Month: April 2020

Looking For A Longer Term Shelter In Place Work Chair?

Quin Bond, CEAS IIILeave a comment

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?

Quin Bond, CEAS IIILeave a comment

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

Quin Bond, CEAS IIILeave a comment

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

Quin Bond, CEAS IIILeave a comment

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.