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As an occupational therapist that is seven months pregnant, I am writing about this topic to bring awareness to employers and to other pregnant employees, the essential accommodations that should be considered and provided to working pregnant women. The literal pain in my butt that is shooting down my leg as I sit here typing away at my computer, is my reminder that accommodation is not just about an employer's responsibility to have a job waiting for the pregnant employee upon their return from maternity leave, but about providing administrative, environmental, and ergonomic supports to reduce her pregnancy symptoms while accommodating the physical and physiological changes that occur over those 9 months. The employer's goal should be to promote comfort and productivity as well as prevent musculoskeletal injuries from developing in their valued pregnant employee.


Pregnancy definitely morphs a women's body inside and out, so it is not surprising that there are changes to the musculoskeletal system that places us at risk of acquiring an musculoskeletal injury like carpal tunnel syndrome, low back pain, sciatica, pelvic girdle pain and many other pregnancy-related conditions (curses).


Healthy pregnant women gain on average 25 to 35 pounds, if they started off with a healthy BMI. However if the woman is overweight before pregnancy or gains more than the average weight during pregnancy, the stressors to the musculoskeletal system are increased. To complicate the risks there are also waves of hormonal and chemical changes that make us forget what "Normal" ever felt like. Here are some examples of how these changes impact our bodies:


Forces across weight bearing joints are increased.


Exaggerated lordosis (lumbar curve) of the lower back, forward flexion of the neck, and downward movement of the shoulders typically occur to compensate for the enlarged uterus and change in center of gravity. Stretching, weakness, and separation of abdominal muscles further impede neutral posture and place even more strain on muscles that support the spine.


Joint laxity in the anterior and posterior longitudinal ligaments of the lumbar spine creates more instability in the lumbar spine and can predispose to muscle strain.

There is widening and increased mobility of the sacroiliac joints and pubic symphysis of the pelvis in preparation for the fetus' passage through the birth canal.


A significant increase in the anterior tilt of the pelvis occurs, with increased use of hip extensor, abductor, and ankle plantar flexor muscles Stance is widened to maintain trunk movement.


Fluid retention can cause compression of certain vulnerable structures such as the median nerve in the wrists or the sciatic nerve in the lower back and legs.


Let's not forget about the well-known symptoms that affect most us as at some point in the pregnancy (or all the way through for other) like morning sickness, fatigue, difficulty concentrating and forgetfulness (Baby Brain).


With this cyclone of symptoms following us to work, extra supports are required to allow us to function and make it through the day as a productive employee. While application of sound ergonomic principles benefits all workers, the following actions can be considered when modifying a pregnant worker's job:


-Assign less physical tasks.
-Restrict lifting to 25 pounds or less.
-Adjust work (flexible scheduling, day shift rather than night shifts, etc.).
-Vary tasks to avoid static posture.
-Adjust height of work surfaces and chairs.
-Install foot rests.
-Limit standing to less than three hours per day.
-Offer shorter, more frequent breaks.
-Reduce the amount of work performed at heights.
-Provide more space for moving around.
-Remove obstacles in the work area, particularly those placed at lower levels.
-Promote safe lifting techniques.
-Provide a quiet space for taking breaks when headaches or nausea ensue.


Accommodations that have worked for me at my workplace include, taking stretching breaks many times throughout the day as muscle fatigue sets in, starting a walking routine at lunch to alleviate sore joints moving my keyboard lower to change the angle of my wrists and reduce the beginning signs of nerve compression, sitting on a supportive cushion to relieve coccyx pain.

Most workplaces have pregnancy accommodation guidelines built into their employee's manual or at least in the Policies and Procedures Binder tucked away in someone's office.  Many workplaces, however still do not have clear guidelines that focus on individual pregnancy accommodations, which is important to consider since each woman experiences pregnancy differently.       


The Canadian Human Rights Commission protects pregnant workers from discrimination and outlines the employer's obligations to accommodate us. If you believe you are being discriminated against at work visit the links below to read about your rights and the best practices for accommodating pregnant women. Canadian law puts a heavy fine on companies if they are found to have committed acts of pregnancy discrimination.


Share your pregnancy workplace accommodation nightmare or success story here to help other readers going through the "invasion of the body snatcher's" pregnancy experience.


Further Reading:






http://www.ehow.com/about_6601639_discrimination-pregnant-women-  workplace.html#ixzz1n2xhLBsM



Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access




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One of the issues that face Health and Safety Officers in the industrial workplace is balancing pressures from management or corporate office to reduce workplace injuries while not affecting production or taking workers off the shop floor. Here are some ways your Health and Safety folks can approach injury prevention without becoming a cog in the company wheel:


-Introduce a stretching program by recruiting a volunteer from each department to lead a stretching routine that can be conducted at the beginning of each shift. Remember that a simple warm up before stretching is more important than stretching alone, to get blood flowing and get muscles ready for the physical work.


-Provide “Manual Material Handling” or other courses in the proper use of body mechanics to the Supervisors, so they understand safer ways to do the work and will be able to identify when employees are using unsafe behaviours in their department.


-Introduce a “Safety Coach Program” that gives supervisors opportunity to demonstrate safe behaviour during the working shift and identify unsafe behaviour by giving out coach cards to employees with “Safe” and “Unsafe” labels.  If the employee demonstrates an unsafe behaviour, the supervisor demonstrates the safer alternative and checks in later to ensure the employee has adopted the new behaviour. Supervisors are encouraged to give out at least 5 cards a week which keeps them watching how the work is being done and employees receive incentives for exhibiting safe behaviour.


