Aging in Place Manitoba : Enabling Access Blog : Latest Blog Posts

Top 10 ways Rehab Professionals and Case Managers can put "Me" back in Mental Health.

Tue, 16 May 2017 01:03:00 GMT

Today’s disability rehab and insurance world, stuffed with heavy caseloads, time pressures, and all-consuming client needs, often stretches rehab professionals and disability case managers to their breaking point. Some days, getting out of bed to drag yourself into the office or clinic can seem overwhelming. One in five Canadians will experience a mental illness at some point in their lifetime^.¹ The annual cost of loss of productivity due to mental illness in the workplace in Canada was estimated to be over $6.4 billion in 2011.² Let's switch our focus from clients to self, for a moment. We all know there are several things we should be doing for our own health and wellness, such as exercising and eating well, but there are also many small steps we can take to improve our mental health and productivity so we are better able to cope with our stressors and support those clients who need us at our best.

1. Take frequent breaks. A recent study found that people who worked for 52 minutes and then took a 17-minute break were the most productive.³ Set a timer, stretch, go to the bathroom, chat with a co-worker, get a drink of water, or go retrieve something from the printer. This will also help discomfort related to static sitting or standing at your desk.

2. Start drinking peppermint tea. Caffeine consumption is often under-recognized as a contributor to the development of anxiety disorders and panic attacks. Peppermint tea can help you feel more alert and improve your memory, but will not contribute to anxiety as both coffee and black can.

3. Spend time with positive, supportive people. This seems like common sense, but we often end up having lunch with whoever happens to be in the lunchroom. Find people whose company you truly enjoy, and who lift you up. Arrange lunch and coffee dates with them. Having strong social supports is an essential part of resilience, so they will help you be able to weather your workplace and home stressors.

4. Shut off your screens (T.V., tablet, phone, etc.) at least an hour before bedtime. Sleep deprivation has so many negative effects on our mental health. Often, we feel like we are resting when we do these activities, but our bodies are actually alert. The blue light from the screens makes us more alert and interferes with our ability to fall asleep. We become distracted by what we are doing and end up staying up way too late, which we regret the next morning.

5. Practice mindful relaxation for 2-5 minutes, twice daily. Relaxation techniques can help boost your mood and find a feeling of calmness when everything feels chaotic. You can do them anywhere and anytime, and they do not have to be difficult or time-consuming. Start by sitting comfortably and closing your eyes. Take several deep breaths and pay attention to the feel and sound of the breath coming in and out of your body. Keep doing this for a couple minutes. When thoughts come into your head (and they will!), let them pass through and re-focus on your breath.

6. Surround yourself with pictures of green spaces. We know that spending time in nature helps relieve depression and anxiety and increase productivity, but working in an office or clinic can be about as far away from nature as possible. Ideally, we would all be out walking in a park on our lunch breaks, but having a plant at our desk and/or pictures of green spaces (e.g. as your computer background picture) can help lower our stress levels.

7. Choose cues to link your habit changes. If you are trying to change a habit, such as exercising more, link it to something you already do. For example, if you want to start meditating, decide to do it when you get your first cup of coffee in the morning (or peppermint tea!), you will be a lot more successful than if you just decide to do it every morning. You can also choose cues to replace an old bad habit with new ones. If you usually use your afternoon break (which is the cue) to go get a donut, you could change that behavior pattern to going for a short walk in a nearby green space with a friend.

8. Take your vacation. When we get busy, it is easy to feel like we need to keep plowing through the work to get it done. However, vacation time decreases our errors and increases our productivity. Shifting focus from work to fun does the body and mind, good!

9. Choose your environment carefully. Just as a shade plant will never thrive in the sun, no matter how often you water or fertilize it, there are some work environments you may never thrive in, no matter how much yoga or deep breathing you do. If you are in this situation, think through your options carefully. Can you do a different job with the same employer? Can you do your same job at a different employer? Is there flexibility available to do your job part-time? You are much better to think through your options now when you are not on stress leave, than to wait until you are no longer able to work. It is much harder to find a new job when you are not working.

10. Do not be afraid to seek help. Talk to your doctor about your mental health. Many employers have an Employee Assistance Plan where you can access free counseling sessions. You do not have to wait to be in a crisis situation to use these. In fact, it is totally fine to do “preventive counseling”.

Co-authors:

1.Linda Harrison, Occupational Therapist with Enabling Access Inc. specializes in mental health screenings, activation therapy, cognitive behavioural therapy, is a certified BrainFX 360 cognitive evaluator and leads our Mental Health and Cognitive OT services.

2. Marnie Courage, Occupational Therapist and Director at Enabling Access Inc.

References and Related Reading:

1.http://www.cmha.ca/media/fast-facts-about-mental-illness/#.WQdHRxgZORt

2.http://www.mentalhealthcommission.ca/sites/default/files/2016-06/Investing_in_Mental_Health_FINAL_Version_ENG.pdf

3.https://www.themuse.com/advice/the-rule-of-52-and-17-its-random-but-it-ups-your-productivity

4.http://apt.rcpsych.org/content/11/6/432

5.http://www.scielo.br/scielo.php pid=S1414753X2014000300009&script=sci_arttext&tlng=en

6.http://jap.physiology.org/content/110/5/1432.full

7.http://www.cochrane.org/CD007142/DEPRESSN_relaxation-for-depression

8.https://depts.washington.edu/hhwb/Thm_Mental.html

9.https://www.theatlantic.com/business/archive/2011/08/why-summer-vacations-and-the-internet-make-you-more-productive/244289/

Brain Awareness Week- Accommodation Resources for Employers

Sun, 16 Apr 2017 01:04:00 GMT

March 13 to 19, 2017 is Brain Awareness Week.

The Canadian Human Rights Act requires that employers ensure that all people are treated equally. This sometimes involves accommodating an employee’s needs, changing the work environment, or duties to enable full participation in their jobs. Duty to Accommodate applies only to needs that are based on one of the grounds of discrimination.

The following are brain function related disabilities:

Neurological Disability - A neurological disability refers to a group of disorders that primarily relate to the central nervous system comprised of the brain and spinal cord. For example, cerebral palsy, epilepsy, acquired brain injury, and multiple sclerosis.

Mental Disorder - A Mental Disorder is a syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. (5th ed.; DSM-5) For example, anxiety disorders, depression, obsessive-compulsive disorder (OCD), and attention-deficit hyperactivity disorder (ADHD).

Mental Illness, like Depression, can cause memory loss and concentration difficulties and anxiety can lead to difficulty with organization of thoughts, concentration, and problem-solving. In fact, 80% of disability costs are related to mental health conditions (Conference Board of Canada 2011).

Learning Disorder - Disorders which may affect the acquisition, retention, understanding, or use of verbal or nonverbal information (Job Accommodation Network, 2013) For example, dyslexia, dyscalculia, and dysgraphia.

The above differences may be invisible to others, but certainly present real challenges for the individual experiencing the conditions, those working with, and supervising the individual. Cognitive performance areas often affected can include working memory, attention, concentration, judgment, calculation, sequencing, and more. Often, emotional regulation and sensory processing issues co-exist.

Sometimes employers are challenged with finding accommodations for employees without fully understanding (or without being provided with) the medical background related to the disability. When there are questions about an employee’s cognitive abilities, A Cognitive-Functional Capacity Evaluation can answer task-specific employee limitations and strengths. If it is determined the current job is no longer a safe match for the employee, a Psycho-Vocational Assessment can assist in determining appropriate job match criteria, further training and accommodations required.

Here are some workplace accommodation resources for brain function related disabilities:

Mental Health Accommodations

Cognitive Accommodations

Cognitive Academic Accommodations

Enabling Access Inc. assists employers with job accommodation services, including the assessments above, as well as, Stay-at-Work and Return-to-Work consultation.

Marnie Courage, OT Reg (MB)

Director of Enabling Access Inc.

Winnipeg, Manitoba, Canada

Daily Living Skills Worksheets- An OT Resource Review

Thu, 16 Mar 2017 01:06:00 GMT

If you are an occupational therapist, work in human services, or have an adult family member with an intellectual or developmental disability, you know that teaching daily living skills takes patience, repetition and demonstration. Often we use role playing, workbooks and computer programs to assist us in getting the content across, as learning this stuff can be a challenging experience for many.

Linda Harrison’s “Daily Living Skills Worksheets” is a great teaching aid for content related to Memory/ safety, Leisure/productivity, Communication, Managing Meetings, Problem Solving/reflection and Recording thoughts and feelings. Each worksheet is accompanied by guidelines that include the purpose and directions for use, including helpful tips.

I can see this being a helpful tool when an individual is moving into a new residence, is having difficulty living on their own, lacks initiative for creating structure in their routine, or lacks awareness of personal hygiene and health, which all can be barriers to living independently. Many worksheets deal with budgeting, home and community management, as well as medication management. There are even a few sheets that deal with social skills.

The importance of first assessing barriers to independence and identifying which occupational performance components to measure, cannot go unmentioned here. The OT, teacher or caregiver should focus on the concepts that require improvement, and not overwhelm the student with working through several concepts at once by working through these sheets quickly. In my experience, choosing one area of focus for several sessions and allowing the student to absorb the information, practice the skills and apply them to their life, is best, before moving other areas. Using SMART goals are a great way to know when it is time to move onto the next concept.

It is refreshing to see occupational therapists sharing information and tools, while making them accessible to all, in order to improve our practices and assist new OT’s in their professional development. You can learn more about this resource at www. dailylivingskills.com.

Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access

Feng Shui Your Way to Healthy, Accessibility Spaces

Thu, 16 Feb 2017 01:13:00 GMT

When working with clients to make a home or work space welcoming, accessible and without barriers, one can incorporate the ancient art of Feng Shui.

Feng Shui (pronounced fung schway) is for everyone. How a house or work space is designed, decorated and put together can ultimately influence your clients to experience positive energy tied to happiness, fulfillment and harmony.

To start, there are four classifications of Feng Shui:

Practical Feng Shui, where you logically design a space for happiness and success;

Energy Feng Shui, where types of energy openly flow through a space, which ultimate affects a person's well-being;

Symbolic Feng Shui, where personal belongings reflect a person's personality, passions and mementos; and

Personal Feng Shui, where physical, emotional, mental and spiritual energies influence a person's path to fulfillment.

To fully embrace Feng Shui and all its components, it's essential that you open a particular space to the many levels where the ancient art has meaning.

Start by walking into a room/space with your client and ask them what they see. If the response is lots of clutter - stacks of papers, bills and unopened mail; clean laundry that needs to be organized and put away; or hoards of collectibles without any true "place" - then the natural flow of energy is displaced, scattered and has created a feeling of "chaos". If the response shows meaning - deep connections to pieces of furniture, décor, and artwork that are present in the space - then your client has already begun to create a self-made sanctuary that is fulfilling and replenishing of the mind, body and soul.

This is just one of many examples of the power behind Feng Shui.

To incorporate Feng Shui into a space, start with the following series of simple steps that will help your client see and feel the positive and lasting impacts of this ancient art:

Clean up the clutter. Actively work with your client to keep their home or work space clean of clutter in order to create a space that promotes happiness, efficiency and peacefulness.

Make room for the things that matter most. If a space is overwhelmed with "stuff", ask your client to prioritize the items that matter most and store away the things that he/she won't miss.

Let there be light. Natural light instantly boosts your spirit, expands your vision and enhances feelings of life, creativity and productivity. Don't let your client close themselves in with darkness - which is associated with feelings of confinement, hibernation and sadness. Instead, open the shutters lift the blinds and let the natural light shine through!

Bring the outdoors in. Nature creates natural feelings of harmony and healing to its surroundings. Incorporate some natural greenery into your client's space - the added oxygen from plants or the soothing sound of flowing water create feelings of serenity, calmness and relaxation.

Experiment with colour. Colour has a powerful influence on your mood. Help your client bring in colours that speak to their personality and energy levels - Red and orange colours spark feelings of passion and excitement; blue and green colours create feelings of calmness and relaxation; and yellow and gold colours add feelings of wealth, optimism and influence.

Have a dedicated work space. Create a room/space that's dedicated to your client's work, which gives them the freedom to leave their stresses behind and soak in the positive energies associated with the other rooms of their space.

Display positive pictures of you and your loved ones. Encourage your client to hang photos that capture feelings of happiness, healthiness and confidence - this will automatically make your client feel more happy, healthy and confident.

These steps are the first of many that can be done to improve accessibility and enhance a client's space as they overcome any physical, mental or spiritual barriers in their own life. Accommodating mobility, cognitive or sensory impairments will be of primary importance, but why not consider some Feng Shui concepts as a secondary goal?

For more information and steps to incorporating Feng Shui into a home or work space, visit your local bookstore and pick up the book, Feng Shui Your Life, by Jayme Barrett. This book is a game-changer and will help your clients learn to love their home and work all over again.

Marnie Courage, OT Reg. (MB)

Director & Inclusive Design Consultant

Enabling Access Inc.

Motivational Interviewing- Return to Work Tool for Chronic Pain

Mon, 16 Jan 2017 01:14:00 GMT

Many employees dealing with chronic pain are not ready to return to work following a long absence from injury or illness. Disability Managers and Rehabilitation Professionals have the task of determining barriers to occupational engagement and providing accommodations where needed, to assist employees back to meaningful work. Occupational Therapists understand that one way we achieve meaning in our lives is through the intrinsic and extrinsic purpose that work can provide us. Intrinsic purpose or motivation could be to master a task, feel good about the work we do, feel that we are contributing, with no ulterior motive. The extrinsic purpose or motivation may be to earn money, please a boss, or get a promotion.

