Introduction

Everybody knows the important of work in daily life. American Occupational Therapy Association recognized work as; paid or unpaid activity that contributes for society. Work is an activity involved element of work skills, physical ability and behavior. (Jacobs et al.,1992).Jastrebowski (1857) stated that work is life and who complained against his work was not life.

Why work so important for human being?

Occupations are keys to being a person and to create and maintain identity (Christiansen C.H 1999). Moreover according to Raven, M (1999), 30% of labor lives were spent for paying bills that reflecting self-respect.

Many people after injury/illness begin to see themselves as “patients” whole role is to rest, take medication, and do basic exercises. Therefore, it is important to help a people with a work-related injury or illness stay connected to their roles, including the worker role.  By resuming their role as a worker, which can contribute to self-confidence and a view of self as a productive member in society, and prevent deconditioning as well as the negative psychosocial consequences of unemployment. (Kaskutas V., Snodgrass J., 2009)

Why work rehabilitation important for OT?

The goal of occupational therapy (OT) is to enable people to participate in the activities of everyday life including the ability to work.As cited from Velerie et al (2002), OT had solid background skills in human’s physiological, biomechanical, psychosocial and behavior that enable client return to his or her work.

The main objectives for OT in work rehabilitation is to facilitate client’s highest level of functional status in all occupation context of life including physical, emotional, social, cognitive and communication dimensions. (Rice V.J and Luster S, 2002)

What are the works related risk factors?

There are many works related risk but common factors are as below:

Figure 1: Works Related Risk

What are the criteria in client’s selection for work rehabilitation?

Work rehabilitation is an individualized program and required a careful patient selection. The selection criteria include the following:-

• Client must independence in activity of daily living.
• Client must not have any medical condition that prohibits a client’s participation such as seizure.
• Client must have physical condition that prohibit client from working.
• Client must be agree to participate in the program.
• Client must have potential to benefit from the program.

What process involved under work rehabilitation?

A systematic process called Functional Capacity Evaluation (FCE) was used to assess client’s functional ability that included physical and psychological abilities required in work setting such as physical, cognitive, emotional and communication abilities.

Two performance categories include general evaluation of physical abilities and an evaluation of job-specific abilities.

What is general evaluation of physical abilities?

OT will assess client’s physical ability using specific and comprehensive tools. This includes client’s body range of motion, static posture tolerance, hand sensation and dexterity, lifting and pushing strength, physical endurance, mood and cognitive function. The types of lifting and endurance test are as below:

Figure 2: Types of Lifting Test

Figure 3: Types of Endurance Test

What is evaluation of job – specific abilities?

OT will compare the client’s physical and cognitive abilities with actual work performance to determine the functional level. Here, work visit is needed to get a comprehensive analysis of client’s work task. OT will do visit client’s office, factory, shop and other work places . Some samples of work visit as below:

Figure 4: Work visit to a Factory with a case of Lower Limb Amputation

Figure 5: Work visit to an Office with a case of Hip Fracture

Figure 6: Driving assessment for lorry driver with a case of Finger Fracture

What types of recommendation produce for client?

There are three types of recommendation :

1. First type of recommendation is, client can return with full performance ability / limit duty. OT will define the parameter based on the results of test data and to include what the client can do as well as what he cannot do.
2. Second, client is not ready to work and might be bought to work standard with interventions such as work conditioning and education
3. Third type of recommendation is client who had no potential to return to work and need vocational exploration of jobs within the client’s physical demand capability.

An example of recommendation was on client who works as technician. Mr. A was suffering from stroke disease. Below is the client’s work station.

Figure 7: A Case of Stroke Who Works As Technician

Explanation on work task :

Technician work demands are including repairing and maintaining electronic equipment which is required bilateral hands flexibility, good in physical strength and endurance.

After a stroke, Mr. A was having right side weakness and unable to meet job demands in the following categories: Mid Lift, Low Lift, and Full Lift by bilateral hands and dexterity components. However, Mr. A can return to work with a modification of duties. Thus, work visit are important to get a comprehensive analysis of client’s work tasks that fits to his capabilities.

During work visit, OT was discussing with the employer to find suitable job that match his current ability. In this case, he was suggested for new work task – stamping boxes which required one handed activity in sitting position. He is also advises to perform work tasks with proper body posture with interval stretch and rest as recommended.

Figure 8: Recommendation On Modification Of Job Task

Is client’s employer will getting report after an OT visit?

Before a comprehensive assessment and work visit done by OT, a written consent will be sign by the client. The consent letter is an agreement by client for OT to expose their medical condition.

What happen if client’s is unemployed?

The work rehabilitation only involved with employed clients’ within their medical leaves period. For unemployed client they can seek help from Job Coach Network Malaysia, Jabatan Kebajikan Masyarakat Kementerian Pembangunan Wanita, Keluarga dan Masyarakat, Tingkat 6, No 55, Persiaran Perdana, Persint 4, 62100 Putrajaya. Contact number: 03-83231000.

References

1. Christiansen C.H (1999). Defining lives: Occupation as identity: American Journal of Occupational Therapy, 52,547 – 558
2. Ellexson, M. (2000). American Occupational Therapy Association. (2011). Occupational therapy services in facilitating work performance. American Journal of Occupational Therapy, 65, S55–S64. doi: 10.5014/ajot.2011.65S55
3. Jacobs et.al. (1992), American Occupational Therapy Association (AOTA)
4. Jastrebowski, W (1987). An Outline of Ergonomics or the Science of Work Based Upon the Truths Drawn From the Science of Nature. Warsaw: Central Institute of Labor Protection. 1997. T Baluk-Ulewiczowa (trans)
5. Kaskutas V, Snodgrass J. (2009). Occupational Therapy Practice Guidelines For Individuals With Work-Related Injuries And Illnesses. American Occupational Therapy Association (AOTA)
6. Raven, M. (1999). http://www.artrns.com/rmsgsed/3rd.htm
7. Valerie J. Rice and Stephen Luster (2002). Occupational Therapy for Physical Dysfunction