-If you can manage to justify the ROI of safety training on work hours to the decision makers, then getting a group off the floor for 45 minutes, providing “Introduction to Ergonomics” or “Safe Manual Material Handling” with demonstration and a practical component using the equipment they handle, will undoubtedly change some unsafe habits. Offering these sessions around the clock to accommodate all shifts is recommended. Groups of approximately 30 seem to work best.


-If there are too many barriers to getting workers off the floor and you are the one man/women safety show, ask for 5 minutes at the beginning of a shift, per department, for you to demonstrate 1-2 safety tips that will help keep the employees safe. Work through the facility 5 minutes at a time!


-Please don’t forget about your office staff. Even though the big cost of injuries comes from those that happen in the shop, musculoskeletal injuries in the office can creep up on people and land them a short term disability claim, which adds up! Provide an “Introduction to Office Ergonomics” workshop as a lunch and learn for the office staff to make them aware of how to set up their workstations and how to use their bodies to conduct their work safely.


-Be present in the shop and learn from the employee on how the work is done. You don’t want to be seen as the “Safety Police”, instead you want them to think of you as “Safety Support.” Don’t just walk around pointing out everything that is unsafe (hopefully you have already done this in your Risk/Hazard Analysis) but talk to employees and get their feedback about what is working and what seems unsafe to them, they will be more willing to volunteer information if you are not seen as “Them” in the us versus them all-to-common workplace culture.


-Brag about safety accomplishments to management or corporate office!  Let them know that your efforts are changing behaviours for the better. If you gain their support you are more likely to get their buy-in for introducing more training and the associated injury prevention cost savings.


-Share what works and what doesn’t with like businesses you know to get creative ideas so you are not reinventing the safety training wheel with each effort.


-Set yearly and quarterly safety training and assessment goals to use as outcome measures. It’s not just about statistics; it's about how you get there. Set the path for the training and assessments you would like to have completed, or like in any plan; if there are no goals, nothing happens!



Marnie Courage, OT Reg (MB)

Managing Director 

Enabling Access



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1. Be a "Positive Pat"
Research shows that having just one "Negative Nancy" or "Doug the Downer" in the bunch can affect the workplace culture negatively, and decrease the productivity of the working group. Try to keep a positive perspective even when your co-worker is pointing out, convincingly, all the potential headaches, complications and timewasters the new software program will bring with it. If you think, speak and behave with a positive attitude, the small stuff will roll off your back and you will lessen the health effects of stress that work life inevitably produces.

2.  Be a Contributor not a Contaminator

If you like Dr. Phil, you will relate to this one.  Phil has used the above phrase when referring to the actions of individuals in a relationship and I find it also applies to employee relations. As our co-workers know too well, there are often many things about our work to complain about. Complaining tends to keep us problem focused and perseverating on frustrating issues, contaminating the workplace. Try to spin the focus to finding solutions when faced with a problem at work, disagreement with a co-worker or boss and you can feel good about being part of the solution, being a contributor, instead of being a contaminator.  Avoid joining in on what seems like light hearted teasing or bullying  of co-workers, trash talking the boss and other contaminating behaviours.

3. Walk it off
With email being the primary mode of communication in the workplace, visiting your co-worker to share some important news or notifying your secretary that the photocopier is low on ink have been replaced by email notifications.  If your job requires you to sit for the majority of your day, you are burning less calories, compromising your circulation and assuming static positions that cause muscle fatigue and discomfort, more so than an employee who gets to stand or walk for some of their day. You can introduce a "Steps to Health" pedometer campaign that tracks the distance you walk in a day and will surely get people moving. You can make the resolution this year to include more walking in your workday, to leave your workstation at lunch, to get water of coffee, and to visit your co-workers to share information, and the will to walk just might spread.  

4. Become Ergonomically Inclined
Advocate to your Health and Safety Committee for an ergonomic education session for all employees to review the principles of ergonomics and to help you all with setting up your equipment and furniture and to apply healthier working behaviours. If your workplace does not have an internal ergonomics program or does not outsource ergonomic services, there is still much you can do to prevent musculoskeletal injuries and be more comfortable and productive as you work. There are many free references and checklists online to help you set up your workstation to improve the fit and function of your furniture.  Search "office ergonomics guidelines" to understand how to position your equipment and apply proper body mechanics to conduct your work in a healthy manner. You could then post the ergo information on your wellness bulletin board, so everyone benefits.

5. Improve Your Food For Thought
We know spikes in blood sugar and the corresponding drops between meals contribute to weight gain in people working sedentary jobs. We are supposed to eat smaller more frequently to stabilize blood sugar, but this task may be difficult to master with the conveniences of fast food.  Many people are not hungry first thing in the morning and skip breakfast, the meal that gets our metabolism engine started, just to get that extra 10 minutes of sleep and race to work. Often lunches are purchased in food courts, cafeterias and fast food restaurants, most offering high sugar and high fats in exchange for speedy service.  Snacks in vending machines are commonly filled with sugar, trans fats and quick burning foods that spike your blood sugar. Caffeine in coffee and soft drinks effect blood sugar the way eating sugar does and will spike your blood sugar level, dehydrate you and deprive you of the water your body needs to stay healthy. You can advocate for a water cooler next to the coffee maker to remind employees they have a healthy fluid choice, request healthier snacks in the vending machines, start a weekly "Healthy Plate Pot Luck Lunch", start a "Healthy Brown Baggers" lunch recipe club, keep healthy snacks at your workstation to prevent those lows mid-morning and mid-afternoon that nearly put us to sleep at our desks. Avoid sugary snack bars and choose high protein snacks likes nuts and cheese to keep you alert and feeling well.