Through Motivational Interviewing (MI), a counselling approach developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. (Miller and Rollnick, 1991), Rehab Professionals can work with an employee to address the intrinsic values that work provides, and assist them to challenge their fears, and self-imposed barriers to returning to work. Common fears are that their symptoms will increase, co-workers’ and supervisor’s attitudes about accommodation, there will be new learning requirements, their replacement is doing a better job, etc.

Using MI to align the employee's values and goals with returning to work, Rehab professionals can help take employees who are at "Pre-contemplation" to the “Contemplation Phase” and right through to “Action Phase” of the Motivational Interviewing: Stages of Change, to reduce fears, and replace with an acceptance that returning to work will bring purpose, meaning, and promote engagement in activities that will lead to improved productivity in preparation for returning to work.

Returning to work can be a challenging endeavour for employees and their advocates for other reasons as well, such as having an employer who is not willing to make reasonable accommodations, the wait for physicians to send medical documentation, employee feeling pushed back to work before being ready, and many more. Using MI might just smooth the ride while navigating around these obstacles.

An Australian article review of MI outcomes in Return to Work suggests, “Whilst evidence for the efficacy of MI in clinical settings to motivate health behaviour change is strong, more research is needed to determine whether MI can be usefully applied to improve RTW and other work-related outcomes.”1

1. Kathryn M. Page and Irina Tchernitskaia (2014). Use of Motivational Interviewing to Improve Return-to-work and Work-related Outcomes: A Review . The Australian Journal of Rehabilitation Counselling, 20, pp 38-49. doi:10.1017/jrc.2014.5.

A National Fight for Occupational Therapy Insurance Coverage

Fri, 16 Dec 2016 01:15:00 GMT

October is Occupational Therapy Month!

If you or a family member has ever required Occupational Therapy Services please help us in the fight to get OT services covered by insurance companies across Canada! Physiotherapy, Massage Therapy and Chiropractic Treatments are all recognized and insured, but Occupational Therapy is not?

As occupational therapy becomes well-known and valued by health care consumers, many Canadians are disappointed to find that that their extended health insurance plans provide limited coverage for occupational therapy services. In order to encourage the coverage of these services, consumers need to contact their extended health insurers. Below is a letter that you can "cut and paste" into a word document to send to your insurance company to begin these conversations.

This letter is intended as a template and may be changed to specific needs and requirement. Let us know if your insurance company covers OT services and we will add the company name here, so others can see who which companies have jumped on board! We want to hear from you.

Address

Date

RE: Inclusion of occupational therapy services in health benefits plan

To Whom It May Concern:

I recently required the services of an occupational therapist and, to my dismay, I learned that my extended health benefits plan through your company does not cover these services. I am requesting coverage of occupational therapy services in my plan.

Occupational therapy is a recognized, registered health profession that provides a broad spectrum of client centered services that focus on health promotion, disability prevention, and functional restoration. Occupational therapy is offered in many settings including the home, workplace, community, hospitals, educational environments, and personal care homes. As part of insurable health service, occupational therapists seek to identify and address issues that affect disability, improve daily function and level of independence, and reduce disability claims by offering a perspective that encompasses both the physical and mental health of the individual. Occupational therapists are key members of health care teams; no comprehensive benefits package is complete without occupational therapy.

As a policyholder with your company, I would appreciate a response indicating when your company will cover occupational therapy services, which I feel is a valuable allied health provider, and whether or not a flexible plan is being considered as an option for your clients so that I may take advantage of the services that an occupational therapist would offer.

Sincerely,

Client’s name & insurance number

Digging for Change - Leadership Training for Construction Supervisors

Wed, 16 Nov 2016 01:17:00 GMT

Here are the top 3 reasons why the construction industry continues to have some of the highest worker’s compensation rates, musculoskeletal injuries and employee lost time:

1. High Physical Demands
2. Productivity Pressures/ Work Pace
3. Supervisors are technicians, not necessarily leaders.

The first two reasons should be familiar and there are some intuitive solutions for these; offer customized ergonomic training at the worker level and ensure messaging that supports a productivity pace that does not sacrifice safety. The third reason may not be as recognized as the first two, and the solution is not being well implemented.

Safety professionals in construction continue to struggle with changing worker behaviour, trying to impress upon the workers, the importance of following safe work procedures and using ergonomics to guide manual material handling, prevent injuries, workers compensation claims, and lost time.

Becoming a skilled bricklayer, concrete worker, drywaller, or other tradesman, requires training and many years of experience. Workers who demonstrate proficient skills, save time and get the work done quickly, are often promoted to Lead Hand, Foreman or Supervisor.

In other industries, supervisors are promoted and offered leadership training to ensure they demonstrate desired corporate behaviours that will lead their team to success. In construction, this is not a routine practice and instead supervisors are often the most skilled technicians, are able to follow productivity focused protocols, and provide direction to their crew....but do not necessary know how to lead, and therefore may not recognize the influence that their behaviour has on their crew. If the Lead Hand on the site is taking short cuts, not using the appropriate tools, not wearing PPE or following safety procedures in every instance, the message to the crew will be that these behaviours are condoned, regardless of the safety messaging they are sending their workers verbally.

Some construction companies have identified the leadership element and are promoting, hiring, and training supervisors with proven leadership skills and are successfully reducing their injuries. More research is needed to evaluate if leadership training for construction supervisors can be correlated to the reduction of injuries, but from what has been proven in the corporate office based workplace, it can change behaviour. This leadership tool, coupled with customized ergonomic training at the worker level and safety messaging that supports a productivity pace that does not sacrifice safety, will surely reduce costly musculoskeletal injuries on the construction site.

Ergonomic Tips and Adaptations for Gardening

Sun, 16 Oct 2016 01:18:00 GMT

With only the few months of gardening weather we have in the Canadian prairies, it's important to make the most of the time we do have outdoors, which can create the "Binge Gardener" in some of us. Quickly getting our plants, veggies and flowers in after the first sign that frost has retired till fall, is a task most gardeners anticipate all winter and for those living in Manitoba, we often have to wait till June to be certain the frost gremlin will not rear its ugly face again till October sometime.

The trouble with binge gardening is that we try to do all the tasks to ready a garden, plant and nurture our new ground residents in concentrated doses, instead of spreading the tasks out over the growing season. The repetitive physical demands such as bending, squatting, kneeling, reaching, etc., involved in gardening can create musculoskeletal injuries, which can be harder to undo than a overflowing spread of Snow in the Valley that creeps into your lawn!

For folks who have mobility challenges, who are pregnant or are seniors who have energy limitations, this once beloved leisure love can turn out to be a source of pain and aggravation just as gardening season gets underway. Here are some ergonomic tips and adaptations that might help you are someone you know who loves to garden, but hates the pain it causes.

1. Energy conservation - Break your gardening tasks up into tasks of 30 minutes or less to ensure you have energy to finish what you need to get done without wiping yourself out for the next two days.

2. Engage in Stretch Breaks - The muscles you use in your back, legs and arms are challenged by having to maintain awkward static positions and your hands and wrists are often grasping tools and plants while conducting repetitive tasks. It's important to stretch those muscles to offer relief and prevent stiffness and muscle fatigue

3. Drink plenty of water - While gardening bring out a water bottle of cold water to keep you hydrated and to keep your joints lubricated as you work. Remember if you feel thirsty, you are already dehydrated.

4. Sit on garden stool - For those who have difficulty getting on or off your knees, the tendency is usually to stand and bend from the hips to reach the plants or ground you are working on. This position creates undue forces on your lower spine and can cause low back muscle strain and aggravate the discs between your vertebrae. Instead purchase a small stool to sit on as you plant or tend to your flowers to prevent low back musculoskeletal injuries.

5. Raise your garden - One of the best ways to prevent the bending and reaching that often causes back pain is to raise your garden bed. This is easily achieved by building a 2-3 foot border with wood or bricks around your garden and filling with the appropriate soil for your gardening zone. Planting in raised beds allows you to sit on your stool or mobility device and reduce the physical demands on your body.

6. Use hose with holes for watering - Gardeners can spend a lot of time watering their plants, especially during a dry season. Instead of lugging watering jugs outside, (which aggravates your shoulders and upper back) use an old hose, lay it alongside your garden and puncture holes along its length to squirt out water, eliminating the need to walk around grasping the spray nozzle and having to wrestle with the knots in the hose as you pull it along.

7. Use proper body mechanics- If you are using wheeled carts for transporting tools or plants, push instead of pull where you can, as pulling a cart behind you can cause injury to your shoulders. When using standing tools like a rake or hoe or claw, stand with feet shoulder width apart, one in front of the other and bend your legs while using your upper leg muscles (quadriceps, hamstrings and buttocks) instead of standing with straight legs and bending or twisting at your low back.

8. Hire help for the tough stuff- Although we would like to say we can do it all, doing it all sometimes does us in. Where possible hire someone to do the most physically demanding working like mowing the lawn or turning the garden beds in the spring. Save your energy for the fun tasks like planting, watering, and pruning, which will give you the gratification only fellow gardeners can appreciate, without the aches and pains.

Marnie Courage. OT Reg. (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Standing Room Only - Barriers in Night Life Design

Fri, 16 Sep 2016 01:20:00 GMT

As new night clubs, restaurants and bars pop up around town, with funky wall murals, modern bar stools and high tables, one may be captivated with how the design brings people together and influences the way people interact in the space. The intent of tall tables and bar stools is often to encourage patrons to stand, lean in, perch on a stool, walk around, and mingle. The other reason to include bar style tables and stools is to avoid the perception that the establishment is full, when all the seats are taken, and instead invites more patrons to consume and join in, backed by the idea that "Standing room only" can translate to it being a hot and happening scene!

Unfortunately, sometimes accessibility gets sacrificed when style is the focus and people can overlook the barriers that this stand-and-perch environment creates. Building Codes vary by region, and although most require the inclusion of at least 5% of the tables to be accessible at 28-34 inches high, just imagine the segregation experience of patrons at a small venue sitting at one of the only low tables, when the majority of people are milling about, leaning or standing at their high tables. Further, take notice of height of the service counter at your favorite night spots, as I would suspect few have a wheelchair accessible counter where a patron can order a drink and pay without having to wheel around the side of the bar or have a friend order for them.

The wonderful thing about inclusive design is that barriers can be removed without sacrificing style, intent or feel of the environment. By including a good mix of high and low tables, considerately distributed throughout, with spacious passage areas, patrons can mingle at varying levels without creating high/low, us/them segregation. This provision is, in many cases, easy and inexpensive to meet, also by removing some of the fixed seats/booths (but leaving the tables) and replacing them with seats that can be removed for a customer who uses a wheelchair. This measure also creates aisles wide enough to people using wheelchairs or other mobility devices to negotiate.

Using the principles of Universal Design, business owners are beginning to understand the benefits of designing spaces where their patrons cab access their services in the same manner and will hopefully start to include an accessible service counter not only for those who are shorter, or in wheelchairs, but for all to use, without barriers.

Achieving Ergonomic Sit/Stand Workstations

Tue, 16 Aug 2016 01:23:00 GMT

As you might know, there is much social buzz about the health concerns related to sedentary work, especially for those who sit for the majority of their workday. There is also a common misconception that anyone who sits to do their work, should stand up for their right to kick the chair to the curb and exclusively use a standing work station. This move, may in fact create new risk factors that will have you looking for that chair again.

The ergonomic research motivating us to stand supports the idea that when compared to sitting, the position of standing creates less compression forces on our low back, in addition to the more obvious benefits of increased circulation to your extremities and the increased caloric expenditure. What isn’t talked about as much is the idea that moving from static sitting, to static standing is not much of an upgrade. Just ask anyone who stands for the majority of their workday. These folks often experience low back pain, heel or forefoot pain, muscle fatigue and other discomforts.

We are designed to be moving creatures, doing work that uses a variety of positions and muscle groups. Therefore, it holds true that we should be designing our workstations to move with us. Instead of throwing out your existing office furniture, look around and get creative.

Here are some practical workstation options to choose from, which allow a single user to change positions while they work:

(Whichever option you choose, remember to use a desktop stopwatch or widget to limit your sitting and standing to an hour, and stretch between positions.)

1. Create a standing station that also allows you to sit. This may require you to install a counter height desk or table (slightly lower than your elbows when standing). You will need a monitor riser or arm. If you use a laptop, you will need a laptop stand and an external keyboard. Have an ergonomic task stool with foot rest ring handy for the standing station if you need to perch a cheek, or take a quick break from standing.

2. Create a height adjustable work station by purchasing a unit that attaches to a standard desk to allow you to adjust the unit up or down, from sitting in an ergonomic task chair to standing, with products such as an Ergotron, Varidesk, or other. These move the keyboard and monitor up and down with some adjustment.

3. Purchase a height adjustable desk surface that moves up and down as you do. An adjustable keyboard tray and monitor arm will be required for ergonomic positioning as you move from sitting to standing. You will require an ergonomic task chair for the sitting position.

It is important to know the ergonomic guidelines for setting up sitting and standing workstations. See our customized Office Stretching Poster and Ergonomic Guidelines Poster at http://enablingaccess.ca/shop-enabling-access-inc-ergonomic-and-stretching-posters.html

Marnie Courage, OT Reg. (MB)
Managing Director
Enabling Access Inc.

