Occupational Therapy

An In-Home Assessment is often the first step in the client's return to pre-accident function. The assessment includes an objective physical assessment of the client (strength, range of motion, tolerances), a functional assessment of the client's current abilities to manage their activities of daily living, a determination of the client's pre-accident essential tasks as well as their medical, social and vocational history. An Assessment of Attendant Care Needs (Form1) can be included if requested by the referrer.

The resulting report is a clear, well-documented baseline of the client's current abilities, their pre-accident essential tasks as well as specific, time-limited recommendations to assist the client in returning to their pre-accident status. 

In-Home Treatment is often the implementation of the recommendations of the In-Home OT Assessment. The OT will work with the client in their home, to actively implement strategies that will allow the client to overcome functional barriers.
Strategies may include:

• Educating the client about their injuries and the impact on the daily function.
• Education on the concept of hurt versus harm.
• Training in proper body mechanics.
• Development and training of alternate techniques to complete essential tasks.
• Provision of strategies to improve strength, range of motion and physical tolerances.
• Prescription of and education in the use of low-cost assertive devices that promote independence.

The goal of In-Home Treatment is the client's resumption of pre-accident essential tasks. Upon discharge, the client will be independent in these tasks and not reliant on external services. If this is not possible, the OT will provide a professional opinion on the client's status and possible courses of action.

Attendant care refers to assistance provided to an individual in the areas of self-care, hygiene and safety within the individual’s home environment/institution.  If the client requires assistance with these basic functions in the community, attendant care time is allotted for the provision of the service in that setting and will be identified as such. Typically performed for the following injury types:

• Fractured limb/spine
• Multiple trauma
• Spinal cord injury
• Acquired brain injury
  

With these systems DMARehability has the capability of providing:

1. Post Offer Evaluations – New hire
2. 1 and 2 day In-Clinic Assessment
3. 1 and 2 day In-Home Assessment
4. Baseline Assessment
5. Injury Specific Assessment
6. Job Match Assessment
7. Return to Work Assessment with recommendations

KEY: The KEY Method FCE is an objective and legally defensible protocol for evaluating people's safe capabilities. When administered by our certified therapists, an FCE can meet the needs of clients, physicians, insurance carriers, employers and lawyers in determining work potential or determining safe activity tolerances. To provide confidence that the assessment results paint a true picture of the client's safe capabilities, each KEY assessment includes a Validity Index indicating the extent of the person's participation. For convenience, the KEY Method FCE equipment is mobile, allowing our therapists to conduct the assessment across Southwestern Ontario in our clinics, employer worksites or at clients' homes.

Ergonomics is the multidisciplinary scientific study of the relationship between man and the work environment. The aim of ergonomics is to create an effective workplace and to help prevent work-related health problems through proper workstation and job design. The workplace contains the tools, equipment and workstations required to perform a job. Problems arise when workers have to adapt to poor workplace and job design. The science of ergonomics involves designing the tasks to accommodate the worker rather than having the worker make adjustments to complete the task.

The objective of assessment is to determine the essential tasks of the client's job and objectively measure the physical demands necessary to complete the tasks. To ensure objectivity, our therapists are equipped with a Chatillon Push/Pull Gauge, Jamar Dynamometer, weight scale and tape measure. These tools are calibrated regularly to ensure admissibility in arbitration or court proceedings.

If the client is unable or unwilling to attend the workplace with the therapist, a theoretical Job Analysis can be performed by observing another person performing the tasks and verifying these with the employer. In all cases, we ask the client and the employer to review the Job Analysis report and sign to agree that it is accurate.

With the increasing incidence of disability due to stress and other non-physical diagnoses this assessment has become much sought after.  The goal is to objectively assess and measure the cognitive demands of the job.  The focus is on the job itself, NOT the worker.  Some of the categories assessed include: Degree of self-supervision required, deadline pressure, exposure to distracting stimuli, exposure to confrontational situations.  The assessment provides professionals involved in return to work planning with a tool to identify obstacles.

This program is designed to ensure their clients get the care they need, when they need it. Within hours of referral, we will contact the client or a family member and arrange for an OT assessment within one business day. QuickCare services include:

• Coordinate all aspects of the hospital discharge
• Complete Home Assessment to ensure client safety
• Complete an Assessment of Attendant Care Needs (Form 1)
• Deliver Occupational Therapy follow-up to facilitate functional improvement
  
• Coordinate convalescent care, if necessary

Our ABI Assessments are function-based, providing information regarding the client's functional strengths and weaknesses as well as barriers to achieving maximum independence. Recommendations are clearly linked to assessment findings and include specific goals, timelines and projected reassessment dates.

Measures of performance are derived from observations of the client engaged in real world tasks, administration of standardized assessment tools and collateral interviews with family members and others central to the client's life. During the treatment process, the client's progress is documented in an individualized goal-specific format. The OT will identify appropriate reductions in treatment as required.

Appropriate return to work/school planning is facilitated by the completion of on-site work assessment and consultation with rehab team members, family and other involved parties. Recommendations regarding the need for any supplemental evaluation (i.e. driving) are provided within the context of the treatment plan.

If requested, the OT can combine the Job Analysis with a Physical Assessment of the client. With an understanding of the client's capabilities as well as the demands of the job, the OT can formulate a Return to Work plan. The OT will seek agreement to the plan from the attending physician, physiotherapist, client, employer and other professionals as required.

Once a consensus on the Return to Work plan has been obtained, the OT will implement the plan. Typically this is graduated over several weeks to allow for tolerances to build and may include ergonomic modifications to the workplace, modified duties, education for the process. At each stage, barriers to the client's progress are identified and actions taken to systematically overcome them.

Our OTs can provide one to one support for individuals returning to work when barriers have been identified. The therapist will provide cues for any physical, cognitive or emotional strategy that has been determined. They will document productivity levels and acknowledge and support gains being achieved. There is documented statistical literature to support the increased services of return to work Programs when a job coach has been involved.

Evaluates an individual's potential to safely operate an automobile following an injury or disability. After reviewing the client's pertinent medical history, the Occupational Therapist evaluates the client's physical and cognitive abilities. This examination is followed by an in-car driving assessment with both the therapist and a qualified driving instructor.

Our driving assessors are members of the Association of Driver Educators for the Disabled (ADED) and we are registered with the Ministry of Transportation of Ontario.