VR Consumers with Medical Disabilities

1
VR Consumers with Medical Disabilities

• Decision Making and Planning

• Strategies for Counselors

Dr. Kevin Horan Rehabilitation Psychologist Consul
tantNavajo OSERS
2
Outline of Presentation
1. Type of Disability (brief overview)

• 2.Trait/Symptoms of Condition

3.Recommendations For VR Planning
4.Top Possible Job Placements
5.Feedback ------gtDiscussion
3
Ten Common and Uncommon Medical Conditions seen
in VR Consumers

• 1. Back Injury

2. Diabeties
3. Epilepsy
4. Spinal Cord Injury
5. Heart/Lung Conditions
6. Pain Syndromes
7. Thyroid Conditions
8. AIDS
9. Hand-Arm-Shoulder injury
10. Multi System Breakdown
4
Back Injury

• Degenerative Disc Disease
• Narrowing of Disc Space
• Bony Spur Development

• Herniated Lumbar Disc
• Spongy Material Seperating each Vertebra.
• Body extrudes through protective covering

• Spinal Stenosis
• Narrowing of Space in Spinal Canal
  (Acquired or Congenital)

• Fracture
• end plate injury due to lifting,carrying, etc.

• Osteoporosis
• Loss of Bone Mass
• Typical (women over 40)

5
Treatments

• Typical Surgery

• Laminectomy (Remove bony arches of one or more
  Vertebra to relieve compression of the spinal
  cord)

• Spinal Fusion (Stabilize spinal section with a
  bone graft or Synthetic Device)

6
Other Treatments

• Epidural Blocks

• TENS Unit

• Medication

• Pain Management Clinic

• Brace Devices

• Chiropracter

• Work Hardening

• Traditional
• (ie. Bone Doctor)

7
Traits Observed in Consumers with Back Injury

• Loss of Income, Bills, Family Stress

• Non Productive Guilt Depression

• Pain Medication ToleranceConfused/ Cognitive
  Changes

• Pain Frustration Temper Conflicts in Family

• Difficulty Accepting Limitations

• Transferable Skills in areas not Compatible with
  Disablity

• Downtime - Long Delay after putting in Job
  applications Depression FT Low Confidence
  Levels

• Vocational Interests are often Unrealistic

• Idle Time may lead to Drinking(Self Med) -Time
  Cycle off

• Limited Strength and Stamina
• Occasional Remarkable Recovery/Presentation

8
Recommendations
1. Use prevention measures (ie.Back Brace)
2. Avoid Discrimination During Job Search
3. Avoid Pain Medication Trap
4. Counselor Make Discomfort Apprasial
5. Be Aware of Unrealistic Rate of Recovery
6. Determine Current Point of Stability
7. Be Aware of Financial Incentives

• 8. Help Consumer Realize Functional
  Limits/Restrictions in relation to Vocational
  Objectives

9.Be Aware of Potential for Long Term System
Breakdown
9

• Top 10 Jobs (Back injury)
• Building Inspector
• Appraiser of Home
• Transportation Jobs -with modifications
• Light Duty Clerical/Computer Operation
• Small Bench Work Repair
• Cashier With Adaptations
• (Home Maker Companion)-Prep Meals for Others
• Telemarketing Phone Sales/Retail Sales/Car Sales
• Intake Worker-Health Info Tech
• Teacher-Teaching Aide Positions

10
Diabetes Mellitus
DX Blood after fasting overnight sugar greater
then140 Mg/dl on two separate occasions. Increas
e in thirst, hunger, and urination

• Pancreas does Not secrete enough Insulin or cells
  of body become resistant to Insulin Blood sugar
  can not get to cells

10 million Americans have diabetes but fewer then
half are DX
Type 1
Type 2
Insulin Dependent (Usually in children Adolesence)
Non Insulin Dependent (usualy onset after 35-40)
90
10
Related
Genetic Factor
Enviromental Factor

Obesity
Onions and Garlic Lower Blood sugar
11
Traits Often Observed in Diabetic VR Consumer

