exercise for optimization of work performance and occupational rehabilitation n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
EXERCISE FOR OPTIMIZATION OF WORK PERFORMANCE AND OCCUPATIONAL REHABILITATION PowerPoint Presentation
Download Presentation
EXERCISE FOR OPTIMIZATION OF WORK PERFORMANCE AND OCCUPATIONAL REHABILITATION

Loading in 2 Seconds...

play fullscreen
1 / 86

EXERCISE FOR OPTIMIZATION OF WORK PERFORMANCE AND OCCUPATIONAL REHABILITATION - PowerPoint PPT Presentation


  • 363 Views
  • Uploaded on

EXERCISE FOR OPTIMIZATION OF WORK PERFORMANCE AND OCCUPATIONAL REHABILITATION. WORK DEMANDS. Physical Task Demands. Work Content. Mental Task Demands. Required Qualification Processor. Physical Environment Demands. Work Context. Non-physical Environment Demands.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'EXERCISE FOR OPTIMIZATION OF WORK PERFORMANCE AND OCCUPATIONAL REHABILITATION' - Anita


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

WORK DEMANDS

Physical Task

Demands

Work Content

Mental Task

Demands

Required

Qualification

Processor

Physical

Environment Demands

Work

Context

Non-physical

Environment Demands

slide3

Job placement assessment

Job Modification

Education &

Training

Work

Conditioning

Work

Demands

Workers’

Qualification

slide5

Seating

Standing

Walking

Kneeling

Squatting

One-legged

Crouching

Crawling

Climbing

Others

Extremity postural

Demands

slide6

Repetitive work

Body segment

Force and Posture

Static work

slide7

Seating

Standing

Walking

Kneeling

Squatting

One-legged

Crouching

Crawling

Climbing

Others

Dynamic work

Extremity postural

Demands

Static

slide8

Aerobic

Energy

System

Anaerobic

Circulatory Function

Cardiorespiratory

System

Heart Function

Respiratory Function

ROM

Physical Fitness

Flexibility

Joint

Tissue

Muscular

Neuromuscular

System

Neural

Fat Mass

Body

Composition

Fat-free Mass

stress s train

Biomechanical

Physiological

Psychological

Stress Strain

Disorders

slide10

TISSUE RESPONSES TO PHYSICAL STRESSORS

Load

Response

Symptoms

Adaptation

Impairment

Disability

work risk factors of prolonged standing
WORK RISK FACTORS OF PROLONGED STANDING
  • Circulation
  • Muscle fatigue
  • Joint compression
slide13
Develop and improve:
  • Strength
  • Endurance
  • Cardiovascular fitness
  • Mobility
  • Flexibility
  • Stability
  • Co-ordination, balance and functional skills

Work

Demands

introduction
Introduction
  • Low back pain is the most common work-related msuculoskeletal disorders, and cause most socio-economical burden.
  • LBP claims account for 16% of all workers compensation claims and 33% of total claims costs (Bernard et al., 1997)
definition
Definition
  • Prevalence
    • percentage of people in a certain population who suffer from the condition concerned
  • Point Prevalence
    • percentage who are found to be suffering at a certain moment in time ( i.e. when the survey is conducted)
lbp prevalence
LBP Prevalence
  • About 70% of people will suffer from one or more episodes of LBP at some time or another during their lives

Bernard 1997

prevalence of low back disorders
PREVALENCE OF LOW BACK DISORDERS
  • Local:
  • 39% in general population (Lau et al., 1995)
  • 58% in a group of manual handling workers
lbp natural history
LBP Natural History
  • Most episodes of LBP are relatively short-lived (subsided within 6 weeks).
  • Recurrent rate is very high (60%)

Biering-Sroenson 1983

sickness absence
Sickness Absence
  • 6 months absence: likelihood of returning to work fall to about 50%
  • After 1 year absence: 25%
  • After 2 years absence: virtually nil
work related risk factors
Work-Related Risk Factors
  • Physical Factors
    • Heavy physical work
    • Lifting and forceful movements
    • Bending and twisting
    • Whole body vibration
    • Static work postures
  • Non-physical factors
    • Psychosocial factors

