AOTA Occupational Rehabilitation and Return-to-Work Programming

An OTR® consultant to a retail store corporation's ergonomics team notices an increase in back pain complaints for workers in the stockroom. The OTR® should present which activity as the next step for intervention?

-Provide an in-service to educate workers on ergonomics. -An in-service would provide secondary injury prevention for workers reporting mild symptoms related to work tasks.

Which option would NOT be considered a clinical indication for an OTR® to conduct a comprehensive functional capacity evaluation (FCE)?

-To determine a level of motivation to return to work *to identify work restrictions, to confirm/rule out/discover diagnosis, to screen after a job offer* all clinical indications for completion of an FCE

-client A client working at a clothing boutique has made progress in completing simulated work tasks but is still unable to resume the prior work status. The OTR® suggests that the client return to work on a light duty schedule. Which of the following outcomes is MOST likely to occur when a client returns to work on light duty?

The client's confidence in his or her abilities to complete job tasks increases. -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 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?

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

Which client would be MOST appropriate for vocational evaluation?

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

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 summary of the fixed heights of the various workstations and tables at the nurses' stations and a list of recommended adjustable-height workstations -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 client with Down syndrome recently began working at a small pizza restaurant. The job duties include keeping the tables clean and restocked with condiments and napkins. The employer reports that the client is disorganized in completing tasks. In addition, when the client becomes frustrated, which occurs often, the client's behavior offends the other workers. Which intervention would be MOST practical in job coaching with this client?

-Adapt the job duties by providing the client with a checklist of duties and having the client mark off tasks as they are completed. -A task adaptation (i.e., checklist) provides the least restrictive support to enable this client to remain in this job.

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?

-Allow the client a flexible work schedule and use of leave time as needed. -Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Allowing the client a flexible work schedule and use of leave time is the most appropriate choice. Flexibility will provide the client with the opportunity to vary the work schedule on the basis of symptoms.

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?

-Application of a resting hand splint at night to stabilize the affected joint -Splints are typically applied during the acute phase of injury. A resting hand splint is not indicated, because the entire hand does not required immobilization. The splint typically prescribed for De Quervain's is a forearm-based thumb spica splint to immobilize the wrist and thumb carpometacarpal and metacarpophalangeal joints, placing the abductor pollicis longus and extensor pollicis brevis at rest.

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?

-Assess whether work tolerance screenings can be completed in the absence of written policies -The OTR® must consider the potential ethical dilemmas that may arise in the absence of written policies, particularly for applicants who fail the screening. -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.

A delivery worker in a large metropolitan city has an acute onset of low back pain. The low back pain is prohibiting the client from performing at a productive level because of the high pain level. What is the MOST IMPORTANT physical risk factor that should be closely examined in an ergonomic assessment?

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

An OTR® is completing a functional capacity evaluation (FCE) with a client with a history of upper-extremity trauma. During the FCE, the OTR® suspects the client is exaggerating the pain level and is not performing at maximum voluntary effort. Which symptoms would MOST LIKELY lead the OTR® to conclude the client's performance is not at maximum voluntary effort?

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

An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR®be MOST likely to include?

-Empowerment of the workers and creation of a positive group-safety culture -Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together. -Visual reinforcement, lectures, and videos are teaching methods, but they do not ensure buy-in and follow-through by the workers.

While reviewing work hardening program documentation, an OTR® realizes there is no entry in the client's medical record of a meeting conducted with the insurance case manager, client, and client's employer regarding light-duty options. According to best practice guidelines, how should the OTR® amend the client's medical record to include a summary of the meeting?

-Enter the information as a late entry into the client's medical record. -Information that must be entered out of sequence should be entered into the medical record as a late entry and must be identified as such per AOTA guidelines.

A client is experiencing headaches at work owing to increased neck and shoulder tension resulting from prolonged computer keyboarding. The client's job duty requires 6 hours of typing on an average workday. What is the BEST stress management approach for the OTR®to suggest to this client?

