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Semester 3 PM Exam 6 > Occupational Medicine > Flashcards

Occupational Medicine Flashcards

1
Q

Occupational medicine

A

Taking care of people who have work related injuries

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2
Q

Injury frequency based on occupation - top 4

A

Manufacturing = 1
Health care = 3
Retail and service = 4

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3
Q

What does ADA stand for

A

Americans with Disabilities Act

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4
Q

When was ADA signed into law

A

1990 by Bush senior

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5
Q

What does ADA say

A

Forbids employment discrimination

Employer cannot discriminate against prospective employee based on disability or perceived disability

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6
Q

An example of perceived disability (ADA)

A

Glasses
Gender
Wheelchair

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7
Q

ADA - employee responsibilities

A

Need to prove/document that they are trained for the job and can do the essential functions of the job
ALL of this without undo hardship for the employer

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8
Q

ADA - Reasonable accommodation ex

A

If physically impaired and has trouble with transfers - accommodation would be to have a PT tech to help with transfers throughout the day

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9
Q

ADA - Take home message

A

Forbids discrimination against those with disability or perceived disability, do they have the training and skill and can they do the essential functions of the job without any undo hardship or risk

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10
Q

What does FMLA stand for

A

Family Medical Leave Act

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11
Q

What does the FMLA do

A

Guarantees 12 weeks of unpaid leave per calendar year before they are subject to termination

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12
Q

What are the guidelines to have FMLA

A

Need to have one year of employment

Company has to have 50 employees are more

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13
Q

Acceptable justifications for FMLA

A

Birth or adoption of a child
To care for ill immediate family member
Serious health condition

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14
Q

What does OSHA stand for

A

Occupational Health and Safety Administration

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15
Q

What does OSHA do

A

Making sure that companies and businesses are operating safe working environments
Underfunded - so is usually mandated
Regulated hazards in industry
Accident and injury investigation

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16
Q

OSHA Recordables

A

Company was at fault

They may not have training or a fine or something

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17
Q

What does NIOSH stand for

A

National Institution of Occupational Safety and Health

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18
Q

What does NIOSH do

A

THey come up with the stats to support the regulations
They develop the safety standards that OSHA enforces
Research center for all types of working components

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19
Q

Workers Compensation Insurance - is what type of law

A

STATE

Each state has their own version of workers compensation laws

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20
Q

Workers compensation - who purchases it?

A

Employer purchased coverage

Some states will say if you have 10 employees, others will say 25 requires you to have this coverage

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21
Q

Benefits to workers compensation insurance

A

Medical benefits will be covered
Wage replacement - you still get paid while you are out of work due to injury (often 2/3 of your usual pay)
Disability payments - if significant enough to take you out of work completely
Job re-training - if can get another job elsewhere

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22
Q

Occupational medicine team members

A 
Employee
Employer
Physician 
Nurse
PT/OT
Vocational rehab specialist 
Case manager
Insurance case manager/reviewer
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23
Q

What is a vocational rehab specialist

A

they are trained in testing individuals to see what they can do and what their interests are to see what they physically can do to get them trained to do it

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24
Q

Injury Management - does your patient care change?