Marnie Courage, OT Reg (MB)

Managing Director 

Enabling Access


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9-5 is dead. The office shackles are loosening. Gone are the days when employees were expected to exclusively be productive and get results within the four confining walls of “the office”.  There has been a clear shift in the last few decades in how companies manage their staff and the deliverables they expect to receive.


ROWE - Results Only Work Environment is a human resource management strategy wherein employees are paid for results (output) rather than the number of hours worked.  Many companies now allow employees to work from home or on the road, teleconference from wherever they may be, and report their sales numbers electronically, from Starbucks, the beach, or perhaps sitting in their pajamas at home. 


Changes within the office environment  have accompanied this contemporary, more flexible management style, which started with Hot Desking in the 80's and 90's and involves one desk shared between several people who use the desk at different times, and can also include the routing of voice and other messaging services to any location where the user is able to log in to their secure corporate network.


More Recently workplaces such as call centres, IT support companies, and online companies are switching to a more systematic and well controlled Hoteling Work Space environment. The system is intended for workplaces who have who have office based shift workers,  traveling sales reps, telecommuters, and employees who work mostly off site.  "Hoteling is a form of "alternative officing" which allows employees who travel on business or work flexible hours to reserve desk space at the employer's offices as needed, rather than maintaining a permanent work space there." This allows the employer to make more efficient use of office space and thus reduce costs.


With Hoteling, there is typically an electronic reservation system for available desk space, which can be accessed from any computer or mobile device. Visiting employees, sales employees on the road and other commuters are able to make a workstation reservation including the ergonomic accessories they require ahead of time while the office facilities personnel get the workstation set up with the accessories requested in place by the time the employee shows up to work.


David T. Wise wrote in the Los Angeles Business Journal. "Where the average ratio for office space is 250 square feet per person, hoteling space can be reduced to as little as 100 square feet per person."


Involving an ergonomic consultant is essential in creating healthy Hoteling working environments to ensure each employee is assessed for the appropriate fit of chair and set-up of computer accessories and input  devices.  Unlike Hot Desking where the workstation is set up for any user, these Hoteling workstations are set up for specific users, which makes better ergonomic sense when considering the health and wellness of the employees utilizing the system.


Of course as with any new trend, the online technology demands increase and as with this case, Hoteling software to manage the equipment set-up and the workstation reservations are booming.  You've got to love new working concepts that demand better attention to individualizing the working experience, meaning a better fit for the employee and better results for the employer.


Marnie Courage OT, Reg. (MB)

Managing Director

Enabling Access

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We all know that after a hard day of work, it feels great to put your feet up and relax! Whether you are sitting at a desk all day, standing at an assembly line, or non-stop walking stocking shelves, most people have sore feet by the end of their work shift, for different reasons.  


When you are on our feet for long periods of time, the balls of your feet, your heels or arches can ache due to the force exerted as you walk, especially if you are not wearing supportive shoes. For those who stand for long periods of time, circulation does not function as well as it does when walking and gravity causes forces to be directed down your spine, through your legs, and into your feet, while fluid drains down and accumulates in your ankles and feet, sometimes causing foot discomfort by the end of the day. Often we recommend using  Anti-Fatigue Mats for those who stand for the majority of thier work, to absorb some of the forces endured by the spine, legs and feet while standing.

If you are someone who sits for work, you might wonder why your feet might get sore when your chair is supposed to be doing the work that your legs would do in standing. The fact is gravity is still in effect when you are sitting and fluid will still drain into your lower legs and feet, making them feel swollen and potentially sore by the end of your workday. In addition, people are not generally taking adequate movement breaks in the day to encourage good circulation and to stretch out the calves and feet, that might cramp up while sitting.


Keep in mind, if your feet are not supported on the floor or footrest in sitting, the circulation under your thighs could be compromised, putting you at risk of blood clots and pinched nerves in the legs. If you have raised your chair to access your keyboard and mouse on the desk surface and your feet are dangling or you have them perched on the footing of your chair, then a foot rest is required to support the bottom of your feet in front of you with a 90 degree bend in the knee. If you can fit your hand easily under your thigh when using a foot rest, then the foot rest is too high and the forces of gravity are not distributed well over your seat pan, adding pressure to your low back.


Sometimes diseases that affect the entire body, such as heart disease, kidney or liver failure, can result in excess fluid build up (edema) that is often concentrated in the legs and feet, leading to swelling not only of the ankles but also of the feet and lower legs. This can also occur with obstruction of the venous system, as may occur with pregnacy and obesity. Diseases of the joints, such as arthritis, can also affect the joints of the ankle and foot, leading to swelling of the involved areas. Please check with your physician if you have any of the above symptoms and ensure your feet are supported on the floor or footrest, depending on the height setting of your chair.


Our bodies crave movement, so whether you sit or stand for the majority of your workday, you should include movement breaks with stretching your legs and feet, to improve circulation, get lymph moving and keep you comfortable at work.  