• May need to frequently urinate

• May have numbness or start of neuropathy

• Could be dizzy or weak-non healing cuts

• May show stress/frustration and depression

• Desire to stay in old line or previous work

• Poor adjustment to extreme work change

• May be unrealistic-May deny limitations

• Self medicate with ETOH-at risk for D coma

• May not understand complications of diabetic

process and balance of body systems

• Family often acts as best option to motivate and
  maintain compliance in consumer

12
Recommendations

• Maintain-Monitor ----gt

• Weight factor

• Blood sugar monitor (Hba1c)

• Long term complications awareness

• Job choice must be short(hrs) with (breaks)

• Post Dx Problems could impact plans

• Find out time since being Dx and comp level

• Avoid future jobs that may require vision tests

• Avoid very hot work environments

• Periodic updated physical and visual exams

13
Top 10 Jobs For Consumers With Diabetes
1. Telemarketing Jobs
2. Light Duty Housekeeping
3. Health Information Technician
4. Kindney Dialysis Technician
5. Nutritionist - Educator
6. Teachers Aide
7. Inventory Work - Retail Outlets
8. Appraisor - Estimation Work
9. Motor Vehicle Worker (clerical)
10. Banking Jobs - Legal aide - Interpreter
14
Epilepsy

• A group of neurological conditions characterized
  by recurrent episodes of convulsive
  seizures,sensory disturbance,abnormal behavior or
  loss of consciousness

Sympotomatic Known Cause
Idiopathic Unknown cause
Main Causes
Head Trauma, Intracranial Infection, Poison,
Brain Tumor, Vascluar Disturbance, Intoxiction
Continued-gt
15

• Types of Seizures

Absence Sudden momentary loss of consciousness
Former name Petit Mal
Focal Abnormal electrical discharge in
localized part of
brain. Usually near motor sensory strip
Tonic-Clonic Generalized Involuntary muscular
contractions
and change in respiration followed by TC spasms
of muscles ie. Grand Mal
Psychomotor Temporary loss of consciousness,
Loss of
judgement, Automatic behaviorisms and possible
abnormal acts-hallucinations, Deja Vu, Temporal
Lobe Disease or Injury
Meds Reduce Seizure Threshold
Stabilize Cell Membrane Decrease Intracellular
Sodium and Excitability of
Eleptogenic Focus
16
Some Traits Observed in Consumers with Epilepsy
1. Memory concerns (short term)
2. Appearance may be altered (dilantin-gums-scars)
3.Quick temper or anger- some may not show this
4. Loss of confidence due to seizures in public
5. Denial of disabilitys impact on day to day
life
6. Frustrated due to transportation limits
7. Non compliance with medication
8. Dependence on family/Possible overprotection
9. Transferable skills often in noncompatible area
10. Substance abuse resulting in seizures
11. Many consumers with epilepsy may be very
well adjusted
17
Epilepsy Recommendationss
1. Encourage compliance with medication, diet,
drinking and general doctors orders - be aware of
individual aura
2. Discourage job placements in work enviroments
that are potentially dangerous (ie driving,
cooking, heavy equipment)
3. Keep seizure log - if seizures are still
occuring, show the log to your doctor to help
adjust medication
4. Discuss if the consumer is operating a motor
vehicle and has not been seizure free for a year
5. Be aware of the possibility of concurrent
depression and frusturation in the consumer
6.Be aware of the possibility of self medication
with ETOH or drugs due to adjustment problems
7.Recommend supportive counseling if you detect
emotional, behavioral, or family problems
Continued--gt
18
8.Provide additional vocational counseling if the
consumer is choosing unrealistic jobs not
compatable with a seizure condition
9.Look closely for memory problems that might
interfere with job or daily living
Top Ten Jobs
Laundry work
Upholstry
Clerical
Tile Layer
Computer operation
Telephone
Cashier
Receptionist
Auto part Salvage
Food Vendor
Top Ten Jobs
19
Spinal Cord Injury
33 Vertebra- 7 cervical, 12 thoracic, 5 lumbar
5 sacral
Sci - Complete or Incomplete cfirst tQuad below
T 1 Para
10,000 new SCI Injuries a year
20 falls 15 sports/rec
15 gunshots, stabbings, industrial, etc.
Majority Young active men
Voc Predictors Young age, high education
positive attitude and ability to drive
Voc Interest -Still like working with things
rather then people or data
Changes Sensation, Motor Control, Sexual
Functioning, Regulation of Internal Temperature,
Blood Pressure, Bowel Bladder Processes, Onset
of Pain, Spasticity, Decubiti (pressure sores)
Ulcers
Cognitive Level usually normal but 16 Para TBI
Premorbid Normal to Impulsive/Rebellious Non
conformity
Continued--gt
20
Profile Possibly More Depression - 45
-Symptoms of Anxiety, Anger, Fear, Low Self
Esteem
Pain 44 to the point it interferes with ADLs
Suicide Slightly more common then general
public but still infrequent
ISDB 62 ETOH, Drugs, Refusing Treatment,
Prolonged Sitting sores
Divorce (25 - pre post injury) some studies
show less divorce after SCI
Family No problem raising a family
Cultural Swiss Paras - 77 working- 67
driving - 25 higher ed
Nigerian Most Paras dead within a year

