Occupational Rehabilitation & Return To Work Programming Flashcards
1
Q
Transition services involve
A
Preparing adolescents & young adults with special needs for work
2
Q
OT vs OTA role in work rehab settings
A
OTA: provides verbal & written reports to OT in eval process, carry out intervention according to OTs plan
OT: completes initial eval report, develops intervention plan
Both: collaborate to meet client’s needs & carry out OT process
3
Q
OTs as educators
A
- Identify who is affected at work (age, gender, skill level, general health)
- Facilitate learning for clients
- Implement strategies according to client’s learning styles
4
Q
Aim of injury prevention programs
A
Decrease employers costs related to work injuries, improve worker fitness/safety, unite employers & workers to improve workplace safety
5
Q
Reimbursement sources for services
A
- Vocational rehab
- Private medical insurance
- Employer or organization direct payment
- Government funding
6
Q
ADA
A
Americans with Disabilities Act
- accommodate those with disabilities
7
Q
OSHA
A
Occupational Safety and Health Administration
- safe & healthful working conditions
- set standards
- provide training, outreach, education, assistance
- ergonomics guidelines for lifting & reducing work injuries
8
Q
NIOSH
A
National Institute for Occupational Safety and Health (part of CDC)
- conducts research and makes recommendations to prevent work injury/illness
- info about work safety and health: injury, hazards, prevention, ergonomics
9
Q
O*NET
A
Occupational Information Network (part of US Dept of Labor, Employment, & Training Admin)
- database of job requirements, worker attributes, info about occupations that are helpful when documenting job demands
- replaced Dictionary of Occupational Titles
10
Q
EEOC
A
Equal Employment Opportunity Commission (part of Uniform Guidelines on Employee Selection Procedures)
- employee selection is fair
- applies to new employees, those returning to work after injury/illness, those with disabilities
11
Q
Work-related musculoskeletal disorders (WMSDs)
A
Soft tissue injuries affecting muscles, tendons, nerves
- slow, insidious onset
- result of micro trauma
- 1/3 of all occupation injuries/illnesses in US
12
Q
Common types of WMSDs
A
- back injuries
- carpal tunnel syndrome
- deQyervain’s tenosynovitis
- lateral epicondylitis
13
Q
Factors increasing WMSD risk
A
- lifting heavy material
- poor workstation design
- poor work process design
14
Q
Is a fall considered a musculoskeletal disorder per US Dept of Labor?
A
No
15
Q
Back & neck rehab training
A
- strategies to improve fitness, job comfort, workplace safety to prevent injury, retrain after injury
- actual or simulated job tasks
- can assess body mechanics through checklists but not to determine actual body movements (no reliability or validity, not sensitive to changes in performance)
- assess for ergonomic risk factors (forceful exertions, repetition, awkward/static posturing, contact stress, excess vibration, cold temps)
- provide ergonomic strategies
16
Q
Body mechanics & postural alignment strategies
A
- Spine aligned
- Objects close to center of gravity
- Avoid twisting spine
- Both sides of body equally, maintain wide base of support
17
Q
Improving environmental fit by
A
Changes to work environment
- workstation modif
- proper tool access/fit
- proper materials handling
- adjustments to environmental factors (temp, lighting)
18
Q
Cognitive behavioral strategies
A
- positive reinforcement
- progressive relaxation
- biofeedback
19
Q
What considers psychosocial needs of clients and physical deficits
A
Holistic & client-centered approach
20
Q
Symptom magnification
A
- non adaptive, static approach to manipulating society with display of symptoms
- consistency of effort, sincerity of effort, max voluntary effort
- unconscious & conscious behavior
21
Q
Malingering
A
Deliberate or conscious faking of symptoms/disability to achieve personal gain
22
Q
3 types of symptom magnification
A
- Refugee/somatoform disorder
- Game player/malingerer
- Identified patient/chronic fictitious disorder
23
Q
Refugee/somatoform disorder
A
Uses symptoms to escape unresolvable conflict or situation
24
Q
Game player/malingerer
A
Consciously attempts to convince other works of the reality of symptoms for positive gain
25
Identified patient/chronic factitious disorder
Person assumes patient role as lifestyle
26
Symptom minimizer
Keeps symptoms hidden so they can return to normal activity and not appear weak
27
Symptom mininterpreter
Responds to physical changes to body in extreme manner due to difficulty processing sensory & kinesthetic input or unrealistic belief systems about manner in which body works
28
What is a required part of functional capacity evaluation (FCE)?
