WORKERS'
REHABILITATION
CENTRE
3700 Westfield Road
Saint John, N.B.
E2M 5Z4
Telephone: (506) 738-8411
Fax: (506) 738-3470
The Workers' Rehabilitation Centre (WRC) is the only rehabilitation centre in Eastern Canada dedicated exclusively
to providing occupational rehabilitation services. The Centre has
been treating injured workers since 1965 and is accredited by the
Canadian Council of Health Services Accreditation. Services are provided
in both official languages.
The WRC offers the following rehabilitation Programs to serve the
clients:
Work Recovery
Pain Management
Vocational Evaluation
Assistive Devices.
WORK RECOVERY PROGRAM
Statement of Purpose:
The Work Recovery Program has been designed to provide quality,
client-centred, interdisciplinary rehabilitation to address the client's
physical, psychological and vocational
needs to facilitate an effective
return to the workplace.
Our clients: Injured workers who have not responded satisfactorily
to medical rehabilitation and who need intensive alternate treatment
to achieve a safe and prompt return to work.
The Work Recovery Program consists of occupational rehabilitation
teams which provide three levels of service as well as three specialized
services.
The treatment team for all clients consists of a physician, physiotherapist,
occupational therapist, psychologist and team coordinator.
The services of a nurse, dietitian, fitness/recreation officer and/or
prosthetist/orthotist are also available, if required.
SERVICE LEVELS
Level 1
The primary focus is confirming the diagnosis and/or treating the
injury to promote recovery. Intensive therapy designed to promote
healing, increase strength, improve conditioning, reduce pain and
restore function is provided to help clients achieve a prompt and
safe return to work.
Admission Criteria:
- requires injury specific treatment
- needs diagnosis confirmed
- requires splinting
- is early post injury
- is early post operative
- requires occupational therapy to get ready for work-related activities
Level 2
The primary focus is physical and work conditioning for the client
who is at a higher level of function although not ready to return
to work and can participate in an active approach.
Admission Criteria:
- ready for work related activity
- requires general and specific conditioning
- requires symptom control strategies
- requires reinforcement of worker role identification
- medium to high level of function
Level 3
The primary focus is on physical and work conditioning for the client
who is at a low level of function and may have behavioral or psychological
issues that need to be addressed.
It is designed to increase tolerance to activity and work, resolve
psychological barriers, improve work habits and discover and develop
alternative vocational skills.
Admission Criteria:
- ready for work related activity
- requires general and specific conditioning
- requires symptom control strategies
- requires reinforcement of worker role identification
- behavioral issues:
* prior unsuccessful return to work
* fear of re-injury
* complex medical history
SPECIALIZED SERVICES
CTD(Cumulative Trauma Disorders)
Many workers are at risk of developing cumulative trauma disorders
or repetitive strain injuries. Our treatment team focuses on effective
self-management of upper extremity CTDs including education, improvement
of work setting ergonomics, pain management and use of personal/work
behavior intervention.
RSD (Reflex Sympathetic Dystrophy)
Workers who develop reflex sympathetic dystrophy or complex regional
pain syndrome require an individualized and specialized approach to
treatment.
Work Recovery provides a specialized service which focuses on teaching
the client pain and stress management techniques and increasing strength,
stamina and endurance despite pain through an aggressive treatment
regiment.
Multidisciplinary Consultation
The purpose of this service is to provide consultation services including
medical, psychological, physical and functional status to determine
appropriate treatment recommendations.
Also available on an out-patient basis:
* Work conditioning focusing on reactivation, education and function
* Psychological counseling
* Nutritional counseling
* Occupational therapy
* Physiotherapy
* Custom-designed group education sessions that may include any of
these topics:
> Back-injury prevention and benefits of exercise
> Manual material handling techniques
> Preventive exercise programs
> Office ergonomics
> Safe lifting
> Transfer class
> Relaxation
PAIN MANAGEMENT PROGRAM
Purpose
The Pain Management Program provides clients who have chronic
pain with an interdisciplinary service to assist them in coping with
chronic pain, prepare them for employment, increase their level of
functional activity and improve their quality of life.
Description
The Pain Management Program at the Workers' Rehabilitation Centre
is classified as a Behavioral Pain Program where the primary focus
is on learning to cope with chronic pain and improve function versus
pain programs where the focus is on injections by an anesthetist.
In addition to learning pain management techniques, a group therapy
environment helps clients learn to deal with interpersonal and emotional
problems. Through mutual support, clients encourage each other to
share concerns and learn new problem-solving techniques.
The Pain Management Program is delivered by a multidisciplinary team
consisting of psychologist, physician, physiotherapist, occupational
therapist, and nurse/team coordinator.
Clients may bring their partners to the Pain Management Program where
they can attend lectures and other treatment components to learn about
the principles of pain management.
Length of Program
The Pain Management Program is a structured daily six-week program.
