Orthopedic Conditions FINAL (Ergonomics, THR/TKR, Chronic Pain)
What are some tools that can be used to prevent/migitate ergonomic problems/injuries due to vibrations?
- Anti-vibration materials -Anti-vibration mounts/handles -External support -Anti-vibration gloves
Describe "blanching".
- Blanching is the turning white of the fingers or parts of hand and arm. -The condition is associated with exposure to vibration. -It's primarily a problem with chain sawyers, and workers using pneumatic tools for grinding, polishing, sanding, and riveting. -The prolonged use of vibration hand tools can cause stress at the joints and muscles leading to the reduction of blood flow. -The risk increases with forceful gripping of the hand-tools and with continuous exposure to vibration both nerves and blood vessels are affected. -Pneumatic tools are worse than electrically powered tools.
What are some ergonomic ideas to consider when working in the kitchen?
- make sure that the blades of can openers and cutting tools are sharp (reduces the amount of force needed) -use electric equipment whenever possible. Food processors decrease the hand intensive repetitive motion used in chopping, shredding, and slicing. - Keep frequently used kitchen tools within close reach to reduce the need for repetitive bending, reaching, and lifting. This is especially important with heavy appliances and pots.
How should a person with an anterior hip replacement go up and down the stairs?
- they should go up the step with the unaffected leg/hip first -they should go down the stairs with the surgical hip first -remember the phrase: "up" with the good, "down" with the bad
What are some ergonomic considerations for wearing a backpack?
-A backpack is preferred over a "messenger bag" - no one should carry more than 25 pounds in their backpack. Those under 100 pounds themselves should carry less than 15 pounds. - Find a pack with wide, padded straps and perhaps a waist belt. -Plan your day to try to split your load into smaller pieces with frequent trips to a locker or other storage location. -Position the backpack so that it hangs just below the shoulders and rests on the hips and pelvis. -Backpacks with several compartments can help distribute the load better. -Heavier items should be packed closer to the back, with pointy and bulky items toward the outside of the pack. -Use the smallest backpack you can that fits your needs.
What is administrative controls?
-Administrative controls are modifications in the way work in a job is scheduled that decrease the duration, frequency, or magnitude of exposure to ergonomic risk factors. -They are procedures and methods, typically instituted by the employer, that significantly reduce daily exposure to MSD hazards by altering the way in which work is performed.
What are some tools that can be used to prevent/migitate ergonomic problems/injuries due to awkward positions?
-Bent or curved handles -Extensions or add-ons -Headphones -Support equipment overhead -Step stool
List and describe eye comfort exercises.
-Blinking and Yawning both produce tears to help moisten and lubricate the eyes. -Focus on a distance object across the room or even outside the window.
Describe engineering controls.
-Engineering Controls are used to implement physical change to the workplace, which eliminates/reduces the hazard on the job/task 1) METHODS USED - Use a device to lift and reposition heavy objects to limit force exertion - Reduce the weight of a load to limit force exertion - Reposition a work table to eliminate a long/excessive reach and enable working in neutral postures - Use diverging conveyors off a main line so that tasks are less repetitive - Install diverters on conveyors to direct materials toward the worker to eliminate excessive leaning or reaching - Redesign tools to enable neutral postures 2) EXAMPLES OF ENGINEERING CONTROLS -Work station design and setup -Ergonomically designed tools -Ergonomically designed equipment -Load weight reduction
Differentiate between heavy lifting, frequent lifting, and awkward lifting.
-For the caution zone, heavy lifting is any lift of 75 lbs or more once per day, or 55 lbs ten or more times per day. -Frequent lifting is 10 lbs or more, more than twice per minute, for more than 2 hours per day. -Awkward lifts are lifts of 25 lbs or more above the shoulders, below the knees, or out at arms' length done more than 25 times per day.
Describe the Functional Capacity Evaluation (FCE).
-It uses standardized and validated advanced testing in order to: (a) determine safe job matches for return to work (b) determine the level of reasonable accommodations necessary for reinstating an injured worker (c) make recommendations regarding future interventions. -The results of the FCE may be used by the physician to make a disability rating for insurance purposes.
What are some tools that can be used to prevent/migitate ergonomic problems/injuries due to the use of force/ grip-strength?
-Longer/shorter and thicker/thinner handles
What are the precautions for a posterior hip replacement? How long should you follow these precautions?
-PRECAUTIONS: 1) Don't flex/bend forward past 90 degrees 2) Don't raise knee above hip 3) Do not adduct leg to midline 4) Don not internally rotate leg or turn toes inward because, when the knee comes in, the femur might dislocate out of the socket 5) no twisting 6) use chairs with arm rests and high surfaces -HOW LONG YOU SHOULD FOLLOW THEM: you should follow them for 3 months following surgery
Describe peripheral nerve blocks in used TKAs and THAs.
-Peripheral nerve blocks are performed by an anesthesiologist who uses ultrasound to guide them to the correct placement and to inject anesthesia around the nerve to deaden it -The ultrasound is accurate for 7-8cm and is not as accurate w/bariatric/obese patients -the nerve blocks are used for post-op pain relief -the purpose of it: sensory pain is blocked but motor function is preserved; this promotes early mobility -ACBs (adductor canal block) and IPACK (interspace btw popliteal artery and the capsule of posterior knee) are normally used for TKAs -Fascia Iliac Block (injection made several centimeters lateral to the femoral artery) is used in THAs
What are some ergonomic considerations for handheld devices?