Identification of symptom magnification
29
What is a common assessment used to assist the clinician in determining max effort
Five level grip test (uses dynamometer)
- client to grasp it at each setting handle
- strongest grip expected on 2nd and 3rd settings
- results graphed & expected to fall in bell-shaped curve
30
4 characteristics for implementation of successful work injury prevention program
1. Ongoing management support
2. Supervisory support
3. Employee participation
4. Ongoing support & reinforcement of the programs
31
Steps to implement injury prevention program
1. Corporate plan
2. Injury prevention team
3. Training for risk factor identification
4. Ergonomic eval
5. Developing risk factor controls
6. Implementing med management strategies (early intervention, transitional work/modified duty programs)
32
Primary prevention
Identify/reduce risk factors early before injuries occur & promote healthy work habits/lifestyle
33
Secondary prevention
Early identification of symptom related risk factors to minimize/reduce duration, severity, cost of work-related injuries
34
Tertiary prevention
Occurs after injury/illness dx
- medically treating work-related injury, restoring work role
35
Job demands analysis
Defines actual demands of a job
- questionnaires, interviews, observations, formal assessments in real work environment
- distinguish between necessary tasks and unnecessary tasks
36
Data to guide job demands analysis
- interview supervisors, workers, or both
- obtain job description (optional)
- determine essential vs marginal tasks
- observe workers
- measure physical environment (height of work table), physical requirements (weight of carried/lifted items), frequency of jobs physical demands
37
DOT
Dictionary of Occupational Titles
- defines physical demands of work using standardized classification system
- defines occupations in US
- defines overall levels of work & strength demands/frequencies of physical components
- replaced by O*NET but still used
38
What are clinicians recommended to refer to when obtaining occupational information?
- DOT
- O*NET
39
Sedentary work
- exerting 10 lbs of force occasionally or negligible force frequently to lift, carry, push, pull, move objects including human body
- mostly sitting
- may involve walking or standing briefly
40
Light work
- exerting as much as 20 lbs of force occasionally to move objects
- requires walking or standing significantly
- sitting most of the time but pushing/pulling of arm or leg controls
- requires walking at production rate or pace entailing constant pushing or pulling of materials even with material weight negligible
41
Medium work
- exerting 20-50 lbs of force occasionally
- 10-25 lbs of force frequently
- more negligible to 10lb of force constantly to move objects
42
Heavy work
- exerting 50-100 lb of force occasionally
- 25-50 lbs frequently
- 10-20 lbs constantly
43
Very heavy work
- exerting force in excess of 100 lbs occasionally
- in excess of 50lbs frequently
- in excess of 20lb constantly
44
DOT definitions for physical demand frequencies
1. Never: does not exist
2. Occasionally: occurs 1/3 of the day
3. Frequently: occurs 2/3 of the day
4. Constantly: occurs 2/3-full day
45
Assess clients physical/cognitive abilities to meet general or specific demands of essential functions of a job
Work tolerance screening
46
When can work therapy occur?
At any point in healing process
- part of acute phase of rehab
47
Provide individuals with a process to help them identify goals for work & plan to return to work after serious illness/injury
- help identify options to match interests, skills, abilities
Work readiness programs
48
Work conditioning/work hardening
Outcomes-focused, individualized interdisciplinary program that addresses medical, physical, psych, behavioral, functional, and vocational components of employability and return to work
- relies on actual task replication
- participate only once high levels of stress no longer pose threat to tissue hemostasis
49
Relies heavily on actual task replication
Work hardening
50
When can a person participate in work hardening?
When high levels of stress no longer pose a threat to tissue hemostasis
51
Functional capacity evaluation
Objective assessment of a person’s ability to perform work-related tasks
- core of all return-to-work programs
- performed by many disciplines
- includes
1. Review of medical records
2. Interview
3. Musculoskeletal screening
4. Eval of physical performance
5. Formation of recommendations
6. Generation of report
52
Documentation in work programs
- more than acute therapy (progress notes, daily schedule, circuit sheets, progress summaries)
- include info whether Pt completed program: pain, behaviors, psychosocial complaints, progress, modalities received, any meetings attended & by whom/why, derogatory remarks, classes, job analysis completed, cancellations/reasons, plans for next session, descriptions of adaptations/modifications
- daily schedule sheets
- progress summaries to communicate with interdisciplinary team & insurance carriers
- documentation is permanent record, should justify need for OT, legal document to communicate progress & reimbursement
53
ASD worker accommodations
1. Provide advanced notice of meeting topics
2. Work requests in writing rather than verbal
3. Split assignments into smaller tasks with deadlines for each step
4. Encourage timer, calendar use
5. Checklist of assignments written out
6. Permit structured breaks for physical activity
7. Allow work from home if appropriate
8. Provide private workspace with room to move, reduced distractions
9. Establish employer policies (no perfume, no products with excessive odor)
54
Job coaching
Provides appropriate level of support on basis of individual needs in work environment
- includes job training, assistance for job task completion
- necessary when client unable to return to work due to injury/illness (WMSD, SCI, TBI, developmental delay)
- involves eval, intervention, re-eval w/nonstandard interview, observation, activity analysis
- occurs in work setting during work duties
- eval includes job analysis to identify activity demands if work setting is known
- help client identify work-related goals/priorities
55
Used to assess a client’s physical and cognitive abilities to meet general or specific demands of essential functions of a job
Work tolerance screening
56
Work tolerance screening
Assesses the physical and cognitive abilities of the client
- client factors: cardiovascular health, strength, balance, coordination
- functional abilities: sitting, standing, walking, kneeling
- job demands: weights, distances, heights
This is completed after job offer is provided. If the client does not pass the screening, then employer can evaluate client for a disability accommodation or job in another department or can remove the job offer.