21
Spinal Cord Injury Traits
1.May show decubiti ulcers/urinary tract
infections/ Breathing Problems/Muscle Spasms
that could be a factor in job development/treatme
nt
2. Hidden Depression - feeling helpless/angry/guil
ty
3. Family and Financial Issues may emerge
4. Social Changes-Isolation less in Public eye
5. Transportation concerns- adaptation of vehicle
6. Development of Dependency
7. Hidden Substance Abuse Concerns
8. Concern over upgrading wheel chairs
9. Sexual Issues may be present in some cases
10. Occasional Excellent Adaptations to SCI
22
Recommendations
1. Concurrent PT-OT. Assistive Technology Evals
may be needed
2. Review need for adaptative equipment in home
- Possible work adaptation
3. Possible need to refer for Independent Living
consultation
4. Review time since injury (new-late-later) to
assess adaptation and VR needs
5. Recommend ongoing health education to adapt to
SCI
6. Counseling may be an individual and/or family
need
7. Determine if any ongoing legal issues need to
be resolved prior to VR plan
8. Determine if individual can be re-employed in
previous position with accomodations or job site
modifications
9. Prioritize driving or mobility needs and
implement non-costly plan
Continued--gt
23

• Top 10 Jobs (SCI)
• Cashier
• Banking Positions
• Bench work
• Counselors
• Education/Teacher
• Computer operation
• Clerical Jobs
• Self employment
• Dispatcher
• Broadcasting

24
Heart Disease
Primary Heart Conditions

• Congestive heart failure Heart can not pump
  enough blood possibly due to prolonged high blood
  pressure, previous heart attack, faulty valve,
  heart muscle problems,chronic lung
  disease(ie.Asthma)

• Symptoms - Weakness, Fatigue, Shortness of Breath

• Arrhythmias Disturbance in the Rhythm of Heart
  beat

Some symptoms mild (no problem) Others are
dangerous

• Ventricular Tachycardia - Rapid uncontrolled
  contractions of Heart

• Cardiomyopathy Disease of Heart Muscle or
  structure Less Force/Contractions Less blood
  circulation can cause Toxic, Viral, Degenerative
  Conditions

25

• Mitral Valve Prolapse Loss of Tone or
  Deformitity of Heart

Valve which can cause leakage or heart murmer

• Atherosclerosis - Buildup of Plaque/
  Cholesterol/Fatty Material or Debris in the inner
  layers of the walls of medium and large arteries

26
Lung Disease

• Asthma - Respiratory Disorder recurring Dyspnea,
  Weezing, Problems breathing due to constriction
  of the bronchi causing much coughing - excessive
  mucous

possibly precipitated by inhaling of
allergens, pollution, exercise, stress , etc

• Emphysema Destructive changes in lung walls -
  Loss of Elasticity, Decreased gas exchange

Causes Chronic Smoking - Old Age

• Bronchitis Acute or Chronic inflammation of the
  mucus membranes or Tracheobronchial tree

Caused by Viral Infection
Continued--gt
27

• Chronic Bronchitis Excessive Secretion of Mucus
  for 3 months over 2 sucessive years (Cig
  smoking/Air pollution)

• Chronic Obstructive Pulmonary Disease or COPD A
  Progressive Irreversible Condition with
  Diminished Capacity of Lungs - Chronic Cough,
  Dyspnea, Aggrevated by Cigs Pollution.