Bernard 1997

effects of physical activities in the prevention of lbp
EFFECTS OF PHYSICAL ACTIVITIES IN THE PREVENTION OF LBP
  • Strong evidence that PA has a primary preventive effect on LBP
effects of pa in secondary prevention van tulder et al 2000
EFFECTS OF PA IN SECONDARY PREVENTION (Van Tulder et al., 2000)
  • Acute LBP - strong evidence that exercise therapy is NOT more effective than inactive treatments or other active treatments.
  • Low stress aerobic activity during the first 2 weeks is indicative to improve recovery and lessen disability.
slide24
Chronic LBP – strong evidence that exercise therapy and conventional physiotherapy are equally effective and exercise therapy is more effective than usual care by GP
  • Strong evidence that strengthening exercises are more effective than other types of exercise.
  • Strong evidence that exercise diminishes the musculoskeletal and cardiorespiratory effects
types of exercise and training principles
TYPES OF EXERCISE AND TRAINING PRINCIPLES
  • FITT
  • TYPES: STRENGTHENING
          • STABILIZER
          • ENDURANCE
          • STRENGTH
  • TYPES: MOBILIZING
rationale
RATIONALE:
  • Relationship between the probability of injury and percentage of strength capacity used by the worker at work. (Chaffin 1973)
  • Relationship between the incidence of firefighter back injuries and level of physical fitness. 7.1% least fit, 3.2% moderate, 0.8% most fit (Candy et al., 1979)
effects of a four week muscle strengthening program on maximum acceptable lifting load
EFFECTS OF A FOUR-WEEK MUSCLE STRENGTHENING PROGRAM ON MAXIMUM ACCEPTABLE LIFTING LOAD

Yeung SS. et al., 1998

method
METHOD
  • Subjects= university students (N=19)
  • Isokinetic measurements of back extensors, knee extensors, shoulder abductors, and elb. Flexors.
  • Maximal acceptable lifting load (psychophysical approach)
training protocol
TRAINING PROTOCOL
  • 4 WEEKS OF TRAINING
  • LOAD: 80% PEAK TORQUE
  • WEEKLY ADJUSTMENT BY 5%
results
RESULTS
  • Significant training effect on MALL and back extensors
yeung ss ng gyf 2000

EFFECTS OF SQUAT LIFT TRAINING AND FREE WEIGHT MUSCLE TRAINING ON MAXIMUM LIFTING LOAD AND ISOKINETIC PEAK TORQUE OF YOUNG ADULTSWITHOUT IMPAIRMENTS

Yeung SS., & Ng GYF 2000

method1
METHOD
  • 36 University Students
  • Training approach:

1. free weight muscle strengthening program;

2. Task specific training programme; and

3. Control

results1
RESULTS
  • Significant improvement in MALL and back extensors
  • No significant differences between the training protocol
objectives
OBJECTIVES
  • To stress both damaged tissue and healthy tissues for tissue repair but avoid excessive loading
  • Exercises that challenge muscle but impose minimal joint loads
exercise principles
EXERCISE PRINCIPLES
  • Frequency: most beneficial when performed daily
  • No pain No gain ?
  • General conditioning exercise is important
  • Endurance more protective value than strength
  • Flexibility (mobilizing) should best be performed at unloaded position
  • No fixed recipes, exercise should be tailored made
back extensor exercise
BACK EXTENSOR EXERCISE
  • Pr lying arch back
  • ½ support back extension
  • Single leg extension with hand and knee support
abdominal exercise
ABDOMINAL EXERCISE
  • No single abdominal exercise challenges all of the abdominal musculature:
  • Curl-up challenges mainly RA
  • Sit-ups (leg straight or knee bent) = high psoas activation and disc compression
  • Leg raises causes even higher activation and compression
  • Isometric side support for QL
occupational rehabilitation
OCCUPATIONAL REHABILITATION
  • To facilitate a return to work or ensure an employee remains at work, ideally in his or her original job
  • Different terminology:work, industrial, vocational rehabilitation
disability management

