Queen West Physiotherapy - Life Long Good Health!

Types of Assessments Performed after an MVA

Depending on the severity of the client’s injuries, often to ensure that maximal recovery is reached within a shorter time period, our treating therapists will recommend the services of Meridian Health Assessments. Meridian Health Assessments is a group of highly trained assessors with varying health discipline specific expertise.

Assessments often recommended include one or more of the following:

  • In-Home
  • Worksite
  • FAE (Functional Abilities Evaluation)
  • Psychological
  • Dental/TMJ
  • Orthopaedic

In-Home Assessments

An In-Home Assessment is a thorough evaluation of a person’s home and their living arrangement within a community context. Issues addressed include the ability to perform activities of daily living such as dressing, bathing, cooking, cleaning and shopping. Our assessors produce an objective report based on all observations and measurements, pointing out all limitations in functional abilities and recommending modifications and techniques to improve function. This could include suggestions for equipment, education on more efficient or easier ways to perform an activity, and a recommendation for personal care assistance. Our goal is to increase the client's independence and safety within their home and their community.

Areas of Potential Difficulty can include:

  • getting in and out of the home
  • using the stairs
  • moving from one room to another
  • moving about in individual rooms
  • using the kitchen
  • preparing meals
  • using the bathtub or shower
  • using the toilet
  • getting in and out of bed, chairs, sofas
  • getting dressed
  • reaching items in closets and cabinets
  • doing laundry
  • cleaning
  • using the telephone
  • answering the door
  • emptying the mailbox
  • opening, closing or locking windows and doors
  • operating light switches, faucets, kitchen appliances, laundry appliances

Risk factors for difficulty with activities of daily living include:

  • physical weakness
  • reduced mobility
  • poor balance, gait
  • use of cane, walker, wheelchair
  • poor grip
  • lack of coordination
  • limited reach
  • cognitive impairment
  • chronic illness
  • polypharmacy (taking many prescription drugs)
  • a fall history
  • poor vision
  • problems with depth perception
  • hearing problems
  • diminished sense of smell
  • diminished sense of touch
  • decrease in sensitivity to heat, pain, pressure
  • height extremes — very short, very tall
  • obesity
  • incontinence

Key problem areas in the home include:

  • stairs and steps
  • bathrooms
  • kitchens
  • basements
  • exteriors: exits, walkways, driveways, garages
  • security

For bathroom

  • grab bars, handrails
  • bath and shower seats (built-in, portable, or folding)
  • hydraulic tub lift
  • raised toilet seat
  • elevated toilet
  • commode
  • single-lever faucet
  • add-on faucet levers
  • no-touch water faucet
  • flexible hand-held shower head
  • non-skid mat and adhesive strips
  • non-skid flooring
  • full-length mirror

For Kitchen

  • appliances with automatic shut-off feature
  • stove with front controls
  • large, easy-to-grasp cabinet door handles
  • slide-out shelving, revolving shelves
  • closet organizers

Lighting, electrical and heating accessories

  • oversized light switches
  • lighted switches
  • night lights
  • touch control lamps
  • cordless battery-operated lights
  • electrical plug with handle
  • cord clips — to secure electrical and telephone cords
  • three-pronged electrical outlets
  • electrical outlet covers
  • thermostat covers

Security devices

  • smoke alarms, smoke detectors
  • fire extinguishers
  • carbon monoxide detectors
  • home security systems
  • personal emergency response systems
  • motion detectors
  • deadbolt locks, chain locks, refrigerator locks

General appliances

  • telephones with large buttons, lights, hearing devices
  • cordless telephones
  • large-face clocks with large numerals
  • talking alarm clocks

Home Modifications

Each room of the house poses its own risks, and avoidable accidents can occur easily in areas that have not been modified to meet their occupants' needs.
Most often the safety problems arise because people are doing things that they've been used to doing all their lives, and they're not able to do it in the same way anymore.

A well performed In-Home Assessment will result in recommendations (and education) on the most effective adaptations to compensate for an individual's limitations or disabilities.

When a person has been injured, home modifications and repairs can accommodate lifestyle changes and increase comfort, promote independence and prevent accidents.

