Industrial Physical Therapy

Introduction to PT

PEP 2020Brian T Larsen, DPT

Objectives 1. Be able to identify and define the goal(s) of

industrial rehabilitation 2. Be able to identify, define and give an example of a

Functional Capacity Exam, and Work Hardening. 3. Be able to define ergonomics, and give proper

ergonomic recommendations for the hand and wrist, the back, office set up, standing, sitting, workstation heights, lighting

4. Be able to identify and explain proper lifting techniques to protect the back

Industrial Rehabilitation

Focus is on: Getting back to work Prevention of initial work injury Prevention of re-injury Increased work productivity Decrease worker’s compensation claims

Getting Back To Work

Immediate care May see patient in an emergency situation if

PT is on site4Goals may include:

• Treatment and protection of the injured area• Instruction of patient to self-care of the injured area• May use modalities to manage pain

Early Intervention The development of many work related injuries

happens over weeks, months, or even years Early and aggressive intervention becomes very

important Involves coordination between employee,

department manager, occupational health, and ergonomics team

Prompt and early reporting of signs and symptoms such as numbness and tingling in the hands, headaches, pain, excessive fatigue, and difficulty focusing

Getting Back to Work

Intermediate care Goal is to restore function, get person back

on job Educate on prevention of re-injury

4Review mechanism of injury4Discuss alternative work methods

• Ergonomics• Function

4May involve occupational therapy

Getting Back to Work

Extensive care In more severe injuries (amputation, severe

burns, etc.) further physical and psychological intervention may be needed

Goals:4Return to work: work hardening (with medical

approval) 4De-emphasize disability4Facilitate motivation – be a realist, but don’t

underestimate the recuperative power of the body

Getting Back to Work

Functional Capacity Testing Describe abilities and limitations to facilitate

a safe return to work Determine the physical demands (max load,

frequency, heights required to lift, etc) of job4Test the person’s ability to complete the

minimum requirements of the job and then make recommendation

Getting Back to Work

Work Hardening After proper treatment and a functional capacity

examination work hardening can begin Blends rehabilitation with needs of job and industry

4 Ex: if the person lost their leg, and the job requires that the person be able to lift and pivot, the rehabilitation may include balance ex’s, and exercises to strengthen the quad doing a similar tasks that are required in the particular job

Prevention of Work Injury

Ergonomics – comes from Greek word ergo (work) and names (law). Multidisciplinary activity that incorporates

people’s capabilities and limitations as they permit the proper design of jobs, products, work places, and equipment.

Goal: adapt the job to fit the person, not to force the person to fit the job

Ergonomics

Interaction with person and job environment Deals with the following:

4Design and function of controls and displays4Lighting4Temperature4Work place layout and design4Tools4Work organization

Ergonomics: Hand and Wrist

Often times tendons and tendon sheaths are common sites of injuries called repetitive trauma disorders Example: carpal tunnel syndrome

Typical culprits for hand and wrist injury: Twisting and flexing Low temperatures Vibration Forceful work Undesirable positions

Ergonomics: Back Back injuries from poor workplace design are

the cause of innumerable back injuries each year costly, lost productivity, pain and suffering and lost

quality of life Related to the following:

Repetitive handling of loads, and sustained bending Awkward body postures Handling excessively heavy and bulky materials Twisting the torso to one side while lifting Handling demands beyond the capabilities of person

4 Strength OR metabolic energy requirements

Getting Back to Work

PTs may make recommendations for return to work: Based on results of functional capacity exam, work

hardening and job demands May need to be reassigned to new job, or

modifications to current job in order to be able to perform4 If a person in work hardening did not make sufficient gains

through rehab (they weren’t able to lift the 70 pounds with safe balance) then the recommendation may be to be reassigned to another job, or that the company use 40 lb boxes instead of 70 pound boxes for example

Prevention of Work Injuries

Basic Design Principles Goal: minimize weight, range of motion, and

frequency of the activity4 Conveyors and platforms should be built above the knee

and below the shoulder height4 The farther away an object is from the person, the more

physically demanding it becomes…moment arm forces4 Lifting and carrying should be converted to horizontal

motion with conveyors and rollers4 When required, pushing is better than pulling

• Low friction wheels, handles easily grasped in an upright posture

Manual Lifting Principles Research has identified the following variables in

predicting work injuries: The horizontal distance from the load to the person The vertical distance through which the load is handled The frequency with which the load is handled Size (bulk) of the load Floor/shoe traction Stability (balance) of the load Adequacy of grip Distance the load is to be carried Available rest between lifts Past injuries to employee’s muscles and skeletal

structure

Standing

Good standing solutions: A footrest or rail to allow the person to put

one foot up while standing Resilient floor mats rather than concrete Height adjustable chairs or stools for resting Frequent opportunities to change position

Sitting Inadequate chairs can contribute to back stress,

circulation problems, fatigue and discomfort Solutions:

Conveniently adjustable back support (vertical and horizontal) and front edge contoured down

Good seat cushioning Adjustable seat height Five legs for stability Swivel Covered with breathable material Seat pan should be large enough to support the buttocks

and thighs without digging into the back of the knees

Workstation Heights

Problem: mismatch between employees workplace and the work they are doing

Solution: Adjustable-height work surfaces and

equipment Work should be done at elbow height Heavier tasks should be done a little lower

while lighter tasks should be done a little higher than elbow height

Lighting

Problem: Poor lighting (too much or too little) can cause eye and neck strain, and loss of productivity

Solution: Focus lighting where needed Reduce glare by indirect lighting Use window shades and antiglare devices Fluorescent lighting can cause glare and

shadows

Office Ergonomics Problem: employees loose flexibility of

movement due to staying in the same position for long periods of time and are exposed to glare from the computer screen

Solution: Keep wrists straight Use wrist and arm supports when needed Reduce stress Take frequent and short stretch/exercise breaks Break up long stretches on the keyboard with

alternative work involving different work motions

Miscellaneous Information Decrease handling of product

It adds not value to product and increases vulnerability to injury

Provide clamps or fixtures to hold a product rather than holding it with the hand

Decrease activities that require the employee to raise hands/arms above shoulder level

Hand tools and equipment should be designed to keep hands and wrists relatively straight Bend the tool, not the wrist Keep grips small enough to hold in the palm of the

hand Eliminate grips with sharp edges or small surface areas

Summary Objectives 1. Be able to identify and define the goal(s) of

industrial rehabilitation 2. Be able to identify, define and give an example of a

Functional Capacity Exam, and Work Hardening. 3. Be able to define ergonomics, and give proper

ergonomic recommendations for the hand and wrist, the back, office set up, standing, sitting, workstation heights, lighting

4. Be able to identify and explain proper lifting techniques to protect the back