A Tale of Two Accommodations

It was the best of accommodations, it was the worst of accommodations….

All apologies to Charles Dickens for stealing his famous opening line but over a very short time period several years ago, we were sent two claimants who fell at the extremes of what can happen during workplace accommodations following a workplace injury.

In both cases, accurate job descriptions could have prevented these issues.

The first of the two cases was an employee at a county run mental health facility.  Unfortunately, we evaluated this claimant after they were injured in the position that was used as an accommodation after their first workplace injury.  The employee’s second injury was a reinjury of their right rotator cuff, which had been injured in the first injury.  At the time of the employee’s first injury, she worked as a Certified Nurses Assistant.  While transferring a patient, she suffered a tear of her right rotator cuff for which she underwent surgical repair of the rotator cuff.  She attended physical therapy for approximately 3 months following surgery.  At the conclusion of physical therapy, the claimant was accommodated through placement in a different position after the treating physician suggested that she was not able to safely return to her previous position as a CNA.  An FCE to determine her physical abilities at the end of treatment was not performed.  The employer chose to accommodate the employee by offering her a position within the housekeeping department of the facility, specifically in a position that was responsible for distribution of clean linens and collection of dirty and/or used linens.

Within 4 months of being switched to the housekeeping department, the employee was lifting a bag of dirty linens into a tall rolling cart when she tore injured her right rotator cuff for the second time.  She underwent a second surgical repair and was sent for an FCE after completing physical therapy.  She provided a consistent effort during the FCE and qualified at the light work level (20 pounds occasional, 10 pounds frequent, negligible constant).  In both cases, the employer did not have customized job descriptions for either of these job titles.   

The Dictionary of Occupational Titles places the CNA position and the linen staff for housekeeping in a hospital at the medium work level (50 pounds occasional, 25 pounds frequent, 10 pounds constant).  While lacking a customized description that accurately and objectively defines the minimum essential physical demands, a cursory look at the DOT entries would indicate that this accommodation was a transfer to a position with a similar physical demand level as the position that the physician had recommended against.  Having measured the physical demands for both positions at several facilities, while the overall tasks performed are different, the forces required to push, pull, and lift in performance of tasks is similar.  Employees working in linen services in most hospital facilities face overstuffed bags of dirty linens that have to be lifted to shoulder height or above when placing in laundry carts as well as several other physically demanding tasks.

The second case started off slightly different.  He had been sent for an FCE due to injuries sustained in a vehicle based accident at work.  Based on the customized job description that was provided by the employer, his FCE results indicated that he did not meet the essential minimum physical and postural demands of his position.  The employer identified a variety of tasks that could be performed by the employee in an accommodation based on his demonstrated physical abilities during the FCE.  They asked us to perform an onsite visit to measure the physical demands and postures of the tasks that would be offered as an accommodation to the employee.   As we were evaluating tasks, the supervisor showed us the equipment on which the employee had been injured.  As we were looking at the equipment, I dug into my notebook where I had a copy of the provided job description. 

The onsite equipment did not match the job description that we had been provided with for the test.  The equipment used for the employee’s job title provided ground level access with handrails and required only an 8 inch step to climb onto the equipment.  The job description had indicated a step height of 22 inches.  We brought this to the attention of the supervisor who looked at the description that I had brought with me.  He realized that they had been using a company wide description that did not accurately reflect the equipment at each of the sites.  The description had been based on a location in another state. 

We continued to evaluate the proposed accommodations but we also measured the demands for the position that the employee held at the time of injury.  After collecting all of the data, a review of the employee’s FCE performance versus site specific equipment measurements indicated that the employee could return to his full duty position with no restrictions.  Fully documented addendums were sent to the case manager and the treating physician.  The treating physician returned the employee to full duty.

While the second case had a successful outcome for both the employer and employee, the case could have been resolved about 1 month earlier had the provided job description been accurate for the specific worksite.  In the first case, a second injury with subsequent surgery may have been prevented if the accommodated position had been validated against the individual’s physical abilities.  In both cases, accurate job descriptions could have prevented these issues.