28
Cardio/Pulmonary DisordersTraits seen in VR
Consumers
1. Dyspnea - Shortness of breath - Deconditioned
HBP
2. Poor Mobility - Limits in stair
climbing/walking/standing
3. Tendency to keep smoking in spite of problems
4.Poor diet choices(ie.fast food)-little
education related to nutrition
5. Overweight - Possible Obesity
6. Often trying for SSDI - Varied levels of
Empowerment
7. Depression over health Problem Functional
limitations tendency to give up and be Passive
8. Turn control over to Doctor - Become External
9. Weakness - Often can not work Fulltime
10. Possible Mix of many medications from many
Doctors
29
Recommendations
1. Physical Restoration including Diet, Exercise
and Strength Building monitored by Health
Professionals
2. Recommend Education regarding further
Complications - Long term effects on Health
3. Be aware of Mood Changes particularly
Depression
4. Need for Smoke Cessation Program- ie. Nicoret
gum - patches zyban - hypnosis-etc.
5. Vocational Counseling to redirect to a more
sedentary job but one that also requires some
PhysMental Action
6. Wellness Center and Group Support
7. Involve Family in Plan but dont let Consumer
rely too much on others Encourage empowerment -
Improve apperance
Continued--gt
8. Dietary/Nutritionist Consultation with family
(read Ingredients)
30
9. Dont develop a bias just because of Consumers
appearance(ie Over weight) -Encourage job
possibility and Positive Factors
Top Ten Jobs
Clerical
Fitness Center (front desk)
Food Preparation
Health Food Store
Floral Arrangment
Intake Workers
Computers
Custodial
Cook-Hospital
Nursery
Top Ten Jobs
31
Pain

• Unpleasant Experience associated with Tissue
  Damage or Disease

AcuteUsually short duration with well defined
cause
Chronic6 months or Longer
Recucurring Acute ie. Arthritis - Tumors

• Estimated 75 million plus Americans have Chronic
  pain

40 million recurring Headaches
15 million Low Back Pain
100s of thousands cancer
20 million arthritis

• Disability Payments 10 times faster then the
  growth of the US Population

Back injury Well over a Billion yearly in
Disabilty Funds

• Problems

Political
Medical
Continued--gt
Economical
Humanitarian
Rehabilitation
32

• Presentations will vary Significantly

• Decreased level of Activity

• Abuse of Medication (selective inactivity)

