Transcript People`s Injury Network Presentation - Oregon Self

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PINN is an Industrial Rehabilitation therapy
provider
We have been in business for over 12 years
Each PINN Clinic specializes in treating the
Injured Worker through a multidiscipline
approach with both Physical & Occupational
Therapy
PINN has a thorough understanding of the
industrial rehabilitation needs of the Injured
Worker
Our PINN Clinics are at least 5,000 square feet in
size
What services do we provide?
Physical Therapy
Work Conditioning
Work Hardening
Physical Capacity Evaluations (PCE’s)
Ergonomic Assessments
On-Site Services for Job Analysis &
Job Modification
Extended Evaluations
Vibrasym Driving Evaluation (PINN Kent)
Post-Operative Testing
or
FCE
Functional Capacity Evaluation
Presented by:
Peoples Injury Network Northwest, (PINN)
Is “a process of measuring an individual’s
ability to dependably sustain performance in
response to broadly defined physical work
demands over time”
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Evaluate current work tolerances and
potential work capacity
Provide information to help determine if an
individual can return to the usual
occupation or perform the work demands of
a new job being considered
If no vocational goals are established
provide guidelines related to the
individual’s physical capacities to assist
with the vocational exploration process
Assist the Medical Professional in
completing the Attending Physician Form
(APF)
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Safety
Reliability
Validity
Practicality
Utility
Respect
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Doctors
Chiropractors
Claims Managers
Attorneys
Vocational
Rehabilitation
Counselors
Nurse Case
Managers
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Explain the purpose of the evaluation
◦ Collect reliable information
 Current physical and functional abilities as that relates
to vocational considerations
◦ Inform the client that they need to participate
with:
 High level of effort
 Reliability of Pain and Disability Report
 Do not perform any activity that they perceive to be
unsafe
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Usually 1-2 days
Determine level of
physical effort and
reliability of pain and
disability report.
Evaluator must be
objective
Should answer the
referral sources
questions
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First Level PCE◦ Limited evaluation primarily to measure
musculoskeletal components of a specific body part
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Active range of motion
Motor Power Using the 5/5 scale
Sensation
No less than 45 minutes of actual patient contact
OAR 436-009-0070(4)(a)
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Second Level PCE
◦ This evaluation is to measure general residual
function capacity to perform work or provide other
general information.
 Musculoskeletal evaluation
 To establish Residual Functional Capacities for claim
closure
 No less than two hours of patient contact
OAR 436-009-0070(4)(b)
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Third Level PCE (WCE)◦ This is a Residual Functional Capacities evaluation.
 Musculoskeletal evaluation for a single body part
 Endurance
 Assess ability to perform essential physical functions
of the job based on a specific job analysis as related to
the accepted condition
 Assess ability to sustain activity over time
 Assess reliability of the evaluation findings
 No less than 4 hours of patient contact
OAR 436-009-0070(4)(c)
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Give brief explanation
of what to expect in
the evaluation
Privacy
Communicate Respect
Establish Rapport
Have tissues and extra
pens available
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Mechanism of Injury
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DOI/Onset & Diagnosis
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Physician/ Physician restrictions
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Diagnostic Testing
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Medications
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Age
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Assistive Devices
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Previous medical treatment & Other medical
conditions
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Current sleep duration
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ADL’s
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Subjective Tolerance Levels
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Height
Weight
Blood Pressure
Pulse
Smoker
Alcohol Usage
Medication
Usage
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Sitting, Standing, Walking Tolerance
Total hours alternating sit/stand/walk at
one time
Total hours alternating stand/walk (being
on feet)
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Lifting capability frequency and levels
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Carry capability frequency and levels
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Push/Pull capability frequency and levels
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Reaching
Fine Manipulation,
pinching
Grasping, gripping,
forceful grasp
Operate foot controls
Operate hand controls
Twisting
Squatting
Kneeling
Bend/Stoop
Crouch
Climb Stairs
Climb Ladders
Crawling
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A Job Site Analysis is a detailed description of
the essential and non-essential job
tasks/functions and the relevant physical
demands to perform the essential and nonessential job tasks.
