Neuro and Vocational OT at Its Best: Supporting a Sustainable Return to Work

Submitted by: Kim Emery, Everyday Living Therapy
Website: www.everydaylivingtherapy.co.uk

The Background

The client worked as a gardener and general groundsman on a private estate. Following an accident, they sustained multiple orthopaedic injuries. As their life demands increased, secondary changes became more evident.

The client found they were no longer able to hold information in mind as effectively as before. They experienced difficulties implementing new plans, organising and prioritising tasks under time pressure, and became distracted and overwhelmed. When absorbed in tasks, they could also overlook longer-term health needs, such as managing their blood sugars.

The Challenge

The referral was received through case management.

At the time of assessment, the client had been absent from work and was unable to consider returning because of the extent of their orthopaedic injuries. They were extremely low in mood and had lost their sense of identity, self-worth and self-efficacy.

They relied on others to assist them in all areas of function, other than meeting their own self-care needs.

The client’s employers wanted to understand when a return to work might be possible. However, both the client and the employer were at a loss as to how a return could ever be feasible.

Assessment and Planning

The assessment included the Neurobehavioural Functional Inventory, MTAP, Functional Pain Scale, a job demands analysis, and observations of the client’s general functional performance and capabilities.

These assessments were undertaken in connection with the client’s treating physiotherapist and in agreement with the case management team.

A few weeks after the initial assessment was completed, a return-to-work meeting was held. A structured, graded and systematic process to support both the client and their employer was proposed and accepted by the employer.

The Vocational Rehabilitation Approach

Structured observations of the client’s job role and daily functioning were undertaken over a number of weeks and months.

The physical, cognitive and psychological aspects of the role were considered and assessed through a job demands analysis. This provided the central framework for the occupational therapy intervention and a clear, directive approach to grading the demands of the client’s work.

Regular meetings were held with the client and employer, initially every four weeks, then every six weeks, and subsequently every eight weeks. These meetings took place alongside direct intervention and treatment.

Within eight weeks of the assessment, the client had commenced a graded return to work, initially completing two four-hour shifts each week. This was combined with ongoing physiotherapy to maintain their wellbeing at work.

Over the following six months, the client’s working role was increased incrementally, reaching 30 hours per week.

The shortfall in working hours was covered through support from an Access to Work grant. This enabled the client to return to work with a funded work buddy or support worker to assist them in fulfilling their role, without additional burden or cost to their employer.

The return-to-work process became an integral part of the client’s wider rehabilitation.

The Outcomes

The intervention achieved the following outcomes:

• Return to work achieved within eight weeks of completing the neuro and vocational occupational therapy assessment.
• 100% of proposed reasonable adjustments implemented.
• Three years of funding support secured through Access to Work.
• Improved functioning through structure, routine, consistency and skilled support.
• Sustained employment, with the client retaining their role and working 30 hours per week on an ongoing basis.

Key Learning

This case demonstrates how a structured, graded approach to returning to work can form an integral part of rehabilitation.

By assessing the physical, cognitive and psychological demands of the role, and working collaboratively with the client, employer, physiotherapist and case management team, the return-to-work process was developed around the client’s functional capabilities and the demands of their work.

With appropriate workplace adjustments and funded support in place, the client was able to return to work and sustain a 30-hour working week.

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