Inclusive Communities by Design - Visitable Homes

Sat, 16 Jul 2016 01:24:00 GMT

According to Visitable Housing Canada, “VisitAble Housing or VisitAbility is the concept of designing and building homes with basic accessibility. VisitAble homes provide easy access on the main level for everyone. VisitAble housing offers a convenient home for residents and a welcoming environment for visitors in all ages and mobility.”

Visitable homes have three basic accessibility features:

No Step Entrance - At minimum, there must be one accessible, no-step entrance at the front, back or side of the house.

Clear Passageways - All doorways and halls must be wider so there is clear passage throughout the main floor.

Accessible Bathroom - The bathroom or powder room on the main floor must be accessible by visitors who use mobility devices.

These visitable homes not only appeal to people living with disability, but also to young families with strollers, and older people who anticipate changes in mobility as they age and want to age in place. Here in Manitoba, the neighbourhood of Bridgewater in South Winnipeg meets visitable design standards. According to Manitoba Housing, the provincial department responsible for the neighbourhood of Bridgewater, the development will include over 1,000 visitable homes and hundreds of multi-family units with visitable features. To date, more than 200 of these homes have already been built.

As societal demand for accessible and sustainable housing grow, and accessibility laws stretch beyond provincial building codes for new residences, we should see more initiatives like Bridgewater in this province, making our communities more inclusive by design. At the very least it is a step in the right direction. See my comment reply to this post for how Canada's Visitability Standards fall short of those in the US.

For more information on visitable housing visit:

http://www.bridgwaterneighbourhoods.com/vision.php

http://visitablehousingcanada.com/wp-content/uploads/2015/08/Wpg-VisitAbility-TF-Intents-Summary-2015-July-revised.pdf

Marnie Courage, OT Reg (MB)

Managing Director of Enabling Access Inc.

Tips For a Successful Return to Work Following a Concussion

Thu, 16 Jun 2016 01:25:00 GMT

A concussion is a mild traumatic brain injury caused by a blow to the head, neck or upper body and may include symptoms such as a headache, dizziness, nausea or loss of consciousness. Unfortunately, some people go undiagnosed, or misdiagnosed and continue to experience memory, attention deficits, poor emotional control, and other lasting symptoms, which prevent them to returning to work months after their injury.

Returning to work after a physical injury is difficult and with a concussion, the experience is complicated further by the interfering cognitive and psycho-emotional symptoms. Often folks are returned to work too quickly without the appropriate supports in place, or healthcare providers are waiting for the employee to recover before recommending a return to work plan.

The following are some tips for case managers and employees when returning to work following a concussion:

1) Once the initial 3-4 week acute injury phase has passed, don’t wait until the employee has “recovered” before returning to the workplace. Instead, discuss opportunity for modified duties as the employee learns to manage their symptoms while being exposed to increasing physical and cognitive demands.

2) Understand that this RTW plan may take longer than a standard 4-6 weeks, as unlike physical injuries, the complexity of symptoms experienced by someone with a concussion may necessitate more time.

3) Consider psychological treatment for co-existing mental health conditions like depression and anxiety that may be associated.

4) Determine workplace accommodations required, prior to the employee returning to the workplace to reduce risk of being overwhelmed.

5) Ensure all cognitive, perceptual, and physical limitations are being accommodated, by involving an occupational therapist.

6) Consider a gradual return to work experience to build tolerance to the physical and cognitive demands of the job.

7) Promote good communication between the employee, the employer and the case manager/therapist to ensure a dynamic return to work plan that is flexible to change with the employee’s needs.

8) Consider allowing the employee to seek quiet/dark space periodically through their shift to reduce the sensory overload they may be experiencing. If employee is sensitive to light allow a visor or sunglasses to be worn.

9) If computer work is involved, symptoms of headaches and nausea can be aggravated. Allow for gradual exposure and breaks for sustained monitor work. Avoid scrolling tasks and instead read full page before scrolling down to next section.

10) Daily communication is required with the employee to assess if the accommodations are helping and to come up with possible solutions to help manage any other aggravated symptoms.

Marnie Courage, OT Reg (MB)
Owner/ Managing Director
Enabling Access Inc.
marnie@enablingaccess.ca
www.enablingaccess.ca

Top 10 Ergonomic Tips for the Classroom

Mon, 16 May 2016 01:26:00 GMT

The following tips can help prevent musculoskeletal disorders from developing and promote good ergonomics in the classroom:

1. Sit/Stand Teaching - alternate between standing and perching on a teller stool to prevent static positions and fatigue.

2. Introduce Standing Work Stations - bar height tables at the side or back of the room, to allow students opportunity to stand and learn.
3. Introduce 2 minute movement breaks, every 30 minutes, and have students alternate the leading of stretching routine.
4. Avoid awkward postures - reduce writing on chalk/white board above shoulder height; use podium or standing height desk for reading books/documents to class.
5. Wear low heeled footwear that support the arch and cushion the forefoot, if standing the majority of the workday.
6. Keep a water bottle on your desk to keep you hydrated and promote walking to fill it up the bottle, and to use the bathroom on breaks.
7. Have a therapy ball or mov’n sit cushion available to allow students who have difficulty sitting still to have some movement built into their day. Use a signup sheet, so everyone gets a chance to move and learn.
8. Use good computer ergonomics-Set up the keyboard and mouse at same height; raise/lower chair so wrists are flat on the keyboard (not bent); use a foot rest if feet not supported on floor; raise or lower monitor so you are looking straight at the top 1/3 of the screen; ensure space between edge of seat and behind knee; raise backrest to lumbar cushion supports the curve of your low back.
9. Pin up stretching posters and ergonomic guideline posters in the classroom a resource.

10. Identify and report any environmental ergonomic risk factors in your classroom or with the furniture in your classroom, so your supervisor can address and mitigate the risks.

Marnie Courage, OT Reg. (MB)
Owner & Managing Director
Enabling Access Inc.

The Presenteeism Virus & a New Workplace Vaccine

Sat, 16 Apr 2016 01:27:00 GMT

Just as an antagonizing strain of virus infects a population and a new vaccine is created to fight it off, symptoms of Presenteeism sneak up on a workplace long before Absenteeism does, and the treatment is all in the prevention.

“Presenteeism is the action of employees coming to work despite having a sickness that justifies an absence and as a consequence, they are performing their work under sub-optimal conditions.”[1]

Some may ask why these employees don’t take time off, and from what surveys have uncovered, it has more to do with the pressures they feel to stay at work and the workload that will be waiting for them when then return. Many workplaces make the error of measuring absenteeism and sickness rates and figure if those numbers are low and productivity is good then their employees are generally healthily.

The unfortunate truth is that many employees, who are undergoing stressful events in their life (either at home or at work) are pushing through life with a mental health affliction that is not being treated, gets worse, and can lead to long term disability claims.

Presenteeism possible causes:

High production expectations
Role Conflict
Relationship issues with co-workers/supervisors
Reduced decision authority
Fear of job security

Possible costs to the Workplace:

Reduced production
Reduced Morale
Toxic Workplace Culture
Us Versus Them
Absenteeism
STD/LTD claims

The vaccine is not a single dose and instead takes multiple doses in the form of Mental Health Check-Ins. A workplace should examine the health of its employees on a continuous base, instead of asking for a doctor’s note once the employee reports an illness. Having human resource policies in place that support employees and provide regular health assessments that include mental health screenings can be the early intervention the employee needs to get back on track.

Learning about workplace conflicts before they erupt, can be very helpful in diffusing situations and keeping employees happy and healthy. Having a Conflict Resolution Specialist, Counsellor or Occupational Therapist at close hand could be a powerful vaccine. Creating a workplace culture of acceptance, trust and respect may be difficult to build, but one based on mistrust, unfair workloads and pressures to attend, can easily fall.

[1] C. Biron et al., “At work but ill: psychosocial work environment and well-being determinants of presenteeism propensity,” Journal of Public Mental Health, 5 (2006) 26

Marnie Courage, OT Reg. (MB)

Owner /Managing Director

Enabling Access Inc.

marnie@enablingaccess.ca

Don't Get Cornered at Work, Ergonomically Speaking.

Wed, 16 Mar 2016 01:29:00 GMT

If your workstation includes an “L-shaped” desk, you may be positioned in the corner of the two desks, where your computer is located. Often one desk is designated for paper work and the other is chaired for coworkers or client interactions. Many of you would say this is how the workstation was set up when you were assigned the office space and so that is how it has remained. There are a few ergonomic risks that exist for employees who are positioned in the corner of two desks that I wanted to share:

Risk Factors:

1. The armrests on your chair most likely hit the front edge of the desks as you approach the corner to do your computer work. I have met many people that have removed their armrests, so they don’t interfere with positioning the chair closer to the corner of the desks. Without arm rests your upper back and shoulders do more work supporting your arms and by mid-day your body is fatiguing, posture is compromised and discomfort sets in.

2. If your armrests are still in place you probably are not able to get close enough to your keyboard and mouse on the desk surface, requiring you to reach to access those tools. This forward reach causes discomfort between your shoulder blades, upper back and shoulders.

3. Further discomfort in the corner position can be caused by your chair being positioned too low in relation to the desk. The lower you are seated, the more shoulder shrugging, elbow abduction (away from the body) that is demonstrated. This awkward positioning results in upper back, shoulder and neck discomfort.

Quick Fixes and Cautions:

DO NOT REMOVE YOUR ARMRESTS. These accessories are required to support your forearms and allow your shoulders to relax while you work and should be positioned at a height so your elbows are bent at 90 degrees.

Ask for a “Corner Creator” which is a flat piece of plastic or metal and sits on the desk surface between the two desks to create a straight edge. The keyboard and mouse are positioned close to the front edge of this Corner Creator and will allow you to move your chair closer to these devices without interference from your armrests or without having to reach to your keyboard.

If you can, reposition your computer, keyboard and mouse to the straight edge of one of the two desks, (you may need longer computer cords from IT). Working at this straight edge will allow you to get closer to your work, prevent reaching and the resulting discomforts.

Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access

Marnie@enablingaccess.ca

Social Media in Health, Safety and Ergonomics

Tue, 16 Feb 2016 01:31:00 GMT

Whether your company was introduced to the world of social media via your tech savvy IT rep or you were strong-armed into joining the conversation by the ever growing influence of young employees, the result is the same: You have opened the can of time sucking worms that social media is. If it is your role to keep up with health and safety best practices, networking with other safety professionals or staying on top of professional development opportunities, then you need to focus on how to use your social media time wisely.

Here are some social media tips for health and safety folks to keep current and still keep up with your workload:

1. Create measurable objectives for your social media program. For example:

"To keep customers and employees up to date with company health and safety initiatives, industry news, and engage potential employees and customers in discussions relevant to the health and safety of our employees by posting educational web resources and intelligent perspectives on trending topics, using built-in social media analytics to track followers, impressions, comments and clicks."

2. Establish rules for who posts to these sites and what gets posted.

3. Create a schedule for your social media tasks broken down into daily, weekly and monthly tasks including searching for relevant web resources and news, updating status, and engaging in discussions.

4. Use social media management applications like Tweetdeck or Hootsuite to see at a glance what others are posting, who is mentioning your company and to schedule posts to more than one site by saving your drafted status to post at a later time.

5. Concentrate your time to complete your tasks instead of "surfing" the web and social media sites throughout your day. Use the timer on your computer to limit the time you spend searching for information to post and reading posts. If you are short on time there is no harm in reposting someone else's posts as long as you work in original thoughts regularly.

6. On Twitter use keywords to search for relevant information like #ergonomics, #safety, #health, #wellness, etc.

7. Follow news and journal publications relevant to Health and Safety to keep current with industry news.

8 Use blog readers like RRS, Blogger and others to narrow down Health and Safety blogs to follow.

9. Don't hesitate to "unfollow" or "unlike" anyone who is posting information not relevant to Health and Safety so you are not bombarded by information you need to weed through.

10. Be transparent in your posts. If the post is provocative then expect negative comments and always respond to negative comments, even if you need to recant a statement or admit you did not represent your company's opinion.

Please share here any other tips Health and Safety professions would benefit from so we can be more mindful of how we spend our social media time.

Marnie Courage, OT Reg (MB)

Owner/ Managing Director

Enabling Access

Return to What?

Sat, 16 Jan 2016 01:32:00 GMT

In the disability management world, returning an injured employee back to work has presented many challenges for the HR departments of industrial companies. Often the jobs are physically demanding and offering modified or light duties can create friction between employees who continue to do the hard work and the injured employees who get to do “the easy stuff”.

Pressure to accommodate injured workers from Workers Compensation Boards, and threats of being fined by Provincial Workplace Safety and Health, keep disability management staff motivated to create jobs that injured workers can return safely to.

Unfortunately, these modified duties may include tasks that do not contribute to maintaining or improving the productivity of the workplace. In addtion, often these injured employees are conducting these duties for an undefined amount of time. Moreover, the cost of the WCB claims and bringing in other employees to cover the injured worker’s job tasks may negatively affect productivity and have a financial impact on the company.

Disability Managers should be challenging physician’s to clearly define the physical restrictions of the injured workers by having them review the job demands analysis of the target job and checking off the duties that the patient should be able to safely conduct. Most importantly, they should be encouraged to stipulate exactly how long the injured employee is restricted so they don’t end up in modified duty wasteland.

Where appropriate, the employer can order a Functional Capacity Evaluation to objectively and functional test which tasks the injured employee is safely able to perform.

If the Disability Manager is getting frustrated with return to work options, creating modified duties for injured employees or having trouble getting injured workers off modified duties, they could invite their Workers Compensation Adjuster to discuss options for accommodation within reason and have independent medical assessments conducted to challenge the employee's physican's note.

