3職業傷病工作手冊[1]曹.PDF

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1 DOH94-HP

3 2 3 ( -1) ( -2) 6,394 3,643 (57.0%)748 (11.7%) ( -1) 2

4 (HIVD) (myofascial pain syndrome) (de Quervain s disease) (tennis elbow) ( )

5 4

6 (OSHA) 1. Sedentary Work 5 2.Light Work Medium Work Heavy Work (Very Heavy Work) ( ) ( )? 5

7 6 1998

8 (A Physician s Guide to Return to Work )

9 7. ( ) ( ) % % 12 % % 13.4 % 4. 23% Prevention, Compensation, Return-to-work Case management 8

10 9

11 (%) 15~24() 25~44() 45~64() 495(4.2) 1524(12.9) 772(6.5) 2791(23.7) 98(0.8) 206( 1.7) 121(1.0) 425( 3.6) 98(0.8) 479( 4.0) 346(2.9) 923( 7.8) 452(3.8) 1429(12.1) 848(7.2) 2729(23.2) 95(0.8) 216( 2.2) 120(1.0) 476( 4.0) 566(4.8) 1448(12.3) 539(4.5) 2553(21.7) 119(1.0) 330( 2.8) 197(1.6) 646( 5.4) 203(1.7) 571( 4.8) 216(1.8) 990( 8.4) 34(0.2) 134( 1.1) 57(0.4) 225( 1.1) 2160(18.3) 6382(54.2) 3216(27.3) 11758(100.0) 10

2) 120(1.0) 476( 4.0) 566(4.8) 1448(12.3) 539(4.5) 2553(21.7) 119(1.0) 330( 2.8) 197(1.6) 646( 5.4) 203(1.

12 -2 ( ) % 47 6% 20% % 64 12% 38% % 71 27% 62% % 54 25% 59% 11

13 ~2001 (Liang, et al, 2004) 12

14 13 ( )

15 14

16 15 (body function and structure) (activity) (participation) (impairment) (symptoms) (signs)

17 16 1. X :

18 17 (risk) (work restriction) (capacity) (current ability) (Functional Capacity Evaluation)

19 (work limitation) (tolerance) (impairment) (functional disability) (job handicap)

20 19 work disability work ability evaluation risk capacity tolerance job analysis functional capacity evaluation / (reaching) 1. 2.

21 endurance -1-2

22 % /

24 23-2 /

25 -1 24

26 alternative job 25

28 1 topographic evaluation (volumeter) Guides to the evaluation of permanent impairment % 3 27

29 4 7. (1) (2) (3) (4) (5)

30 4. 6~

31 daily noteprogress note (1)daily note 30

32 (2)progress note progress notes

33 32

34 33 immobilization device reduction

35 Guides to the evaluation of permanent impairment (1) (2)

37 8. Guides to the evaluation of permanent impairment 1. (1) 3-4 (2) (3) (4) a. 36

38 b c % 1 2 d. 2. (1) 110% (2) (3) (4) (5) 37

39 Pransky % 20% 20% 68% 47% 42%

40 () (Back strain) X () (Acute herniated nucleus pulposus) (annulus fibrosus) ( ) 35 (90%) (L4-5) (L5-S1) L4-S1 39

41 (SLR) ( ) ( ) (push up) (extension exercise) (centralization) ( ) (traction) (decompression) (traction) (massage) (mobilization and manipulation) ( ) (mobilization or manipulation) (orthoses) Werneke M Fritz JM 40% (flexion) (extension) (HIVD) (facet joint dysfunction) (mobilization and manipulation) (spondylolisthesis) (segmental instability) (stabilization exercise) Jackson CP Brown MD 1983 (decrease pain) (strengthen weak muscles) (stretch contracted muscles) (decrease mechanical stress to spinal 40

42 structures) (improve fitness to prevent injury) (stabilize hypermobile segments) (improve mobility) Williams PC (radicular pain) (flexion exercise) (intervertebral foramen) McKenzie (extension exercise) (Pilates) (multifidus) (transversus abdominus) (flexor muscle) (extension muscle) 30% (strength) (endurance) (exercise programs) McKenzie (Centralization) (flexion) (extension) (range) (centralization) 41

43 (peripheralization) 1. (push up ) (end range) (knee to chest ) (end range) 1 2 (lumbar stabilization) (transverses abdominis) (multifidus) (erector spine) (quadratus lumborum)

