Hands-on Help

Occupational Therapist Sue Hammerich, top, works on patient Esther Gonzalez's wrists Nov. 8. Gonzalez recently had carpal tunnel surgery, and receives the therapy to further the healing process. //Tina Larkin/Staff
 

“I really wasn't a believer in therapy, but after going, I can only imagine where I'd be without it,” said Jaime Silveira of Lompoc, who has been undergoing physical therapy since an accident on the job forced him out of work several years ago.

Silveira fell from makeshift scaffolding while working at a construction site. His body landed on dirt, but his arm on concrete slab. Injuries from the fall led to more than five surgeries on his arms and his neck.
 

After a doctor's referral and insurance company approval, Silveira found himself at Lompoc's Carnahan Therapy Rehabilitation center for physical therapy, which revolved around strengthening the muscles that had been injured in the fall and weakened in the resulting surgeries.
 

The physical therapy helped Silveira to recover, but didn't prepare his body to return to his labor-intensive construction job without risking further injury, so with additional doctor and insurance provider approval, he began a work conditioning program with Carnahan's occupational therapy group. “They want to see me out there as much as I want to see me out there,” he said of his employers.

Work conditioning is part of Carnahan's WorkAbility program, an “industrial rehabilitation” program that involves assessing a person's physical capabilities and then assessing what is required of them at their job site. Work conditioning comes into play when those measurements don't match up.
 

Although the physical therapy was necessary to strengthen Silveira's muscles, his preference is for the work conditioning, which he can see translating into his success on the job. “I am starting to realize it (physical therapy) is a good thing, even though I hated it at the time,” said Silveira. “But this (work conditioning) is more useful, I think, by a long shot.”
 

When Silveira arrived Nov. 8 for a work conditioning session, Adrian Asencio, an occupational therapist who heads up the WorkAbility program, presented him with a patient flow chart, which is a computer-generated schedule of the exercises he was required to do in that session.
 

The chart listed exercises to be done, the number of repetitions required and the times that were to be met. After warming up on the treadmill, Silveira was ready to begin his required exercises. His workout was not consistent with what one might expect at the gym. Rather, his conditioning revolved around exercises that mimic what he would do at his construction job.
 

He began by tossing a medicine ball, a weighted rubber ball, into a net. Five balls of different weights were available; Silveira used a middle-weight one. “I started with the little one,” he said proudly.

In his next exercise, Silveira pushed a wooden sled loaded with weights back and forth across the room. Asencio observed, occasionally offering verbal cues to correct Silveira's posture to ensure he was pushing the device safely. “This feels a lot lighter than it did on Friday,” Silveira said.
 

In another exercise, Silveira is instructed to lift a weighted box onto different levels of shelves, bending at the knees to protect his back as he lifts. In another, he used a screw driver - one he brought from home - to bore screws into a wooden plank.
 

At this point, Silveira was two weeks into his work conditioning program, which consists of three two-hour sessions per week. The work had gotten easier over time.
 

“At first I hated Adrian,” he said. “But in the long run, it's all good.” Work conditioning and the WorkAbility program make up a small piece of Carnahan Therapy Rehabilitation's occupational therapy group. In general, the clinic focuses on hand injuries that affect a patient's occupation. And that's not to say occupational therapy is only for working adults. “Occupation is how you occupy your life,” explained Sue Hammerich, another occupational therapist at Carnahan.
 

Indeed, Carnahan's patients include teenagers who have been hurt in skateboarding accidents, office workers with carpal tunnel syndrome, laborers who have sustained injuries at their manufacturing jobs and retirees with arthritis. Occupational therapy is also used to help adults with disabilities learn to live on their own, with therapists teaching them everything from dressing for an interview to writing a resume to taking a bus to their job. At-risk youth have benefited from occupational therapy programs that help them learn how to make good decisions, from managing money to staying out of jail. Carnahan's out-patient setting allows occupational therapists to spend one-on-one time with their patients, determining how an injury occurred, how to treat it, and how to help the person live with the injury and prevent it from happening again or getting worse in the future.