Marnie Courage, OT Reg(MB)

Managing Director

Enabling Access

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Now that most people are aware of office ergonomics, employer's obligations though legislation, have an ergonomics program or at least have invested in equipment from the 2000's, employees are able to freely identify risk factors at their workstations without fear of being labelled a "squeaky wheel".


The Return on Investment (ROI) for creating a workplace ergonomics program is obvious; reduced costs associated with injuries, decreased employee lost time and WCB rates, increased productivity and employee morale. What might not be as clear is whether it is better to hire an Ergonomist or train employees to conduct the ergonomic assessments in your workplace. Here are some considerations for you to keep in mind when at this crossroad:


Hiring an Ergonomist: Professional fees in Canada can range from $85-$150/hr  for a certified ergonomist/ergonomic specialist to conduct individual assessments. The Profession of Ergonomics is widely represented by several disciplines and choosing the right Ergonomic Consultant should include researching the consultants to find the right fit for your workplace.  You may want to choose an Ergonomists with a medical background like physiotherapists and occupational therapists  to accommodate employees with medical issues and disabilities. Occupational Therapists also treat clients with Mental Health issues, which is a great skill set to have when looking at workplace issues that might affect the employee's health including stress and production deadlines.


An office ergonomic assessment report usually takes about an hour and the report may take longer. The report should outline all the ergonomic risk factors and provide recommendations in the areas of administration, engineering and behaviour. These professionals should be keeping your suppliers and your budget in mind when making recommendations to allow for ease of implementation. Beware of Ergonomic Specialists that represent ergonomic product retailers, although it is unethical to recommend products they could benefit gains from, it does happen, so an independent consulting firm is a better choice for feature focused not brand focused recommendations.


A good Ergonomist stays in touch with best practices in ergonomics, ergonomic products and equipment features, so you can rest assured they have seen it all and have a solution for most everything they encounter. They can answer questions about products and  barriers you experience, so t your ergonomic issues are solved quickly and cost effectively.


If you are a large office of more than 50 people, you may find hiring an Ergonomist to conduct an ergonomic assessment for every employee that identifies a risk factor, could break your budget, both with professional fees and the cost of implementing the recommendations. You may choose to create a priority list of those employees needing assessments that you could approve as your budget allows.


Training Employees to be Assessors: If you are interested in saving money on professional fees you may want to invest in having one or two employees trained to be Ergonomic Assessors. They would obviously not have the expertise that a professional Ergonomist does, but they could learn to identify risk factors and solve ergonomic issues for their co-workers. Choose employees who are on your Workplace Safety and Health Committee or who are interested in the area of ergonomics, as it will be adding to their current job responsibilities and will require outside time researching ergonomic products and solutions.


You should research Ergonomic Assessor Training in your area to determine which company you will hire to train your employees and what your budget allows for. Often these courses are between $900-3000 so it's worth it to shop around. The training for office ergonomic assessors should be at least a full day that includes theory and guided practice so the participants can learn what information they need to collect, how to identify risk factors and how to solve those risks through administrative, engineering and behavioural changes. Ensure the instructor is a professional ergonomist so their expertise seeps into the veins of the participants. Ask about consultation fees for supporting the newly trained Ergonomic Assessors, so that if they need questions answered or help with a tough ergonomic scenario, the consultant is available to provide support with no hidden charges.


The advantage of training your employees to do the assessments is that you save on professional fees with every assessment, but remember the cost of the solutions will be the same, or more if your in-house assessors do not have the inside scoop on no or low cost solutions or where to get products or solutions for less. It is a good idea to send your in-house assessors for professional development workshops and training ongoing,  to make sure they are current with Ergonomic best practices.


Final thoughts on this are; Hiring an ergonomist to conduct hundreds of assessments may bust your budget, but if you hire one for the occasional assessment and to handle the assessments for employees with medical issues, you benefit from their ergonomic expertise, medical background, problem solving and product knowledge. Training employees to be Ergonomic Assessors saves on professional fees but solutions may cost more due to lack of experience,  no medical background modest product knowledge. If you are hiring a professional Ergonomist, ensure they do not represent ergonomic product brands, have good medical background and share references. If you are Training your employees to be Ergonomic Assessors, ensure the training company provides on-going support, and send them to workshops and additional training moving forward to assist them in keeping up with best practices.  


Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access





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As an employer, whether you conduct your ergonomic assessments in house or contract a professional ergonomic specialist to come in, you want to ensure that you are saving your time and money where possible, while still preventing costly work related injuries.


Unless your company is committed to a strong preventative ergonomic program and has budgeted for mass individual ergonomic assessments, you are probably not offering all of your 50 office staff ergonomic assessments. Instead, the compromise is usually reached by providing assessments in reaction to those employees who have identified an issue or the ergonomic risk factors are obvious.


In either case, you are addressing ergonomics in your workplace and you want to know that you money is being spent wisely. Each ergonomic assessment usually results in recommendations for repositioning equipment, teaching new work behaviour, adjusting furniture and in some cases it means purchasing new equipment or furniture. Often employers link ergonomic assessments with having to spend money, instead of looking at the long term savings the assessments bring, preventing injury claims, employee lost time and retraining, not to mention some assessments include no or very  low cost solutions.


An  Office Ergonomic  Survey is a great way to prioritize those employees who need their workstations assessed the most. It also can be used to screen your employees for those who might be at risk of developing a musculoskeletal injury and to prioritize those who are already dealing with these associated symptoms and may be incurring regular sick time due to their pain.