Categories of Home Modifications

  1. Changing the way in which daily living activities are carried out, e.g., moving the bedroom from an upper level to the first floor.
  2. Altering the location of a piece of furniture, e.g., moving the sofa chair to make maneuvering space for the wheelchair
  3. Adding or replacing special equipment, e.g., adding a spacer to raise the toilet seat, addition of grab bars or handrail, etc.
  4. Changes or additions to the structure of the home e.g., adding a ramp or first floor bathroom, widening doorways or hallways, etc.

Common Modifications

In the Bathroom

  • addition of grab bars on one or both sides of the toilet, shower entry, and around the tub
  • raised toilet seat
  • installation of a transfer bench - the client can sit down on this and then swing their legs over. A seat in the tub helps the client to conserve energy and prevent a slip and fall
  • installation of a flexible hand-held shower - this helps direct water where needed when the client is sitting
  • installation of non-skid flooring
  • replacement of rotating faucet handles

In the Kitchen

  • installation of additional illumination
  • installation of a wall oven
  • lowering the sink
  • providing open space beneath the sink
  • installing slide-out shelves
  • installing non-skid flooring.

Other common kitchen modifications

  • Things that are used most commonly should be stored between hip and shoulder height. Sometimes, this requires the installation of other kinds of cabinets or, ideally, using a pantry.
  • A seated work area in the kitchen. There is no rule that one has to stand to cook or work in the kitchen. An adjustable sink is another helpful item if the renovation budget allows for such an expense.
  • Other helpful items are dustpans and brooms with long handles to avoid bending, an electric, rechargeable can opener, and utensils with handles that you can grab comfortably.

In the Bedroom

  • Room around the bed - important for a client with a wheelchair or scooter
  • Bed - height should be compatible with being able to get up and down easily. A bed rail helps the client pull toward or against the rail when moving from a lying down position to a sitting position, or with a sit to stand movement.

Other home modifications sometimes recommended

  • Widening of doorways and hallways if the individual uses a mobility device such as a wheelchair or scooter. Most bathroom doors are two feet wide, and that's barely the width of a walker.
  • Elimination of outdoor steps and replacement by a gently sloping walkway.

Worksite Assessments

A Worksite Assessment is a thorough evaluation of all work duties in the work environment. The assessment is designed for either individuals who are at work, but may be having difficulty with specific parts of the job due to an injury or illness, or clients who are ready to return to work after an injury that has forced them to take some time off.

An evaluation of the individual's work (or school) environment and his/her ability to perform the work demands is completed. This may include photographing or videotaping of tasks that may cause potential problems and identification of protocols that may help mitigate a particular problem.

Some of the factors considered are: accessibility, work methods, workplace design and ergonomics, productivity demands, equipment in use, and the individual's abilities and limitations. Issues considered and noted include: posture, pace, work speed, range of motion, position at the workstation, force applied to equipment, and repetition rate required.

Our expert assessors provide a detailed, objective report with clear recommendations for workplace modifications and job re-design. Recommendations are designed to improve function, and might address changes to the environment, changes to work methods, training and education needs, and equipment needs.

Common issues considered include: seating, computer station ergonomics, desk, mouse, foot rest, document holder head set and keyboard.

If warranted, a complete ergonomics study may also be suggested down the road.

At the conclusion of our Worksite Assessment, a re-assessment is often scheduled 6 to 8 weeks later to ensure that the recommended changes and protocols have been applied appropriately (this re-assessment is often also carried out for In-Home Assessments).

To summarize, goals of the Worksite Assessment include:

  • Identification of factors in a workplace that are interfering with a person's ability to work successfully.
  • Improvement of work performance by removing any existing barriers.
  • We use the services of Meridian Health Assessments for our Worksite Assessments. This organization ensures proper measurement of work performance and an early recovery to enable return to either modified or normal work duties.

Functional Abilities Evaluations (FAE'S)

FAE's determine the client's current functional abilities and physical tolerances through a battery of objective tests and measurements. They identify the specific objective limitations and restrictions of the client's returning to his/her regular functional level, including Return to Work and Activities of Daily Living.

FAE's also identify barriers preventing the client from functioning at a regular level. Additionally, these comprehensive assessments can comment on the client’s physical abilities to perform regular work tasks, and the benefit from further rehabilitation.

