Staff Education and Training

In nursing homes, retirement centers or senior homes, Occupational Therapists provide information about client handling techniques. What does this mean exactly? The Occupational Therapist educates staff members on how to safely transfer residents in and out of bed or in and out of wheelchairs, for example. This is crucial for the safety of the residents and helps to reduce the incidences of work place injuries. This education keeps both the staff and the residents safe, and ensures the comfort of all involved.

Occupational Therapists also understand the proper use of body bio-mechanics. This forms the basis of client handling education, and training is required to properly utilize these principals by staff members. Occupational Therapists are able to effectively train staff members in this area and others, such as fall prevention. To help staff members with this, the Occupational Therapist will outline physical risks for individual residents, environmental risks, and risky behaviors of the elderly who are mobile and who have a diagnosis of arthritis, hip arthritis, or osteoarthritis. Understanding risky behaviors is particularly important as it is a significant factor in maintaining the independence of elderly residents while simultaneously ensuring their safety.

Occupational Therapists working in long term care also educate staff and family members on ways to keep residents safe with the use of mobility aids such as walkers or wheelchairs, tilt-in-space wheelchairs, or canes. In order to keep residents at nursing homes, senior centers or retirement homes safe, this type of training must take place. Occupational Therapists also help staff members learn the proper use of sit to stand lifts and ceiling lifts in order to prevent workplace injuries.

Occupational Therapists do more than perform wheelchair assessments or help rehabilitate people. Their role is multi-faceted and, as we can see from the above examples, often includes education and training, something many people don’t think of when they think about Occupational Therapy. In order for a nursing home, senior center or retirement home to have a rounded team of healthcare specialists, an Occupational Therapist must be involved because of the wide range of roles he or she plays in the long term care field.

Complete Manual and Power Wheelchair Assessments

For most people, selecting a wheelchair for mobility is a daunting task. There is so much that goes into choosing the right one that it can be overwhelming and very confusing, especially if you are selecting one for a family member in a nursing home or retirement center. An Occupational Therapist helps with the wheelchair assessment process and makes it less stressful for the buyer. For example, an Occupational Therapist will assess the resident’s physical and functional abilities after a careful review of their diagnosis. A person in long term care could be dealing with anything from a stroke, arthritis, hip arthritis, or osteoarthritis.

Once the Occupational Therapist understands the functional abilities of a resident, they can fit the products to the individual’s unique needs. They will also ensure that the individual understands the features of the recommended products. Having an Occupational Therapist help with the wheelchair assessment process can alleviate stress from both the resident in long term care and the people in his or her life.
 

Complete cognitive assessments

Individuals in nursing homes, senior centers or retirement homes sometimes need Occupational Therapists for cognitive assessments. An Occupational Therapist can administer these cognitive assessments for residents who have an early onset of dementia or a diagnosis of Alzheimer’s to ensure their safety and well-being. These assessments can be completed within long term care facilities, making the Occupational Therapist even more of a crucial team player in long term care.
 

Recommending pressure and redistribution surfaces

Having an Occupational Therapist on hand who can recommend pressure redistribution is crucial for residents living in nursing, senior or retirement homes. Individuals who use wheelchairs on a regular basis or people who are bed ridden benefit greatly from having an Occupational Therapist who can suggest pressure redistribution as often staying in one position can cause medical problems to arise.

Beyond that, OT’s can make recommendations for residents who have existing pressure sores or for residents who are at an increased risk for developing pressure sores. There can be many reasons for this increased risk: declining mobility, declining cognition, or even a medical diagnosis. Preventing sores from developing in the first place requires a multi-disciplinary approach where allied health professionals such as Occupational Therapists, dietitians, physiotherapists, and nurses work together in improving the resident’s positioning and comfort. The team approach in long term care is one of the best ways to ensure good health.
 

