Making a Case for Independence

By Irene Harris

Return to work? With a physical injury? In times of high unemployment? Why not? The ultimate goal of rehabilitation is to return to work. But how?

In their move to community care, occupational therapists identified a missing step within the health care system: the critical step between leaving the hospital as a patient, and returning to work as an employee. If you are injured at work, the Workers Compensation Board (WCB) will assist in restoring your ability to return to work. However, in the case of traumatic injuries that occur outside of work, such as automobile accidents, there is no facility within the medical system that assists an individual, post-discharge, in returning to work.

In situations where the injury occurs outside of the workplace, rehabilitation is a hit-and-miss process. To obtain compensation for damages, legal action is required. Lawyers are required to provide information to the court regarding an individual’s ability to return to work and an estimate of fair compensation for both wage loss and future care to restore the individual’s ability to work. Unfortunately, medical information obtained from the physician has been scant and based on subjective reports of the injured individual. The courts demand medical facts and objectivity.

Enter occupational therapists with the medical background to understand injury and associated physical impairments. Add to this their ability to analyze a complex task and break it down into "bite-size" pieces for the purpose of determining a person’s physical strengths and weaknesses. Compare these criteria for employment. This process, called the Physical Capacity Evaluation (PCE), is acceptable in a court of law.

The PCE is a one-day assessment that looks at an injured person’s physical ability to return to work and tolerance for work by examining every physical skill identified for work. It does this using standardized tests and standardized clinical procedures which satisfy the legal criteria for objectivity. The standardization is important not only for gathering objective data but also in comparing the injured person to an average worker. Recommendations for full- or part-time work may be appropriate.

Given the information on physical strengths and weaknesses, participants can begin to see the work options available to them. Intelligence and interest testing provides individuals with information on specific jobs that are within their abilities and available in Canada.

What about restoring independence regardless of employment? Occupational therapy services are also used to assist the individual in obtaining care and equipment which they will need on a lifelong basis, if full recovery is not possible. This need for equipment and services must be a direct result of the injury and enable the individual to regain a lifestyle comparable to his or her pre-injury one. Occupational therapists, with their medical knowledge and ability to assess independence in activities of daily living, can make recommendations based on promoting independence. This information is acceptable in court when costs are awarded for future care.

While both the analysis for future care costs and the PCE seem a natural continuation of the rehabilitation process in the move to independence, these services are not covered by any government medical plan. It is only through the insurance system that payment is made for these services.

Occupational therapists, traditionally in hospital settings, have identified for themselves a role within the private sector that can promote productivity in the community and guarantee independence in the home. By bridging the gap from hospital to community, occupational therapists help injured workers return to living independently.

Return to work? With a physical injury? In times of high unemployment? Why not?

(Irene Harris, a member of the Canadian Association of Occupational Therapists, is president of OT Consulting/Treatment Services in Vancouver, BC, which specializes in return-to-work assessments as well as ergonomic evaluations which prevent cumulative trauma injuries in the workplace.)