functional capability. For example, use of large numerals on telephones; large, well-marked keys on television remote controls; and door levers rather than knobs may be equally desirable for people with and without disabilities.
Curb cuts outside supermarkets are a fairly simple example of universal design; they make entering and exiting easier for shoppers pushing grocery carts, elderly persons with mobility difficulties, small children, and wheelchair users.
Another excellent resource is the TRACE Center, which focuses on universal design and accessibil- ity of advanced technologies
The development and design of products and places for individuals with disabilities include a need for developmental and operational testing of those products during the prototyping and final design processes.
Although therapists and medical practitioners may not typically be involved in product development and user testing, this is another area ripe for collaboration between ergon- omists and therapists.
Medical and rehabilitation equipment must be designed with the users (medical practitioners, clients, and clients’ family members and caregivers) in mind.
Thus, iterative testing, including usability testing, is essential to achieve an ergonomic product—one that truly fits the user. Such products can increase user accep- tance, decrease errors, increase productivity, and improve quality of life
Therapists can provide ergonomists and design engineers with valuable information on the func- tional capabilities and limitations of, environmen- tal effects on, and overall prognosis of individual clients and diagnostic groups.
The information is essential to development of products for those with disabilities, as well as for identifying needed accommodations for workers with disabilities.
These issues are particularly important in accor- dance with the ADA39-41 and as our population ages.
Ergonomics applies equally to the interaction of humans and the tools and environments in- volved in pursuits other than work.
Both thera- pists and ergonomists consult about human performance with regard to recreation, transporta- tion, the hospitality industry, city planning, and the layout and design of home construction.
Typically therapists consult regarding those with dis- abilities, ergonomists consult regarding the healthy population, and both consult regarding musculoskeletal injury prevention.
Research Interests
Therapists and ergonomists often need the same information on human performance.
Therapists can and do use ergonomics data in clinical treat- ment and prevention programs.
For example, when treating hospitalized clients, a therapist should be aware of the effects of diurnal variation on muscle strength during muscle strength testing.
Therapists should also be aware of the effects of sleep deprivation on cognition, perceptual-motor performance, and learning.
Much of this informa- tion is found in ergonomics research among the populations without disabilities.
Therapists use ergonomic data from both able- bodied persons and individuals with disabilities during the evaluation of, goal-setting with, and treatment of clients.
It is easy to envision thera- pists, perhaps primarily those serving in academia, contributing to the body of knowledge in areas such as human performance, neurosensory func- tion, and strength testing, especially as they re- flect the functionality of those with disabling conditions.
Certainly, national research goals could be established that would cover the common areas between ergonomics and health care and rehabili- tation.
Some of these goals might include anthro- pometric and strength (capabilities and limitations) databases to assist with design for special po- pulations, technology use by and design for spe- cial populations, epidemiologic investigations of injuries and illnesses common to people with dis- abilities with suggestions for prevention, and com- pilations of ergonomics-for-one success stories.