Equipment reassessments

While some people believe that all they must do is obtain the prescribed equipment, reassessment is critical. At regular intervals, an Occupational Therapist ensures that the equipment still meets the resident’s needs. In most cases, modifications or changes have to be made to the prescribed equipment in order to better fit it to the resident’s changing physical and cognitive needs. Your Occupational Therapist will ensure that as the individual’s needs change, the equipment he or she uses is appropriate.

As you can see, Occupational Therapists are extremely important in long term care facilities. A nursing home, retirement home, or senior center benefits greatly from having Occupational Therapy as part of the allied health approach for residents.

Pelvic Symmetry

Wheelchair pelvic tilt is evaluated as forward tilt (anterior), backward tilt (posterior), slant (obliquity), or rotation. The pelvis is the key to proper wheelchair body positioning. Many physical conditions cause an uneven pelvis, but proper ergonomic assessment distributes pressure and prevents muscle contracture. Tight hamstrings, self positioning, and an inability to maintain 90 degree hip to leg angles causes posterior tendencies. Weak stomach muscles, weak hamstrings and tight hip muscles promote anterior tilt. Muscle imbalance, muscle contracture and incorrect wheelchair size contributes to pelvic rotation and obliquity.

After an occupational therapist evaluates a wheelchair user’s needs and medical condition, correct pelvic positioning will correct flexible deformities, accommodate fixed deformities and minimize postural supports. One of the accessories used for proper pelvic positioning is a wheelchair belt. Both forward and backward pelvic tilt can be corrected to a certain extent with a properly positioned belt. Two point, four point, or harness belts assist positioning.
 

Wheelchair Back

A person’s spine should maintain a natural S-curve alignment. The shoulders should be above the hips and ears above the shoulders. A good starting point begins with a wheelchair’s backrest angle as close to 90 degrees from the floor as possible. As the backrest is moved just below the mid-body spinal curve, it should contact the lower curve, or lumbar spine. Beginner users may need a higher backrest and larger backrest angle, which can be changed as their body strengthens.
 

Support and cushioning

Body pressure should be divided between the seat and the backrest. Pressure should not be higher in one location more than the other. The larger the contact area, the less likely pressure sores will form. The user should sit as far into the seat as possible. Occupational therapists palpate pressure in all body-to-chair contact areas as proper assessment procedure. Padded backrests and lap trays provide extra reinforcement to keep users comfortable throughout the day. Extra arm cushioning elevates arms to keep shoulders at comfortable levels.
 

Lower Extremity

The ideal posture for the lower body involves both the legs and feet. Feet need to be flat on foot supports in a neutral position with ankles at 90 degrees. Foot supports need to be at least two inches from the floor. The thighs need to be parallel to the wheelchair seat with knees bent just over 90 degrees, with one to two inches of space between the back of the knee and the front of the seat. Foot and leg positioning directly affects the position of the pelvis. Improper footrest leg height increases pressures on other body areas.
 

Affects of Poor Posture

Poor posture causes pain and deformities in wheelchair users. Improper body positioning causes flexed muscles to shorten, thus reducing a person’s usability. Back and shoulder pain do not need to be an inevitable consequence of wheelchair users. Complete skeletal assessment, followed by postural changes, can alleviate typical musculoskeletal pain, and allow functional stability.
 

Wheelchairs provide variable mobility to people with various physical disabilities. There are four major types of wheelchairs: indoor, outdoor, combined and special. Ergonomics, or design of equipment to prevent injury, considers all physical and anatomical limitations of the users. Occupational therapists perform ergonomic assessments to evaluate proper wheelchair fit for each individual client. A complete assessment may prevent future injury, and improve mobility.
 

SEAT WIDTH

The width of the wheelchair seat is based on the users’ widest point, usually the hips or thighs. If shoulders are wide, consider the shoulder width when choosing a seat width. A too-wide seat leads to difficulty in mobility, inadequate support and discomfort. A narrow seat contributes to pressure sores, inadequate support and discomfort. It is important to have an exact measurement of the seat width for optimal mobility and environmental accessibility.
 

