WORKER CARE

SPECTRUM
CHINDHURA
MPT 1ST YEAR
• Industrial therapy today is multifaceted to mirror the many aspects of
the worker/ work site interaction.
• Proper intervention is not only physical but educational and emotional
as well, both pre injury and post injury.
• The worker care spectrum schematic developed by key methods in
Minneapolis provides an excellent visualization of the areas
comprising the Industrial Therapy continuum of care.
• Industrial therapy involves variety of persons and specialities working
with optimal interaction to move the patient rapidly toward the goal of
good health.
• It focuses on both treating disability and enhancing ability.
JOB PLACEMENT ASSESSMENTS
• Job placement assessment or preplacement assessments objectively
measure the workers capabilities in a variety of tasks related to the
jobs available.
• They are essential mechanisms for properly interfacing the worker
with the machines at the job site.
• Two reasons for the job placement assessment:
1. Worker is placed in a job that he/she can perform safely.
2. Weakness or rom deficit can be detected and remedied to better
prepare the worker for safely performing the assigned job as well as
expanding job opportunities in the future.
• Job placement assessment incorporates consideration of physiological
factors, but it places greater emphasis on functional capabilities to
perform job related movements.
• There are number of functional assessment tools available which may
be called Functional Capacity Assessments, physical capacity
evaluations ,work assessments, or worker Functional Capacity
Assessments.
JOB ANALYSIS
• Two components – Tasks involved and the persons interactions within
the job site.
TASKS ANALYSIS
• Every job consists of a series of tasks done over a period of time. An
industrial therapist works closely with the company to develop a job
description which details physical demands of the job.
• This includes measuring the components of the jobs such as lifts, bends,
push/pull resistance, materials handling requirement, repetitions ,
heights, distances and the length of the time involved in each activity.
• With the advent of the Americans with Disabilities Act those tasks which
are “essential functions of the job must now be defined in an objective
manner to avoid suits under this Act regarding denial of a job to an
applicant.
JOB ANALYSIS
• The job site is another aspect which needs to be carefully analyzed to
prevent injury.
• Having been designed by a mechanical engineer to effectively build
box, or fasten a particular product, the human factor may not have
been a consideration or a priority in development.
• Therefore, working heights of counters ,shelves, or doors should be
analyzed to best match the worker to the work site.
• The power needed to pull a lever the height or push a dolly, or the
height of a lift may need to be altered to suit an employee who must
interface with the machine.
• An Industrial Therapist should be an integral part of the design team of
any product to assess compatibility of employee to machine.
• A change in the design phase can pre-empt a tremendous cost of
redesign or injury in the production line phase.
ACUTE CARE AND REHABILITATION
• The Industrial Therapist also deals with the worker post-injury to
maximize function and minimize time away from the job.
• Early intervention is paramount in the acute phase to insure rest from
function while at the same time maintaining mobility for the workers
health.
• Injury assessment is accomplished with full knowledge of the work setting
and tasks involved.
• Entry into rehabilitation phase is also facilitated by familiarity with job
demands of the worker, coupled with assessment information from the
examination and Functional Capacity Assessment.
• Rehabilitation is conducted using simulation of motions, resistances,
repetitions, and often the actual machines to which the worker must return.
FUNCTIONAL CAPACITY
ASSESSMENT
• Static testing on an individual or single axis testing does not translate
well to the work place where tri-planner movements are routine.
• Therefore testing the patient for their ability to perform a full body
task in light of the specific area of injury is important.
• The focus could also be on both upper and lower extremities if the job
entails moving levers with the hands and pushing pedals with the feet,
as many heavy equipment operators do an a daily basis.
• A functional capacity assessment performed at the beginning of a
rehabilitation program enables assessment of the workers beginning
capabilities so that improvement can be measured.
• The FCA also provides baseline information that drives the planning,
implementing, and monitoring of other Worker Care Spectrum
components.
• If job placement assessment had been done prior to injury, this
information would help clarify the workers normal pre injury capacity.
• A job analysis either before or after the injury, in combination with the
FCA would help determine when return to work is possible.
• Functional capacity assessment also yields defensible data to support
decisions regarding workers compensation payments, disability
classification, insurance settlements, litigation “awards”, job abilities,
and rehabilitation goals.
JOB ANALYSIS
• ERGONOMICS- the study of fitting the work place to the worker- is
involved at this point.