Admission Criteria
* pain that persists beyond normal healing time
* traditional medical intervention for injury is completed
* pain is interfering with quality of life (family relationships,
work, recreational)
* may demonstrate difficulty coping with pain (sleep disturbance,
lowered activity level, depression)
* may demonstrate excessive medication use due to pain
* may demonstrate dependence on health care and financial system
Treatment components
Following admission, the client is assessed by each member of the
treatment team and, in conjunction with the client, an individual
interdisciplinary rehabilitation plan is developed. The team, including
the client, meets every two weeks to assess progress and update the
plan.
Components of treatment include:
Group therapy - sessions facilitated by various members of
the team to educate the client about chronic pain issues in a group
environment. Clients are educated on strategies to manage pain, i.e.
stress management, communication, grieving process, work simplification,
accepting responsibility, importance of exercise, medical issues,
and good body mechanics.
Exercise therapy - custom designed exercise programs given
by the physiotherapist in the gym and large therapeutic pool to increase
flexibility, mobility, strength and cardiovascular conditioning, to
help the client regain a more active lifestyle.
Functional/Vocational activities - clients participate in
a variety of activities to increase their functional level, to develop
a more active lifestyle and readiness to return to the work force.
Individual therapy - individualized counseling designed to
bring about better knowledge and insight about emotions and behavior
in order to facilitate better emotional and social adjustment.
Medication reduction monitoring - for the clients who take
more medication than is required for their condition, medication intake,
especially narcotics, is gradually reduced to a pre-set schedule and
is checked on a daily basis by the nurse along with the physician,
for any signs of withdrawal symptoms.
Analgesic modalities - agents such as heat, ice or TENS can
be used for the relief and management of pain.
Relaxation - training in the use of various techniques which
promote relaxation.
Significant other activities - the spouse or significant
other is invited to attend the program from one to five days, or more
if desired. This service assists and supports the client in dealing
with chronic pain issues and work related, family or personal problems.
Additional Services
The Electrical Stimulator Service is an additional service offered
by the Pain Management Program. An electrical stimulator (TENS) is
a device which can help clients control their pain at home and at
work. Before the provision of the TENS unit, the physiotherapist will:
* evaluate the effectiveness of TENS for a client to ensure a purchase
is warranted and that maximum pain relief is obtained.
Once a TENS unit has been provided, the physiotherapist will:
* follow-up regularly to ensure the client continues to get maximum
benefit from the unit;
* provide supplies needed for ongoing use of the device.
The Pain Management Program staff also provides individual psychology
counseling, biofeedback treatment and acupuncture on an outpatient
appointment basis.
VOCATIONAL EVALUATION PROGRAM
The team of health professionals in Vocational Evaluation can identify
if an injured worker can return safely to the job, what level of activity
can be safely performed, and the realistic options for his or her
vocational future.
The team includes physiotherapists, occupational therapists, physicians
and a psychologist who perform physical, functional and psychometric
testing. Based on the client's abilities and aptitudes, they can determine
his/her current capabilities and vocational options.
Standardized testing compares the client's results against national
normative data, and provides a comprehensive picture of his/her abilities.
Results are reliable and defensible.
Depending on the information needed, the Program can provide a single
assessment or any combination, custom-designed to meet the referral
source's needs. Our staff will be pleased to suggest the appropriate
assessment.
Depending on the scope of testing required, a client may be at the
Workers' Rehabilitation Centre for only a half day, or as much as
three days. Assessment reports are completed within five working days.
Assessment Services Include:
Job Specific Work Capacity Evaluation - determines a client's
performance of the physical demands of a specific job (performed on
site at the WRC)
General Work Capacity Evaluation - determines a client's general
functional capabilities (performed on site at the WRC)
Key Functional Assessment - computerized assessment that determines
a client's safe working capabilities and predicts work day tolerances
(performed on site and off site)
Job Site Evaluation - determines a client's ability to sustain
performance in a specific job for the purpose of making recommendations
regarding the worker, the workplace or the environment (performed
at the job site).
Job Site Analysis - determines the physical and environmental
demands of a specific job as documented in a detailed analysis (performed
at the job site).
Ergonomic Assessment - determines the workplace modification
and adaptations required to improve the client's working environment
thus lessening strain on the body.
Physical Status Assessment - determines physical dysfunction
through evaluation of the client's joint mobility, muscle function,
neurological status and ligamentous stability.
Psychological Status Assessment - determines a client's particular
psychological needs through an interview (performed on site and off
site).
Aptitudes Assessment - determines a client's aptitudinal
skills and aptitudinal patterns (performed on site or off site).
Interest Assessment - determines a client's likes and dislikes
as it relates to occupations (performed on site or off site).
Academic Assessment - determines a client's academic achievement
levels in arithmetic, reading and spelling (performed on site or off
site).
Personality Assessment - determines a client's behavioral
characteristics (perceiving, thinking, feeling) - (performed on site
or off site).
Neuropsychological Assessment - determines the correlation
between cognitive functions and the physical status of the brain (performed
on site at the WRC).
The Program has also performed specific assessments of hand function,
dyslexia and activities of daily living functioning.
ASSISTIVE DEVICES PROGRAM
The Assistive Devices Program works as a team to provide the best
in technology and care to clients who require special equipment to
return to work safely, comfortably and quickly.