“Please Do Not Lick Me”

A favorite BBQ place of mine, Mainely Meat on Mt. Desert Island in Maine,  has a silhouette of a Sasquatch in the middle of its outside dining area.  It’s a fun thing to put the kids next to for a picture.  One day, last summer, I was seated behind the Sasquatch and noticed some writing on the back.  It said “Please don’t lick me.”  It was one of those things that I was not going to be able to let go of without finding out the story.

“Please Do Not Lick Me” written on back of Sasquatch – all because someone licked Sasquatch.

When I asked the waitress, she said that they felt that they had to place the instructions on Sasquatch after they brought out an order to a table, only to find somebody licking Sasquatch.  She finished the story with “I never thought I’d have to tell people to not lick a big wooden silhouette of Sasquatch.” 

At that point, I looked at a friend who was dining with us and we both laughed.  He is a park ranger and we have both sat down numerous times to share stories of people doing silly things that should have never happened in the first place.

I was sharing this story recently when I was out in the field doing interviews of personnel to write a job description for a public works department.  The two employees laughed, started to say that something like that would never happen, and then began to remember some things that they have seen and agreed with my comment that most rules are put in place because of somebody doing something that wasn’t the brightest idea.

At the most simple level, we all deal with this when buying electronics and footwear.  Almost all shoes come with a silica gel pack to absorb moisture emblazoned with the instructions “Do Not Eat”.  The gel packs are not poisonous but the beads don’t break down and can become a choking hazard – this happens more frequently than one would expect.

Often, TV commercials have disclaimers to remind viewers that a car or motorcycle was driven at high performance levels on closed tracks and that you shouldn’t try it at home or if you aren’t a professional stunt driver.

A warning statement because somebody might try to travel back to the future in a Delorean.

Recently, popular culture has had several products that have been involved in dangerous fads, such as eating Tide pods.  It doesn’t take much to know that consuming a Tide pod is a bad idea but some people still tried it anyway.  With the recent pandemic, this has extended to drinking bleach or consuming other chemicals in hopes of preventing an infection.

There is a great Twitter feed, @safetyphoto that reinforces the concept that sometimes we need to remind people not to do something – even though we think that nobody would try doing it.  If you’ve had the thought that nobody would be dumb enough to try a certain action, you probably need a sign because it isn’t a matter of if, it is a matter of when.  In the field, I have had people explain to me how they perform certain tasks and then they stop to think for a minute about the process they shared.  That pause is typically followed with “You don’t work for OSHA, do you?”

Feel free to share your stories of “things you thought people wouldn’t do” in the comments. 

Bringing Back School Buses After The Shelter In Place

It has been a guessing game in many states as to how the 2020-2021 school year is going to start at the end of this summer.  While many are focused on how to physically distance the classrooms, handle lunches, run physical education classes, and keep classrooms disinfected, there is another area that needs to be addressed well before teachers and students return to the school grounds. 

Many school districts parked their buses in their transportation department parking lots back in the middle of March when shelter in place orders went into effect.   They have now been sitting for longer than they would during a typical summer break – and many schools use their buses during the summer to transport students involved in extended school year programs.  Long term non-use of the school vehicles can cause many different problems when they are brought back into usage. 

“Buses are vehicles. Vehicles aren’t meant to sit, they are meant to move.”

– Mike Werner, Director of Fleet Maintenance for Cobb County schools during a recent podcast.

This means that while the administration and faculty are determining the best way to address the return to school guidance provided by the state, the transportation staff needs to be assessing the mechanical status of their bus fleet and preparing them for whatever the upcoming school year may bring. 

Keep in mind that if schools are running split sessions on a daily basis, the amount of mileage and general wear and tear on the fleet of buses will be double.  This may also cause a change to maintenance intervals when compared to a typical school year. 

Transportation directors and their mechanics/maintenance staff should look at starting their bus evaluation program earlier than they may typically start during a normal summer.  They need to plan to address issues of logistics for personnel, bus inspections and maintenance, and plan for issues related to cleaning and disinfecting vehicles.

