Hand Rehabilitation Issues Affecting
Return to Work

uestions & Answers features staff members of Rockhill Orthopaedics and the Baptist Medical Center Rehabilitation Pavilion. This issue we feature Janet Morgan, OTR, with a specialty in industrial rehabilitation; and Rita Millner, M.Ed., vocational specialist with the Rehabilitation Institute, whose services are contracted to the Pavilion.

Q: What is the next step if a hand patient cannot be rehabilitated enough to return to a former job?

Morgan: Typically we complete an in-depth functional capacities evaluation to assess abilities and limitations so we know exactly this person's capabilities. We evaluate such things as grip strength, ability to lift, carry, push and pull, ability to climb a ladder. All types of work-related functional activities are reviewed.

Millner: In the meantime, I gather specifics about the physical demands of the person's former job so we can compare tasks versus abilities. Once the patient has completed work hardening and his or her physician has determined what job restrictions there will be, we may go back to the employer to work out modifications for the job, or we may try to find another job with the employer that this person can do. If the patient cannot return to his or her job, then we may approach the employer and/or the insurance company about outplacement services, or provide information regarding other vocational services that would be beneficial.

Q: Do you find employers reluctant to have employees who have experienced work injuries return to work for fear they will re-injure themselves?

Morgan: Just because a patient can't go back to the original employer doesn't mean he or she can't go back to some form of work. We know people do better overall if they work, so that's our goal.

Millner: Employers worry when they see splints and casts. We're working hard to change old perceptions. We are finding that because of the Americans with Disabilities Act (ADA), employers are educated and therefore are more willing to work with us in returning employees to work.

Q: How do you help patients accept the realities of new restrictions on what they can and can't do?

Morgan: We use a team approach in our work hardening program. Each patient's team consists of an occupational therapist, a physical therapist, a physical therapy assistant, a vocational specialist and a psychologist. We work together to help the patient with all facets of return-to-work issues. This tam approach is part of the work hardening concept formulated in the 1980s by a psychiatrist named Leonard Matheson who recognized that beyond acute therapy, the worker also needed assistance with vocational and psychological issues. Many injured workers are afraid of going back to work, or they may get lost in the system and never get back to work. We want to insure against these possibilities.

Millner: The patient is a key member of the team. We try to help the patient focus on his or her strengths, skills, abilities and how these can be applied to their existing job, or to other jobs within the labor market.

Q: What is an example of your team helping to get an injured worker back to work?

Morgan: One of our recent patients was a food service worker in an institutional setting, a woman with 20 years on the job. Because of repetitive stress trauma, she had to have surgery, twice on each hand for carpal tunnel syndrome. She went through acute rehabilitation with a hand therapist, as well as work hardening, but could not return to her former job.

Millner: She wanted to stay with her same employer. We worked closely with the employee health nurse and identified a job still within the food service field that we thought might work. We then did a job site analysis, found out what skills were necessary, and integrated that information into her work hardening program. When her physician felt she was ready, she started the job part time and eventually worked into full time. Currently, it's going very well.

Q: What is the secret of ensuring that your team works together successfully?

Morgan: Good communication and the ability to focus on the common goal of helping somebody return to employment.

Millner: I would add to that utilizing the expertise of each team member.

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Return to "On Track" Spring 2000