Week 3 Flashcards
- a disabled employee receives a portion of his or her usual monthly salary during the disability and may receive more for permanent physical injuries, or if he or she has dependents.
- federal statutes are limited to non-military, federal employees - state statutes - each has its own individual program
worker’s compensation
name 4 things that worker’s compensation provides.
- fixed monetary awards for injuries and illnesses
- medical care and expenses due to the injury/disability
- funding for job retraining
- benefits for dependents of workers killed because of work-related accidents or illnesses
form of insurance providing wage replacement and medical benefits in exchange for relinquishing the right to sue the employer for negligence.
worker’s comp
misclassifies employees to avoid having to pay a workman’s comp insurance premium
fraud by employer
prohibits discrimination on the basis of disability in local programs and activities benefiting from federal financial assistance
rehab act of 1973
name 4 “realizations” of veterans/service members.
- psychosocial - PTSD, depression
- TBI
- amputation
- SCI
name 6 problems with returning to work for serviceman/veterans.
- servicemen and women are young
- many have little or no previous work experience
- training received in armed services may not be helpful in process of finding employment after disabling condition
- many want to return to the field
- considerations regarding pay and benefits
- now really beginning to see the importance of psychosocial needs, recreation and emotional support - enhance adaptive stress reactions
- required mainstreaming of children with disabilities into classrooms
- required the establishment of IEPs
- early intervention
- now called individuals with disabilities education act (IDEA)
the education for all handicapped children act of 1974
- injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs
- painful disorder of muscles, tendons, nerves, etc.
musculoskeletal disorders (MSD)
work-related musculoskeletal disorders (WMSDs) are conditions in which what 2 things…
-work environment and performance of work contribute significantly to the condition
and/or
-condition is made worse or persists longer due to work conditions
___ ___ are the predominant occupational health problem in most industrialized countries.
musculoskeletal disorders
how do MSDs occur??
overuse, repetitive NOT traumatic
t/f - MSDs can result in loss of productivity.
true
- a class of musculoskeletal disorders in which chronic discomfort, pain, and functional impairment may develop over time resulting from frequent, sustained, and repetitive motions.
- a group of painful disorders of muscles, tendons, and nerves. work activities which are frequent and repetitive, or activities with awkward postures cause these disorders which may be painful during work or rest
work-related MSDs (WRMDs)
what % of reported WRMDs are UE symptoms?
20-30%
WRMDs cause more ___ or ___ than any other group of diseases.
absenteeism, disability
name 8 risk factors for WRMDs.
- high reps
- high force
- awkward postures
- psychological
- direct pressure
- contact pressure
- vibration
- prolonged static position
lead to tissue and microtrauma and fatigue
repetitions
proportional to the amount of force and duration of the force application
fatigue
lead to increased intramuscular pressure, leading to decreased blood flow, leading to muscular energy crisis and pain
repetition and force
name 4 aspects of treatment for repetition and force injuries.
- rest
- splinting
- anti-inflammatory meds
- RICE
describe recovery for repetition and force injuries regarding time.
- sufficient time may increase strength of tissue
- insufficient - muscular injury
awkward postures may lead to which 2 things…
- muscular imbalance - weakness, pain, muscular lengthening/shortening
- reiterative problem
name 4 aspects of treatment for awkward posture injuries.
- ergonomic modifications
- rest/modalities
- alternative postures
- fitness
name 5 components of a job that can lead to psychological distress.
- job repetition, dissatisfaction
- anxiety
- depression
- pain
- lack of job rotation
describe treatment for psychological job stressors.
- comprehensive approach to treatment required
- goal-directed and education approach gives clients sense of control and relief
incompatibility between volume of PN structure and anatomical space available to nerve
nerve compression (entrapment) syndrome
inflammation of tendon and synovial membrane of tendon sheath
tendonitis
name 4 tendon-related disorders.
- tenonitis
- dequervain’s
- dupuytren’s
- trigger finger
name 2 nerve-related disorders.
- carpal tunnel
- cubital tunnel
name 3 muscle-related disorders.
- tension neck
- muscle sprain or strain
- myalgia
name 2 vascular-related disorders.
- hypothenar hammer syndrome
- raynoud’s
name 1 joint-related disorder.
osteoarthritis
name 2 types of tendonitis of the shoulder.
- rotator cuff muscles
- biceps brachii (long head)
name 2 types of tendonitis of the elbow.