Guidelines for the logistics of keeping your transportation staff healthy include:

  • Determine whether changes need to be made in scheduling your mechanics to allow them to practice appropriate physical distancing (keeping in mind that this is not always possible when performing tasks that require two people to perform).
  • If you have more than one shift of mechanics, build a 15 minute “break” into the end of each shift for mechanics to write notes about vehicles that are being repaired rather than having them verbally update the second shift.
  • If there is a shared breakroom for mechanics and drivers, separate the room into individual areas to reduce mixing of mechanics and drivers.  Reduce the number of chairs and tables as appropriate to encourage physical distancing.  Try to encourage one way use of entrances when possible – create a “one way traffic flow”.
  • Plan for appropriate pre-screening procedures based on established public heath guidelines for your region.  If temperature checks are required, make sure that this is built into the plan for someone to be available to screen bus drivers before their shifts and that they are aware of the time that the drivers will need to be screened.
  • Determine how the vehicle maintenance schedules will need to be adjusted for vehicle inspections and required maintenance based on updated school schedules.
  • Determine how changes in usage and schedules will impact onsite parts inventories.
  • Plan now for the possibility that as buses are put back into operation that there may be shortages of required parts due to the fact that buses have sat for extended periods through out the country.

Vehicles that have been sitting for the last several months will need:

  • A solid review of the electrical and mechanical systems by your maintenance staff which should include a test ride with a duration of 20-25 minutes for each vehicle which will allow the mechanics to complete an “eyes and ears” inspection in addition to checking fluid levels and voltage levels.
  • A check of the engine bay for evidence of animal infestation as well as checking wiring throughout the vehicle for damage by mice or other rodents.
  • A check of not only the visual condition of the tires but ensuring that there is still a good seal.
  • A check of the charging system as well as checking the batteries for damage due to parasitic discharge.
  • After the vehicle has been taken for a test drive, it should be checked for fluid leaks due to seals that may have dried out during the last several months.
  • Parts such as wiper blades may have dried out over the last several months
  • Check emergency buzzer switches as well as other switches that may have contacts that have failed over time. 
  • Lightbulbs (both interior and exterior) may need increased replacement.
  • Plan for having your mechanics and/or drivers routinely drive the vehicles after they are inspected until school restarts so that seals do not dry out and any problems can be addressed.  Do not let them sit after they have been inspected.  Establish a set driving route so that all vehicles are getting the same amount of operational time – approximately 20-25 minutes.

Cleaning and disinfecting of buses will need to be readdressed:

  • Communicate with your school community (teachers, students, families) about how you are cleaning and disinfecting the vehicles in terms of schedule as well as the agents used so that they are more comfortable with the process.
  • Remember that different surfaces react differently to each type of disinfectant.  The strongest chemical may not be the best for every situation.
  • Using the wrong chemical solution on instrument gauge clusters can cause the lens over the cluster to fog up.
  • Using bleach on seatbelts will shorten the safety lifespan of seatbelts by breaking down the fibers of the seatbelt.  The damage may not be visible but it can decrease the strength of the fibers. 
  • Make sure that there is adequate ventilation when cleaning and disinfecting – for the cleaners on the bus as well as the mechanics if the bus is being cleaned and disinfected indoors.
  • Clean bus floors first so that dirt and dust on the floor is not spread into the air as the cleaning staff moves about the bus.
  • Remember that cleaning and disinfecting a school bus is a four step process:
    • Clean – cleaning helps to remove the dirt and residue that can hide pathogens (bacteria, viruses, etc.)
    • Disinfect – Disinfectants are used to either kill/deactivate or disrupt the reproductive cycle of any pathogens that are left after the cleaning phase.  Please note that each disinfectant agent has a specified dwell time (time that the surface is wet with the agent) for each type of pathogen.  Information can be obtained by the manufacturer or if being used for disinfecting surfaces for coronavirus prevention on the EPA’s List N.
    • Rinse – The rinse phases is important as it helps to remove any chemical residues from the cleaning and disinfecting phases that may cause irritation to drivers and/or students who ride the bus.
    • Dry – Dry the surfaces that have been cleaned, disinfected, and rinsed.

