Work Rehabilitation

Question 1

Occupational therapy practitioners promote health and wellness through educational activities in the work rehab settings. Which two areas does this include?

Answer 1

Educational programs
Identify clients within the work environment (e.g., by age, gender, skill level, general health)
Facilitate learning for clients
Implement strategies that take into consideration clients’ learning styles

Injury prevention programs
Decrease employers’ costs related to work injuries
Improve worker fitness and safety
Unite employers and workers in a collaborative plan to improve workplace safety.

Question 2

What is the CDC National Institute for Occupational Safety and Health (NIOSH)?

Answer 2

NIOSH is a research agency that provides information about workplace safety and health topics including injury, hazards, prevention, and ergonomics for various types of industries.

See http://www.cdc.gov/niosh/topics/ergonomics/ (NIOSH ergonomics resources).

Question 3

What is the Equal Employment Opportunity Commission (EEOC)?

Answer 3

The EEOC’s Uniform Guidelines on Employee Selection Procedures are in place to ensure that fair employee selection processes are in place (Biddle Consulting Group, 2015; EEOC, 2017). These guidelines apply to new employees, workers returning to work after an injury or illness, and workers with disabilities.

Question 4

What is the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA)?

Answer 4

OSHA (n.d.-a) sets and enforces workplace standards and provides information about general workplace safety and health, including ergonomics guidelines for lifting and to reduce workplace injuries.

See https://www.osha.gov/dts/osta/oshasoft/ and https://www.osha.gov/sites/default/files/2018-12/fy14_sh-26336-sh4_Ergonomic-Assessment-Checklist.pdf (Ergonomic Assessment Checklist).

Question 5

What is a Work-related musculoskeletal disorder (WMSDs)?

Answer 5

A class of soft-tissue injuries affecting the muscles, tendons, and nerves

Typically characterized by a slow and insidious onset
Thought to be the result of microtrauma

Account for one-third of all occupational injuries and illnesses in the United States.

Common WMSDs include carpal tunnel syndrome, de Quervain’s tenosynovitis, lateral epicondylitis, and some neck and back injuries

Question 6

Back and neck WMSDs are common among those who sit at computer monitors and/or desks for long stretches of time. They are also caused by heavy lifting and repetitive motions.

Back and neck rehabilitation training is used for?

Answer 6

to prevent injury or to retrain clients after injury.

Emphasizes strategies focused on improving fitness, job comfort, and workplace safety

Question 7

What are some intervention strategies or back and neck rehabilitation (work rehab)?

Answer 7

Body mechanics and postural alignment strategies
Keep the spine in alignment
Hold objects close to the center of gravity
Avoid twisting through the spine by facing the object straight on
Use both sides of the body equally and maintain a wide base of support.

Environmental fit can be improved by changes to the work environment, such as workstation modification, proper tool access and fit, proper materials handling, and adjustments to environmental factors such as temperature and lighting.

Question 8

True or false: WMSDs often have psychological sequelae.

Answer 8

True

Posttraumatic stress, anxiety, depression, and chronic pain can be detected 3 months postinjury.

Many people with peripheral nerve injuries also have depression.

Question 9

_________________ occurs when the client believes, contrary to evidence, that the situation is far worse than it actually is (e.g., believing that walking will never be possible after a treatable knee injury). Note that the client has no volition over the catastrophizing thoughts, feelings, or states.

Answer 9

Catastrophizing

Question 10

_________________ occurs when the client’s reported symptoms are not consistent with the injury (e.g., the client is unable to bear weight even though the physical exam indicates no serious injury or issue with healing). Identifying symptom magnification is a required part of a functional capacity evaluation.

Answer 10

Symptom magnification

Question 10

______________ is falsification or exaggeration of illness (physical or mental) to gain external benefits (i.e., avoiding work, seeking attention).

Answer 10

Malingering

Question 11

What is a “primary prevention goal” in work rehab?

Answer 11

to identify and reduce risk factors early, before injuries occur, and to promote healthy work habits and lifestyle

Question 12

What is a “secondary prevention goal” in work rehab?

Answer 12

early identification of symptom-related risk factors, ultimately to minimize or reduce the duration, severity, and cost of work-related injuries

Question 13

What is a “tertiary prevention goal” in work rehab?

Answer 13

occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work role.