Our team of two prosthetists/orthotists, an occupational therapist,
a physiotherapist and an on-site technician works to help the client
achieve self-sufficiency in both the workplace and home while focusing
on the needs of each individual client. The Program can serve clients'
needs at the Centre and in their own environment.
PROSTHETICS
Our clients
Any amputee requiring a prosthesis. Prosthetic clients are usually
clients for life as prostheses require regular repair and replacement.
Our services
Amputees can rely on us for a number of services:
AMP REHAB
Who is appropriate?
All new amputees and any amputee receiving a new limb which requires
re-training or extended treatment within this Centre. Amp rehab is
a comprehensive service which helps amputees adjust to both amputation
and their prosthesis.
What is involved?
Physiotherapy prepares the client for the new prosthesis and ensures
that the overall body is conditioned to meet the demands of wearing
the prosthesis.
The prosthesis is fabricated, fitted and adjusted. The client is taught
to care for, maintain and recognize problems with the prosthesis.
The amputee is taught to use the prosthesis to return to his or her
normal pre-accident activities.
Parts and maintenance
Parts for all prostheses are available through our department. As
clients' bodies or their use of the prosthesis changes, modifications
are needed. In most cases, this requires a visit to the Centre.
* New limbs
Clients' needs for new prostheses are assessed as their old prostheses
age. Once a replacement has been authorized, the limb is fabricated
and the client must visit to be fitted and re-trained with the new
prosthesis. Often this requires a short series of visits to the Centre.
As a pilot site for Clinch Technologies' computer assisted prosthetic
system (CAD CAM), below-knee amputees are provided with the most high-tech
fit available for amputees today.
* Prosthetic and Treatment Information
Staff is aware of new technology and product changes in the prosthetic
field. Amputees can, and expect to, learn new care solutions and new
information on how they can make living with their amputation easier
from the prosthetic team.
ORTHOTICS
Orthotic devices are designed to be corrective, protective or supportive
to compensate for physical dysfunction.
Who is appropriate?
Any clients who require an external device to correct a muscle, motion
or skeletal problem.
What is involved?
Clients are assessed to determine which type of orthotic will best
suit their needs and are fitted by certified orthotic treatment staff.
Some problems are treated with pre-fabricated orthotics (i.e. most
back supports), however, other orthotics must be custom made to meet
the client's needs. All clients are instructed in how to properly
use and care for their orthotic.
Common types of Orthotics
* Hand or wrist splints
* Back braces, belts and supports
* Corrective footwear or insoles
* Neck collars and braces
* Leg, knee or ankle braces.
HAND THERAPY
Who is appropriate?
Any clients whose hand(s) have been seriously injured or traumatized.
This can result from finger amputation, tendon injury, scarred or
traumatized hands.
What is involved?
Hand function is increased by integrating practical activities with
exercises to simulate or meet the everyday needs of the client. The
occupational therapist also determines if there are orthotics or aids
which may help increase function.
Transfer of Dominance Training is hand therapy aimed at teaching
a client to change dominant hands (become left or right handed as
needed) when their dominant hand is severely injured. They re-learn
basic tasks with the opposite hand, and strengthen the newly dominant
hand through exercise and everyday activity.
WHEELCHAIRS & MOBILITY AIDS
Who is appropriate?
Clients who require the use of a wheelchair or other mobility aids
to help with mobility in the home, at work or at leisure as a result
of their injury. Also for clients whose current wheelchairs, scooters
or walkers require parts or service.
What is involved?
* Evaluation or Assessment
The client and their home environment are evaluated to determine which
type of mobility aid and features will best suit the client's needs.
* Training
The chair, scooter or walker is delivered and the client is taught
to use, care for and maintain it. Modifications are made as needed
and cushions and covers are supplied to the client for seating purposes.
* Service
Service, parts and regular inspections are supplied as the chair,
scooter or walker ages, and as the client's needs change. Regular
inspection ensures that the condition of the chair or aid is maintained.
HOME VISITS
Who are they for?
Clients who require devices to improve the function and safety of
their activities of daily living, and their independence at home and
work.
What is involved?
Physiotherapy home visits
The therapist designs in-home exercise program, addresses return-to-work
or home difficulties and works to help clients meet their physical
demands.
Assistive Devices and Care Allowance visits
The therapist assesses the home and/or workplace to determine which
devices are needed, specializing in the areas of bathroom safety and
tool modification for the workplace. The therapist also counsels clients
on the best use and care of their devices.
CONSULTATIONS AND ASSESSMENTS
Who are they for?
Case managers, doctors, other occupational therapists and physiotherapists
- anyone who may have questions or concerns, or require information
within any of our areas of expertise.
We can provide:
* Physiotherapy, prosthetic, orthotic and occupational therapy consulting
and assessing for second opinions or alternate care solution recommendations.
* Educational information to help case managers and doctors in prescribing or approving the proper devices for the problem.
* A valuable resource for new product and technological information
by providing the latest information on all of the products and devices
a client may need.
* (Assessments and consultations can be done in the Centre, or in
satellite clinics in the client's local home or work environment).