Returning students to school is going to be a big project for all stakeholders. Transportation of the students is just one part and this post has been a small discussion of some of the issues that will need to be addressed by district personnel that are tasked with transportation issues. Transportation of students is a difficult situation in the best of times with issues of budgets, driver shortages, and scheduling. Over the next couple of weeks, we will provide additional posts to help identify areas that may help in terms of getting school transportation back up to speed safely.

Don’t Forget Hand Sanitizer May Be Flammable

Last week, the Mechanical Contractors Association of America put out a reminder that hand sanitizers that contain alcohol are flammable.

Current guidance from the Centers for Disease Control suggests that individuals in clinical settings should be using hand sanitizer (an alcohol based hand rub with greater than 60% ethanol or greater than 70% isopropyl alcohol) due to greater compliance over soap and water.  If hands are visibly soiled or if an alcohol based hand rub are not available, hands should be washed with soap and water for at least 20 seconds.

When using an alcohol based hand rub, you need to make sure that your hands are dry and all of the alcohol has evaporated off before touching anything.  The MCAA put out the reminder that hand sanitizers with alcohol are flammable due to an incident where an employee used hand sanitizer per guidelines to sanitize his hands.  However, the alcohol had not evaporated off of his hands when he touched a metal surface.  The remaining alcohol in the hand sanitizer on his hands was ignited by static electricity.  The employee was able to get to a sink and extinguish the flames however he suffered first and second degree burns on his hands.

When using hand sanitizer please be aware of any risks of flames or sparks and make sure that you allow your hands to fully dry before touching anything that can generate a spark or a static discharge.

20-038-Hand-Sanitizer-Hazard

20-038-Hand-Sanitizer-Hazard

Looking For A Longer Term Shelter In Place Work Chair?

When I initially posted about “virtual school” ergonomics in March, it was with the intent that those tips would be a temporary fix. Ordering office equipment and supplies from places like Amazon isn’t any quicker than it was back in March at the early stages of sheltering in place, but for many states it looks like many of us will be working from home for a while longer.

I’ve been seeing posts and hearing that the kitchen chair or bench at the table isn’t really working out any more and that aches and pains are starting to become a little more chronic. This is not a surprise as these chairs aren’t made for sitting in all day long. The good news is this is a problem that can be corrected. Where and how you sit is an important part of reducing aches and pains.

The before and after photo below shows a couple of quick changes with setting up a temporary home workstation.

savannah ipad before and after

While this photo illustrates using an iPad and keyboard, the process is the same when using a laptop.  On the left, the chair is set too low and the feet are not adequately supported.  With some adjustments, the feet are supported and the chair is at a better height for using the keyboard without stressing the wrists, elbows, or shoulders.  With the display slightly higher, there is less flexion of the neck and the back posture is improved.  With a regular kitchen chair, it would be much more difficult to improve sitting posture for using a keyboard without adjusting the desk height.

A good chair for performing desk work should:

  • Allow you to maintain a good neutral posture with the ears over the shoulders and the shoulders over the hips.
  • Allow you to adjust the height to get you to an appropriate height for using the keyboard and mouse.
  • Provide adjustable back rest support to allow the back rest to be upright or slightly reclined.
    • Provide adjustable support for your lumbar spine.
  • Have a seat pan that supports the upper legs and provides a 2 to 4 finger gap between the front edge of the seat pan and your knees.  This helps to make sure that the seat isn’t too short and not supporting your thighs as well as not being too long and reducing blood flow at the knees.
  • Have your knees slightly lower than your hips.
  • Provide adjustable arm rests that can raise to a level that support your arms when typing at the computer.
  • Has a weight capacity that will accommodate anybody that will be using it.  The hydraulic cylinder that allows the chair to raise and lower has a weight capacity (typically between 250-275 pounds) but stronger cylinders are available based on user weight.

The Kroy Mesh Task Chair from Staples is a solid, basic ergonomic chair with a reasonable price for home usage.  It has adjustable arms, lumbar support, and the main hydraulic cylinder can accommodate users up to 275 pounds.   (Note:  I have no affiliation with Staples and do not earn anything from any purchases via the link.)