PCE should address the client’s
demonstrated physical and functional
tolerances in relation to essential job tasks
and required physical demands.
PHYSCIAL
DEMAND
LEVEL
SEDENTARY
OCCASIONAL*
FREQUENT*
CONSTANT*
0 – 33% OF TIME
34 – 66% OF TIME
67 – 100% OF
TIME
10 lbs.
Negligible
Negligible
10 lbs.
Negligible
LIGHT
20 lbs.
(walk/stand and/or
push/pull of arm-leg
controls)
MEDIUM
50 lbs.
20 lbs.
10 lbs.
HEAVY
100 lbs.
50 lbs.
20 lbs.
VERY HEAVY
Over 100 lbs.
Over 50 lbs.
Over 20 lbs.
(push/pull of arm-leg
controls while sitting)
*Occasional, Frequent, and Constant are terms defined by the Dictionary of Occupational Titles that refer to
the frequency of “exerting a force,” including lifting, carrying, pushing, pulling, or any other physical activity.
“Physical Effort Testing concerns to an
individuals levels of physical exertion during
encountered testing procedures. This type of
testing is best evaluated via a multi-facted
approach under distraction based clinical
conditions. Results of such testing are not
intended to imply intent”
(Kyi, 1997-2009)
 Isometric
– Jamar Grip
 Cardiovascular
– EPIC and NIOSH
heart rate guidelines
 Behavioral
Jamar
Dynamometer
Evaluates:
Strength
Consistency of
effort
Rapid Exchange
 Bell Curve & SD
 Coefficient
variation cut
points
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NIOSH 65-70% of
age predicted
maximum
EPIC - >150% of
Standing Resting
Heart Rate
“The musculoskeletal and/or behavioral
tendency to maximize one’s test score and
performance under evaluation conditions. CTP
is best evaluated in a distraction-based testing
environment (Kyi, 1997-2009 RMA)
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Posture and Alignment
Flexibility/mobility
Strength
Neurological Examination
Gait
Special Tests Waddell and Placebo Tests
Movement patterns, quality of movement,
comparison of movement and pain
Palpation
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Finklestein’s Test
Phalen’s Test
Tinel’s Sign
Femoral Nerve Test
Straight-Leg Raise Test
Patrick’s test (FABERE)
Thomas Test
Cubital Tunnel Syndrome
Yergasson’s Test
Waddell’s Non-Organic Physical Signs and
Placebo test
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Posture
Range of Motion
Gait
PCE should determine if these objective findings
are or are not reliable and consistent as the
client did/did not self limit secondary to
reported pain
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Biomechanical
Cardiovascular – Metabolic
Psychophysical
Blood Pressure exceeds 160/100
Heart rate exceeds the target zone of 85% of
MAAHR
Client develops chest pain, nausea, vomiting,
dizziness, blurred vision, pale
Client is unsafe or is unable to perform activity or
movement patterns
Request to stop
MET/Endurance Testing
• Risk Factors
 Single Stage Treadmill Protocol
 Modified Bruce Treadmill Test
 Balke Substandard Treadmill Test
 Bench Step Test
 Circuit Testing (Material Handling or
non-material handling)
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Purpose is to assess safe
maximum occasional
lifting capacity
Instructions for specific
test protocol and safety
Termination of the Tests:
1. biomechanical failure
2. heart rate
3. client request
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Isoinertial Lifting
PILE test, Lumbar PILE and the Cervical PILE
WEST II Lifting Evaluation
EPIC
Normative data for maximum acceptable
weights and forces
Stover H.Snook and V.M.Ciriello
◦ Ergonomics,1991 vol. 34, No.9,1197-1213
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Endurance circuit to determine
Frequent Material Handling or
Frequent tolerances for work postures
Work simulation to determine
Frequent or Constant tolerances for
work postures
Performed in 30-60 minute
increments
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Method-Time Measurement
– “is a procedure which analyzes any manual
operation or method into the basic motions
required to perform it and assigns to each motion a
predetermined time standard which is determined
by the nature of the motion and the conditions
under which the motion is made”
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MTM - Based on
Industry standards
which are more
reliable in
determining
suitability to a job
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Normative - Based
on a sample
population may be
biased by race,
gender
Percentile scores do
not necessarily
predict whether or
not someone meets
industry standards
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Reliability and Validity
Assess the various diagnoses of the clients to
be seen
Can used assess the type of industry near the
clinic and the type of work performed
Can be used for evaluation or work
simulation
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Evaluates physical tolerances for prolonged
standing, repetitive and sustained horizontal
reaching, stooping , prolonged light strength
work, hand and finger dexterity
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Valpar 9 (Whole
Body ROM)
WEST 7 Bus
Bench
Balancing
Crawling
Stairs
Ladder
Flexibility
Squatting
Crouching
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Used to evaluate a
person’s ability to
manipulate very fine
objects.
