Industrial Rehab Flashcards
(30 cards)
Role of OT
Evaluation (specific or consultation)
- Individual, job, body part
Intervention (specific or consultation)
- Preventative
- Restorative
- Compensatory
Other names for industrial rehab
Occupational Rehabilitation
Work Training
“Always Working”
“Work Start”
“The Industrial Athlete”
Others
Industrial rehab includes
Functional (or Physical) Capacity Evaluations (FCE or PCE)
Vocational Evaluation
Job Demand Analysis (Job Description Development) (JDA)
Worksite evaluation and treatment
Pre-employment screening
Work hardening or conditioning
Modified/transitional employment
Education
Ergonomics
Wellness and prevention programs
Typical diagnoses seen
Can run from CHI to spinal cord
Work related musculoskeletal disorders
Repetitive stress injury
Functional (physical) capacity evaluations
Objective assessment of a client’s ability to safely complete a job- or work-related activity
Heavy on task analysis
Must be valid!
Used to:
- Be the “initial evaluation” to set goals for rehab
- Assess current work capacity
- Determine disability status/ close a case
- Screen for new hire
Components of the FCE
FCE’s can be very different (just like initial evaluations)-2-8 hours
Typical Components:
- Interview with client
*Comparison of job duties
*Goals and desires
*All that psych comes into play here!
- Physical exam: AROM, MMT, sensation, cardiac screen (MET levels) balance scale, pain, etc.
- Functional performance
* What you saw them do
* Must be safe to count
* Can be basic or computer driven
* Work tolerance and effort or cooperation
- Psychological screen
* Depression Index
* Indicators of consistency
* Ransford pain diagram
- Formation of recommendations
* Acute therapy
* Work hardening
* Discharge to return to work
* Other referral
- Formal report
* Expect to go to court!
* Be careful what you say or write, it will be true forever!
Referral (reimbursement for FCE) or other aspects
Can come from:
- Physicians
- Insurance companies
- Case managers
- Employers
Medicare and Blue Cross are not usually involved in this area.
Need to know state law in regard to requirements
Components commonly tested
Lifting (materials handling): often a separate section
- Static: can be used to get a baseline or start portion
- Dynamic: always preferred
- Various Levels – floor to waist, waist to shoulder, shoulder to overhead
- Various times: occasional, frequent, constant
Positioning
Positional testing
Kneeling
Standing
Walking
Sitting
Carrying
Pushing
Pulling
Balancing
Stooping
Materials handling
Crouching
Crawling
Reaching
Handling
Feeling
Climbing
Hearing
Seeing
Other
The DOT
GOE: 06.04.15 STRENGTH: M GED: R2 M2 L2 SVP: 3 DLU: 77
What does it mean??
GOE: Guide for Occupational Exploration
- 06=industry, 04= the work group (similar ed levels), .15= work group- interests, aptitudes and adaptability
Strength: based on level of work required (see chart in next slide).
