Return-to-Work Rehabilitation

Our occupational therapists combine knowledge of impairment and disability with expertise in job analysis, ergonomics, and functional evaluation to provide customized Return-to-Work programs that meet the needs of employers, insurance companies and workers. They are skilled in assisting clients with physical, cognitive/neurological and mental health conditions. Programs are provided in collaboration with the client’s physician, healthcare team and employers to ensure a coordinated and well supported plan is implemented. Clients are actively engaged in helping design their Return to Work Program. For client’s requiring job placement or training to re-enter the work force, our assessments can assist vocational consultants and funders by identifying client abilities, limitations, adaptive equipment and compensatory strategies that can be used to design a successful vocational plan. Occupational therapy assessments can also address risk of injury in the workplace.

Return to Work (RTW) Program

The purpose of the RTW program is to facilitate a return to pre-injury/disability occupation. If the client’s job is no longer available, the program objective is to increase functional tolerances to match pre-injury job demands.

RTW programs typically begin with a Work Capacity Screen. Depending on the degree of disparity between job demands and client function, recommendations may include a RTW Activation program followed by a Graduated Return to Work (GRTW) or direct entry into a GRTW. A Worksite Evaluation may be utilized to clarify job demands and formulate the GRTW. These components are further described below.

Work Capacity Screen (WCS)

A work capacity screen (WCS) is conducted to determine physical abilities and limitations in relation to critical job demands. The screen includes range of motion, strength, postural tolerances, body dexterity, and lifting, carrying, and other job specific functional requirements. For clients with cognitive limitations, this assessment determines the functional implications of cognitive skill deficits related to critical job demands. The client's level of awareness and ability to generalize compensatory strategies to the job-site is determined. The WCS determines the potential to return to work by comparing the client’s functional capacity to critical job demands.

Worksite Evaluation

The work site evaluation (WSE) further quantifies physical, cognitive and/or psychosocial job demands in clear and work relevant terms. The WSE is conducted in collaboration with the client and employer. Assessment findings are correlated with the client’s functional abilities to facilitate development of an achievable Graduated Return to Work (GRTW). In some situations, a WSE is conducted to establish parameters for an OT supervised Activation RTW Program and/or clinic-based Work Conditioning Program. The WSE also provides an opportunity to determine adaptive equipment requirements and ergonomic strategies that will effectively reduce the impact of symptoms and the risk of re-injury. An emphasis on adapting work style ensures workers approach new or previous job tasks in a safe and efficient manner.

Return to Work Activation

Activation may be an important part of a Return to Work program when a client is not work ready due to insufficient functional and/or activity tolerance. Activation RTW is a function-based program that combines home and community activities, exercise and/or work simulation activities, in order to increase a client’s activity tolerance in preparation for the return to work process. Activities may include work simulation tasks within the home, household management tasks and/or other productive tasks that are work-relevant (i.e. tasks requiring sustained postures or sustained attention). Client education on pain management, “hurt versus harm”, pacing, body mechanics/posture, work simplification, compensatory strategies and energy conservation is also provided. Activation RTW programs are delivered by a kinesiologist under the direction of an occupational therapist and/or physiotherapist and provide the opportunity to increase the core physical, cognitive and functional skills necessary to participate in work duties.

At the end of a RTW Activation program, if the client is demonstrates insufficient activity tolerance, participation in a clinic-based work conditioning program can facilitate the next step towards GRTW. Following a period of work conditioning, the client then proceeds to the GRTW program component. If the client has no job to return to, a final Work Capacity Screen may be conducted to establish functional ability to meet critical job demands. Depending on the nature of presenting return to work barriers, a full day Functional Capacity Evaluation may be indicated.

Graduated Return to Work

A Graduated Return to Work plan is developed based on assessment of functional abilities compared to information gathered about critical job demands. The occupational therapist modifies and grades job tasks to facilitate safe and productive work performance. Symptom control strategies, work task modifications and ergonomic equipment may also be implemented in the workplace.

For clients with cognitive impairment, the Graduated Return to Work program offers the opportunity to generalize compensatory strategies learned in the community to the workplace setting and increase productivity to a level acceptable for paid employment. If competitive employment is infeasible, supported employment and/or a durable volunteer placement is targeted.

Functional Capacity Evaluation (FCE)

A 1-2 day comprehensive evaluation determines the client’s current functional capacity and identifies transferable physical skills. The assessment relies on standardized, criterion referenced and activity simulation tests to build a profile of client abilities & limitations that can be used to generate realistic vocational options or evaluate the suitability of potential training and employment programs. Assessment findings can also be compared against a variety of non occupational activity demands including homemaking, childcare and leisure activities. Assessment addresses body dexterity, muscle strength, range of motion, postural tolerances, fingering and handling, lifting, carrying and other abilities. Evaluation of physical effort, reliability of symptom and disability reports and stability of function qualifies findings. In addition to determining client abilities and limitations, FCE can also identify specific rehabilitation services and aides that may enhance or help maintain client function.

Please visit our Workplace Health page for information regarding about our Ergonomic Assessments & Job Demands Analyses.

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