Occupational Rehabilitation/Return to Work

Malingering is ALSO known as the

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

work habit-related risk factors (ergonomics evaluation)

(e.g., not taking breaks or delayed breaks, cradling telephone between shoulder and ear, hand held actively over the keyboard during a pause, improper body mechanics in lifting) and worker's perspective on ergonomic risk factors

strongest grip on 5-level grip test expected on the

2nd and 3rd settings

Job demands analysis

A job demands analysis looks to define the actual demands of the job and involves use of questionnaires, interviews, observations, and formal assessments completed in the real work environment. Use of employer-provided job descriptions assists clinicians in identifying essential job functions. Many FCEs include a job demand analysis. During the course of a job demands analysis, it is important to distinguish between tasks that are essential and those that are not.

Determination for level of work

Clinicians should use both: The Dictionary of Occupational Titles (DOT) and O*NET. The O*Net 98 database developed by the U.S. Department of Labor (2010; n.d.-b) is a newer format for classifying occupations.

Comprehensive FCE includes all of the physical demands of work as defined by

Dictionary of Occupational Titles (DOT)

DOT specifications of physical demands of work

Lifting Standing Walking Sitting Carrying Pushing Pulling Climbing Balancing Stooping Kneeling Crouching Crawling Reaching Handling Fingering Feeling Talking Hearing Seeing

core of the FCE

Musculoskeletal evaluation. It includes ROM, strength, sensation, volume, and soft tissue status.

Format of FCE

The format varies on the basis of the purpose of the referral, the type of worker's compensation system, and the amount of time authorized. The typical kinesiophysical approach includes an intake or initial interview, including subjective pain assessment, effect of injury or illness on ADLs, and functional abilities and effect of cosmesis. Physical (neuromusculoskeletal) evaluation includes ROM, strength, sensation, volume, soft tissue status, and special tests. Physical demand testing includes standardized tests, work simulation, situational assessment, evaluation of specific func- tional capacity, computerized variable resistance testing, and manual material handling evaluation. Reevaluation includes inflammatory response to activity, sensation, or pain and a follow-up questionnaire. Evaluation typically begins with the most physically demanding components. Physical demand components of evaluation should gradually increase in resistance and complexity. The initial interview is an opportunity to establish rapport, explain the procedure and purpose of the evaluation, confirm the consistency of preevaluation records, and determine the feasibility of the client's proceeding on the basis of the client's cognitive, psychological, and medical issues and vocational goals. A subjective evaluation focuses on the client's subjective experience of the injury or illness with a primary focus on pain, impact on ADLs, and cosmesis. Pain assessments include the use of pain diagrams, pain scales, location, changes in pain levels over the course of a day or activity, and factors that increase or decrease pain and have an impact on sleep and rest. Pain assessments may be repeated periodically through- out the course of evaluation. Care must be given to avoid increasing the client's focus on pain. On the basis of the client's subjective reports, the clinician may include classic components of ADL assessment in the FCE. The clinician should document the appearance of the client and extremity or extremities. Disease process and trauma may affect appearance and have an impact on function. Musculoskeletal evaluation is the core of an FCE. It includes ROM, strength, sensation, volume, and soft tissue status. A comprehensive FCE should be well designed; use standardized, practical, objective, reliable, and valid assessments; and include all the physical demands of work as defined by DOT. Clients should not be pushed beyond their maximum level of performance. Physical demand testing includes standardized assessments with associated norms and nonstandardized components. A standardized test should be chosen by the clinician on the basis of the client's age, gender, culture, education, and occupation. Clinicians selecting a standardized test should consider its validity, reliability, and test specificity. Nonstandardized assessments or structured activities allow the evaluator to grade and tailor the FCE to the individual worker. Work simulation requires the client to perform tasks similar to the actual job. This is a treatment approach and not an evaluation. Situational assessment requires an exact duplication of all the physical demands of the target occupation. Computerized variable resistance tests test function in both dynamic and static modes. They are not a necessary component of FCE. Manual material handling evaluation quantifies the client's lifting capacity for comparison with future performance or with general job requirements. The clinician should consider instructing clients in the use of proper body mechanics to avoid risk for injury. Onsite evaluation involves evaluation of the client in the workplace and occurs with the consent and authorization of the employer and insurance carrier. Reevaluation and postevaluation are the final component of the FCE and are completed a day or more after the evaluation. They are used to determine activity performance and to monitor edema, discoloration, and pain levels postassessment. The FCE report should include an overview of referral and background information; in- take information; summary of intake subjective findings; physical examination findings; observations from the physical demand findings, including results from standardized and nonstandardized tests; observations from work- or task-specific evaluations; comments on the apparent presence or absence of symptom magnification; and a summary with conclusions and recommendations.