Resistance to these surveys comes from fear that these surveys will indeed identify many ergonomic risk factors that the employer will then have to spend money on to solve. It should be made clear that including  the employees in the process will instil loyalty, foster improved employee engagement and let  staff know that management does care about their health. You can expect a rise in complaints at the onset of any ergonomic program, as word spreads that the company may be willing to spend money on new furniture.  It's what I call the preschooler "I want a new ball too" phenomenon that strikes employees when they hear that their co-worker got a new chair, but the risk identifiers and complainers will settle down as the novelty wears off. The survey allows a starting spot for your ergonomic program focus, it does not promise anything, other than your attention to ergonomics in the workplace.


The survey can be customized for your current office equipment set up  and can include information about the workstation, the chairs, the equipment and the workflow, to generate answers that will help you in identifying the risk factors that need addressing and those employees most at risk.


The following is an example of a short survey I created for a company of 50 office employees, who wanted to offer assessments to their employees but budget limitations meant they couldn't do everyone's in the first year. Feel free to reformat and customize this survey to your workplace  ergonomic goals, so employees are engaged in the process, know you care and might even offer solutions you had not thought of to save money and prevent injuries at work!


Remember that the interpretation of this survey relies on the evaluator having knowledge of office ergonomic guidelines and you will want to include your safety officer, or ergonomics specialist. Please email me if you would like a copy of our ergonomics guidelines and tips sheet at marnie@enablingaccess.ca.


Marnie Courage, OT Reg.(MB)

Managing Driector 

Enabling Access


[Company Name] Ergonomic Survey

1. Do you have any of the following symptoms of pain or discomfort while sitting at your workstation?

   Numbness or tingling in legs or feet           yes        no

   Numbness or tingling in arms or hands    yes        no

   Pain or discomfort in neck or upper back   yes        no

   Pain or discomfort in low or mid back         yes        no

   Pain or discomfort in the arms or hands    yes        no


2. Do you find that your chair is comfortable   yes         no               If no:

    Is your chair adjustable in seat height and depth?                          yes      no

    Does your chair's back rest adjust in height and recline?              yes      no

    Are your arm rests adjustable in height and width ?                        yes      no

    Is your chair adjustable in seat height and depth?                           yes      no

    Are your feet flat on the floor or footrest?                                             yes      no


3.  If using the phone frequently, do you have a head set? yes      no


4. If using a built in  or external keyboard tray, are both mouse and keyboard positioned at the same level?        yes       no


5. With your keyboard and mouse both on the desk or keyboard tray are you able to position the tray or your chair height so that your elbows are bent at 90 degrees?     yes       no


6. With a monitor stand, phone books or built in monitor height adjustability, are you able to adjust your monitor height so you are viewing the top 1/3 of the screen when looking straight ahead?         yes      no 


Other ergonomic concerns or possible solutiosn to risk factors in your work area:

____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

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After attending a session on "Ergonomics In Health Care" and discussing injury prevention initiatives by hospitals and long term care facilities, I was struck by how much money, and effort goes into these government and privately funded programs to ensure the safety of the Health Care employees.


Patient lifting and handling  training has been around for years is in integral part of protecting nurses and other hospital staff from MSI's, and most places do a great job of offering the training regularly to reduce employee injures and lost time. With the shift to e-health from paper charting, it is not surprising  that we are now seeing a rise in upper extremity MSI's due to nurses and medical staff using the portable computer stations in the hallways and nursing stations.

 With computer related injuries on the rise in hospitals,  I can't help wonder how small community based disability serving health care companies like private home care, respite , residential agencies, day programs and employment support programs are dealing with this challenge.  For these agencies, generally they have by law a Workplace Safety & Health Committee or maybe only one WPSH rep, but  they usually can't afford consultation from a professional ergonomist or hire can hire a safety officer or have resources to pull together an ergonomics committee. So, I'm left thinking that other than regular lifting and transferring training, these high risk employees and their office staff may not be addressing all the ergonomic risk factors in their jobs, especially if using computers have become an essential function in their work day.


There are many online  office ergonomics guidelines as well as patient lifting and handling guidelines available for community agencies to use and adapt for their specific business. My hope is that these companies will apply the principals of office ergonomics when buying furniture and equipment for their office staff, accommodating injured workers,  and make computer ergonomics as big of a priority as the patient lifting and handling, in reducing the MSI's related to caring for people with disabilities in the community.  Because of the large sample populations in hospitals,  there are many studies about computer related MSI, but I have yet to find a study about computer related injuries in community health care, due to the variety of settings and nature of work.


I have been discussing the need for more ergonomic training with community health care agencies and will be bringing these groups  together in Winnipeg , Spring 2012 for a two day "Improving Ergonomics in Community Health Care"- A Workshop  for caregivers and managers,  that will include a trade show of disability and ergonomic related products, a half day Client Lifting and Handling Certification Training , a half day of Office Ergonomics Training, and a full day of breakout sessions dealing with topics related to protecting employees from injury from pre-employment to return to work, following an injury. If you would like to take part in this initiative or would like to share resources with other community health care companies, please submit your name and email and I will add you to the network.


Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access 


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Often production demands in Industrial workplaces ebb and flow. When they flow, employers may have to bring in more man power to quickly meet the rising demand for product. Many Industrial workplaces struggle with trying to find the right people for the job, when bulk hires are required.  HR reps can be challenged with first finding enough suitable applicants to interview and offer positions to, hoping they meet the skills and abilities criteria.