-Texting and some other small-screen features can be hard on the thumbs. Limit typing time to no more than 10-15 minute sessions. -Stretch often when spending extended concentrated time on your device. -If you use a stylus, try to find one with a larger grip handle. -Think about maintaining a neutral posture while on your device. You may elect to use something to support the arms so that you are not holding them aloft for long periods and/or maintaining a prolonged bent-neck posture.
Describe work hardening.
-This approach is similar to work conditioning - it is multidisciplinary and can involve psychomedical counseling, ergonomic evaluation, job coaching, and/or transitional work services - Treatment is typically provided 5 days per week for 2 to 4-plus hours per day. -Clients may progress to transitional work programming by actually performing job duties at their place of employment. If necessary, final adaptations and/or reasonable accommodations can be determined during this period of transition.
Describe transition services.
-Transition services are a coordinated set of outcome-oriented activities for a student that promotes the shift (or transition) from school to work or post-school activities. -The coordinated set of activities is based on a student's needs, preferences and abilities. -Transition services may include the following: a) Instruction and related services b) Community experiences c) Development of employment d) Post-school adult living objectives e) Daily living skills instruction f) Functional vocational evaluation g) The outcome or goal that transition -Students strive for is employment or post-school activities, which may include: • Post-secondary education • Vocational training • Integrated and/or supported employment • Continuing and adult education • Adult services • Independent living services • Community participation • Job placement • Job coaching
What are some ergonomic considerations for writing?
-While writing, especially for long periods, remember to take breaks and check your posture. -try to find a comfortable chair that allows your knees and hips to be at about the same level, and a desk height that puts your hands and wrists at about elbow level when you are seated upright with the arms relaxed by the sides. - Make sure your pens and pencils work well to minimize the amount of pressure you need to apply while writing. Felt-tips, gel pens, or roller ball pens all have tips that glide easily over paper. -Use the lightest grip possible -Try to keep a neutral wrist posture and don't plant your forearm or wrist on the table. -Use your shoulder to initiate the movement of writing. -Get close to your work surface to minimize reaching and make sure nothing's in the way of your writing - extra items should be stored elsewhere if there is little writing surface. -Try not to lean on the wrist or forearm, especially on the sharp edge of a desk.
Describe central pain syndrome.
-it's a neurological condition caused by a process that specifically affects the CNS, which includes the brain, brainstem and spinal cord -it occurs in people who have/have experienced strokes, MS, Parkinson's disease, brain tumors, limb amputations, brain injuries or SCIs -it may develop months/years after injury to the CNS -it also includes conditions such as chronic headaches, fibromyalgia, complex regional pain syndrome -pain feels as though it is emanating from a specific place in the body but the sensation is being generated by the nervous system/ brain
Describe a sliding hip screw/blade/ TFN (trochanteric femoral nail) surgery.
-it's commonly used for intertrochanteric/subtrochateric fractures - a dynamic hip screw and a side plate may be used to stabilize the fracture or a TFN -does not have hip precautions but may have weight bearing restrictions
Describe HAVS.
-it's hand-arm vibration syndrome caused by vibration transmitted through hand-held and stationary tools -HAVS is an advanced condition, and the entire hand or arm may be affected by exposure to vibration. -Early signs of HAVS are infrequent feelings of numbness and/or tingling in the fingers, hands, or arms, or numbness and whiteness in the tip of the finger when exposed to cold. -As the disease progresses, a worker experiences more frequent attacks of numbness, tingling, and pain and finds it difficult to use his or her hands. - A worker with advanced HAVS may be disabled for a long time.
Describe a hemiarthroplasty/bipolar hip surgery.
-it's usually performed on patients who have a femoral neck fracture -it's similar to THA, but it involves only half of the hip -it replaces only the ball portion of the hip joint -it will have hip precautions if performed with the posterior or anterolateral approach
Describe an open reduction internal fixation (ORIF) hip surgery.
-it's usually used for more stable femoral neck fractures where the blood flow is not disrupted -the surgeon repositions the bone fragments into their normal alignment, then inserts screws/attaches metal plates to the outer surface of the bone to stabilize the fracture -does not have hip precautions, but may have weight-bearing restrictions
What is flare-up pain?
-it/s a transitory increase in pain in someone who has relatively stable and an adequately controlled level of baseline pain -it may be caused by changes in underlying disease; involuntary/voluntary physical actions; stress and emotions like anxiety, anger fear or worry; and activity imbalance
Describe Musculoskeletal disorders.
-they account for 1/3 of all lost day injuries each year and costs businesses $15-20B each year in worker's comp -The causes are: repetitive and/or prolonged activities; awkward postures/positions for an extended time; static postures; vibration; high/low Temperatures; forceful exertions 1)ERGONOMIC STRESS AREAS -eyes, neck, shoulder, elbow, wrist, hand, back/spine, hip, and knee 2) SIGNS OF MSD - Decreased ROM; loss of function; deformity; cramping; loss of color; decreased grip; strength; loss of balance; swelling; redness 3) SYMPTOMS OF MSD -Muscle fatigue or pain -Aching -Burning -Numbness -Stiffness -Tingling
What are work practice controls?