The image below demonstrates optimal angles for sitting and standing when using the computer. As mentioned above, when sitting, the ears should be over the shoulders and shoulders over the hips. The keyboard should be at a height that allows your elbow to be flexed between 90 and 120 degrees (whether sitting or standing).

basic sitting and standing postures

What about my feet touching the floor?

You shouldn’t let your feet dangle in the air. If your feet don’t touch the floor once you have adjusted your chair for your workspace (correct height for using the computer keyboard and mouse and performing other tasks on your work surface), you need to use a footrest to support your feet. A box or a stack of books work as a good temporary foot rest. Ideally, an adjustable height foot rest, such as the Eureka Ergonomic Tilt Adjustable Footrest, works best as it is easier to adjust to the appropriate height for a range of users.  (Again, I do not receive any compensation for these linked items.)

What if I have to use my kitchen chair?

While not ideal, using your kitchen chair is not the end of the world.  If you can add a thin seatpad to cushion the seat and a lumbar pad or lumbar pillow to support your back, you can make your kitchen chair comfortable for longer stretches.  Make sure that you have a box or footrest to support your feet.

What else should I know about being more comfortable in my chair at home?

Get out of your chair at least once an hour to move around and stretch.  If you didn’t spend the bulk of your work day sitting in your normal work environment, you won’t be used to sitting all day at home.  Walk around the room a little bit.  Do some easy backward bends and bend forward towards your toes.  Remember when you are stretching, you should feel slight discomfort but not pain.

A few additional resources

“Virtual School” Ergonomics – This blog post discusses best improvised setups for using tablets and laptop computers, raising the laptop to a better display height, and adjusting the chair and footrest.  It also covers improving ergonomics if you have to use a couch as a workstation.

Here is a powerpoint presentation on SlideShare that I have put together that explains some ergonomic basics for improving your temporary workstation, including converting a kitchen

 

 

 

 

 

 

 

 

 

 

 

What Infection Control Practices Will Come To Your Workplace?

The Smithfield plant in Sioux Falls, South Dakota is the largest current coronavirus hotspot in the United States (over 600 positive cases related to the plant as of today). When states reopen for business, there are going to need to be changes in how businesses operate in terms of physical distancing of employees. Gov. Murphy of NJ is already talking about restaurants operating at about 50% capacity to provide physical distancing of customers and employees (along with employees wearing masks).  Many stores have gone to special hours to protect their customers who are at greatest risk.

cvs at risk customers

PPE (masks, etc.) are typically considered by safety professionals as a line of last defense in protecting an individual after exhausting the usage of elimination and substitution.

ppe pyramidElimination involves whether a task has to be done – can the task step be eliminated?  That may be no longer performing a task onsite by getting a completed component from another vendor or eliminating areas of the production floor where people may congregate with no value added function.   Substitution looks at whether a different process can be used to make the same process safer.  Both of these are effective but may take more time to implement – and in the current situation may be difficult with reduced supply chains both nationally and internationally.

Companies will need to look at engineering controls such as physical distancing, protective barriers (such as the plexiglass shields now being used to protect retail cashiers in food stores) and administrative controls such as altering production rates, staggering shifts to reduce employees onsite at a given time, and temperature check points before entering a job site. Both engineering and administrative controls will be impacted by ability to decontaminate areas between shifts.   Companies will need to incorporate a combination of these controls.

In practical application, medical offices and personal care offices will need to look at changing how some services are performed (telemedicine becomes a great tool for both substitution and elimination controls – does the person need to be seen or can they be treated by telemedicine) as well as administrative and engineering controls (spacing out appointments, having people wait in cars or changing the waiting areas to increase personal distancing).

There will be a new normal when people return to business. It remains to be seen what that new normal will be for each business.    What do you think will be changed at your work site?

Never Too Early To Start Teaching Basic Safety

Sometimes the fun activities that our kids become involved in provide lessons well beyond what we would expect. Some of these lessons are well known – many sports help to teach kids discipline and teamwork. Scouting helps to teach a variety of basic principles including many involving safety – I know that my son and his friends took all of the lessons from earning their Whittling Chips seriously. We still hear them reminding each other of the blood circle (for those without scouts, this is the circle that one can make with an extended arm and a carving knife – the rule is everyone needs to be out of each other’s blood circle).

