Occupational Rehabilitation and Return-to-Work Programming

An OTR® completes a job demand analysis for the job requirements of a printer position. The OTR® determines that the job requires 95% of time spent in standing; the pacing of the job is predetermined by the printing rate of the machine, and the worker lifted as much as 30 pounds occasionally and 15 pounds frequently. According to the definitions of overall level of work, what type of work is the printer position? A. Sedentary B. Light C. Medium D. Heavy

Because of the amount of standing required, the job would not be considered sedentary work. Frequently lifting more than 15 pounds defines the level of work as medium.

A client attending back-neck school is given an ergonomics checklist to complete. Which item is the BEST to include in an ergonomics checklist? A. Use a wide base of support when performing tasks. B. Increase tolerance for aerobic exercise activity. C. Use the dominant body side to complete tasks. D. Take frequent breaks between tasks.

Principles of ergonomic training for back injury prevention include maintaining a wide base of support during task completion.

An OTR® is considering using an ergonomics rating scale with a worker participating in back training. Which factor is MOST important to consider in selecting an ergonomics rating scale? A. Whether the rating scale can detect subtle change in task performance B. Whether the rating scale provides information on fatigue tolerance C. The extent to which the rating scale is reliable and valid D. The worker's preference for body position when performing tasks

Rating scales (e.g., checklists) in work rehabilitation may not have established reliability and validity. The use of reliable and valid scales supports more accurate outcome comparison and ensures that factors intended to be measured are actually measured by the scale.

Heavy Work

Requires exerting 50-100 lbs of force occasionally, 25-50 lbs of force frequently, or 10-20 lb of force constantly to move objects. Physical demand requirements are in excess of those for medium work

The identified patient

assumes the patient role as a lifestyle

Undue Hardship

is an exception to the requirement of employers to provide reasonable accommodations per ADA. Undue hardship refers to any accommodation that would be unduly costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business

Reasonable accommodations

may 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 individuals with disabilities

Individual with disabilities (defined)

one who has a physical or mental impairment that substantially limits one or more major life activities

The symptom misinterpreter

responds to the physical changes in the body in an extreme manner because of difficulty processing sensory and kinesthetic input or unrealistic belief systems about the manner in which the body works

The refugee

uses symptoms to escape an unresolvable conflict

Work Hardening programs may include

warm-up and cool-down exercises, conditioning exercise, practice of body mechanics, and use of job modifications

A client with Down syndrome is preparing for transition from high school to work and is seeking a work placement. The client needs to identify vocational interests and abilities for general job tasks. To which service should the OTR® refer the client? A. Job coaching B. Functional capacity evaluation C. Job site evaluation D. Prework screening

Job coaching provides vocational evaluation to identify a client's vocational interests and abilities along with physical and mental tolerances for general job activities. Explanations of Incorrect Answers B: Functional capacity evaluation provides information about a client's physical abilities to complete a specific job activity. C: Job site evaluations assess the physical demands and layout of a specific job setting. D: Prework screening is done when a client has been offered a job.

An OTR® receives a referral to complete a job demand analysis on a client who is a diesel mechanic. At the job site, what should the OTR® do FIRST? A. Assess the design of the workstation. B. Conduct interviews with staff at the work site. C. Assess the client's material handling skills. D. Complete force gauge measurements on all equipment.

Job demand analysis looks to define the essential actual job demands. It often includes questionnaires, interviews, observation, and formal measurements and is conducted in the actual work environment. OTR®s are recommended to use objective means to gather information, because interview may not be considered the most accurate means to determine job demands. Clinicians often use interview in conjunction with functional capacity evaluation and job description. Interviewing staff is therefore an appropriate first course of action, because the OTR® must determine which tasks are considered essential to job performance.

Essential Job Functions (defined)

Job duties fundamental to the position the individual holds or desires to hold, as opposed to functional that are marginal functions. Essential functions are those functions an individual must be able to perform with or without reasonable accommodations

Clinical Indications for conducting a comprehensive FCE

-To identify work restrictions - As a provocative means to confirm, rule out, or discover a diagnosis - As a post offer or pre injury screening to determine whether an employee can perform the physical demands of the job -To objectify physicians' recommendations - To limit physicians' liability - To determine whether a worker is a candidate for remedial programs - To determine whether a worker is a candidate for vocational rehabilitation - To determine general upper extremity functional capacity - To determine the probability that a worker performed consistently -To learn whether a worker has been abused by the system - To determine the level of reasonable accommodations necessary to reinstate an injured worker

Whom would an OTR® working in an outpatient return-to-work program NOT consider a primary referral source for an FCE? A. Physician B. Case manager C. Attorney D. Career counselor

A career counselor is defined as an individual who counsels individuals or provides group educational and vocational guidance services. A career counselor would not be considered a primary referral source. Explanations of Incorrect Answers A, B, C: Physicians, case managers, and attorneys are all considered primary referral sources for FCE.

Hierarchy of Functional Return

A gradation from gross to fine motor, from less to more resistive, form skill to speed focused, and from simple to complex

A client with Down syndrome recently began working at a small pizza restaurant. The job duties include keeping the tables clean and restocked with condiments and napkins. The employer reports that the client is disorganized in completing tasks. In addition, when the client becomes frustrated, which occurs often, the client's behavior offends the other workers. Which intervention would be MOST practical in job coaching with this client? A. Implement a monthly consultation meeting for all workers at the restaurant to discuss their concerns with employee performance. B. Prevent work injuries for the client by enrolling the client in an ergonomic training program with the other workers. C. Adapt the job duties by providing the client with a checklist of duties and having the client mark off tasks as they are completed. D. Provide cognitive retraining to teach the client strategies for sequencing job duties for improved organization.

A task adaptation (i.e., checklist) provides the least restrictive support to enable this client to remain in this job.

An OTR® has been treating a client who sustained a chemical burn to both hands 6 months ago while cleaning up a spill at the adhesive manufacturing plant where the client is employed as a janitor. The client has been participating in a work conditioning program for the past 6 weeks and has made gains in all areas. The client plans to transition back to full-time, full-duty employment within the next 2 weeks. The OTR® included instruction in proper body mechanics as part of the client's treatment program to reduce the client's risk for reinjury. What type of intervention would this treatment program be considered? A. Primary intervention B. Secondary intervention C. Tertiary intervention D. Wellness intervention

A tertiary prevention program occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications.

A client with a disability works through a supported employment agency in a hotel housekeeping department. The client has difficulty staying on task. Which support would be the MOST effective in helping this client stay on task? A. Hold a social event for workers in the housekeeping department. B. Give the client a written reprimand. C. Place the client in another department. D. Add duties to keep the client busy.

A. Hold a social event for workers in the housekeeping department. Socializing and developing relationships with coworkers provide a natural support and opportunities to work along with and mentor with coworkers without disabilities; such activities also assist in learning the culture of a workplace. Explanations of Incorrect Answers B: A reprimand is a punishment and does not provide support. C: Changing the worker's department will require new task learning and may not address the reason for the worker's distractibility. D: Additional duties may add to the worker's distractibility and do not offer support to address the behaviors the worker is demonstrating.

Workers' compensation claims resulting from low back muscle strains and sprains have increased at an auto mechanic company, and management asks an OTR® for a consultation on implementing an injury prevention program. Which goal would be reasonable for this program? A. Reduce costs for the employer resulting from lost work days and workers' compensation claims B. Promote an atmosphere of intimidation to stop workers from filing injury reports C. Train workers in the use of back brace supports to reduce injury risk. D. Initiate a training program that addresses work behaviors to improve back alignment

A. Reduce costs for the employer resulting from lost work days and workers' compensation claims A goal of any injury prevention program is to minimize employer expenses related to lost time and wages. Explanations of Incorrect Answers B: A goal of injury prevention programs should be to provide an environment of support for workers to identify strategies to improve work conditions. C: Back brace supports should be provided on the basis of individual need, not prescribed to all workers. D: The focus of injury prevention programs should be on the process of creating a culture of safety and wellness rather than on specific activities within the injury prevention program. The activities within the injury prevention program may help the injury prevention program reach the goal, but the activity is not the goal itself.

A factory worker is seen in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® recommends a job site analysis to facilitate the client's return to work. How does the focus of intervention change in the transition from outpatient services to the workplace? A. The focus moves from the individual client to the work environment. B. The focus moves from the client to the employer's policies for task completion. C. The focus moves from outpatient setting supports to workplace design. D. The focus moves from client-centered to employer-focused needs and goals.

A. The focus moves from the individual client to the work environment. Environmental supports facilitate the client's return to work. Explanations of Incorrect Answers B: The employer's policies may influence task completion, but these policies are not the main focus of intervention. C: Neither component is a relevant focus of intervention. D: Occupational therapy intervention always remains client centered.

An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR® be MOST likely to include? A. Visual reinforcement with signs posted around the office and workstations B. Empowerment of the workers and creation of a positive group-safety culture C. A series of lectures and videos showing bad versus good workstation ergonomics D. Education of supervisors in how to identify noncompliant workers

B. Empowerment of the workers and creation of a positive group-safety culture Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together. Explanations of Incorrect Answers A, C: Visual reinforcement, lectures, and videos are teaching methods, but they do not ensure buy-in and follow-through by the workers. D: A focus on identifying noncompliant workers may create feelings of negativity and resentment from the workers regarding the program.