A 
NO everything is the same
Patient exam, eval, Dx
Plan of care
Intervention
Discharge
Outcomes
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25
Work conditioning
Getting the patient back in shape to go work - doesn't matter what the job is though - it is more about general conditioning - the overall goal is to build up conditioning
26
Work hardening
Getting the patient back to their job specifically Very job specific, highly structured and individualized program, includes a psychosocial component, and timing is also a component here
27
Work hardening vs. Work conditioning
Hardening is job specific and conditioning is general conditioning - can have some job related conditioning but the main goal is to build up conditioning whereas hardening the goal is to get back to a specific job
28
Functional Capacity Examination - what is it
Comprehensive exam that assesses individuals ability to complete work tasks NOT a test specifically given to see if someone can perform a specific job - it is a comprehensive test to see what in general the person can physically do
29
Who can order an FCE
Physician or referral source Lawyer Patient (PT can recommend but cannot order it)
30
Who can perform the FCE exam
PT OT Athletic trainers depending on the test
31
Cost for FCE
1 day vs. 2 day 2 day is better These can cost 30,000 but you charge the company 500-1500 dollars depending on the test
32
Standardized vs. Non-standardized
Standardized - someone will come and teach everyone how to do the test - it is standardized Non - someone coming up with it on their own
33
Benefit of standardized test
Specific instructions stating the protocol | Also there is normative data to compare to
34
Components
Body mechanics, vital signs, verbal statements, nonverbal observations
35
Functional Job Description - purpose
Clearly outline what the job is and what the essential functions of the job are Needs to clearly state the essential functions of the job (this is where people can get into trouble with ADA)
36
Creation of a functional job description
PT can help make a job description after going into the workplace and watching people do the job - video it and analyze it to create their functional job description (measurements and all) - look at one person who has been there for about a year and someone who is a veteran - avg. those
37
Pre-placement screens
Assessing a prospective employee's fit to the job
38
When can a pre-placement screen be done
You are offered a job conditionally and one of the conditions is that you pass the pre-placement screen - taken things out of the job description to create a mini 30 min test to see that the prospective employee can perform the tasks Can also be done if coming out of injury and want to see if ready to go back into work
39
Pre-placement screen - next steps if employee has difficulty
Do accommodations need to be made | Is there a reasonable accommodation - decision of the director and human resources department
40
Ergonomics and Work Station Design - what would this be
Going into a job site and looking at the working environment to see what they are doing Taking the information you find and trying to figure out a way to change it to prevent further injuries
41
Injury prevention
Educational presentations - maybe transfer training, load lifting, nutrition, smoking cessation, exercise Ergonomics programming
42
Consultation - reasons for it
Injury prevention programming Ergonomics and workstation design Injury management strategies Legal expert
43
Symptom magnification and malingering - definition
Can happen in any patient population!!! Patients presenting with s/s that are not necessarily things you can see or assess Embellishing or acting like more is wrong
44
Types of symptom magnification and malingering
Refugee Game player Identified patient
45
Types of symptom magnification and malingering - Refugee
The person that has so many life roles and when they get injured they get a break and time to say they can't do it all - injury that may resolve in 3 days is taking weeks
46
Types of symptom magnification and malingering - Game player
Intentionally trying to deceive you They are getting gain from this Watching olympics, getting out of lay offs, getting sympathy from others
47
Types of symptom magnification and malingering - identified patient
This is a role in their life - may be their only role or the most important role in their life Identify themselves as only a patient
48
Waddell's Non-Organic Signs - define
Signs to look for the people may not be giving things their all
49
Waddell's Non-Organic Signs - what are they
``` Tenderness Simulation test Distraction tests Regional disturbances Over-reaction ```
50
Waddell's Non-Organic Signs - how many is a red flag
3 out of 5 positives
51
Waddell's Non-Organic Signs - Tenderness
Tender in places you would suspect it - ankle sprain but complain of tenderness at their hip and knee even after that joint has been cleared
52
Waddell's Non-Organic Signs - Simulation test
Patient thinks you are testing a certain area but you really are not - trunk rotation for example - but then look at hip IR and ER in standing
53
Waddell's Non-Organic Signs - Distraction tests
Assess patient and trick them | Check shoulder AROM limited but then later ask to take shirt off and does it no problem
54
Waddell's Non-Organic Signs - Regional disturbances
They black out entire areas | Carpel tunnel and they blacked out the entire arm
55
Waddell's Non-Organic Signs - Over reaction
Literally 11/10 pain even after explaining it to them
56
What do you do if you find someone presenting with the Waddell signs
Talk to them Explain what you are noticing and give them an out - can contact case manager if applicable DO NOT say the person is lying - just document what you see and measure
57
How to address the issue of symptom magnification and malingering
``` Written agreement Rules Address - dont confront (having conversations) Documentation Outside party (have work with other PT) Discharge ```
58
Documentation - with Occ Med
The same Concise No inc in legal issues - typically is employer and employee but your documentation is important
59
On site services with Occ Med - Pros
Ease of access Easy for individuals to go to you if injured versus going to a clinic off site Also easier for you as therapist to see what they are doing at the job In down time you can go and observe too
60
On site services with Occ Med - Cons
If nobody to see there is potential loss in revenue | Also would need a second office with separate equipment and stuff
61
Programming and marketing
Identify your population (employers and employees) Identify your populations needs )what type of services they need and see what else is out there already offering those services) Devise a service package (what you will offer them and what you can guarantee) Introduce plan of attack
62
How to make your services successful
Provide excellent services Do not make promises you cannot keep Develop excellent lines of communication Always look for new opportunities
63
FCE - how many reps
5
64
FCE - how many trials
5
65
FCE - frequency levels
Never (0%) Occasional (1-33%) Frequent (34-66%) Continuous (67-100%)

Semester 3 PM Exam 6 (2 decks)

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