Occupational Rehab/Return to Work Flashcards
Injury prevention program aims:
- Decrease employer costs related to work injury (NUMBER ONE GOAL)
- Improve worker fitness and safety
- Bridge employee and worker collaboration to improve safety
Occupational Information Network (O*Net)
A database of requirements, worker attributes and other info about thousands of occupations that can be helpful when documenting job demands
*Replaced dictionary of occupational titles
Uniform Guidelines for Employee Selection Procedures
Part of the Equal Employment Opportunity Commission (EEOC) that is in place to ensure fair employment selection process
WSMDs
Work Related Musculoskeletal Disorders -A class of soft tissue injuries affecting the muscles, tendons, and nerves; characterized by slow and insidious onset and a result of microtrauma
WSMDs and workplace
WSMDs account for 1/3 of all occupational injuries
-Poor body mechanics often contribute to these repeated microtraumas, making body mechanics important when addressing
Most common WSMDs
Back injuries, carpal tunnel syndrome, de Quervain’s (condition affecting the tendons on radial side of wrist), and lateral epicondylitis
Risk factors for WSMDs
- Heavier level of material handling
- Poor work station design
- Poor work process design (e.g. body mechanics)
Ergonomic risk factors
- Forceful exertions
- Repetition
- Awkward or static posturing
- Contact stress
- Excessive vibration
- Cold temperatures
Body mechanic strategies
- Keep spine in alignment
- Hold objects close to center of gravity
- Avoid twisting through the spine by facing objects straight on
- Use both sides of the body equally and maintain a WIDE base of support
Environmental fit
Work environment redesign through workstation modification, proper tool access and fit, proper material handling, and environmental adjustments such as temperature and lighting
Symptom magnification
A non-adaptive, static approach to manipulating society with displays of symptoms.
- Can be conscious or unconscious
- FCE process necessitates that clinician assess for symptom magnification
Malingering
Deliberate or conscious symptom magnification to avoid work or responsibility to achieve personal gain.
Types of symptom magnification
- Refugee: uses symptoms to escape unresolved conflict.
- Symptom misinterpreter: responds to physical changes in extreme manner due to difficulty processing sensory and kinetic input or an unrealistic understanding of how body works
- Game player: Consciously attempts to convince those working with them of the reality of symptoms for positive gain
- Identified patient: assumes patient role as a lifestyle
Symptom minimizer
Keeps symptoms hidden to return to normal work or avoid being seen as weak.
Five-level grip test
A common assessment to test maximum effort (look for malingering)
-Jamar dynometer is used at each handle setting; should see bell curve if maximum effort (strongest should be second or third trial)
Successful work injury prevention should include:
- Ongoing management support
- Supervisory support
- Employee participation
- Ongoing support and reinforcement of program
Primary prevention goal
To identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle.
Secondary prevention goal
Early identification of symptom-related risk factors; ultimately, to reduce the duration, severity, and cost of work-related injuries.
Tertiary prevention goal
Occurs after injury or illness has been diagnosed; intervention focuses on medically treating the work-related injury and restoring the work role
Job demand analysis
Defines actual demands of job and involves questionnaires, interviews (employer and employee), observations and formal assessments in real work environment
-provides objective analysis of each job task, taking into account the physical environment in which job occurs
Secondary work
Exerting as much as 10 lbs. of force occasionally or a negligible amount of force frequently to life, carry, push or pull objects.
Light work
Exerting as much as 20 lbs. of force occasionally, as much as 10 lbs. of force frequently, or a negligible amount of force constantly.
Medium work
Exerting 20-50 lbs. of force occasionally, 10-25 lbs. of force frequently, or 10-20 lbs. constantly.
Heavy work
Exerting 50-100 lbs. of force occasionally, 25-50 lbs. frequently, and 10-20 lbs. constantly.