Evaluation in the context of work activity should be done with the support of reliable and valid assessments. Areas to assess:

Worker's social and communication skills Physical abilities of worker Cognitive and perceptual skills of worker Job analysis to define actual demands of the job Work organizational culture Client's vocational aptitudes and interests Injury prevention including ergonomics evaluations Assessing and modifying the workplace

Transition services involve preparing adolescents and young adults with special needs

for work.

Industrial work rehabilitation and return-to-work programming involve

the client, employer, human resources department, safety personnel, and case managers.

refugee

uses symptoms to escape an unresolvable conflict.

Symptom magnification

"a non- adaptive, static approach to manipulating society with display of symptoms." AKA consistency of effort, sincerity of effort, or maximum voluntary effort. - encompasses conscious and unconscious behavior

Several federal resources are available to assist in complying with regulations.

- ADA - OSHA - National Institute for Occupational Safety and Health (NIOSH) - the Occupational Information Network (O*NET) - Uniform Guidelines on Employee Selection Procedures from the Equal Employment Opportunity Commission (EEOC)

DOT definitions for overall levels of work

- Sedentary - Light - Medium - Heavy

occupational therapist provides strategies to help clients maintain ergonomic principles:

- body mechanics - environmental fit - holistic client-centered approach to address psychosocial needs (cognitive behavioral strats like positive reinforcement, progressive muscle reinforcement, biofeedback)

According to Miller (cited in Schultz-Jacobs, 2011, p. 1830), pain associated with a true pathological condition appears

- in the anatomical areas associated with the pathological condition - in response to stress related to force, repetition, or position - increases with increased stress

Documentation may be written in

- may be written in SOAP note format -memos outlining recommendations and education provided - or standardized evaluation forms.

4 characteristics of successful work injury prevention program

1. ongoing management support, supervisory support, employee participation, and ongoing support and reinforcement of program, develop corporate plan; 2. establish injury prevention team; 3. training for risk factor identification, ergonomic evaluation; develop risk factor controls; 4. medical management strategies such as early intervention and transitional work/modified duty programs

recommended participation in work hardening in final stages of program

5 days a week

A comprehensive FCE should be

A comprehensive FCE should be well designed; use standardized, practical, objective, reliable, and valid assessments; and include all the physical demands of work as defined by DOT. Clients should not be pushed beyond their maximum level of performance.

when is a work tolerance screen conducted?

A work tolerance screening is generally done after the client has received an offer of employ- ment, and the client is hired for the position only after passing the screening. If the client does not pass, he or she is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job. The employer may allow the client to take a job in another area while regaining skills or strengths identified at screening as needing attention. The employer may also release the client from the job offer if the client is unable to pass the screen. The EEOC provides guidelines to ensure that fair employee selection processes are upheld with work tolerance screens.

Back and neck rehabilitation

Back and neck rehabilitation training provides strategies focused on improving fitness, job comfort, and workplace safety for individuals or groups of workers to either prevent injury or retrain clients after injury. Several factors influence a client's capacity to use new strategies: Physical and cognitive abilities Intellectual abilities Emotional status Work skills and work tolerances Work habits and values in a given occupational situation

Administrative controls (intervention type)

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

Who performs FCE?