Marnie Courage, OT Reg. (MB)

Owner/Managing Director

Enabling Access

Ergonomics of Housework

Wed, 16 Dec 2015 01:34:00 GMT

There is much written about workplace ergonomics, specifically dealing with risk factors that may result in musculoskeletal injuries, including repetitive strains, which account for almost 50% of workplace injuries in Manitoba (Safe Work MB). Less is written about the ergonomics of housework that present similar risk factors and may lead to injuries preventing you from doing the job of living.

Think about the tasks you do during your workday, the positions you assume and the strength requirements you meet in your daily work tasks. If you are engaging in activities and tasks at home that involve the same positions, and present similar strength requirements, your risk for injury is increased.

Consider a person who’s job is mainly computer based, involving static seated positioning, requiring a flexed neck to read documents on the desk, involving repetitive typing and filing. They should be aware that exposing themselves to household tasks with these physical demands, such as spending extended time on the home computer, flexing their neck when standing to do dishes at the sink and over the counter for meal preparation, scrubbing to cleaning the bathtub, etc will present similar ergonomic risk factors.

Reduce your exposure to ergonomic risks at home by:

1. Limit or break up the activities you engage in at home that require the same awkward postures, repetitive movements and forces on your body that you are exposed to in your workday.
2. Have family members take turns doing more physically demanding tasks by creating a sign up chart so everyone knows their tasks for the week.
3. Try not to do all your chores in one afternoon and instead spread them out over the week.
4. Build in stretch breaks to tasks that require awkward postures like bending, twisting, reaching, etc.
5. If grocery shopping and lugging bags from the car puts you at greater risk of injury because you do similar physically demanding work, consider purchasing a grocery deliver service.

6. When taking out the garbage try filling two smaller bags instead of one big one to carry and distribute the weight evenly between both sides of your body.

7. Purchase a long handled dust pan and use a Swiffer wet jet instead of bending down if you have symptoms in your low back.

8. You can use a swiffer wetjet in your bathroom to clean your tub and avoid awkward twisting and bending needed to scrub the tub.

9.On your days off try to set goals that will allow for rest time so you can recharge and have energy to get your list of chores completed.

10. Remember to use proper body mechanics when lifting, bending and reaching during your chores to protect your back and limit your exposure to ergonomic risks at home.

Mrnie Courage, OT Reg. (MB)

Owner/Managing Director

Enabling Access

marnie@enablingaccess.ca

Technology Pain...is there an APP for that?

Mon, 16 Nov 2015 01:35:00 GMT

Running my business from my home office with a seven month old has forced me to modify how I work. Instead of spending hours in front of my desktop computer up in my office, I am grabbing fifteen minutes here and there on my smart phone and tablet whenever and where ever I can .This change in working behaviour has brought with it new aches and pains that no APP (that I can find) will fix.

With devices getting smaller and more portable to keep up with the busy lifestyles we lead, the physical demands have changed but the work related aches and pains have followed. Repetitive Strain Injuries are common and our busy fingers, thumbs, and wrists are taking the heat. Here are a few tips to reduce discomfort and increase productivity in our tech savvy day:

Pain in the thumb-Thumb pain can be related to texting with the thumb when holding the mobile device in the same hand. Instead hold the phone in one hand use index finger of the opposite hand with full arm movements, so you are not making small repetitive movements with the finger. Of course this might mean you will have to put down your coffee.

Pain in the neck -Instead of holding the phone to your ear with neck flexed to the side, use the Hands Free option, unless you are listening to a co-worker vent about your jerk of a boss, when he is sitting in your office.

Pain in the neck-The portability of a tablet far surpasses the ergonomics. To use a tablet, you either hold it in your hands or set it on a table/desk to use. The nature of its design requires that you flex your neck down to view. When possible, bring your tablet up closer to your eye level to reduce upper back and neck pain, and don’t use your tablet on your tummy while lying in bed, as your neck will surely be flexed and you might just fall asleep waiting for a cat video to load.

Pain in the eyes- When reading web content on your device, the continous scrolling requires that you read moving text, for some this can causes eye strain or headaches, and if you are me....motion sickness. Scroll down and read the whole screen before you scroll again. Virtual vertigo can feel very real!

Pain in the eyes- If you wear glasses, but don’t always have them on, you may have trouble reading the font on your phone. Go to your settings and increase the size of the font so you can leave your glasses where you lost them.

Look for “short cut” key combinations to reduce the number of keystrokes or button pushing on your phone or tablet or use voice activation when you can, to dial a contact, or search the web for delivery options at 11 pm, because you just realized you haven’t taken you r eyes off your device since you got home from work.

Wrist pain- Using a touch on-screen keyboard on a tablet is slow and requires that your wrists be extended (bent up) to type on the screen in front of you. To reduce wrist pain, get a tablet cover with WIFI keyboard, and make writing long emails, reports or editing your kid’s resume so he will actually get a job and move out someday.

There seems to be an APP for everything, but until someone comes up with one that will help us tweak our tech behavior to prevent injuries, we might want to listen to our bodies whispers of discomfort before they become screams of agony.

Marnie Courage OT Reg. (MB)

Owner of Enabling Access

marnie@enablingaccess.ca

Big Thinking, Small Budget Ergonomics

Fri, 16 Oct 2015 01:37:00 GMT

One challenge that small and large businesses have in common is being able to afford the strategies that they believe will lead them to achieving their business goals. Certainly, one of those strategies is to retain and protect valued employees by ensuring their health and safety at work. The costs associated with workplace injuries, employee lost time, WCB and disability claims far outweigh the costs of implementing some proactive ergonomics.

Here are some cost effective ergonomic considerations that will help your staff stay safe and will help you stay within your budget:

1. Provide ergonomic screening assessments and accommodation for all new employees to ensure the proper set up of furniture and accessories and to prevent future musculoskeletal injuries. This could be a simple checklist tool that outlines ergonomic risk factors for chair, desk and accessory set up and include commonly recommended items for quick implementation.

2. Provide ergonomic education to new and existing employees to promote healthy working behaviors, proper body mechanics and will teach them how to recognize symptoms of MSI's, so early intervention can be introduced before their condition becomes chronic.

3. Choose task chairs that accommodate most of your employees, offering adjustable seat depths and backrest heights. For the very short, very tall and very wide, there are some chairs that you can order different sized seat pans and back rests to mix and match as your employees require. One example is the Global Tritek Ergo Select.

4. Create an Ergonomic Solutions Catalogue for your workplace that includes products from your office supply and furniture vendors, as a go-to list of commonly prescribed ergonomic solutions. This will make it easy to quickly implement the solutions when ergonomic risk factors have been identified.

5. Provide Ergonomic Assessor Training for designated employee/s to conduct the ergonomic assessments in house, saving on professional consultation fees associated with each ergonomic assessment that will be required.

6. Get connected with social media; namely Facebook, LinkedIn and Twitter, using the hashtag #ergonomics, read blogs and evidenced based articles on ergonomics to keep current with best practices in the field.

If you are part of a large business, creating an ergonomics committee using your WPHS group is a great way to get the topic of ergonomics on an agenda. If you are part of a small business, appointing an Ergonomic Coordinator would be the first step to creating accountability and designating some of the above duties. Regardless of the size of the company, the goal is the same; spend as little as possible and protect your employees as much as you can.

If you have some cost-effective ergonomic methods that have been successful in your workplace, please share!

Marnie Courage, OT, Reg(MB)

Owner/Managing Director

Enabling Access

marnie@enablingaccess.ca

Pregnancy Related MSI Risks and Ergonomic Accommodation in the Workplace

Wed, 16 Sep 2015 01:38:00 GMT

As an occupational therapist that is seven months pregnant, I am writing about this topic to bring awareness to employers and to other pregnant employees, the essential accommodations that should be considered and provided to working pregnant women. The literal pain in my butt that is shooting down my leg as I sit here typing away at my computer, is my reminder that accommodation is not just about an employer's responsibility to have a job waiting for the pregnant employee upon their return from maternity leave, but about providing administrative, environmental, and ergonomic supports to reduce her pregnancy symptoms while accommodating the physical and physiological changes that occur over those 9 months. The employer's goal should be to promote comfort and productivity as well as prevent musculoskeletal injuries from developing in their valued pregnant employee.

Pregnancy definitely morphs a women's body inside and out, so it is not surprising that there are changes to the musculoskeletal system that places us at risk of acquiring an musculoskeletal injury like carpal tunnel syndrome, low back pain, sciatica, pelvic girdle pain and many other pregnancy-related conditions (curses).

Healthy pregnant women gain on average 25 to 35 pounds, if they started off with a healthy BMI. However if the woman is overweight before pregnancy or gains more than the average weight during pregnancy, the stressors to the musculoskeletal system are increased. To complicate the risks there are also waves of hormonal and chemical changes that make us forget what "Normal" ever felt like. Here are some examples of how these changes impact our bodies:

Forces across weight bearing joints are increased.

Exaggerated lordosis (lumbar curve) of the lower back, forward flexion of the neck, and downward movement of the shoulders typically occur to compensate for the enlarged uterus and change in center of gravity. Stretching, weakness, and separation of abdominal muscles further impede neutral posture and place even more strain on muscles that support the spine.

Joint laxity in the anterior and posterior longitudinal ligaments of the lumbar spine creates more instability in the lumbar spine and can predispose to muscle strain.

There is widening and increased mobility of the sacroiliac joints and pubic symphysis of the pelvis in preparation for the fetus' passage through the birth canal.

A significant increase in the anterior tilt of the pelvis occurs, with increased use of hip extensor, abductor, and ankle plantar flexor muscles Stance is widened to maintain trunk movement.

Fluid retention can cause compression of certain vulnerable structures such as the median nerve in the wrists or the sciatic nerve in the lower back and legs.

Let's not forget about the well-known symptoms that affect most us as at some point in the pregnancy (or all the way through for other) like morning sickness, fatigue, difficulty concentrating and forgetfulness (Baby Brain).

With this cyclone of symptoms following us to work, extra supports are required to allow us to function and make it through the day as a productive employee. While application of sound ergonomic principles benefits all workers, the following actions can be considered when modifying a pregnant worker's job:

-Assign less physical tasks.
-Restrict lifting to 25 pounds or less.
-Adjust work (flexible scheduling, day shift rather than night shifts, etc.).
-Vary tasks to avoid static posture.
-Adjust height of work surfaces and chairs.
-Install foot rests.
-Limit standing to less than three hours per day.
-Offer shorter, more frequent breaks.
-Reduce the amount of work performed at heights.
-Provide more space for moving around.
-Remove obstacles in the work area, particularly those placed at lower levels.
-Promote safe lifting techniques.
-Provide a quiet space for taking breaks when headaches or nausea ensue.

Accommodations that have worked for me at my workplace include, taking stretching breaks many times throughout the day as muscle fatigue sets in, starting a walking routine at lunch to alleviate sore joints moving my keyboard lower to change the angle of my wrists and reduce the beginning signs of nerve compression, sitting on a supportive cushion to relieve coccyx pain.

Most workplaces have pregnancy accommodation guidelines built into their employee's manual or at least in the Policies and Procedures Binder tucked away in someone's office. Many workplaces, however still do not have clear guidelines that focus on individual pregnancy accommodations, which is important to consider since each woman experiences pregnancy differently.

The Canadian Human Rights Commission protects pregnant workers from discrimination and outlines the employer's obligations to accommodate us. If you believe you are being discriminated against at work visit the links below to read about your rights and the best practices for accommodating pregnant women. Canadian law puts a heavy fine on companies if they are found to have committed acts of pregnancy discrimination.

Share your pregnancy workplace accommodation nightmare or success story here to help other readers going through the "invasion of the body snatcher's" pregnancy experience.

Industrial Workplaces Feeling the Health and Safety Squeeze

Sun, 16 Aug 2015 01:48:00 GMT

One of the issues that face Health and Safety Officers in the industrial workplace is balancing pressures from management or corporate office to reduce workplace injuries while not affecting production or taking workers off the shop floor. Here are some ways your Health and Safety folks can approach injury prevention without becoming a cog in the company wheel:

-Introduce a stretching program by recruiting a volunteer from each department to lead a stretching routine that can be conducted at the beginning of each shift. Remember that a simple warm up before stretching is more important than stretching alone, to get blood flowing and get muscles ready for the physical work.

-Provide “Manual Material Handling” or other courses in the proper use of body mechanics to the Supervisors, so they understand safer ways to do the work and will be able to identify when employees are using unsafe behaviours in their department.

-Introduce a “Safety Coach Program” that gives supervisors opportunity to demonstrate safe behaviour during the working shift and identify unsafe behaviour by giving out coach cards to employees with “Safe” and “Unsafe” labels. If the employee demonstrates an unsafe behaviour, the supervisor demonstrates the safer alternative and checks in later to ensure the employee has adopted the new behaviour. Supervisors are encouraged to give out at least 5 cards a week which keeps them watching how the work is being done and employees receive incentives for exhibiting safe behaviour.

-If you can manage to justify the ROI of safety training on work hours to the decision makers, then getting a group off the floor for 45 minutes, providing “Introduction to Ergonomics” or “Safe Manual Material Handling” with demonstration and a practical component using the equipment they handle, will undoubtedly change some unsafe habits. Offering these sessions around the clock to accommodate all shifts is recommended. Groups of approximately 30 seem to work best.