-they are controls that reduce the likelihood of exposure to MSD hazards through alteration of the manner in which a job or physical work activities are performed. -Work practice controls act on the source of the hazard - The protection that work practice controls provide is based upon the behavior of managers, supervisors, and employees to follow proper work methods. -Work practice controls include procedures for safe and proper work that are understood and followed by managers, supervisors, and employees.
Standards require that the user's viewing area should be located between ________and _________degrees below the horizontal plane.
0 and 60 degrees
What types of ADLs and transfers do OTs/OTAs work on with patients with THAs/TKAs?
1) ADLs -bathing -dressing -hygiene 2) TRANSFERS -car -shower -toilet -bed
How should the computer monitor be positioned for a bifocal user vs. a non-bifocal user?
1) BIFOCAL USER -The top of the computer monitor should be LOWER than the eye. This allows the eye to have a 15-30 degree downward gaze which is ideal. 2) NON-BIFOCAL USER -The top 1-2" of the computer monitor should be LEVEL with the eye. This allows the eye to have a 15-30 degree downward gaze which is ideal.
Differentiate btw chronic and acute pain.
1) CHRONIC PAIN -persistent pain; pain that is continuous or recurrent and of sufficient duration and intesity to adversely affect a person's well-being, level of function and quality of life -usually lasts more than 3-6 months -pain that continues when it should not -can be nociceptive or neuropathic 2) ACUTE PAIN -pain that has a recent onset, is transient and usually comes from an identifiable cause
Describe OT intervention in THA/TKA post-operation.
1) DAY #1 -work on dressing -might have to give the patient a hip and knee kit which includes a reacher, sock aide, shoe horn, and long-handled sponge to help with dressing 2) DAY #2 -work on transfers -make sure patient uses a leg lifter to guide surgery leg onto the bed if they've had a posterior hip replacement; make sure they move both legs as a unit and their legs are straight and moving with the hips if they have an anterior hip replacement -encourage patient to sleep on back and not hip -tell patient to place a pillow under their knee to avoid getting a flexion contracture -when getting into the tub= tell patient to lead with their unaffected leg and to lift their surgery leg behind them
List and describe the 5 methods/principles of administrative controls.
1) EMPLOYEE ROTATION/ JOB TASK EXPANSION -if possible rotate employees between job tasks so that an employee is assigned to perform one task then moved to another. -Or enlarge the employees tasks so the employees have the opportunity to perform a different task. 2) PHYSICAL ADJUSTMENTS TO THE WORK PACE -hard to do. But if possible slow it down a little. Make sure you work at a reasonable pace, don't stress yourself. 3) REDESIGN OF WORK METHODS -Redesign how the work is performed. Another procedure. Is there a better way to do the task with less stress, strain, is there a tool or piece of equipment that could be used to help perform the task. 4) ALTERNATIVE TASKS -Whenever possible have employees alternative their tasks frequently throughout the day. Rotate heavy and/or repetitive tasks with lighter, less repetitive tasks. Example is break up typing with filing. Break up use of a jackhammer with moving materials. Be aware that even tasks such as manual stapling, sorting through large volumes, and mail sorting were repetition and awkward positions may contribute to repetitive motion injuries (MSDs). 5) BREAKS -Encourage employees to change position, stand up or stretch whenever they start to feel tired. Encourage motion rather than static positions. -It is recommended that you take 1 or 2 minute breaks every 30 minutes and 5 minute breaks every hour when performing stationary type work. -Remember a "break" could be doing another activity rather than just "taking a break"; it can be making a phone call, file something, or other activity. -It is also recommended that every few hours, you try to get up and move around.
Describe the body angles/position of someone in a proper sitting position.
1) HEAD -Should be straight and balanced over the spine while looking forward.(no flexed-neck position). -If on a computer, the monitor should be centered in front of you and positioned 2" to 3" above seated eye level. -the neck in a neutral or aligned position. 2) SHOULDERS - Should be kept level and straight and relaxed. - armrests should be adjusted correctly so you are not hunching up your shoulders. -Adjust chair so back is supported with proper lumbar curve. 3) ELBOWS - Keep elbows in a slightly open angle (100-110 degrees) with your wrists is a straight position. -Keep the mouse within close reach so do not have to stretch to use it. -Adjust the height of the armrests so they allow the user to rest arms at their sides and relax their shoulders while keyboarding. -Elbows and lower arms should rest lightly so as not to cause circulatory or nerve problems. 4) HANDS AND WRISTS - Your hands should be slightly lower than your elbows. Keep wrists neutral. - safe zone of movement for your wrist= 15 degrees in all directions. 5) WAIST - Straight and not twisted. Keep at 90-120 degree angle. -Hips should be against the back of the chair. 6) LEGS - Thighs should be parallel to the floor and the knees at about the same level as the hips. -If you feel pressure on the back of the thigh, lower the chair slightly. -Back of knees 3" to 4" away from chair to prevent the seat from cutting off circulation to the lower legs. -You should be able to easily slide your fingers under the front area of the thigh. -The chair should be long enough and wide enough to support your hips and thighs. 7) FEET -Place your feet flat on the floor. Use a foot rest if needed.