Clinicians who perform FCE are recommended to have several years of experience in the field. FCE is not recommended for the novice clinician. Clinicians new to return-to-work programs are recommended to attend conferences and trainings, access resources, and network with colleagues to become familiar with terminology and regulations and to enhance skills and knowledge.

Dictionary of Occupational Titles

DOT developed by U.S. Department of Labor (n.d.-a) defines the physical demands of work using a standardized classification system and defines occupations in the United States. It defines overall level of work and strength demands for and frequencies of the physical demands of work. It was last revised in 1991.

intervention guidelines

Engineering controls: modification of the environment, the workstation, and set-up with or without use of assistive devices Workstation checklist (OSHA, n.d.-a) Workstation components, such as keyboard, mouse, and so forth (OSHA, n.d.-c) Workstation environment (OSHA, n.d.-e) Good working positions (OSHA, n.d.-b) Recommended dimensions of workstations for seated and standing work Recommended chair characteristics at workstation ii. Work practice controls Modification of work habits through use of assistive devices or adaptive strategies Body mechanics training Tool maintenance Selection and use of personal protective equipment Provision of conditioning or stretching exercises Practice and incorporation of new work habits and exercises into work routine Modification to work process (OSHA, n.d.-d) Administrative controls Changes in line speed, staffing, and physical demands of the job, such as decreasing production rates or limiting overtime work Job rotation through different workstations that require different task demands Allowing and enforcing regular periodic rest breaks throughout the day Provision of personal protective equipment Provision of equipment to prevent heavy lifting Worker education on work safety, identification of ergonomic risk factors, and injury prevention; employer education regarding reasonable accommodations Checklist for combating ergonomic risk factors State of Wisconsin, Department of Administration (2013; www.doa.state.wi.us/docview. asp?docid=2585) Haruko Ha et al. (2013, p. 363, Table 14-5). v. Empowering corporate clients Understand the organizational culture. Obtain management commitment Establish an incentive system: monetary versus groupthink and positive praise. Create and nurture a teamwork environment and a sense of team accomplishment.

Occupational therapists promote health and wellness through educational activities. OTs role as educators

Identify affected people and populations within the work environment (e.g., by age, gender, skill level, general health). Facilitate learning for clients. Implement strategies that take into consideration clients' learning style.

Jobs demands analysis assessment guideline

Interview supervisors, workers, or both to gather information on the number of job tasks for the job. May or may not obtain a job description to confirm the nature and requirement of the job tasks. Determine essential versus marginal functions of the job tasks. Observe workers performing each of the job tasks. Measure the physical environment (such as table height), physical requirements (such as weight to be lifted or carried, sitting vs. standing), and frequency of the physical demands.

Job Site Analysis

Job Site Analysis may be used to assess a client's workspace (design, equipment, tools, etc.) and specific job requirements that may contribute to injury or cumulative trauma. Recommendations are provided to help prevent work related injuries where improper ergonomics, excessive stresses, and repetitive motions may be harmful.

DOT definitions for physical demand frequencies are as follows:

Never: Activity or condition does not exist. Occasionally: Activity or condition occurs as much as one-third of the day. iii. Frequently: Activity or condition occurs one-third to two-thirds of the day. iv. Constantly: Activity or condition occurs two-thirds of the day to a full day.

where could find guidelines for ergonomics to use in evals?

OSHA website

industrial rehab back and neck: OT evaluation methods (observation vs. assessments)

OT actively engages client in actual or simulated job tasks to assess dynamic activity sustained over time. Checklists are one form of rating scales that may be used to assess a client's body mechanics but are not useful in determining the client's actual body movements. Moreover, most body mechanics instruments do not have established reliability and validity and are not sensitive to change in task performance.

levels of injury prevention

Primary prevention goal: to identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle Secondary prevention goal: early identification of symptom-related risk factors; ultimately, to minimize or reduce the duration, severity, and cost of work-related injuries Tertiary prevention: occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work role

Injury and Return-to-Work Management

Process of getting someone back to work following injury (e.g., work hardening). Interruptions in ability to work may be related to physical (work-related musculoskeletal disorders; cumulative trauma disorders; repetitive motion injuries; traumatic injuries; aging; progressive dis- ability), cognitive, psychological/behavioral, or sociocultural.