An OTR® consultant is hired to perform a job demand analysis for the assembly-line workers in a meat-processing factory. What areas will the OTR® MOST likely be measuring and reporting on? A. The ordering, assembly line, and documentation processes B. Height of the table, cutter and tool design, and vibration frequency of the automated tools C. Administrative hierarchy, lines of command, and ratio of supervisors to workers at the factory D. Job description, lifting requirement for the tasks, and the training process.

B. Height of the table, cutter and tool design, and vibration frequency of the automated tools A job demand analysis is an objective evaluation of each task of a job, taking into consideration the physical environment in which the job occurs. The workstation's dimension and layout, equipment, tools, and any other factors that can affect workers will be documented. The ergonomic risk factors are also considered in a job demand analysis. Explanations of Incorrect Answers A, D: This information is gathered before the start of a job demand analysis to guide the therapist through the analysis. They are not areas that require assessment by the OTR®. C: Administrative information is not assessed in a job demand analysis.

An OTR® is preparing a job demand analysis report for a furniture manufacturing company. The report includes several recommendations to decrease risk factors for musculoskeletal cumulative trauma disorders at work. For administrative controls, the OTR® recommends the implementation of task rotation every 4 hours of work. What recommendation will MOST likely be included under the engineering controls? A. Job rotation through different workstations B. Raising the table height of the assembly line by 3 inches C. Implementing factorywide stretching exercises during breaks D. Introducing high-speed, high-vibration power tools for speedy assembly

B. Raising the table height of the assembly line by 3 inches The goals of engineering controls are to provide proper design of the work environment, tools, and processes. Adjusting the height of the workstation is one example of engineering controls. Explanations of Incorrect Answers A: Job rotation is an example of an administrative control. C: Implementing factorywide stretching exercises is an example of work practice controls. D: Using high-vibration power tools can be a risk factor contributing to cumulative trauma disorders, not reducing them.

Which SOAP format statement would be appropriate and objective in documenting a client's modified duty program? A. The client stated, "My grip strength is not the same as it was before my injury, but I am still able to do my job." B. The client has decreased grip strength of the right hand of 15 lb with a standard dynamometer measure. C. The client's medical history includes a recent work injury resulting in a distal radius fracture and high blood pressure. D. The client has decreased grip strength of the left hand, which limits the client's ability to operate the machine handle.

B. The client has decreased grip strength of the right hand of 15 lb with a standard dynamometer measure. This objective statement provides a measure of client ability and the source of that measurement.

A manager at a clothing manufacturing plant hires an OTR® as a consultant to improve injury management in the company. Which goal would be the MOST reasonable for this program? A. The program will reduce injuries related to work-related musculoskeletal disorders. B. The organization will control the severity and incidence of work-related musculoskeletal disorders. C. Management will drive the program by making decisions on wellness activities to be implemented. D. Workers will improve performance, becoming more efficient and increasing productivity.

B. The organization will control the severity and incidence of work-related musculoskeletal disorders. Injury prevention programs aim to control work-related musculoskeletal disorders by implementing processes focused on identifying risk for musculoskeletal problems, providing skill training for management and worker evaluation of risk factors, and developing effective controls for identified risk factors. Explanations of Incorrect Answers A: Reducing injuries may be a secondary effect of an injury prevention program; workers must always be encouraged to report injuries, so the organization's focus should not be on reducing injuries. C: Effective injury prevention programs involve collaboration between management and workers. D: A secondary effect of injury prevention programs may be that workers improve performance because of improved work processes.

A client who fell from a roof while at his roofing job suffered a traumatic brain injury and is unable to return to his job. The worker has identified computers as an interest and is enrolled in a work readiness program. Which vocational skill activity would MOST likely be part of his work readiness program? A. Typing class to maximize typing efficiency B. Work-related tasks using a computer aimed at assessing aptitude C. Completion of job applications for computer-based jobs posted in newspapers D. Ergonomic training for optimal positioning at computer workstation

B. Work-related tasks using a computer aimed at assessing aptitude Work readiness programs aim to identify a person's skills and interests to develop his or her readiness for work and to achieve the person's goals related to work. The client has expressed an interest in working with computers, and work-related tasks in this area will help the client identify skills and aptitudes in this area.

An OTR® is establishing an intervention plan for a client who sustained a work-related musculoskeletal injury to the low back. The client has been out of work for 6 months and presents with generalized deconditioning. What would be the MOST appropriate duration for this client's treatment program? A. A minimum of 8 hours of treatment per day for 1 month. B. A minimum of 8 hours of treatment per day for 1.5 months. C. A minimum of 5 hours of treatment per day for as long as 3 months. D. A minimum of 5 hours of treatment per day for as long as 1 month.

C. A minimum of 5 hours of treatment per day for as long as 3 months. Total body deconditioning may require from 1 month to as long as 3 months of reconditioning the worker to preinjury status.

A client diagnosed with C7 spinal cord injury requires a functional capacity evaluation to determine whether the client can perform the job of accountant. Which of the following abilities would be MOST appropriate to assess? A. Mathematical reasoning B. Speech clarity C. Finger dexterity D. Selective attention

C. Finger dexterity Because accountants often type on computer keyboards, finger dexterity is an ability used in the job, as defined by the O*NET Occupational Information Network. A C7 spinal cord injury could affect finger dexterity.

Since getting new workstations, clerical workers at a law office are noticing increased neck stiffness and fatigue, and an OTR® is preparing a 1-week educational program for them. Which strategy would be MOST likely to reduce neck stiffness and fatigue? A. Require workers to stand and march in place for 5 min once every hour during the day B. Provide neck stretching and strengthening exercises to improve flexibility C. Move computer monitors into alignment with keyboards so workers face the monitor straight on D. Position workers with forearms resting on the edge of the desk while typing for support

C. Move computer monitors into alignment with keyboards so workers face the monitor straight on Maintaining head and neck alignment reduces the risk of strain to the neck.

An OTR® will be presenting the benefits and description of work therapy programs at an in-service meeting. How would the OTR® describe these programs? A. They are a component of a subacute intervention program. B. They are focused on increasing ROM, strength, and coordination. C. They occur at any point in the treatment of injured tissues. D. They are a team approach optimizing clients' abilities to return to work.

C. They occur at any point in the treatment of injured tissues. Work therapy may occur during any point in the healing of injured tissues. It typically occurs during the acute phase of rehabilitation before tissue homeostasis.

A client who suffered a stroke would like to return to work as a computer specialist. The OTR® is asked to explain vocational evaluation to the client. What explanation should the OTR® provide? A. Vocational evaluation determines the essential functions of a job area to conduct work tolerance screenings. B. Vocational evaluation identifies safety risks that may impede a worker's ability to complete job tasks. C. Vocational evaluation assesses a client's readiness and ability to engage in a particular occupation. D. Vocational evaluation determines an organization's compliance with the Americans With Disabilities Act.

C. Vocational evaluation assesses a client's readiness and ability to engage in a particular occupation. Vocational evaluation may be conducted for a person who has not worked previously, who has been injured and is preparing to return to work, or is unable to return to a previous job. Vocational evaluation may be general or specific addressing a person's potential for work or readiness to return to a specific occupation.

A client left employment as an elementary school teacher because of impairments from a stroke 12 months previously and is now interested in pursuing a new occupation. A work skills interest assessment and performance skill measures indicate suitability for work as an administrative assistant. The client needs assistance in entering this new occupation and working with impairments. Which program would BEST provide this service? A. Vocational rehabilitation B. Supported employment C. Community center D. Employer consultation

Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to that or another workplace. Explanations of Incorrect Answers B: Supported employment provides support to clients with disabilities through training and support at the job site. C: Community centers provide services to certain populations (e.g., clients who are homeless, have mental illness, are living with HIV/AIDS, are in welfare-to-work programs). D: Employer consultation occurs directly through an employer and an organization.

What does best practice dictate for a newly graduated OTR® who wants to administer a functional capacity evaluation (FCE)? A. The OTR® should have knowledge of the physical demands and aptitudes that pertain to the upper extremity as defined by the U.S. Department of Labor. B. The OTR® should appreciate the range of recovery consistent with various pathological conditions. C. The OTR® should defer evaluation of the client to a clinician with several years' experience. D. The OTR® should have knowledge of the worker's compensation system, Americans With Disabilities Act of 1990 (Pub. L. 101-336) regulations, accommodations, and unions.

Completion of an FCE is not recommended for entry-level or novice clinicians. New graduates should attend conferences, access resources, and network with colleagues to become familiar with terminology and regulations and enhance skills and knowledge.

An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client 2 months after a Stage 2 quadriceps strain. The client is employed as a police officer and sustained the injury during an altercation with a suspect. To identify the client's essential job functions, which sources would be BEST for the OTR® to use? A. The U.S. Department of Labor's Dictionary of Occupational Titles, O*Net, job classifications, and client interview B. Employer-provided job description, client and supervisor interview, and completion of a vocational evaluation C. The National Institute of Occupational Safety and Health (NIOSH) guidelines, job description, and client interview D. The U.S. Department of Labor's Dictionary of Occupational Titles job classifications and job description

D. The U.S. Department of Labor's Dictionary of Occupational Titles job classifications and job description A comprehensive FCE should assess all the physical demands of work as defined by the Dictionary of Occupational Titles (DOT). The DOT serves as a source document for job demands and aptitudes for all job classifications. OTR®s should refer to DOT and the employer-provided job description to identify essential job functions.