-If there are too many barriers to getting workers off the floor and you are the one man/women safety show, ask for 5 minutes at the beginning of a shift, per department, for you to demonstrate 1-2 safety tips that will help keep the employees safe. Work through the facility 5 minutes at a time!

-Please don’t forget about your office staff. Even though the big cost of injuries comes from those that happen in the shop, musculoskeletal injuries in the office can creep up on people and land them a short term disability claim, which adds up! Provide an “Introduction to Office Ergonomics” workshop as a lunch and learn for the office staff to make them aware of how to set up their workstations and how to use their bodies to conduct their work safely.

-Be present in the shop and learn from the employee on how the work is done. You don’t want to be seen as the “Safety Police”, instead you want them to think of you as “Safety Support.” Don’t just walk around pointing out everything that is unsafe (hopefully you have already done this in your Risk/Hazard Analysis) but talk to employees and get their feedback about what is working and what seems unsafe to them, they will be more willing to volunteer information if you are not seen as “Them” in the us versus them all-to-common workplace culture.

-Brag about safety accomplishments to management or corporate office! Let them know that your efforts are changing behaviours for the better. If you gain their support you are more likely to get their buy-in for introducing more training and the associated injury prevention cost savings.

-Share what works and what doesn’t with like businesses you know to get creative ideas so you are not reinventing the safety training wheel with each effort.

-Set yearly and quarterly safety training and assessment goals to use as outcome measures. It’s not just about statistics; it's about how you get there. Set the path for the training and assessments you would like to have completed, or like in any plan; if there are no goals, nothing happens!

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Top Five Ways You Can Help Create a Healthier Workplace in 2012

Thu, 16 Jul 2015 01:50:00 GMT

1. Be a "Positive Pat"
Research shows that having just one "Negative Nancy" or "Doug the Downer" in the bunch can affect the workplace culture negatively, and decrease the productivity of the working group. Try to keep a positive perspective even when your co-worker is pointing out, convincingly, all the potential headaches, complications and timewasters the new software program will bring with it. If you think, speak and behave with a positive attitude, the small stuff will roll off your back and you will lessen the health effects of stress that work life inevitably produces.

2. Be a Contributor not a Contaminator

If you like Dr. Phil, you will relate to this one. Phil has used the above phrase when referring to the actions of individuals in a relationship and I find it also applies to employee relations. As our co-workers know too well, there are often many things about our work to complain about. Complaining tends to keep us problem focused and perseverating on frustrating issues, contaminating the workplace. Try to spin the focus to finding solutions when faced with a problem at work, disagreement with a co-worker or boss and you can feel good about being part of the solution, being a contributor, instead of being a contaminator. Avoid joining in on what seems like light hearted teasing or bullying of co-workers, trash talking the boss and other contaminating behaviours.

3. Walk it off
With email being the primary mode of communication in the workplace, visiting your co-worker to share some important news or notifying your secretary that the photocopier is low on ink have been replaced by email notifications. If your job requires you to sit for the majority of your day, you are burning less calories, compromising your circulation and assuming static positions that cause muscle fatigue and discomfort, more so than an employee who gets to stand or walk for some of their day. You can introduce a "Steps to Health" pedometer campaign that tracks the distance you walk in a day and will surely get people moving. You can make the resolution this year to include more walking in your workday, to leave your workstation at lunch, to get water of coffee, and to visit your co-workers to share information, and the will to walk just might spread.

4. Become Ergonomically Inclined
Advocate to your Health and Safety Committee for an ergonomic education session for all employees to review the principles of ergonomics and to help you all with setting up your equipment and furniture and to apply healthier working behaviours. If your workplace does not have an internal ergonomics program or does not outsource ergonomic services, there is still much you can do to prevent musculoskeletal injuries and be more comfortable and productive as you work. There are many free references and checklists online to help you set up your workstation to improve the fit and function of your furniture. Search "office ergonomics guidelines" to understand how to position your equipment and apply proper body mechanics to conduct your work in a healthy manner. You could then post the ergo information on your wellness bulletin board, so everyone benefits.

5. Improve Your Food For Thought
We know spikes in blood sugar and the corresponding drops between meals contribute to weight gain in people working sedentary jobs. We are supposed to eat smaller more frequently to stabilize blood sugar, but this task may be difficult to master with the conveniences of fast food. Many people are not hungry first thing in the morning and skip breakfast, the meal that gets our metabolism engine started, just to get that extra 10 minutes of sleep and race to work. Often lunches are purchased in food courts, cafeterias and fast food restaurants, most offering high sugar and high fats in exchange for speedy service. Snacks in vending machines are commonly filled with sugar, trans fats and quick burning foods that spike your blood sugar. Caffeine in coffee and soft drinks effect blood sugar the way eating sugar does and will spike your blood sugar level, dehydrate you and deprive you of the water your body needs to stay healthy. You can advocate for a water cooler next to the coffee maker to remind employees they have a healthy fluid choice, request healthier snacks in the vending machines, start a weekly "Healthy Plate Pot Luck Lunch", start a "Healthy Brown Baggers" lunch recipe club, keep healthy snacks at your workstation to prevent those lows mid-morning and mid-afternoon that nearly put us to sleep at our desks. Avoid sugary snack bars and choose high protein snacks likes nuts and cheese to keep you alert and feeling well.

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Having Reservations About Creating "Hoteling Workstations" At Your Office?

Tue, 16 Jun 2015 01:52:00 GMT

9-5 is dead. The office shackles are loosening. Gone are the days when employees were expected to exclusively be productive and get results within the four confining walls of “the office”. There has been a clear shift in the last few decades in how companies manage their staff and the deliverables they expect to receive.

ROWE - Results Only Work Environment is a human resource management strategy wherein employees are paid for results (output) rather than the number of hours worked. Many companies now allow employees to work from home or on the road, teleconference from wherever they may be, and report their sales numbers electronically, from Starbucks, the beach, or perhaps sitting in their pajamas at home.

Changes within the office environment have accompanied this contemporary, more flexible management style, which started with Hot Desking in the 80's and 90's and involves one desk shared between several people who use the desk at different times, and can also include the routing of voice and other messaging services to any location where the user is able to log in to their secure corporate network.

More Recently workplaces such as call centres, IT support companies, and online companies are switching to a more systematic and well controlled Hoteling Work Space environment. The system is intended for workplaces who have who have office based shift workers, traveling sales reps, telecommuters, and employees who work mostly off site. "Hoteling is a form of "alternative officing" which allows employees who travel on business or work flexible hours to reserve desk space at the employer's offices as needed, rather than maintaining a permanent work space there." This allows the employer to make more efficient use of office space and thus reduce costs.

With Hoteling, there is typically an electronic reservation system for available desk space, which can be accessed from any computer or mobile device. Visiting employees, sales employees on the road and other commuters are able to make a workstation reservation including the ergonomic accessories they require ahead of time while the office facilities personnel get the workstation set up with the accessories requested in place by the time the employee shows up to work.

David T. Wise wrote in the Los Angeles Business Journal. "Where the average ratio for office space is 250 square feet per person, hoteling space can be reduced to as little as 100 square feet per person."

Involving an ergonomic consultant is essential in creating healthy Hoteling working environments to ensure each employee is assessed for the appropriate fit of chair and set-up of computer accessories and input devices. Unlike Hot Desking where the workstation is set up for any user, these Hoteling workstations are set up for specific users, which makes better ergonomic sense when considering the health and wellness of the employees utilizing the system.

Of course as with any new trend, the online technology demands increase and as with this case, Hoteling software to manage the equipment set-up and the workstation reservations are booming. You've got to love new working concepts that demand better attention to individualizing the working experience, meaning a better fit for the employee and better results for the employer.

Marnie Courage OT, Reg. (MB)

Managing Director

Enabling Access

What's All The Stink About Good Foot Support in Ergonomics?

Sat, 16 May 2015 01:55:00 GMT

We all know that after a hard day of work, it feels great to put your feet up and relax! Whether you are sitting at a desk all day, standing at an assembly line, or non-stop walking stocking shelves, most people have sore feet by the end of their work shift, for different reasons.

When you are on our feet for long periods of time, the balls of your feet, your heels or arches can ache due to the force exerted as you walk, especially if you are not wearing supportive shoes. For those who stand for long periods of time, circulation does not function as well as it does when walking and gravity causes forces to be directed down your spine, through your legs, and into your feet, while fluid drains down and accumulates in your ankles and feet, sometimes causing foot discomfort by the end of the day. Often we recommend using Anti-Fatigue Mats for those who stand for the majority of thier work, to absorb some of the forces endured by the spine, legs and feet while standing.

If you are someone who sits for work, you might wonder why your feet might get sore when your chair is supposed to be doing the work that your legs would do in standing. The fact is gravity is still in effect when you are sitting and fluid will still drain into your lower legs and feet, making them feel swollen and potentially sore by the end of your workday. In addition, people are not generally taking adequate movement breaks in the day to encourage good circulation and to stretch out the calves and feet, that might cramp up while sitting.

Keep in mind, if your feet are not supported on the floor or footrest in sitting, the circulation under your thighs could be compromised, putting you at risk of blood clots and pinched nerves in the legs. If you have raised your chair to access your keyboard and mouse on the desk surface and your feet are dangling or you have them perched on the footing of your chair, then a foot rest is required to support the bottom of your feet in front of you with a 90 degree bend in the knee. If you can fit your hand easily under your thigh when using a foot rest, then the foot rest is too high and the forces of gravity are not distributed well over your seat pan, adding pressure to your low back.

Sometimes diseases that affect the entire body, such as heart disease, kidney or liver failure, can result in excess fluid build up (edema) that is often concentrated in the legs and feet, leading to swelling not only of the ankles but also of the feet and lower legs. This can also occur with obstruction of the venous system, as may occur with pregnacy and obesity. Diseases of the joints, such as arthritis, can also affect the joints of the ankle and foot, leading to swelling of the involved areas. Please check with your physician if you have any of the above symptoms and ensure your feet are supported on the floor or footrest, depending on the height setting of your chair.

Our bodies crave movement, so whether you sit or stand for the majority of your workday, you should include movement breaks with stretching your legs and feet, to improve circulation, get lymph moving and keep you comfortable at work.

Marnie Courage, OT Reg(MB)

Managing Director

Enabling Access
marnie@enablingaccess.ca

Your ROI for Training Employees To Conduct Ergonomic Assessments vs. Contracting an Ergonomist

Thu, 16 Apr 2015 01:56:00 GMT

Now that most people are aware of office ergonomics, employer's obligations though legislation, have an ergonomics program or at least have invested in equipment from the 2000's, employees are able to freely identify risk factors at their workstations without fear of being labelled a "squeaky wheel".

The Return on Investment (ROI) for creating a workplace ergonomics program is obvious; reduced costs associated with injuries, decreased employee lost time and WCB rates, increased productivity and employee morale. What might not be as clear is whether it is better to hire an Ergonomist or train employees to conduct the ergonomic assessments in your workplace. Here are some considerations for you to keep in mind when at this crossroad:

Hiring an Ergonomist: Professional fees in Canada can range from $85-$150/hr for a certified ergonomist/ergonomic specialist to conduct individual assessments. The Profession of Ergonomics is widely represented by several disciplines and choosing the right Ergonomic Consultant should include researching the consultants to find the right fit for your workplace. You may want to choose an Ergonomists with a medical background like physiotherapists and occupational therapists to accommodate employees with medical issues and disabilities. Occupational Therapists also treat clients with Mental Health issues, which is a great skill set to have when looking at workplace issues that might affect the employee's health including stress and production deadlines.

An office ergonomic assessment report usually takes about an hour and the report may take longer. The report should outline all the ergonomic risk factors and provide recommendations in the areas of administration, engineering and behaviour. These professionals should be keeping your suppliers and your budget in mind when making recommendations to allow for ease of implementation. Beware of Ergonomic Specialists that represent ergonomic product retailers, although it is unethical to recommend products they could benefit gains from, it does happen, so an independent consulting firm is a better choice for feature focused not brand focused recommendations.

A good Ergonomist stays in touch with best practices in ergonomics, ergonomic products and equipment features, so you can rest assured they have seen it all and have a solution for most everything they encounter. They can answer questions about products and barriers you experience, so t your ergonomic issues are solved quickly and cost effectively.

If you are a large office of more than 50 people, you may find hiring an Ergonomist to conduct an ergonomic assessment for every employee that identifies a risk factor, could break your budget, both with professional fees and the cost of implementing the recommendations. You may choose to create a priority list of those employees needing assessments that you could approve as your budget allows.

Training Employees to be Assessors: If you are interested in saving money on professional fees you may want to invest in having one or two employees trained to be Ergonomic Assessors. They would obviously not have the expertise that a professional Ergonomist does, but they could learn to identify risk factors and solve ergonomic issues for their co-workers. Choose employees who are on your Workplace Safety and Health Committee or who are interested in the area of ergonomics, as it will be adding to their current job responsibilities and will require outside time researching ergonomic products and solutions.

You should research Ergonomic Assessor Training in your area to determine which company you will hire to train your employees and what your budget allows for. Often these courses are between $900-3000 so it's worth it to shop around. The training for office ergonomic assessors should be at least a full day that includes theory and guided practice so the participants can learn what information they need to collect, how to identify risk factors and how to solve those risks through administrative, engineering and behavioural changes. Ensure the instructor is a professional ergonomist so their expertise seeps into the veins of the participants. Ask about consultation fees for supporting the newly trained Ergonomic Assessors, so that if they need questions answered or help with a tough ergonomic scenario, the consultant is available to provide support with no hidden charges.