Environmental ergonomic hazards amplify/increase the risk of MSDs. What are some examples of environmental ergonomic hazards?
1) Hot weather 2) Cold weather - affects worker coordination and dexterity 3) High-temperature indoor (steam rooms, attics) 4) Cold-temperature indoor (walk-in freezers, cold process rooms) 5) Low visibility
What are the indications and contra-indications for a unicompartmental knee replacement?
1) INDICATIONS -isolated to one compartment -intact ACL -Varus < 5 degrees -Valgus <10 degrees -Flexion contracture <5 degrees 2) CONTRA-INDICATIONS -Rheumatoid arthritis or any inflammatory arthritis -Pain in PF or opposite compartment -Absent ACL or non-functional
What are the essential elements of an injury prevention program?
1) Management Leadership and employee participation -Name someone to be responsible for the ergonomics and supply resources and training for the program. - Be sure the policies do not discourage employees from reporting problems and let employees know how they can be involved in the ergonomics program. 2) Hazard information and reporting Job Hazard Analysis and Control -Provide information to the employees periodically on: a. ergonomic risk factors (force, repetition, awkward positions, etc) b. signs and symptoms of of MSD c. importance of reporting the signs and symptoms early to prevent damage and how to make reports. d. Analyze problem jobs for ergonomic risk factors 3) Training A. Train employees in jobs with covered MSD and supervisors and staff responsible for the ergonomic program. B. Teach recognition of MSD hazards, and control measures used to reduce hazards. C. Conduct training initially and periodically and at least once every 3 years thereafter. Provide prompt response to an injured employee. 4) MSD Management b. Work with employees to eliminate or materially reduce MSD hazards using engineering, administrative and/or work practice controls c. Use PPE to supplement other controls d. Track progress, and when jobs change, identify and evaluate MSD hazards 5) PROGRAM EVALUATION -Evaluate the program periodically-at least every 3 years -Consult with employees on program effectiveness and deficiencies-look at injuries that have occurred.- and correct any deficiencies -Encourage employees to take breaks and move around regularly throughout the day and take steps to prevent stress from interfering with employees' well-being by -Ask for input from employees often, and ensure everyone feels comfortable bringing safety hazards to their supervisors' attention. Maybe hang a comment box at a convenient location. Hang signs by stairwells to encourage walking instead of using the elevator.
What are the goals of work rehabilitation?
1) Maximize levels of function following injury and/or illness to maintain a desired quality of life for the worker 2) Facilitate the safe and timely return of individuals to work following injury and/or illness 3) Remediate and/or prevent future injury or illness 4) Assist individuals in retaining or resuming their worker role, which can contribute to self-confidence and a view of self as a productive member in society, and prevent the negative psychosocial consequences of unemployment.
What are some examples of treatment for osteoarthritis?
1) NSAIDS (ibuprofen) to control pain and swelling 2) keep moving 3) injections 4) joint replacement
What are the hip precautions for a hip replacement done using the anterolateral approach?
1) No active hip abduction 2) No hip external rotation (no twisting/rotating leg to side) 3) No hip extension (to avoid this, they should lead w/their unaffected leg when stepping back)
List and describe the 3 surgical approaches of hip replacements.
1) POSTERIOR APPROACH -from the back; doctor has to cut through fascia and gluteus max -most common -has more risk for dislocations 2) ANTEROLATERAL APPROACH -from the side; cuts through fascia but no muscle -least common 3) DIRECT ANTERIOR APPROACH -done from the front; no muscles are detached -has the lowest dislocation rate and a lower infection risk -has quick healing time -has no hip precautions -Hana table is used to make it easier; fewer assistants are needed for the operation
Describe the role of the OT/OTA in transition services.
1) Prepare the youth, family, and community agency representatives for changes in roles and routines (e.g., the role of youth changes from student to worker) 2) Educate the family, school staff, and community on diverse needs of the youth in the new setting (e.g., educating members of a community agency about how to support youth to live in a group home) 3) Evaluate supports for employment, further education, and independent living (e.g. observe youth while at their job) 4) Facilitate skills needed for employment and/or further education and independent living (e.g., teach youth how to use the bus system to travel to community settings) 5) Work with youth to develop self-determination skills for community participation 6) Enhance skills needed for social and leisure participation in the community (e.g. coach youth on how to ask for what they want) 7) Assist with community mobility, and recommend modifications, and equipment (e.g. evaluate the need for supports in new settings) 8) Collaborate with the transition team, including families, to coordinate adult health care resources and disability benefits, and promote self-advocacy skills (e.g. help set up a calendar to remind when to make needed appointments)
What are some causes of localized pressure?
1) Pressing the body/part of the body against hard or sharp edges 2) Standing/kneeling for prolonged periods on hard surfaces 3) Using tools with hard handle surfaces or short handles 4) Using hands/knees as a hammer more than 10 times in 1 hour or more than 2 times per day (long-term)
Give some examples of proper work practices.