• Excessive Over Utilization of Health Resources

• Mental Status Change Depression in 70 of Cases

• Work Disability and Vocational Maladjustment

33
Traits in Pain Patients
1. Some may exaggerate pain - Some endure the
pain- Look at pre morbid life style and
personality traits
2. High levels of pain often result in frequent
body change of position, irritation and possible
depression
3. The family of Pain victims is also impacted by
condition
4. Some people develop a pain identity that often
gets reinforced
5. Some consumers have additional tolerance to
pain medication
6. Cognitive decreases often co-exist with pain -
due to medication or the effect of pain on the
consumers functioning
7.Substance Abuse or self medication may also be
a variable
8.Consumers show a decline in physical activity-
Which may lead to other negative health problems
Continued--gt
34
9.Secondary gain may be a factor impacting
motivation or empowerment
10.Pain related disablities often result in
consumer placing school or extended training
above a more available job placement
35
Recs for consumers with Pain
1. Have all medication and psychological records
available to review - use Consultants from
medical field if necessary
2. Be aware of possible legal (ie. workers comp)
or ongoing litigation which may impact motivation
or outcome
3. Look for signs of pain medicine tolorance or
abuse
4. Be aware of co existing physical conditions or
substance abuse or other problems
5. Recommend - pain management or alternative
methods to cope or aleviate pain- ie.
(accupuncture, hypnosis, biofeedback)
6.Determine the acual motivation for seeking
help- is the consumer serious about pursuing
modified job placement options
7.Assess transferable skills for alternative non
physically demanding or pain inducing job options
Continued--gt
8.Be very observant of physical signs of pain in
consumer - estimate degree of time consumer can
work
36
9.Review background- is this a pattern or does
the consumer have good work history?
Top Ten Jobs
Self employment (crafts)
Computer (modified)
Telephone
Temp fill in
Clerical (with breaks)
Light duty driving
Light duty schd.
In home cook
Cashier
Elderly care
Top Ten Jobs
37
Thyroid
Hyper-May cause heart disturbance, insomnia,
severe anxiety
Thyroid is in front of neck below larynx-It
regulates metabolism
Greek word shield
Pituitary gland secretes hormone that stimulates
thyroid (TSH)
1 to 4 of Population has moderate to severe
hypothyroid condition
10 to 12 of Population has mild hypothyroid
condition.
Advanced age increases rate of hypothyroid more
frequently in women
Most common past cause of hypothyroid Iodine
deficiency
T gland adds Iodine to Amino Acid Thyrosine to
create hormones
Iodine added to table salt - 1924 - Michigan
population had 47 Thyroid problems before this
Goiter 200 million world wide
Certain foods block iodine utilization
goitrogens including turnips, cabbage, mustard,
soybeans, peanuts, pine nuts
Hashimotos disease (most common form)
Antibodies are formed that bind to the Thyroid
and prevent manufacture of sufficient levels of
thyroid hormones
Continued--gt
38
Symptoms often seen in Thyroid Conditions Sensitiv
ity to Cold - Tissue swelling found in hyper/hypo
active thyroid
Higher Cholesterol (Triglyceride) Risk of
Cardiovascular Disease
Irregular heavy periods
Nails thin and brittle
Brain sensitive to low thyroid hormone levels
First symptoms Depression, Weakness, Fatigue
Late signs Difficulty concentrating
Joint Stifness
Treatment Desiccated Thyroid or Synthetic
Thyroid supplement
39
Traits periodically seen in VR Consumer/ Thyroid
Conditions
1. Hypo- If poorly controlled - Overweight,
Sluggish, Neck swelling, Often Depressed, Bulging
eyes, sensitivity to cold
2. Hyper - If poorly controlled Thin - Anxious -
Paranoid almost might suspect amphetamine abuse
3. If Un-DX - May be treated for alternative
Physical Condition
4. Freq Job change and problems with co
workers/supervision
5. Often left alone, divorced, may develop
physical or psychological problems
6. Frequent cases seen on Reservation or in rural
areas-Often VR Consumers may have lived near
Uranium mines
7.Often can not loose weight in spite of diet and
exercise
8.May miss a lot of work due to energy decline or
changes in motivation 9.Mood Swings/Cognitive
Changes
Continued--gt
40
Recommendations -VR Consumers with Thyroid
Conditions

• Ongoing monitoring of blood THS levels
• Encourage med/diet compliance-Avoid
  etoh/cigs/caff.
• Use transferrable skills from previous low stress
  jobs
• Avoid Physically demanding work/exposure to x
  rays
• Rec-Supportive counseling if emotional changes
• Involve family/educate re. symptoms/treatment
• If employed-use Employee Assistance programs
• Encourage exercise and stamina building-ie.Exercis
  e stimulates thyroid gland secretions and
  increases tissue sensitivity to thyroid hormones

41
TOP 10 JOBS-THYROID CONDITIONS

• 1.Dog/Pet Groomer
• 2.Floral Arranger
• 3.Cake Decorator
• 4.Secretarial
• 5.Driving Jobs
• 6.Maintence Man
• 7.Hotel/Motel Clerk
• 8.Teacher (Elementary)
• 9.Self Employed-ie.Office Cleaning
• 10.Plumbing/Trades

