Ergonomics and Mechanics
OT and Ergonomics involves...
equipment adaptations
job site adaptations
client practice adaptations
What is the difference between a career, profession, and occupation?
•Career: Chosen profession or occupation
•Job: An activity performed regularly for payment, especially a trade, occupation or profession; a specific piece of work to be done for a set fee
•Occupation: An activity serving as one’s regular employment
What is a work conditioning program? What does it look like?
•Work Conditioning:Program focused on returning clients to workplace,
Musculoskeletal, Cardiovascular, Workplace simulations, Intensive treatment 3-5 times per week 2-4+ hours per session
•**Most common compared to hardening**
What is a functional job description?
Written document of job requirements
Includes:Physical demands, Cognitive demands, Job tasks
Does the FCE assess what a client can do or cannot do?
can do- match functional abilities to the job requirements
OT's role in Ergonomics
consultative!
contracted by business, often self-employed, determine contract conditions
Injury Risk in Workplace: How many non-fatal "private" workplace injuries in 2017? How many non-fatal "public" 2015?
private- 2.8 million (2.8/100)
public- 752,000 (5.1/100)
What is work work hardening?
•Work Hardening:
•Similar to work conditioning, includes behavioral component
•Psychiatrist involved
•Physician on site
•Generally 5 days per week
•Clock in and out
•*Uncommon with current payers**
OT Process After Injury
Acute care:Traumatic injuries
Inpatient Rehabilitation: Examples: TBI, SCI, Spinal fractures, multi trauma
Outpatient Rehabilitation:Repetitive stress, Hand and upper extremity injuries
Work conditioning or hardening: ***Separate from outpatient rehabilitation***, OT’s treat whole body- low pack pain, LE injuries, UE injuries
Who can complete an FCE
OT, PT, Physicians (rare)
Primary Risk Factors for Ergo-Related Injuries
posture- static/awkward (2hrs)
force- lift, push/pull, grip and pinch (specific force or 2 hrs)
repetition- frequency and speed over time (2-4 hours)
contact stress- compressive force (2hrs)
vibration- segmental or whole body (30 min one time or 2 hrs exposure)
Definition of injury in Iowa
•Injury definition in Iowa:
•Broad definition: Health impairment that affects normal body functions, Body tissue affected, Must be from employment
•Oversight: Iowa Workforce Development
What is an FCE?
•Functional Capacity Evaluation: Assessment to determine client’s current level of function including physical, cognitive, cardiovascular, and motivation levels
•Used for return to work
•Physician use for disability
•Legal documentation
Keys to documentation!
•Focus on work and work tasks
•Functional job description
•Job task analysis
•Subjective information- utilize quotations
•Utilize objective numbers*
OTPF and FCE
work, client factors, performance skills, context and environment
Good Ergonomics in the Office
•Head: straight forward with slight cervical flexion
•Back: Straight posture with lumbar support
•Upper LE’s: parallel to floor, 2” hip clearance from lateral sides of chair
•Knees: 2” space from chair, 90°
•Feet: contact with floor 90°
•Shoulders: Adducted to side, relaxed (no elevation)
•Elbows: 90° preferred
•Hand, wrist, and forearm: straight posture parallel to floor
Common Workplace Injuries
•Low back pain
•Shoulder injuries
•Rotator cuff rupture
•Impingement
•Repetitive stress
•DeQuervain’s
•Tendinitis
•Carpal tunnel syndrome
•Cubital tunnel syndrome
•Trauma:
•Fractures
•Lacerations
•Burns
•Amputations
•Tendon injury
•Other injuries:
•TBI
•SCI
•Vision or hearing loss
Work conditioning versus Work rehab?
•Work Rehabilitation: Rehabilitation immediately following injury, Generally refers to outpatient therapy, Body part specific, Range: 2 weeks-2-3 months or more
•Work Conditioning: Discharged from outpatient therapy, Unable to return to work full duty, Whole body, Endurance, strength, flexibility
Work Conditioning Positional Tolerances
See pic on desktop
What are the basics of an FCE? How much time they take, what is involved, etc.?
Purpose: Determine current level of function in relation to functional job description
Average 4-6 hours or more
May take place over 2 days
Referral sources: Physicians, PA’s, nurse practitioners, case managers, attorneys, other therapists
Self referral in direct access states*
Equipment Recommendations for the Office
•Work Stations, Preferred: Height adjustable & curved edges
•Keyboard Trays--> Allow clearance for upper LE’s Preferred: Tray with keyboard and mouse
•Monitors: Distance: Arm length or 20-36 inches, Preferred: Fully adjustable, Height, tilt, and placement
•Keyboards:Posture: neutral positions, avoid resting wrist/hand, Other options:Voice to text, Wave keyboards & split, Large, promotes neutral postures, learning curve, Mini keyboard, Awkward postures, space constraints
•Mice: Posture-Limit “cramped position”, overuse/repetition
Progression of Care After Injury
1.Injury
2.Emergency room or Occupational Health
3.Acute Care, Surgery, or f/u with Occupational Health
4.Inpatient Rehabilitation and/or Outpatient Rehabilitation
5.Work Conditioning or Work Hardening* (not required)
6.Functional Capacity Evaluation*(not required)
7.Return to Work or Disability
Subjective versus Objective in a Rehab Evaluation
•Subjective information: PLOF, PMH, PSH, Functional job description, Client concerns, Current work status: Full time, part time, modified duty, etc.
•Objective measures: ROM, Strength, participation in work tasks, Edema, Sensation, Pain, DASH/QuickDash
Components of an FCE...
•Chart review & Interview
•Observations
•Psychosocial behaviors
•Assessments: Physical and cognitive assessments, Job-specific evaluation, Pain (Frequently assessed)
•Results, documentation, and recommendations
Why would someone order an FCE?
Pre employment screen (Rare to do full FCE)
Return to work vs altered work (Compare to Functional Job Description)
Disability benefits
Vocational rehabilitation seekers