Which assessments would be considered the BEST format for an upper-extremity functional capacity evaluation (FCE) for an outpatient occupational therapy department currently developing a return-to-work program? A. Assessment of manual material handling, ADL assessment, ROM, manual muscle testing, sensory assessment, volumeter testing, Visual Analog Scale, and postevaluation questionnaire B. Subjective interview, sustained grasp assessment, Purdue peg board, work simulation testing, and computerized resistance testing C. Initial intake, pain assessment, musculoskeletal evaluation, Crawford Small Parts Dexterity Test, assessments using Valpar work samples D. Initial intake interview, subjective pain assessment, ADL assessment, musculoskeletal evaluation, physical demand testing, material handling skills, and postevaluation questionnaire

D. Initial intake interview, subjective pain assessment, ADL assessment, musculoskeletal evaluation, physical demand testing, material handling skills, and postevaluation questionnaire FCE should be individually tailored for each client. Physical demands should gradually increase in resistance and complexity. Evaluation should start with the most physically demanding components, and the evaluator should be aware of test specificity to determine test appropriateness. Explanations of Incorrect Answers A: Material handling is most physically demanding component of testing and is therefore not appropriate for an FCE. B, C: Best practice dictates an individual evaluation plan for FCE; therefore, use of the Perdue peg board and computerized resistance testing may not be applicable to all jobs. A subjective intake interview should be included to promote a client-centered intervention plan and postevaluation questionnaires.

An OTR® is contacted by a small grocery store chain to develop an injury prevention program for its employees. As a guiding framework, which element should the OTR® consultant NOT include in the corporate plan? A. Procedures to identify potential risk factors in the workplace B. Strategies to address reoccurring injuries C. Protocols for data collection that support skill trainings D. Plans to reduce the number of injuries sustained by employees

D. Plans to reduce the number of injuries sustained by employees Injury prevention consultants do not reduce injuries. Their role is to help companies reduce their losses.

Which setting is MOST effective for job coaching with an adult client with mental illness? A. Sheltered workshop environment B. Outpatient rehabilitation setting C. Program offering simulated work D. Workplace with assigned job duties

D. Workplace with assigned job duties Support approaches with on-site training are recommended as the most effective setting for job coaching. Explanations of Incorrect Answers A, B, C: Training for job placement in settings outside the workplace does not support generalization of skills to the workplace.

Sedentary Work

Exerting as much as 10 lb of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are only required occasionally and all other sedentary criteria are met

Workers at a meat processing plant are participating in a back injury prevention program. Which factor should be stressed as presenting a major ergonomic risk? A. Dynamic posturing B. Forceful exertions C. Standing position D. Armrest location

Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor.

An OTR® is asked to consult with a local meat packing plant to establish a work injury prevention program because of an increase in the number of work-related musculoskeletal disorders among employees. For the program to be successful, what should the OTR® FIRST ensure? A. Complete employee participation B. Projection of new injuries C. Anticipated reoccurring injuries D. Long-term beneficial outcomes

Four characteristics of successful implementation of a successful work injury prevention program are ongoing management support, supervisory support, employee participation, and ongoing support and reinforcement of program. The meat packing plant sought out the services of the consultant, therefore demonstrating a commitment to establishing a culture of safety and wellness for its employees. Employee participation is a key component of success.

A construction worker was referred to occupational therapy as part of a work hardening program. During the interview, the OTR® discovers that the client is required to lift construction equipment weighing 20 lb on a frequent basis. At what level of work must the OTR® create work simulation tasks? A. Medium B. Heavy C. Very heavy D. Light

Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects.

A client working at a clothing boutique has made progress in completing simulated work tasks but is still unable to resume the prior work status. The OTR® suggests that the client return to work on a light duty schedule. Which consequence is MOST likely to result when a client returns to work on light duty? A. The client learns how to push through the pain. B. The employer has lower workers' compensation costs. C. The client's confidence in his or her abilities to complete job tasks increases. D. The client receives higher ratings on the reevaluation assessment.

Returning to work provides psychological benefits to clients by building their confidence in their ability to complete some job duties and allowing them to participate in the social environment of the workplace.

An administrative assistant at a university has developed overuse injury affecting the right, dominant hand characterized by pain in the wrist after extensive keyboarding use. The client was treated with static splinting, rest, and a course of anti-inflammatory medication for 2 weeks. The client attempted to return to work; however, the pain persists, and the client is unable to sleep at night, affecting the ability to focus and complete daily tasks. In determining the client's ability to return to work, what should the occupational therapist do FIRST? A. Compete an initial intake interview and document the client's perceived ability to perform job duties. B. Consult with the client's supervisor to determine the feasibility of the client's returning to modified duty. C. Perform ROM, manual muscle testing, and sensory testing to predict the client's ability to return to work. D. Simulate a workstation to assess the job the client must perform daily.

Simulation of actual activity demands will provide the most accurate and objective assessment of capabilities. Explanations of Incorrect Answers A: An initial intake interview and the client's perceived ability to perform job duties are subjective components of a functional capacity evaluation; however, subjective data are not predictive of ability to return to work. B: The client's physical abilities should be assessed before exploring options for modified duty. C: The types of assessments are not indicative of the client's actual ability to perform job tasks and cannot predict recovery.

An OTR® is treating a client after surgery for De Quervain's tenosynovitis. The client is employed as a receptionist in a dental office and will participate in a return-to-work program designed by the OTR®. Which option would be CONTRAINDICATED for treatment? A. Application of a resting hand splint at night to stabilize the affected joint B. Progressive AROM of the abductor pollicis longus and extensor pollicis brevis C. Instruction in proper body mechanics to avoid wrist ulnar and radial deviation D. Modifications including use of telephone headset and built-up handled pens

Splints are typically applied during the acute phase of injury. The splint typically prescribed for De Quervain's is a forearm-based thumb Spica splint to immobilize the wrist, thumb carpometacarpal and metacarpophalangeal joints, placing the abductor pollicis longus and extensor pollicis brevis at rest. A resting hand splint is not indicated because the entire hand does not required immobilization Explanations of Incorrect Answers B: The abductor pollicis longus and extensor pollicis brevis are tendons that are within the first dorsal compartment of the wrist. Postoperative treatment will focus on wearing a splint to promote tissue healing followed by gradual progression of AROM. C: Avoiding excessive radial and ulnar deviation is recommended to decrease pain. D: Use of telephone headset and built-up handled writing implements may relieve or reduce stress on thumb and wrist joints.

A 30-year-old construction worker has developed work-related right biceps tendonitis. In the past 2 weeks, the client has primarily been working on the drainage system, which requires sawing a lot of metal pipes. What risk factor should be closely assessed during a worksite evaluation? A. Handle size of the hand saw B. Sawing repetitions per minute C. Length of the saw blade D. Diameter of the metal pipes

Tendonitis is a musculoskeletal injury resulting from repetition. A high-risk repetition rate for the elbow is more than 10 repetitions per minute.

A client working as a machine operator was diagnosed with right shoulder tendonitis related to overuse during work activities. The worker's English proficiency is limited. When preparing to complete an assessment of the worker's upper-extremity strength and coordination, which factor should the OTR® consider? A. The worker does not want to be touched by an OTR® of the opposite sex because of cultural beliefs and the language barrier. B. The Disabilities of the Arm, Shoulder, and Hand (DASH) assessment may be applicable because it has been translated into the worker's native language. C. The worker is likely to be unmotivated to return to work because of the language barrier and fear of job loss because of the injuries. D. Assessments of the work environment (e.g., on-site job analysis) must take into consideration the worker's culture.

The DASH has been translated into several languages, and cross-cultural validity has been established.

A client receiving special education instructional support arrives at the occupational therapy clinic for an evaluation as part of the student's transition planning needs. As part of the evaluation process, what must the OTR® FIRST determine? A. The client's interests and roles B. The client's performance skills C. The client's career opportunities D. The client's community interests

The OTR® should first assess the client's performance skills to develop a transition plan to promote movement from school to postschool activities. Explanations of Incorrect Answers A: Interests and roles are components of an occupational profile; however, they would not be the first areas to assess during evaluation. C, D: These responses are not components of a client-centered transition plan.

An employer of a meat-packing plant contacts an OTR® to provide consultation because of a recent increase in the prevalence of work-related musculoskeletal injuries. What would the OTR®'s FIRST course of action be? A. Conduct role interest checklists with all employees. B. Complete functional capacity evaluations for injured employees. C. Administer vocational aptitudes tests to all employees. D. Complete a job site analysis of activity demands.

The OTR® should gather information through job site analysis in collaboration with the employer to obtain information regarding the physical demands of the work.

A client with developmental coordination disorder is referred for evaluation by the transition services team at a high school. Which assessment is the MOST appropriate for the OTR® to complete first with the client? A. Self-Directed Search B. Cognitive Status Examination C. Box and Block Test D. Functional capacity evaluation

The Self-Directed Search measures a client's vocational interests.

While completing an FCE on a client referred to a work hardening program, the OTR® suspects the client, who experienced a muscle sprain to the shoulder, is magnifying symptoms. The client has repeatedly made comments to the therapist about experiencing pain during all activities and being unable to return to work because of constant severe pain. The client is 4 months postinjury. Which type of symptom magnification is the client MOST LIKELY exhibiting? A. The "refugee" B. The "identified patient" C. The "game player" D. The "symptom misinterpreter"

The game player (traditionally known as a malingerer) uses symptoms for positive gain and consciously attempts to convince others of the reality of the symptoms.