SEAT DEPTH

The seat depth is measured from the back of the pelvis to the back of the knee. Users with one leg longer than the other require both legs measured. Also, make sure the user is in a proper posture prior to all measurements. Subtract 1 to 2 inches from the measurements for optimal comfort.
 

SEAT HEIGHT AND ANGLE

The distance of the seat from the floor needs to consider a ground clearance of foot rests at 2 to 3 inches. When using a seat cushion, its thickness needs to be considered in this measurement. Also, drop hooks lengths need to be subtracted. It is important to have knees at 90 degrees when the feet are placed on the ground.

Tilting the back of the wheelchair seat down towards the floor provides multiple benefits. It assists gravity with positioning, improves vision, improves stability, and trunk control, while increasing comfort. The tilt is accomplished by decreasing rear wheel size, or increasing the front castor.
 

BACK HEIGHT

The back height of the wheelchair is measured from the top of the seat cushion to the top of the back support cloth. Occupational therapists assess the height of the user, their balance needs, and their need for support in relation to the wheelchair. If the back height is too high a user will have limited arm and shoulder mobility. If the height is too low, the user has inadequate support resulting in fatigue and sliding. The therapists will use five anatomical landmarks for these measurements, depending on the condition of the user. Also, proper seat to back angle needs evaluation.
 

FOOTRESTS AND ARMRESTS

The footrest settings must accommodate the length of the users’ legs. A measurement is taken from the back of the knee to the heel. Shoes should be worn during the measuring. The thickness of the cushion is subtracted from this measurement. If the footrest length is high it leads to pelvic pressure, hip rotation and discomfort. Too low footrests result in thigh pressure, hip rotation and sliding. Also, footrest angles usually sit at 60, 70 or 90 degrees. Pediatric users find 90 degrees helpful.

Armrest height is measured from the seat surface, or cushion, to the elbow. During measurements the elbow is flexed at 90 degrees, the arms are comfortable at the sides, while the shoulders remain relaxed. Armrest width should accommodate the environment and assist in transfers to and from the wheelchair.

A safe and supportive computer work station is essential for health and production. Occupational therapists use ergonomic assessment as an evaluation tool to recommend equipment design for both work and home. Studies done by the British Chiropractic Association found that 59 percent of the working population sits all day at work, and 56 percent of chiropractors view office workers as vulnerable to back pain. Therefore, proper chair design and adjustment may prevent or reduce health issues related to improper posture and position.
 

ERGONOMICS

Ergonomics is the science of design, which is intended to maximize productivity in the workplace. Proper design reduces fatigue and discomfort. Since many jobs require long hours sitting in a chair, reducing physical discomfort logically increases efficiency. Along with occupational therapy, proper ergonomics decreases error rates and overuse injuries. The need for occupational therapists performing ergonomic assessments proves that one size does NOT fit all.
 

CHAIR SEAT

Since providing every employee a custom designed chair is not feasible, providing them with a fully adjustable chair covers a large range of people. According to the Canadian Centre for Occupational Health and Safety, proper chair seat height is 25 to 30 centimeters below the work surface. A seat that is too high forces a person to work with feet unsupported or the body too far forward on the chair. A low seat will put excess pressure on the buttocks of taller users. Feet should be flat on the floor and knees should form a 90 degree angle with the hips.
 

The size of the seat pan should be at least 43 centimeters wide, leaving 5 to 10 centimeters of space between the seat and the back of the chair. The seat pan should support the thighs, without permitting knee back to contact the front of the seat pan. If needed, a footrest raises knee height to relieve pressures on the back of the leg.
 

BACKREST

Back pain and fatigue occur when poor chair conditions allow inadequate back support and uncomfortable postures. A person’s chair needs fitted lumbar support, which means the backrest fits closely into the curve at the small of the lower back. Correct support will maintain the natural S curvature of the spine. Backrest height adjustments allow proper alignment of chair lumbar support with a person’s size. To enable the body trunk to stay within a recommended 30 degrees from upright, a reclining backrest tilt adjustment needs to be present. Also, moving the backrest forward and backward allows shorter or taller people proper adjustments for leg length on the seat pan.
 

