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Vocational and functional assessment of clients reopened for service.

Former clients (107) of the Massachusetts Rehabilitation Commission were evaluated to determine the reasons for their return to the Commission a second time. Clients returned to obtain physical restoration services, employment or training such as in a vocational school or college. Clients were given a vocational interview (the Goldberg Scale) and the Tufts Programmed Functional Assessment, embracing the Barthel and PULSES Profile. Work status at follow up was significantly predicted by the Goldberg Scale and the PULSES Profile. A significant number returned to work after receiving services a second time.

Adult↗

[Principles of medical expert testimony regarding adolescents' capacity for practical vocational training and work].

The presented approach to adolescents' vocational guidance is based on the ILO principle that work should conform to psychophysical conditions of the worker which should be evaluated before the beginning of work. In the paper the main health problems influencing the work capability have been discussed. It is suggested that the student, his parents and tutor should be informed about his health impairments, the degree of disability and therapeutic possibilities. The psychophysical features characteristic of the adolescence justify the health protection against occupational exposure to harmful agents as well as the activities, for health education and health promotion at school.

Adolescent↗

[Work capacity of mitral stenosis patients before and after mitral commissurotomy].

Analysis of the working capacity of 1,000 patients who underwent mitral commissurotomy showed that 67.0% of individuals who were operated on for grade III stenosis and 27.99% of those operated on for grade IV stenosis resumed work. Frequent exacerbations of rheumatism and changes in the myocardium and valvular apparatus are among the causes of the decrease in the number of persons who resume work after the operation. Another reason is overestimation of the group of invalidity or its unjustified qualification

Disability Evaluation↗

[Comparative analysis of the informational merits of ergometric and functional indicators of work capacity].

Informational merits of ergometric and routine functional indices (MPK, anaerobic threshold--AT, PWC170) were compared by testing performance of 20 young males with high levels of fitness. Criterion for work ability was maximum time of rowing ergometer with incremental loading and two tests with permanent load in the regions of submaximum (about 7 W/kg) and high (about 4 W/kg) loading. Ergometric indices, i.e. individual limits of relative power, were calculated from Muller's equation tlim = eb x W-a. Before, during, and after 5-20 minutes of test session gas exchange, pulse rate, and blood lactate were measured to calculate MPK, AT and PWC170, and oxygen demand fraction. Ergometric indices were found to be no less informative in evaluation of work ability than the common indices involving determination of gas exchange, PR and lactate. Ergometric and functional indices showed high correlation. It was stated that none of the indices can be equally informative regarding all types of work ability testing. Application of two-increment test and subsequent calculation using Muller's equation allows to get around the principle of uncertainty according to which none of the test can be at one and the same time used to assess power and capacity of energy systems of the skeletal muscles. Besides, ergometric tests provide reliable enough characteristics of work ability without resort to expensive and bulky equipment.

Adolescent↗

[Work capacity and fatigue of helicopter pilots].

In helicopter pilots the direct index of their work capacity increased while indirect indices decreased in the course of the flying shift. The peak of their professional performance occurred at the end of the flying shift coinciding with the expressed feeling of fatigue. Evaluation of professional work capacity using direct methods does not yield adequate information about the state of pilots, making them unsuitable to diagnostics fatigue and to measure permissible work load. Proper diagnostics of fatigue does not necessarily require examinations of the pilot's state inflight. Adequate information can be obtained on the ground during the flying shift.

Aerospace Medicine↗

Background and objectives of the Finnish research project on aging workers in municipal occupations.

In Finland, the proportion of 45- to 64-year-old people in the work force is expected to increase from 31.1 to 40.1% between 1980 and 2000. A multidisciplinary study was carried out to test the factors of work, health, work ability, functional capacity, and perceived strain as criteria for determining new concepts for retirement age. The first phase of the project comprised cross-sectional studies in which the age of the 6257 working subjects ranged from 45 to 58 years. The second phase covered a four-year follow-up of these same subjects. The main results of the 15 various studies are given in separate articles. Recommendations for improving the work and promoting the work ability of the aging worker have been made on the basis of the findings of the project.

Aged↗

Work capacity in women in relation to age as judged from a maximal work performance test.

Work performance test could be carried out on a population sample of women aged 38-60 years without complications. The work capacity decreased with increasing age and at the same time the maximal heart rate during work decreased with increasing age. Blood pressure increased with age and these differences between the various ages were about the same as at rest. Respiratory frequency and perceived exertion on maximal work were similar in the ages studied. ECG changes were common and were found to be as common as in men who had been studied with the same technique and in the same ages. As ECG changes were very common and as myocardial infraction is very seldom in women of these ages, ECG changes during and after work did not seem to be a good discriminator of women subjected to myocardial infraction.

Adult↗

Vocational potential assessment.

Determination of employment potential will become increasingly important in the foreseeable future, largely due to pending Federal legislation which relates to welfare reform. The heretofore "permanently and totally disabled versus able-bodied" principle in welfare reforms is being abbandoned. Pending legislative proposals dealing with welfare reform provide for considering physically impaired persons as partially disabled and partially employable simultaneously. Thus, the need to systematically and effectively assess physically impaired citizens' capacities to participate in the job market will increase. Unquestionably, rehabilitation medicine in general, and the emerging art and science of vocational evaluation in particular, will contribute much to supplying these services. While it is widely acknowledged that the vocational potential of physically impaired persons should be evaluated in an organized manner, there are differences of opinion among professional evaluators as to which approach, or approaches, are the most meritorious; The four principal approaches are: (1) mental testing, (2) work sampling, (3) situational analysis, and (4) job tryouts. Each of these approaches is explained, contrasted, and evaluated in this paper.

Disability Evaluation↗

[Avoidable mistakes in neurological expert testimony].

A physician thinking in the usual diagnostic/therapeutic fashion is faced with numerous pitfalls when presenting expert opinions as a medical advisor in courts of law. The main source of errors in assessment is the lack of understanding of differences and peculiarities of terminology and how health disturbances are rated in the various legal fields. Additionally, there are major problems with different valuations of evidence in the "causative chain" and how to estimate the influence of previous health disturbances. Finally, it is important to avoid formal mistakes in the formulation of expert opinions and to avoid creating confusion in presentation, role conflicts, and conflicts of interest.

Accidents↗