1) Proper lifting techniques (NIOSH) 2) Stretch 3) Task variety 4) Increase rest breaks 5) Require that heavy loads are only lifted by two people to limit force exertion / team lift heavy/bulky/ awkward loads 6) Work rotation: Establish systems so workers are rotated away from tasks to minimize the duration of continual exertion, repetitive motions, and awkward postures. Design a job rotation system in which employees rotate between jobs that use different muscle groups 7) Staff "floaters" to provide periodic breaks between scheduled breaks 8) Properly use and maintain pneumatic and power tools
What are some standard ways and some innovative ways you can adjust the workstation to better fit the employee and reduce awkward positions?
1) STANDARD WAYS -Adjustable workstation -Adjustable chair -Ass Foot rests -Adjustable monitor -Document holder 2) INNOVATIVE WAYS -Cut legs off the desks -Add blocks under the workstation to raise the height -Build foot rest or use a thick book as a foot rest -Put a book under the monitor to raise it to the proper height -Build platform to stand on to get the proper height
Differentiate btw static and dynamic biomechanics. Give an example of each.
1) STATIC - Holding one object or body part in one position for an extended period. -EX. Standing or sitting in a parking booth or at a microscope. 2) DYNAMIC - An activity created by the rhythmic contraction and relaxation of the muscles. -EX. Walking
List and describe the 3 procedures used for work practice controls.
1) Safe and proper work techniques and procedures for performing the job tasks that are understood and followed by managers, supervisors, and employees. -The work techniques could include proper positions and angles when sitting at your computer station to standing and performing tasks. 2) Training recognition of hazards and work techniques that can reduce exposure or ease task demands and burdens. -Use written procedures to train such as the JSA. -Workers acquire certain behaviors over a long period of time. This affects the way they work, their posture, lifting techniques, etc and could create potentially hazardous situations. -Regular ongoing training is an essential part of the program. 3) Conditioning period for new or reassigned employees to learn the work techniques and procedures. -Supervise the employees performing the tasks to ensure understood the training and are performing correctly. If not provide additional training.
List and describe 6 specific examples/syndromes of MSD.
1) TENDONITIS - An inflammation of the tendon that typically occurs in the shoulder, wrist, hands, or elbow. -common examples are tennis elbow-usually indicated by pain or ache on along the outside of the elbow and golfer's elbow-usually indicated by pain or ache along the inside of the elbow 2) CARPAL TUNNEL SYNDROME -Irritation of the median nerve, which runs through a bony channel in the wrist called the carpal tunnel. Usually results from excessive flexing or twisting of the wrist. -symptoms/signs of numbness, tingling, pain and weakness in the thumb, index, middle and ring fingers. 3) TRIGGER FINGER SYNDROME - Tendons in the fingers become inflamed, causing pain, swelling, and a loss of dexterity. 4) EYE STRAIN - The eyes become strained as a result of poor lighting, glare or viewing from awkward positions. 5) HAND/ARM VIBRATION SYNDROME -Tingling, numbness, blanching, loss of dexterity in the hand/arm 6) MUSCLE STRAIN - Pain in muscles
Differentiate btw traditional work, modified work and alternative work?
1) TRANSITIONAL WORK -allows an employee with temporary work restrictions to work in a modified or alternative capacity for a defined period of time, while recuperating from an illness or injury -can consist of modified work or alternative work. 2) MODIFIED WORK - may include changing, transferring or eliminating specific job duties within the employee's regular job to meet the temporary work restrictions. 3) ALTERNATIVE WORK - may include offering the employee a position other than his or her regular job to meet the temporary work restrictions.
Describe how repetitive motions are an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD - Repeating same motion [especially lifting] for more than two hours per day with hands, wrists, elbows, shoulders, or neck or intense keying for more than 4 hours per day can be just as hazardous [as heavy lifting] because of the fatigue it causes -When you lift frequently you can tire out the muscles, making them more prone to injury. If your muscles can't handle the load, the strain can be shifted to your joints and the disks in your spine, placing them at risk for injury, too. 2) SOLUTIONS -Arrange work to avoid unnecessary motions -Let power tools and machinery do the work -Spread repetitive work out during the day -Take stretch pauses -Rotate task with co-workers if possible Change hands or motions frequently
Describe how reaching above the head/shoulders is an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD - Working with the hands above head for more than 2 hours per day is a potential hazard because w orking on overhead tasks in awkward posture with the hands raised above the shoulder may restrict blood flow and result in nerve compression that affects the upper extremities and shoulders causing numbness, tingling, discomfort and fatigue when these postures are maintained for long periods of time." 2) SOLUTIONS: -Keep items within close reach (design reach distance for the shortest worker) -Elevate work areas -Platform ladders and lifts allowing for easier access to items -Pullout steps on vehicles -Elevated racks that can be lowered to an appropriate height when access is needed -conduct pre-planning to ensure that employees are provided with appropriate height ladders - remove obstacles -Utilize equipment to raise and lower items or move items closer to worker, such as: gravity feed racks (these are racks on shelves with little wheels that allow boxes stored on them to slide forward as the front box is removed; kind of like taking a can of beverage out of the cooler case at a convenience store.); a small portable forklift -"Provide "pick sticks" or "bow peep" hooks to pull small, light-weight items closer to edge prior to lifting."