• Again, a review of the heights, weights, lifts, pulls and pushes is
imperative.
• Worker height, arm span, weight, ROM, and functional strength and
endurance need to be analyzed against information from the work
place, to see if alterations to the work site can be accomplished in an
economically feasible manner.
• Ergonomics applied to the worker post- injury involves analyzing the
cause, in order to avoid perpetuation rather than prevention.
• Industrial therapy allows for an assessment of the whole person in
perspective to the job site.
• Besides physical assessment, there may be a psychosocial aspect to
the problem.
• The psychosocial component may be addressed simply by counselling
at the work place, or it may require more complex intervention by a
psychologist or psychiatrist.
• In many cases, intervention can be in the form of lower cost
preventive counselling and assertiveness training or stress
management.
 WORK HARDENING AND CONDITIONING
• Work hardening is designed to gradually strengthen and condition the
worker to maximum possible function.
• Work conditioning is a term which has been developed to delineate
the physical conditioning aspect of the work hardening.
PREVENTION
• Survey and analyzes of needs should be conducted and prevention
programs developed for all employees.
• Educational programs can be general, such as the mechanisms of safe
lifting, “back school”, upper extremity, cumulative trauma prevention,
or proper use of protective measures.
• Prevention may also address a specific problem recurring in an
identified target group, such as carpel tunnel syndrome prevention in
computer operators, or impingement syndrome in the shoulders of
workers doing overhead work, like an auto mechanic who works on
cars raised on hoists.
• Prevention can involve activity programs such as group exercise at the
work site, group calisthenics, as is done in China, development of
fitness centres and specific programs for cardiopulmonary fitness,
muscular fitness, or coordination activities done as a group or
individually.
• Prevention can also come in the form of stress management programs,
family counselling, coping skills, or assertiveness training.
• Such programs can help avoid psychosomatic manifestations of inner-
conflict.
• Prevention pays itself in decreased medical care claims, reduced injury
rates and reduced insurance premiums to the company.
• Prevention programs are also responsible for increased production in
some industries.
INDUSTRIAL THERAPY PARTICIPANTS
WORKER- The worker endeavors to do productive work which creates a
sense of accomplishment and pride, as well as earn an income which
provides support for self and any dependants.
EMPLOYER- The employer aims to supply a product, or provide a
service which is of marketable quality with the least interruptions of
the process. This includes providing a safe, worker- friendly
environment which is supportive to all on the job site.
PHYSICIAN- The physician serves as a team player tom determined
physical or emotional problems while working with and supporting
team members who assume the responsibility of intervention at many
points in the process.
PHYSICAL THERAPIST-The physical therapist works to enhance the
physical abilities of the worker, to attain and maintain their physical
health, to meet the tasks demands in the work environment , in an
preventive as well as rehabilitative manner.
OCCUPATIONAL THERAPIST- The occupational therapist works to
enhance the worker ability to perform physical and manipulative tasks,
as well as conduct occupational testing for returning to work, or
alternate job selection.
VOCATIONAL REHABILITATION CONSULTANT-Vocational rehabilitation
consultant work to match the skills of the worker with those that the
jobs requires. They also act as team coordinates helping all participants
to reach consensus on the patient goals and objective.
PSYCHOLOGIST COUNSELOR- The psychologist counsellor can play a
contributing role in many phases of the worker care spectrum but their
participation is vital in work hardening programs. Prevention in the
form of stress management and assertiveness training, family,
counselling, worker interaction counselling, and total environmental
dynamics are essential components of an effective work hardening
program. Intervention may also includes overcoming fear of failure, re-
injury , and education.
ATTORNEY- Although the author does not feel that the attorney should
be included, in this age of litigation, the attorney is involved in case
management from the standpoint of worker and employer rights, as
well as fair and equitable compensation to either party. These
professionals need to be knowledgeable and efficient in their actions to
ensure proper settlement and management of their cases.
CASE MANAGER-Case management is becoming a method of
monitoring and controlling health care costs. The most effective case
managers are intimately knowledgeable of the situation, the persons
involved, and their services available. Sometimes case managers
operate from distant locations, and are required to make decisions
without complete knowledge of either the workplace or the worker.
When this happens , they are at the same disadvantage as the
traditional medical practitioner in trying to make fair decisions outside
the full context of the job environment and the worker’s functional
interactions.
THANKYOU