- lateral (Extensor) epicondylitis
- medial (Flexor) epicondylitis
what does inflammation and thickening of a tendon indicate?
compression of nerve and vascular supply
what do hormone changes indicate?
nerve compression
which type of involvement is more involved in nerve compression injuries?
sensory more than motor involvement
name 4 symptoms of nerve compression.
- pain
- tingling
- numbness
- weakness
aching and tiredness of limb during work but disappears at night/days off. no reduction of work
early symptoms of WMSD
aching and tiredness of limb occurs early in work day, persists at night, reduced capacity for repetitive work
intermediate symptoms of WMSD
all symptoms persist at rest, inability to sleep and perform even light duties
late symptoms of WMSD
describe the cycle of tendonitis.
overuse = micro trauma = swelling, pain, less motion followed by rest, disuse, and weakness
the 5 functional grades of CTD go from __ to __.
least severe to most severe
- pain after activity, resolves with rest
- no decrease in amount or speed of work
- no objective findings
Grade 1 - Functional Grades of CTD
- pain while working, resolves with rest
- productivity mildly affected
- may have objective findings
Grade 2 - Functional Grades of CTD
- pain in 1 or more sites while working
- pain after activity stops
- productivity affected, many breaks needed
- may affect activity outside of work
- weakness, loss of dexterity, tingling, numbness
- may have active or latent trigger points
Grade 3 - Functional Grades of CTD
- all common uses of hand and UE cause pain 50%-75% of the time
- may be able to work or work in limited capacity
- objective findings - weakness, loss of control and dexterity, tingling, numbness, trigger points
Grade 4 - Functional Grades of CTD
- loss of ability to use hand/UE due to chronic unrelenting pain
- usually unable to work
- symptoms may persist indefinitely
Grade 5 - Functional Grades of CTD
name 3 general aspects of OT treatment for WRMDs.
- variety of treatment recommendations but no one will work for all patients
- OT must take active role in investigating relationship between injury and activity
- OT doesn’t make diagnosis but results of careful eval. will be valued by MD- special tests can assist helping to dx
name 6 specific OT treatment methods for WRMDs.
- restriction of movement - RICE
- application of heat/cold/modalities - US, paraffin, iontophoresis
- exercise/gentle stretch
- k tape
- medication surgery
describe phase 1 of OT treatment. (2 aspects)
- symptom control and teach self-management
- gentle ROM/then strengthening-home program - can only begin when symptoms begin to subside
which 2 braces/splints are recommended for patients with lateral epicondylitis.
- inelastic, non-articular, proximal forearm strap
- wrist splint
describe phase 2 of OT treatment. (3 aspects)
- conditioning - when acceptable strength has returned but endurance is needed, all symptoms resolved
- ergonomic assessment/recommendations - esp. effective in acute phase
- return to work - job analysis, physical capacity eval. (PCE)
- person as client
- OT works with variety of rehab professionals to find suitable employment for injured worker
- as job options are developed, OT reviews for physical appropriateness, suggests supports and adjustments.
vocational model
- OT works as consultant to insurance company
- follows injured worker through medical and rehab. process
- coordinates services, stays in communication with worker
- facilitates progression worker through WC system so that time is not wasted and person returned to work.
case management model
- intervention on site includes: occupational health RN, risk manager, MD, supervisor, ergonomist
- ergonomic training of employees and supervisors, on site evals, prevention of injury
- screening of new employees to comply with ADA
industrial model
name the 3 intervention models.
- vocational model
- case management model
- industrial model
name 4 ways in which OTs can prevent WMSDs.
- job design - mechanization, rotation, enlargement/enrichment, teamwork
- workplace design
- tools and equipment design
- work practices
- objectively measures an injured employee’s capability, not DISABILITY, by identifying safe performance capabilities and comparing them to the job requirements detailed in the job analysis.
- evaluates an individual’s capacity to perform work activities.
- and other IADL areas that support work can be evaluated
- usually measures ability to perform physical demands but can include cognitive demands if warranted
functional capacity evaluation (FCE)
name the 3 priorities of the FCE.
- patient safety
- reliability
- useful measures
- designed to maximize the individual’s ability to return to work
- interdisciplinary
- progressively improve the biomechanical, neuromuscular, cardiovascular/metabolic and psychosocial functions
- transition between acute care and return to work
- addresses the issues of productivity, safety, physical tolerances, and worker behaviors
functional capacity eval. (FCE)
name 6 aspects of the OTs role in the FCE for a job.