Question 14

What are at least 2 characteristics of a successful work injury prevention program?

Answer 14

Ongoing management support

Supervisory support

Employee participation

Ongoing support and reinforcement of the program.

Question 15

Name at least 2 ergonomics risks facts?

Answer 15

Repetitive movement (e.g., high-risk repetition rates for the upper extremity)

Forceful or prolonged exertion of the hands

Frequent or heavy lifting, pushing, pulling, or carrying of heavy objects

Awkward or static postures, especially for a prolonged period

Excessive vibration

Extreme temperatures, especially cold

Prolonged contact stress

Material handling with faulty body mechanics, especially if lifting or twisting movement is required

Question 16

Name 2 work habit-related risk factors?

Answer 16

Not taking breaks or delaying breaks

Cradling telephone between shoulder and ear

Holding hand actively over the keyboard during a pause

Using improper body mechanics in lifting

Question 17

What are workstation and environment set up risk factors?

Answer 17

Workstation height

Seat height

Monitor height

Keyboard and mouse height

Positions of commonly used items in the workstation

Commonly used tools

Question 18

What are at least 3 ergonomic interventions in work rehab?

Answer 18

Engineering controls
Workstation checklist
Workstation components, such as keyboard and mouse
Workstation environment
Good working positions
Recommended dimensions of workstations for seated and standing work
Recommended chair characteristics at workstations

Work practice controls
Modification of work habits through use of assistive devices or adaptive strategies
Body mechanics training
Tool maintenance
Selection and use of personal protective equipment
Provision of conditioning or stretching exercises
Practice and incorporation of new work habits and exercises into work routine
Modification of work processes

Administrative controls
Changes in line speed, staffing, or physical demands of jobs (e.g., decreasing production rates, limiting overtime work)
Job rotation through different workstations that require different task demands
Allowing and enforcing regular periodic rest breaks throughout the day
Provision of personal protective equipment
Provision of equipment to prevent heavy lifting
Worker education on work safety, identification of ergonomic risk factors, and injury prevention; employer education regarding reasonable accommodations

Question 19

What is the purpose of a job demands analysis?

Answer 19

Provides objective information about the physical requirements of a job.

Is used in hiring, determining compensation, and in worker rehabilitation.

Defines the actual demands of a job, including essential job functions.

Is based on questionnaires, interviews, observations, and formal assessments completed in the real work environment.

Question 20

Define “sedentary” work.

Answer 20

Lifting or carrying up to 10 lb seldom or occasionally, or a negligible amount of weight (less than 1 lb) frequently. Involves standing less than or equal to one third of the time. Up to 2% of the day is spent performing physical demands.

Question 21

Define “light” work.

Answer 21

Lifting or carrying 11–25 lb seldom or occasionally, up to 10 lb frequently, or a negligible amount of weight constantly. Even though the weight lifted may only be a negligible amount, a job should be rated as light work when more than one third of the day is spent standing.

Question 22

Define “medium” work.

Answer 22

Requires lifting or carrying 26–50 lb seldom or occasionally, 11–25 lb frequently, and 1–10 lb constantly

Question 23

Define “heavy” work.

Answer 23

Requires lifting or carrying 51–100 lb seldom or occasionally, 26–50 lb frequently, or 11–25 lb constantly.

Question 24

Define "very heavy" work.

Answer 24

Requires lifting or carrying more than 100 lb seldom or occasionally, more than 50 lb frequently, or more than 25 lb constantly.

Question 25

What is a work tolerance screening?

Answer 25

Is used to **assess a client’s physical and cognitive abilities to meet the general or specific demands** of the essential functions of a job.

Question 26

What is the difference between a job demands analysis and a work tolerance screening?

Answer 26

In a **job demands analysis**, the focus is on the **job** in a **work tolerance screening**, the focus is on the **worker**.

Question 27

When is a work tolerance screening conducted?

Answer 27

**A work tolerance screening is generally conducted after the client has received an offer of employment conditional on the client passing the screening.** If the client does not pass, he or she is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job. The employer may allow the client to take a job in another area while regaining skills or strengths identified through the screening as needing attention. The employer may also release the client from the job offer if the client is unable to pass the screening. The EEOC provides guidelines to ensure that fair employee selection processes are upheld when conducting work tolerance screenings.

Question 28

What is a worksite evaluation?

