FUNCTIONAL CAPACITY ASSESSMENT

FUNCTIONAL CAPACITY ASSESSMENT (FCA)

1. NITHIN NAIR UNDER GUIDANCE OF DR. POTHIRAJ P. (PT)

2. LEARNING OBJECTIVES After this session students will be able to – Explain the outline of Industrial Rehabilitation Explain Functional Capacity Assessment in a detailed manner.

3. PREVENTION PRIMARY SECONDARY TERTIARY RISK ASSESSMENT ERGONOMIC INTERVENTION ORGANIZATIONAL INTERVENTION PERSON – ORIENTED INTERVENTION JOB ANALYSIS INJURY PREVENTION PROGRAM INJURY CARE POST INJURY CARE PHASE : ( FUNCTIONAL CAPACITY ASSESSMENT) RETURNING TO WORK PROGRAM (WORK CONDITIONING AND WORK HARDENING)

4. SECONDARY PREVENTION AIM TO IDENTIFY WORKERS AT RISK OF INJURY AND MONITORING THEIR HEALTH RECOGITION OF RED FLAGS AND YELLOW FLAGS (POTENTIALLY SERIOUS PHYSICAL OR PSYCHOLOGICAL/PSYCHOSOCIAL RISK FACTORS FOR DEVELOPMENT OF WMSD. TASK ANALYSIS PAUSE EXERCISES / WARM UP EXERCISES / STRETCHING EXERCISES TARGETED OCCUPATIONAL HEALTH PREVENTIVE CHECK UPS OF EMPLOYEES WITH PRE-EXISTING CONDITION / EARLIER DISORDERS/ EXPOPSURES WITH REGARD TO PARTICULAR RISK AT WORK PLACE

5. INJURY ACUTE CARE FCA JOB ANALYSIS WORK HARDENING JOB MODIFICATION CONDITIONING WORK CONDITIONING RETURN TO WORK EXIT ASSESSMENT TERTIARY PREVENTION

6. POST INJURY CARE PHASE TAKE THE REFERRAL SET UP THE FILE SCHEDULE THE CLIENT INTAKE INTERVIEW ORIENTATION / SIGNING – FACILITY POLICIES AUTHORIZATION – RELEASE OF INFORMATION CLIENTS RIGHTS LIST JOB ANALYSIS OR WORK INFORMATION REVIEW ASSESSMENTS FLEXIBILITY / MOBILITY STRENGTHENING CONDITIONING JOB SIMULATION FUNCTIONAL CIRCUIT EDUCATION VOCATIONAL REHAB PSYCHOSOCIAL OUTCOMES ADMINISTER FCA REVIEW MEDICAL HISTORY COMPARE FCA RESULTS WITH JOB REQUIREMENTS DEVELOP EXIT GOAL IDENTIFY PROGRAM LENGTH CONFIRM PROBABILITY OF REACHING JOB REQUIREMENTS LEVEL IF LOW PROBABILITY – JOB MODIFICATION IDENTIFY STARTING POINT IDENTIFY WEEKLY PROGESSION CHECK IDENTIFY BODY MECHANICS ADAPTATIONS NEEDED IDENTIFY EDUCATIONAL NEEDS IDENTIFY EXERCISE NEEDS PLAN JOB SIMULATION ACTIVITIES IDENTIFY NEED FOR OUTSIDE SERVICES. SCHEDULE IMPLEMENT ESTABLISH INTAKE

7. FUNCTIONAL CAPACITY ASSESSMENT IS A PROCESS OF MEASURING , RECORDING , AND ANALYZING A PERSON’S ABILITY TO SAFELY PERFORM A NUMBER OF JOB-RELATED FUNCTIONS SUCH AS LIFTING, LOWERING, PUSHING, PULLING AND CARRYING WEIGHTS, CLIMBING LADDERS AND STAIRS, SITTING, STANDING, BENDING, STOOPING, CROUCHING, KNEELING, CRAWLING AND GRASPING. THE ASSESSMENT RESULTS ARE USED AT APPROPRIATE POINTS IN THE WORKER CARE SPECTRUM TO DETERMINE A WORKER’S SAFE WORKING LEVELS FOR JOB PLACEMENT , INJURY PREVENTION AND REHABILITATION . FUNCTIONAL CAPACITY ASSESSMENT