A dental hygienist is referred to occupational therapy for establishment of a work conditioning program after carpal tunnel release 1 month ago. The client is anxious to return to work but fearful of reinjury. Which intervention is MOST appropriate for the OTR® to include in the client's work conditioning program? A. Instructing the client in median nerve gliding exercises B. Instructing the client in ulnar nerve gliding exercises C. Guiding the client in progressive resistive exercises using therapy putty D. Writing simulated client progress notes

The median nerve travels through the carpal tunnel. Active exercises of wrist, thumb, and fingers are encouraged 24-48 hours postoperatively. Median nerve glides can be incorporated into a work routine between dental clients to decrease the risk for reinjury Explanations of Incorrect Answers B: The ulnar nerve does not travel through the carpal tunnel. C: Progressive grasp and repetitive finger flexion should be gradually introduced once recommended by physician between 3 and 6 weeks postoperation. One month may be too soon in recovery to incorporate it into the program. D: Writing activities require periods of sustained prehension and are not the most appropriate intervention to include as part of a work conditioning program.

A recently graduated OTR® is designing interventions for a work hardening program seeking accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF). According to CARF, what is the most commonly accepted client-to-staff ratio? A. 4:1 B. 5:1 C. 6:1 D. 3:1

The most commonly accepted ratio is 5 clients to 1 staff member. A trained professional is required to monitor clients for problem identification and appropriate interventions. 1:1 individual attention is required for the OTR® to complete evaluations and attendance at meetings.

An OTR® is establishing reasonable accommodations for a client employee as a tax auditor. The client has recently been diagnosed with posttraumatic stress disorder (PTSD) characterized by panic attacks as a result of being stalked and harassed by a disgruntled taxpayer. The essential job functions include auditing financial records to determine tax liability; information gathering; analyzing finances to determine net worth or reported financial status and identify potential tax issues; conferring with taxpayer or representative via phone or in person to explain the issues involved and the applicability of pertinent tax laws and regulations; and participating in informal appeals hearings on contested cases. Which accommodation is MOST appropriate for the OTR® to recommend? A. Recommend that the employer allow the client to play soothing music using a digital music player and a headset throughout the work day to relax and reduce stress. B. Provide the client with a telephone with a caller ID function, call blocking function, or both so that the client can screen callers in advance. C. Institute a policy for employees to participate in daily meditation and yoga classes. D. Hire a full-time security guard and install a surveillance system throughout the workplace.

The right answer is B Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. PTSD is a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging and natural or human-caused disasters, accidents, or military combat. Many people with PTSD repeatedly reexperience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. As a result of being stalked and harassed while performing job duties, this client may benefit from use of caller ID to screen calls in advance of answering the phone.

An OTR® ergonomic consultant in a hospital is notified of a significant increase in work-related musculoskeletal disorders among nurses since the implementation of electronic health records. The OTR® is asked to present a report on the issues to the upper-level management team. What should the OTR® include in the report to identify the problem and generate possible solutions? A. A list of the injured nurses with their corresponding musculoskeletal disorder conditions and total lost days away from work B. A report on the average time spent on the computer per shift per department and a recommendation for a hospital-wide computer training class for all nurses C. A summary of the fixed heights of the various workstations and tables at the nurses' stations and a list of recommended adjustable-height workstations D. A slide show documenting improper positioning and posture of nurses at the current workstations and recommendations for hospital-wide body mechanics training

The right answer is C Proper positioning of the monitor and keyboard are the main factors to be considered in ergonomics. Because nurses are of different heights and can be documenting in different environments (e.g., in patients' rooms, at the nurses' stations, or sitting vs. standing), it is important that the workstations be versatile and accommodate each nurse and each situation. Explanations of Incorrect Answers A: Providing a list of injured nurses and conditions does not help to identify problems and generate solutions. B: If the majority of the nurses have been identified as lacking computer skills that therefore leads to prolonged documentation time on the computer, then a hospital-wide computer training class is one possible solution. However, if the ergonomic set-up is not addressed with adjustable-height workstations, training will not solve the problem of having a high incidence of musculoskeletal disorders. D: Providing a slide show of improper posture during documentation may help to illustrate some of the problems but will not help to generate any solutions.

The symptom minimizer

a client who keeps symptoms hidden so he or she can return to normal activity or avoid appearing weak

The Game Player

consciously attempts to convince those working with him or her of the reality of symptoms for positive gain

A client who had a recent CVA would like to return to work on an assembly line at a manufacturing plant. An OTR® preparing to provide job coaching to this client should review which document FIRST? A. Functional capacity evaluation B. Job analysis for essential functions C. Performance reviews of worker D. ADL and IADL checklist results

The job analysis identifies the physical, psychological, cognitive, and social functions of a specific position and is used to assess whether a worker with a disability or injury can perform the job task requirements.

Key concept of the work hardening program

the gradation of activities to progressively increase task demands

An OTR® recently completed a functional capacity evaluation (FCE) on a client who is a piano teacher at a school for the performing arts. The client recently sustained an avulsion injury of the index finger on the client's dominant hand at the level of the distal interphalangeal joint, which resulted in the amputation of the distal phalanx on that finger. What would the results for the FCE completed by the OTR® MOST APPROPRIATELY be used to determine? A. Impairment rating B. Disability rating C. Client's fitness for duty D. Quantifiable physical loss rating

A disability rating considers the worker's impairment and the impact of the impairment on the client's ability to perform preinjury for any job and considers the unique characteristics of the job. (Impairment rating does not take into account the unique factors relating to worker vocation.) In this case, the client's missing joint affects the ability to play the piano, which is one of the primary demands of the client's position. Amputation of the distal phalanx would render the piano teacher disabled from his or her career. Explanations of Incorrect Answers A: An impairment rating relates to the percentage of whole-body function and translates to a final monetary settlement for an injured worker. Impairment rating focuses on permanent quantifiable physical loss related to injury when the client is considered to be at the maximum medical endpoint. Because this client just began the therapy program, the client's medical endpoint has yet to be determined. C: Fitness-for-duty tests are completed by occupational medicine physicians after injury. D: Quantifiable physical loss is not a rating used in work rehabilitation.

A client working as a receptionist in an office reports pain on the left side of the neck. An OTR® observes the client holding the phone between the left ear and shoulder while scheduling appointments. The worker was observed to have 10 calls in 20 min. Which modification is BEST to improve the worker's performance during this task? A. Wear a hands-free headset for phone calls. B. Use a built-up writing utensil when taking notes. C. Align the computer keyboard with the computer monitor. D. Put foam on the phone handle to decrease neck rotation.

A hands-free headset allows workers to keep the head in neutral position and have both hands available for typing on the computer or writing while on the phone.

An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client who is employed full time as a machinist in the tool-and-die trade. The client completed a course of outpatient therapy after a wrist fracture to the dominant hand. Which assessment would be MOST clinically appropriate to determine a client's ability to return to full-duty employment? A. A hand evaluation B. A situational assessment C. A vocational assessment D. A job site analysis

A job site analysis looks to define the actual demands of the job and involves the use of questionnaire, interviews, observations, and formal assessment completed in the real work environment. Many FCEs include a job demand analysis. A: A hand evaluation is a comprehensive assessment of upper-extremity function that does not assess the actual material handling skills required for job performance. B: Situational assessment is used to assess a client's ability to perform the exact same tasks in an environment identical to that of the actual target vocation. C: Fitness-for-duty evaluation determines whether a worker can perform the essential functions of a specific job. The evaluation screens for conditions that may place the worker at risk for injury and takes place only after an employer has offered employment.

An OTR® is conducting a job demand analysis in a food production company. The OTR® observes the workers in the shipping and handling department loading and unloading a delivery truck. According to the Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), which aspect of the occupational therapy domain is being assessed? A. Communication and social skills B. Habits and routines C. Motor and praxis skills D. Activity demands

A job task analysis is a nonclient's specific observation of the job's activity demands, including required body functions, required actions and tools used, and space and social demands needed to complete the task.

A client is evaluated by an OTR® to determine ability to return to work as a dry cleaner assistant after a total hip replacement 4 months ago. The client reports having to carry loads of laundry weighing as much as 10 lbs. one-third to two-thirds of the day. Per the Dictionary of Occupational Titles (DOT), at what strength demand should the OTR® design work simulation tasks? A. Sedentary B. Light C. Heavy D. Very heavy

A light strength demand is defined by DOT as requiring a force exertion or weight carried of 20 lb occasionally as much as one-third of the day, 10 lb frequently one-third to two-thirds of the day, and negligible weight constantly over two-thirds of the day.

What is included when using a top-down approach to reduce risks in jobs? A. Work hardening program to increase endurance B. Maintaining neutral spine alignment in lifting C. Involving managers in work simplification D. Individual workstation ergonomic assessment

A top-down approach includes systemwide changes and management support of the change process. Explanations of Incorrect Answers A, B, D: These options are bottom-up approaches that focus on addressing the person's risk for the job task.

Back pain injury reports from workers at a bicycle manufacturing company have increased. Management is seeking an OTR®'s recommendations for redesigning the work environment using engineering controls, particularly to reduce awkward postures and repetitions on the assembly line. Which recommendation is the BEST engineering control to redesign the work environment for this organization? A. Place bicycles on a wheeled platform for movement along the assembly line. B. Slow the speed of the assembly line so workers have more time. C. Implement stretch breaks every 45 minutes to improve posture. D. Enforce a work safety policy that requires workers to wear a back support.