42
Acquired Immunodeficiency Syndrome (Aids)
Discovered by Scientists in 1983
HIV Human Immunodeficiency Virus Lowers Body
Immune System
ARC AIDs Related Complex Tired, Night
Sweats, Weight Loss, Yeast Infections
AIDs caused by infection with Human
Immunodeficiency Virus
HIV does not kill --it cripples the Immune System
Person may die from severe infections or cancer
1.Pneumonia
CD4 (Helper Lymphocye) Count is less then 200
cells per micro-leiter
2. Kaposis Sarcoma - cancer of the blood vessel
walls
CD8 ( of helper cells) to total Lymphocytes -
less then 14
3.Meningitis
Vectors Sexual - Needles - Blood Transfusions
Continued--gt
43
HIV is not a Death Sentence but is very serious
United Nations estimate over 40 million
worldwide living with AIDs
USA - AIDs of Cumulative cases to the year 2000
765,559 442,882 Died
AIDs - .3 or 2,337 Native Americans
Trend is going up in the minority Populations
AIDs Dementia Complex (ADC) - Neurological
effect of brain inflammation in one third of AIDs
patients
Memory loss - Dementia loss of cog functioning
and possible destruction of neurons density- 40
lower then non AIDs cases
44
AIDS VR Consumer Traits
1. Usually Reserved - Quiet - Uncomfortable
2. Possible Family Conflicts - Breech of
Confidentiality
3. Low Physical Stamina -Frequently Tired
4. Unable to Continue at Previous Job but may try
to stay at it
5. Usually a Lack of Education related to the
Condition but Basic Treatment is Maintained
6. Quiet, Often Isolated, and Depressed, Out of
Place - Limited Support
7.Many are Gay and maintain lifestyle but others
are Heterosexuals-- All must deal with Stigma and
Gossip
8.Marriage strained - Family divided
9.Often will Relocate back to the Res when
diagnosed but then will Re-Relocate when support
falters
10.Concurrent concern over substance abuse and
reckless or risky behaviors or impulsivity in
some cases
45
Recs for AIDs VR Consumers
1. Feasibly Issue with Supervisors needs to be
reconciled -possibly with medical consultation
2.Can present job be modified or is not suitable
given dianosis ?
3.Find support group- treat priorities with
Confidentiality - Does Consumer feel comfortable
with it - ie. AIDs- Sponser ?
4.Determine the level of family acceptance, is it
genuine or problematic?
5.Employ Traditional Healing Services - try to
avoid placing in a job that requires Health
Dept., Food Prep, ect.
6.Consult a Nutritionist for possible Diet
Modification
7.Consider Mental Health issues including fear,
depression, anxiety,frustration, etc.
8.Use alternative sources for rehabilitation- ie.
immune building, healing services, Prayer,
imagery,etc. 9.Insist on Medical Compliance with
Treatments
Continued--gt
46
Top Ten Jobs
Acountant
Drivers
Law /Professional
Factory - Assembly
Administrative
Sales
Secretarial
Self employment
Arts- Creative
Casino jobs
Top Ten Jobs
47
Arm/Hand or Shoulder InjuryINTRODUCTION
Brachial Plexus Injury(Nerve damage
muscles-skin of arm) resulting inPain andlimited
movement use of arm
Compartment SyndromeArterial Compression
Reduction of blood supplySwelling and restricted
movement with possible severe painwhich could
cause permanent contractive deformity of the hand
Carpal Tunnel SyndromeDisorder of the wrist and
handCompression of the median nerve causing
tingling, numbness, and painwhich could radiate
to forearm and or shouldersDecreases in Strength
and Dexterity
48
Elbow Joint InjuryCarpenters ElbowOveruse/Arthri
tic changes /pain
Claw handExtreme Flexion/Hyperextension caused
by Atrophy of Muscles
ArthritisInflamation of joints swelling pain
OsteoarthritisNon inflammitory joints degenerate
- loss of cartillage,development of bone spurs
Rheumatiod ArthritisChronic inflamatory
deformaty/ collagen disease - swelling joints /
pain
49
Hand-Arm-Shoulder Injury Traits In VR Consumers
1. Often seen in trades, labor, secretarial and
cashier jobs
2.Chronic pain may be evident with concurrent
irritation-headaches stress, depression,and
discomfort
3.May be taking pain medication to excess
resulting in additional problems ie (emotional or
behavioral)
4.Rehab plan may be interupted due to a pending
surgery - medical consults - etc
5.Confusion over doctors prognosis, release for
work, workers compensation involvement,appointment
dates, etc.
6.Uncertain regarding alternative work or
training options
7.Often will be in denial and will pursue
previous jobs in spite of injury and functional
limits
8.Unaware of compounding problems such as
arthritis, restricted ROM (Range of Motion),med
side effects, etc.
Continued--gt
50
9.Secondary gain may be a concern (ie. impending
trial or settlement)
10.Schedule is thrown off - used to working hard
and usually has high work ethic making inactivity
more debilitating
51
Recommendations
1. Consider OTPT consultation/evaluation
2.Be aware of the impact of pain medication or
tolerance
3.Determine if concurrent substance abuse may be
present - given that trades often have drinking
as part of the life style
4.Determine if any court or legal settlements are
part of consumers immediate plans or in the near
future
5.Find out if workers compensation funding is
still on and will they assist with future
training monies
6.See if any braces, assistive devices or
additional medical procedures might help improve
functional capacity
7.Use wellness center - yoga - alternative
treatment methods if available
Continued--gt
8.Try to redirect to alternate job choices - use
vocational evaluation results for career change
planning
52
9.Investigate work site alternatives or
modification and other jobs within Consumers
previous company
Top Ten Jobs
1.Was Carpenter now Building Inspector 2.Was
Cashier now Store Manager Trainee 3.Was Plumber
now Job Bidder/Estimator 4.Was Roofer now
Insurance Estimator 5.Was Driver now
Dispatcher 6.Factory Worker (Assembly) now
Inventory Control 7.Was Postal Worker now
Administration /Job Hiring 8.Was Dealer/casino
now Self Employed Crafts Sales 9.Was Cocktail
Waitress now Therapist/Counselor 10.Was Fast Food
Worker now Nutrition Store Manager Trainee
53
Multiple Systems Breakdown
A combination of physical, emotional, sensory and
or cognitive problems/symptoms seen in an
individual VR consumer
The symptoms may be stable or progressive in
nature
Usually one condition starts the decline in
functioning and this is followed by additional
breakdowns or problems in unrelated or possibly
related systems
This MSB Condition is seen more frequently in
female VR consumers between the ages 30-55
54
Multi-Systems Conditions
Mental Health Condition
Back injury
weight gain
substance abuse
stamina drop
pain meds misuse
high cholesterol
depression - anger
high blood pressure
deconditioned
Carpal TS
Spinal injury
arthritis
Depression/anger
smoking/lung probs.
risk taker personality
anxiety
prone to infections
dependency
substance abuse
Lupus
arthritis
stomach pain
cancer / colon
obesity
55
One Actual MSB ConsumerFemale - age 40
Herniated Discs at L4-L5 level
Diabetic Condition
Possible Brain Cyst
Past ear infections - mind low freq hearing loss
Asthma
Dizzyness
Degenerative Knees
Arm pain/hand pain (multi joint pain)
Fatty liver with high cholesterol
Irritable bowel syndrome
Endometriosis
Depression
56
Traits seen in MSB Consumers

