Vr consumers with medical disabilities
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VR Consumers with Medical Disabilities. Decision Making and Planning. Strategies for Counselors. Dr. Kevin Horan Rehabilitation Psychologist Consultant:Navajo OSERS. Outline of Presentation. 1. Type of Disability (brief overview). 2.Trait/Symptoms of Condition.

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Vr consumers with medical disabilities

VR Consumers with Medical Disabilities

  • Decision Making and Planning

  • Strategies for Counselors

Dr. Kevin Horan

Rehabilitation Psychologist

Consultant:Navajo OSERS

Outline of presentation

Outline of Presentation

1. Type of Disability (brief overview)

2.Trait/Symptoms of Condition

3.Recommendations For VR Planning

4.Top Possible Job Placements

5.Feedback ------>Discussion

Ten common and uncommon medical conditions seen in vr consumers

Ten Common and Uncommon Medical Conditions seen in VR Consumers

1. Back Injury

2. Diabeties

3. Epilepsy

4. Spinal Cord Injury

5. Heart/Lung Conditions

6. Pain Syndromes

7. Thyroid Conditions


9. Hand-Arm-Shoulder injury

10. Multi System Breakdown

Back injury

Back Injury

  • Herniated Lumbar Disc

    • Spongy Material Seperating each Vertebra.

    • Body extrudes through protective covering

  • Degenerative Disc Disease

    • Narrowing of Disc Space

    • Bony Spur Development

  • Spinal Stenosis

    • Narrowing of Space in Spinal Canal (Acquired or Congenital)

  • Fracture

    • end plate injury due to lifting,carrying, etc.

  • Osteoporosis

    • Loss of Bone Mass

    • Typical (women over 40)



  • Typical Surgery

  • Laminectomy (Remove bony arches of one or more Vertebra to relieve compression of the spinal cord)

  • Spinal Fusion (Stabilize spinal section with a bone graft or Synthetic Device)

Other treatments

Other Treatments

  • Epidural Blocks

  • TENS Unit

  • Medication

  • Pain Management Clinic

  • Brace Devices

  • Chiropracter

  • Work Hardening

  • Traditional

    • (ie. Bone Doctor)

Traits observed in consumers with back injury

Traits Observed in Consumers with Back Injury

  • Loss of Income, Bills, Family Stress

  • Non Productive = Guilt = Depression

  • Pain Medication = Tolerance=Confused/ Cognitive Changes

  • Pain = Frustration + Temper = Conflicts in Family

  • Difficulty Accepting Limitations

  • Transferable Skills in areas not Compatible with Disablity

  • Downtime - Long Delay after putting in Job applications = Depression + FT =Low Confidence Levels

  • Vocational Interests are often Unrealistic

  • Idle Time may lead to Drinking(Self Med) -Time Cycle off

  • Limited Strength and Stamina

  • Occasional Remarkable Recovery/Presentation

Vr consumers with medical disabilities


1. Use prevention measures (ie.Back Brace)

2. Avoid Discrimination During Job Search

3. Avoid Pain Medication Trap

4. Counselor Make Discomfort Apprasial

5. Be Aware of Unrealistic Rate of Recovery

6. Determine Current Point of Stability

7. Be Aware of Financial Incentives

8. Help Consumer Realize Functional Limits/Restrictions in relation to Vocational Objectives

9.Be Aware of Potential for Long Term System Breakdown

Vr consumers with medical disabilities

Top 10 Jobs (Back injury)

  • Building Inspector

  • Appraiser of Home

  • Transportation Jobs -with modifications

  • Light Duty Clerical/Computer Operation

  • Small Bench Work Repair

  • Cashier With Adaptations

  • (Home Maker Companion)-Prep Meals for Others

  • Telemarketing Phone Sales/Retail Sales/Car Sales

  • Intake Worker-Health Info Tech

  • Teacher-Teaching Aide Positions

Diabetes mellitus

DX= Blood after fasting overnight sugar greater then=140 Mg/dl on two separate occasions.