ARMRESTS

Using armrests is optional, but if used should be adjustable with padding for comfort. Low armrests may cause a person to lean to one side for resting, distorting posture. High armrests cause raised shoulders, and muscle tension in neck and shoulders. Armrests too wide or too close cause additional fatigue. Also, if they interfere with desk to chair placement, the chair may be too far from the desk for correct posture. If armrests are not adjustable remove them. Otherwise, adjust them to support the lower arms with shoulders relaxed.
 

BASE

The base of a chair needs at least five strong legs. Otherwise, the chair has inadequate support and is prone to tipping. Casters must be appropriate for the type of flooring. A chair without casters or improper casters increases reaching and bending, which leads to muscle strain.

The first thing to do before lifting a heavy load is to take a minute and assess everything. Are you sure that you can lift the load alone? Are there any obstacles in the way that may be a hazard? Make sure you know how far the load needs to be carried and for how long you will be carrying it. Just being prepared can help you quite a bit.

Once you’ve assessed the load, you will want to begin by standing with your feet shoulder width apart. This is important because it will keep you stable as you lift the object and will help prevent a potential fall. Once you have a solid grasp on the object, carry it as close to your body as possible. This is important for a few reasons: holding an object close reduces the load on your muscles while also ensuring that the object is not at the end of your reach. When something is at the end of your reach, you become unstable and could possibly fall.

You also will want to keep your back straight. Many people believe that the strongest muscles in the body are those in the back; however the strongest muscles are actually found in your legs. Keeping your back straight will provide more stability when lifting. To utilize your leg muscles, bend at the knees and slowly stand while keeping your eyes on the load—and, again, keep that back straight! To further protect your back, tighten your stomach muscles during the lifting process. This will prevent you from exerting too much pressure on your spine.

All in all, follow these tips to safely lift large loads. Remember, though—if you think something looks too heavy, ask someone else for assistance.

Ergonomics is the science of fitting a worker to their workplace – making sure that an employee is comfortable and safe while working. Occupational therapists come into workplaces and make recommendations to help prevent injuries, and a successful ergonomic assessment will not only greatly reduce strain and injuries on the job but also improve worker morale and boost job productivity

A lot of Ergonomics focuses on your back and proper seating, but your back isn’t the only thing you’re hurting when you sit incorrectly. You’re also potentially stressing or injuring your neck, hips, legs, shoulders and wrists. Basically, your entire body is at risk. Today, I’m going to tell you about three easy fixes to problems that can damage more than just your back when you’re sitting.

Something that effects a lot of women, and some shorter men, is keeping your chair too high (Figure A). Whether it’s because your monitor or desk is too high or because your chair is too tall, this is terrible for both your lower back and hips, and it can cause muscle cramps and numbness in your legs. The easiest way to fix this is to lower your chair, but if you’re very petite or the chair is very large, another answer is to get a footrest so that your feet can rest flat on the surface. Having your feet flat on the ground is your goal as this takes stress off of your legs and hips.

Another problem for many people is using a computer without properly supporting their wrists (Figure B). Whether you’re using a mouse or a keyboard, making sure you have enough wrist support is important not just for your wrists and helping to prevent RSI and Carpal Tunnel, but also for your shoulders, which hold a lot of tension from the awkward position. Any occupational therapist would encourage you to look at your wrists and make sure that the angle is neutral when you type and most keyboards have the ability to alter their angle with the little legs on the bottom. A wrist rest can also be helpful and they make them
both for keyboard and on mousepads.

The final problem I’m going to talk about today is monitor height, which is often too low (Figure C). If you find yourself looking down to see the screen, you’ve got a problem — this is usually an issue with laptops, but you’d be surprised at how many ergonomic assessments discover desktop monitors that are positioned too low as well. The top line of text on the screen should be at eye level, and if it’s below that, you need to adjust the monitor height. Trust me, your neck will thank you, your head isn’t the lightest thing in the world and leaning forward all the time puts a lot of strain on the muscles in your neck.

