occ return to work
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 area should provide for sitting or standing preferences. C. The workstation should enable the worker to reach overhead during the task. D. All workstation tools should be placed beyond arm's reach during the task.
A 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. ---- 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.
A factory worker is seen by a COTA® in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® working in the outpatient OT program 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 Environmental supports facilitate the client's return to work. --- 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.
A client employed full-time at a bakery began having numbness and tingling in both hands. An OTR® provided ergonomic assessment and the COTA® provided intervention to address the client's acute injuries. The client met the goals, and the OTR® and COTA® collaborated in preparing to discharge the client from outpatient services. The OTR® asked the COTA® what step should be taken 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 able to return to work. C. Recommend that the client return to the role as baker but seek light duty to minimize risk of reinjury. D. Postpone discharge and continue services to help the client maintain ADL performances at home.
A 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. ---- B, C: The client met the ergonomic retraining goals in outpatient services, which indicates the client is able to return to work and does not require light duty modifications. D: Payers do not reimburse for ADL maintenance intervention.
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 COTA® create work simulation tasks? A. Medium B. Heavy C. Very heavy D. Light
A 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. ---- B: Heavy work requires exerting 50-100 lb of force occasionally, 25-50 lb of force frequently, or 10-20 lb of force constantly to move objects. C: Very heavy work requires exerting 100 lb of force occasionally, in excess of 50 lb of force frequently, or in excess of 20 lb of force constantly to move objects. D: Light work requires exerting as much as 20 lb of force occasionally, as much as 10 lb of force frequently, or a negligible amount of force constantly to move objects. The physical demands are in excess of those for sedentary work.
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 to minimize distractions.
A 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. ----- 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.
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. The COTA® is collaborating with the OTR® for writing goals for the worker. Which short-term goal would be BEST, using the RUMBA tool for goal writing? A. Client will improve work tolerance use of right hand and wrist to lift 5 lb. bucket within 2 weeks. B. Client will receive ultrasound twice daily to radial wrist area for 2 weeks to reduce pain. C. Client will demonstrate improved functional 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 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. ---- B: This goal does not include a relevant outcome for a functional occupational task. C: Improving test measures is not generally an acceptable outcome for goals. D: This goal is not relevant to the client's current work tasks.
An OTR® has written 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 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.
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. An older worker who wants to find part-time job opportunities in preparation for retirement C. An employer who needs to know essential job functions of a position for a worker D. A work group at a manufacturing plant that needs ergonomic training to minimize work injuries
A Vocational evaluations are most appropriate for people who have never worked or are unable to return to a previous job due to disability. --- B: Vocational evaluation and rehabilitation are not appropriate for a worker preparing for retirement. C: Determining the essential job functions of a position requires a job demands analysis. D: Ergonomic training does not require vocational evaluation and is typically done through direct consultation.
An OTR® completes a work tolerance screening with a worker at a manufacturing plant. What information would the COTA® assigned to treat the client expect to be included in the screening documentation? A. Weight limits for various job tasks B. Worker's statements to remain in the job C. Worker's ability to perform IADLs at the job site D. Financial issues the worker currently experiences
A Work tolerance screenings identify limitations in the worker's ability to meet the activity demands of essential job functions, such as weights, distances, forces, angles, repetitions, and tools. --- B, C, D: Work tolerance screenings address the worker's ability to perform essential job functions, not the worker's subjective reports or occupational profile.
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 COTA® design work simulation tasks? A. Sedentary B. Light C. Heavy D. Very heavy
B 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. ---- A: A sedentary strength demand is defined by DOT as requiring a force exertion or weight carried of 10 lb occasionally and negligible weight one-third to two-thirds of the day and more than two-thirds of the day. C: A heavy strength demand is defined by DOT as requiring a force exertion or weight carried of 50-100 lbs. occasionally, 25-50 lbs. one-third to two-thirds of the day, and 20-50 lbs. more than two-thirds of the day. D: A very heavy strength demand is defined by DOT as requiring force exertion or weight carried of more than 100 lbs. occasionally, 50-100 lbs. one-third to two-thirds of the day, and 20-50 lbs. over two-thirds of the day.
A COTA® 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 COTA® 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
B 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. ---- 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®-COTA® team 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®-COTA® team 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.