Increase in thirst, hunger, and urination

Diabetes Mellitus

10 million Americans have diabetes but fewer then half are DX

Pancreas does Not secrete enough Insulin or cells of body become resistant to Insulin= Blood sugar can not get to cells

Type 1 =

Type 2 =

Insulin Dependent (Usually in children Adolesence)

Non Insulin Dependent (usualy onset after 35-40)




Genetic Factor

Enviromental Factor


Onions and Garlic Lower Blood sugar

Vr consumers with medical disabilities

Traits Often Observed in Diabetic VR Consumer

  • May need to frequently urinate

  • May have numbness or start of neuropathy

  • Could be dizzy or weak-non healing cuts

  • May show stress/frustration and depression

  • Desire to stay in old line or previous work

  • Poor adjustment to extreme work change

  • May be unrealistic-May deny limitations

  • Self medicate with ETOH-at risk for D coma

  • May not understand complications of diabetic

process and balance of body systems

  • Family often acts as best option to motivate and maintain compliance in consumer

Vr consumers with medical disabilities


  • Maintain-Monitor ---->

  • Weight factor

  • Blood sugar monitor (Hba1c)

  • Long term complications awareness

  • Job choice must be short(hrs) with (breaks)

  • Post Dx Problems could impact plans

  • Find out time since being Dx and comp level

  • Avoid future jobs that may require vision tests

  • Avoid very hot work environments

  • Periodic updated physical and visual exams

Vr consumers with medical disabilities

Top 10 Jobs For Consumers With Diabetes

1. Telemarketing Jobs

2. Light Duty Housekeeping

3. Health Information Technician

4. Kindney Dialysis Technician

5. Nutritionist - Educator

6. Teachers Aide

7. Inventory Work - Retail Outlets

8. Appraisor - Estimation Work

9. Motor Vehicle Worker (clerical)

10. Banking Jobs - Legal aide - Interpreter



Sympotomatic = Known Cause

A group of neurological conditions characterized by recurrent episodes of convulsive seizures,sensory disturbance,abnormal behavior or loss of consciousness

Idiopathic = Unknown cause

Main Causes

Head Trauma, Intracranial Infection, Poison, Brain Tumor, Vascluar Disturbance, Intoxiction


Types of seizures

Absence = Sudden momentary loss of consciousness

Former name Petit Mal

Focal = Abnormal electrical discharge in localized part of

brain. Usually near motor sensory strip

Tonic-Clonic = Generalized Involuntary muscular contractions

and change in respiration followed by T+C spasms of muscles ie. Grand Mal

Types of Seizures

Psychomotor = Temporary loss of consciousness, Loss of

judgement, Automatic behaviorisms and possible abnormal acts-hallucinations, Deja Vu, Temporal Lobe Disease or Injury

Meds = Reduce Seizure Threshold

Stabilize Cell Membrane = Decrease Intracellular Sodium and Excitability of

Eleptogenic Focus

Vr consumers with medical disabilities

Some Traits Observed in Consumers with Epilepsy

1. Memory concerns (short term)

2. Appearance may be altered (dilantin-gums-scars)

3.Quick temper or anger- some may not show this

4. Loss of confidence due to seizures in public

5. Denial of disability’s impact on day to day life

6. Frustrated due to transportation limits

7. Non compliance with medication

8. Dependence on family/Possible overprotection

9. Transferable skills often in noncompatible area

10. Substance abuse resulting in seizures

11. Many consumers with epilepsy may be very

well adjusted

Vr consumers with medical disabilities

Epilepsy Recommendationss

1. Encourage compliance with medication, diet, drinking and general doctors orders - be aware of individual aura

2. Discourage job placements in work enviroments that are potentially dangerous (ie driving, cooking, heavy equipment)

3. Keep seizure log - if seizures are still occuring, show the log to your doctor to help adjust medication

4. Discuss if the consumer is operating a motor vehicle and has not been seizure free for a year

5. Be aware of the possibility of concurrent depression and frusturation in the consumer

6.Be aware of the possibility of self medication with ETOH or drugs due to adjustment problems

7.Recommend supportive counseling if you detect emotional, behavioral, or family problems


Vr consumers with medical disabilities

8.Provide additional vocational counseling if the consumer is choosing unrealistic jobs not compatable with a seizure condition

9.Look closely for memory problems that might interfere with job or daily living

Top Ten Jobs

Laundry work



Tile Layer

Computer operation




Auto part Salvage

Food Vendor

Top Ten Jobs

Vr consumers with medical disabilities

Spinal Cord Injury

33 Vertebra- 7 cervical, 12 thoracic, 5 lumbar 5 sacral

Sci - Complete or Incomplete c+first t=Quad below T 1 = Para

10,000 + new SCI Injuries a year

20% falls 15% sports/rec

15% gunshots, stabbings, industrial, etc.

