OCCUPATIONAL REHABILITATION CENTER

William Todd Martin, C. Tucker Cope, Matthew Morrison, Zufhair Hadi Case Engineering Service Group, Case School of Engineering, Cleveland, Ohio Case Western Reserve University

ABSTRACT

A local hospital desired a "next-step" facility for the rehabilitation of industrial workers trying to return to the work force. It was essential that this facility was an accessible, controlled area which could be used to train individuals with temporary or permanent disabilities to return to an industrial vocation without risk of further injury. The final product, the occupational rehabilitation center (O.R.C.), was designed as a set of work stations where patients graduating from the traditional rehabilitation program could seek advanced occupational therapy and vocational training in an atmosphere typical of their given occupation. Since its opening in July 1995, the workstation has been used by patients recovering from illness or injury to return to their former jobs, to acquire another job, or as a means of evaluation of cognitive abilities by hospital therapists.

BACKGROUND

The occupational rehabilitation center (O.R.C.) was designed with the intent of providing the hospital's "Work Link" program with an industrial rehabilitation center which would subject patients to a realistic environment where rehabilitation could be tailor-made to individual needs. Although the hospital's previous "Work Link Program" provided patients with a means of physical rehabilitation through exercise, therapists were not able to prepare patients for their return to a specific occupational activity or to evaluate the appropriateness of the re-entrance to the former job environment. The O.R.C. is utilized as a next-step rehabilitation center where patients and therapists work together on specific body mechanics and cognitive skills in order to strengthen a particular feature of the patient or to practice techniques which could prevent future injuries to the patient and return or initialize the job entrance.

The student group spent over 400 hours in design, development and construction of the center. The benefits were not only the design experience, but also the professionalism and project management that was needed to successfully complete the project.

The student group completed the project under a three thousand dollar budget, this was in contrast to the one hundred twenty thousand dollar estimate for the project to be completed by an independent contractor which was consulted by the hospital.

DESIGN ANALYSIS

The O.R.C. was designed through the combined efforts of the student design team and rehabilitation staff members. The therapists requested general areas which would augment their current industrial rehabilitation program and satisfy the "Work Link" client pool. The student team designed specific components which would fulfill the requests of the hospital and be compatible with the available floor space. The Center was required to fit into a fenced-in sixty-five foot by twenty foot section of a parking garage located below the hospital.

A rough floor plan was laid out to include the prescribed work areas. The floor plan consisted of three main stations: an automotive station, a plumbing, electrical, and general construction station, and a general labor station. Each station included several sub-stations which would allow the patient and therapist to concentrate on performing a particular exercise in order to rehabilitate a specific injury. The student team worked as a cross disciplinary team with the therapists to decide on the specific activities that would incorporated. The designs of the sub stations were developed through analysis dealing with structural integrity, strength of materials and manufacturability. Ongoing adjustments were applied to the sub-stations in order to accommodate various physical and feasibility limitations of the project. To ensure that all facets of the Center were realistic and in compliance with local codes, research was performed through consultation of various private contractors, therapists, university professors, and local libraries. The final design was reviewed and approved by the facility engineering staff of the hospital.

DEVELOPMENT AND EVALUATION

The configuration of the three stations served as a means to isolate patients into an area specific to their occupation. Though the floor space was minimal, each station was designed to allow patients to work in an accessible environment similar to their actual vocation. All stations also provided the basic requirements for proper simulation of the patient's occupation while allowing space for modification and improvements.

The automotive station was created for a large range of patients. Planned around the donation of two automobiles, this station will be able to aid patients ranging from automotive technicians to chauffeurs. A Saturn sedan with an automatic transmission and a MG convertible with a manual transmission were placed side by side near the entrance of the Center. The Saturn was mounted on a structure that would allow the front to be elevated by a car jack, but would not allow any other movement to ensure safety. The MG convertible was permanently mounted onto stands that would allow a patient to work underneath the vehicle on his or her back without danger of the vehicle swaying.

Another sub-station of the automotive work station was a six foot by three foot metal frame containing the elements of the undercarriage of an auto. This station was elevated eight feet off of the ground in order to simulate a vehicle being worked on from below. The elevated frame was designed to allow patients to work on the underside of a auto, who otherwise would not be able to physically lower themselves below one of the actual vehicles.