The advantage of training your employees to do the assessments is that you save on professional fees with every assessment, but remember the cost of the solutions will be the same, or more if your in-house assessors do not have the inside scoop on no or low cost solutions or where to get products or solutions for less. It is a good idea to send your in-house assessors for professional development workshops and training ongoing, to make sure they are current with Ergonomic best practices.

Final thoughts on this are; Hiring an ergonomist to conduct hundreds of assessments may bust your budget, but if you hire one for the occasional assessment and to handle the assessments for employees with medical issues, you benefit from their ergonomic expertise, medical background, problem solving and product knowledge. Training employees to be Ergonomic Assessors saves on professional fees but solutions may cost more due to lack of experience, no medical background modest product knowledge. If you are hiring a professional Ergonomist, ensure they do not represent ergonomic product brands, have good medical background and share references. If you are Training your employees to be Ergonomic Assessors, ensure the training company provides on-going support, and send them to workshops and additional training moving forward to assist them in keeping up with best practices.

Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Ergonomic Survey Saves Employers More Than Money

Mon, 16 Mar 2015 01:57:00 GMT

As an employer, whether you conduct your ergonomic assessments in house or contract a professional ergonomic specialist to come in, you want to ensure that you are saving your time and money where possible, while still preventing costly work related injuries.

Unless your company is committed to a strong preventative ergonomic program and has budgeted for mass individual ergonomic assessments, you are probably not offering all of your 50 office staff ergonomic assessments. Instead, the compromise is usually reached by providing assessments in reaction to those employees who have identified an issue or the ergonomic risk factors are obvious.

In either case, you are addressing ergonomics in your workplace and you want to know that you money is being spent wisely. Each ergonomic assessment usually results in recommendations for repositioning equipment, teaching new work behaviour, adjusting furniture and in some cases it means purchasing new equipment or furniture. Often employers link ergonomic assessments with having to spend money, instead of looking at the long term savings the assessments bring, preventing injury claims, employee lost time and retraining, not to mention some assessments include no or very low cost solutions.

An Office Ergonomic Survey is a great way to prioritize those employees who need their workstations assessed the most. It also can be used to screen your employees for those who might be at risk of developing a musculoskeletal injury and to prioritize those who are already dealing with these associated symptoms and may be incurring regular sick time due to their pain.

Resistance to these surveys comes from fear that these surveys will indeed identify many ergonomic risk factors that the employer will then have to spend money on to solve. It should be made clear that including the employees in the process will instil loyalty, foster improved employee engagement and let staff know that management does care about their health. You can expect a rise in complaints at the onset of any ergonomic program, as word spreads that the company may be willing to spend money on new furniture. It's what I call the preschooler "I want a new ball too" phenomenon that strikes employees when they hear that their co-worker got a new chair, but the risk identifiers and complainers will settle down as the novelty wears off. The survey allows a starting spot for your ergonomic program focus, it does not promise anything, other than your attention to ergonomics in the workplace.

The survey can be customized for your current office equipment set up and can include information about the workstation, the chairs, the equipment and the workflow, to generate answers that will help you in identifying the risk factors that need addressing and those employees most at risk.

The following is an example of a short survey I created for a company of 50 office employees, who wanted to offer assessments to their employees but budget limitations meant they couldn't do everyone's in the first year. Feel free to reformat and customize this survey to your workplace ergonomic goals, so employees are engaged in the process, know you care and might even offer solutions you had not thought of to save money and prevent injuries at work!

Remember that the interpretation of this survey relies on the evaluator having knowledge of office ergonomic guidelines and you will want to include your safety officer, or ergonomics specialist. Please email me if you would like a copy of our ergonomics guidelines and tips sheet at marnie@enablingaccess.ca.

Marnie Courage, OT Reg.(MB)

Managing Driector

Enabling Access

[Company Name] Ergonomic Survey

1. Do you have any of the following symptoms of pain or discomfort while sitting at your workstation?

Numbness or tingling in legs or feet yes no

Numbness or tingling in arms or hands yes no

Pain or discomfort in neck or upper back yes no

Pain or discomfort in low or mid back yes no

Pain or discomfort in the arms or hands yes no

Other:____________________________________________________________________

2. Do you find that your chair is comfortable yes no If no:

Is your chair adjustable in seat height and depth? yes no

Does your chair's back rest adjust in height and recline? yes no

Are your arm rests adjustable in height and width ? yes no

Is your chair adjustable in seat height and depth? yes no

Are your feet flat on the floor or footrest? yes no

3. If using the phone frequently, do you have a head set? yes no

4. If using a built in or external keyboard tray, are both mouse and keyboard positioned at the same level? yes no

5. With your keyboard and mouse both on the desk or keyboard tray are you able to position the tray or your chair height so that your elbows are bent at 90 degrees? yes no

6. With a monitor stand, phone books or built in monitor height adjustability, are you able to adjust your monitor height so you are viewing the top 1/3 of the screen when looking straight ahead? yes no

Other ergonomic concerns or possible solutiosn to risk factors in your work area:

____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

Meeting the Need for Ergonomic Training in Community Health Care

Mon, 16 Feb 2015 01:58:00 GMT

After attending a session on "Ergonomics In Health Care" and discussing injury prevention initiatives by hospitals and long term care facilities, I was struck by how much money, and effort goes into these government and privately funded programs to ensure the safety of the Health Care employees.

Patient lifting and handling training has been around for years is in integral part of protecting nurses and other hospital staff from MSI's, and most places do a great job of offering the training regularly to reduce employee injures and lost time. With the shift to e-health from paper charting, it is not surprising that we are now seeing a rise in upper extremity MSI's due to nurses and medical staff using the portable computer stations in the hallways and nursing stations.

With computer related injuries on the rise in hospitals, I can't help wonder how small community based disability serving health care companies like private home care, respite , residential agencies, day programs and employment support programs are dealing with this challenge. For these agencies, generally they have by law a Workplace Safety & Health Committee or maybe only one WPSH rep, but they usually can't afford consultation from a professional ergonomist or hire can hire a safety officer or have resources to pull together an ergonomics committee. So, I'm left thinking that other than regular lifting and transferring training, these high risk employees and their office staff may not be addressing all the ergonomic risk factors in their jobs, especially if using computers have become an essential function in their work day.

There are many online office ergonomics guidelines as well as patient lifting and handling guidelines available for community agencies to use and adapt for their specific business. My hope is that these companies will apply the principals of office ergonomics when buying furniture and equipment for their office staff, accommodating injured workers, and make computer ergonomics as big of a priority as the patient lifting and handling, in reducing the MSI's related to caring for people with disabilities in the community. Because of the large sample populations in hospitals, there are many studies about computer related MSI, but I have yet to find a study about computer related injuries in community health care, due to the variety of settings and nature of work.

I have been discussing the need for more ergonomic training with community health care agencies and will be bringing these groups together in Winnipeg , Spring 2012 for a two day "Improving Ergonomics in Community Health Care"- A Workshop for caregivers and managers, that will include a trade show of disability and ergonomic related products, a half day Client Lifting and Handling Certification Training , a half day of Office Ergonomics Training, and a full day of breakout sessions dealing with topics related to protecting employees from injury from pre-employment to return to work, following an injury. If you would like to take part in this initiative or would like to share resources with other community health care companies, please submit your name and email and I will add you to the network.

Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access

How Pre-Employment Testing Prevents Injuries

Fri, 16 Jan 2015 01:59:00 GMT

Often production demands in Industrial workplaces ebb and flow. When they flow, employers may have to bring in more man power to quickly meet the rising demand for product. Many Industrial workplaces struggle with trying to find the right people for the job, when bulk hires are required. HR reps can be challenged with first finding enough suitable applicants to interview and offer positions to, hoping they meet the skills and abilities criteria.

According to Statistics Canada, Manufacturing Companies have the highest work related injuries among industries, with Manitoba having the highest in the country. In addition, Injuries usually occur within the first 6 months of employment, putting these new hires at risk of injury, lost time and disability. Finding the right people for the job involves more than just interviewing folks with the appropriate work experience and skills; it also includes ensuring these potential new hires can manage the physical demands of the job.

Post-offer Pre-placement Testing (POPPT) is an objective process to ensure the potential worker has the physical capabilities to perform the job. It is a proven method for screening potential new hires that have been given a conditional offer of employment, while securing the employment is dependent of the passing of a customized test, which includes simulation or actual carrying out of the essential job tasks.

Usually testing is administered for only the most physically demanding jobs, or jobs with the highest rates of injuries. The testing has to be administered to all applicants, as testing only those who you suspect may not be able to do the physical tasks, is discrimination according to ADA. A policy should be developed to outline those identified positions that testing will be conducted for, as well as outline if Fit For Duty Testing will be done every 2, 5, or other specified year period, to ensure current employees are still able to safely do their work.

Post Offer Pre-placement Testing assists the employer:

-during the hiring phase, by minimizing poor placement decisions, determining true level of function, compared to the job demands and ensuring the potential hires are able to safely conduct the work.

-with Fit For Duty Testing done regularly for identified positions to ensure employees are still able to safely conduct their jobs.

-when an employee has been injured, the level of disability compared to POPPT results can help determine entitlement by examining level of function prior to the injury.

-in the rehabilitation process by knowing previous level of functioning.

-by Reducing Escalating Costs associated with injuries.

-by using best practices to keep up with changing labour legislative focus.

-to maintain a team of healthy workers supported by strong injury prevention initiatives.

A professional occupational therapist develops, conducts and scores the testing to ensure reliability and validity of the standardization for all testing. The pass/fail results are provided to the employer who is then responsible for communicating the results to the potential new hires. Between this Pre-employment testing, Work Safe Education and Orientation, and Ergonomic Assessments for new hires, your HR reps, Health and Safety Officers are truly embracing a preventative approach to protecting employees from costly injuries at work.

Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access

Keeping Remote Employees Ergonomically Safe

Tue, 16 Dec 2014 02:01:00 GMT

Conducting ergonomic assessments for your in-house employees is most likely, by now, a straight forward process for both small and large companies. Either your company's ergonomic assessor conducts the assessments or you hire a professional ergonomic consultant to come in and solve the issues.

What about those employees who are working in other cities or rural areas, where your ergonomic team does not travel and sending out a professional consultant is financially prohibitive? Unfortunately, often these folks do not get the responsive ergonomic services that their "closer to home" coworkers do.

After interviewing some local companies, it seems that company ergonomics are not always equally accessible to all, and this leaves those employees outside of the geographical "ergozone" at greater risk for injury, and the employer at greater risk of incurring big costs related to workplace injuries.

Even some national and international companies who have made significant investments in their sound ergonomic programs, have overlooked the ergonomic safety of their employees who are working out in the field, those working in small towns, rural communities and especially the remote workers who have minimal connection with the hub of the company located in the major centres.

Having Job Demands Analysis (JDA's) and Safe Work procedures in place, are a great start in the prevention of injuries for these remote employees, but early intervention is the best tool for preventing signs of discomfort and pain from morphing onto costly disability claims and lost time.

Virtual Ergonomic Assessments may be the key to the fast response, early intervention ergonomic service, these remote employees require. Videoconferencing is a great way to solve ergonomic issues but is only practical if the equipment supports are in place in the remote areas. The good news is that if the employee has access to a computer and the internet they will have access to a virtual ergonomic assessment. These can take place in a variety of formats, from sharing digital photos and video, troubleshooting through email or downloadable forms, to using Skype and other online tools.

The ergonomic assessor simply requires a visual of the workstation set up or work being done, some anthropometrics (measurements of the body), equipment measurements and an idea of the essential job demands being conducted to solve many ergonomic issues and offer recommendations for behavioural, administrative and engineering changes.

Ergonomics should be accessible to all and not cost an arm or a leg.....literally.

Marnie Courage, OT Reg(MB)

Managing Director

Enabling Access

What's Up Doc? Validating a Doctor's Note with Medical Report Form

Sun, 16 Nov 2014 02:02:00 GMT

After posting my last blog on Challenging the Validity of a Doctor's Note and providing recommendations for employers, I had many discussions with corporate clients about how they deal with Employees who bring in a note saying "light duties only" or something equally as vague.

The best practise solution came from one of my manufacturing clients who shared with me a simple tool that helps them sort through what to do with the doctor's note that provides no details of what the employee can actually do. When an employee brings in any doctor's note about limitations in ability to work at full capacity, they immediately provide the employee with a Medical Evaluation Report Form, which is a one page form including specifics on Employee abilities/limitations, that they are to bring to their physician to fill out.

Unfortunately the form was not as specific as I would like, if I were the employer who has to accommodate the injured employee. I took a look online to compare this form with other Medical Forms and decided to create a form based on relevant information from a few of these. My revised form makes it easier for the physician to give the employer the qualitative information they require when accommodating the injured worker.

The first part of the form asks the physician to fill in complaint/prognosis information and asks them to check boxes as they apply, regarding specifics about modified duties, how long they will not be fit for regular duties, etc. There are 6 scenarios the doc can choose from. Here are two of those statements that require action:

"This employee is able to return to MODIFIED DUTIES for ____days and then: ____return to regular duties OR ____reassess."

"This employee is not fit to return to any work activity for a period of ____days."

