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Educational Objectives. Understand the concepts of injury and the role of the physician in rehabilitation of the injured worker with painRecognize the complexity of the pain processList the stages of disability in workers compensation injury systemIdentify the frequent problems in the evaluation
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1. Rehabilitation of the Injured Worker with Pain Sridhar V. Vasudevan, M.D.
Clinical Professor of P.M.& R.
Medical College of Wisconsin Milwaukee, WI
2. Educational Objectives Understand the concepts of injury and the role of the physician in rehabilitation of the injured worker with pain
Recognize the complexity of the pain process
List the stages of disability in workers compensation injury system
Identify the frequent problems in the evaluation & management of work injuries
Discuss the strategies useful in effective and efficient rehabilitation of the injured worker
3. DEFINITIONS INJURY
WORKER
RESIDUALS OF INJURY
ACUTE PAIN
CHRONIC PAIN
CONCEPTS OF DISABILITY
REHABILITATION
LIMITATION / RESTRICTION
CONCEPTS OF DISABILITY
4. Definitions / Concepts INJURY
A mental or physical harm to an employee caused by accident or disease.
It includes damage to or destruction of artificial members (hearing aids, eye glasses )
5. Definitions / Concepts WORKER
Employee covered by the workers compensation laws of the State of Wisconsin. (Wis. Chapter 102 )
At the time of the injury, the employee should be performing services OUT OF and INCIDENTAL TO the employment
The injury is not intentionally self inflicted
6. Definitions / Concepts RESIDUALS OF INJURY
Pain
Weakness
Decreased range of motion- Stiffness
Deformity
Amputation
Decreased endurance
(All leading to “ Disability from Work “)
7. Definitions / Concepts ACUTE PAIN
A warning of a physical condition needing correction
Is biologically meaningful, useful, time limited
An UNPLEASANT Sensory AND Emotional EXPERIENCE which is primarily associated with tissue damage or described in terms of such damage or both ( I.A.S.P. )
8. Definitions / Concepts CHRONIC PAIN
A condition that lasts beyond its healing period ( 3 to 6 months ) and is associated with significant lifestyle alterations including : loss of employment, decreased physical, social, and recreational activities, psychological changes and disability
Frequently associated with D’s that include: Drug misuse, Depression, Deconditioning, Disuse, Dysfunction & Disability that exceeds identifiable objective pathology
9. Definitions / Concepts CHRONIC PAIN
Persistent or recurrent acute pain of sufficient duration and intensity to adversely effect the function of the person (WMS)
NOCIOCEPTION – Tissue injury
PAIN – Unpleasant sensory experience
SUFFERING – Emotional consequence of pain
anxiety, fear, depression
PAIN BEHAVIOR – What a person says, does, or does not do, that indicates pain
10. CONCEPTS OF DISABILITY PATHOLOGY
Is the change occurring from injury and the response of the body
Altered Anatomy and / or Physiology
Example: Lumbar strain, Disc herniation with radiculopathy, rotator cuff tendinitis
11. CONCEPTS OF DISABILITY IMPAIRMENT
The anatomic, physiologic, psychologic abnormalities or loss that are medically determinable by objective means
May be temporary or permanent
Examples: Decreased range of motion, decreased sensation / strength, absent reflexes, abnormal MRI / EMG, depression, decreased cognition
12. CONCEPTS OF DISABILITY LIMITATION OF FUNCTION
Those functions that could be POTENTIALLY limited due to the impairment (s)
Example: Inability to do overhead work, Inability to lift over 20 lbs. avoid twisting
13. CONCEPT OF DISABILITY DISABILITY
Task-specific inability to perform specific function that may be related to the role of the patient
Example: Inability to perform heavy construction job
14. REHABILITATION A treatment PROCESS concerned with the medical, physical, psychological, social, emotional, and vocational aspects of the individual.
It focuses on maximizing FUNCTION and assisting in the assumption of USUAL ROLES, in individuals with impairments that compromise function
15. DEFINITION / CONCEPTS LIMITATION
Activities that “ CAN’T” be done due to
Anatomic loss- amputation, contracture
Functional loss-vision, hearing, sensory loss
Subjective symptoms- pain, fatigue, dizziness
Motivation- secondary gain, FEAR, stress avoidance
16. DEFINITION / CONCEPTS RESTRICTION Activities that “ SHOULD NOT” be done as they may: Delay healing Aggravate condition Accelerate course of disease Precipitate symptoms Provide safety threat to employee and co-workers