• Strong External (hand over) locus of control not
  internal

• Numerous medications and interactive effects

• Relationships strained or diminished - family
  problems

• Employment options often very very limited

• Lengthy pre-existing conditions limited job
  opportunities and possible job discrimination

• Helpless and often dependent, often seeking SSDI
  but, not always - many have strong work ethic

• Often, but not always progressive in nature
  leading to further decline and a concern over
  feasibility of services

• May be a systems user - may want lengthy
  unrealistic training provided by VR

• Usually middle age - often set in ways

Continued--gt

• Empowerment issues are often apparent

57
Recommendations for MSC
1. Evaluate and prioritize conditions and the
extent of restoration needed prior to development
of rehab plan/training
2.Medical Consultation and work releases are
needed
3.Are consumers priority plans compatible with
functional limitations or unrealistic? Is the job
restricted (ie.CDL) ?
4.Evaluate for hidden medication or substance
abuse problems
5.Determine level of motivation - consider
psychological evaluation
6.Are current secondary reinforcments maintaining
disabilities (ie. family treatment / injured
indentity)?
7.Find out if consumer is depending on benefits
and is willing to give them up
8.Determine if consumer has been to vocational
rehabilitation many times before and knows how to
use systems 9.Transportation may become an issue
with job placement
Continued--gt
58
Top Ten Jobs
Self Employed
Senior/respite care Worker
Transcription
Artist
Beautician
Jewelry
Dog grooming
Part time Secretarial
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