Describe vibrations can be an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD - using hand tools with high vibration levels for more than 30 minutes per day; using hand tools with moderate vibration levels for more than 2 hours per day; -Whole body vibration occurs while standing or seated in vibrating environments, such as trucks or heavy machinery and whole body vibration in a seated position has been found to increase the prevalence of reported low back pain. -tractor driving, forklift operating, truck driving, and driving earth moving machines have been found to result in increased back pain. "Both hand-held and stationary tools that transmit vibration through a work piece can cause vibration "white fingers" or hand-arm vibration syndrome (HAVS). -White fingers, or Raynaud's Syndrome, is a disease of the hands in which the blood vessels in the fingers collapse due to repeated exposure to vibration. The skin and muscle tissue do not get the oxygen they need and eventually die. 2) SOLUTIONS -Use low-vibration tools and devices that may reduce vibration (tool balancers, extension handles, vibration isolators or damping techniques [most effective]) -Adequate rest periods -Rotate jobs -Maintenance -PPE -Choose chain saws [tools] with the lowest vibration level suitable for the job. -Perform routine chain saw [tool] maintenance. -Instruct workers not to grip saws too tightly. -Remind workers that smoking decreases blood flow to fingers. -Advise workers to exercise hands and fingers frequently to increase blood flow.
Describe how awkward grips are an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD -Gripping 10 or more pounds or force for 2 or more hours per day is a hazard because using a lot of hand force increases the risk for hand, wrist and elbow injuries, and in some cases shoulder injuries. -Holding something between the tips of the fingers and the thumb is called a pinch grip. This type of grip uses very small muscles in the hand and wrist, so even holding something that weighs only 2 pounds can be a risk for injury if it's done for more than 2 hours per day. -Because you can't get as good a grip with your fingertips as with your whole hand, you tend to use more force to hold onto something than just the weight of the object. -When you grip something with your whole hand you're able to use the larger muscles in your forearm, and this gives you a grip that's five times stronger than a pinch grip. You're also able to get a better grip so the amount of grip force you use is pretty much equal to the weight of the object you're holding. 2) SOLUTIONS -Design work layout to reduce hand-carrying -Reduce amount of items carried at one time -Use non-pinch grip postures to hold and carry items -Use ergonomically designed tools/aids, such as: Friction-reducing aids on fingers to reduce amount of force exerted in the pinch grip -Use job/task rotation that includes tasks not requiring pinch grip -Limit the amount of product that is lifted at one time to reduce the finger force exerted. Some recommendations for repetitive tasks that require pinch grips and that include force should be limited to about 2 to 4 pounds of force.
Describe how localized pressure on a body part is an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD -Some desks and computer equipment have hard, angled leading edges that come in contact with a user's arm or wrist and create localized pressure. Localized pressure can create contact stress, affecting nerves and blood vessels, possibly causing tingling and sore fingers. 1) SOLUTIONS -Use tools with longer handles -Use tools with padded grips -Alternate between bending, kneeling, sitting, and squatting; use sit/stand stools or tables -General controls to reduce contact stress: use electric or power tools, knives and scissors; use spring-loaded scissors; attached well-designed handles to tools; wrap or coat tool handles and grips with cushioning material; use palm pads; use sit stand stools to reduce static loading on legs and back; use shoes with thick or cushioned soles -Pad table edges or use tables/desktops with rounded edges -Use wrist rests, anti-fatigue mats, knee pads, shoe inserts or other items that reduce stress on body parts -Buy furniture with rounded desktop edges
Describe how awkward body posture is an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD -Working with the neck or back bent forward more than 30° for more than 2 hours per day is a hazard our head weighs 10 to 12 pounds, so it can be quite a strain to work with your neck bent. -Working with the neck bent like this is pretty common in inspection jobs, such as with this cherry sorter. It also is common in job such as: welding, microscope work, dental hygienists - Your upper body is 60 percent of your total body weight, so like your neck holding up your head, it's also a strain for your back to hold you in a bent over position for more than two hours per day, such as landscapers who work near ground level. -If the location of your work is too low, you're going to have to get into an awkward posture to get to it. Typically that means bending your back, kneeling or squatting. It can also mean bending your head and neck forward. 2) SOLUTIONS: -Raise and/or tilt the work for better access -Use a stool for ground-level work -Use tools with longer handles -Alternate between bending, kneeling, sitting, and squatting
Describe how lifting objects is an ergonomic hazard and give some solutions on how to fix it.