Work

Conditioning

FCE

Work

Hardening

Acute Mx

Return to Work

Work

Demand

Analysis

Work

Modification

DISABILITY MANAGEMENT

Injury

functional capacity evaluation
FUNCTIONAL CAPACITY EVALUATION
  • Functional: Meaningful, useful and purposeful
  • Capacity: maximum ability and capability
  • Evaluation: Systematic approach including observation, measurement, reasoning and conclusion
functional capacity evaluation1
FUNCTIONAL CAPACITY EVALUATION
  • Systematic, comprehensive approach
  • Objective and valid measurements to predict a person’s ability to perform work related tasks.
functional capacity evaluation2
FUNCTIONAL CAPACITY EVALUATION
  • Generic - Baseline Capacity Evaluation
    • Usually based on physical demands of DOT
  • Job oriented – Job capacity Evaluation
    • Focus on the match of the worker’s ability to the work demands of specific job
  • Worker oriented – Work capacity Evaluation
    • Determine worker’s capabilities to the basic demands of earning occupation
application
APPLICATION
  • Ensure workers’ health and safety in job placement (OSHA);
  • Identify an individual’s physical abilities and limitations (ADA)
  • Determine an injured worker wage-earning potential and return to work abilities (Insurance company and legal profession)
slide49
FCEs
  • ARCON
  • BLANKENSHIPS
  • TRACKER
  • BTE
  • ERIC
  • MVE Battery Tests
  • Non-computerized system
typical components of fces
TYPICAL COMPONENTS OF FCES
  • Interview – patient information
  • Job analysis (questionnaire)
  • Behavioural profile
  • Physical measures/muscuoskeletal evaluation
  • Physiological measures
  • Functional measures
  • Comparison of testing with job requirements
functional measures
FUNCTIONAL MEASURES
  • Isometric strength test (6 positions)
  • Material handling test (3 positions)
  • Frequency of manual handling: Occasional (0-33%), frequent (34-66), and constant (67-100%) manual handling
  • Hand function – hand and pinch grip
  • Fine hand dexterity
  • Non-materials handling test
  • Positional tolerance test
isometric strength test
ISOMETRIC STRENGTH TEST
  • Arm Lift
  • Torso Lift
  • Leg Lift
  • High Far Lift
  • Floor Lift
  • High Near Lift
occasional material handling tests
OCCASIONAL MATERIAL HANDLING TESTS
  • 0-33% of the working day, <32 repetitions
  • Psychophysical approach
  • Floor to knuckle
  • Shoulder lift
  • Overhead lift
  • Carrying - 30 ft.
  • Pushing/Pulling - 30 ft.
frequent material handling tests
FREQUENT MATERIAL HANDLING TESTS
  • 33-66% of working day or 32-200 repetition per day.
  • 4 lifts in 20 seconds
hand tests
HAND TESTS
  • Maximum Grip Strength Test - Jamar
  • 5-position Grip Test
  • Rapid Exchange Grip Test
non material handling activities
NON MATERIAL HANDLING ACTIVITIES
  • Sitting
  • Standing
  • Walking
  • Bending
  • Reaching
  • Squatting
  • Kneeling
non material handling activities1
NON MATERIAL HANDLING ACTIVITIES
  • Crawling
  • Climbing
  • Balancing
  • Arm Controls / Leg Controls
acron
Interview