The largest station in the O.R.C. was the plumbing, electrical, and general construction station. This station focused on a twelve foot by eight foot wood-framed room which contained the electrical, construction, and a portion of the plumbing sub-stations. The room contained fifty feet of Romex electrical wiring, three outlet boxes, one lighting fixture, one light switch, a vanity sink with faucet, and seventy five feet of PVC piping. Sharing a wall with the room was a platform elevated three feet from the ground with a shower stall containing a faucet and drain which utilized hot, cold, and drainage plumbing. A five step staircase was placed at the end of the platform to provide the patients with a means of reaching the shower stall and to provide a site for the patient to practice hauling objects up a set of stairs.

In order to create the most realistic environment possible, the wiring and plumbing in this station was placed overhead, inside walls, and inside a three foot by three foot, eight foot long confined crawl space under the shower platform. The wiring, plumbing, stairs, and door frame were all constructed according to local codes.

The final work station was designed to rehabilitate general laborers such as steel and factory workers. One of the sub-stations of this area, an I-beam elevated one foot off of the ground by two four inch square wood beams at either end, was implemented as a mechanism to test the patient's agility and coordination. In an exercise which would simulate the everyday process of a common steelworker, the patient would be asked to traverse, strike, or align the six holes in the I-beam with the six holes on a custom gusset plate located on the end of one of the supporting beams. The second sub-station in this area was a eight foot by eight foot wooden frame which supported an I-beam containing a trolley and hoist capable of supporting two thousand pounds. The frame for the trolley and hoist was designed with a safety factor of 4, to ensure safe operation of the largest mechanism in the O.R.C.

DISCUSSION

The O.R.C. was built as an authentic link between the traditional clinical rehabilitation atmosphere and the industrial working world. The O.R.C. incorporates a realistic environment in addition to functional rehabilitation devices, such as the automobiles and the twelve by eight room. The first step of the "Work Link" rehabilitation program allows the patient to practice isolated movements through weight training and simple exercises, while the O.R.C. allows the patient to work on specific functions or processes directly linked to his or her particular occupation. To accommodate the needs of all patients, the O.R.C. was designed to meet A.D.A. accessibility standards.

The "real-world" setup of the O.R.C. was not only necessary to accommodate the patients physical needs because the mental aspect of industrial rehabilitation is extremely arduous and difficult to control. Therefore, the environment in which the patient is rehabilitated must be appealing to the patient while useful to the therapist. The process must prepare the patient for the shock of reentering the work force while allowing the therapist to complete a thorough evaluation of the patient's progress.

Currently, therapists who have been using the center since July, 1995 have reported that the ability to simulate a real-world working environment, observing patients performing various activities and educating them on the appropriate body mechanics has allowed for a more thorough and comprehensive rehabilitation program than was possible in their traditional rehabilitation program. The therapists are currently collecting long-term data from their patients in order to determine the over all impact of this type of "hands on," therapy compared to traditional weight, flexibility and range of motion therapy.

ACKNOWLEDGMENTS

Funding for this project was provided by the Case Engineering Service Group, Case Western Reserve University, Cleveland, Ohio. Special recognition to: Metro Health Medical Center, the Case School of Engineering, C.T. Cope Construction and LTV Steel. Individual recognition to: Jack Daly, Julie Grubaugh, Ann Janes, Chris Zamiska, Kristine Samonte, Jacob Hirst, Dave Gray, and Randey for their inspiration and assistance.

REFERENCES

C. Tucker Cope Construction Inc. Columbiana Ohio.

Daly, John F.X. Senior Instructor. Case School of Engineering. CWRU, Cleveland, Ohio.

Grubaugh, Julie. Rehabilitation Engineer. Daly Technology. Cleveland, Ohio.

Jones, Peter. The Complete Book of Home Plumbing. Scribner, New York: 1980.

Neidle, Michael. Basic Electrical Installations. MacMillan Press, London: 1977.

Riley, William F. Introduction to Mechanics of Materials. Wiley: New York: 1989.

William Todd Martin 1363 Red Bush Lane Macedonia, Ohio 44056 wtm2@po.cwru.edu (216)467-3161

Occupational Rehabilitation Center