a. Preferred lift b. Floor to knuckle lift c. Knuckle to shoulder lift d. Shoulder to overhead lift e. Bimanual carry f. Push/pull

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1 TITLE/ DESCRIPTION: Work Capacity Evaluation DEPARTMENT: Rehab Services PERSONNEL: PT, Work Hardening Specialist, Clerical EFFECTIVE DATE: 3/00 REVIEWED: 6/00 6/17 REVISED: PURPOSE of WCE A. Establish the appropriateness of the client to participate in the Work Hardening/ Work Conditioning Program. (WH/WC) in terms of symptom magnification, medical condition, musculoskeletal condition and functional tolerance levels. Identify job-related goals. B. Establish a baseline to which progress in WH/WC can be compared. C. Identify if other services may be necessary in addition to the WH/WCP. I. COMPONENTS A. NEUROMUSCULOSKELETAL EVALUATION Exam performed by a physical therapist and to include Waddell s tests for symptom magnification. B. INTAKE INTERVIEW This includes history and job history. The W/H Specialist should thoroughly explain to the client the purpose of the WCE program, including a summarized list of components of the program, the criteria for discontinuing a functional task and the need to put forth a genuine effort. 1. Manual Material Handling a. Preferred lift b. Floor to knuckle lift c. Knuckle to shoulder lift d. Shoulder to overhead lift e. Bimanual carry f. Push/pull 1. Static Postures and Positions a. Kneeling b. Overhead work c. Balance

2 d. Sitting e. Standing 1. Repeated Motion Activities a. Stair climbing b. Repetitive squatting c. Repetitive kneeling I. EQUIPMENT NEEDED Standard Box with 2 sets of handles Small Box with 1 set of handles Push/Pull Sled Plastic Bucket 18" from extended handle to bottom 2 or more 3.5-pound weights Overhead station Dynamometer Stairs Adjustable shelves or West Lift station 5 and 10 pound weights Stopwatch Foot pump apparatus Floor mats II. GENERAL CONSIDERATIONS FOR BASELINE EVALUATION

3 A. Body Mechanics Technique used for each functional activity below. B. Cardiopulmonary Heart Rate (HR) is monitored periodically throughout the evaluation and whenever client exhibits outward signs of fatigue or exertion or complains of symptoms. Target HR = 220 age X.80. If client exceeds Target HR during evaluation, adjust evaluation task accordingly and document response. C. Report of symptoms Document any symptoms and their correlation with objective changes noted. D. Safe Body Mechanics/Technique Ability to perform a task without undue signs of the following: Clear sign of fatigue, abnormal muscle recruitment or change in technique with repetition. Examples include but are not limited to. Falling forward or backwards of original center of gravity, a progressive increase in hyperextension or flexion of the spine, scapular winging, shoulder elevation, shakiness, increase in heart rate above target heart rate, pace, ect E. Symptom Magnifier For the purpose of an WCE, a Symptom Magnifier is anyone who: 1. Scores3 of 5 positive on Waddell s tests for non-organic source of symptoms 2. Exhibit inconsistencies between ability in the neuromusculoskeletal portion of the evaluation and the functional activity portion of the evaluation. 3. Exhibits inconsistencies between two or more functional activities, which actually test the same body part in a similar way. 4. Exhibit bizarre body mechanics or other behaviors in one portion of the evaluation, which does not correlate with the general presentation of the client in other portions of the evaluation, or in the waiting room or parking lot, ect I. CRITERIA FOR DISCONTINUING A. Client asks to discontinue B. Less then Safe Body Mechanics are noted. C. In certain cases during tasks, the WH Specialist at his/her discretion decides to discontinue task if less than Optimal Body Mechanics are noted. Reasons for this decision would include wishing to minimize any risk of client soreness the next day in order to gain client trust or a previous history which might lead the WH Specialist to be even more cautious that usual. I. DESCRIPTION OF STANDARDS METHOD FOR EACH TASK

4 A. Preferred lift West Lift Station Weights (.5 to 100+ pounds) Task Description: The client is asked to lift a weight from the floor to the overhead shelf and back to the floor. The task is modified if need be. B. Push/Pull Push/Pull sled Weights ( pounds) Task Description: The client is asked to push the sled 20 feet using the top rail. The client then pulls the sled 20 feet backward. Bimanual grip should be used in both cases. C. Repetitive kneeling Stopwatch Peg board Pillow Task Description: The client transfers 32 pegs one at a time from chest height to floor level using a kneeling motion for a maximum of 5 minutes. D. Overhead

5 Overhead station Stop watch Task Description: The client is asked to unscrew the nuts holding 6 different wooden figures in place and replace them in 12 minutes. E. Balance 10 foot area market on the floor Task Description: The client is asked to walk from point A to point B on their heels, then on their toes then tandem and finally braiding. F. Squatting Table for support Task Description: The client is asked to squat 5 times with their back straight and foot shoulder with apart. They are instructed that they can hold the table if necessary. G. Stair Climbing Stairs with hand rails Task Description: The client is asked to walk up and down the stairs 5 times. They are instructed that they can use the hand rail if necessary. H. Crawling

6 Padded floor or mat Task Description: The client is asked to crawl on their hands and knees 20 feet and then backwards 20 feet on the mat. I. Grip Strength JAYMAR Dynamometer Task Description: The client is asked to grip the dynamometer as hard as they can for a series of grip tests with their elbow bent at 90 degrees and the dial facing away from the client. J. Repetitive foot pump Foot pump apparatus Chair Task Description: The client is asked to sit in a chair with their back straight and pump 20 times with their right, left and both feet. K. BTE Work Set Simulator BTE Work Set Simulator Task Description: The client is asked to perform supination and pronation of the right and left arm/wrist with 6 different tools. The coefficient of variance is calculated and determined whether the client is giving consistent effort.