Physical measures/muscuoskeletal evaluation

Physiological measures

Functional measures

Comparison of testing with job requirements

Standardized format

Hand Strength Testing System

Pinch Strength Testing System

Electronic Goniometer

Lifting platform

Methods-Time Measurement

ACRON
occupational rehabilitation1
OCCUPATIONAL REHABILITATION
  • Initial Occupational Assessment
  • Functional assessment
  • Advice or assistance in vocational re-education
  • Advice or assistance in job-seeking
  • Work Conditioning
occupational rehabilitation2
OCCUPATIONAL REHABILITATION
  • Occupational Rehabilitation Counselling
  • Functional Education
  • Workplace Analysis
  • Vocational Assessment
  • Vocational Re-education
team approach
TEAM APPROACH
  • Injured worker (worker’s family)
  • Physician
  • Therapist
  • Psychologist
  • Vocational specialist
  • Ergonomist
return to work
RETURN TO WORK
  • How much can this injured work perform?
  • Suitability of job
  • job demand
  • restrictions / limitation
  • how to imposed
return to work program
RETURN TO WORK PROGRAM
  • Initial Occupational Rehabilitation Assessment
  • Functional Assessment
  • Vocational Re-education
  • Assistance in Job seeking
  • Working Conditioning
slide74

Seating

Standing

Walking

Kneeling

Squatting

One-legged

Crouching

Crawling

Climbing

Others

Dynamic work

Extremity postural

Demands

Static

work conditioning and hardening
WORK CONDITIONING AND HARDENING
  • A structured, goal-oriented, individualised program
  • To improve the biomechanical, neuromuscular, cardiovascular/metabolic, behaviour and vocational function
  • Education of injury prevention
  • Work-risk identification
work conditioning
WORK CONDITIONING
  • Training should be based on job requirement (job analysis) and work functional limitation (FCE)
typical work conditioning program
Typical work conditioning program
  • Warm-up and stretching exercise
  • Cardiovascular training – ergometer, treadmill, stair-stepper
  • Lumber stabilization training – therapeutic balls
  • Strength & endurance training – circuit training (multi-gym), dead wt, isokinetic training)
  • Balance – BAPS, therapeutic balls
  • Functional activities – MMH
  • Work simulation activities
  • Dexterity training – hand or upper limbs injury (e.g. Perdue peg board, Valpar)
  • Education & pain management
work hardening
WORK HARDENING
  • Interdisciplinary
  • use real or simulated work activities in a relevant work environment and conditioning tasks.
  • Address patient’s physical, behavioural and vocational needs
  • Daily sessions: 4-8 hrs/day
difference between work conditioning and health related conditioning
Difference between work conditioning and health related conditioning
  • Exercise prescription based on job requirement and FCE (job goal oriented)
  • Identifiable outcome measure (work nature that can be performed)
  • Multiple components involves education components related to work
slide81

Seating

Standing

Walking

Kneeling

Squatting

One-legged

Crouching

Crawling

Climbing

Others

Dynamic work

Extremity postural

Demands

Static

work conditioning and hardening1
WORK CONDITIONING AND HARDENING
  • Potential client
  • Chronic injured worker
  • Poor physical conditioning
  • Compromised cardiovascular status
  • Pain on activities
  • Psychosocial dysfunction
slide84

Conditioning

Work conditioning

Work Hardening

Strength

Endurance

Cardiovascular fitness

Flexibility

Mobility

Stability

Co-ordination

Job simulation

Education

Training

Vocational

Rehabilitation

Psychosocial

Rehabilitation

references
REFERENCES
  • Key GL. (1995) Industrial Therapy, Mosby- YearBook Inc., Chapter: 14-15, 21.
  • Isernhagen JS. (1997) Industrial Physical Therapy In: Orthopaedic and Sports Physical therapy. Ed. Malone TR, McPoil T. & Nitz AJ. 3rd edition, Mosby.
  • Yeung, S.S., Chan, M.C., Leung, D.C., Ma, M.S., Tsang, S.Y., 1998, The effects of a four-week muscle strengthening program on maximum acceptable lifting load, Journal of Occupational Rehabilitation, 8(4): 265-272.
  • Yeung, S.S., Ng, G.Y.F., 2000 Effects of Functional Lifting Training and Free Weight Muscle Training on Maximum Acceptable Lifting Load and Isokinetic Peak Torque of Normal Young Adults. Physical Therapy, 80:570-577.
slide86
McGill SM. 1998, Low back Exercise: Evidence for improving exercise regimens. Physical therapy 78: 754-765.