1. Industrial Physical Therapy
Introduction to PT
PEP 2020
Brian T Larsen, DPT

2. 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

3. 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

4. Getting Back To Work Immediate care
May see patient in an emergency situation if PT is on site
Goals 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

5. 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

6. Getting Back to Work Intermediate care
Goal is to restore function, get person back on job
Educate on prevention of re-injury
Review mechanism of injury
Discuss alternative work methods
Ergonomics
Function
May involve occupational therapy

7. Getting Back to Work Extensive care
In more severe injuries (amputation, severe burns, etc.) further physical and psychological intervention may be needed
Goals:
Return to work: work hardening (with medical approval)
De-emphasize disability
Facilitate motivation – be a realist, but don’t underestimate the recuperative power of the body

8. 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 job
Test the person’s ability to complete the minimum requirements of the job and then make recommendation

9. 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
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

10. 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

11. Ergonomics Interaction with person and job environment
Deals with the following:
Design and function of controls and displays
Lighting
Temperature
Work place layout and design
Tools
Work organization

12. 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

13. 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
Strength OR metabolic energy requirements

14. 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 perform
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

15. Prevention of Work Injuries
Basic Design Principles
Goal: minimize weight, range of motion, and frequency of the activity
Conveyors and platforms should be built above the knee and below the shoulder height
The farther away an object is from the person, the more physically demanding it becomes…moment arm forces
Lifting and carrying should be converted to horizontal motion with conveyors and rollers
When required, pushing is better than pulling
Low friction wheels, handles easily grasped in an upright posture

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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