Majority =Young active men

Voc + Predictors = Young age, high education positive attitude and ability to drive

Voc Interest -Still like working with things rather then people or data

Changes = Sensation, Motor Control, Sexual Functioning, Regulation of Internal Temperature, Blood Pressure, Bowel + Bladder Processes, Onset of Pain, Spasticity, Decubiti (pressure sores) Ulcers

Cognitive Level usually normal but 16% Para +TBI

Premorbid = Normal to Impulsive/Rebellious Non conformity


Vr consumers with medical disabilities

Profile = Possibly More Depression - 45% -Symptoms of Anxiety, Anger, Fear, Low Self Esteem

Pain = 44% to the point it interferes with ADL’s

Suicide = Slightly more common then general public but still infrequent

ISDB = 62% ETOH, Drugs, Refusing Treatment, Prolonged Sitting = sores

Divorce = (25% - pre + post injury) some studies show less divorce after SCI

Family = No problem raising a family

Cultural = Swiss Para’s - 77% working- 67% driving - 25% higher ed

Nigerian= Most Para’s dead within a year

Vr consumers with medical disabilities

Spinal Cord Injury Traits

1.May show decubiti ulcers/urinary tract infections/

Breathing Problems/Muscle Spasms that could be a factor in job development/treatment

2. Hidden Depression - feeling helpless/angry/guilty

3. Family and Financial Issues may emerge

4. Social Changes-Isolation less in Public eye

5. Transportation concerns- adaptation of vehicle

6. Development of Dependency

7. Hidden Substance Abuse Concerns

8. Concern over upgrading wheel chairs

9. Sexual Issues may be present in some cases

10. Occasional Excellent Adaptations to SCI

Vr consumers with medical disabilities


1. Concurrent PT-OT. Assistive Technology Evals may be needed

2. Review need for adaptative equipment in home - Possible work adaptation

3. Possible need to refer for Independent Living consultation

4. Review time since injury (new-late-later) to assess adaptation and VR needs

5. Recommend ongoing health education to adapt to SCI

6. Counseling may be an individual and/or family need

7. Determine if any ongoing legal issues need to be resolved prior to VR plan

8. Determine if individual can be re-employed in previous position with accomodations or job site modifications

9. Prioritize driving or mobility needs and implement non-costly plan


Vr consumers with medical disabilities

Top 10 Jobs (SCI)

  • Cashier

  • Banking Positions

  • Bench work

  • Counselors

  • Education/Teacher

  • Computer operation

  • Clerical Jobs

  • Self employment

  • Dispatcher

  • Broadcasting

Vr consumers with medical disabilities

Heart Disease

Primary Heart Conditions

  • Congestive heart failure= Heart can not pump enough blood possibly due to prolonged high blood pressure, previous heart attack, faulty valve, heart muscle problems,chronic lung disease(ie.Asthma)

  • Symptoms - Weakness, Fatigue, Shortness of Breath

  • Arrhythmias = Disturbance in the Rhythm of Heart beat

Some symptoms mild (no problem)

Others are dangerous

  • Ventricular Tachycardia - Rapid uncontrolled contractions of Heart

  • Cardiomyopathy = Disease of Heart Muscle or structure Less Force/Contractions= Less blood circulation can cause Toxic, Viral, Degenerative Conditions

Vr consumers with medical disabilities

  • Mitral Valve Prolapse = Loss of Tone or Deformitity of Heart

Valve which can cause leakage or heart murmer

  • Atherosclerosis - Buildup of Plaque/ Cholesterol/Fatty Material or Debris in the inner layers of the walls of medium and large arteries

Vr consumers with medical disabilities

Lung Disease

  • Asthma - Respiratory Disorder recurring Dyspnea, Weezing, Problems breathing due to constriction of the bronchi causing much coughing - excessive mucous

possibly precipitated by inhaling of allergens, pollution, exercise, stress , etc

  • Emphysema = Destructive changes in lung walls - Loss of Elasticity, Decreased gas exchange

Causes = Chronic Smoking - Old Age

  • Bronchitis = Acute or Chronic inflammation of the mucus membranes or Tracheobronchial tree

Caused by Viral Infection


Vr consumers with medical disabilities

  • Chronic Bronchitis = Excessive Secretion of Mucus for 3 months over 2 sucessive years (Cig smoking/Air pollution)

  • Chronic Obstructive Pulmonary Disease or COPD = A Progressive Irreversible Condition with Diminished Capacity of Lungs - Chronic Cough, Dyspnea, Aggrevated by Cig’s + Pollution.