8. OVERALL NEEDS MORE OBJECTIVITY & LESS JUDGMENT GREATER VALIDITY GREATER RELIABILITY GREATER PREDICTABILITY COST EFFECTIVE PLACEMENT NEEDS MORE OBJECTIVE & ACCURATE MATCHING OF CAPABILITIES MORE PRECISE INPUT INTO JOB MODIFICATION EMPHASIS ON “CAN DO” THAN “SHOULD NOT DO” REHABILITATION NEED RELIABLE ASSESSMENT OF RTW TIME FRAMES & CAPABILITIES PLANNING & DECISION MAKING RELIABLE PRE AND POST COMPARISON OBJECTIVE DETECTION OF MANIPULATION, MAGNIFICATION OR MALINGERING DEPENDABLE ASSESSMENT FOR TREATMENT OUTCOMES PREVENTION NEEDS - ACCURATE IDENTIFICATION – SAFE CAPABILITIES, LIMITS, AREAS OF RISK BETTER INPUT FOR EDUCATIONAL & CONDITIONING PROGRAM RELIABLE DETERMINATION OF SAFE WORK ENVIRONMENT

9. THERAPIST OBJECTIVITY TO MEET LEVEL OF RELIABILITY – 2 DIFFERENT THERAPISTS TESTING THE SAME PATIENT AT THE SAME POINT OF TIME SHOULD GET SAME RESULTS. BY INCORPORATING MORE OBJECTIVITY – THERAPIST EXPOSURE IS REDUCED AND THIS STRENGHTEN THEIR POSITION IN ANY DISPUTE. STANDARDIZED PROCESSING AND REPORTING BY USING FINAL STATISTICS TO VERIFY PROTOCOLS AND INTERRELATE DATA THE RELATIONSHIP BETWEEN FCA RESULTS AND OUTCOMES BECOME QUANTIFIABLE AND PREDICTABLE. THUS THIS REDUCES THERAPIS’S EXPOSURE AND STRENGTHEN THEIR POSITION IN LEGAL OR REIMBURSEMENT DISPUTES. CONSISTENT METHODOLOGY EQUIPMENTS, INSTRUCTIONS, ANALYSIS OR RECOMENDATIONS SHOULD BE CONSISTENT AND STANDARDIZED AS IT IS THE BASIS OF RELIABILITY, VALIDITY, AND REPEATABILITY. TESTING DEVICES / PROTOCOL SHOULD BE SAFE, QUICK AND EASY TO USE. INSTRUCTIONS SHOULD BE CLEAR, NEUTRAL, NONINFLUENCING, NONDEMEANING. COMPLETION POINT OF EACH TASK SHOULD BE DETERMINED OBJECTIVELY AND CONSISTENTLY. INFORMATION SHOULD BE ANALYSED AND REPORTED USING STANDARDIZED METHODS AND REPORTING FORMATS. STANDARDIZED EQUIPMENT EQUIPMENTS SHOULD HAVE GOOD RELIABILITY AND VALIDITY. EQUIPMENTS SHOULD BE MADE TO ACCOMMODATE REQUIREMENTS. EQUIPMENTS MUST BE FLEXIBLE TO ACCOMMODATE FUTURE TEST ADDITIONS / MODIFICATIONS.