For example, carpal tunnel syndrome can lead to pain, a loss of sensation and a tendency to drop things. Occupational therapists try to reduce the pain using traditional methods like heat, ice and exercise. In addition, they figure out how the injury developed in the first place and how it can be prevented from developing further. “I think it (occupational therapy) really encompasses the whole person, and not just the injury,” said Asencio.
 

Asencio takes pride in Carnahan being a progressive clinic, “and in Lompoc, of all places,” he said smiling. The clinic's progressive stance comes from their proactive steps in counteracting changes to workers' compensation laws that went into effect in 2004. The reforms placed a cap on the number of therapy visits a patient is allowed after a work-related injury. Visits for people injured on the job after 2004 are now capped at 24 per year. The limit applies to any kind of therapy and does not adjust if a patient has a change in status. That means that a patient who has 12 visits in preparation for a surgery will only have 12 left, even after the surgery.
 

The cap was implemented in an effort to curtail workers' compensation costs. “And that's valid,” said Hammerich, agreeing that worker's comp costs have skyrocketed for businesses. The reforms have forced occupational therapists like Asencio and Hammerich to make the most of their time with patients, and to encourage patients to practice therapy at home on their own.

After all, receiving therapy isn't like taking a car into the shop for repairs, said Hammerich. In therapy, “you drop you off, we give you the tools and you're the one who actually has to repair yourself,” she explained. Therapists at Carnahan also work to make sure the exercises patients practice are meaningful to the patient. For example, rather than run on a treadmill and lift weights, Asencio instructed Silveira to push heavy loads on a sled, lift heavy boxes onto various heights of shelves and to use a screw driver to bore screws into a plank. The tasks match with work Silveira would do on the job, and he easily recognized their usefulness to preparing him to return to work. While the client-centered approach is essential to preventing many injuries from recurring, “it's hard to convince people to change the way they do things,” admitted Asencio.

In their efforts, occupational therapists use several tools to help them guide their patients. Ice, heat and custom hand splints allow them to treat injuries. Theraputty, a kind of therapeutic Play-Doh, is used for hand therapy. Giant clothes pins help people relearn how to grip and squeeze objects. Patients can dip their hands into a bowl filled with rice or beans, bringing a soothing sensation to their tender nerves. Hot paraffin wax treatments can soothe sore hands, too.

“We take for granted the biomechanics of the hand,” said Hammerich. Her patients have learned not to. They rejoice when they discover that because of therapy they are able to use the bathroom on their own, to tie their own shoes or to wash their own hair. “We focus on what skills this person needs to do to get their life back,” said Hammerich.

Is your job site safe?
 

Through its WorkAbility program, Carnahan Therapy Rehabilitation offers Ergonomic Job-site Analysis. Carnahan's ergonomic assessments call for an occupational therapist to visit a work site and assess the risk factors posed there. A visit to an office, for example, might reveal workers sitting at computers with unadjustable chairs, using poor typing habits and incorrect posture, explained Adrian Asencio, occupational therapist at Carnahan.

The visits don't mean the office will be talked into buying expensive new equipment to meet the physical needs of the workers. Asencio first looks for what modifications workers can make with what they have. Maintaining proper posture, for example, is a first step.

A tip from Asencio: “The chair is the most important piece of equipment you can invest in.”

For information on the WorkAbility program, including ergonomic assessments, call 737-6547.

- Emily Welly

About Carnahan

Carnahan Therapy Rehabilitation has been providing physical and occupational therapy services in Lompoc for more than 25 years. The Walnut Pier Health Club fitness facility and recently opened Studio II yoga and Pilates center also fall under Carnahan's ownership.

The physical therapy and health club facilities are at 803 E. Walnut Ave. in Lompoc. The occupational therapy clinic and Studio II yoga and Pilates center are at 217-D W. Central Ave.

For information on physical or occupational therapy, call Carnahan at 735-3714. For information on the health club or yoga classes, call Walnut Pier at 736-3493 or visit www.walnutpier healthclub.com.

Emily Welly can be reached at 739-2220 or ewelly@santamariatimes.com.