Vr consumers with medical disabilities

Cardio/Pulmonary DisordersTraits seen in VR Consumers

1. Dyspnea - Shortness of breath - Deconditioned HBP

2. Poor Mobility - Limits in stair climbing/walking/standing

3. Tendency to keep smoking in spite of problems

4.Poor diet choices(ie.fast food)-little education related to nutrition

5. Overweight - Possible Obesity

6. Often trying for SSDI - Varied levels of Empowerment

7. Depression over health Problem + Functional limitations tendency to give up and be Passive

8. Turn control over to Doctor - Become External

9. Weakness - Often can not work Fulltime

10. Possible Mix of many medications from many Doctors

Vr consumers with medical disabilities


1. Physical Restoration including Diet, Exercise and Strength Building monitored by Health Professionals

2. Recommend Education regarding further Complications - Long term effects on Health

3. Be aware of Mood Changes particularly Depression

4. Need for Smoke Cessation Program- ie. Nicoret gum - patches zyban - hypnosis-etc.

5. Vocational Counseling to redirect to a more sedentary job but one that also requires some Phys+Mental Action

6. Wellness Center and Group Support

7. Involve Family in Plan but don’t let Consumer rely too much on others Encourage empowerment - Improve apperance


8. Dietary/Nutritionist Consultation with family (read Ingredients)

Vr consumers with medical disabilities

9. Don’t develop a bias just because of Consumers appearance(ie Over weight) -Encourage job possibility and Positive Factors

Top Ten Jobs


Fitness Center (front desk)

Food Preparation

Health Food Store

Floral Arrangment

Intake Workers





Top Ten Jobs

Vr consumers with medical disabilities


  • Unpleasant Experience associated with Tissue Damage or Disease

Acute=Usually short duration with well defined cause

Chronic=6 months or Longer

Recucurring Acute= ie. Arthritis - Tumors

  • Estimated 75 million plus Americans have Chronic pain

40 million recurring Headaches

15 million Low Back Pain

100’s of thousands = cancer

20 million arthritis

  • Disability Payments = 10 times faster then the growth of the US Population

Back injury = Well over a Billion yearly in Disabilty Funds

  • Problems =







Vr consumers with medical disabilities

  • Presentations will vary Significantly

  • Decreased level of Activity

  • Abuse of Medication (selective inactivity)

  • Excessive Over Utilization of Health Resources

  • Mental Status Change = Depression in 70% of Cases

  • Work Disability and Vocational Maladjustment

Vr consumers with medical disabilities

Traits in Pain Patients

1. Some may exaggerate pain - Some endure the pain- Look at pre morbid life style and personality traits

2. High levels of pain often result in frequent body change of position, irritation and possible depression

3. The family of Pain victims is also impacted by condition

4. Some people develop a pain identity that often gets reinforced

5. Some consumers have additional tolerance to pain medication

6. Cognitive decreases often co-exist with pain - due to medication or the effect of pain on the consumers functioning

7.Substance Abuse or self medication may also be a variable

8.Consumers show a decline in physical activity- Which may lead to other negative health problems


Vr consumers with medical disabilities

9.Secondary gain may be a factor impacting motivation or empowerment

10.Pain related disablities often result in consumer placing school or extended training above a more available job placement

Vr consumers with medical disabilities

Recs for consumers with Pain

1. Have all medication and psychological records available to review - use Consultants from medical field if necessary

2. Be aware of possible legal (ie. workers comp) or ongoing litigation which may impact motivation or outcome

3. Look for signs of pain medicine tolorance or abuse

4. Be aware of co existing physical conditions or substance abuse or other problems

5. Recommend - pain management or alternative methods to cope or aleviate pain- ie. (accupuncture, hypnosis, biofeedback)

6.Determine the acual motivation for seeking help- is the consumer serious about pursuing modified job placement options

7.Assess transferable skills for alternative non physically demanding or pain inducing job options


8.Be very observant of physical signs of pain in consumer - estimate degree of time consumer can work

Vr consumers with medical disabilities

9.Review background- is this a pattern or does the consumer have good work history?

