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WORK INJURY
What is "Return
To Work?"
Work-related injuries are among the highest if not
the highest risk exposure that business and industry
face today. The impact on a company and it's employees
can be emotionally, physically and financially devastating.
The loss in productivity, escalating health care costs
and increased state and federal regulations have caused
business and industry to take a serious look at how
they are preventing and managing their work injuries.
They are more willing to assume control of this problem
and are demanding more effective and efficient services
from health care providers.
The prevention and management of work-related injuries
requires a number of components. Each component in isolation
will not provide the total solution. Each component
needs to be linked, a continuum, to produce a satisfactory
outcome. The emphasis placed on each part will vary
from company to company. The success in preventing or
reducing the impact of work injuries is enhanced by
including each component that is pertinent. Each company
may not need all components; however, they need a well-rounded,
integrated approach to reduce work-related injuries
successfully. There is no simple or quick remedy to
solving this problem.
Innovative
Physical Therapy and Sports
Medicine Centers, with its "Return
to Work" Program has responded to business and
industry with a variety of services and programs that
focus on the intent to decrease the company's risk exposure
to work-related injuries. This has provided a refinement
and expansion of the continuum that is needed. The following
components are programs and services that are provided
by Innovative and are valuable parts of the total continuum.
Innovative's physical & occupational therapy programs
focus is on immediate treatment, protection of the injured
part and a return to work as soon and as safely as possible.
The success that sports medicine has had in getting
an athlete back in the game rapidly and safely has demonstrated
the benefits of immediate and aggressive therapy in
our physical therapy and sports rehabilitation programs.
This same approach has also been demonstrated to be
effective when working with injured workers or "The
Industrial Athlete."
The longer an injured worker is away from work, the
less likely the chance for a successful return to work.
A conservation approach to treatment with rest causes
deconditioning of the worker which further complicates
the return to work process. The psychologic factors
that affect the outcome of injured workers are powerful
and the dissociation from the workplace causes a negative
reaction by the employer, fellow workers and sometimes
significant others of the injured worker. This dissociation
has a negative impact on the injured worker, which makes
it more difficult for the injured worker to return to
work after a prolonged period of time.
The Evaluation
The evaluation of an individual with respect to work
requires a comprehensive musculoskeletal assessment
as it relates to work activities. There is no high-tech
equipment that will give a therapist this comprehensive
view. The evaluation takes into consideration kinesiology,
physiology, pathology, psychology and ergonomics. Our
therapists use this knowledge while observing movement
patterns, interpreting the body's response to this movement,
and identifying the weak components. An example is an
evaluation of an individual to determine restrictions
such as lifting. Innovative not only includes the limits
the individual can "safely" perform, but also
the causative factors for limitations, such as weak
quadriceps, low back instability, knee dysfunction,
upper extremity weakness and low aerobic capacity.
Functional Capacity Evaluation
The most comprehensive evaluation may include a Functional
Capacity Evaluation (FCE). The FCE is an extensive assessment
of the worker's physical ability to perform specific
work activities. The purpose of this evaluation is to
determine the individuals current abilities and limitations
in such tasks as lifting, carrying, standing and climbing.
The FCE tests all the essential functions of the job
is used to match the worker with his/her current physical
capabilities. The information is used by the physician
and/or therapist to determine the proper course of therapy.
It can also be used by the employer to place the worker
back to work at a safe level and allows the worker will
know his/her full work capabilities in relation to the
physical demands of the job.
Work Hardening/Work Conditioning
Innovative's Work Hardening and Work Conditioning Programs
are individualized, goal oriented programs designed
to maximize the persons ability to return to work.
Our return to work programs provide a means for an
injured worker to improve on his or her physical abilities
to meet the critical demands of the job. It is an extension
of the rehabilitation process that enables the workers
to build up their tolerance to actual work situations.
Innovative's work hardening and work conditioning programs
are medically supervised with specific goals set by
the employee and the therapist.