The main chunk of the form deals with specifics regarding employee abilities and includes lifting, positional demands, category of work (sedentary, light, medium, heavy), and manual dexterity including these statements, that require a check if they apply:

___Can lift up to shoulder height ___

___Can lift up to ____lbs from waist to shoulders

___Able to Work extended hours

The last section outlines clear restrictions regarding lifting, position demands and repetitive activities, so there is no room for interpretation and includes statements like:

___No kneeling ___No bending

___Limited reaching ___Limited pushing

Finally the physician AND employee need to sign the form and return to the employer. As a clinician, this form filled out would give me all the information I would need to effectively put the modified duties or return to work plan in action. It also provides me with great information, should a Functional Capacity Evaluation be required.

If your workplace is using a strong Medical Evaluation Report and you would like to share it with me, I will collect them and make revisions to the form I am working on and then I will post the update revised Medical Report Form as a resource for employers dealing with this issue. It is time we share best practices strategies to ensure the safety of the employees and to guide HR decision making.

Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access

Protecting New Hires With Ergonomic Orientation

Thu, 16 Oct 2014 02:05:00 GMT

By now most companies have ergonomics on their radar and have at least added the topic to the WPSH committee meeting agendas. Others have been nudged into paying more attention to ergonomics by government WPSH orders or penalty fees, following injuries and subsequent WCB claims.

I have assisted companies who pride themselves in having sound ergonomic programs, having Safe Work procedures in place and policies that elicit quick responses to reports of pain, injury, and identified risk factors, as well as investing in administrative and engineering changes to solve the issues. Although off to a great start, they are reactionary in their methods and their injury statistics do not reflect a decreasing trend in injuries, most likely due to a lack of prevention in their focus.

Safe Work policies alone do not prevent musculoskeletal injuries, as they are job specific and not employee specific. Many ergonomic risk factors are individual in nature and warrant an individual ergonomic assessment to best match the environment to the worker. Providing ergonomic assessments for newly hired employees can prevent future injuries and therefore save the employer costs they incur responding to injuries.

Leaders in Health and Safety have taken their ergonomic prevention procedures a step further by including an ergonomic education session in the orientation of new hires along with the WHIMS and Safe Work Procedure training, to create a sound prevention program.

We know the risk of MSI is high in the first six months of being on the job, so spending loads of time and energy finding the right person for the job, might prove less than fruitful without ergonomic prevention measures in place. OK, so I'm sure you see the value in this type of prevention method, but how do you get your HR and Health and Safety Reps to get on board and put the plan in action?

Marnie Courage, O.T.Reg(MB)

Owner/Managing Director

Enabling Access

The Importance of Creating a Critical Job Inventory

Tue, 16 Sep 2014 02:06:00 GMT

Developing a Critical Job Inventory (CJI) is an important task in creating an effective Injury Prevention Program at your workplace. The following is a Safe Work guideline to developing your CJI :

1. Develop a system for identifying critical jobs:

Review specific tasks conducted by occupations. If you have a large workplace, start by identifying the departments within your workplace. Identify the different occupations within those departments. List the jobs or tasks within each one of the occupational groups.

Review the equipment used at the workplace. Multiple jobs or tasks may be performed with one piece of equipment. Remember to look at set up, calibration, changing blades and equipment operation for examples.

Review the statistics you have on file, accident/injury records, first aid books, etc. These will guide you to jobs or tasks that you may have overlooked. What were the injured workers doing when they were hurt? Did you capture this jon or task in the inventory?

Review new jobs or infrequently performed jobs. When a new job is introduced into your workplace, make sure you evaluate it and add it to your critical job inventory. It is important that this process does not stop. It is also important that jobs or tasks that are infrequently done are included and are high on the priority list to develop safe work procedures. These jobs must include a clear procedure so that when workers are to perform then, they are familiar with the safe way to do it.

2. Evaluate your critical jobs. Examine the degree of risk. Factors that you will take into account include:

Severity-what would the extent of the worker's injuries be if they were hurt while performing this job? Would the injuries be permanent? Would the injuries cause any time off?

Probability-what is the likelihood of the worker being injured when doing the job? Would it be probable in time? Remotely possible?

Frequency-how often is the job performed? How many workers would be exposed to the hazards associated with the job?

3. Create a CJI. Your CJI must include the job description and priority so that you can develop Job Hazard Analysis and Safe Work Procedures for the most critical tasks. You then have a plan of action for the remainder of the jobs on your CJI. Things to include on your CJI:

The date the inventory was done (this should be removed at a minimum every three years along with your program)
The department the job is conducted in and the manager or supervisor responsible for the area

The occupation that conducts the job

The critical rating or priority rating that you have assigned to the job after your evaluation or risk assessment.

Knowing the jobs is the most valuable action you can take towards reducing costs associated with injuries in the workplace. You will need good job descriptions for each job, which are easily compiled with an occupational therapist conducting a Job Demands Analysis (JDA) on jobs listed on your CJI, with prioritization given to those jobs with the highest risk ratings. The JDA will outline and measure all of the physical and cognitive demands of the job, making it easy to draft good job descriptions and help you better match employees to the jobs, at the time of hire.

Please let me know if this post has been helpful. I would like to hear your comments.

Marnie Courage

Owner|Managing Director

Enabling Access

marnie@enablingaccess.ca

The Skinny on Why Full-Figured Employees Are at High Risk for Wrist Injuries

Sat, 16 Aug 2014 02:44:00 GMT

As an occupational therapist, conducting office ergonomic assessments, I have come across many employees who are unable to position themselves ergonomically, because their body shape prevents them from assuming the positons, we are recommending.

In ergonomics, we typically set up people at their workstation so their elbows are at their sides bent at 90 degrees to access the keyboard and mouse, which are positioned in midline, either on the desk surface or on a keyboard tray. This positioning allows the employee to relax their shoulders and have their forearms supported on the arm rests of their chair while they type and mouse, while preventing reaching.

For employees who are "full-figured", and carry their weight in their stomachs and chest, keeping their elbows at their sides while typing and mousing becomes an impossible task. Instead, these folks have to reach around their larger chests or middles to access the keyboard and mouse which are certain to be positioned farther away from them, then their thinner coworkers, placing them at greater risk of musculoskeletal injury.

Here's why:

Reaching forward activates the muscles of the upper back and shoulders. These muscles work hard to sustain the forward reaching and eventually fatigue, resulting in discomfort and pain. By about 2 pm, these folks are wishing they had a personal assistant who is also a massage therapist.

To get their hands in typing position in midline, they have to assume ulnar deviation at the wrist (awkward posture) which creates stress on the wrists, discomfort and pain along the outside boarder of the hands and sensitive underside of the wrists.

With time, repetitive strain can develop in the wrists and without rest, change in position or treatment, the employee may become disabled and unable to work.

Solutions:

Purchase a split keyboard to allow the wrists to access the keyboard in a neutral position, preventing the ulnar deviation. There are many brands of these available.
Separate the two keyboard panels so they are positioned in line with the arm rests of the chair, away from midline to allow the forearms to be positioned on the armrests while typing, if possible.

Position the split keyboard close to the front edge of the desk to prevent reaching forward.

It is important for the employee to take Movement Breaks, Stretch throughout the day, as well as drink lots of water.

Just so you know, skinny folks also have other ergonomic challenges, so do tall folks, and so do short folks...so who's left? The point here is that we want to get people working as comfortable as possible, with the least amount of stress to the body. Guidelines for ergonomic positioning are just that, guidelines. Ergonomics is about fitting the environment to the individual, and if this helps to reduce someone's pain, then we all are headed down the right path! What's your ergo issue?

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access

Bathroom Safety For All Ages

Wed, 16 Jul 2014 02:11:00 GMT

When we think about bathroom safety those of us around in the 80’s think about the elderly and the TV commercial for LifeCall where the older woman is lying on the bathroom floor and calls out “Help, I’ve fallen and I can’t get up!”. It’s true the elderly are intrinsically more at risk of bathroom falls than the younger, stronger generation who have better balance and righting reactions, but the environmental risk factors that send our parents to the hospital with a broken hip are the same for us and could land us on our keisters calling out those memorable 8 words.

According to Public Health Agency of Canada, “One third of community-dwelling Canadian seniors experience one fall each year and half of those will fall more than once. The likelihood of dying from a fall-related injury increases with age; among seniors, 20% of deaths related to injury can be traced back to a fall. Nearly half of all injuries among seniors occur at home. The bathroom and stairs are particularly hazardous due to the risk of slipping, tripping and stumbling.”

You can use these tips to make your bathroom safe for anyone to use, at any age:

1. Prepare all supplies in or near the shower or bath before you bathe. For example, lay the towel on the toilet or stool close to the shower or tub so you don’t have to lean out of the tub and reach up to the towel rack which may be more than an arm’s reach away.

2. Remove any loose mats on the floor as they present a trip hazard. Instead use only a mat with grippy backing to step onto out of the bath.

3. Remove rubber bath mats in the tub as they present a trip hazard and instead use adhesive no slip decals on the bottom of the tub.

4. Remove sliding glass doors into tub and replace with shower curtain and rod for full access to the tub.

5. The highest risk for falling happens as you step into the tub and all weight is on one foot. To prevent having to step into the shower, consider using a bath chair or bench so you sit on the chair and then swivel and lift your legs into the tub one at a time. Bath chairs can eliminate all falls that occur in standing. Reserve bathing on the bottom of the tub for those achy body days or when you need an at home spa treatment.

6. Install a hand held shower head so you can access it when sitting on the bath chair and have it hanging down before you get into the tub so you don’t have to stand to access it once in the tub.

7. Do not use towel racks as grab bars as they are not designed to withstand our body weight. If you or someone in your home is using the towel rack or facecloth bar for support, remove and replace with a grab bar designed for bathroom safety and ensure installation meets safety standards.

8. Try siting on the toilet or stool to dry off and eliminate standing and lifting up one leg to dry when wet and slippery.

We are not too young to be safe in the bathroom and teaching our kids these tricks will create safe behaviors and prevent injuries from occurring at home.

Grab Bar Guidelines

Marnie Courage, Reg. O.T. (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Risk Factor Education in Preventing Pressure Ulcers

Mon, 16 Jun 2014 02:13:00 GMT

For people with stroke, spinal cord injuries, amputation, obesity and other conditions, the development of a pressure ulcer could be the beginning of a downward health spiral that could lead to death. As I was teaching this topic to university students studying Occupational Therapy, the need for community education for care givers became clear. In posting these risk factors I hope to share some basic info that will get caregivers thinking about what they could do to prevent this serious health issue.

Typically these ulcers originate when folks with limited mobility maintain static positions in their wheelchair or bed without relief. Sufficient pressure (either in duration or intensity) can alter blood flow compressing capillaries and depleting the skin and structures beneath of oxygen and essential nutrients. Metabolic wastes accumulate and the vascular and lymphatic systems are unable to evacuate them. As the tissues begin to die and inflammation occurs, infection and subsequently more cells die. The result is a pressure ulcer, defined as "any lesion caused by unrelieved pressure resulting in damage of underlying tissue." 1

Most people think that this breakdown starts at the skin surface, when in fact pressure ulcers typically develop at the subcutaneous level (muscle or bone). As pressure is translated through tissues to the bone the measure of pressure intensity may be significantly higher and the amount of external pressure required to prevent oxygenation is much less over the bone than over muscle. Common areas on the body which are prone to pressure ulcers from sitting are locations with boney prominences such as under the buttocks, the low back, shoulder blades. From lying in bed the heels, ankles, back, shoulders, elbows and hips.

Although healthcare professions are trained to spot the initial signs of pressure ulcer development, they are not with the disabled person day to day and the lack of education provided to caregivers and family is what sends these folks to the hospital with stage 3 or 4 ulcers because risks factors went unknown and undetected. The following are a list of 10 common pressure ulcer risk factors:

1. Perpendicular Pressure - Direct point pressure will ultimately result in compromised circulation and cell death. This is usually the result of inadequate pressure management either in intensity or duration.

2. Parallel Pressure (Shear) - When the body slides across a surface and friction is in effect, usually the result of improper positioning, movement or non-uniform pressure distribution.

3. Moisture - At the body surface can be due to incontinence, perspiration; insufficient drying after bathing which all can create friction and magnify the risk of shear.

4. Friction - Caused by repetitive movements, sliding transfers, spasticity, agitation, over high friction surfaces can result in the damage to superficial skin causing mild burn.

5. Increased Age - With normal aging there is a general atrophy of soft tissue such as fat and muscle, which normally acts as a protective cushioning barrier to external pressure.

6.Decreased Sensory Perception - Due to nervous system impairment impedes the person from receiving cues to change position.

7. Impaired Mobility - A person who is unable to physically reposition themselves.

8. Decreased Mental Status - A person who has an impaired responsiveness to their environment.

9. Circulation Impairment - blood vessels that are structurally compromised are more likely to become occluded due to pressure, shear and resulting tissue ischemia.

10. Poor Nutrition - Decrease nutritional status can result in weight loss and loss of protective soft tissue. Decrease protein intake as well as Vitamin C, impairs collagen formation.

Early signs of pressure ulcers include any areas of redness after exposure to pressure, hardening of the skin, bogginess and increased skin temperature at the suspected area. If caught early worsening of these pressure ulcers can be prevented. Knowing the risk factors and learning about prevention strategies could make the difference in saving someone from the deadly infections that often show up with aggressive pressure ulcers.