Over the last couple of months, I’ve realized that my son’s newest hobby is teaching him many advanced safety lessons that will carry over well when gets older. Much of it is safety training that should be taught to adults on worksites.

My 11 year old son recently acquired a Traxxas Slash RC car through a lot of saving and a lot of chores. While learning how to cut the grass and the associated safety issues with lawn mowers is a post for a different day, this whole process has been a learning experience for him.

One of the chores was cutting the grass, which helped to teach him about lawn mower safety and the use of some basic PPE – eye protection and ear protection. Most modern lawn mowers include their own version of a simple “lock out tag out” in that an additional handle needs to be held in the closed position to operate and if it is let go, the mower shuts down. This is a good start to understanding that certain tools should only be energized when being operated in a safe manner.

When he received his Slash, he learned several new safety concepts. The first has to do with batteries and charging. His slightly older cousin, who is also involved in RC cars, had warned him that you need to be careful with Lithium Ion RC car batteries. With a little bit of extra research, my son has learned that you need to physically inspect the battery pack on a regular basis to make sure that there is no physical damage to the battery. Each time he either plugs in the battery or unplugs the battery, he checks the battery to make sure that there are no bulges in the battery or damage to the battery that causes the casing to open. He has also learned that care needs to be taken in charging batteries through using appropriate battery chargers and using a fire resistant battery charging case to reduce the risk of damage in the event of problems.  Everything in the list below while directed towards the use of an RC car can be applied to most tools used in the workplace:

  • Never leave batteries to charge unattended.
  • Remove the batteries from the model while charging.
  • Allow the battery packs to cool off between runs (before charging).
  • Always unplug the battery from the electronic speed control when the model is not in use and when it is being stored or transported.
  • Do not use battery packs that have been damaged in any way.
  • Do not use battery packs that have damaged wiring, exposed wiring, or a damaged connector

The second concept is an extension of the “lock out tag out” concept that I mentioned earlier is getting reinforced for him with his RC car. RC cars are paired to their controllers which allows multiple cars to be operated by multiple users in the same area. As a result, he has learned that when he is turning on his car, the controller gets turned on before the speed controller on the car is powered on. This prevents the car from running out of control when it is turned on. While this is not “lock out tag out” in the traditional sense, it has taught him to always think about procedures when turning things on and off as well as making sure that motors and controls are de-energized before working on them.

The third concept that he has learned from using his RC car involves situational awareness. At the most basic level, he has learned to know the limits of the radio control of his car both from radio distance and visual limitations so that he does not operate the car unsafely in a way that can hurt other people or damage other property or his car. More importantly, he has learned to be aware of any potential issues in the area in which he is operating his car – he has developed a solid idea of whether he has enough room to operate the car or if there are objects in the area that represent a danger to himself, others, or his car.

I’m glad that he is learning these in a way that he is able to understand how basic safety rules work and is able to understand the next phases of those rules. This learning process has been helpful because it is not just me as a parent putting a rule in place. He sees the rules in the manual for his car and has begun to understand how they keep him safe, keep others around him safe, and protect his investment in his car.  The fact that he is learning them while having fun makes me hopeful that they will continually be reinforced for him – I know that I have seen him explain these concepts to friends when they use his car.

traxxasDSC_0098-Recovereda

You Can’t Have Good Work Conditioning Without Good Job Descriptions

Recently**, a physical therapist who I’ve known for years reached out to me for some advice. She had two patients that were being sent for “work conditioning” to her. The problem was that job descriptions weren’t provided for either of the two patients. She knew that the “I only have to do this…..I never have to do that” wasn’t the whole story. She also knew that I had been involved in writing job descriptions for those positions for some of our clients. Having performed Functional Capacity Evaluations with us in the past, she also knew that having a solid job description is key in matching up demonstrated performance to essential physical and postural demands.

Work conditioning is defined by the American Physical Therapy Association as “work related, intensive, goal-oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The objective is to restore the injured employee’s physical capacity and function for return to work.”