According to Statistics Canada, Manufacturing Companies have the highest work related injuries among industries, with Manitoba having the highest in the country. In addition, Injuries usually occur within the first 6 months of employment, putting these new hires at risk of injury, lost time and disability. Finding the right people for the job involves more than just interviewing folks with the appropriate work experience and skills; it also includes ensuring these potential new hires can manage the physical demands of the job.


Post-offer Pre-placement Testing (POPPT) is an objective process to ensure the potential worker has the physical capabilities to perform the job.  It is a proven method for screening potential new hires that have been given a conditional offer of employment, while securing the employment is dependent of the passing of a customized test, which includes simulation or actual carrying out of the essential job tasks.


Usually testing is administered for only the most physically demanding jobs, or jobs with the highest rates of injuries. The testing has to be administered to all applicants, as testing only those who you suspect may not be able to do the physical tasks, is discrimination according to ADA.  A policy should be developed to outline those identified positions that testing will be conducted for, as well as outline if Fit For Duty Testing will be done every 2, 5, or other specified year period, to ensure current employees are still able to safely do their work.  


Post Offer Pre-placement Testing assists the employer:


-during the hiring phase, by minimizing poor placement decisions, determining true level of function, compared to the job demands and ensuring the potential hires are able to safely conduct the work.
-with Fit For Duty Testing done regularly for identified positions to ensure employees are still able to safely conduct their jobs.
-when an employee has been injured, the level of disability compared to POPPT results can help determine entitlement by examining  level of function prior to the injury.
-in the rehabilitation process by knowing previous level of functioning.
-by Reducing Escalating Costs associated with injuries.
-by using best practices to keep up with changing labour legislative focus.
-to maintain a team of healthy workers supported by strong injury prevention initiatives.


A professional occupational therapist develops, conducts and scores the testing to ensure reliability and validity of the standardization for all testing. The pass/fail results are provided to the employer who is then responsible for communicating the results to the potential new hires. Between this Pre-employment testing, Work Safe Education and Orientation, and Ergonomic Assessments for new hires, your HR reps, Health and Safety Officers are truly embracing a preventative approach to protecting employees from costly injuries at work.



Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access




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Conducting ergonomic assessments for your in-house employees is most likely, by now, a straight forward process for both small and large companies. Either your company's ergonomic assessor conducts the assessments or you hire a professional ergonomic consultant to come in and solve the issues.


What about those employees who are working in other cities or rural areas, where your ergonomic team does not travel and sending out a professional consultant is financially prohibitive? Unfortunately, often these folks do not get the responsive ergonomic services that their "closer to home" coworkers do.


After interviewing some local companies, it seems that company ergonomics are not always equally accessible to all, and this leaves those employees outside of the geographical "ergozone" at greater risk for injury, and the employer at greater risk of incurring big costs related to workplace injuries.


Even some national and international  companies who have made significant investments in their sound ergonomic programs, have overlooked the ergonomic safety of their employees who are working out in the field, those working in small towns, rural communities and especially the remote workers who have minimal connection with the hub of the company located in the major centres.


Having Job Demands Analysis (JDA's)  and Safe Work procedures in place, are a great start in the prevention of injuries for these remote employees, but early intervention is the best tool for preventing signs of discomfort and pain from morphing onto costly disability claims and lost time.


Virtual Ergonomic Assessments may be the key to the fast response, early intervention ergonomic service, these remote employees require. Videoconferencing is a great way to solve ergonomic issues but is only practical if the equipment supports are in place in the remote areas. The good news is that if the employee has access to a computer and the internet they will have access to a virtual ergonomic assessment. These can take place in a variety of formats, from sharing digital photos and video, troubleshooting through email or downloadable forms, to using Skype and other online tools.


The ergonomic assessor simply requires a visual of the workstation set up or work being done, some anthropometrics (measurements of the body), equipment measurements and an idea of the essential job demands being conducted to solve many ergonomic issues and offer recommendations for behavioural, administrative and engineering changes.     


Ergonomics should be accessible to all and not cost an arm or a leg.....literally.



Marnie Courage, OT Reg(MB)

Managing Director

Enabling Access

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After posting my last blog on Challenging the Validity of a Doctor's Note and providing recommendations for employers, I had many discussions with corporate clients about how they deal with Employees who bring in a note saying "light duties only" or something equally as vague.


The best practise solution came from one of my manufacturing clients who shared with me a simple tool that helps them sort through what to do with the doctor's note that provides no details of what the employee can actually do. When an employee brings in any doctor's note about limitations in ability to work at full capacity, they immediately provide the employee with a Medical Evaluation Report Form, which is a one page form including specifics on Employee abilities/limitations, that they are to bring to their physician to fill out.


Unfortunately the form was not as specific as I would like, if I were the employer who has to accommodate the injured employee. I took a look online to compare this form with other Medical Forms and decided to create a form based on relevant information from a few of these. My revised form makes it easier for the physician to give the employer the qualitative information they require when accommodating the injured worker.


The first part of the form asks the physician to fill in complaint/prognosis information and asks them to check boxes as they apply, regarding specifics about modified duties, how long they will not be fit for regular duties, etc. There are 6 scenarios the doc can choose from. Here are two of those statements that require action:


"This employee is able to return to MODIFIED DUTIES for ____days and then: ____return to regular duties OR ____reassess."