-Frequent stretching breaks at the computer station every 30 minutes of keyboarding -Aside from ergonomic workstation modification to prevent straining the neck and shoulder during keyboarding, moving away from the static posture of keyboarding and performing different stretching exercises at the workstation is also important.

An OTR® consultant is hired to perform a job demand analysis for the assembly-line workers in a meat-processing factory. What areas will the OTR® MOST likely be measuring and reporting on?

-Height of the table, cutter and tool design, and vibration frequency of the automated tools -The workstation's dimension and layout, equipment, tools, and any other factors that can affect workers will be documented. The ergonomic risk factors are also considered in a job demand analysis

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?

-Hold a social event for workers in the housekeeping department. -Socializing and developing relationships with coworkers provide a natural support and opportunities to work along with and mentor with coworkers without disabilities; such activities also assist in learning the culture of a workplace.

An OTR® is establishing reasonable accommodations for a client with a history of chronic fatigue syndrome. The client is employed as a receptionist for a small extermination company. The client exhibits decreased short-term memory, periodic joint pain and stiffness, and frequent headaches. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR® to recommend FIRST?

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

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

The owner of a construction company asks an OTR® completing work tolerance screenings to notify applicants whether they have been hired on the basis of their screening results. What should the OTR® do?

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

Which assessments would be considered the BEST format for an upper-extremity functional capacity evaluation (FCE) for an outpatient occupational therapy department currently developing a return-to-work program?

-Initial intake interview, subjective pain assessment, ADL assessment, musculoskeletal evaluation, physical demand testing, material handling skills, and postevaluation questionnaire -FCE should be individually tailored for each client. Physical demands should gradually increase in resistance and complexity. Evaluation should start with the least physically demanding components, and the evaluator should be aware of test specificity to determine test appropriateness.

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?

-Instruction in progressive-resistance lower-body strengthening exercises, performance of work simulation tasks, and lifting objects floor to waist -The hierarchy of functional return involves gradual gradation of tasks from gross to fine motor movements, increased resistance, and repetition from simple to complex tasks with postural changes to promote neuromuscular reeducation.

A client with autism spectrum disorder wants to seek employment after graduation. The OTR®on the transition team receives the referral for evaluation. What should the first approach to evaluation include?

-Interview with the client to determine what type of employment the client wants to seek -Evaluation of vocational interests through top-down approaches such as interview, situational observation, and activity analysis should be the first step in evaluation.

Since getting new workstations, clerical workers at a law office are noticing increased neck stiffness and fatigue, and an OTR® is preparing a 1-week educational program for them. Which strategy would be MOST likely to reduce neck stiffness and fatigue?

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

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?

-Performing full upper body stretches after every 20 minutes of mouse use -Frequent stretches and movements away from the static posture and prolonged use of a mouse is another strategy to prevent repetitions and muscle strain.

Back pain injury reports from workers at a bicycle manufacturing company have increased. Management is seeking an OTR®'s recommendations for redesigning the work environment using engineering controls, particularly to reduce awkward postures and repetitions on the assembly line. Which recommendation is the BEST engineering control to redesign the work environment for this organization?

-Place bicycles on a wheeled platform for movement along the assembly line. -A wheeled platform will decrease the frequency of lifting, bending, twisting, and squatting. -Engineering controls include workstation modifications, changed work methods, or tool modifications; stretch breaks are not engineering controls.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR®decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. After the ergonomic assessment, the OTR® determines that a simple change in the set-up of the computer station could help to reduce the client's symptoms. What change to the computer monitor would MOST likely alleviate the client's neck and shoulder discomfort?

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

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?

-Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy -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 law firm is redesigning its workspace. The clerical staff, many of whom work long hours, have frequently complained about back stiffness and fatigue. An OTR® has been consulted about how the new office space might be designed to prevent or alleviate these problems. Which strategy would be MOST likely to reduce back stiffness and fatigue?