M= Medium
GED=General Education Development-Ed level required (formal and informal)-1= commonsense and one and two step instructions, basic add and sub, two and three syllibul words,
- R= reasoning
- M=math
- L= language
* 6 is the highest, scientific process and logic, advanced calculus, literature, scientific and technical journals
SPV= Specific Vocational Training
1-9, length of “on the job training”
1- short demonstration only
9= 10 year or more
DLU- Date last updated
77=1977
Most common way to characterize work loads
Definition of demand frequency
Never: activity does not occur as part of the job
Occasionally: up to 1/3 of the day
Frequently: 1/3 - 2/3 of the day
Constantly: 2/3 - full day
Job Demands Analysis
Formally called Job Description
Details the:
- Essential elements of the job
- Physical requirements
- Cognitive requirements
- Educational requirements
- Equipment operated
- Environmental exposure
Developed based on:
- Observations
- Formal reports
- Interviews
- Questionnaires
- Often involves pictures
Usually the basis for the FCE
FCE vs. vocational evaluation
The Voc Eval is typically done by a Vocational Evaluator
- Sometimes that is an OT or PT
The FCE might be a part of the Voc Eval, but there will be more:
- Education evaluation
- Aptitude and interests
- FCE results
- Cognitive results
- Skills
- Emotional stability
- Work habits and tolerance
Two types of Voc Evals
- General
- Looks at a clients potential to do any type of work
- People who have never worked, don’t have a job to go back to, or are not able to go back to a previous job
- Specific
- For someone who wants to return to a specific type of job
- Includes elements of that job
- Accommodations
Work hardening/conditioning
Thousands of different names:
- “Work Start”, “Re-Work”, “Always Working”
What they have in common:
- Based on job analysis
- Components of conditioning (cardio) and work simulation
- Multidisciplinary-OT, PT, ATC, Exercise Science
* New Rules as they apply to billing ect
Differences:
- Time- 2hours to 8 hours, 3 x week vs 5x week
- Onsite vs off site/transition programs
- Specific to employment market
* Forestry vs factory
Issues in work hardening
Motivational issues
- Fear
- Malingering
- Secondary Gain
- Fraud
- Employer attitude
* Willingness to make accommodations
* Only come back at 100%
Can’t leave your psych behind
Time is of the essence!!
- With therapy in the first 3 months: 50% RTW
- Those 12 months off the job only: 18% RTW
Basic rules of ergonomics
Plan the lift or motion before you do it – what is the best way for your back, not necessarily the most automatic motion. Make sure the lift is within your capability.
Stand close to the load and face it.
Keep the weight close to your body.
Get a firm footing. Keep your feet apart for a more stable base of support.
Bend at the knees and hips, not from the waist.
Don’t twist from the waist – pivot on your feet or take a small step to turn instead of twisting.
Use the largest muscles to do the job – leg muscles are much stronger than arm
Tighten your abdominal muscles when moving objects. These muscles are nature’s corset, and keeping them firm will help protect your back. Core Strength
Lift smoothly with a single fluid motion – avoid jerking.
Keep your spine in a balanced (neutral) position. You should not be hunched over or swaybacked – both extremes are hard on your spine.
Stay in shape
Push instead of Pull
Others who get involved
Attorney’s
Families
OSHA - Occupational Safety and Health Administration
- Developing and enforcing workplace safety and health regulations
- Investigates and can fine, or shut down
NIOSH - The National Institute for Occupational Safety and Health
- Conducts research and makes recommendations for preventing work place injury and illness.
Injury prevention programs
Primary: healthy individuals to keep then from getting hurt
- Hard hat
- Stretching program
Secondary: early stages of the disease to prevent it from getting worse or progressing
- Ergonomics after a flare up
Tertiary: deals with people after there is a problems
- Industrial rehab
Pre-employment/ post-offer testing
Variety of Tests to see if an individual is able to complete the essential elements of a job
EEOC mandates that the Pre-Employment testing not have an adverse effect on any group-race, color, religion, sex, or national origin.
The process must be:
- Valid
- Of business necessity
- Bona fide occupational requirements
- Based on job description
- Test only essential function
- Dynamic testing is highly recommended
- Can be onsite or off site
- Use equipment associated with the job when possible
Pre-employment testing
Typically completed after an offer is made
EEOC forbids:
- Monitoring of BP or heart rate
- Questions regarding medical history
Results are pass or fail
Don’t have to test all jobs (usually the high risk)
Don’t have to test all elements (usually high risk)
Do have to test all that apply for that job
If they pass, they are typically hired.
What if they fail a pre-employment test?
It varies
The employer can rescind the offer
Can allow the employee to improve and retake
Have to see if it is due to a disability
- ADA and reasonable accommodation comes into play
Future and emerging areas
Work Readiness Programs and Training Centers
- After non work related injury
- Special populations
- High school graduates
- Drop outs
Homeless shelter programs
Prison Programs
Welfare to work
Ticket to Work-SSI and SSDI
Roles for OT:
- Run the programs, therapist
- Advisory panels
- Support services
