Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Occupational Therapy


Related Terms

  • OT

Specialists

  • Occupational Therapist

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the individual's underlying condition, extent of therapy needed, level of individual’s motivation, and the individual’s response to therapy.

Medical Codes

ICD-9-CM:
93.83 - Occupational Therapy; Daily Living Activities Therapy
V57.21 - Care Involving Use of Rehabilitation Procedures; Encounter for Occupational Therapy

Overview

Occupational therapy is a rehabilitation process that helps individuals perform their daily activities despite the presence of any illness, disability, or injury. The goal of occupational therapy is to help individuals with compromised physical functioning adapt to their impairment(s) to regain optimal function. Three categories of activities are addressed by occupational therapy: activities of daily living, work and productive activities, and recreational or leisure activities. Occupational therapists are primarily trained in functional rehabilitation of the upper limbs.

Occupational therapy (OT) is the profession concerned with the evaluation, treatment, and prevention of physical disabilities caused by disease or injury of the upper extremities. This medical discipline is used as a conservative measure prior to, in conjunction with, or following other treatment options such as medicines or surgery. OT is practiced in hospitals, rehabilitation centers, private therapist offices, extended care facilities, home health agencies, special diagnostic clinics in outpatient treatment centers, academic institutions, fitness and wellness centers, and research centers.

Activities of daily living (ADLs) are tasks such as grooming, personal health care needs, dressing, bathing, mobility, eating, and communication. Relearning these essential skills decreases dependence on others. Tasks focus on the use of orthotic or prosthetic devices and the adaptation of the individual's physical environment.

Work and productivity activities include home management skills such as domestic tasks, money/budget management, and job-related activities such as pursuing a career and performing well on the job. Productivity and employability training focuses on skills the individual needs to be successful at a job. Work performance skills, safety, grooming, appropriate attire and appearance, psychosocial aspects of the workplace, punctuality, following instructions, use of proper body mechanics, and work habits also may be taught.

Since OT focuses on the whole person, attention must be given to activities the individual pursues for recreation/pleasure. Individuals are taught how to safely engage in specific leisure activities and also learn how participation in leisure activities contributes to their overall health and well being.

Because OT intervention focuses on the individual within the context of his or her environment, activities that are meaningful to the individual are addressed. This may involve modifying the individual's environment so that participation in desired activities can be resumed after injury or illness. A further benefit of OT is education on proper ergonomics for prevention of further injury.

Source: Medical Disability Advisor



Reason for Procedure

Individuals receive OT if they are unable to fulfill their desired social roles, perform ADLs and personal health care needs, perform essential functions at work, or participate in recreational activities, due to physical or mental impairments. OT addresses the timely return to both personal tasks such as household management and professional tasks that are found within the individual's job. Conditions such as carpal tunnel syndrome, surgery such as total hip replacement, diseases such as multiple sclerosis, recovery from acute illness such as strokes (cerebral vascular accident [CVA]) or heart attacks (myocardial infarction), and mental impairments such as those due to a traumatic brain injury are examples of conditions in which there is a need for OT intervention.

For example, after surgery such as total hip replacement, individuals receive OT to learn how to dress while protecting the new hip. Individuals may receive OT after injury or surgery to the hand (e.g., carpal tunnel syndrome or carpal tunnel release) to maximize function in the injured hand by regaining dexterity and strength. Some individuals who engage in OT do so to maintain functional ability or to adjust to a progressive illness. For example, the individual with multiple sclerosis will be encouraged to use tools such as writing implements with thicker shafts to compensate for impaired hand movement. With a chronic illness such as pulmonary disease, individuals may receive OT to learn how to perform their ADLs in a manner that conserves energy and oxygen needs. Individuals also may undergo OT to help strengthen the arms and hands due to fractures, nerve injuries, or disease processes such as osteoarthritis or rheumatoid arthritis. Individuals learn appropriate ergonomics and exercises to increase dexterity and grip strength and to increase range of motion in the upper extremities.