The activities are intensive and job-related. Work
hardening and work conditioning programs simulate the
activities performed on the job in order to enhance
the ability to return to work rapidly and safely. The
components of our return to work programs are listed
and discussed below. Each of these components needs
to be included to obtain a satisfactory outcome. Each
component in isolation may restore an element of function,
however, each component is associated with the other
and when combined will provide a higher level of restoration.
Physical Reconditioning
An injured worker like an injured athlete has lost
the physical ability to perform certain tasks or activities
safely or adequately. Deconditioning of the total body
occurs due to the lack of activity and loss of function.
There may be a loss in strength, coordination, endurance,
mobility, aerobic capacity or balance. These functions
must be restored in order for the individual to return
to work in a safe and productive manner. Restoration
of these functions are done in the proper sequence to
insure safety. If a work activity requires a certain
amount of strength and endurance to perform, that level
needs to be obtained before the individual is allowed
to practice the work activity in a repetitious manner.
If these functions are not restored at a proper level,
the individual may develop adaptive work patterns in
order to perform the certain tasks. This will eventually
lead to more dysfunction and unsafe work, which will
increase the potential of re-injury.
Aerobic Conditioning
An injured worker who has been off work for a period
of time will be somewhat deconditioned. The worker may
not have the endurance to perform the physical demands
of the job over an 8-hour day for 5 days a week. The
worker is not conditioned for work by merely being able
to perform a brief episode of the physical requirement
of the job. He or she must have the aerobic capacity
needs to be improved at least to the capacity that the
job requires. It should be improved to a point beyond
the level only required for the job. This provides a
reserve for the worker, which will improve the safety
level of function.
Work Simulation
Simulation of the actual work is provided by Innovative
to ensure that the individual is able to perform the
essential job functions to the job in a safe manner.
The work simulation activities are designed from the
job description or more accurately from a visit to the
job site by our therapist.
A good understanding of the job by the therapist is
necessary to develop the proper work simulation program.
It enhances the training of program to include actual
equipment or tools used in the job. Examples of such
equipment includes hammers, screw drivers, baskets,
carts and railroad switches. Often employers are open
to lending or giving us pieces of equipment or tools
to facilitate a safe and rapid return to work process.
A good understanding of the tasks involved in the injured
employee's work allows our therapists to design work
simulation that actually reproduces the job function.
The therapists becomes a coach and teacher with guidance
in proper body mechanics, lifting technique, pacing
and other characteristics of the job. The program progresses
until the worker in able to perform the essential functions
of the job and return to his/her full work duties on
a daily basis.
Education
Education and coaching are an ongoing part of each
segment of Innovative's "Return To Work" program.
The workers are not just taught proper safety such as
body mechanics, they need to demonstrate on a repeated
basis that they to demonstrate on a repeated basis that
they can safely perform the essential functions of the
job.
Our education classes are provided both in a classroom
setting and in a practical application setting. The
material being taught is reinforced thoughout the entire
program. We implement a variety of classes that are
appropriate for a work hardening or work conditioning
program. These include:
- Anatomy of the spine and musculoskeletal system
- Mechanism of Injuries
- Body mechanics and back schools
- Healthy living topics such as good nutrition, exercise
and stress management
- Return to work skills such as interviewing skills,
writing of resumes, communication with potential employers
and establishing vocational goals and objectives
- Psychologic support groups to include assistance
with relationships with both family and work, how
to deal with the worker's compensation system and
the impact that attitude has on an individual
These classes are provided in a group setting by a
professional who has expertise in the topics discussed.
The emphasis behind the classes are to assist the worker
in understanding the things that have impact on his
or her ability to return to work and to take personal
responsibility in the rehabilitation program.
Job Site Evaluation
It is important to analyze the environment in which
the employee works when attempting to prevent work-related
injuries. An analysis of the job site will identify
potential hazards and conditions that may cause musculoskeletal
injuries. Innovative studies work postures, motions
and stresses that may lead to problems and provides
assistance in making modifications in the work site
or in the way the work is being performed in order to
minimize the exposure to potential injury.