10. INSTRUCTIONS GIVE SPECIFIC,CLEARLY DEFINED, OUTCOME VERIFIED, IDENTICAL INSTRUCTIONS. CONSISTENT PROTOCOL. TONE OF VOICE SHOULD BE NEUTRAL AND NONDEMEANING. BODY LANGUAGE SHOUULD BE CONTROLLED FOR CONSISTENCY. TRANSLATING RESULTS TO RECOMMENDATIONS RESULTS HAVE IMPACT ON CLIENT’S LIFE. TWO POSSIBILITIES – OVERSTATES CAPABILITIES (WORKER AT RISK) OR UNDERSTATES CAPABILITIES (UNABLE TO WORK) NEED FOR PROCESS WHICH IS ACCURATE AND RELIABLE. ALGORITHMIC TRANSLATION OF RESULTS TO RECOMMENDATIONS. DEMONSTRATION WHETHER DEMONSTRATION OF THE ACTIVITY SHOULD BE PROVIDED BEFORE THE CLIENT PRODUCES IT ? YES / NO 1 ST SCHOOL OF THOUGHT – IT MIGHT INTERJECT AN ARTIFICIAL VARIABLE THAT OVERSTATES OR UNDERSTATES THE CLIENT’S TRUE CAPABILITIES 2 ND SCHOOL OF THOUGHT – ALLOWING THE CLIENT TO USE SELF SELECTED POSTURES DURING THE ASSESSMENT YIELDS A MORE RELIABLE TRANSLATION TO WHAT WILL HAPPEN IN WORK PLACE. HERE THERAPIST WILL BE ABLE TO OBSERVE AND NOTE THE CLIENT’S POSTURE WHICH INTURN CAN DETERMINE WHETHER EDUCATION PROGRAM OE STRENGTHENING PROGRAM IS ESSENTIAL. STOPPING POINT IT WOULD BE A POINT AT WHICH THE CLIENT IS ENTERING THE LEVEL OF RISK. TWO POSSIBILITIES – STOP THE CLIENT BELOW TRUE CAPABILITY OR PUSHES THE CLENT BEYOND SAFE LIMITS CURRENTLY NO METHOD AVAILABLE TO DETERMINE THIS EXACT POINT 1 ST SCHOOL OF THOUGHT – THERAPIST SHOULD DETERMINE THE STOPPING POINT 2 ND SCHOOL OF THOUGHT – THERAPIST SHOULD ASSIST THE CLIENT IN REACHING THEIR OWN STOPPING POINT DETERMINATION.

11. VALIDITY OF PARTCIPATION STATISTICAL VALIDATION IS BASED UPON THE PRINCIPLE THAT A PERSON’S ABILITY TO PERFORM ONE TASK IS AN INDICATOR OF THE RANGE OF CAPBILITY TO PERFORM ANOTHER.

12. VERIFYING FORMULAS FORMULAS CAN BE ESTABLISHED BASED ON PROTOCOLS OF THE ASSESSMENT. ACCURACY OF THE FORMULAS MUST BE TESTED. IF FOUND INCORRECT – MUST BE CORRECTED & RETESTED AVOID EXTRAPOLATING FORMULAS FROM WORKS OF OTHERS, UNLESS TESTING METHODS ARE IDENTICAL. TRAINING FOR CONSISTENCY AND STANDARDIZATION – ALL POLICIES AND PROCEDURES SHOULD BE WRITTEN , MANUAL PUBLISHED AND TRAINING PROCESS ESTABLISHED. THERAPIST SHOULD BE KNOW THE PURPOSE OF DATA AND HOW IT WILL BE UTILIZED. FOLLOW RULES MENTIONED DURING INSTRUCTIONS. MUST MASTER THE METHOD OF DETERMINING THE STOPPING METHOD MUST PRACTICE GIVING DEMONSTRATION WHERE APPROPRIATE AND WITHHOLD IT WHEN NECESSARY. THERAPIST MUST BE OBSERVANT, ATTENTIVE, AND SHOULD ACCURATELY RECORD CRITICAL OBSERVATIONS AND FEEDBACK FROM CLIENT.