Top Ten Jobs

Self employment (crafts)

Computer (modified)


Temp fill in

Clerical (with breaks)

Light duty driving

Light duty schd.

In home cook


Elderly care

Top Ten Jobs

Vr consumers with medical disabilities


Hyper-May cause heart disturbance, insomnia, severe anxiety

Thyroid is in front of neck below larynx-It regulates metabolism

Greek word = shield

Pituitary gland secretes hormone that stimulates thyroid (TSH)

1 to 4%of Population has moderate to severe hypothyroid condition

10 to 12% of Population has mild hypothyroid condition.

Advanced age increases rate of hypothyroid more frequently in women

Most common past cause of hypothyroid = Iodine deficiency

T gland adds Iodine to Amino Acid Thyrosine to create hormones

Iodine added to table salt - 1924 - Michigan population had 47% Thyroid problems before this

Goiter = 200 million world wide

Certain foods block iodine utilization = goitrogens including turnips, cabbage, mustard, soybeans, peanuts, pine nuts

Hashimoto’s disease (most common form)=

Antibodies are formed that bind to the Thyroid and prevent manufacture of sufficient levels of thyroid hormones


Vr consumers with medical disabilities

Symptoms often seen in Thyroid Conditions

Sensitivity to Cold - Tissue swelling found in hyper/hypo active thyroid

Higher Cholesterol = (Triglyceride) Risk of Cardiovascular Disease

Irregular heavy periods

Nails thin and brittle

Brain sensitive to low thyroid hormone levels

First symptoms = Depression, Weakness, Fatigue

Late signs = Difficulty concentrating

Joint Stifness

Treatment = Desiccated Thyroid or Synthetic Thyroid supplement

Vr consumers with medical disabilities

Traits periodically seen in VR Consumer/ Thyroid Conditions

1. Hypo- If poorly controlled - Overweight, Sluggish, Neck swelling, Often Depressed, Bulging eyes, sensitivity to cold

2. Hyper - If poorly controlled Thin - Anxious - Paranoid almost might suspect amphetamine abuse

3. If Un-DX - May be treated for alternative Physical Condition

4. Freq Job change and problems with co workers/supervision

5. Often left alone, divorced, may develop physical or psychological problems

6. Frequent cases seen on Reservation or in rural areas-Often VR Consumers may have lived near Uranium mines

7.Often can not loose weight in spite of diet and exercise

8.May miss a lot of work due to energy decline or changes in motivation

9.Mood Swings/Cognitive Changes


Recommendations vr consumer s with thyroid conditions

Recommendations -VR Consumer’s with Thyroid Conditions

  • Ongoing monitoring of blood THS levels

  • Encourage med/diet compliance-Avoid etoh/cigs/caff.

  • Use transferrable skills from previous low stress jobs

  • Avoid Physically demanding work/exposure to x rays

  • Rec-Supportive counseling if emotional changes

  • Involve family/educate re. symptoms/treatment

  • If employed-use Employee Assistance programs

  • Encourage exercise and stamina building-ie.Exercise stimulates thyroid gland secretions and increases tissue sensitivity to thyroid hormones

Top 10 jobs thyroid conditions


1.Dog/Pet Groomer

2.Floral Arranger

3.Cake Decorator


5.Driving Jobs

6.Maintence Man

7.Hotel/Motel Clerk

8.Teacher (Elementary)

9.Self Employed-ie.Office Cleaning


Vr consumers with medical disabilities

Acquired Immunodeficiency Syndrome (Aids)