- EEOC must ensure fairness with employee selection process
57
Work tolerance screening documentation
Directed to the payer (insurance)
- weight limits
- activity tolerance in time
- environmental restrictions
- pain
- OT observation of the client
58
Ergonomics
Ensures workplace is fitted to the human body
- can be done for an individual, group of employees, or employer
- scheduled during normal work hours
- conduct interviews
- obtain job requirements
- observe how the job is done, habits, and task demands
59
Common ergonomic risk factors
1. Forceful repetitions
2. Poor body mechanics
3. Awkward/static body posture
4. Excessive vibration
5. Frequent/heavy lifting
6. Extreme temperatures
7. Prolonged contact stress
60
Work habit-related risk factors
1, not taking breaks
2. Improper body mechanics while lifting
3. Cradling telephone between face and shoulder
4. Holding hand actively over keyboard during pause
61
Interventions for ergonomics: engineering controls
Modification of environment, workstation, or setup with or without assistive devices
1. Workstation checklist
2. Workstation components: keyboard, mouse
3. Workstation environment
4. Good working positions
5. Recommended dimensions of workstations for seated/standing work
6. Recommended chair characteristics at workstations
62
Ergonomic interventions: work practice controls
1. Modification of work habits through assistive devices or adaptive strategies
2. Body mechanics training
3. Tool maintenance
4. Selection/use of personal protective equipment
5. Conditioning/stretching
6. Practice/incorporation of new work habits & exercises
7. Modification of work processes
63
Ergonomic interventions: administrative controls
1. Line speed, staffing, physical demand changes (decreasing production rate, limiting overtime)
2. Job rotation through different workstations requiring diff task demands
3. Periodic rest breaks throughout the day
4. Provision of personal protective equipment
5. Provision of equipment to prevent heavy lifting
6. Worker education: work safety, ergonomic risk factors, injury prevention, reasonable accommodations
64
Ergonomic interventions: checklists for combating ergonomic risk factors
1. State of Wisconsin dept of administration
2. Hauko Ha et al
65
Ergonomic interventions: empowering corporate clients
1. Understand organizations culture
2. Obtain management commitment
3. Establish incentives: monetary vs groupthink & positive praise
4. Create/nurture teamwork environment & team accomplishment
66
OT role in work hardening
- work on interdisciplinary team
- tx plan to address problem areas through work-oriented activities that challenge cline to attain next level of functioning
- activities within client’s capabilities, challenge without causing stress, fatigue, risk of reinjury
- warm up and cool down exercises, conditioning, body mechanics practice, job modifications
- grading activities to progressively increase task demands (hierarchy of functional return)
Program length/duration depends on workers needs
- with improvement, increase involvement time in activities
- should be available up to 5 days per week in final program stages
Person with general physical status deterioration
- total body reconditioning requirement of 1 month min and 3 month ma
67
Work conditioning
- restore client’s systematic neuromuscular skeletal function
- involves only one discipline
- focus on limited work tasks, emphasis on exercise, aerobic conditioning, education
- OT observe client’s performance for signs/symptoms of overexertion, fatigue & make adjustments to the program if necessary
