Workers Comp

The earlier a person recieves treatment, the greater the chance

that person will return to meaninful work

Percentage of disability determined by

MD as a percentage of loss to injured body

Compensation rate

pay rate is 2/3 of the average weekly wage at time of injury, part until a cap

compensation formula

weeks assigned to body part (x) % diability (x) compensation rate

Job analysis

the process of gathering and analyzing information about the content and the human requiremenets of jobs, along with the context in which jobs are performed

performed on site, analyzing all aspects of a certain job position

With job analysis you need to assess

the most difficult aspects of the position

this is used to determine the physical demand level of a job

WDL: sedentary

exerting up to 10lbs of force occasionally

WDL: light

exerting up to 20lb of force occasionally, and/or up to 10lbs of force frequently and or a negligble amount of force constantly

WDL: medium

MOST COMMON, like warehouse and factory

exerting 20-50lb of force occasionally, and/or 10-20lbs or force frequently and/or greater than negligible up to 10lb

WDL: heavy

exerting 50-100lbs of force occasionally and or 25-50lbs of force frequently (like 2/3 of your day)

WDL: very heavy

exercise greater than 100lbs of foce occasionally, and or 50-70lbs force frequently and 25-50lbs of force constantly (ex dry wall)

Process of workers comp injury

worker is injured at work by an accident or maybe repetitive trauma

injury is reported to supervisor and worker is sent to company physician

often x-rays are taken, meds is prescribed, therapy is ordered, and work restrictions are given

if no progress then referal to specialist

then more testing

no progress then alternative treatment is examined

Workers comp psyche

multiple factors may influence attitude of worker

relationship with employer

interaction with employer handing the case

treatment from doctor

financial stress

family stress

PT goals are determined with the end goal

being level of function to allow return to work

in PT we need to reduce dependency on

therapist and modalities for “healing” powers

Can we say when a work can return to work?

NOPE not our job

purpose of work hardening program

improve functional use/movement of affected area

improve strength and work tolerance

educate in proper body mechanics and postural tolerances

improve overall conditioning

is the goal to be painfree

nope afterwards, but functional focus on ways to reduce stress on body and modify behavior to control symptoms

Include gross motor assesment (GMA) if applicable

examine specific site of injury

check for effort and consistent behaviors it is a general screening

ROM and strength at site of injury

Work conditioning

combines PT and job related activities

generally 1 ½ to 2 hours per day, 3-5 days per week

may still have therapy skills

half day work hardening

3-4 hours per day, usually 3-5 days per week

more conditionings

generally o specific therpay treatments

full day work hardening

7-8 hours per day, usually 4-5 days per week, torture for PT

lost of repetition with work tasks

generally las step in returning to work and much rarer now

work conditioning/hardening evaluation

assess postural tolerance, consider overall flexibiilty and mobility of entire body

instruct in proper body mechanics keeping in mind the worker’s flexibility and mobility

body mechanics for lifting

keep load close to your body

keep your lumbar curve

lift with your legs

direclty overhead

functional capacity evaluation

see what they are capable doing

2-8hour evaluation performed to determine a worker’s level of function and to aid in the dtermination of his/her ability to return to work or determine level of diability

ONLY PUT WHAT THEY CAN DO

Compare physical abilities during GMA with

abilities during functional taks or compare movement throughout evaluation from task to task

Waddell signs (only for lower back injuries)

flip (distraction) test

overreaction

tenderness

regional disturbance

axial loading and simulated rotation

Flip (distraction) test

compares seated knee extensio (SKE) to supine SLR. During SKE worker must maintain good lumbar posture compare pain response with both

Overreaction

to palpation or inappropriate postural moements with pain compaints, also may have complants once with palpation but then not later in the same area

Tenderness

compaints of tenderness that are out of proportion to amount of palpation or crosses variable non anatomic borders

Regional disturbance

neurological complaints that are not consistent with dermatomal or myotomal patterns

axial loading stimulated rotation

both subcategories must be positive for this one category to be positive. place a few pounds of pressure into the spine

then rotated the shoulders and hips together to elimiate any trunk rotation

do this to elicit a lower back pain response

hoover test

assessing for counter pressure under the heel of one foot while the other leg perfomrs a SLR

signs of overreaction

inappropriate verbal response

excessive facial grimacing

unexplained muscle tremors

collapsing with muscle testing

cogwheel with muscle testing

pre-employment screenings

physical/functioanl tests provided for employers to assess a candidate ability to perform the physical demands of the position for which they are applying