A wheeled platform will decrease the frequency of lifting, bending, twisting, and squatting.

Which client would be MOST appropriate for vocational evaluation? A. A client with a recent spinal cord injury who wants to pursue a new occupation. B. A worker who wants to find volunteer opportunities in preparation for retirement C. An employer who wants to know the essential job functions of a position D. A work group at a manufacturing plant that needs ergonomic training

A. A client with a recent spinal cord injury who wants to pursue a new occupation. Vocational evaluations are most appropriate for people who have never worked or are unable to return to a previous job due to disability.

A grocery store company hires an OTR® to complete work tolerance screenings for potential employees. The company has no written policies regarding work screening processes. What should the OTR®'s FIRST step be? A. Assess whether work tolerance screenings can be completed in the absence of written policies B. Provide a written statement indicating that the organization is required to provide written policies for work screenings C. Complete the work tolerance screenings as the OTR® would for any organization D. Offer to write policies for the work tolerance screening process for the organization

A. Assess whether work tolerance screenings can be completed in the absence of written policies The OTR® must consider the potential ethical dilemmas that may arise in the absence of written policies, particularly for applicants who fail the screening. Explanations of Incorrect Answers B, C: Employers are not required to have policies for work tolerance screening processes but should be encouraged to establish such policies to ensure fair and objective consideration of job applicants. D: The OTR® should remain separate from the hiring process, including related policy development, to maintain objectivity and third-party distance.

An OTR® is completing a functional capacity evaluation (FCE) with a client with a history of upper-extremity trauma. During the FCE, the OTR® suspects the client is exaggerating the pain level and is not performing at maximum voluntary effort. Which symptoms would MOST LIKELY lead the OTR® to conclude the client's performance is not at maximum voluntary effort? A. Client reports that significant pain is present with most activities. B. Client reports that pain is radiating throughout the upper extremities. C. Client reports that pain increases with stress. D. Client exhibits increased heart and respiratory rate with exertion

A. Client reports that significant pain is present with most activities. When associated with a true pathological condition, pain is not consistently present during most activities. Clients will often respond in predictable manner.

An OTR® is evaluating a construction worker who recently experienced radial wrist pain in the right dominant hand. The worker has been unable to perform the duties of the job and is working light duty. Which short-term goal would be BEST, using the RUMBA tool for goal writing? A. Client will improve work tolerance to use right hand and wrist to lift 5-lb bucket during work activities within 2 weeks. B. Client will receive ultrasound twice daily to right radial wrist area for 2 weeks. C. Client will increase score on the Jebsen-Taylor Hand Function Test within 2 weeks. D. Client will be able to type 2 minutes using right wrist cockup splint within 2 weeks.

A. Client will improve work tolerance to use right hand and wrist to lift 5-lb bucket during work activities within 2 weeks. The goal includes the relevant outcome (improve work tolerance) and time to meet goal (2 weeks) and is understandable, measurable, behavioral (i.e., the outcome can be observed), and achievable in the time frame given.

An OTR® is writing treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal? A. Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. B. Client's employer will implement reasonable accommodations to promote the client's ability to complete full-time physical demands as a surgical technician within 4 weeks. C. Client will return to full duty as a surgical technician with the ability to carry over proper body mechanics to reduce risk for reinjury. D. Client will use proper body mechanics 100% of the time while completing the job of a surgical technician within 4 weeks.

A. Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. The goal is client centered, objectively focused on the goal of full-duty and full-time employment in the role of surgical technician within a specified timeline. Explanations of Incorrect Answers B: The goal is not client centered; the focus is on the employer. C: The goal lacks a specified timeframe in which the outcome is to be achieved D: The goal lacks an objective measure specifying full-time and full-duty employment

An OTR® is explaining to a client who was recently evaluated the value and benefit of a transitional work program. Which of the following components would be included in a transitional work program? A. Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks. B. Client's exploration of options for full-time employment while participating in work conditioning program. C. Client's return to full-time employment while performing at modified work capacity. D. Client's return to part-time employment, performing all required physical job demands.

A. Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks. Transitional programs include monitoring the client's progress and reassessing performance to determine when job tasks can be upgraded to full time or full duty.

An OTR® is instructing a client diagnosed with rheumatoid arthritis on the use of energy conservation techniques. During treatment, the client informs the therapist of tingling in the right thumb and index and middle fingers and of night pain in that area of the hand that often keeps the client awake. The client works as a tailor. On the basis of these symptoms, what might the OTR® suspect is causing the client's disorder? A. Cumulative trauma B. Orthopedic impairment C. Autoimmune symptoms D. Neurological complications

A. Cumulative trauma Work-related musculoskeletal disorders are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. These disorders account for one-third of all occupational injuries and illnesses in the United States.

An OTR® is using an adaptive approach with a client returning to work after bilateral carpal tunnel release surgery 6 weeks ago. The client works as a supermarket checker. Which job task modification incorporates an adaptive approach? A. Handheld barcode scanner B. Strengthening exercise using 2-pound weight C. Adjustable-height stool at the cash register D. Upper body stretching breaks every hour

A. Handheld barcode scanner An adaptive approach supports functional performance through use of compensatory techniques such as changes in activity demand.

A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client's workstation? A. Workstation height should allow some elbow extension during the task. B. The workstation should enable the worker to sit or stand during the task. C. The workstation should enable the worker to reach overhead during the task. D. Workstation tools should be placed beyond arm's reach during the task.

A. Workstation height should allow some elbow extension during the task. A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature Explanations of Incorrect Answers B: Sitting is not recommended during heavy lifting tasks. C: Repetitive heavy lifting overhead is not recommended. D: Tools used during tasks should be kept within arm's reach for ease of access

An OTR® is establishing reasonable accommodations for a client with history of Type 1 diabetes employed as a computer programmer. Which accommodation is LEAST appropriate for the OTR® to recommend? A. Alteration of the client's work schedule allowing for blood glucose monitoring and insulin injection B. Purchase of a refrigerator for the client's office to provide the client with ready access to insulin and snacks C. Alteration of lunch break duration from 60 minutes to permit the client two 30-minute breaks D. Provision of improved lighting at the client's desk area and use of an antiglare magnifying computer screen

Although access to a refrigerator would be recommended, provision of an office with a refrigerator may be considered an undue hardship for a small company. The employee should have access to a break room while at work to store insulin and snacks. Undue hardship is an exception to the requirement that employers provide reasonable accommodations per ADA. Undue hardship refers to any accommodation that would be unduly costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business. Explanations of Incorrect Answers A, C, D: These accommodations would be considered reasonable on the basis of the client's condition and physical demands of the job. Reasonable accommodations may include an altered work schedule and duties, facility modifications, purchasing of adaptive equipment or assistive technology, or modifying or designing a new product.

An OTR® is hired as a consultant to design a productive modified-duty program for a small manufacturing plant. Which element should the OTR® NOT incorporate into the program design? A. Focus on maintaining injured employees in a productive work capacity while facilitating progressive recovery. B. Provide opportunities for injured workers to interact with coworkers in the context of the work environment. C. Identify designated staff to be trained to monitor a worker's adjustment and tolerance to work tasks. D. Ensure that the demands of an assignment are within the stated restrictions of the employee's abilities.

Although opportunities to interact with coworkers provide the injured worker the benefit of socialization and exposure to the work environment during recovery, they are not the primary focus of modified duty programs.

A Qualified Individual with a Disability (defined by ADA)

An individual with a disability who satisfies the requisite skills, experience, education, and other job related requirements of the employment position he or she holds or desires, and who with or without reasonable accommodation, can perform the essential functions of the employment position that the individual holds or desires

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. What is the purpose of the onsite ergonomic assessment? A. To identify possible risk factors for the cumulative trauma disorders B. To identify suitable break times for the client C. To assess the job appropriateness of the client D. To educate coworkers in the importance of ergonomics

An onsite ergonomic or worksite assessment is the best method to identify risk factors for work-related injury. Risk factors may include awkward posture, inappropriate layout or physical environment, or inappropriate use of equipment. The assessment is often conducted in the work environment with the worker present performing the job as normally as possible.

Reasonable Accommodations (as defined by the ADA)

Any change in the work environment or in the way work is customarily performed that enables an individual with a disability to enjoy equal employment opportunity. Employers need only make reasonable accommodations for employees who are qualified individuals with a disability

at work owing to increased neck and shoulder tension resulting from prolonged computer keyboarding. The client's job duty requires 6 hours of typing on an average workday. What is the BEST stress management approach for the OTR® to suggest to this client? A. Work hardening program to increase endurance for prolonged keyboarding B. Frequent stretching breaks at the computer station every 30 minutes of keyboarding C. Assertiveness training to advocate for having extra personnel to assist with the client's work D. Decreased work hours per workday but spread to 6 workdays per week to catch up

Aside from ergonomic workstation modification to prevent straining the neck and shoulder during keyboarding, moving away from the static posture of keyboarding and performing different stretching exercises at the workstation is also important.

An OTR® is in the process of completing a functional capacity evaluation (FCE) on a client employed as a cashier in a lumber yard. The client was referred to occupational therapy after sustaining a ruptured biceps while lifting a sheet of lumber. The OTR® suspects the client is exhibiting less than maximum effort during assessment. How would the OTR® BEST assess grip strength to determine whether client is exhibiting maximal effort? A. Have the client complete three trials on the second handle setting of the Jamar dynamometer. B. Have the client complete one trial on each of the five handle settings of the Jamar dynamometer. C. Have the client perform rapid exchange between the left and right hands for a total of 20 trials for each hand using the Jamar dynamometer. D. Have the client perform two trials on each of the five handle settings of the Jamar dynamometer and compare the results with normative data.

