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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
Q

Work conditioning

A

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

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26
Q

Work hardening

A

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

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27
Q

Work hardening vs. Work conditioning

A

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
Q

Functional Capacity Examination - what is it

A

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
Q

Who can order an FCE

A

Physician or referral source
Lawyer
Patient
(PT can recommend but cannot order it)

30
Q

Who can perform the FCE exam

A

PT
OT
Athletic trainers depending on the test

31
Q

Cost for FCE

A

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
Q

Standardized vs. Non-standardized

A

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
Q

Benefit of standardized test

A

Specific instructions stating the protocol

Also there is normative data to compare to

34
Q

Components

A

Body mechanics, vital signs, verbal statements, nonverbal observations

35
Q

Functional Job Description - purpose

A

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
Q

Creation of a functional job description

A

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
Q

Pre-placement screens

A

Assessing a prospective employee’s fit to the job

38
Q

When can a pre-placement screen be done

A

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
Q

Pre-placement screen - next steps if employee has difficulty

A

Do accommodations need to be made

Is there a reasonable accommodation - decision of the director and human resources department

40
Q

Ergonomics and Work Station Design - what would this be

A

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
Q

Injury prevention

A

Educational presentations - maybe transfer training, load lifting, nutrition, smoking cessation, exercise
Ergonomics programming

42
Q

Consultation - reasons for it

A

Injury prevention programming
Ergonomics and workstation design
Injury management strategies
Legal expert

43
Q

Symptom magnification and malingering - definition

A

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
Q

Types of symptom magnification and malingering

A

Refugee
Game player
Identified patient

45
Q

Types of symptom magnification and malingering - Refugee

A

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
Q

Types of symptom magnification and malingering - Game player

A

Intentionally trying to deceive you
They are getting gain from this
Watching olympics, getting out of lay offs, getting sympathy from others

47
Q

Types of symptom magnification and malingering - identified patient

A

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
Q

Waddell’s Non-Organic Signs - define

A

Signs to look for the people may not be giving things their all

49
Q

Waddell’s Non-Organic Signs - what are they

A 
Tenderness
Simulation test
Distraction tests
Regional disturbances
Over-reaction
50
Q

Waddell’s Non-Organic Signs - how many is a red flag

A

3 out of 5 positives

51
Q

Waddell’s Non-Organic Signs - Tenderness

A

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
Q

Waddell’s Non-Organic Signs - Simulation test

A

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
Q

Waddell’s Non-Organic Signs - Distraction tests

A

Assess patient and trick them

Check shoulder AROM limited but then later ask to take shirt off and does it no problem

54
Q

Waddell’s Non-Organic Signs - Regional disturbances

A

They black out entire areas

Carpel tunnel and they blacked out the entire arm

55
Q

Waddell’s Non-Organic Signs - Over reaction

A

Literally 11/10 pain even after explaining it to them

56
Q

What do you do if you find someone presenting with the Waddell signs

A

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
Q

How to address the issue of symptom magnification and malingering

A 
Written agreement 
Rules
Address - dont confront (having conversations)
Documentation 
Outside party (have work with other PT)
Discharge
58
Q

Documentation - with Occ Med

A

The same
Concise
No inc in legal issues - typically is employer and employee but your documentation is important

59
Q

On site services with Occ Med - Pros

A

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
Q

On site services with Occ Med - Cons

A

If nobody to see there is potential loss in revenue

Also would need a second office with separate equipment and stuff

61
Q

Programming and marketing

A

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
Q

How to make your services successful

A

Provide excellent services
Do not make promises you cannot keep
Develop excellent lines of communication
Always look for new opportunities

63
Q

FCE - how many reps

A

5

64
Q

FCE - how many trials

A

5

65
Q

FCE - frequency levels

A

Never (0%)
Occasional (1-33%)
Frequent (34-66%)
Continuous (67-100%)

Semester 3 PM Exam 6 (2 decks)

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