FAE's determine if the client would benefit from:

  1. a Return to Work plan with various job modifications or restrictions
  2. certain equipment items to allow for performing the job tasks in a safe, ergonomic, and efficient manner.

At Queen West Physiotherapy, we use the services of Meridian Health Assessments - trained Registered Physiotherapists and Occupational Therapists who have extensive experience in performing accurate and complex FAE's using various standardized measuring tools. The FAE reports are very objective and detailed, including charts, and graphs, which make them easy to read and understand. In general, the FAE reports comment on the individual physical and functional tolerances and address more specific questions. They are completed and delivered to the referral source within one week of the assessment.

Types of FAE's Offered

Job Specific FAE's

For the purposes of job re-integration Post Injury - the injured client’s true capacity for meeting physical demands of a job is identified and compared to the Job Demands Analysis.

Benchmark FAE's

Worker’s abilities are documented before the commencement of the treatment program and are monitored closely throughout the rehabilitation period to determine the success and appropriateness of the rehabilitation program.

Testimonials about FAE's completed at Queen West Physiotherapy

The Functional Abilities Test was beneficial in that it showed my limitations, as well areas where I can still make some further improvements. It also provided me with an independent view of my positions, and posture that I was unaware before.
Steven V: (May 22, 2009)

I think that the FAE was very effective, in-depth, and covered my everyday and work activities. It was very valuable because I learned about my abilities, things to avoid, and how to approach working, including lifting techniques, and sitting postures. I found that the test was useful to prepare me for my RTW after my car accident. It gave me less anxiety, I thought “I will dive in and return to my former job”. The staff at QW did a great job looking at the entire person, as we deal with everyday activities.
Thank you, Mary F: (May 12, 2009)

The Approach that makes us Unique

  • The client and their family is always involved in goal setting and treatment planning.
  • We communicate with the insurer and all health disciplines involved to ensure that the treatment is co-ordinated.
  • We educate the client on the purpose of any assessment and treatment that we provide. We also encourage the client to be an active participant in their rehabilitation.
  • We provide one on one therapy throughout each phase of treatment and also motivate the client to take responsibility for their own rehabilitation.
  • We take a functional approach to treatment and ensure that if necessary, the client is seen in their home or work place or any other community environment.
  • We provide concise, thorough and prompt reports outlining the client’s current status, along with recommendations on needed modifications, aids and other treatment services.

Additional Assessments Offered and Associated Programs Available

In-Home Activities of Daily Living (ADL) Assessments: Assessment of the client’s ability to perform self-care, homemaking and caregiving tasks. Assessments involve review of the client’s pre-accident status and assessment of the client’s current abilities based on observation of the client’s performance within their home. Recommendations are made regarding equipment needs, the need for further occupational therapy and the need for homemaking assistance.

Job Site Analysis: Based on an employer client interview and thorough observation of the client’s work area, the essential tasks of the job are determined. A physical demands analysis is completed with input from the employer and client and based on objective measurement of the job demands. Comments may be made about the client’s current ability to perform the job and recommendations given regarding the steps that should be taken to facilitate a timely and successful return to work.

Attendant Care Needs Assessments: Completion of Assessment of Attendant Care Needs Forms (Form 1) through an interview with the client and their caregivers and completion of an assessment to determine the client’s functional status and their care needs.

Return to Work Program: In collaboration with the client, the employer and other treating health professionals, a graduated return to work program is devised. Prior to implementation, the client’s physician and all other contributors approve and sign the program. Implementation of the program may involve providing work hardening and equipment recommendations. The therapist will maintain client/employer contact throughout the program and will make revisions as necessary for a successful outcome. Upon successful completion of the program, a signed certificate is obtained from the doctor, approving the client’s return to work.

Chronic Pain Treatment Program: This program is designed for clients who have persisting pain of greater that three months in duration, which is resulting in functional disability. The goal of the program is not to decrease pain (although this may occur), but to help the client learn to cope with their pain and enhance their quality of life. Treatment components are client specific, but are likely to include education and programs to improve diet, sleep habits, exercise routines, relaxation and stress reduction skills, daily activity level, and return to work plans. Cognitive-behavioral strategies are used by our Psychologists to help the client understand the relationship between emotions, thoughts and behavior and the control over these areas in their life.

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