B The five-level grip test is used to determine maximum and consistent effort by clients. The OTR® should expect the strongest grip on the second and third handle settings

An OTR® is establishing reasonable accommodations for a client with a history of attention deficit disorder who is employed as a receptionist for a lawn care company. The client exhibits decreased attention span, concentration, and periodic physical restlessness. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR® to recommend? A. A digital voice messaging system to save and review phone messages B. A redesign of the work space to minimize distractions C. A day planner to organize tasks D. A color-coded filing system to organize records

B. A redesign of the work space to minimize distractions Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Redesigning the office space to limit distractions to promote the client's ability to attend to tasks would be the most appropriate choice. Explanations of Incorrect Answers A: Before purchasing a digital voice messaging system, the OTR® should recommend minimizing distractions in the client's work environment. According to the Job Accommodation Network, most job accommodations cost less than $500. Accommodations may involve altering the job duties or work schedule, modifying the facility, purchasing adaptive equipment or assistive technology, or modifying or designing a new product. C, D: Using a day planner and a color-coded filing system are compensatory strategies to improve organizational skills.

An OTR® is establishing reasonable accommodations for a client diagnosed with osteoarthritis in the left shoulder. The client is employed as a plumber. Essential job functions include reaching, bending, crawling, lifting, pushing and pulling, using tools, and lifting materials weighing 25-50 lb. Which accommodation is MOST appropriate for the OTR® to recommend? A. Provide the client with modified-handle tools to reduce torque on the shoulder joint. B. Allow the client a flexible work schedule and use of leave time as needed. C. Ensure materials and equipment are within functional reach. D. Recommend use of wheeled cart to transport tools.

B. Allow the client a flexible work schedule and use of leave time as needed. Essential job functions are 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 equipment or assistive technology, or modifying or designing a new product. Allowing the client a flexible work schedule and use of leave time is the most appropriate choice. Flexibility will provide the client with the opportunity to vary the work schedule on the basis of symptoms. Explanations of Incorrect Answers A: Modified-handle tools would be appropriate if the client had arthritis of the hands. C: Ensuring materials are within reach at all times may not be feasible because plumbers must access pipes in hard-to-reach areas. D: A wheeled cart may not permit the client access to all locations and may add to lifting requirements.

The owner of a construction company asks an OTR® completing work tolerance screenings to notify applicants whether they have been hired on the basis of their screening results. What should the OTR® do? A. Suggest that the owner revise the written policies for work tolerance screenings to reflect this change in the process B. Inform the owner that the OTR® will review the results of the completed work tolerance screenings with the owner so the owner can summarize the results with applicants and notify them of the hiring decision. C. Keep good documentation of the agreement to support the need for this change in the work tolerance screening process. D. Implement a quality assurance monitoring system to determine reasonable outcomes for this revised process.

B. Inform the owner that the OTR® will review the results of the completed work tolerance screenings with the owner so the owner can summarize the results with applicants and notify them of the hiring decision. The OTR® should remain separate from the hiring process, including notification of hiring decisions, to maintain objectivity and third-party distance.

An OTR® has received a referral to establish a work conditioning program for a client employed as a roofer. The client has a history of low back sprain. When implementing a work conditioning program, which intervention is MOST appropriate to reduce the client's risk for reinjury? A. Completing a job demand analysis at the job site B. Instructing the client in proper body mechanics C. Improving the client's heavy material handling skills D. Modifying the client's work schedule to part time

B. Instructing the client in proper body mechanics Work-related musculoskeletal disorders (WSMDs) are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. WSMDs account for one-third of all occupational injuries and illnesses in the United States. Poor body mechanics may be a contributing factor and result in repeated microtraumas; therefore, instructing the client in proper body mechanics should be included in the treatment plan.

An assembly-line worker is returning to work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client's workstation? A. Above elbow height B. Just below elbow height C. 4 inches below elbow height D. 8 inches below elbow height

B. Just below elbow height The ideal position for precision assembly is to position the workstation above elbow height, but for a worker with recent nerve compression at the elbow, it is important to set up the work environment so as to not induce further prolonged pressure at the elbow. Therefore, the workstation should be just below elbow height, eliminating all pressure at the elbow. In this case, use of a magnifying device will allow for precision in assembly, compensating for the lack of close proximity.

A cabinetmaker is referred to occupational therapy with a recent onset of stenosing tenosynovitis of the right middle and ring fingers. The client has a history of rheumatoid arthritis. As part of the ergonomic education, what will the OTR® MOST likely include? A. Prevent static wrist positioning, hold tools close to the fulcrum, and use a thick protective glove. B. Reduce use of excessive gripping force, prevent contact stress, and implement task rotation. C. Stenosing tenosynovitis is common in rheumatoid arthritis; no ergonomic education is needed D. Switch to manual tools to reduce vibration from power tools and conduct a regular tool check for wear and tear.

B. Reduce use of excessive gripping force, prevent contact stress, and implement task rotation. Stenosing tenosynovitis (trigger finger) is a condition associated with prolonged or high repetitions in forceful gripping. All of these modifications prevent or eliminate exposure to forceful gripping.

An OTR® is establishing reasonable accommodations for a client diagnosed with fibromyalgia. The client has been employed as a bookkeeper for a small website design company. The client's symptoms include fatigue, disturbances in sleep pattern, chronic headaches, and skin and temperature sensitivity. Essential job functions include filing, maintaining records of expenses using a computer accounting system, reconciling and balancing accounts, and managing the payroll for the company's eight employees. Which accommodation is MOST appropriate for the OTR® to recommend? A. Permit the client to set temperature controls and ventilation for the entire workplace. B. Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. C. Accommodate the client with a telephone headset to eliminate fatigue and the repetitive motion of lifting the telephone from the cradle. D. Provide the client with a computer with access to work accounts so that the client can work from home on a flexible schedule.

B. Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Fibromyalgia is a complex, chronic condition that causes widespread pain and fatigue and a variety of other symptoms. Deep muscular pain is the most common symptom of fibromyalgia. The pain associated with fibromyalgia varies according to the time of day, weather, sleep patterns, and stress level. Use of scheduled rest breaks and relaxation techniques would assist the client with avoiding fatigue and completing essential job functions.

An OTR® is concerned that a worker participating in a back-neck school program may be magnifying symptoms. On assessment measures, the worker inconsistently reports pain throughout body mechanics training activities. The worker often refuses to complete tasks, citing pain as the reason. Which reason is the MOST likely for the worker to magnify symptoms? A. The worker is satisfied in the worker role and lacks motivation to complete tasks. B. The worker fears increased pain from task completion. C. The employer is supportive and is encouraging the return to work. D. The worker values work and perceives work as a source of motivation.

B. The worker fears increased pain from task completion. Workers may increase their pain reports in an attempt to avoid an increase in pain after task completion.

An OTR® is establishing reasonable accommodations for a client with Asperger's syndrome. The client is employed as a dining room attendant in a restaurant. The client does not exhibit any physical limitations but does exhibit decreased appropriateness when socializing with others and will perform stimulatory behaviors when stressed. The essential job functions include refilling condiment containers, filling customer drink orders, ensuring restrooms are clean for customers, carrying dirty dishes from dining room to kitchen, wiping table tops and chairs, and setting tables with silverware and glassware. Which accommodation is MOST appropriate for the OTR® to recommend? A. Provide the client with a task list to assist with prioritizing job duties. B. Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. C. Make the employee attend social functions with coworkers to promote socialization away from the work site. D. Provide written expectations and require the client to take frequent rest breaks to reduce stress.

B. Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Use of role-play scenarios and training videos to provide guidelines for acceptable workplace behaviors is the most appropriate choice because the client has decreased appropriateness when socializing with others.

The client, a landscaper, fell from a ladder while trimming branches and sustained a Colles fracture. The client wore a short arm cast for 6 weeks. After the cast removal, the client began a work conditioning program. The OTR® established a plan for recovery that included job simulation tasks, strengthening, and endurance training. The client was anxious to return to work because the injury occurred during the busy season, and the OTR® is concerned about potential for overexertion and reinjury. Which of the following signs is NOT an indication of overexertion? A. Difficulty completing the number of prescribed repetitions B. Sustained effort with an unstable respiratory rate C. Consistent speed while performing a job simulation task D. Decreased ROM and increased distractibility during job simulation

Consistent speed is not an indication of overexertion. Decreased speed or rate of performance would indicate overexertion.

An OTR® consultant is educating a group of supervisors from a furniture manufacturing company about common work-related risk factors for cumulative trauma disorder. What are some of the PRIMARY physical risk factors that the OTR® would explain to the supervisors? A. Regulated temperatures, noise and lighting B. Body mass index greater than 25 C. Forceful exertions, repetition, and excessive vibration D. Older age, being female, and lower socioeconomic group

Cumulative trauma disorder is a group of conditions that develop slowly over time from repeated microtrauma to the body. It is also known as repetitive strain injury when the body or muscles are engaged in an awkward position or used repeatedly. Hence, forceful exertions, especially performed in a repetitive manner, and excessive vibration from the use of power tools are risk factors for clients working in a furniture manufacturing company.

