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Work Hardening

Work Hardening. Arbeitsbezogene Rehabilitation (ABR). Work Hardening. The focus of this treatment is to build capacities for quick and safe return to work. Milestones in the development of Work Hardening. L. Matheson (Ende 70er-Jahre)

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Work Hardening

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  1. Work Hardening Arbeitsbezogene Rehabilitation (ABR)

  2. Work Hardening • The focus of this treatment is to build capacities for quick and safe return to work.

  3. Milestones in the development of Work Hardening • L. Matheson (Ende 70er-Jahre) • Work Hardening-Programm = Work oriented program that has an outcome which is measured in terms of improvement in the client’s productivity • T. Mayer und R. Gatchel (1988) • Functional Restoration for Spinal Disorders. The Sport Medicine Approach

  4. Milestones ... • S. Isernhagen 1991 • Functional Capacity Evaluation and Work Hardening Perspectives • L. Darphin (1995) • Work-Hardening and Work-Conditioning Perspectives • M. Nordin (Campello et al 1998) • Approaches to improve the outcome of patients with delayed recovery

  5. In Switzerland • Ergonomie-Trainingsprograms since 1995 • Rehaklinik Bellikon • Unispital Zürich • Klinik Valens Growing need for new clinics…

  6. Guidelines, Accreditation • Commission for Accreditation of Rehabilitation Facilities CARF (1988) • American Physical Therapy Association APTA (1991)

  7. Guidelines APTA: Definition • Work Hardening is a highly structured goal-oriented, individualized treatment program designed to return a person to work. Work Hardening programs, which are interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions. Work hardening addresses the issues of productivity, safety, physical tolerances, and worker behaviors."

  8. Work Conditioning Undisciplinary Work Hardening interdisciplinary Guidelines APTA: Treatment

  9. Work Conditioning Work Conditioning Assessment Physical Conditioning Work related functional Aktivities Work Hardening Work Hardening Assessment Work related physical Conditioning Real or simulated workability Psychosocial Interventions Guidelines APTA: Treatment

  10. Guidelines APTA: Triage for Work Conditioning and Work Hardening

  11. Criteria for admission to a work hardening program: • The worker is able to participate in a progressive rehabilitation program for a minimum of 4 hours a day, three to five days a week. • A specific return to work goal is identified. • Ability to benefit from the program based on a screening process. • The worker has still a Job (= not unemployed)

  12. Global goals for Rehab 1. Zielorientierung Goaling process:functional and work related goalsetting Work with weekly goals “Self Efficacy” Basic elements for Work Hardening

  13. Basic elements ... 2. Painmanagement and coping with pain • Information and practical teachingabout pain coping strategies

  14. Basic elements... 3. Work related Assessment • The Base: Evaluation der funktionellen Leistungsfähigkeit EFL • Important:Evaluation of symptom magnification

  15. Baseline Tests • Complete patient history related to current diagnosis and any past medical history important to the FCE evaluation. • Cardiovascular response to activity • Pain intensity and PACT-questionnaire pre and postrehab • Assessment of fine motor skills • Assessment for balance • Positional tolerance testing • Material handling test • Musculoskeletal evaluation if there is evidence of symptom magnification or submaximal effort Functional Capacity Evaluations are performed by Occupational Therapists and Physical Therapists who have had specific training in performing Functional Capacity Evaluations.

  16. Individualized programs include: • Simulated job activities with body mechanics instruction to prevent re-injury • Aerobic conditioning • Flexibility and strengthening exercises • Learning about pain coping strategies • Relaxationtechniques • Sports and leisure time activities

  17. Material Handling Janitorial Services Delivery Jobs Construction Tasks Clerical Task Packaging Operations Electrical Wiring Climbing Ladders  Packaging Jobs Simulated Truck Cab Stocking of Shelves Wallboard Installation Brick/Block Building Electronic Assembly Use of Shovels & Rakes Use of Drills & Saws Use of Hammers & Screwdrivers Some actual job simulations include:

  18. Specific job simulations allow the patients to place their bodies similar to those of their actual jobs

  19. “Work is the grand cure of all maladies and miseries that ever beset mankind.” Thomas Carlyle, 1866

  20. Wenn ich dass gewusst hätte das ich 100-jährig werde, hätte ich besser auf meinen Körper geachtet - ein 100-Järige Kinese -

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