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OCC Return To Work – Questions With
Objective Solutions
An OTR® is evaluating a construction worker who recently experienced radial wrist pain in the right dominant hand. The worker has been unable to perform the duties of the job and is working light duty. The COTA® is collaborating with the OTR® for writing goals for the worker. Which short-term goal would be BEST, using the RUMBA tool for goal writing? A. Client will improve work tolerance use of right hand and wrist to lift 5 lb. bucket within 2 weeks. B. Client will receive ultrasound twice daily to radial wrist area for 2 weeks to reduce pain. C. Client will demonstrate improved functional score on the Jebsen-Taylor Hand Function Test within 2 weeks. D. Client will be able to type 2 minutes using right wrist cockup splint within 2 weeks. Correct Answer - A The goal includes the relevant outcome (improve work tolerance) and time to meet goal (2 weeks) and is understandable, measurable, behavioral (i.e., the outcome can be observed), and achievable in the time frame given.
B: This goal does not include a relevant outcome for a functional occupational task. C: Improving test measures is not generally an acceptable outcome for goals. D: This goal is not relevant to the client's current work tasks. An OTR® has written treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal?
A. Client will return to full duty as a surgical technician in a full- time capacity within 4 weeks. B. Client's employer will implement reasonable accommodations to promote the client's ability to complete full-time physical demands as a surgical technician within 4 weeks. C. Client will return to full duty as a surgical technician with the ability to carry over proper body mechanics to reduce risk for reinjury. D. Client will use proper body mechanics 100% of the time while completing the job of a surgical technician within 4 weeks. Correct Answer - A The goal is client centered, objectively focused on the goal of full-duty and full-time employment in the role of surgical technician within a specified timeline. An OTR® is conducting a job demand analysis in a food production company. The OTR® observes the workers in the shipping and handling department loading and unloading a delivery truck. According to the Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), which aspect of the occupational therapy domain is being assessed? A. Communication and social skills B. Habits and routines C. Motor and praxis skills D. Activity demands Correct Answer - D A job task analysis is a non-client-specific observation of the job's activity demands, including required body functions, required actions and tools used, and space and social demands needed to complete the task.
A, B, C: These options relate more to the client's specific performance skills or patterns. A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10 lb. discs onto a dowel. Which design element should be considered for the client's workstation?
The five-level grip test is used to determine maximum and consistent effort by clients. The OTR® should expect the strongest grip on the second and third handle settings
A: The second handle setting is the standard setting for testing grip strength over 3 trials. C: Rapid exchange grip testing requires 10 trials for each hand. D: The standard five-level grip test requires one trial per handle setting. A factory worker is seen by a COTA® in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® working in the outpatient OT program recommends a job site analysis to facilitate the client's return to work. How does the focus of intervention change in the transition from outpatient services to the workplace? A. The focus moves from the individual client to the work environment. B. The focus moves from the client to the employer's policies for task completion. C. The focus moves from outpatient setting supports to workplace design. D. The focus moves from client-centered to employer-focused needs and goals. Correct Answer - A Environmental supports facilitate the client's return to work.
B: The employer's policies may influence task completion, but these policies are not the main focus of intervention. C: Neither component is a relevant focus of intervention. D: Occupational therapy intervention always remains client centered.
An OTR®-COTA® team is establishing reasonable accommodations for a client diagnosed with osteoarthritis in the left shoulder. The client is employed as a plumber. Essential job functions include reaching, bending, crawling, lifting, pushing and pulling, using tools, and lifting materials weighing 25-50 lb. Which accommodation is MOST appropriate for the OTR®- COTA® team to recommend? A. Provide the client with modified-handle tools to reduce torque on the shoulder joint. B. Allow the client a flexible work schedule and use of leave time as needed. C. Ensure materials and equipment are within functional reach. D. Recommend use of wheeled cart to transport tools. Correct Answer - B Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Allowing the client a flexible work schedule and use of leave time is the most appropriate choice. Flexibility will provide the client with the opportunity to vary the work schedule on the basis of symptoms.
A: Modified-handle tools would be appropriate if the client had arthritis of the hands. C: Ensuring materials are within reach at all times may not be feasible because plumbers must access pipes in hard-to-reach areas. D: A wheeled cart may not permit the client access to all locations and may add to lifting requirements. A client employed full-time at a bakery began having numbness and tingling in both hands. An OTR® provided ergonomic assessment and the COTA® provided intervention to address the client's acute injuries. The client met the goals, and the OTR®
third of the day, 10 lb frequently one-third to two-thirds of the day, and negligible weight constantly over two-thirds of the day.
