Treatment is unlikely to be effective without modification of potentially provocative occupational exposures, especially for WRCTS. Occupational exposures may be modified via administrative controls or engineering controls, which modifiy repetition, forcefulness, vibration, and non-neutral or static upper limb postures through the (re)design of the work environment.
Administrative controls may be more cost effective than engineering controls and can be implemented for short durations. They may be used in conjunction with engineering controls or when engineering controls are not feasible. These modifications may include changes in work practices and policies, increases in job task variety, increases in rest breaks, rotation of workers through strenuous tasks, and worker education in risk reduction techniques.
Engineering controls are preferable to administrative controls because they are more permanent, but are usually more expensive. Engineering controls include changes in work processes, equipment, parts, tools and workstation layout.
For example, repetitive work may be reduced by adjusting the work pace, for example assembly line speed, or scheduling of rest breaks to permit recovery. To reduce forcefulness employers could increase in the coefficient of hand tool friction or suspend tools to reduce their weight for ease of use. Non-neutral and static postures may be minimized with the use of adjustable equipment or changing the workstation layout.
Role of the Occupational Therapist
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Administrative controls may be more cost effective than engineering controls and can be implemented for short durations. They may be used in conjunction with engineering controls or when engineering controls are not feasible. These modifications may include changes in work practices and policies, increases in job task variety, increases in rest breaks, rotation of workers through strenuous tasks, and worker education in risk reduction techniques.
Engineering controls are preferable to administrative controls because they are more permanent, but are usually more expensive. Engineering controls include changes in work processes, equipment, parts, tools and workstation layout.
For example, repetitive work may be reduced by adjusting the work pace, for example assembly line speed, or scheduling of rest breaks to permit recovery. To reduce forcefulness employers could increase in the coefficient of hand tool friction or suspend tools to reduce their weight for ease of use. Non-neutral and static postures may be minimized with the use of adjustable equipment or changing the workstation layout.
Role of the Occupational Therapist
Occupational therapists focus intervention on the person's physical abilities, environment, and the activities they engage in. Intervention emphasizes enabling function in work and lifestyle activities. The occupational therapist may perform a detailed step-by-step breakdown of what's involved in the activity to look at the specific tasks that could be affected by or be contributing to CTS symptoms. The occupational therapist may also observe the environment in which the activity is being performed and identify risk factors and compensatory strategies. The following are a few of the areas that an occupational therapist can assist with,
- Identify non-neutral wrist or upper extremity postures and activities
- Modify activities to maintain a neutral wrist and to reduce forceful gripping
- Task variety
- Work and rest breaks
- Tool design, use, and maintenance
- Postural corrections
- Minimize static postures
- Minimize forceful grips: use vices to hold material/equipment in place
- Minimize use of tools that produce significant vibration
- Bring the work to a comfortable level: height-adjustable and/or tilted workstations
- Keep elbows close to the body
- Reduce forward or vertical arm extension
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