"This employee is not fit to return to any work activity for a period of ____days."


The main chunk of the form deals with specifics regarding employee abilities and includes lifting, positional demands, category of work (sedentary, light, medium, heavy), and manual dexterity including these statements, that require a check if they apply:


___Can lift up to shoulder height ___

___Can lift up to ____lbs from waist to shoulders

___Able to Work extended hours


The last section outlines clear restrictions regarding lifting, position demands and repetitive activities, so there is no room for interpretation and includes statements like: 


___No kneeling ___No bending

___Limited reaching ___Limited pushing


Finally the physician AND employee need to sign the form and return to the employer. As a clinician, this form filled out would give me all the information I would need to effectively put the modified duties or return to work plan in action. It also provides me with great information, should a Functional Capacity Evaluation be required.


If your workplace is using a strong Medical Evaluation Report and you would like to share it with me, I will collect them and make revisions to the form I am working on and then I will post the update revised Medical Report Form as a resource for employers dealing with this issue. It is time we share best practices strategies to ensure the safety of the employees and to guide HR decision making.



Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access



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By now most companies have ergonomics on their radar and have at least added the topic to the WPSH committee meeting agendas. Others have been nudged into paying more attention to ergonomics by government WPSH orders or penalty fees, following injuries and subsequent WCB claims. 


I have assisted companies who pride themselves in having sound ergonomic programs, having Safe Work procedures in place and policies that elicit quick responses to reports of pain, injury, and identified risk factors, as well as investing in administrative and engineering changes to solve the issues. Although off to a great start, they are reactionary in their methods and their injury statistics do not reflect a decreasing trend in injuries, most likely due to a lack of prevention in their focus.


Safe Work policies alone do not prevent musculoskeletal injuries, as they are job specific and not employee specific. Many ergonomic risk factors are individual in nature and warrant an individual ergonomic assessment to best match the environment to the worker. Providing ergonomic assessments for newly hired employees can prevent future injuries and therefore save the employer costs they incur responding to injuries.                       

Leaders in Health and Safety have taken their ergonomic prevention procedures a step further by including an ergonomic education session in the orientation of new hires along with the WHIMS and Safe Work Procedure training, to create a sound prevention program.


We know the risk of MSI is high in the first six months of being on the job, so spending loads of time and energy finding the right person for the job, might prove less than fruitful without ergonomic prevention measures in place. OK, so I'm sure you see the value in this type of prevention method, but how do you get your HR and Health and Safety Reps to get on board and put the plan in action? 



Marnie Courage, O.T.Reg(MB)

Owner/Managing Director

Enabling Access


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Developing a Critical Job Inventory (CJI) is an important task in creating an effective Injury Prevention Program at your workplace. The following is a Safe Work guideline to developing your CJI :


1. Develop a system for identifying critical jobs:


Review specific tasks conducted by occupations. If you have a large workplace, start by identifying the departments within your workplace. Identify the different occupations within those departments. List the jobs or tasks within each one of the occupational groups. 


  • Review the equipment used at the workplace. Multiple jobs or tasks may be performed with one piece of equipment. Remember to look at set up, calibration, changing blades and equipment operation for examples.


  • Review the statistics you have on file, accident/injury records, first aid books, etc. These will guide you to jobs or tasks that you may have overlooked. What were the injured workers doing when they were hurt? Did you capture this jon or task in the inventory?

Review new jobs or infrequently performed jobs. When a new job is introduced into your workplace, make sure you evaluate it and add it to your critical job inventory. It is important that this process does not stop. It is also important that jobs or tasks that are infrequently done are included and are high on the priority list to develop safe work procedures. These jobs must include a clear procedure so that when workers are to perform then, they are familiar with the safe way to do it.


2. Evaluate your critical jobs. Examine the degree of risk. Factors that you will take into account include:


  • Severity-what would the extent of the worker's injuries be if they were hurt while performing this job? Would the injuries be permanent? Would the injuries cause any time off?


  • Probability-what is the likelihood of the worker being injured when doing the job? Would it be probable in time? Remotely possible?


  • Frequency-how often is the job performed? How many workers would be exposed to the hazards associated with the job?


3. Create a CJI. Your CJI must include the job description and priority so that you can develop Job Hazard Analysis and Safe Work Procedures for the most critical tasks. You then have a plan of action for the remainder of the jobs on your CJI. Things to include on your CJI:


  • The date the inventory was done (this should be removed at a minimum every three years along with your program)
  • The department the job is conducted in and the manager or supervisor responsible for the area


  • The occupation that conducts the job


  • The critical rating or priority rating that you have assigned to the job after your evaluation or risk assessment.

Knowing the jobs is the most valuable action you can take towards reducing costs associated with injuries in the workplace. You will need good job descriptions for each job, which are easily compiled with an occupational therapist conducting a Job Demands Analysis (JDA) on jobs listed on your CJI, with prioritization given to those jobs with the highest risk ratings. The JDA will outline and measure all of the physical and cognitive demands of the job, making it easy to draft good job descriptions and help you better match employees to the jobs, at the time of hire.


Please let me know if this post has been helpful.  I would like to hear your comments. 



Marnie Courage

Owner|Managing Director

Enabling Access




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As an occupational therapist, conducting office ergonomic assessments, I have come across many employees who are unable to position themselves ergonomically, because their body shape prevents them from assuming the positons, we are recommending.