Basic information and guidelines have already been
provided by the National Institute of Occupational Safety
and Health (NIOSH). Innovative's ability to combine
this information with knowledge in kinesiology, physiology,
pathology and ergonomics can provide an effective work
site evaluation.
The Job Site Evaluation is not only important in the
prevention of work injuries, but is also important in
the development of a job description which identifies
the essential functions of the job.
Job Description
Every job consists of a series of tasks done over a
period of time. The physical demands of the job include
such activities as lifting, bending, pushing, pulling
and materials handling. Measuring repetitions, heights,
distances and the length of time involved in each activity
must also be considered.
Innovative works closely with the employer to develop
a job description which details the employees work responsibilities
and the essential functions of the job. Without knowledge
of the work site and a description of the essentials
functions of the job, a therapist cannot effectively
rehabilitate the injured employee and return him/her
to work.
The rehabilitation process is only partially complete
when the individual has the physical ability to perform
the job. If the employee is placed back into the same
job that caused the injury without the job being evaluated
for risk factors, the potential for re-injury is apparent.
Job Site Analysis and
Modification
When a worker has regained adequate function to return
to work, Innovative will match the individual's physical
abilities and restrictions to the actual job. This requires
our therapist to visit the job site. With the knowledge
gained from the job description, the functional capacity
evaluation and the job site analysis, the therapist
knows the physical parameters in which the worker can
safely function. If the job is going to cause potential
reinjury because it is outside the safe parameters,
job modifications may be recommended. The therapist
and the employer cooperate when there is a physical
reason for modification. The actual discharge of a worker
from the work hardening program is done at the work
site when possible. This provides a valuable opportunity
to make necessary modifications to the work site and
to communicate job restrictions with both the worker
and the employer.
The first level of work injury prevention is to insure
that there is a match between the worker and the work.
Can the worker physically do the work without risk of
injury to self or to fellow workers? This question needs
to be answered before an individual is placed on a job.
The Americans With Disabilities Act requires that any
physical screening be done in a manner that will simulate
the essential functions of the job as outlined in the
job description. This screening must determine if the
individual can physically perform the work with or without
reasonable accommodations.
The ADA is intended to discourage denial of employment
based on disability. If a candidate has the knowledge,
skill and physical ability to perform the work, he or
she must be given equal opportunity for the job. For
an employer to provide a fair and accurate screening
they will require a job analysis that focuses on the
essential functions of the job. Innovative's ability
to evaluate the essential functions of the job puts
us in an excellent position to assist employers in complying
with the ADA.
Injury Prevention Programs Emphasis on prevention education
at the workplace has increased steadily. State and federal
laws require more employee education programs. In the
past, the primary focus of work site education provided
by therapists was on manual material handling. These
programs have included body mechanics and safe lifting
techniques and were reflective of the high incidence
of injuries caused by these activities.
Innovative has expanded their knowledge on this subject
and developed prevention education programs that focus
on the specific needs of the worker. Emphasis is not
only given to manual material handling activities such
as lifting and carrying, but also includes repetitive
activities and non-material handling activities. Workers
become more aware of ergonomics and how they can make
their work environment safer. They develop an understanding
of the mechanics of injury as it pertains to their specific
job demands.
Our Occupational Safety Programs are not given in a
generic format. We have found that the most effective
means to deliver these programs is to provide realistic,
on-site instruction in such areas as proper lifting
technique, use of safety equipment and an ergonomic
arrangement of the work site. This can best be done
through identification of risk factors and providing
a problem-solving approach. These occupational safety
programs are implemented and delivered at a level of
understanding appropriate to the intended group. This
approach increases the participants' retention and practical
application of the information. Summary The prevention,
care and management of work-related injuries is not
a simple process. Innovative provides an integrated
approach with good communication between all individuals
involved, including the employee, employer, health care
professional, insurance carrier, rehabilitation and
vocational consultants, attorneys and risk managers.
Each component of Innovative continuum is linked to
the next. This assures a cost effective approach to
patient care and maximum functional outcomes. The element
that will cement the continuum is a positive attitude.
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