A: A sedentary strength demand is defined by DOT as requiring a force exertion or weight carried of 10 lb occasionally and negligible weight one-third to two-thirds of the day and more than two-thirds of the day. C: A heavy strength demand is defined by DOT as requiring a force exertion or weight carried of 50-100 lbs. occasionally, 25- 50 lbs. one-third to two-thirds of the day, and 20-50 lbs. more than two-thirds of the day. D: A very heavy strength demand is defined by DOT as requiring force exertion or weight carried of more than 100 lbs. occasionally, 50-100 lbs. one-third to two-thirds of the day, and 20-50 lbs. over two-thirds of the day. A COTA® is establishing reasonable accommodations for a client with history of Type 1 diabetes employed as a computer programmer. Which accommodation is LEAST appropriate for the COTA® to recommend? A. Alteration of the client's work schedule allowing for blood glucose monitoring and insulin injection B. Purchase of a refrigerator for the client's office to provide the client with ready access to insulin and snacks C. Alteration of lunch break duration from 60 minutes to permit the client two 30-minute breaks D. Provision of improved lighting at the client's desk area and use of an antiglare magnifying computer screen Correct Answer - B Although access to a refrigerator would be recommended, provision of an office with a refrigerator may be considered an undue hardship for a small company. The employee should have access to a break room while at work to store insulin and snacks. Undue hardship is an exception to the requirement that employers provide reasonable accommodations per ADA. Undue hardship refers to any accommodation that would be unduly
costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business.
A, C, D: These accommodations would be considered reasonable on the basis of the client's condition and physical demands of the job. Reasonable accommodations may include an altered work schedule and duties, facility modifications, purchasing of adaptive equipment or assistive technology, or modifying or designing a new product. A construction worker was referred to occupational therapy as part of a work hardening program. During the interview, the OTR® discovers that the client is required to lift construction equipment weighing 20 lb on a frequent basis. At what level of work must the COTA® create work simulation tasks? A. Medium B. Heavy C. Very heavy D. Light Correct Answer - A Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects.
B: Heavy work requires exerting 50-100 lb of force occasionally, 25-50 lb of force frequently, or 10-20 lb of force constantly to move objects. C: Very heavy work requires exerting 100 lb of force occasionally, in excess of 50 lb of force frequently, or in excess of 20 lb of force constantly to move objects. D: Light work requires exerting as much as 20 lb of force occasionally, as much as 10 lb of force frequently, or a negligible amount of force constantly to move objects. The physical demands are in excess of those for sedentary work. A client was involved in a car accident and sustained an incomplete injury at the T12 spinal cord level. Before the injury,
B, C, D: Work tolerance screenings address the worker's ability to perform essential job functions, not the worker's subjective reports or occupational profile. Which client would be MOST appropriate for vocational evaluation? A. A client with a recent spinal cord injury who wants to pursue a new occupation B. An older worker who wants to find part-time job opportunities in preparation for retirement C. An employer who needs to know essential job functions of a position for a worker D. A work group at a manufacturing plant that needs ergonomic training to minimize work injuries Correct Answer - A Vocational evaluations are most appropriate for people who have never worked or are unable to return to a previous job due to disability.
B: Vocational evaluation and rehabilitation are not appropriate for a worker preparing for retirement. C: Determining the essential job functions of a position requires a job demands analysis. D: Ergonomic training does not require vocational evaluation and is typically done through direct consultation. A COTA® has been treating a client who sustained a chemical burn to both hands 6 months ago while cleaning up a spill at the adhesive manufacturing plant where the client is employed as a janitor. The client has been participating in a work conditioning program for the past 6 weeks and has made gains in all areas. The client plans to transition back to full-time, full-duty employment within the next 2 weeks. The COTA® included instruction in proper body mechanics as part of the client's treatment program to reduce the client's risk for reinjury. What type of intervention would this treatment program be considered?
A. Primary intervention B. Secondary intervention C. Tertiary intervention D. Wellness intervention Correct Answer - C A tertiary prevention program occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications.
A: Primary programs focus on protecting healthy workers against a targeted condition before the condition occurs. B: Secondary programs emphasize early detection and intervention with asymptomatic workers at risk for work-related medical problems or treatment of workers with mild medical symptoms or reversible stages of injury. Comprehensive injury prevention programs incorporate all three phases of prevention programs (primary, secondary, and tertiary) and may include worksite and ergonomic interventions. D: Because the client is receiving services as a result of an existing injury, the focus of the program is to help the client regain maximum function and prevent further injury. An OTR®-COTA® team is establishing reasonable accommodations for a client employee as a tax auditor. The client has recently been diagnosed with posttraumatic stress disorder (PTSD) characterized by panic attacks as a result of being stalked and harassed by a disgruntled taxpayer. The essential job functions include auditing financial records to determine tax liability; information gathering; analyzing finances to determine net worth or reported financial status and identify potential tax issues; conferring with taxpayer or representative via phone or in person to explain the issues involved and the applicability of pertinent tax laws and regulations; and participating in informal appeals hearings on contested cases.