Without understanding what the functional demand is for a specific position, it is difficult to define the goals of a work conditioning program. One of the patients that she had inquired about was a school bus driver. He had told my friend that he “really didn’t have to do much beyond sit in the driver’s seat and drive. Maybe, open the door every so often to let the kids on in the morning or off in the afternoon.” He was returning to work from a lower extremity injury that resulted in a joint replacement. Having performed FCEs for school bus personnel before, she knew that the demands were more but was unsure of the other tasks.

School bus drivers are tasked with performing pre- and post- inspections of their vehicles. This involves checking in and around the vehicle, checking storage compartments (if the bus has one), ensuring that all emergency exits (including the roof exits) are operational, and being able to check under the seats for both children and their belongings. Also, in some districts, bus drivers may be switched to different routes based on employer needs. Switching routes may require drivers to pick up students who may be in wheelchairs. When the wheelchair lift malfunctions, drivers use a manual, hydraulic pump to elevate and lower the lift as needed. This task requires the driver to be able to squat or kneel to a level to operate the manual pump. Drivers, if an aide is not present, may have to secure wheelchairs to floor mounted devices, which requires the ability to kneel while reaching. With demands such as those listed, she needed to work with this patient on being able to step up/down to get into and out of the bus, to be able to kneel to perform tasks, and make sure that the driver demonstrated the ability to perform the overhead tasks of checking the emergency exits. The ability to perform these demands are even more important as a result of the NTSB school bus driver recommendations that I mentioned in a January blog post.

Based on the APTA definition, work conditioning covers a larger swath than when the patient was being treated solely for the injury that brought them to physical therapy. During that initial portion of the treatment, therapy focused on the needs of healing for the specific body part along with improving range of motion and strength as appropriate based on the healing process. Work conditioning helps to pick up to make sure that the other aspects of the injured worker such as their cardiovascular endurance, strength, power, and muscular endurance are not impaired when they are returned back to work. As a result, work conditioning includes activities to improve physical capacity in all of these areas. When an individual begins a work conditioning program, their initial status in these components should be documented – both as a baseline as well as for comparison to the essential postural and physical demands. This will help the therapist communicate to the patient, the case manager, the physician, and the employer as to where the patient is in regard to return to duty.

When quarantine/shelter in place orders begin to be lifted, work conditioning is going to play an important role in returning workers that had been out on workers comp prior to the pandemic to their previous roles. For many of these patients, they may have been shifted over to telerehab as clinics closed for safety issues. Telerehab and “virtual physical therapy” are great for keeping in contact with the worker and moving them along in their rehab journey as best as can be done in these circumstances. However, they may not have access to the resources or guidance to recondition themselves for work prior to returning to their job. Correcting this deconditioning is going to be vital to their success upon return to work as well as for reducing their risks for suffering another injury after return to work.

Yellow school bus. Vector illustration
Yellow school bus. Vector illustration

** – I had started writing this several weeks before all of the “shelter in place” orders started to come down from the different states and it sat in a draft folder for a while. As I revisited the draft after a little over 3 weeks in quarantine, it made me think about the fact that some injured workers currently in PT may be deconditioned if not by now, but definitely by the time the shelter in place orders are lifted. Getting these workers into a work conditioning program at the soonest appropriate time point may be the best chance for a successful return to work process.

Staying In Work Shape During A Pandemic

The newest extension of federal physical distancing guidelines now extends until the end of April. For many, that means that they may be out of work for six or more weeks before returning to work.  When we return to work after a vacation, it can take a couple of days to get back into “work shape” but most vacations are only a week or two in duration. Six weeks is a lot longer but with a few tips, we can stay healthy and maintain fitness levels to be ready to return to work.