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. ----- A: Recommending that the employer allow the employee to play soothing music using a digital music player and a headset to relax and reduce stress would affect the client's ability to perform essential job functions. C: Instituting a general policy for employees to participate in daily meditation and yoga classes may not be appropriate. The client may benefit from exploring these options individually. D: Depending on the size of the company, hiring a full-time security guard and installing a surveillance system throughout the workplace may be undue hardship on employer.
A COTA® 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 COTA® 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 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. ------ A: Before purchasing a digital voice messaging system, the COTA® 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®-COTA® team 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®-COTA® team 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 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. ---- 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.
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,k
B Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor. ----- A: Static or nonmoving postures are a risk factor. C: Standing position alone is not a risk factor. D: "Armrest location" is not descriptive enough to identify it as a risk factor.
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 have the COTA® 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 ----- A: The second handle setting is the standard setting for testing grip strength over 3 trials. C: Rapid exchange grip testing requires 10 trials for each hand. D: The standard five-level grip test requires one trial per handle setting.
Which SOAP-format statement would be appropriate and objective in documenting a client's return-to-work modified duty program? A. The client stated, "My grip strength is not the same as it was before, but my work gets done." B. The client has decreased grip strength in 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 in the left hand, limiting the client's ability to operate the machine handle.
B This objective statement provides a measure of client ability and the source of that measurement. ----- A: This is a subjective statement. C: Medical history is not reported in the Objective section of documentation. D: This is an interpretation of an objective statement indicating assessment of the client's deficits.
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 COTA® 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 is MOST appropriate to assist the client in identifying vocational options? A. Vocational rehabilitation program B. Work readiness program C. Ticket to Work program D. Community-based program
B Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities. ---- A: Vocational rehabilitation programs are run by state- and federally funded agencies that provide job training and placement services to people with disabilities. C: The Ticket to Work program is not an example of a return-to-work program. D: Community-based programs are not focused on matching vocational interests, skills, and abilities.
A COTA® 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 COTA® 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
C 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: Primary programs focus on protecting healthy workers against a targeted condition before the condition occurs. B: Secondary programs emphasize early detection and intervention with asymptomatic workers at risk for work-related medical problems or treatment of workers with mild medical symptoms or reversible stages of injury. Comprehensive injury prevention programs incorporate all three phases of prevention programs (primary, secondary, and tertiary) and may include worksite and ergonomic interventions. D: Because the client is receiving services as a result of an existing injury, the focus of the program is to help the client regain maximum function and prevent further injury.
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 be included FIRST 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
C 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. ------ A: Although baking is former occupation in which client engaged before the injury, the resistance of the bread dough may add to the client's pain and discomfort. B, D: PROM and progressive resistive exercises must be used with care and are often contraindicated because of risk for increased swelling and pain.
An OTR®-COTA® team 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®-COTA® team 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
C 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. ---- A: Altering the work schedule may be a consideration if the client identifies difficulty completing the morning routine. It would not be considered the most appropriate initial accommodation. B: A motorized scooter may be a prohibitive accommodation for a small company. Joint pain and stiffness are periodic, and the essential job functions are primarily sedentary; therefore, provision of a scooter would not be an initial modification. D: A flexible work schedule with ability to work from home may not be a reasonable accommodation for a small business.
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. After collaboration with the OTR®, the OTR® suggests that the COTA® inform the client 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 resulting in decreased occupational therapy services. 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.
C 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. ---- A: The purpose of light duty is not to put a worker back to work when he or she is experiencing pain. B: Although decreased costs to the employer may be a benefit, this is not a client-centered benefit. D: Returning a client to work should not be done exclusively to improve reevaluation ratings; it should be done because it is a client-centered intervention approach.
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
D A job task analysis is a non-client-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, B, C: These options relate more to the client's specific performance skills or patterns.
Which setting is MOST effective for job coaching with an adult client with mental illness? A. Sheltered workshop B. Community-based services C. Work readiness program D. Workplace environment
D Support approaches with on-site training are recommended as the most effective setting for job coaching. ---- A, B, C: Training for job placement in settings outside the workplace does not support generalization of skills to the workplace.
An OTR®-COTA® team 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 client education C. Restorative interventions and compensatory techniques D. Client-specific work productivity standards
D 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. ----- A, B, C: Key services include wellness and prevention services, restorative and compensatory intervention consultation, education, and advocacy and case management.