1) WHY IT'S A HAZARD -lifting only becomes a risk for injury if it's heavy lifting, it the lifting is done frequently, or if it's done in an awkward posture. - The load on the low back when lifting something heavy can strain the muscles and damage the disks in your spine. The load can strain the muscles in the shoulders and upper back as well. -When you lift frequently you can tire out the muscles, making them more prone to injury. -Lifting even moderate loads while bent over or reaching up or out can also place you at risk of injury, to either your back or your shoulders because when you bend over to pick something up from below your knees, not only does your back have to lift the object, but it also has to lift the weight of your upper body. 2) SOLUTIONS - For safer lifting: plan lifts; minimize lifting distances; avoid manually lifting/lowering loads to/from floor; identify/reduce unstable or heavy loads; reduce frequency of lifting and duration of lifting tasks; provide clear access -Plan the workflow to eliminate unnecessary lifts. -Organize the work so that the physical demands and work pace increase gradually. -Position pallet loads of materials at a height that allows workers to lift and lower within their power zone. -Store materials and/or products off the floor. -Arrange materials to arrive on pallets, and keep materials on pallets during storage. Use a forklift to lift or lower the entire pallet of material, rather than lifting or lowering the material individually. -Arrange to have material off-loaded directly onto storage shelves. Store only lightweight or infrequently lifted items on the floor. -Use mechanical devices (e.g., lifts, hoists ) whenever possible. -For loads that are unstable and/or heavy: Tag the load to alert workers; test the load for stability and weight before carrying the load; use mechanical devices or equipment to lift the load. -Reduce the weight of the load by: Putting fewer items in the container; using a smaller and/or lighter-weight container; repack containers so contents will not shift and the weight is balanced. Use team lifting as a temporary measure for heavy or bulky objects. - Reduce the frequency of lifting and the amount of time employees perform lifting tasks by: Rotating workers in lifting tasks with other workers in non-lifting task; having workers alternate lifting tasks with non-lifting tasks. -Clear spaces to improve access to materials or products being handled. Easy access allows workers to get closer and reduces reaching, bending, and twisting." -Employee guidelines for safer lifting: 1)Stretch before lifting 2)Check for tags on loads 3)Test load for stability and weight 4)Plan the lift 5) Use proper lifting techniques - grip; two hands; smooth, even motions; load close to body; legs to push up and lift load; avoid twisting; alternate with less physically demanding tasks; rest breaks -Keep the lifts in your power zone (i.e., above the knees, below the shoulders, and close to the body), if possible. -When lifting: Get a secure grip. Use both hands whenever possible. Avoid jerking by using smooth, even motions. Keep the load as close to the body as possible. To the extent feasible use your legs to push up and lift the load, not the upper body or back. Do not twist your body. Step to one side or the other to turn. Alternate heavy lifting or forceful exertion tasks with less physically demanding tasks. Take rest breaks.
List and describe the 4 ergonomic study areas.
1) WORKERS - what they bring to the job 2)TOOLS - what they bring to the worker 3)TASKS - what the worker must do 4) ENVIRONMENT - the conditions surrounding the worker and the tool
How does a TKA (total knee arthroplasty) work?
1) diseased areas at the top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped 2) a polyethylene insert is placed btw the femoral component (covers the femur) and the tibial component (covers the shin bone) 3) the patellar component replaces the kneecap
Vibrating panels of machine housings and guards may be controlled by use of damping materials applied to the panels. Give some examples of effective damping materials.
1) felt 2) liquid mastics 3) elastomeric damping sheets
What are some materials used to make a total hip arthroplasty?
1) ivory hips 2) glass 3) metals (vitalium, stainless steel, cobalt-chromium, titanium)
What are some reasons/conditions that a person can have that can cause them to need a joint replacement?
1) osteoarthritis 2) rheumatoid arthritis 3) AVN (avascular necrosis= necrosis to the femoral head) 4) post traumatic injury/ fracture 5) dysplasis
What are the symptoms of osteoarthritis?
1) pain 2) stiffness 3) swelling 4) popping, clicking 5) night pain 6) instability 7) falls
Chronic pain is classified by pathophysiology? What is the definition of pathophysiology and what are the 2 types associated with the classification of chronic pain/
1) pathophysiology= the functional changes associated with or resulting from disease or injury 2) 2 TYPES: -nocicptive= due to ongoing tissue injury -neuropathic= resulting from damage to the brain, spinal cord, or peripheral nerves
What is the role of the OT/OTA in ergonomics?
1) they evaluate worker capacities, task performance, and the work environment, and to provide interventions related to these areas 2) OTs possess the distinct ability to evaluate the intersection of an individual's work demands and the work environment through evidence-based task analysis 3) identify supports and barriers to success in the work environment, including work culture, that can be addressed in the intervention plan 4) considers other contexts and environments that may support or hinder the ability to fulfill the worker role, such as access to transportation and the ability to dress oneself in a timely manner for the work day.
It takes about __________ pounds of force to hold a 12 oz. soda can and about ___________ pounds of force to fully open a small binder clip
2; 5
What is the best height for the kitchen cabinet?
36 inches or 3 ft
Describe ergonomics in the home.
Basically speaking, ergonomic in the home encompasses the following components: 1) Designing equipment and systems so that they are as easy to use as possible and less likely to cause damage to the homeowner when used. 2) Designing equipment and organizing the layout of the home so that the body's posture is improved and the loads on the body are reduced. 3) Designing the environment so that lighting and temperature are at optimal levels 4) Evaluate your back and leg posture when driving your car. Make sure that your low back is firmly supported by the seat. If the support is not adequate, add a low back pillow. A seat back position of 100 - 110 degree tilt provides for the least amount of stress to the back. The seat should be positioned so that there is a slight bend in the legs.
Applying contact force with a body part more than 10 times per hour for more than 2 hours per day (e.g. using the hand or knee as a hammer) is called _____________.