68
Clinical indications for conducting comprehensive FCE
1. Identify work restrictions
2. Confirm/rule out/discover dx
3. Postoffer or preinjury screening to determine if worker can perform job’s physical demands
4. Objectify physician’s recommendations
5. Limit physician’s liability
6. Candidate for remedial programs or vocational rehab?
7. Determine general UE functional capacity
8. Probability of worker performing consistently
9. Have they been abused by the system?
10. Determine if accommodations are necessary to reinstate injured worker
69
What an FCE can and can’t do
CAN: assist physician in generating impairment & disability ratings, set goals for after rehab
CANNOT: prove worker fraud, screen worker motivations
70
- worker’s % of whole-body function
- determines final monetary settlement for injured worker
- focuses on permanent quantifiable physical loss related to injury when worker is at max medical endpoint
Impairment rating
71
- combines worker’s impairment & impact of impairment on their ability to perform preinjury job or any job
Disability rating
72
Who can perform FCE
- need several years of experience in the field
- not for novice clinicians
73
Approaches to FCE
1. Typical kineophysical approach
2. Physical (neuromuscular) eval
3. Physical demand test
4. Re-evaluation
74
FCE: typical kineophysial approach
1. Intake/initial interview that assesses
- subjective pain
- effect of injury/illness on ADLS & functional abilities
- effect of cosmetics (restoring/preserving beauty)
75
FCE: physical/neuromuscularskeletal approach
1. ROM
2. Strength
3. Sensation
4. Volume
5. Soft tissue status
6. Special tests
76
FCE: physical demands testing
1. Standardized tests
2. Work simulation
3. Situational assessment
4. Eval of specific functional capacity
5. Computerized variable resistance testing
6. Manual material handling eval
77
FCE: re-eval
1. Inflammatory response to activity, sensation, pain
2. Includes follow-up questionnaire
78
FCE process
Begins with least physically demanding components and increases in resistance/complexity
1. Initial interview (establish rapport, explain procedure/purpose, confirm consistency of pre-eval records, determine feasibility of client’s preceding with eval due to cognitive, psych, medical issues, vocational goals)
2. Subjective eval (worker’s experience of injury, focus on pain, ADL impact, cosmesis)
3. pain assessments (pain diagrams, pain scales, record pain location, changes in pain levels, what inc/dec pain, affects on sleep): can repeat periodically throughout eval, be sure not to inc pain
4. May include classic ADL assessment components based on subjective report
5. Document client’s appearance of extremities involved
6. Musculoskeletal eval (core of FCE): ROM, strength, sensation, volume, soft tissue status
7. Use standardized/reliable/valid/relevant assessments, include DOT physical demands of work- can use nonstandardized tests to grade/tailor FCE to worker
8. Work simulation: tx approach, not evaluation
9. Situational assessment: exact physical demands of occupation
10. Computerized variable resistance tests: assess static & dynamic function, not necessary for FCE
11. Manual material handling eval: lifting capacity for comparison w/future performance or job requirements (instruct in proper body mechanics)
12. On-site eval: eval client in workplace w/consent of employer & insurance
13. Re-eval & post eval: final components, completed day or more after eval to determine activity performance, monitor edema, discoloration, pain levels postassessment
79
What should be included in an FCE report?
1. Referral & background info
2. Intake info
3. Intake subjective findings
4. Physical exam findings
5. Observations from physical demand findings (results from standardized & nonstandardized tests)
6. Observations from work/task specific evals
7. Comments on presence/absence of symptom magnification
8. Summary w/ conclusions & recommendations
80
Job accommodations
Process of identifying reasonable job accommodations
- requires cooperation between worker, employer, & OT
- no cost
1. Altering job duties/schedule
2. Modifying facility
3. Purchasing adaptive equip or assistive tech
4. Modifying/designing new product
81
Impact of ADA on work-oriented programs
1. Prohibits discrimination of disabled individuals by private, non gov employers w/15+ workers
2. Postoffer, preplacement, fitness-for-duty screenings are permissible
82
Reasonable accommodations
Any change in work environment or in the way work is customarily performed that enables disabled individual to have equal employment opportunities (only for qualified disabled individuals)
- physical environmental changes
- job restructuring
- schedule changes
- job reassignment to vacant position
- mods or acquisition to equipment
- adjustment/modified examination, training manuals, policies/procedures
- qualified readers/interpreters
83
Qualified individual with a disability
Disabled individual who satisfies requisite skills, experience, education, & other job related requirements of the employment position they hold or desire & performs essential functions of that position with or without reasonable accommodations
84
Undue hardship
Any accommodation that would be unduly costly, extensive, substantial, disruptive that would alter nature of business operation
85
Vocational/work evaluation
Provides info about person’s capabilities/interests for work in new work situations or looking for a new job after injury/illness
- examines individual interests/abilities to explore work opportunities
- uses actual or simulated work for assessment & helps client in vocational development
- assessment lasts 3-10 consecutive days depending on goals
OTs can conduct in public & private medical & non medical settings
1. General vocational eval
2. Specific vocational eval
86
General vocational evaluation
Comprehensive assessment of person’s potential to do any type of work
- determines person’s aptitudes, abilities, interests, explores all reasonable work options
87
Specific vocational evaluations
Assesses person’s readiness to return to particular occupation
88
When are transitional programs offered?
During transition period when client is able to complete some but not all job tasks
- may encompass job coaching, education, instruction, monitoring of company’s return-to-work programs
- use environmentally focused interventions to fascilitate return to work
- part of IEP
- movement from school to post school activities
- OT conducts transitional eval
Completion of job site analysis is clinically indicated, component of transition services eval
89
Interventions for job coaching /OT role
1. Training client in visualizing what they want to be, ensuring small success, fascilitate identification of work that has value to them
2. Identify amount/type of support provided
3. Develop client’s work skills
4. Consider modifications to tasks and natural support sources
