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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 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 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
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.
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 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. 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
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 A goal of any injury prevention program is to minimize employer expenses related to lost time and wages. 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 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
A Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to that or another workplace. B: Supported employment provides support to clients with disabilities through training and support at the job site.
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.A dd duties to keep the client busy.
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.
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
A 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. 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 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- The OTR must consider the potential ethical dilemmas that may arise in the absence of written policies, particularly for applicants who fail the screening. 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 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 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. 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 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 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.
B Overhead lighting problems can contribute to awkward posturing at workstations.
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
B 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 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.
B 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, C, D: All these components should serve as guidelines when establishing a productive modified-duty program.
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 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. D: Rest breaks should be provided as needed but may not be required. Written expectations will not promote socialization skills.
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 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. 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.
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.
B 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. OTRs 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.
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 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.
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 factory-wide stretching exercises during breaks D. Introducing high-speed, high-vibration power tools for speedy assembly
B 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. A: Job rotation is an example of an administrative control. C: Implementing factory-wide stretching exercises is an example of work practice controls.
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 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 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
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.
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- 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. wrong D: Allowing an individual with a disability to work at home may be a form of reasonable accommodation. The Americans With Disabilities Act (ADA) requires employers with 15 or more employees to provide reasonable accommodation for qualified applicants and employees with disabilities. Because the company has 8 employees, this accommodation may be an undue hardship for the employer.
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 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.
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
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.
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
C A top-down approach includes systemwide changes and management support of the change process. A, B, D: These options are bottom-up approaches that focus on addressing the person's risk for the job task.
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
C Frequent stretches and movements away from the static posture and prolonged use of a mouse is another strategy to prevent repetitions and muscle strain. 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.
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
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. 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.
A client diagnosed with C7 spinal cord injury requires a functional capacity evaluation to determine whether the client can perform the physical demands of the job of sporting events promote. What task demand would be MOST appropriate for the OTR to assess? A. Lifting and balancing B. Pushing and pulling C. Sitting and fingering D. Grasping and releasing
C Sitting and fingering are 2 of the 20 physical demands of work as defined by the Dictionary of Occupational Titles (DOT), and they are 2 of the physical demands required for a position as a sporting events promoter per DOT. A: Lifting and balancing are 2 of the 20 physical demands of work as defined by the DOT; however, they are not physical demands required for a position as a sporting events promoter. B: Pushing and pulling are 2 of the 20 physical demands of work as defined by the DOT; however, they are not physical demands required for a position as a sporting events promoter. D: Grasping is 1 of the 20 physical demands of work as defined by the DOT.. Releasing is not considered a physical job demand.
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 Total body deconditioning may require from 1 month to as long as 3 months of reconditioning the worker to preinjury status.
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 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. A: A transition-related evaluation is typically completed by an OTR. B: Completion of a job site analysis is clinically indicated and is a component of a transition services evaluation. C: Provision of written directions and work samples may be components of client's program implementation; however, the OTR must determine whether the client has the cognitive ability to follow written directions.
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 Injury prevention consultants do not reduce injuries. Their role is to help companies reduce their losses. OSHA Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health.
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
D 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. Physicians, case managers, and attorneys are all considered primary referral sources for FCE
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 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. OTRs should refer to DOT and the employer-provided job description to identify essential job functions. A: Client interview is subjective; therefore, review of an employer-provided job description is recommended. B: Supervisor interview is subjective. Vocational evaluation is a comprehensive assessment to evaluate a person's potential to do any type of work and to determine one's aptitudes, abilities, and interests to explore all reasonable options for work. C: NIOSH provides recommendations related to prevention of workplace illness and injuries.
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 Aerobic conditioning is a component of a work conditioning program. 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 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
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. 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.
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
D Referral for FCE is not used to determine the worker's motivation to return to a preinjury job A, B, & C: These responses are all clinical indications for completion of an FCE.
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.
D Simulation of actual activity demands will provide the most accurate and objective assessment of capabilities. 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.
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 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, B, D: These responses do not apply the principles of hierarchy of functional return, which consists of gradual gradation of activity based on movements, resistive levels, and repetitions that were either difficult to perform or contraindicated during earlier stages of healing.
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 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. A: The workstation design is too specific to the current caseload and not able to be readily generalized to a variety of work. B, C: Computerized resistive and commercially generated work samples are often valuable tools; however, they are not necessarily key components of workstation design
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
D 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.