44 43 1. (abdominal hollowing) (3-1) (ASIA) (3-2) (bridging) (3-3) 2. (all four) (hollowing) (4-1) (4-2) 3. (5-1) ( 5-2) (dynamic stabilization) (aerobic exercise)

45 1. (Swiss ball) (hollowing) (weight shifting)(6-1) (6-2) (6-3) ( ) (hollowing) (7-1) (7-2) (extension) (8-1) 8-1 (extension) (trunk slight flexion) 44

46 (9-1) (9-2) (9-3) (10-1)

47 ( ) ( ) ( )

48 (Cumulative trauma/repetitive motion injury) 1990 (OSHA, Occupational Safety and Health Administration)Cumulative trauma disorder 2001 (Cumulative trauma disorder CTD) (Repetitive stress injury RSI) (over use) (muscle tension) (incorrect posture) (repetitive motion) (static posture) ( ) ) (muscle strains) (myofascial trigger point) (thoracic outlet syndrome) (carpal tunnel syndrome) (tendinitis) (arthritis) (neuritis) (nerve compression) (tenosynovitis) (ganglions) (microtrauma) (inflammation) (scar formation) 47

49 % ( ) (Rotator Cuff Impingement Syndrome) 1. (rotator cuff syndrome) (impingement syndrome) (subacromial impingement syndrome) (painful arc syndrome) (supraspinatus tendon) (subacromial bursa) (long head of biceps tendon) (painful arc) (disused atrophy) 2. (DFM) (dynamic stabilization) 48

50 (1) (internal rotation) ( ) 0 (1-1) (subscapularis) (pectoralis major) (latissimus dorsi) (teres major) (anterior deltoid) (2) (external rotation) ( ) (infraspinatus) (teres minor) (posterior deltoid) (3) ( ) (scapular plane) (supraspinatus) (anterior and middle deltoid)

51 (4) ( ) (horizontal abd) (Lateral Epicondylitis, Tennis Elbow) 1. (wrist extensors) (supinators) (extensor carpi radialis brevis) (extensor carpi radialis longus) 2. ( ) (1)

52 (2) (3) (ulnar deviation) 7-1 (Medial Epicondylitis, Golfer s Elbow) 1. (racquetball elbow) (swimmer s elbow) (pronator teres) (flexor carpi radialis) (pronation) (ulnar neuropathy) 2. (1) (gripping exercise) 8-1 (intrinsic muscle) 8-1 (2)

53 (9-1) (3) 90 (10-1) 10-1 (4) 90 (11-1) 11-1 (DeQuervain s Tenosynovitis and Tendinitis) 1. (first dorsal compartment) (abductor pollicis longus) (extensor pollicis brevis) Finklestein s test( ) 2. (splint) (resting position) (1) (fingers total extension)

54 (12-1) (2) (wrist extension and radial deviation exercise) 90 (13-1) 13-1 (3) 90 ( ) (Carpal Tunnel Syndrome) 1. (transverse carpal ligament) (flexor digitorum superficialis) (flexor digitorum profundus) (flexor pollicis longus) (median artery) ( ) Phalen s test Tinel s sign 2. (splint) (neutral position) (pulse) (taping) 53

55 (1) (median nerve gliding exercise) 90 (side bending) ( ) (2) (tendon gliding exercise) (15-1) (metacarpophalangeal joints) (proximal interphalangeal joint) (distal interphalangeal joint) (15-2) ( (15-3) (15-4)

56 1. American Medical Association. Guides to the evaluation of permanent impairment. 5rd Ed., Revised. Chicago: American Medical Association, Anderson VP. Cumulative trauma disorders : a manual for musculoskeletal diseases of the upper limbs. London, Taylor & Francis, Armstrong FJ. Functional capacity evaluation. In: Kornblau BL, Jacobs K. Work: Principles and practice: A self-paced clinical course from AOTA. Bethesda, Maryland: The American Occupational Therapy Association, Inc, Battie MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K. Determinants of lumbar disc degeneration. Spine 1995;20(24): Borenstein DG, Wiesel SW, Boden SD. Low Back Pain: medical diagnosis and comprehensive management. 2 nd ed. Saunders, Philadelphia, Cassvan A, Weiss LD, Weiss JM, Rook JL, Mullens SU. Cumulative trauma disorders. Boston, Butterworth-Heinemann, Cordasco F, Parkes J. Oeruse injuries of the elbow. St.Louis, Mosby, Diorio PG & Fallon LF: Workers compensation, impairment and disability. Philadelphia, PA: Occupational Medicine: State of the Art Review 1989; 4(1): Gamboa AM Jr, Holland GH, Tierney JP. Assessing work and earning capacity. Advan Clin Rehabil 1988; 2: Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in U.S. industry and estimate of lost workdays. Am J Public Health 1999;89: Herington TN, Morse LH. Occupational injuries: evaluation, management, and prevention. St.Louis, Mosby,