It’s important to reassess these things every once in a while, it’s very easy to get into bad habits without realizing it. And one of the most important things you can do is to make sure you’re getting regular breaks and regular exercise. Once an hour, at least, you should get up and stretch and move around a little and if you make all these changes and are still sore, you should definitely get in touch with an occupational therapist and have an ergonomic assessment done.

Enter ergonomics.

If you were to ask an average joe what ergonomics was, they would say it was a kind of chair, and while there are chairs that are ergonomic, there’s a lot more to it than that. Ergonomics is the science of creating a proper fit between the workplace and the worker, to ensure that the work gets done and no one gets injured in the process. Most people think that ergonomics addresses problems that develop from those long hours logged in a chair in front of a desk, but ergonomics also addresses the difficulties of standing all day (like a bank teller, or someone in retail), lifting heavy boxes (like a UPS delivery person might), and just about any work environment you can think of.

To get an ergonomic assessment, an Occupational Therapist would come to the workplace and point out the things that could be done to make the job less strenuous for the individuals working there. That might mean better chairs, sturdier shoes, or more frequent breaks, depending on the situation. These small changes can mean big differences in worker productivity and job satisfaction, and a much lower rate of injuries on the job.

Even better news for workers and employers is that many health care plans will cover an ergonomic assessment. As in, you can have an Occupational Therapist come to your workplace and do the ergonomic assessment for free. Considering all the productivity gains, it seems unwise not to call your health care service provider to see if they will cover this.

Until you do get in touch with an Occupational Therapist and in lieu of a personalized ergonomic assessment, here are some tips for people who are trapped in front of a computer for most of the day. If your back, shoulders, and neck are hurting, you’re probably either sitting with bad posture or in a non-ergonomic chair. There are easy ways to fix this, and there are two common bad posture positions:
slouching and hunching.

When you slouch, you lean back into your chair, your lower back far from the back of the chair; when you hunch you curl up towards the computer, away from the back of the chair entirely. An Occupational Therapist would suggest that both of these positions are terrible for your back and can be caused by a bad chair or by your own bad posture — the fanciest ergonomic chair in the world won’t do you any good if you don’t sit in it right.

Sitting correctly means your feet are flat on the ground, your back is relatively straight and touching the back of the chair, and your shoulders are not hunched. If you find yourself slouching back, you may need more lumbar support, if you find yourself hunching forward you may need to adjust the position of your monitor, or make the type larger so you don’t have to lean forward to read it.

But one of the most important pieces of advice an Occupational Therapist would give you is that you should be taking regular breaks. Every hour you should stand up, stretch and move around for a little while. And, just as importantly, you should be getting regular exercise. Even just walking and yoga, neither of which are strenuous, can make huge differences in your level of comfort at work.

So, get an ergonomic assessment, and look into getting one for free from your health care provider, your back and your work will thank you.

Occupational Therapy Education and Training

Both Canada and the United States regulate occupational therapists. A bachelor’s degree, followed by a master’s degree meets minimum requirements. All Occupational Therapists must complete training in programs accredited by the Accreditation Council for Occupational Therapy Education and pass a national certification exam to practice. Also, training must include supervised fieldwork, as part of the occupational therapy curriculum. Only then, will an occupational therapist be allowed to obtain a license to practice occupational therapy.
 

Occupational Therapist duties

Occupational therapists assess clients and help them perform a myriad of daily tasks. Accurate records and evaluations are an important aspect of supplying a client with proper therapeutic exercises. For example, a client with short-term memory loss will be encouraged to make lists, while a client with problems in coordination will be assigned exercises for hand-eye coordination. A work-site environmental evaluation can lead to modifications, which result in a client’s success at work. An ergonomic assessment enables a computer user to minimize the risk of developing repetitive strain injuries. Variable clients lead to variable duties for an occupational therapist.
 