13. SCHEDULING AND PREPARATION FCA REFERRALS CAN ORIGINATE FROM MANY SOURCES. POLICIES NEED TO BE ESTABLISHED – WHO GETS AUTHORIZATION FOR PAYMENT. FEES SHOULD BE COMMUNICATED CLEARLY. FILES MUST BE PREPARED TO COLLECT SCHEDULING INFORMATION & MEDICAL HISTORY PRIOR TO ASSESSMENT. PREPARE – ANSWERING THE QUESTIONS REFERRING ABILITY TO READ AND WRITE, PRIMARY LANGUAGE SPOKEN, LITIGATION STATUS, DATE OF INJURY, PRIMARY DIAGNOSIS COMPONENTS THREE PRIMARY CATEGORIES OF WORK WEIGHTED ACTIVITIES POSTURE AND TOLERANCE UPPER EXTREMITY ACTIVITY GREETING THE CLIENT CLIENT’S APPREHENSION AND QUESTIONS MUST BE ADDRESSED PROVIDE ORIENTATION OF THE FACILITY, THE SCHEDULED ACTIVITIES, AND PURPOSE AND USE OF ASSESSMENT THERAPIST SHOULD TRY TO - ALLEVIATE FEARS EXPLAIN OVERALL ASSESSMENT PURPOSE ACTIVITIES REVIEW EXPECTED DURATION INTRODUCE ANY OVERLYING PHILOSOPHIES POINT OUT REFRESHMENT SOURCES POINT OUT WHERE BATHROOM ARE POTENTIAL PROBLEMS TO ANTICIPATE CLIENTS SHOW UP LATE CLIENTS BRINGING FAMILY MEMBERS CLIENTS INFLUENCED BY INSTRUCTIONS FROM ATTORNEY OR FAMILY MEMBER EMOTIONAL RESPONSES CLIENTS FRUSTRATION CLIENTS RESISTING PARTICIPATION CLOSE TO TERM PREGNANCY REFERALLS WITH DIAGNOSIS – INAPPROPRIATE FOR FCA’S PHYSICIAN’S RESTRICTIONS THAT ARE LOWER THAN CLIENT’S FULL CAPABILITY INAPPROPRIATE ADVANCES UNABLE TO FINISH ASSESSMENT ALCOHOLIC CLIENTS

14. WEIGHTED ACTIVITIES CARRYING LIFTING ABOVE SHOULDER LIFTING DESK TO CHAIR LIFTING CHAIR TO FLOOR PULLING PUSHING UPPER EXTREMITY ACTIVITY CIRCUIT BOARD TOLERANCE FASTENER BOARD TOLERANCE FINE MANIPULATION FIRM GRASPING GRIP STRENGTH KEY BOARD TOLERANCE SIMPLE GRASPING TOOL STATION TOLERANCE POSTURE AND TOLERANCE BALANCING BENDING CLIMBING CRAWLING CROUCHING KNEELING REPETITIVE FOOT MOTION SITTING SQUATING STANDING STOOPING WALKING CERVICAL MOBILITY WORK DAY TOLERANCES

15. SEQUENCING COMPLETE ENTIRE ASSESSMENT IN THE TIME FRAME DESIGNATED SEQUENCE ACTIVITY TO AVOID FATIGUE SEQUENCE THE COMPONENTS BASED ON FUNCTION BEING TESTED AND SEVERITY OF INJURY TAXING ACTIVITY → LESS TAXING ACTIVITY (INTERSPACER) COMPLETING THE VISIT REVIEW THE RESULTS WITH THE CLIENT DISCUSS IMPORTANCE OF WORKING ON BODY MECHANISM WHO WILL RECEIVE THE COPY OF THE REPORT AND WHEN CONFEDENTIAL CUSTOMER SATISFACTION SIGNED REPORTING FCA REPORTS SHOULD BE CLEAR AND CONSISE USE USERS LANGUAGE AVOID MEDICAL JARGON EG: PRONATION – PALM DOWN POSITION REPORTING RESULTS SHOULD BE OBJECTIVE

16. REDUCE OR TERMINATE WORKERS’ COMPENSATION BENEFITS

17. INDUSTRIAL THERAPY – GLENDA KEY (1 ST EDITION) TEXTBOOK OF PREVENTION PRACTICE AND COMMUNITY PHYSIOTHERAPY (VOLUME: 1) – Dr. BHARATI BELLARE (1 ST EDITION) PHYSIOTHERAPY IN COMMUNITY HEALTH AND REHABILITATION – WAQAR NAQVI (1 ST EDITION) THE ERGONOMICS KIT FOR GENERAL INDUSTRY – DAN MACLEOD (2 ND EDITION)