- determine goals for rehab or readiness for discharge
- determine if/when person can safely return to work (RTW)
- determine readiness for work for vocational rehab
- worker’s compensation case settlement ($$$)
- determine a person’s ability to meet job demands as part of hiring process
- results of FCE can also be used to determine ability to meet demands of other activities
what are the time requirements for the FCE?
usually 2-8 hours
name 3 types of people who should be referred for FCE.
- have reached maximum medical benefits and are awaiting case closure.
- need function quantified prior to RTW
- have history of subjective complaints but without objective findings
the FCE should take place where?
within the context of the demands of the job
rehab phase of returning a person injured on the job to the workplace
work hardening
name 5 components of developing a client’s program.
- simulation activities
- conditioning activities
- activity
- education
- documentation
___ ___ are important components of your OT tx session.
simulation activities
- may include simple stretching and flexibility exercises
- vary strengthening, aerobics, etc.
- encourage client to perform exercises intermittently at the workstation to avoid muscular fatigue and reinjury
conditioning activity
making a small injury look bigger than it is
inflating injury
getting injured at home and saying it happened at work
remote injury
you’re getting better but you’re not saying so
malingering injury
happened a while ago but reporting it now
old injury
how does contact pressure occur?
while holding tools
describe splint laws at work.
by law can’t have rigid parts while working - other ones that are less rigid are better
what should we use to help classify and specify disorders?
special tests
regarding nerve compression syndromes, ___ issues are harder to address.
sensory
attachment of the muscle is where the injury is
tendonitis
golfer’s elbow
medial epicondylitis
tennis elbow
lateral epicondylitis
vascular, caused by vibration of something
white finger vibration syndrome
used to be used a lot for tendonitis
iontophoresis
used for elbow injuries - lateral and medial epicondylitis
k tape
portable form of iontophoresis
hybresis
come in different sizes, not easy, painful to do the first time even if done correctly, should practice on yourself first before you instruct patients
therabar
can be done in outpatient with weights, therabands, putty, etc.
work conditioning
very specific to specific work tasks, how do we have pt. work up to those, how do we simulate in the clinic, true work tasks, getting the person back to what they’re doing
work hardening
the FCE shows what and not what?
shows what the worker is capable of, not what the injury or disability is limiting
capability not disability
tool to help simulate work easily, has different attachments
baltimore therapeutic exercise (BTE)
specialized standardized test that measures work-related skills
valpart
name 3 reasons why we use ergonomics at workstations.
- to make them safe, comfortable, and productive.
- to maintain neutral body posture where joints are naturally aligned.
- to eliminate or reduce stress and strain that leads to the MSD that we as OTs treat.
if a workstation is set up properly, a worker may have less… which 5 things?
- eyestrain
- headaches
- neck pain
- back pain
- tendonitis, bursitis, joint pain - which can all be linked to doing repetitive tasks
- the posture the body assumes in microgravity (weightlessness, or g-force close to zero)
- adopting any other position while floating assumes muscular effort
- maintain natural alignment as much as possible - wrist, elbow, cervical, thoracic, and lumbar vertebrae.
neutral body posture
how is position of rest determined?
by passive tendons in opposing muscle groups
describe finger position at rest.
-at rest, fingers in slightly flexed position and partly spread. small finger is usually most flexed and index finger is least flexed
name the 3 principle injury factors for workers who do repetitive tasks.
- working posture
- repetition rate
- force application
describe why injuries occur regarding wrist position.
- repeated forceful gripping and turning action with wrist in deviated position.
- gripping actions alone less likely to cause injury if wrist is in neutral
describe percentages of grip strength regarding wrist position (5 things).
- neutral = 100%
- RD - 80%
- UD - 75%
- extension - 60%
- flexion - 45%
eliminate working with a deviated wrist by… (name 4 things).
- redesigning hand tools - to offer better grip and more mechanical advantage
- changing height of work surface or making it adjustable
- tilting work surface or work pieces towards the worker
- tilting containers for ease of access
- jobs that remain in these categories fall into high risk category
- prevalence of musculoskeletal problems increases and these workers become our patients
production line workers
if you’re unable to change the rate of repetitions, what should you change instead?
reduce force (muscle effort)
if non-powered tools must be used, to avoid injury we need which 3 things?
- less force
- less repeated movement
- less awkward positioning
fingers flex around object and clamp it against palm
power grip
object is held between the tips (pads or sides) of the thumb and one or more fingers
precision grip
closed kinetic chain - parts of hands used in mechanical opposition to each other, exerting force on the object and holding in place
gripping action