Physical (neuromusculoskeletal) evaluation includes

ROM, strength, sensation, volume, soft tissue status, and special tests. Physical demand testing includes standardized tests, work simulation, situational assessment, evaluation of specific func tional capacity, computerized variable resistance testing, and manual material handling evaluation. Reevaluation includes inflammatory response to activity, sensation, or pain and a follow-up questionnaire.

goals in the medical system may be written in a variety of formats including

Relevant, Understandable, Measurable, Behavioral, Achievable (RUMBA); Client, Occupation, Assist level, Specific conditions, Timeline (COAST), and Significant, Measurable, Achieve, Relate, Time-limited (SMART).

risk factors to watch out for during ergonomics evaluation process

Repetitive movement (for high-risk repetition rates for the upper extremity) Forceful or prolonged exertion of the hands Frequent or heavy lifting; pushing, pulling, or carrying of heavy objects. Awkward or static postures, especially for a prolonged period of time Excessive vibration Extreme temperatures, especially cold temperatures Prolonged contact stress Material handling with faulty body mechanics, especially if lifting or twisting movement is required

Medium work

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

Heavy work

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

Very heavy work

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

ergonomics: evaluation process

Schedule the evaluation during normal work hours to observe activities in a typical work shift. Gather information by interviewing the worker and the supervisor. Obtain an overview of all the job-task requirements. Observe how the worker performs the job in his or her normal fashion. Observe work habits inherent to the worker. Observe task demands inherent to the environment and setup. Identify common risk factors: Repetitive movement (for high-risk repetition rates for the upper extremity) Forceful or prolonged exertion of the hands Frequent or heavy lifting; pushing, pulling, or carrying of heavy objects. Awkward or static postures, especially for a prolonged period of time Excessive vibration Extreme temperatures, especially cold temperatures Prolonged contact stress Material handling with faulty body mechanics, especially if lifting or twisting movement is required Identify work habit-related risk factors (e.g., not taking breaks or delayed breaks, cradling telephone between shoulder and ear, hand held actively over the keyboard during a pause, improper body mechanics in lifting) and worker's perspective on ergonomic risk factors Identify workstation and environment set-up Workstation height Seat height Monitor height Keyboard and mouse height Position of commonly used items in the workstation Tools

OSHA

The Occupational Safety and Health Administration (OSHA), part of the U.S. Department of Labor, was created to ensure "safe and healthful working conditions . . . by setting and enforcing standards and by providing training, outreach, education, and assistance" (OSHA, 2013). Provides information about: - general workplace safety and health - including lifting ergonomics guidelines - ergonomics to reduce workplace injuries

Work Hardening

The Work Hardening program combines simulated work activities and specific job related tasks with physical conditioning and worker education. Work tolerance goals are established that are consistent with the physical demands placed on the employee in the customary occupation. This program usually ranges from two to six hours every day, lasting two to four weeks in duration.

work hardening: length and duration

The length and duration of the program depends on the needs of the worker. As the worker im- proves, involvement gradually increases to as much as 5-8 hr. There is not a prescribed num- ber of days per week or hours per day a worker is to participate in a work hardening program. The design of the program establishes the type, duration, and intensity of services according to predicted outcome. Professionals in work-oriented services agree that attendance and workplace tolerance are relevant to the competitive marketplace and programs should be available 5 days per week. This level of participation is recommended in the final stages of the program. For a person whose general physical status has deteriorated, total body reconditioning requires a minimum of 1 month to a maximum of 3 months.