Discovered by Scientists in 1983

HIV = Human Immunodeficiency Virus = Lowers Body Immune System

ARC = AID’s Related Complex = Tired, Night Sweats, Weight Loss, Yeast Infections

AID’s caused by infection with Human Immunodeficiency Virus

HIV does not kill --it cripples the Immune System

Person may die from severe infections or cancer


CD4 (Helper Lymphocye) Count is less then 200 cells per micro-leiter

2. Kaposi’s Sarcoma - cancer of the blood vessel walls

CD8 (% of helper cells) to total Lymphocytes - less then 14%


Vectors = Sexual - Needles - Blood Transfusions


Vr consumers with medical disabilities

HIV is not a Death Sentence but is very serious

United Nations estimate over 40 million worldwide living with AID’s

USA - AIDs # of Cumulative cases to the year 2000

765,559 442,882 Died

AIDs - .3% or 2,337 Native Americans

Trend is going up in the minority Populations

AID’s Dementia Complex (ADC) - Neurological effect of brain inflammation in one third of AIDs patients

Memory loss - Dementia = loss of cog functioning and possible destruction of neurons density- 40% lower then non AID’s cases

Vr consumers with medical disabilities

AIDS VR Consumer Traits

1. Usually Reserved - Quiet - Uncomfortable

2. Possible Family Conflicts - Breech of Confidentiality

3. Low Physical Stamina -Frequently Tired

4. Unable to Continue at Previous Job but may try to stay at it

5. Usually a Lack of Education related to the Condition but Basic Treatment is Maintained

6. Quiet, Often Isolated, and Depressed, Out of Place - Limited Support

7.Many are Gay and maintain lifestyle but others are Heterosexuals-- All must deal with Stigma and Gossip

8.Marriage strained - Family divided

9.Often will Relocate back to the Res when diagnosed but then will Re-Relocate when support falters

10.Concurrent concern over substance abuse and reckless or risky behaviors or impulsivity in some cases

Vr consumers with medical disabilities

Recs for AID’s VR Consumers

1. Feasibly Issue with Supervisors needs to be reconciled -possibly with medical consultation

2.Can present job be modified or is not suitable given dianosis ?

3.Find support group- treat priorities with Confidentiality - Does Consumer feel comfortable with it - ie. AID’s- Sponser ?

4.Determine the level of family acceptance, is it genuine or problematic?

5.Employ Traditional Healing Services - try to avoid placing in a job that requires Health Dept., Food Prep, ect.

6.Consult a Nutritionist for possible Diet Modification

7.Consider Mental Health issues including: fear, depression, anxiety,frustration, etc.

8.Use alternative sources for rehabilitation- ie. immune building, healing services, Prayer, imagery,etc.

9.Insist on Medical Compliance with Treatments


Vr consumers with medical disabilities

Top Ten Jobs



Law /Professional

Factory - Assembly




Self employment

Arts- Creative

Casino jobs

Top Ten Jobs

Vr consumers with medical disabilities

Arm/Hand or Shoulder InjuryINTRODUCTION

Brachial Plexus Injury(Nerve damage = muscles-skin of arm) resulting inPain andlimited movement use of arm

Compartment SyndromeArterial Compression + Reduction of blood supplySwelling and restricted movement with possible severe painwhich could cause permanent contractive deformity of the hand

Carpal Tunnel SyndromeDisorder of the wrist and handCompression of the median nerve causing tingling, numbness, and painwhich could radiate to forearm and or shouldersDecreases in Strength and Dexterity

Vr consumers with medical disabilities

Elbow Joint InjuryCarpenters ElbowOveruse/Arthritic changes /pain

Claw handExtreme Flexion/Hyperextension caused by Atrophy of Muscles

ArthritisInflamation of joints swelling pain

OsteoarthritisNon inflammitory joints degenerate - loss of cartillage,development of bone spurs

Rheumatiod ArthritisChronic inflamatory deformaty/ collagen disease - swelling joints / pain

Vr consumers with medical disabilities

Hand-Arm-Shoulder Injury Traits In VR Consumers

1. Often seen in trades, labor, secretarial and cashier jobs

2.Chronic pain may be evident with concurrent irritation-headaches stress, depression,and discomfort

3.May be taking pain medication to excess resulting in additional problems ie (emotional or behavioral)

4.Rehab plan may be interupted due to a pending surgery - medical consults - etc

5.Confusion over doctors prognosis, release for work, workers compensation involvement,appointment dates, etc.