57 12. Hertling D, Kessler RM. Management of common musculoskeletal disorders : physical therapy principles and methods. 3 rd ed. Philadelphia, Lippincott, Kasch MC. Hand injuries. In: Pedretti LW. Occupational therapy: Practice skills for physical dysfunction (4th ed). St. Louis: Mosby, Kasdan ML. Occupational hand and upper extremity injuries and diseases. Philadelphia: Hanley & Belfus, Inc., Key GL. Industrial therapy. St. Louis: Mosby, King PM. Work hardening and work conditioning. In: King PM (ed). Sourcebook of Occupational Rehabilitation. New York, NY: Plenum Press, Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Physical Therapy 2005;85(3): Law DK. Worker employability and earning capacity. Report to the Royal Commission on Workers Compensation in British Columbia, Liang HW, Chen SY, Hsu JH, Chang CW. Work-related Upper Limb Amputation in Taiwan, American Journal of Industrial Medicine. 2004;46: Liemohn W. Exercise prescription and the back. McGraw-Hill, New York, Mahmud MA, Webster BS, Courtney TK, Matz S, Tacci JA. Christiani DC. Clinical management and the duration of disability for work-related low back pain. Journal of Occupational & Environmental Medicine 2000;42(12): Matheson LN. Functional capacity evaluation. In: Demeter SL, Andersson GBJ, Smith GM. Disability evaluation. St. Louis: Mosby, Mayer TG, Gatchel RJ, Polatin PB. Occupational musculoskeletal disorders: functional, outcomes and evidence. Philadelphia, Lippincott, National Research Council and Institute of Medicine, Musculoskeletal Disorders 56

58 and the Workplace: Low Back and Upper Extremities, National Academy Press, Washington, DC, Osterman AL, Bednar JM, Skirven T, Moscony AMB. Vocational capacity and physical impairment in the upper extremity. In: Scheer SJ (ed). Medical perspectives in vocational assessment of impaired workers. Gaithersburg, Maryland: Aspen Publishers, Inc., Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council and Institute of Medicine. Musculoskeletal disorders and the workplace: low back and upper extremities. Washington, D.C., National Academy Press, Pransky G, Benjamin K, Hill-Fotouhi C, Fletcher KE, Himmelstein J, Katz JN. Work-related outcomes in occupational low back pain: a multidimensional analysis. Spine 2002;27(8): Prentice WE, Voight MI. Techniques in musculoskeletal rehabilitation. New York, McGraw-Hill, Randolph DC, Nguyen TH, Osborne P. The functional capacity evaluation: Is it helpful? In: Talmage JB, Melhorn JM, ed. A physician s guide to return to work. USA: American Medical Association, Redford JB. Vocational capacity with amputation. In: Scheer SJ. Medical perspectives in vocational assessment of impaired workers. Gaithersburg, Maryland: Aspen Publishers, Inc., Rock LM, Atkins DJ. Upper extremity amputations and prosthetics. In: Pedretti LW. Occupational therapy: Practice skills for physical dysfunction (4th ed). St. Louis: Mosby, Rondinelli RD, Katz RT. Impairment rating and disability evaluation. Philadelphia: 57

59 W.B. Saunders Company, Snook SH. Work-related low back pain: secondary intervention. Journal of Electromyography & Kinesiology 2004;14(1): Talmage JB, Melhorn JM. How to think about work ability and work restrictions: Risk, capacity, and tolerance. In: Talmage JB, Melhorn JM, ed. A physician s guide to return to work. USA: American Medical Association, Tramposh AK. The functional capacity evaluation: Measuring maximal work abilities. Occupational Medicine: State of the art reviews 1992; 7: U.S. Department of Labor: Employment and Training Administration. (1993). Selected characteristics of occupations defined in the revised dictionary of occupational titles. Washington, D.C.: U.S. Government Printing Office. 37. William H, Thomas N. Managing low back pain. 4 th ed. Churchill Livingstone, New York, ICF, 39., Occupational Low Back Pain (5) Pilates and Core Rehab

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