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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” 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) Safety Reliability Validity Practicality Utility Respect Doctors Chiropractors Claims Managers Attorneys Vocational Rehabilitation Counselors Nurse Case Managers 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 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 First Level PCE◦ Limited evaluation primarily to measure musculoskeletal components of a specific body part 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) 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) 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) Give brief explanation of what to expect in the evaluation Privacy Communicate Respect Establish Rapport Have tissues and extra pens available Mechanism of Injury DOI/Onset & Diagnosis Physician/ Physician restrictions Diagnostic Testing Medications Age Assistive Devices Previous medical treatment & Other medical conditions • Current sleep duration • ADL’s • Subjective Tolerance Levels Height Weight Blood Pressure Pulse Smoker Alcohol Usage Medication Usage Sitting, Standing, Walking Tolerance Total hours alternating sit/stand/walk at one time Total hours alternating stand/walk (being on feet) Lifting capability frequency and levels Carry capability frequency and levels Push/Pull capability frequency and levels 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 • • 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 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) 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 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 • • • 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 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) • 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 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 • • • 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 • 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” MTM - Based on Industry standards which are more reliable in determining suitability to a job 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 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 Evaluates physical tolerances for prolonged standing, repetitive and sustained horizontal reaching, stooping , prolonged light strength work, hand and finger dexterity Valpar 9 (Whole Body ROM) WEST 7 Bus Bench Balancing Crawling Stairs Ladder Flexibility Squatting Crouching Used to evaluate a person’s ability to manipulate very fine objects. Evaluates a person’s ability to manipulate small objects Four tests that require proper selection, placement and use of hand tools. 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 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.” 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” WEST Tool Sort/Loma Linda Activities Sort PACT Spinal Function Sort EPIC Hand Function Sort 0= 1-2 = 3-4 = 5= 7= 10 = 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 Performed during assessment of range of motion, strength and movement patterns 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. • • • • • • • 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 Regional symptoms that do not make anatomical sense Inactive lifestyle or “couch potato” Has others perform ADL’s/chores Reinforcement of behaviors by others Noncompliance Length of time off work is extensive 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. 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