-Provide chairs that are more fully adjustable for lumbar and other back support. -Providing seating that is individually adjustable for back support would be the first step in addressing back issues in a group of workers who are seated for long hours. Intervention for back pain in individual workers would be handled in a individualized, client-centered approach.

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?

-Provide opportunities for injured workers to interact with coworkers in the context of the work environment. -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.

An OTR® is establishing reasonable accommodations for a client employee as a tax auditor. The client has recently been diagnosed with posttraumatic stress disorder (PTSD) characterized by panic attacks as a result of being stalked and harassed by a disgruntled taxpayer. The essential job functions include auditing financial records to determine tax liability; information gathering; analyzing finances to determine net worth or reported financial status and identify potential tax issues; conferring with taxpayer or representative via phone or in person to explain the issues involved and the applicability of pertinent tax laws and regulations; and participating in informal appeals hearings on contested cases. Which accommodation is MOST appropriate for the OTR®to recommend?

-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. -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. -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.

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?

-Reduce costs for the employer resulting from lost work days and workers' compensation claims -A goal of any injury prevention program is to minimize employer expenses related to lost time and wages.

A cabinetmaker is referred to occupational therapy with a recent onset of stenosing tenosynovitis of the right middle and ring fingers. The client has a history of rheumatoid arthritis. As part of the ergonomic education, what will the OTR® MOST likely include?

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

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 planning process for the student's transition from high school?

-Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance -An effective transition-related evaluation primarily uses situational observation, interview, and activity analysis to determine a match between the client's abilities and expected occupational performance. -A transition-related evaluation is typically completed by an OTR®, not a vocational rehabilitation counselor.

In a job demand analysis, what factors are included to accurately assess the overall level of work?

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

An OTR® is 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?

-Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. -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. -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.

A client working as a machine operator was diagnosed with right shoulder tendonitis related to overuse during work activities. The worker's English proficiency is limited. When preparing to complete an assessment of the worker's upper-extremity strength and coordination, which considerations should the OTR® take into account?

-The Disabilities of the Arm, Shoulder, and Hand (DASH) assessment may be applicable because it has been translated into the worker's native language. -The DASH has been translated into several languages, and cross-cultural validity has been established. -An OTR should not assume that a client experiencing a language barrier will also have gender concerns. -An OTR should not assume that a client experiencing a language barrier will have certain values and motivations regarding occupational therapy.

What does best practice dictate for a newly graduated OTR® who wants to administer a functional capacity evaluation (FCE)?

-The OTR® should defer evaluation of the client to a clinician with several years' experience. -Completion of an FCE is not recommended for entry-level or novice clinicians. New graduates should attend conferences, access resources, and network with colleagues to become familiar with terminology and regulations and enhance skills and knowledge. -the evaluator should refer to the U.S. Department of Labor regarding upper-extremity physical demands as national standards. FCE is the most demanding form of upper-extremity evaluation, requiring the evaluator to objectively qualify a client's functional capacity as it affects performance from legal, social security, insurance, and worker's compensation.

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?

-The U.S. Department of Labor's Dictionary of Occupational Titles job classifications and job description -A comprehensive FCE should assess all the physical demands of work as defined by the Dictionary of Occupational Titles (DOT). The DOT serves as a source document for job demands and aptitudes for all job classifications. OTR®s should refer to DOT and the employer-provided job description to identify essential job functions. -Client & supervisor interviews are subjective; therefore, review of an employer-provided job description is recommended.

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?

-The organization will control the severity and incidence of work-related musculoskeletal disorders. -Injury prevention programs aim to control work-related musculoskeletal disorders by implementing processes focused on identifying risk for musculoskeletal problems, providing skill training for management and worker evaluation of risk factors, and developing effective controls for identified risk factors.

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?

-The transcriptionist is experiencing glare from overhead lighting. -Overhead lighting problems can contribute to awkward posturing at workstations.