Functional Capacity Evaluation

The purpose of a Functional Capacity Evaluation (FCE) is to determine the baseline physical capacities as they relate to a person's injury. Objective information, including lifting, carrying, pushing, pulling, positional and dexterity testing, is established. A person's cardiovascular fitness, employability, and work level physical demand characteristics are determined. Professional recommendations, based on objective data and observation, are made to assist physicians, payers, and counselors in making the most appropriate and cost effective decisions regarding the employee. An FCE usually takes between three to five hours to administer.

unconscious forms of symptom magnification

The refugee uses symptoms to avoid an unresolvable conflict. B: The identified patient assumes the role of patient as a lifestyle and sees all accomplishments as being a result of symptoms. D: The symptom misinterpreter responds to physical changes in an extreme manner as a result of unrealistic belief systems or difficulty processing sensory input.

Clinical indications for conducting a comprehensive FCE

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

v. Empowering corporate clients (intervention type)

Understand the organizational culture. Obtain management commitment Establish an incentive system: monetary versus groupthink and positive praise. Create and nurture a teamwork environment and a sense of team accomplishment.

Work-related musculoskeletal disorders (WSMDs)

WSMDs are defined as a class of soft tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. WSMDS account for one-third of all occupational injuries and illnesses in the United States. Common types and examples of WSMDs include some back injuries, carpal tunnel syndrome, de Quervain's tenosynovitis, and lateral epicondylitis. Increased risk for developing WSMSDs includes heavier levels of material handling, poor work station design, and poor work process design. An injury sustained in a fall is not considered a musculoskeletal disorder per the U.S. Department of Labor (Sanders, 2004, p. 302).

Work conditioning/work hardening

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

differentiation of services

Work readiness: Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities. May also help workers find NEW jobs. SIMILAR TO VOCATIONAL EVAL IN THAT SENSE. Worksite evaluation: usually done after job site analysis. where job site analysis is looking at job descriptions/requirements, this looks at worker within context of that to see fit/safety/if can return to work. can maybe determine if modified duty appropriate. work hardening: can include vocational counseling not just biomechanics etc. occurs in a clinic with gradual return to work duties.

Medical management and acute rehabilitation:

Work therapy involves work tasks to improve function. Work therapy can occur at any point in the healing of injured tissues, and it is typically part of the acute phase of the rehabilitation program (Schultz-Jacobs, 2011, pp. 1840-1845).

Engineering controls: modification of the environment, the workstation, and set-up with or without use of assistive devices (intervention type)

Workstation checklist (OSHA, n.d.-a) Workstation components, such as keyboard, mouse, and so forth (OSHA, n.d.-c) Workstation environment (OSHA, n.d.-e) Good working positions (OSHA, n.d.-b) Recommended dimensions of workstations for seated and standing work Recommended chair characteristics at workstation

Identify workstation and environment set-up (ergonomics evaluation)

Workstation height Seat height Monitor height Keyboard and mouse height Position of commonly used items in the workstation Tools

O*NET

a database of requirements, worker attributes, and other information about thousands of occupations that can be helpful when documenting job demands

For a person whose general physical status has deteriorated, total body reconditioning requires

a minimum of 1 month to a maximum of 3 months.

Light or modified duty programming (returning to work)

allows a worker to temporarily perform job duties with less physical demand. The worker's regular duties are gradually added as he or she improves in skill and strength. An employer who wants the worker to return to work only when he or she has full capabilities may challenge the need for a modified duty program; the occupational therapist helps the employer understand that early return to work improves a worker's long-term success. The occupational therapist always considers the employer's capacity to provide modifications, particularly in small organizations

identified patient

assumes the patient role as a lifestyle.

results of the 5-level grip test should fall on a

bell shaped curve

Vocational rehabilitation programs are run

by state- and federally funded agencies that provide job training and placement services to people with disabilities.