Assessment Areas

Three major areas need assessment by the occupational therapist prior to prescribing a therapy program. First, self-care abilities require evaluation. For example; does the client wake up, shower, dress and brush teeth? Secondly, leisure activities need assessment. Does the client continue being involved in fun activities such as hobbies, sports and socialization? Third, how affected is the clients ability to participate in paid work or volunteer work? All three aspects of a client’s life need evaluation for the Occupational Therapist to create a functional occupational therapy program.
 

Occupational Therapist specializations

Clients of all ages and disabilities benefit from occupational therapy. Occupational Therapists work in hospitals, rehabilitation centers, schools, and in the community. Occupational Therapy treatment for toddlers at risk of developmental delays will promote listening, social play, grooming, and dressing skills. Those working with elderly clients may assist with wheelchair assessment, scooter assessment, driver rehabilitation, home accessibility evaluation or proper alternative transportation options. A medically disabled person with spinal injuries may be able to increase mobilization with a light-weight wheelchair or scooter, per suggestion of an occupational therapist. Occupational Therapy involving mental health teaches clients to engage and cope with daily life, such as shopping, homemaking and public transportation.
 

Client Collaboration

The client has a collaborative role in the implementation of a treatment program. Goals of occupational therapy include client participation and enablement of occupation. The occupational therapist works closely with the client to decide on implementation of goals. As client-based programs begin execution, monitoring, modification and evaluation become critical to positive therapy outcome. Together, the client and the Occupational Therapist develop a symbiotic relationship.

Leaning forward with your forearms on the desk

This is commonly seen in people who spend good part of their day reading lengthy e-mails or articles on their monitors. Depending on the frequency and the amount of time spent in this position, it may cause shoulder and neck muscle strain. There also may be some symptoms of discomfort and pain. This can easily be corrected by raising the monitor at eye level or slightly below eye level or by adjusting the chair higher, ensuring that both the feet are flat on the floor.

Eye strain and your computer workstation

Many people are noted to squint their eyes while viewing their monitor screens. This is a sign of eye fatigue and it is usually seen in people towards the end of their workday. Other probable causes include the viewing distance from the monitor, lack of taking regular breaks at work and lack of sleep. The viewing distance should be at an arm’s length between the person and their monitor. For people working in the computer industry, it is recommended that an eye examination be completed once every two years. Taking your breaks regularly ensures that your muscles do not get over fatigued and it also increases your overall productivity.

Neck posture and Ergonomics

Do your ever experience neck and shoulder pain while working at your computer workstation? If your answer is yes, then you are probably flexing your neck forward while viewing the monitor screen and this is one of the most common problems seen in computer users. This is directly related to your posture while working and this problem can easily be resolved. Follow this simple rule; sit with your ears over your shoulders and shoulder over your hips. This will not only reduce the incidence of your neck and shoulder pain; it will also promote a more neutral sitting posture.

Keyboard and your posture

Have you ever noticed while working at your computer workstation, especially at night, you tend to put your feet up and the keyboard ends up in your lap? Placing your keyboard in your lap while typing or working on the computer puts more strain on your neck and shoulder muscles. The above described posture also strains your low back muscles. Therefore, it is crucial that you maintain a neutral posture while working at your computer workstation i.e. by placing the keyboard on a drop down keyboard tray while ensuring that the keyboard and the mouse are on the same level.

Forearm position and the mouse pad

Have you ever started using the mouse placed close to your keyboard in the morning and noticed it getting further away from the keyboard as the day progresses? Let’s face it – these days when you enter your office, there are several e-mails to read, phone messages to be picked up, meetings to be attended, reports to be reviewed, and several projects on the go. What ends up happening is that the keyboard and the mouse pad keep migrating sideways as the day progresses. Therefore, it is recommended that an L-shaped workstation be used. Computer can be set-up in the middle or on one side of the desk and the remaining space can be utilized for completing non-computer related tasks.

Within Vancouver, each workplace requires different practices to ensure your safety. Please contact the trained Occupational Therapists at Complete Rehab Solutions to see if an ergonomic assessment is suitable for you. We can provide recommendations for safe working practices to ensure that you work healthier for much longer.