An OTR® is concerned that a worker participating in a back-neck school program may be magnifying symptoms. On assessment measures, the worker inconsistently reports pain throughout body mechanics training activities. The worker often refuses to complete tasks, citing pain as the reason. Which reason is the MOST likely for the worker to magnify symptoms?

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

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. What is the purpose of the onsite ergonomic assessment?

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

An OTR® will be presenting information on transitional work programs at an inservice meeting. Which statement BEST describes such programs?

-Transitional work programs use actual work tasks and environments as a form of rehabilitation. -After becoming familiar with the client's job requirements and measuring the client's functional abilities, the occupational therapist determines tasks that the client can safely and dependably perform at work.

An OTR® is establishing reasonable accommodations for a client with autism. 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?

-Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. -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.

A client who suffered a stroke would like to return to work as a computer specialist. The OTR® is asked to explain vocational evaluation to the client. What explanation should the OTR® provide?

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

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?

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

A client who fell from a roof while at his roofing job suffered a traumatic brain injury and is unable to return to his job. The worker has identified computers as an interest and is enrolled in a work readiness program. Which vocational skill activity would MOST likely be part of his work readiness program?

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

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?

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

An OTR® wants to design a work performance program based on AOTA's Occupational Therapy Practice Framework: Domain and Process (4th ed.). According to the OTPF-4, what would the therapist NOT include in the program?

-client specific work productivity standards -Key services include wellness and prevention services, restorative and compensatory intervention consultation, education, and advocacy and case management

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. Before the onsite ergonomic assessment, what is the MOST important information for the OTR® to gather?

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

An OTR® is asked to consult with a local meat packing plant to establish a work injury prevention program because of an increase in the number of work-related musculoskeletal disorders among employees. For the program to be successful, what should the OTR® FIRST ensure?

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

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?

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

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

-cumulative trauma

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?

-design a circuit to include aerobic conditioning -aerobic conditioning = work conditioning

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

-disability rating -A disability rating considers the worker's impairment and the impact of the impairment on the client's ability to perform preinjury for any job and considers the unique characteristics of the job. (Impairment rating does not take into account the unique factors relating to worker vocation.) In this case, the client's missing joint affects the ability to play the piano, which is one of the primary demands of the client's position. Amputation of the distal phalanx would render the piano teacher disabled from his or her career.

A client diagnosed with C7 spinal cord injury requires a functional capacity evaluation to determine whether the client can perform the job of accountant. Which of the following abilities would be MOST appropriate to assess?

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

A factory worker is seen in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® recommends a job site analysis to facilitate the client's return to work. How does the focus of intervention change in the transition from outpatient services to the workplace?

-focus moves from the individual client to the work environment -Environmental supports facilitate the client's return to work.

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?

-forceful exertions -Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor. -static/non moving postures are risk factor too; standing position alone is not risk factor

An OTR® consultant is educating a group of supervisors from a furniture manufacturing company about common work-related risk factors for cumulative trauma disorder. What are some of the PRIMARY physical risk factors that the OTR® would explain to the supervisors?

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

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

-frequent -The DOT defines as frequent an activity or condition that occurs one-third to two-thirds of the day. -consistent is not a frequency rating -occasional: activity/condition that occurs as much as one-third of the day -constant: activity or condition that occurs as much as two-thirds to a full day.

An OTR® is using an adaptive approach with a client returning to work after bilateral carpal tunnel release surgery 6 weeks ago. The client works as a supermarket checker. Which job task modification incorporates an adaptive approach?

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

A dental hygienist is referred to occupational therapy for establishment of a work conditioning program after carpal tunnel release 1 month ago. The client is anxious to return to work but fearful of reinjury. Which intervention is MOST appropriate for the OTR® to include in the client's work conditioning program?

-instructing client in median nerve gliding exercises -The median nerve travels through the carpal tunnel. Active exercises of wrist, thumb, and fingers are encouraged 24-48 hours postoperatively. Median nerve glides can be incorporated into a work routine between dental clients to decrease the risk for reinjury -Progressive grasp and repetitive finger flexion should be gradually introduced once recommended by physician between 3 and 6 weeks postoperation. One month may be too soon in recovery to incorporate it into the program.