6.Uncertain regarding alternative work or training options

7.Often will be in denial and will pursue previous jobs in spite of injury and functional limits

8.Unaware of compounding problems such as arthritis, restricted ROM (Range of Motion),med side effects, etc.


Vr consumers with medical disabilities

9.Secondary gain may be a concern (ie. impending trial or settlement)

10.Schedule is thrown off - used to working hard and usually has high work ethic making inactivity more debilitating

Vr consumers with medical disabilities


1. Consider OT+PT consultation/evaluation

2.Be aware of the impact of pain medication or tolerance

3.Determine if concurrent substance abuse may be present - given that trades often have drinking as part of the life style

4.Determine if any court or legal settlements are part of consumers immediate plans or in the near future

5.Find out if workers compensation funding is still on and will they assist with future training monies

6.See if any braces, assistive devices or additional medical procedures might help improve functional capacity

7.Use wellness center - yoga - alternative treatment methods if available


8.Try to redirect to alternate job choices - use vocational evaluation results for career change planning

Vr consumers with medical disabilities

9.Investigate work site alternatives or modification and other jobs within Consumer’s previous company

Top Ten Jobs

1.Was Carpenter now Building Inspector

2.Was Cashier now Store Manager Trainee

3.Was Plumber now Job Bidder/Estimator

4.Was Roofer now Insurance Estimator

5.Was Driver now Dispatcher

6.Factory Worker (Assembly) now Inventory Control

7.Was Postal Worker now Administration /Job Hiring

8.Was Dealer/casino now Self Employed Crafts Sales

9.Was Cocktail Waitress now Therapist/Counselor

10.Was Fast Food Worker now Nutrition Store Manager Trainee

Vr consumers with medical disabilities

Multiple Systems Breakdown

A combination of physical, emotional, sensory and or cognitive problems/symptoms seen in an individual VR consumer

The symptoms may be stable or progressive in nature

Usually one condition starts the decline in functioning and this is followed by additional breakdowns or problems in unrelated or possibly related systems

This MSB Condition is seen more frequently in female VR consumers between the ages 30-55

Vr consumers with medical disabilities

Multi-Systems Conditions

Mental Health Condition

Back injury

weight gain

substance abuse

stamina drop

pain meds misuse

high cholesterol

depression - anger

high blood pressure


Carpal TS

Spinal injury



smoking/lung probs.

risk taker personality


prone to infections


substance abuse



stomach pain

cancer / colon


Vr consumers with medical disabilities

One Actual MSB ConsumerFemale - age 40

Herniated Discs at L4-L5 level

Diabetic Condition

Possible Brain Cyst

Past ear infections - mind low freq hearing loss



Degenerative Knee’s

Arm pain/hand pain (multi joint pain)

Fatty liver with high cholesterol

Irritable bowel syndrome



Vr consumers with medical disabilities

Traits seen in MSB Consumers

  • Strong External (hand over) locus of control not internal

  • Numerous medications and interactive effects

  • Relationships strained or diminished - family problems

  • Employment options often very very limited

  • Lengthy pre-existing conditions = limited job opportunities and possible job discrimination

  • Helpless and often dependent, often seeking SSDI but, not always - many have strong work ethic

  • Often, but not always progressive in nature leading to further decline and a concern over feasibility of services

  • May be a systems user - may want lengthy unrealistic training provided by VR

  • Usually middle age - often set in ways


  • Empowerment issues are often apparent

Vr consumers with medical disabilities

Recommendations for MSC

1. Evaluate and prioritize conditions and the extent of restoration needed prior to development of rehab plan/training

2.Medical Consultation and work releases are needed

3.Are consumers priority plans compatible with functional limitations or unrealistic? Is the job restricted (ie.CDL) ?

4.Evaluate for hidden medication or substance abuse problems

5.Determine level of motivation - consider psychological evaluation

6.Are current secondary reinforcments maintaining disabilities (ie. family treatment / injured indentity)?

7.Find out if consumer is depending on benefits and is willing to give them up

8.Determine if consumer has been to vocational rehabilitation many times before and knows how to use systems

9.Transportation may become an issue with job placement


Vr consumers with medical disabilities

Top Ten Jobs

Self Employed

Senior/respite care Worker





Dog grooming

Part time Secretarial

Food Vendor

Temp service jobs

Questions answers


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