Answer 28

**Worksite evaluations ​are conducted to determine whether a person can return to work after onset of disability.** The objective is to determine whether the person can safely carry out the essential functions of the job and whether the person needs reasonable accommodations to do so. These on-the-job evaluations typically take place after a job demands analysis has been completed. The evaluation includes assessment of The essential functions of the job, The functional assets and limitations of the worker, and The physical environment of the workplace.

Question 29

What is a Functional capacity evaluation (FCE)?

Answer 29

**an objective assessment of a person’s ability to perform work-related tasks** A typical FCE includes a review of medical records, an interview, a musculoskeletal screening, an evaluation of physical performance, the formation of recommendations, and the generation of a report. Many FCEs include a job demands analysis.

Question 30

_________________ provide individuals with a process to help them identify goals for work and a plan to return to work after serious illness or injury. Such programs help people identify options that match their interests, skills, and abilities.

Answer 30

Work readiness programs

Question 31

______________ allows a worker to temporarily perform job duties involving less physical demand. The worker’s regular duties are gradually added as he or she improves in skill and strength.

Answer 31

Light- or modified-duty programming

Question 32

_______________ is an outcomes-focused, individualized, interdisciplinary program that addresses the medical, physical, psychological, behavioral, functional, and vocational components of employability and return to work. Work hardening relies heavily on actual task replication.

Answer 32

Work conditioning/work hardening

Question 33

Under ADA, can an employer screen for a job applicant's ability to perform essential job functions?

Answer 33

**YES** Postoffer, preplacement, or fitness-for-duty screenings of a job applicant’s ability to perform essential job functions are permissible.

Question 34

Under ADA, what is considered a reasonable accommodation?

Answer 34

According to the ADA, reasonable accommodations include physical changes to the environment; job restructuring; part-time or modified-duty schedules; job reassignment to a vacant position; acquisition of or modification to equipment; adjustment or modification of examinations, training manuals, and policies and procedures; provision of qualified readers or interpreters; and any other similar accommodations for people with disabilities.

Question 35

What are some examples of accommodations for a worker with sensory differences?

Answer 35

Provide advance notice of topics to be discussed at meetings. Provide the worker(s) with work requests in writing rather than through verbal interaction. Divide assignments into smaller steps, with specific deadlines for each step. Encourage the use of a timer or handheld organizer or calendar (paper, computer, or phone-based. Provide a written checklist of assignments. Permit structured breaks to provide an opportunity for physical activity. Allow working from home if appropriate for the job duties. Provide a private workspace with adequate room to move around, and with reduced distractions (e.g., white noise machine, desk lamp rather than overhead lighting). Establish employer policies that specify no perfume or use of other products with excessive odor (e.g., air freshener plug-ins).

Question 36

_____________________ is a comprehensive assessment of a person’s potential to do any type of work. It is used to determine the person’s aptitudes, abilities, and interests and to explore all reasonable options for work.

Answer 36

**General vocational evaluation** *Specific vocational evaluation* assesses a person’s readiness to return to a particular occupation.

Question 37

________________ Are offered during a period when the client can complete some but not all job tasks. May encompass job coaching, education, instruction, and monitoring of the company’s return-to-work programs.

Answer 37

Transitional programs

Question 38

____________________ Provides an appropriate level of support on the basis of individual needs in the work environment May include job training or assistance for job task completion)

Answer 38

**Job coaching** Is necessary when a client is unable to return to work because an injury or illness (e.g., work-related musculoskeletal disease, brain injury, spinal cord injury) prevents him or her from fulfilling job requirements. Clients with developmental delays or other childhood conditions may need job coaching during the transition from school to work.

Question 39

What is the occupational therapists role in supported employment settings?

Answer 39

The occupational therapist’s role in supported employment settings is to **identify the amount and type of support to be provided and to develop clients’ work skills to enable them to complete job tasks**. *Natural supports* are a primary component of supported employment. Natural supports are methods of assistance that are seen as normative within the setting, such as onboarding, mentoring, and positive relationships with coworkers. Modifications to job tasks may include task adaptation, job-specific training for the individual, or coworker support in specific task completion.

Question 40

What should be included in documentation of work tolerance screening?

Answer 40

Should specify **weight limits, activity tolerance in time, restrictions within the environment**, the client’s report of **pain**, and the occupational therapist’s **observations** of the client.