An OTR® has received a referral to establish a work conditioning program for a client employed as a roofer. The client has a history of low back sprain. When implementing a work conditioning program, which intervention is MOST appropriate to reduce the client's risk for reinjury?

-instructing client in proper body mechanics -Poor body mechanics may be a contributing factor and result in repeated microtraumas; therefore, instructing the client in proper body mechanics should be included in the treatment plan.

What is included when using a top-down approach to reduce risks in jobs?

-involving managers in work simplifications -A top-down approach includes systemwide changes and management support of the change process.

A worker is returning to precision assembly work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOSTappropriate height for this client's workstation?

-just below elbow height -The ideal position for precision assembly is to position the workstation above elbow height, but for a worker with recent nerve compression at the elbow, it is important to set up the work environment so as to not induce further prolonged pressure at the elbow. Therefore, the workstation should be just below elbow height, eliminating all pressure at the elbow. In this case, use of a magnifying device will allow for precision in assembly, compensating for the lack of close proximity. -Positioning above the elbow will increase pressure on the elbow as the worker rests the elbows on the surface. -Positioning the workstation 4-8 inches below elbow height will be too low for any precision assembly work.

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

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

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?

-min 5 hours of tx per day for as long as 3 months -Total body deconditioning may require from 1 month to as long as 3 months of reconditioning the worker to preinjury status.

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, Domain and Process (4th ed.), which aspect of the occupational therapy domain is being assessed?

-performance skills -Performance skills are observable, goal-directed actions and consist of motor skills, process skills, and social interaction skills. A job task analysis is a nonclient's specific observation of the job's activity demands, including the performance skills needed to complete the task.

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?

-plans to reduce the number of injuries sustained by employees -Injury prevention consultants do not reduce injuries per se. Their role is to help companies reduce their losses by instituting various activities.

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?

-raising table height of assembly line by 3 inches -The goals of engineering controls are to provide proper design of the work environment, tools, and processes. Adjusting the height of the workstation is one example of engineering controls. -job rotation = administrative control -implementing stretching exercises = work practice controls

A 30-year-old construction worker has developed work-related right biceps tendonitis. In the past 2 weeks, the client has primarily been working on the drainage system, which requires sawing a lot of metal pipes. What risk factor should be closely assessed during a worksite evaluation?

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

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

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

An OTR® 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?

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

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

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

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?

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

A 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?

-vocational rehab -Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to that or another workplace. -Supported employment provides support to clients with disabilities through training and support at the job site.

A client working as a receptionist in an office reports pain on the left side of the neck. An OTR®observes the client holding the phone between the left ear and shoulder while scheduling appointments. The worker was observed to have 10 calls in 20 min. Which modification is BEST to improve the worker's performance during this task?

-wear a hands free headset for phone calls

An OTR® completes a work tolerance screening with a worker at a manufacturing plant. What should be included in the documentation?

-weight limits for various job tasks -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.

An OTR® is a member of a comprehensive team of occupational rehabilitation professionals who treat clients in a return-to-work program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF). Which type of return-to-work approach does the team use?

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

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?

-work readiness program -Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities. -Vocational rehabilitation programs are run by state- and federally funded agencies that provide job training and placement services to people with disabilities.

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

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

An OTR® is providing back-neck training to workers at a food production service as a primary injury prevention program. The OTR® can expect the target population to consist primarily of which type of worker?

-workers with no back or neck symptoms -Primary injury prevention is aimed at workers who have not experienced symptoms of a work-related injury.

Which setting is MOST effective for job coaching with an adult client with mental illness?

-workplace with assigned job duties -Support approaches with on-site training are recommended as the most effective setting for job coaching. -Training for job placement in settings outside the workplace does not support generalization of skills to the workplace.