Evaluation and Rehabilitation of an Impaired Worker

This man has a fruit shop. With the crutches you see at the back, he is able to move from his home to the street where he can do his work. He is proud of being able to make a living for himself; and with good reason. ^{© G.Van Den Bergh}

Systematic Evaluation and Rehabilitation Process

A systematic approach to the rehabilitation process is needed. When a person comes to a rehabilitation center, for instance, the first step is to undertake an evaluation of the worker so that a plan can be made. This evaluation process can be described by these six steps:

1. What is the medical diagnosis of the patient?

2. What types of impairment is related to the medical diagnosis and what is the extent of the impairment?

A good, detailed description of the impairment is needed, based on an interview with the patient and an examination of their clinical function level. The evaluation must be individualized to the specific person and to the specific, relevant work tasks. It is complicated to make such evaluations, and requires multi-dimensional knowledge. There are a number of different systems to measure impairment. Some are developed by the benefit systems themselves since economic benefits may follow certain reductions in function. Others are quite complicated and many are used for research. There are forms for self-reports, questionnaires for pain affecting function, questionnaires for depression and psychiatric ratings, well-being forms, personality tests and measures for behavior, just to name a few. In developing countries, a focused interview by a skilled person might be the best method. Also, there are a number of measures for the examination of the worker, different functional measures and tests. Again, simple clinical examinations and evaluations are probably the most useful approach, in combination with descriptions given by the patient.

3. Is the impairment caused by, or aggravated by, the work?

This is of course important information, as aggravation of the impairment must be avoided. However, it is not uncommon that this type of evaluation is not performed, leading a patient into a very unhealthy work situation, which can further aggravate any problems For instance, if a worker has developed an asthmatic condition due to work in the cotton fields, it is not wise to give him a new job in another dusty factory.

4. What is the impact on the impairment on the patient’s ability to obtain employment

Sometimes a disability will have no impact on the work at all. For instance, office work can be performed by persons without legs, as long as the office worker has the skills for the work to be done. The only problem will be transport to and from the office.

5. What kind of sources for information on work capability should be considered?

Often work place visits and meetings with employers are needed to be able to evaluate the situation properly. This type of preparatory work is very important.

6. Is the patient entitled to any economic benefits?

Many countries have some kind of economic benefits. In most situations, the worker needs help with these issues.