Source: Medical Disability Advisor



How Procedure is Performed

Occupational therapists evaluate physical and mental function and an individual's ability to perform daily, necessary tasks. They evaluate range of motion, strength, sensation, balance, fine motor coordination, and cognition to determine where deficits may lie. In addition, occupational therapists evaluate home and work environments to enable accessibility and safety in these areas. The specific therapeutic measures employed take into account the individual's needs and interests. Following interviews, observation-specific tests, and physical measurements to establish a baseline, a program of specific goal-oriented activities and instruction is designed for the individual. Therapy is conducted either on an individual basis or as part of group therapy.

Occupational therapists may provide education on and general exercises for strengthening and stretching the musculoskeletal system. Occupational therapists may have individuals perform exercises to improve fine motor coordination, and individuals who have altered sensation in an area of the upper body may undergo desensitization techniques. Individuals may engage in practicing their ADLs after injury or illness, and may learn strategies for home management such as planning household tasks to decrease the amount of energy that is expended. Individuals may learn adaptive strategies for work such as using an ergonomic keyboard to enhance productivity while preventing upper body strain. Individuals may also learn community mobility such as maneuvering a wheelchair in a store, and may be taught to compensate for thinking process (cognitive) deficits by writing down any instructions they need to remember.

Source: Medical Disability Advisor



Prognosis

Therapeutic outcomes vary depending upon the severity of the individual's diagnosis, pre-existing and co-existing conditions, access to health care, financial coverage for health care, the individual's motivation, and availability of social support. Therapeutic outcomes are generally good for individuals with acute impairments (e.g., rotator cuff injury). Those persons with severe, chronic, or multiple deficits may see delayed and or marginal improvement during therapy. In some cases, recovery gains may continue to occur well after the formal therapy program has been completed.

In general, those individuals who receive OT achieve faster recovery than those individuals who do not participate in rehabilitation programs. For individuals with neurological diagnoses such as stroke or spinal cord injury, rehabilitation is crucial for recovery of function. Most individuals can expect to engage to their maximum functional ability in the activities that they participated in prior to disability either independently or by using adaptive equipment.

Source: Medical Disability Advisor



Complications

Individuals may experience muscle pain due to exertion. Individuals may also experience pain due to over-exertion from being progressed too quickly in rehabilitation.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Many persons treated with OT continue to work. If the OT requires the use of hand splints, an individual whose job requires extensive hand use may require temporary reassignment to other duties. Work restrictions and accommodations will need to be tailored to the individual's disability. The occupational therapist may need to visit the work site to observe/assess the essential functions of the job before making recommendations for accommodations or alternate job placement.

Risk: Occupational therapists are trained in how to approach, treat, and educate individuals with complex hand and upper limb injuries. There is always a risk of injury with therapy; however, therapy is often required to obtain maximum function.

Capacity: Capacity is one of the topics that the therapist will review with the individual as part of education and training. This education is important to assist the injured individual to understand goals, limitations, and expectations.

Tolerance: Pain is the limiting factor along with the specific injury. Pain tolerance is one of the topics that the therapist will review with the individual as part of education and training to help further the individual’s understanding of goals, limitations, and expectations.

Accommodations: The therapist can help with understanding of reasonable accommodations and may be able to provide adaptive aids.

Source: Medical Disability Advisor



Maximum Medical Improvement

This is a broad category making MMI difficult to provide. Please see specific diagnosis for which the occupational therapy is being provided for details.
Possible range of 30 to 180 days (wide range reflecting variable conditions requiring OT).

Source: Medical Disability Advisor



References

General

Twersky, Jack, and Helen Hoenig. "Rehabilitation and Assistive Devices." Practice of Geriatrics. Eds. Edmund H. Duthie, et al. 4th ed. Maryland Heights, MO: Elsevier Saunders, 2007. MD Consult. Elsevier, Inc. 21 Oct. 2014 <http://home.mdconsult.com/das/book/body/0/852/1.html>.

Source: Medical Disability Advisor






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