Disability rating

combines the worker's impairment and the impact of that impairment on the ability to perform the preinjury job or any job.

game player

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

Work practice controls (intervention type)

controlling workplace injuries by altering the way a task is performed Modification of work habits through use of assistive devices or adaptive strategies Body mechanics training Tool maintenance Selection and use of personal protective equipment Provision of conditioning or stretching exercises Practice and incorporation of new work habits and exercises into work routine Modification to work process (OSHA, n.d.-d)

Malingering

deliberate or conscious faking of symptoms and disability to avoid work or responsibility to achieve personal gain. AKA game player

functional capacity evaluation (FCE)

evaluates an individual's capacity to perform work activities related to his or her participation in employment. Compares the individual's health status, and body functions and structures to the demands of the job and the work environment.

sedentary work

exerting as much as 10# of force occasionally, using negligible amount of force frequently to move objects, and involves sitting most of time

Light work

exerting as much as 20# of force occasionally, 10# frequently, or negligible amount constantly to move objects; may require walking/standing to significant degree or maintaining a production rate pace

common assessment for determining maximum grip strength

five-level grip test. Using the Jamar dynamometer, the client is instructed to grasp the dynamometer at each setting handle on the dynamometer. Strongest grip is expected on the second and third settings. When graphed, results are expected to fall in a bell-shaped curve ONLY ONE TRIAL ON EACH SETTING ARE NEEDED

The occupational therapist assesses for ergonomic risk factors including

forceful exertions, repetition, awkward or static posturing, contact stress, excessive vibration, and cold temperatures.

hierarchy of functional return

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

Indications for FCE

i. A post-offer screening is performed after a worker receives a job offer to determine whether work demands match the person's work capacity. ii. Fit-for-duty tests are performed by occupational medicine physicians to determine whether the worker can return to work after an injury. iii. FCE should not be used with the intent to prove worker fraud. iv. FCE assists the physician in generating impairment or disability ratings. v. Impairment rating is the percentage of whole-body function and often translates into a final monetary settlement for an injured worker. It focuses on the permanent quantifiable physical loss related to injury when the worker is at the maximum medical endpoint. vi. Disability rating combines the worker's impairment and the impact of that impairment on the ability to perform the preinjury job or any job.

Body mechanics and postural alignment strategies

i. Keep the spine in alignment. ii. Hold objects close to the center of gravity. iii. Avoid twisting through the spine by facing the object straight on. iv. Use both sides of the body equally, and maintain a wide base of support.

Functional capacity evaluation (FCE)

is an objective assessment of a person's ability to perform work-related tasks and is the core of all return-to-work programs. Assessment can be performed by a multitude of disciplines, and a wide variety of FCEs are currently used in practice. A typical FCE includes review of medical records, interview, musculoskeletal screening, evaluation of physical performance, formation of recommendations, and report generation. Comprehensive FCE includes all of the physical demands of work as defined by the Dictionary of Occupational Titles (DOT) pub- lished by U.S. Department of Labor and last revised in 1991.

Impairment rating

is the percentage of whole-body function and often translates into a final monetary settlement for an injured worker. It focuses on the permanent quantifiable physi- cal loss related to injury when the worker is at the maximum medical endpoint.

What DOT level of work? It requires walking or standing to a significant degree. It requires sitting most of the time but entails pushing or pulling of arm or leg controls. It requires working at a production rate pace entailing constant pushing or pulling of materials even though the weight of those materials is negligible. Note: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding for a worker, even though the amount of force exerted is negligible.

light

Work conditioning is specifically designed to restore the client's systematic, neuromuscular- skeletal function and typically involves only one discipline. The focus is on

limited work tasks with more emphasis on exercise, aerobic conditioning, and education

Is a fall injury considered a work-related musculoskeletal disorder (WSMD)?

no

accompanied by

observable physical responses

A work hardening interdisciplinary team often involves

occupational and physical therapists and assistants, psychologists, vocational evaluators and counselors, addictions counselors, licensed professional counselors, exercise physiologists, and dieticians.

focus of tertiary prevention

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

A subjective evaluation focuses on the client's subjective experience

of the injury or illness with a primary focus on pain, impact on ADLs, and cosmesis (looks, appearance).