Six weeks after a wrist sprain, a client was diagnosed with complex regional pain syndrome (CRPS), Type 1. The client is employed as an electromechanical equipment assembler. The client is able to perform all ADLs and light meal preparation. The client reports previously enjoying baking and being unable to bake since the injury. The client's pain increases to 6 or higher on a 0-10 scale while using the hand. The skin presents with mild discoloration of the dorsal surface of the wrist. What should be included FIRST when establishing the client's work conditioning program? A. Kneading bread dough B. Upper-extremity PROM exercises C. Stress-loading tasks D. Progressive resistive exercises Correct Answer - C During Type 1 (traumatic stage) CRPS, treatment should focus on management of pain and edema along with AROM. The most recognized therapeutic intervention for CRPS is a stress loading program.
A: Although baking is former occupation in which client engaged before the injury, the resistance of the bread dough may add to the client's pain and discomfort. B, D: PROM and progressive resistive exercises must be used with care and are often contraindicated because of risk for increased swelling and pain. Workers at a meat processing plant are participating in a back injury prevention program. Which factor should be stressed as presenting a major ergonomic risk? A. Dynamic posturing B. Forceful exertions C. Standing position D. Armrest location,k Correct Answer - B Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor.
A: Static or nonmoving postures are a risk factor.
C: Standing position alone is not a risk factor. D: "Armrest location" is not descriptive enough to identify it as a risk factor. Which SOAP-format statement would be appropriate and objective in documenting a client's return-to-work modified duty program? A. The client stated, "My grip strength is not the same as it was before, but my work gets done." B. The client has decreased grip strength in the right hand of 15 lb with a standard dynamometer measure. C. The client's medical history includes a recent work injury resulting in a distal radius fracture and high blood pressure. D. The client has decreased grip strength in the left hand, limiting the client's ability to operate the machine handle. Correct Answer - B This objective statement provides a measure of client ability and the source of that measurement.
A: This is a subjective statement. C: Medical history is not reported in the Objective section of documentation. D: This is an interpretation of an objective statement indicating assessment of the client's deficits. An OTR®-COTA® team wants to design a work performance program based on AOTA's Occupational Therapy Practice Framework: Domain and Process (2nd ed.). According to the Framework, what would the therapist NOT include in the program? A. Interventions including wellness and prevention B. Consultative services and client education C. Restorative interventions and compensatory techniques
Network, most job accommodations cost less than $500. Accommodations may involve altering the job duties or work schedule, modifying the facility, purchasing adaptive equipment or assistive technology, or modifying or designing a new product. C, D: Using a day planner and a color-coded filing system are compensatory strategies to improve organizational skills. A client working at a clothing boutique has made progress in completing simulated work tasks but is still unable to resume the prior work status. After collaboration with the OTR®, the OTR® suggests that the COTA® inform the client that the client return to work on a light duty schedule. Which consequence is MOST likely to result when a client returns to work on light duty? A. The client learns how to push through the pain. B. The employer has lower workers' compensation costs resulting in decreased occupational therapy services. C. The client's confidence in his or her abilities to complete job tasks increases. D. The client receives higher ratings on the reevaluation assessment. Correct Answer - C Returning to work provides psychological benefits to clients by building their confidence in their ability to complete some job duties and allowing them to participate in the social environment of the workplace.
A: The purpose of light duty is not to put a worker back to work when he or she is experiencing pain. B: Although decreased costs to the employer may be a benefit, this is not a client-centered benefit. D: Returning a client to work should not be done exclusively to improve reevaluation ratings; it should be done because it is a client-centered intervention approach. An OTR®-COTA® team is establishing reasonable accommodations for a client with a history of chronic fatigue syndrome. The client is employed as a receptionist for a small
extermination company. The client exhibits decreased short-term memory, periodic joint pain and stiffness, and frequent headaches. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend FIRST? A. Change the client's work schedule to provide additional time for the client to complete the morning routine B. Provide a motorized scooter to minimize walking, conserving the client's energy and preventing pain C. Implement a day planner and list of prioritized job tasks to serve as memory aids D. Provide a flexible work schedule by permitting the client to work from home at least 3 day Correct Answer - C Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Implementing use of a day planner is the most appropriate initial accommodation under these circumstances because it allows the client to continue to perform essential job functions while accommodating the short-term memory issue.
A: Altering the work schedule may be a consideration if the client identifies difficulty completing the morning routine. It would not be considered the most appropriate initial accommodation. B: A motorized scooter may be a prohibitive accommodation for a small company. Joint pain and stiffness are periodic, and the essential job functions are primarily sedentary; therefore, provision of a scooter would not be an initial modification. D: A flexible work schedule with ability to work from home may not be a reasonable accommodation for a small business.
