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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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”
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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Common Pitfalls – Inappropriate Work
Barriers / Warning Signs
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
Source: Institute for Work and Health
Common Pitfalls – Unsuitable Tasks
Barriers / Warning Signs
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
Source: Institute for Work and Health
Ensure Suitable Tasks Clarify precautions and functional abilities to ensure appropriate job matching
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Barriers / Warning Signs
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
Source: Institute for Work and Health
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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Source: Institute for Work and Health
Accommodating Upper Limb Injuries
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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.
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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?
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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
Acceptable for Bill?
Sit stand ‘all-in-one’ options
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
Acceptable for Bill?
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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Sit stand ‘all-in-one’ options
Dual Kangaroo
free-standing desk
unit
Quick Stand by
Humanscale
Sit stand ‘all-in-one’ options
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
Acceptable for Bill?
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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?
Challenging Accommodations – Tips for RTW Success
© ERGO Inc. 2015 www.ergoconsulting.ca [email protected] 705.436.4504
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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?
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Challenging Accommodations – Tips for RTW Success
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