Work Safe


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).