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Challenging Accommodations – Tips for RTW Success

© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504

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Challenging

Accommodations- Ergonomic Tips for RTW Success

Presented By:

Marnie Downey, M.Sc., CCPE, R.Kin.

About Inc.

www.ergoconsulting.ca

Workshop Objectives 1. Background on RTW

Pitfalls & barriers to successful RTWs

2. Accommodation The role of ergonomics

3. Accommodating challenging injuries Upper limb injuries – elbow vs. wrist examples Back injuries – sitting limitations

4. Beyond Accommodating- Cleaner



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Return to Work

Source: The Office of the Worker Advisor

Return to Work

Rates of successful RTW decline once client has been out of the workforce for over 1 year

Key is early reporting and early intervention

Responsibilities Employer

– To accommodate to the point of undue hardship once worker can perform the “essential duties”



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Responsibilities Employee

⁻ To work within abilities/precautions

⁻ To assist in identifying suitable work/accommodations

WSIB

– Provide information, clarify functional abilities

– Resolve disputes, & provide RTW or WTS services

Common Pitfalls – RTW too early

Barriers / Warning Signs

ₓ RTW too soon

ₓ RTW with unclear diagnosis

ₓ RTW with no functional information

ₓ Absences after returning

Good Process

Accurate timing of RTW

Good functional abilities information

RTW Plan that is flexible

Source: Institute for Work and Health

The “Diagnosis” Barrier



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Common Pitfalls – Inappropriate Work


ₓ Embarrassing work

ₓ Making up jobs for employee to RTW

ₓ Using one job as the “modified” task

ₓ Addressing only physical restrictions

ₓ Co-worker harassment

Good Process

Collaboration

Productive, meaningful work provided

Completion of Physical Demands Assessments

Review of pre-injury job first, then provide alternative work

Educating all parties on RTW


Common Pitfalls – Unsuitable Tasks


ₓ Not able to perform job tasks

ₓ Attempting to accommodate vague restrictions

ₓ Requests co-worker assistance

ₓ Can not keep up with production

Good Process

Discuss accommodation requirements

Workplace Assessment

Physical Demands Assessments

Ongoing monitoring

Job coaching


Ensure Suitable Tasks Clarify precautions and functional abilities to ensure appropriate job matching



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An Effective Job Match

Review essential duties of the job (PDA)

Determine if injured workers capabilities equal the job demands

If they do not, accommodation is required

Function Demand

Low High

Function Demand

Low High

No match

Rehabilitation Accommodation

Common Pitfalls – Lack of Accommodation


ₓ Not agreeing on accommodation needs

ₓ Lack of physical accommodations

ₓ Inflexible learning environment

ₓ Assuming other workers will help with “heavy” tasks

ₓ Work absences

Good Process

Appropriate workplace ergonomic accommodations

Written accommodation plan

Alternative learning

Follow up and reviews for resolution of issues


Job Accommodation

A change in the work environment or job tasks that enables a person with an impairment to participate in workplace activities safely and productively.

Source: National Institute of Disability

Management & Research



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Accommodation

Common Pitfalls – Poor RTW Process

Barriers

ₓ Setting up entire plan for complex cases

ₓ Employee is overwhelmed

ₓ No opportunity to modify plan

ₓ Too fast or too slow progression of hours and work duties

Good Process

Collaboration

Flexible RTW plans

Regular status reviews

Hours of progression based on employee health and progress and injury type


Accommodating Upper Limb Injuries



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Upper Limb Injuries

Common types – shoulder, elbow, wrist

Common limitations:

– Repetitive work

– Lifting

– Above shoulder work

– Reaching

– Gripping

– Handling

Upper Limb Injuries

Do we accommodate all types of upper limb injuries the same?

The Healthy Elbow

The forearm is in the most relaxed/neutral posture when the elbow is bent approx. 90° and the thumb is pointed up

Hand shake position

Neutral

S(ou)pination Pronation



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The Healthy Elbow/Forearm

Are elbows bent more than 90 degrees?

Is there direct contact on the inside elbow bone?

Is the forearm rotated?

The Healthy Wrist

Hand in a relaxed position with fingers below knuckles

No fingers elevated. E.g. ‘tea drinkers’ pinky elevation

Ideal neutral hand posture

Hands and fingers should be relaxed with tips of fingers falling lower than knuckles.

Try: Could you sit your palm on a golf ball? That shapes hand into relaxed posture.



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The Healthy Wrist

Are wrists bent more than 20 degrees?

Is the employee over gripping the mouse?

Are accessories too small or large for the user?

Alternate Mice Designs

Evoluent vertical mouse

– Left or right handed models

– Regular and small sizes available (right)

– Has been modified regularly to improve performance

Accommodating the elbow

Promote neutral forearm and elbow joint

Use mouse and keyboard that allows more neutral postures (like handshake)

The forearm may be okay, is the wrist?



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Alternate Mice Designs

Contour Roller Mouse (free, pro

red)

– Ensures that there is minimal lateral (to the side) reaching (some reaching in front may occur in smaller stature people)

– Eliminates gripping

– Large learning curve

Accommodating Back Injuries

Back Injuries

Common types – muscle & disc



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Back Injuries

Common limitations include:

– Lifting

– Pushing / Pulling

– Prolonged sitting and / or standing

– Bending / Stooping

Case Study

1. Bill is returning to work from an accident that injured his lower back.

2. He has permanent sitting limitations (Not > 1 hr).

3. No lifting > 10 lbs. 4. He works at his

computer for 90 % + of the day

Necessary Accommodations

Ability to stand

Frequently

Ease of adjustment

Change in posture



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Sit stand ‘modify’ options

Scissor lift platform

– Temporary and semi-portable solution

– 7 heights, up to 9.25”

– Suitable for lower desk

– Approx. Cost: $295

Acceptable for Bill?

Sit stand ‘all-in-one’ options

Add-ons to work desk keeping continuity between keyboard/mouse and monitor



Ergotron WorkFit-S

All in one sit-stand units either sit

or clamp directly on desk

Adjustable keyboard & monitor

arms

Various models

Ensure height ranges is

acceptable for employee




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Dual Kangaroo

free-standing desk

unit

Quick Stand by

Humanscale


Varidesk.com

An affordable (as low as $275) all in one option that

sits directly on a work surface.

Sit Stand Desks

Electric or hydraulic

Allows frequent and easy changes in height

All equipment is kept at desired placement – continuity between keyboard and monitor

www.ergocanada.com

Elite or Electra height adjustable

bases

Need a desk top or use your own

Float Table

by

Humanscale


http://www.ergocanada.com/



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Case Study – Beyond the Accommodation

Cleaner Accommodation

Cleaner RTW

All accommodations have been provided.

3 weeks after returning a follow up is completed. • Not using tools provided at all or not properly

• Shoulder remains sore

• States to employer that they are having difficultly mopping and wiping surfaces.

What do you do? Why was this not a successful RTW?



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Beyond the job match…. Identify barriers to assist with problem solving

Facilitate communication between worker, employer, medical providers, and others

Job coaching for pacing and good body mechanics

Employer/supervisor may need education on condition, particularly in case of chronic pain

QUESTIONS?

Upcoming Events

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challenging accommodations- › wp-content › uploads › 2017 › 11 › 18534... ·...

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