Contact stress
What is ergonomics?
Ergonomics is the science of fitting the job to the worker.
What about back belts give you extra strength so you can lift more weight. True or False? NO, can give a false sense of security. Should be used as a reminder to employees to use proper lifting procedures.
FALSE, back belts can give a false sense of security but they should only be used as a reminder to employees to use proper lifting procedures.
A lot of ergonomic solutions it require a great amount of capital expense. True or False?
FALSE; Most solutions are simple ones that do not require a lot of expense.
Why is kneeling for more than 2 hours per day an ergonomic hazard?
Kneeling is a risk factor for knee injuries, since it creates pressure both in front of and behind the knee cap.
What is the best position of the hand and wrist to prevent ergonomic hazards that arise from awkward grips?
Maintain hand postures that provide maximal finger force. Generally, the hand span should be about 1.75 to 2.25 inches for maximum finger exertion and the hand should be in the shape of a "C"....Ensure that the hand is maintained in a neutral posture where it is not bent either up or down or to either side. Bending the wrist reduces the amount of force that can be safely exerted by the fingers. "
What is the purpose of PPE (personal protective equipment)? Give some examples of PPE.
Personal Protective Equipment (use protection to reduce exposure to ergonomics-related risk factors) - Use padding to reduce direct contact with hard, sharp, or vibrating surfaces - Wear good fitting thermal gloves to help with cold conditions while maintaining the ability to grasp items easily Examples of PPE: Gripping gloves Knee pads Vibration gloves Thermal gloves Lifting straps Shoulder harness Lifting braces
Describe the chair adjustment sequence.
Please follow these in order: 1)Move your chair away from your desk. 2) Adjust the seat height so that your feet feel comfortable on the floor. 3) Adjust the seat depth so that you have 2-3 finger width between the front edge of the chair and your calf. 4) Raise/lower the lumbar support to fit in the curve of your back. You will either adjust the entire backrest or just the lumbar within the backrest. 5) Backrest tilt and tension. Adjust the backrest tilt to your comfort and adjust the tension that it takes to recline or remain more upright via knob. 6) Adjust the armrests: a. Lower one armrest completely. b. Bend that elbow to 90 degrees. c. Raise that armrest to hold the forearm in the 90 degree position, without pushing the shoulders up.
Describe work conditioning.
The occupational therapist uses a systematic approach to restore the performance skills of workers recovering from long-term injury or illness. There is a focus on restoring musculoskeletal and cardiovascular systems, as well as safely performing work tasks. This is typically achieved through work simulation and individualized interventions to improve physical capacity that occur 3 to 5 days per week for 2 to 4 hours per session.
What is the goal of ergonomics?
To minimize injuries due to chronic physical and psychological stresses, while maximizing productivity and efficiency
As early as the 1700's scientists were aware of repetitive movement injuries to workers. True or False?
True
Low temperatures can reduce finger flexibility and accuracy. True or False?
True
Muscles fatigue easier when held in the same position for extended periods of time. True or False?
True
Squatting for more than 2 hrs a day is an ergonomic hazard. True or False?
True
TKAs and THAs are both weight-bearing as tolerated (WBAT). True or False?
True
The greater the effort to maintain control of a tool the higher the potential for injury. True or False?
True
Tools with a longer handle allows the user to generate more leverage by applying a smaller force at a greater distance whereas a thicker tool handle allows more surface for grasping, or in the case of a standard screw driver, increase the torque thereby reducing the overall required force. True or False?
True
Working with the elbows above the shoulders for more than 2 hrs per day is an ergonomic hazard. True or False?
True
What is a tool that can be used to prevent/migitate ergonomic problems/injuries due to static positions?
anti-fatigue mats
Whether your tasks are performed while sitting or standing, always maintain proper posture & angles and avoid _______________, and ______________ for materials.
awkward positions; extreme reaches
The science of measuring the amount of force put on the muscles and joints of people when working in different positions.
biomechanics
Excessive noise levels above 90 decibels (dBA) and noise peaks above 100 decibels cause headaches and increases ______________, muscle tension and fatigue.
blood pressure
______________ is pain that is typically present for approximately half the day or more.
continuous pain
The toe kick is a recess at the bottom of a base cabinet and provides a recess for your feet so that you can get close to the countertop without losing your balance. What is the ideal depth and height for a toe kick?
depth= 3 in; height= 3.5 inches
In some situations, a hand tool with a pistol grip may require less gripping force than an in-line tool handle. Conventional hand tools such as pliers and wrenches are designed with slightly wider handles that allow the grip force, and resultant contact stress, to be distributed over a larger surface and thus decrease the ____________.
grip strength
What is posture?
it's the position and carriage of the body as a whole
What the best way for someone with an anterolateral hip replacement to get out of bed?
on the side opposite of the joint replacement
____________ is the wear and tear of cartilage.
osteoarthritis
With a ______________, only half of the knee joint is replaced with a prosthesis and mobility and ROM are better.
partial knee replacement
What is a total knee replacement?
removal of damaged bone and cartilage from your thighbone, shinbone, and kneecap with insertion of an artificial joint (prosthesis)
You should ALWAYS check for hip precautions and if you don't have them who should you ask for them?
the physician