Very heavy work
Exerting force in excess of 100 lbs. occasionally, in excess of 50 lbs. frequently, and in excess of 20 lbs. constantly.
DOT definitions of demand frequency
- Never: activity or condition does not exist
- Occasionally: activity or condition occurs as much as 1/3 of the day
- Frequently: activity or condition occurs as much as 1/3 to 2/3 of day
- Constantly: activity or condition occurs 2/3 of time to full day
Productive modified duty programs should focus on:
- Maintaining injured employees in a productive work capacity while facilitating progressive recovery
- Identify designated staff to be trained to monitor a worker’s adjustment and tolerance to work tasks
- Ensure that the demands of an assignment are within the stated restrictions of the employee’s abilities
Work-hardening documentation should include:
- Daily notes that reflect a detailed description of circuit training, including duration and number of reps.
- Progress notes that include pain reports, psychosocial complaints, modalities received, job analysis, and plan for next session.
- ->progress notes should also include clients attendance, number of sessions, and response to the program
Work therapy
Work therapy involves work tasks to improve function and can occur at any point of healing of injured tissues and is typically part of the acute phase of rehab
Top-down vs bottom-up approach
Bottom-up starts with the specific injury or client. Top-down approach includes site-wide changes and management support.
**Work comp is top-down because the main focus is to cut employer costs
Engineering control
Provide proper design of the work environment, tools, and processes.
-Includes: workstation checklist, workstation component, workstation environment, good positioning, recommended dimensions for workplace and chair choice
Work practice controls
Modifications to work habits through assistive devices or adaptive strategies
-Includes: body mechanics, tool maintenance, selection of protective equipment, conditioning or stretching exercises
Administrative controls
Changes in line speed, staffing, and physical demands of job, such as decreasing production rates or limiting overtime
-Includes: job rotation through different workplaces, requiring rest breaks, provision of protective equipment or heavy lifting equipment.
Vocational Rehabilitation
Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to work with new roles or find a new workplace to fit needs.
Can a new grad preform FCE?
FCE’s are not recommended for entry-level or novice clinicians. New graduates should attend conferences, access resources, and network with colleagues to become equipped to perform.
Job coaching setting
Support approaches with on-site training are recommended as the most effective setting for job coaching (Actual workplace training opposed to simulation).
Work-hardening program: client-to-therapist ratio
Most commonly accepted ratio: 5 clients to 1 therapist
Total body deconditioning recovery
Total body deconditioning may require anywhere from 1 to 3 months of reconditioning to get worker back to preinjury status
Transitional work programs
Offered when the client is able to complete some tasks, but not all job tasks and may require job coaching, education, instruction, and monitoring of the company’s return-to-work programs.
Heavy tasks and elbow position
Heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature.
Ergonomic principals for computer positioning
- Monitor should be approximately one arms length away and the top one-third of the monitor should be at the user’s eye level
- elbows, knees, and hips at 90 deg
- Feet flat on surface
- wrists at neutral
Spine injuries and work accommodations
- C1-C3: Usually ventilator dependent
- C5-C7: requires electrical wheelchair
- C6-C7: electric or manual wheelchair (some independence with ADLs)
- T12-L2: respiration is functional, independent with ADLs and can drive with hand controls
- L4-L5: can drive independently and ambulate w/ AFOs or canes
Essential job functions
Job duties fundamental to the position the individual holds or desires to hold.
- Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive technology or modifying tools used
- If essential job functions causing injury or discomfort, best option may be allowing flexible work schedule on basis of symptoms
OTR work tolerance screening and hiring
The OTR® should remain separate from the hiring process, including notification of hiring decisions, to maintain objectivity and third-party distance
Essential component of injury prevention program:
Training in symptom identification: can reduce severity of injury and subsequent costs
The hierarchy of functional return
Involves gradual gradation of tasks from gross to fine motor movements, increased resistance, and repetition from simple to complex tasks with postural changes to promote neuromuscular reeducation