A delivery worker in a large metropolitan city has an acute onset of low back pain. The low back pain is prohibiting the client from performing at a productive level because of the high pain level. What is the MOST IMPORTANT physical risk factor that should be closely examined in an ergonomic assessment? A. Excessive stop-and-go because of the high-productivity delivery expectations B. Prolonged static sitting posture from driving longer than 60 minutes without a break C. Contact stress from pressing the body against the packages when carrying them D. Awkward posture and overreaching when pulling packages out of the truck

D. Awkward posture and overreaching when pulling packages out of the truck Low back pain is a common work-related musculoskeletal disorder arising from poor body mechanics. Regardless of the weight of the packages, the client needs to be able to maintain proper body mechanics and back alignment when reaching to retrieve packages at different levels. The OTR® will need to determine the client's body build type and the space and the package locations in the truck, and make recommendations to maintain proper body mechanics or use of adaptive equipment to prevent further strain to the low back.

An OTR® wants to design a work performance program based on AOTA's Occupational Therapy Practice Framework: Domain and Process (2nd ed.). According to the Framework, what would the therapist NOT include in the program? A. Interventions including wellness and prevention B. Consultative services and patient education C. Restorative interventions and compensatory techniques D. Client-specific work productivity standards

D. Client-specific work productivity standards The occupational therapy process involves provision of occupational therapy interventions and approaches to facilitate work performance with the exception of implementation of work productivity standards.

An OTR® completed a functional capacity evaluation on a client previously employed as a painter before undergoing a rotator cuff repair. To ensure quality services are provided as part of this client's work conditioning program, what should the OTR® do FIRST? A. Refer the client to a vocational rehabilitation counselor. B. Instruct the client in proper body mechanics. C. Modify paint roller and brush handles. D. Design a circuit to include aerobic conditioning.

D. Design a circuit to include aerobic conditioning. Aerobic conditioning is a component of a work conditioning program. Explanations of Incorrect Answers A: Vocational counseling and assessment is a component of work hardening program, not a work conditioning program. B: Instruction in proper body mechanics can be incorporated into the work conditioning program. C: Before making modifications to tools, the client should undergo treatment to maximize functional abilities.

An OTR® is designing a work hardening program for a client 3 months post-knee replacement. The client is employed as florist delivery person. In designing a circuit program, the OTR® applies best practice through application of the principles of hierarchy of functional return. Which circuit program BEST reflects the principles of hierarchy of functional return? A. Application of cold pack, instruction in proper body mechanics, modification of seating surface, and use of weighted wheeled cart B. Instruction in ROM exercises, performance of progressive-resistance lower-extremity exercises, and performance of tasks in standing with increasing duration C. Instruction in progressive-resistance lower-body strengthening exercises, performance of work simulation tasks, and lifting objects floor to waist D. Manipulation of small objects, performance of reaching tasks, lifting objects with increasing speed and resistance from floor to waist

D. Manipulation of small objects, performance of reaching tasks, lifting objects with increasing speed and resistance from floor to waist 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.

A client with a learning disability is interested in exploring work opportunities after high school graduation. The client has difficulty sequencing more than three-step directions and lacks attention to detail. Which option would be considered a component of the student's transitional program plan? A. Completion of a transition-related evaluation by a vocational rehabilitation counselor to identify the student's strengths, weaknesses, and interests B. Completion of a job site analysis with physical demands to determine the feasibility of the client's performing specific tasks C. Provision of written directions to complete a three-step task and use of samples to promote problem solving D. Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance

D. Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance An effective transition-related evaluation primarily uses situational observation, interview, and activity analysis to determine a match between the client's abilities and expected occupational performance.

In a job demand analysis, what factors are included to accurately assess the overall level of work? A. Variations in workstation and seat height for different tasks B. Frequency and distance of overhead reaching and extended reaching C. Lifting and carrying demands in terms of weight and distance D. Strength demands, physical demands, and frequency of work tasks

D. Strength demands, physical demands, and frequency of work tasks The overall level of work is classified as sedentary, light, medium, heavy, or very heavy by determining the strength and physical demands of the work and frequency of tasks.

An OTR® is developing a return-to-work program as part of a hospital-based outpatient clinic because of an increase in the number of referrals for hand and musculoskeletal injuries. The hospital is located in a suburban area. The OTR® has several clients who are employed as hair stylists. Which workstation design is MOST appropriate? A. Barber chair, simulated hair-washing sink with mannequin, scissors, wigs, razors, hair rollers, hair dryer, mirror, combs and brushes, and shelving with hair products and weights B. Computerized resistive equipment, commercially generated work samples to increase eye-hand coordination, upper-extremity and hand ROM, manual and fine motor dexterity, standing tolerance and balance C. Computerized resistive equipment to increase upper-extremity and hand strength, customized work samples to increase upper-extremity and hand ROM, weighted sled, weighted boxes, and shelves D. Weighted boxes and sled, shelves, therapeutic crafts projects to improve fine motor dexterity, hair-washing sink with mannequin, wigs, hair care supplies, scissors, hair dryer, and therapy putty

D. Weighted boxes and sled, shelves, therapeutic crafts projects to improve fine motor dexterity, hair-washing sink with mannequin, wigs, hair care supplies, scissors, hair dryer, and therapy putty The key to equipment selection is the therapist's creativity and understanding of the basic apparatus requirements. Workstations should simulate physical demand characteristics and aptitudes of a variety of work at graded levels and incorporate jobs that may be unique to a specific geography. Custom-designed samples and therapeutic projects offer significant therapeutic benefit to clients.

Six weeks after a wrist sprain, a client was diagnosed with complex regional pain syndrome (CRPS), Type 1. The client is employed as an electromechanical equipment assembler. The client is able to perform all ADLs and light meal preparation. The client reports previously enjoying baking and being unable to bake since the injury. The client's pain increases to 6 or higher on a 0-10 scale while using the hand. The skin presents with mild discoloration of the dorsal surface of the wrist. What should the OTR® FIRST include when establishing the client's work conditioning program? A. Kneading bread dough B. Upper-extremity PROM exercises C. Stress-loading tasks D. Progressive resistive exercises

During Type 1 (traumatic stage) CRPS, treatment should focus on management of pain and edema along with AROM. The most recognized therapeutic intervention for CRPS is a stress loading program.

An OTR® is establishing reasonable accommodations for a client with a history of chronic fatigue syndrome. The client is employed as a receptionist for a small extermination company. The client exhibits decreased short-term memory, periodic joint pain and stiffness, and frequent headaches. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR® to recommend FIRST? A. Change the client's work schedule to provide additional time for the client to complete the morning routine B. Provide a motorized scooter to minimize walking, conserving the client's energy and preventing pain C. Implement a day planner and list of prioritized job tasks to serve as memory aids D. Provide a flexible work schedule by permitting the client to work from home at least 3 days per week

Essential job functions are 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 equipment or assistive technology, or modifying or designing a new product. Implementing use of a day planner is the most appropriate initial accommodation under these circumstances because it allows the client to continue to perform essential job functions while accommodating the short-term memory issue.

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 to move objects. Physical demands are in excess of those for sedentary work, Even though the weight lifted may only be a negligible amount, a job should be rated as light work when -It requires walking or standing to a significant degree -It requires sitting most of the time but entails constant pushing or pulling of arm or leg controls - It requires working at a production rate pace entailing constant pushing or pulling of materials even though the weight of those materials is negligible NOTE: the constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding for a worker, even though the amount of force exerted is negligible

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. During the ergonomic assessment, the OTR® observes that the client uses the mouse 80% of the time. What will the OTR® MOST likely recommend? A. Using a vertical mouse and placing it at desktop level B. Changing to a laptop so that the client can use the touchpad instead of a mouse C. Performing full upper body stretches after every 20 minutes of mouse use D. Assigning the client other tasks that require less frequent use of the mouse

Frequent stretches and movements away from the static posture and prolonged use of a mouse is another strategy to prevent repetitions and muscle strain. Explanations of Incorrect Answers A: Putting the mouse at regular desktop height is usually too high for most workers and can lead to shoulder tension. B: From an ergonomic standpoint, using a laptop without modifying the level of the monitor screen or the keyboard may lead to other musculoskeletal symptoms. D: Job changes are usually not part of the recommendations after an ergonomic assessment.

A client employed full-time at a bakery began having numbness and tingling in both hands. An OTR® provided ergonomic assessment and intervention to address the client's acute injuries. The client met the goals, and the OTR® prepared to discharge the client from outpatient services. Which step should the OTR® take to BEST minimize the client's risk of reinjury? A. Suggest that the client participate in an injury prevention program at the workplace. B. Refer the client for job retraining because it is unlikely that the client will be successful following return to the role as baker. C. Recommend that the client return to the role as baker but seek light duty to minimize risk of reinjury. D. Postpone discharge to allow the client to participate in services to maintain ADL performance at home.

Injury prevention programs allow collaboration between the worker and employer to decrease work injuries by addressing safety and proper job task performance. Maximizing worker health and fitness may also be a part of the injury prevention program, which promotes worker wellness and reduces risk of reinjury.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. Before the onsite ergonomic assessment, what is the MOST important information for the OTR® to gather? A. Company's and supervisor's names B. Client's loyalty to the company C. Times of the day when the client takes breaks D. Client's daily routine work pattern

Obtaining information on the client's daily routine work pattern will help to identify job and productivity expectations, how the client prioritizes work tasks, the number of nonstop hours the client spends on the computer, and the client's work habits.