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Evaluates a person’s
ability to manipulate
small objects
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Four tests that require
proper selection,
placement and use of
hand tools.
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Evaluates manipulative
skill independent of
intellectual factors such
as understanding of
mechanical principles or
the ability to plan a task
or follow directions
Measures dexterity or
hand function
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Measures strength
and dexterity
◦ 3 point or palmer
pinch
◦ Tip pinch or finger
pinch
◦ Lateral pinch
Jamar Dynamometer
Evaluates: Strength Consistency of effort
◦ Rapid Exchange
◦ Bell Curve & SD
◦ Coefficient variation cut points
RPDR “involves completion of a battery of tests
designed to asses the dependability and
accuracy of a client’s subjective reports of pain
and associated disability. The battery includes
test which evaluate the presence or absence of
non-organic findings as well as tests which
compare a client’s subjective report to their
demonstrate ability through distraction- based
clinical observations.”
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Use to obtain a subjective rating of perceived
ability to perform various household, work
and daily activities
Use for evaluation of client’s with a wide
variety of physical limitations
Evaluates “work function themes”
Evaluates “ unrealistic self-perception of
ability”
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WEST Tool Sort/Loma Linda Activities Sort
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PACT Spinal Function Sort
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EPIC Hand Function Sort
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0=
1-2 =
3-4 =
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5=
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7=
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10 =
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no pain
pain is present but not limiting
pain is starting to affect your ability
to perform current activity
pain causes you to be unable to
complete current activity
you cannot use or move the painful
area, can’t talk, are tearful, need to
lie down
requires immediate hospitalization
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Performed during assessment of range of
motion, strength and movement patterns
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Performed Pre and Post testing
Look for change in movement patterns in
comparison to reported pain and disability
Look for change in performance time in
comparison to reported pain and disability
“The acceptability of the worker in the general
sense i.e. worker traits and behaviors”
The person being evaluated perceives
themselves in the “worker role” and not in the
“patient” role.
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Lack of attention to the evaluator
Resistance to testing - voiced refusal or
fearful of testing
Signs of Anger
Descriptions are too explicit or vague
No future goals or goals are simple with no
detail
Want a better doctor to “fix them”
Lack of active control of symptoms
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Regional symptoms that do not make
anatomical sense
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Inactive lifestyle or “couch potato”
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Has others perform ADL’s/chores
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Reinforcement of behaviors by others
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Noncompliance
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Length of time off work is extensive
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Evaluate Physical effort and RPDR
Intervene and confront the evaluee in a
respectful manner to attempt to foster
physical effort and RPDR
Document the PCE to provide functional
validity.
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U.S. Department of Labor Dictionary of
Occupational Titles, fourth Edition
www.lni.wa.gov Washington State Labor and
Industries
Roy Matheson and Associates
www.oregon.gov Department of Consumer
and Business Services Workers Compensation
Division
Peoples Injury Network Northwest, (PINN)
PINN Kent
PINN Tacoma
20640 84th Ave S
Kent, WA 98032
253-395-1131
6704 Tacoma Mall Blvd
Tacoma, WA 98409
253-475-7466
PINN Olympia
PINN Vancouver
2120 Mottman Rd
Tumwater, WA 98512
360-357-7466
2501 SE Columbia Way
Suite 120
Vancouver, WA 98661
360-260-7466