For more information on the prevention of pressure ulcers visit http://www.preventpressureulcers.ca

Marnie Courage, OT reg (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

1.Bergstrom,N.,Bennett,M.A.,&Carlson,Ce.E. (1994). Clinical practice guideline: Pressure ulcer treatment

Needs Based Life Care Planning

Fri, 16 May 2014 02:14:00 GMT

There is a growing demand for Life Care Planning or "Future Cost of Care Analysis" as we refer to it in Canada. A life care plan is defined as “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health needs" (International Academy of Life Care Planners, 2002, Standards of Practice. Journal of Life Care Planning.1 (1), 49-57) The cost of these documents varies based on geographic location and the experience of the Life Care Planner. In Canada you can anticipate costs on average to run anywhere from 20-60 hours of billable time for a catastrophic injury at anywhere from $90-150/hr. An even higher rate is typical for court appearances.

Life Care Plans are prepared by many disciplines including Nurses, Physiotherapists, Occupational Therapists, Kinesiologists, and more. There is now a certification for Life Care Planners, and companies are popping up everywhere dedicated to providing this service exclusively. Typically, these Life Care Plans are required for judicial/forensic use when determining compensatory damages and assisting the court in assessing the disability. They are also prepared for clinical use as a cost effective case management tool to help clients prevent future injuries, and they provide details how the plan can be implemented - a road map of the future for the individual and family. Insurance companies also request these Life Care Plans for making decisions regarding optimal allocations of resources for the client.

The Life Care Plan is usually required for individuals with catastrophic Injury (Brain Injury, Spinal Cord Injury, Amputation, Low Vision, Burns, Multiple Orthopedic Injuries, etc). When sourcing out professionals to conduct the Life Care Plan, ensure that the approach used by the Life Care Planner is neither Plaintiff Oriented or Defense Oriented, and instead is "Needs based" to ensure a fair and defendable product. All recommendations should maximize the individual's level of independence and ability to participate in society, and prevent functional deterioration and medical complications.

If you, or someone you know has filed a personal injury claim or if you are a case manager or lawyer who deals with catastrophic injury cases, knowing what you get from a Future Cost of Care Report or Life Care Plan is essential in ensuring that the best interests of the client are being addressed. If possible, hiring a Life Care Planner who resides in the same city as the client will save you money as they will have good knowledge of local resources for the client, looking down the road at rehabilitation, housing, personal care supports and more. These reports need to be defendable in court and you don't want to have the Life Care Planner questioned about availability and quality of resources in an unfamiliar community.

Choosing an occupational therapist who provides rehabilitation services to catastrophic injured clients will give you peace of mind, knowing they have the practical knowledge of physical and mental rehabilitative needs for these clients. Remember, the final product is not just a document, but you are also paying for the author to potentially appear in court, be professional, fair and be able to articulate well the defense of that document regardless of being on the plaintiff or defendant side of the courthouse.

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

When the Smoke Clears - A New Perspective on Disability

Wed, 16 Apr 2014 02:17:00 GMT

I am writing this blog using Windows Voice Recognition software on my laptop, to demonstrate just one of the accommodations I have had to make following a recent injury. I am having some frustration with traditional typing due to a Scaphoid fracture in my wrist, which I sustained a couple of weeks ago when I fell getting into a boat, at our family’s cottage near Kenora, Ontario.

A fractured wrist is a temporary impairment resulting in a mild disability. The injury occurred as I was attempting to assist a badly burned man into our boat to get him to the ambulance that was waiting for us on the mainland. This man had barely escaped a fire which had destroyed the cottage he was staying at, and took the life of his friend who didn’t get out. The cause of the fire is still undetermined and the man we helped suffered severe smoke inhalation, 3^rd degree burns, and major lacerations from breaking a window to escape. He is still in critical condition in an induced coma. This tragedy has taught me many things, and has offered me a gift I can’t ignore.

I’ve been struggling with reliving the sequence of events, the sights, smells and other sensations I experienced during the event, trying to process if there was more we could have done. My husband assures me that we gave the man we helped the best chance of survival. Luckily, one of our neighbours is a paramedic and his wife is a nurse. Together, the four of us cared for this injured man and got him to the ambulance as fast as we could, keeping in mind it was pitch black at 4 am, with no moon and we were on an island 20 minutes from mainland. Although I did not know the man I helped, I feel connected to him and I am fearfully anticipating the tremendous journey he has before him, should he survive his critical status in a U.S. burn center.

I have worked with people living with disabilities since I was a teenager. As an occupational therapist for the past 11 years, I feel like I’ve been an empathetic therapist, understanding the needs and pain of my clients and how their impairments affect their lives on a daily basis. I also thought that I was doing a good job assisting clients with mental health issues like depression, post-traumatic stress disorder and grief, return to work and to their previous level of function, following accidents and injury.

By witnessing the fire, loss of life and suffering, my eyes have been opened to the horrors one must feel after living through a traumatic event. The cast on my left arm is a constant reminder that life is precious and it can be taken from us, in just minutes. I also see it as a call to action, prompting me to share with others, that we all have a responsibility to be prepared and have a plan in place in case of emergency, as it may prove to save a life.

Although my injury is not life changing, it has made me aware of the difficulties people living with disabilities encounter on a daily basis. Having to only use one hand for all of my activities of daily living, although frustrating, is a minor inconvenience when compared to the barriers people living with more involved disabilities face each day. Tasks that I took for granted like getting dressed, cutting my food, driving, and using my computer, have become difficult and require that I modify how I conduct them. For folks who have been impacted by injuries or diseases that render these basic tasks impossible, I am truly empathetic and will be more compassionate and patient, moving forward.

I just returned from travelling to another city and had to explain what had happened to me to many curious people I met throughout the week. I had a short script prepared explaining, “ I slipped and fell into a boat” so I didn’t have to relive the event over and over again. It makes me wonder how people with profound disabilities deal with curious observers, feel about the second looks, and also what scripts they have prepared for the inevitable questions.

Even as someone who works with people who live with a variety of disabilities, it took a tragic event for me to finally understand and appreciate fully what people may be going through after experiencing loss, illness or injury. Although I don’t want people to go through a similar experience, I do hope we can all dig a bit deeper in our hearts and minds to image what our clients, our neighbours, or strangers may be going through. We can each advocate, donate or make changes in our lives to prevent injuries, and to remove barriers in our homes and workplaces to make our communities more accessible for people living with mental or physical disabilities.

Please share this link. It might save someone you know. http://www.foca.on.ca/Fire-Safety

Marnie Courage

Managing Director

Enabling Access

marnie@enablingaccess.ca

Cognitive Work Hardening - Helping Clients with PTSD Get Back to the Job of Living

Sun, 16 Mar 2014 02:18:00 GMT

Work Hardening in the rehabilitation world has widely been used to assist people with regaining physical capabilities in efforts to return them back to work, following injury or illness. We are seeing more and more people suffering from mental health issues, either as a result of having to live with their physical disability or from injuring or ending someone else’s life.

Rehabilitative treatment for clients who are physically injured may involve Work Hardening in a clinic setting to improve strength, coordination, endurance and pain tolerance, with their simulated job tasks. Often clients make good improvements in this type of intensive treatment program. Unfortunately, once they complete the program some folks still have difficulty returning to work, due to their mental health status.

Symptoms of depression, anxiety and anger are common barriers to successful Return to Work experiences. In these cases, clients are usually sent for psychological consult, to determine if regular treatment sessions are warranted. After much time, many beneficial sessions and several attempts of returning to work, we still see these clients struggling to work at the capacity they did prior to their accidents.

Cognitive Work Hardening is like the physical Work Hardening we see in the clinic, but it is conducted by an occupational therapist who works closely with the client in their place of work. The goal of Cognitive Work Hardening is to walk with the client, through their daily tasks, evaluating potential challenges, barriers and triggers that may result in exacerbating their symptoms of depression, anxiety, anger or other emotional distress.

In Cognitive Work Hardening, we can assist our clients by providing strategies for managing work flow, simplifying processes, dealing with coworkers, providing recommendations for clustering like-energy tasks, incorporating mental breaks, thought blocking, self-talk, and much more. The common goal is to increase productivity, motivation, confidence and reduce emotional pain and non-productive thinking that stems from emotional distress.

Just because the accident or incident that caused the client to be off work is in the past, doesn’t mean it's not presently running through that client’s mind several times a day. It takes both Body and Mind to heal from injury or loss and we should make sure we are treating both in our rehabilitative programs.

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access

marnie@enablingaccess.ca

Occupational Therapists Wear Many Hats But Still Fighting for Insurable Service Crown

Sun, 16 Feb 2014 02:20:00 GMT

Even after practicing occupational therapy in Canada for 11 years, I still have a hard time defining what I do in one sentence. The profession of Occupational Therapy (OT) has been around since the First World War, as we provided wives of husbands, who were off at war, the skills to make them employable in previously male dominated industries. We also assisted the injured soldiers with relearning their "activities of daily living" (a term adopted by the profession to describe all tasks related to self-care, productivity and leisure).

Since then, the profession, which has grown worldwide, includes rehabilitative therapy for people living with disability throughout the lifespan, from infancy to death. OT's can specialize in a variety of practice areas including the treatment of clients with Mental Health conditions, orthopaedic injuries, spinal cord and brain injuries, the science of Ergonomics and the effects on people, acute hand injury intervention, neonatal care and much more. Through education and skill building we teach injury prevention techniques at work and home, which many companies and groups are benefiting from.

Most Canadian OT's are now graduating from a Master’s Program in schools of Medical Rehabilitation within the faculty of Medicine, along with other allied health professionals, such as physiotherapists. Our academic credibility is supported by the vast amount of research that comes from the profession of many hats, making strong contributions to the medical research community. For more information about the profession, please visit the Canadian Association of Occupational Therapy at http://www.caot.ca

It might seem surprising that most insurance companies do not recognize OT as a basic insurable service, as they do with Massage Therapists, Physiotherapists, Chiropractors and other allied health professionals. Some insurance companies have included OT in their extended health packages, but often these limit coverage to one visit per year or the equivalent in maximum limits. The Canadian Association of Occupational Therapists have been fighting the battle for many years to get the recognition we deserve in the eyes of the insurance companies, with only minimal success.

In speaking with insurance companies locally, it is clear that their members are not asking for the services OT's provide, unless they have a family member with a disability or they themselves have been injured. Unfortunately, like any other insurance coverage, you many only see the value in it following a loss, like house insurance if your house burns down. These insurance companies only include services the majority of their members are requesting they cover.

We need to do a better job, at least in Canada, to educate people about how occupational therapy can help people following an injury, medical diagnoses, or in later life when the physical changes with aging affect mobility and independence. People need to start requesting that their insurance providers cover the services that they or their family member may urgently need one day. We also need to do a better job of marketing the profession. You have seen commercials for Physiotherapy and Chiropractors, but have you ever seen a commercial about Occupational Therapy? Instead of blaming my association for not putting enough resources into marketing and advocating our profession, I am doing my part to spread the word. OT's are building skills for living, and its time everyone knew what we do and how we can help them.

Here is my best stab at a one sentence definition of what an occupational therapist does: "Helping people to be as healthy and independent as possible in all areas of living, at home, work and play, throughout the lifespan." I would love to hear how you define what OT is or how it has helped you, a friend or family member. I will post a collection of definitions titled "What OT Means to Me" that can be used in our national campaign to have OT recognized by the majority of insurance companies as a basic insurable service.

Marnie Courage, OT Reg (OT)

Managing Director

Enabling Access

marnie@enablingaccess.ca

'More Wheeling' Not Best Exercise Option for Wheelchair Users

Thu, 16 Jan 2014 02:21:00 GMT

We all understand the importance of exercise in maintaining our strength, flexibility and endurance as we age. But, as you know, it is sometimes difficult to fit in 30 minutes of daily activity into our busy lives. We use lunch break walks, weekly yoga classes, chasing after kids, wherever and however we can get it.

If you are in a wheelchair, the same principle exists for supporting a healthy body and mind, yet the options for exercise are much more limited. Independently using a manual wheelchair as a main mobility device requires that the individual self- propel by pushing the wheel rims. Some people assume that a self-wheeler should just do more wheeling if they want exercise.... but that might cost the wheeler more than post exercise burn.

Self-propelling does require energy, muscle power and burns calories with every stroke, however our shoulders, much like our knees are vulnerable to repetitive strain injuries (RSI). If you develop a condition in your knee that makes walking or standing painful, your exercise options become more limited. You might still be able to swim or ride a bike, but most have to skip the long walks and runs, so to not aggravate the knee further. The same holds true with wheel chair users, but it has a greater impact. If you develop RSI in one or both shoulders, not only are your exercise options going to be limited, but so will your mobility, as your tolerance for self-propelling decreases.

Shoulder RSI for wheelchair users can be caused by improper wheelchair configuration, involving precise wrist, elbow and shoulder positioning to optimize push forces and reduce resistance. If the seating or wheelchair set up does not provide optimal self-propelling positioning, the user is at risk of developing RSI in any of the arm joints. Even those wheelchair users who are set up perfectly, can develop RSI just from overuse and then can have difficulty conducting their activities of daily living. So more wheeling is not the answer when looking for exercise options for wheelchair users.

Adapted fitness is the modification of traditional excise to meet the physical needs of those living with a disability. Few community resources exist and are not marketed well enough to reach these end users. Sledge Hockey, Wheelchair Rugby, Wheelchair Basketball are now considered professional sports, but for the less competitive, Swimming, Adapted Weight Training, Adapted Boot Camps, and Adapted Yoga are some of the ways wheelchair users can enjoy the benefits of exercise without risking losing their mobility from an RSI. Participating in a variety of exercise modalities (Cross Training) has shown to be the best way to work different muscle groups and work our joints, without creating undue strain on the joints we require for our activities of daily living, including just getting around.

Marnie Courage, OT reg. (MB)

Managing Director

Enabling Access