A client working as a transcriptionist for a law firm experiences neck pain. The pain begins on Mondays, increases over the course of the week, and diminishes over the weekend. An OTR® completes an ergonomic evaluation of the client's workstation. Which explanation for the pain is BEST? A. The transcriptionist is using lightweight writing tools. B. The transcriptionist is experiencing glare from overhead lighting. C. The transcriptionist uses an adjustable chair. D. The transcriptionist is using a hands-free headset for the telephone.

Overhead lighting problems can contribute to awkward posturing at workstations.

An OTR® is providing back-neck training to workers at a food production service as a primary injury prevention program. The OTR® can expect the target population to consist primarily of which type of worker? A. Workers with mild back or neck pain B. Workers with no back or neck symptoms C. Workers, human resource staff, employers, and family members D. Workers who need medical treatment for back or neck injuries

Primary injury prevention is aimed at workers who have not experienced symptoms of a work-related injury.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. After the ergonomic assessment, the OTR® determines that a simple change in the set-up of the computer station could help to reduce the client's symptoms. What change to the computer monitor would MOST likely alleviate the client's neck and shoulder discomfort? A. Position the monitor a minimum of two arm lengths away from the client. B. Position the monitor at eye level and one arm length away from the client. C. Tilt the monitor up so that the client is looking at the lower half of the screen. D. Recommend that the client use a large type size of no less than 16 points.

Proper ergonomic principle recommends the monitor be approximately one arm length away and the top one-third of the monitor be at the user's eye level.

Vocational Evaluation

Provides information about a person's capacities and interests for work in situations when he or she has not worked before or is looking for a new job after injury or illness. Vocational evaluation may also generally examine individual interests and abilities to explore work opportunities

Which option would NOT be considered a clinical indication for an OTR® to conduct a comprehensive functional capacity evaluation (FCE)? A. To identify work restrictions B. To confirm, rule out, or discover diagnosis C. To screen after a job offer D. To determine a level of motivation to return to work

Referral for FCE is not used to determine the worker's motivation to return to a preinjury job

Medium Work

Requires exerting 20-50 lbs of force occasionally, 10-25 lbs of force frequently, or more than negligible to as much as 10 lb of force constantly to move objects. Physical demand requirements are in excess of those for light work

A client with a herniated lumbar disk was referred to occupational therapy. The OTR® completes an initial evaluation and develops an intervention plan. Which task can the OTR® assign to the COTA®? A. Write up the initial evaluation B. Alter the initial plan to address pain C. Do a complete reevaluation of strength D. Educate the client in proper body mechanics

The COTA®'s focus is on intervention implementation under the guidance of the OTR®. The COTA® may carry out the plans detailed in the intervention plan, including educating the client.

The results of a functional capacity evaluation for a client 3 months after carpal tunnel repair reveal that the client performs manipulation of small objects one-third to two-thirds of the time in the capacity of a medical lab technician. At what frequency would the OTR® rate performance of manipulation tasks according the Dictionary of Occupational Titles (DOT)? A. Consistent B. Frequent C. Occasional D. Constant

The DOT defines as frequent an activity or condition that occurs one-third to two-thirds of the day.

A client is referred to a return-to-work program 3 months postlaceration with subsequent flexor tendon repair to the index finger. The client sustained the injury while working as a sous chef. Which option would provide the OTR® with the MOST comprehensive summary of the physical demands of the client's job? A. Dictionary of Occupational Titles (DOT) and O*Net B. Occupational Safety and Health Administration (OSHA) and National Institute of Occupational Safety and Health (NIOSH) C. Employer-provided job description and Occupational Safety and Health Administration (OSHA) D. U.S. Department of Labor and job demand analysis

The DOT is a standardized classification system used to define physical demands of work and occupations within the United States. It is the primary source for generic occupational descriptions worldwide and was last revised in 1991.O*Net is an online searchable database for information about occupations. Both DOT and O*Net are consulted when obtaining occupational information. Explanations of Incorrect Answers B: OSHA is an agency of the U.S. Department of Labor. Its mission is to ensure safe and healthful working conditions. NIOSH, a division of the Centers for Disease Control and Prevention, is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. C: An employer-provided job description may not be the most inclusive or comprehensive source. D: The U.S. Department of Labor is the department of the U.S. government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, reemployment services, and some economic statistics.

Work tolerance screenings must be compliant with fair selection processes for employees. Which agency may the OTR® consult to ensure that the employee selection process is fair? A. Equal Employment Opportunity Commission B. Occupational Safety and Health Administration C. Bureau of Labor Statistics D. Workers' Compensation Board

The Equal Employment Opportunity Commission addresses fair selection process and policy.

An OTR® is a member of an interdisciplinary work hardening program. When completing documentation according to best practice guidelines, which type of documentation should the OTR® NOT use? A. Progress notes that include pain reports, psychosocial complaints, modalities received, job analysis, and plans for next session B. Daily notes that reflect a detailed description of circuit training, including duration, number of repetitions, or both C. Progress notes that reflect the client's attendance, number of sessions, and response to the program D. Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy

The right answer is D Daily gradations may not be clinically indicated for all clients. In the case of cumulative trauma disorders, clients may need to have tissue tolerance established by focusing on one specific job demand. Explanations of Incorrect Answers A, B, C: These responses are reflective of documentation content that should be included in work hardening programs. A: Progress notes may also include pain behaviors, progress to date, meetings held, classes attended, cancellations of appointments, and client's attempts to problem solve and descriptions of any modifications. B: Daily circuit and schedule sheets are recommended for all clients to foster client responsibility for and independence with the program. C: Progress notes should complement initial and discharge summaries and keep the treatment team abreast of progress or problems.

Work Conditioning/ Work Hardening

Work Hardening is an outcomes-focused, individualized, interdisciplinary program that addresses the medical, physical, psychological, behavioral, physical, functional, and vocational components of employability and return to work. Work Hardening relies heavily on actual task replication. A person may only participate in a work hardening program once high levels of stress will no longer pose a threat to tissue hemostasis

An OTR® works as a member of a Commission on the Accreditation of Rehabilitation Facilities (CARF)-accredited comprehensive team of occupational rehabilitation professionals. Which type of return-to-work program BEST reflects the program of which the OTR® is a member? A. Work simulation B. Work hardening C. Work conditioning D. Work therapy

Work hardening involves an interdisciplinary approach and is the only type of program listed that can obtain CARF accreditation.

A worker is injured at a construction site. The worker's case manager requests a referral to an OTR® through the employer's workers' compensation carrier. The employer frequently checks in with the worker and the case manager about the status of the case. Who is the client in this situation? A. Insurance carrier B. Case manager C. Worker D. Employer

Work injury cases involve many parties; the worker with the injury remains the client.

A client was involved in a car accident and sustained an incomplete injury at the T12 spinal cord level. Before the injury, the client was employed as a heavy equipment operator. After some discussion, the client and OTR® determine it is no longer feasible for the client to return to this occupation. The client is interested in exploring other options for employment. What program would the OTR® use to MOST appropriately assist the client in identifying vocational options? A. Vocational rehabilitation program B. Work readiness program C. Ticket to Work program D. Community-based program

Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities.

An OTR® is providing a back injury prevention program for workers at a food manufacturing plant. The OTR® has provided education in proper body mechanics and on proper equipment use to decrease effort with tasks. Which component should the OTR® also include in the program? A. Support group B. Functional capacity evaluation C. Instruction in the use of physical agents D. Training in symptom identification

Workers should be educated to identify and report symptoms early; evidence indicates that early identification of musculoskeletal disorders in the workplace reduces the severity of the injury and associated costs.

A sales associate for a pharmaceutical company developed bilateral carpal tunnel syndrome 3 months ago. During an occupational interview, the OTR® finds out that the associate has recently switched from a sedentary office job to a job that requires frequent traveling. On average, the sales associate visits five to seven medical offices per day, using a rolling briefcase that weighs about 15 pounds. The sales associate uses a laptop computer in different environments, often including countertops at medical offices. The associate also uses the laptop at home several hours per day on the kitchen counter. What work-related factor would the OTR® MOST likely describe as the main contributor to the sales associate's carpal tunnel syndrome? A. Inappropriate height for the laptop computer on different countertops B. Lifting the rolling briefcase in and out of the car C. Lifting the laptop computer in and out of the briefcase D. Excessive and sustained gripping on the steering wheel of the car

Working with a laptop computer at different countertop heights creates static environments for awkward joint posture, especially in relation to static loading of the wrist, and contributes to the carpal tunnel syndrome.

General vocational evaluation

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

Light or modified duty programming

allows a worker to temporarily perform job duties with less physical demand

Functional Capacity Evaluation (FCE)

an objective assessment of a person's ability to perform work-related tasks and is the core of all return-to-work programs

Specific vocational evaluation

assesses a person's readiness to return to a particular occupation

Worksite Evaluations

on-the-job assessments to determine whether an individual can return to work after onset of a disability or whether a person can benefit form reasonable accommodations to maintain employment. The following areas are assessed: -The essential job functions -The functional assets and limitations of the worker -Physical environment of the workplace The outcome of the work site evaluation is to determine whether the person can safely and adequately carry out the essential functions of the job with or without any reasonable accommodations

Work Readiness Programs

provide individuals with a process to help them identify goals for work and identify a plan for returning to work. This process prepares a person for return to work

Work Conditioning

specifically designed to restore the client's systematic, neuromuscular-skeletal function and typically involves only one discipline. The focus is on limited work tasks with more emphasis on exercise, aerobic conditioning, and education.