  • Gyms are closed but there are lots of choices that you can make. Walking is a great choice, especially if you job involves walking on a daily basis. There are many great apps that you can download onto a tablet or a smartphone that will help guide you through a home based, body weight work out. If your job involves lifting and carrying, you may have objects in your garage, shed, or yard that you can pickup and carry in the yard to simulate work type tasks. If you don’t have a weight set but want to do slightly more formal lifting, you can build your own sandbags. Sandbags can be used to simulate many gym movements. Find some steps to climb or a walking route with a hill to maintain/build leg strength. YouTube and Amazon Prime both have plenty of exercise videos that you can use for guided workouts.
    • You Are Your Own Gym is a great app, developed by an Air Force Pararescue NCO, for an at home workout that does not require any fancy equipment.  We have recommended this app to several firefighters in the past who didn’t like the gym and they loved it.
    •  A couple of simpler one exercise apps are 100 pushups200 situps, and 200 squats.  They work to build up the amount of repetitions you can do of each exercise.  A pre-test serves as a baseline to guide workouts.  My advice is to deduct a couple of reps from your pre-test when giving the app the information to build the workouts.
  • Maintain good sleep hygiene. A lack of sleep can compromise your immune system. Set a regular bed time and wake time.  There is a great TED Talk on sleep  by Matthew Walker as well as a great podcast interview series between him and Peter Attia, MD.   Freakonomics did a great podcast on the economics of sleep.
  • Eat healthy. This is admittedly tricky with limited selection at the food stores as well as potential per customer limits on certain products. Try to limit the amount of processed foods for main meals and limit the unhealthy snacking choices during the down time between meals. If you can, try to make sure that you pick up some fresh fruits and vegetables with each food run at the store.
  • Stay hydrated. It’s easy when you are sitting at home to either not drink enough or to drink the wrong things. But make sure that you are getting enough water and limit the soft drinks.
  • Don’t Overdo the Exercise. If you regularly train, either strength or cardio, this is not the time to be working towards a PB in a strength exercise or a PR in an event. Don’t go out and try to win KOM honors on Strava for your daily ride. Super intense workouts that leave you beat up for a day or two tend to weaken the immune system a little.   This is a time for people who regularly exercise/train to work on base building and work on correcting any weaknesses that they may have.

me sandbagRight now, I’ve been walking my talk while I’ve been working from home. We have been trying to be good about what we are eating in our house and have tried to stay to the healthier food in our every 7-10 day food runs. This helps limit the in between meal snacking. I’ve been doing some sort of exercise every day, getting the kids out for long walks or bike rides. Some of the workouts are mine alone such as kettlebell workouts, rides on my bike on the trainer, and I am starting to work my way through a deck of Bruteforce Sandbag workout cards that I had received as a stocking stuffer from my wife. Stay safe, be smart, and wash your hands.

If you have any questions about what type of exercises are appropriate to stay in work shape for a particular type of job, drop me an e-mail at quin@njergonomics.com.

Words Matter – Switching to Physical Distancing from Social Distancing

With over 15 years of writing job descriptions, post-offer testing, FCE experiences and ergonomic evaluations, you learn that in the world of workers compensation, physical rehab, and the legal realms that swirl between that words matter. We try to get people to use the term “modified duty” instead of “light duty” because the latter has been accepted by some to mean performing job demands with minimal physical requirements (some look at it as 20 pounds occasional, many look at light duty as 10 pounds or less). We’ve also tried to move people from “Pass/Fail” to “Meets/Does Not Meet” as the former is more about the individual and the latter is more about the actual demands of the position.

Mark Milligan (@MarkMilliganDPT) is an innovative DPT down in Austin, Texas who has been trying to get people moving over the last couple of years through the #IMovedToday hashtag on Twitter and has been a huge advocate for mobile and virtual services through his anywhere.healthcare business and his physical therapy practice. Mark had a great idea that he shared on Twitter on March 20, 2020. He suggested getting rid of the term “social distancing” and replacing it with “physical distancing”. I think he is definitely on to something.

physical distancing

In thinking about it, physical distancing is a significantly better term. We’re talking about staying 6 feet away from people when out in public or if the person is symptomatic at least 10 feet away. Or in California and New York (and probably New Jersey in the near future), staying in when possible and shutting down non-essential businesses to limit exposure. Physical distancing just means we are separated by a physical separation of distance. Humans by nature are social. In times like this, we shouldn’t be distancing ourselves socially from each other. We need to be reaching out by phone, text, e-mail, Facetime, or Skype to check on relatives, friends, neighbors, and co-workers. Sometimes it may be just to say hello and check in but sometimes to let them vent or to vent to them. This is uncharted territory but communication and connection are two of the things that will help everyone get through this together.