Worksite evaluations (returning to work)

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

National Institute for Occupational Safety and Health (NIOSH)

part of the Centers for Disease Control and Prevention, is "the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness" (NIOSH, 2013). The agency provides information about workplace safety and health topics including injury, haz- ards, prevention, and ergonomics for various types of industry.

Work readiness programs

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

4 types of symptom magnification are unconscious:

refugee, symptom misinterpreter, game player, and identified patient.

Identification of symptom magnification

required as part of FCE. Clients should present with predictable levels of function and dysfunction. The clinician should screen for behaviors, symptoms, and signs that are inconsistent with the client's medical history.

symptom misinterpreter

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

during work conditioning, the OT should monitor for

signs and symptoms of overexertion, muscle fatigue, or both, including slowed performance, distraction, perspiration, increased respiratory rate, performance of exercise pattern through decreased ROM, and inability to complete prescribed number of repetitions. Any of these signs and symptoms may indicate an adjustment to the program

A key concept of the work hardening process is

the gradation of activities to progressively increase task demands. The hierarchy of functional return is a gradation from gross to fine motor, from less to more resistive, from skill to speed focused, and from simple to complex

Evaluation typically begins with

the most physically demanding components. Physical demand components of evaluation should gradually increase in resistance and complexity.

In assessing physical demands for work tolerance screening

the occupational therapist focuses on client factors and function- al abilities and the activity demands of the job. Client factors include flexibility, strength, bal- ance, coordination, cardiovascular condition, and body mechanics. Functional abilities include sit, stand, walk, lift, carry, bend, squat, crawl, climb, reach, stoop, and kneel. Activity demands include forces, angles, weights, distances, repetitions, work area layout, and tools and equipment General strength testing is not an accurate predictor of potential for injury; the focus is on whether applicant can perform the tasks required to do the job.

The initial interview is an opportunity

to establish rapport, explain the procedure and purpose of the evaluation, confirm the consistency of preevaluation records, and determine the feasibility of the client's proceeding on the basis of the client's cognitive, psychological, and medical issues and vocational goals.

Work tolerance screening

used to assess a client's physical and cognitive abilities to meet the general or specific demands of the essential functions of the job. A useful screening is based on an accurate job description. In assessing physical demands, the occupational therapist focuses on client factors and function- al abilities and the activity demands of the job. Client factors include flexibility, strength, bal- ance, coordination, cardiovascular condition, and body mechanics. Functional abilities include sit, stand, walk, lift, carry, bend, squat, crawl, climb, reach, stoop, and kneel. Activity demands include forces, angles, weights, distances, repetitions, work area layout, and tools and equip- ment (Rice & Luster, 2008, p. 886; Sladyk et al., 2010, p. 130). General strength testing is not an accurate predictor of potential for injury; the focus is on whether applicant can perform the tasks required to do the job. A work tolerance screening is generally done after the client has received an offer of employ- ment, and the client is hired for the position only after passing the screening. If the client does not pass, he or she is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job. The employer may allow the client to take a job in another area while regaining skills or strengths identified at screening as needing attention. The employer may also release the client from the job offer if the client is unable to pass the screen. The EEOC provides guidelines to ensure that fair employee selection processes are upheld with work tolerance screens. Documentation of a work tolerance screening should specify weight limits, activity tolerance in time, restrictions within the environment, the client's report of pain, and the occupational thera- pist's observations of the client. Documentation should be directed to the identified payer (e.g., vocational rehabilitation program, workers' compensation insurer, long-term disability insurer).

Work hardening may include

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

Environmental fit

work environment redesign through workstation modification, proper tool access and fit, proper materials handling, and environmental adjustments such as temperature and lighting.

Injury prevention programs aim to decrease employer costs related to

work injuries, improve work- er fitness and safety, and bridge employer and worker in a collaborative plan to improve workplace safety.

Services may be provided in a variety of settings, such as the

workplace, community, school, shelter, or psychiatric center, and with a variety of populations.

Does the FCE process necessitate assessing for symptom magnification?

yes (required)