EKCO Frequently Asked Questions
Employers often ask, "What is a pre-employment screening assessment and how can it benefit me and my new employee?"?
A pre-employment screening assessment examines the overall general fitness of a potential employee. Additionally, if provided with the critical job demands the Occupational Therapist/Physiotherapist can tailor components of the test to match those required in the position.
A typical assessment includes:
- Comprehensive review of a client's medical history
- Examination of dynamic tolerances (such as walking, squatting, stair/ladder negotiation) and static tolerances
- Assessment of weighted tolerances
It should be noted however, that this is not an exhaustive list of assessments available, with components varying depending on the specifications of the role the potential employee has applied for.
Additionally the pre-employment screening can be coupled with an Occupational Physician's assessment to provide a comprehensive assessment of the persons' physical performance and capabilities. This can assist in safely matching a potential employee with the physical demands of the job. Furthermore the screening allows for comparative reporting, for rehabilitation purposes, should an injury occur.
I am treating a patient who complains of severe pain following a wrist fracture. How can I tell if my patient is developing CRPS (RSD) and how can I treat it? - B. Simms, GP?
CRPS Type 1 (Complex Regional Pain Syndrome, previously called RSD) is a chronic pain condition which can develop after an injury or infection. (To distinguish between CRPS Type 2 which occurs following direct injury to a nerve).
The key symptom of CRPS Type 1 is intense, continuous pain out of proportion to the severity of the injury. Other symptoms of CRPS include:
- Swelling
- Stiffness ( often secondary to reluctance to move part)
- Discoloration
- Vasomoror instability (usually vasoconstriction and increased cold intolerance)
- Trophic changes (atrophy of the skin and subcutaneous tissue, causing the skin to have a shiny appearance with loss of skin creases).
Often the pain spreads to include the entire limb.
Causes
The cause of CRPS is not completely understood. It is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands. The damaged nerves are no longer able to properly control blood flow, sensation and temperature to the affected area. This leads to further problems in the nerves, blood vessels, skin, bones and muscles. Symptoms tend to worsen when the patient is stressed, angry or frightened.
Treatment
As CRPS is a complex condition, a multidisciplinary approach is required. In addition to medication, therapy is essential and often psychological intervention is required.
It is important not to frighten or stress the patient if you feel they may be developing CRPS. The best initial advice is to reassure them that their symptoms are likely to pass and to continue to use the extremity as normally as possible within pain limits.
Referral to an Occupational Therapist or Physiotherapist, pain specialist and Psychologist may be required should symptoms persist or worsen.
Drug treatments can include antidepressants, opioids and corticosteroids. However, no single drug or combination of drugs has produced consistent long term improvement of symptoms.
Sympathetic nerve blocks, spinal cord stimulation and intrathecal drug pumps can assist with pain relief.
Physical therapy approaches include functional use of the affected extremity where possible, often following medication, stress loading, and more recently, research has focused on Mirror therapy and hand laterality programs which have shown good results in research.
Psychological intervention from a suitably qualified Psychologist may assist the patient to come to terms with their condition, to understand how to manage their pain and to manage feelings of anger, depression and fear.