In ergonomics, we typically set up people at their workstation so their elbows are at their sides bent at 90 degrees to access the keyboard and mouse, which are positioned in midline, either on the desk surface or on a keyboard tray. This positioning allows the employee to relax their shoulders and have their forearms supported on the arm rests of their chair while they type and mouse, while preventing reaching.


For employees who are "full-figured", and carry their weight in their stomachs and chest, keeping their elbows at their sides while typing and mousing becomes an impossible task. Instead, these folks have to reach around their larger chests or middles to access the keyboard and mouse which are certain to be positioned farther away from them, then their thinner coworkers, placing them at greater risk of musculoskeletal injury. 


Here's why:


  • Reaching forward activates the muscles of the upper back and shoulders. These muscles work hard to sustain the forward reaching and eventually fatigue, resulting in discomfort and pain. By about 2 pm, these folks are wishing they had a personal assistant who is also a massage therapist. 


  • To get their hands in typing position in midline, they have to assume ulnar deviation at the wrist (awkward posture) which creates stress on the wrists, discomfort and pain along the outside boarder of the hands and sensitive underside of the wrists. 


  • With time, repetitive strain can develop in the wrists and without rest, change in position or treatment, the employee may become disabled and unable to work.




  • Purchase a split keyboard to allow the wrists to access the keyboard in a neutral position, preventing the ulnar deviation. There are many brands of these available.
  • Separate the two keyboard panels so they are positioned in line with the arm rests of the chair, away from midline to allow the forearms to be positioned on the armrests while typing, if possible.


  • Position the split keyboard close to the front edge of the desk to prevent reaching forward.


  • It is important for the employee to take Movement Breaks, Stretch throughout the day, as well as drink lots of water.


Just so you know, skinny folks also have other ergonomic challenges, so do tall folks, and so do short folks...so who's left? The point here is that we want to get people working as comfortable as possible, with the least amount of stress to the body. Guidelines for ergonomic positioning are just that, guidelines. Ergonomics is about fitting the environment to the individual, and if this helps to reduce someone's pain, then we all are headed down the right path! What's your ergo issue? 



Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access


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When we think about bathroom safety those of us around in the 80’s think about the elderly and the TV commercial for LifeCall where the older woman is lying on the bathroom floor and calls out “Help, I’ve fallen and I can’t get up!”. It’s true the elderly are intrinsically more at risk of bathroom falls than the younger, stronger generation who have better balance and righting reactions, but the environmental risk factors that send our parents to the hospital with a broken hip are the same for us and could land us on our keisters calling out those memorable 8 words.


According to Public Health Agency of Canada, “One third of community-dwelling Canadian seniors experience one fall each year and half of those will fall more than once. The likelihood of dying from a fall-related injury increases with age; among seniors, 20% of deaths related to injury can be traced back to a fall. Nearly half of all injuries among seniors occur at home. The bathroom and stairs are particularly hazardous due to the risk of slipping, tripping and stumbling.”


You can use these tips to make your bathroom safe for anyone to use, at any age:

1. Prepare all supplies in or near the shower or bath before you bathe. For example, lay the towel on the toilet or stool close to the shower or tub so you don’t have to lean out of the tub and reach up to the towel rack which may be more than an arm’s reach away.

2. Remove any loose mats on the floor as they present a trip hazard. Instead use only a mat with grippy backing to step onto out of the bath.

3. Remove rubber bath mats in the tub as they present a trip hazard and instead use adhesive no slip decals on the bottom of the tub.

4. Remove sliding glass doors into tub and replace with shower curtain and rod for full access to the tub.

5. The highest risk for falling happens as you step into the tub and all weight is on one foot. To prevent having to step into the shower, consider using a bath chair or bench so you sit on the chair and then swivel and lift your legs into the tub one at a time. Bath chairs can eliminate all falls that occur in standing. Reserve bathing on the bottom of the tub for those achy body days or when you need an at home spa treatment.

6. Install a hand held shower head so you can access it when sitting on the bath chair and have it hanging down before you get into the tub so you don’t have to stand to access it once in the tub.

7. Do not use towel racks as grab bars as they are not designed to withstand our body weight. If you or someone in your home is using the towel rack or facecloth bar for support, remove and replace with a grab bar designed for bathroom safety and ensure installation meets safety standards.

8. Try siting on the toilet or stool to dry off and eliminate standing and lifting up one leg to dry when wet and slippery.


We are not too young to be safe in the bathroom and teaching our kids these tricks will create safe behaviors and prevent injuries from occurring at home.

Grab Bar Guidelines



Marnie Courage, Reg. O.T. (MB)

Managing Director

Enabling Access



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For people with stroke, spinal cord injuries, amputation, obesity and other conditions, the development of a pressure ulcer could be the beginning of a downward health spiral that could lead to death.  As I was teaching this topic to university students studying Occupational Therapy, the need for community education for care givers became clear. In posting these risk factors I hope to share some basic info that will get caregivers thinking about what they could do to prevent this serious health issue.


Typically these ulcers originate when folks with limited mobility maintain static positions in their wheelchair or bed without relief. Sufficient pressure (either in duration or intensity) can alter blood flow compressing capillaries and depleting the skin and structures beneath of oxygen and essential nutrients. Metabolic wastes accumulate and the vascular and lymphatic systems are unable to evacuate them. As the tissues begin to die and inflammation occurs, infection and subsequently more cells die. The result is a pressure ulcer, defined as "any lesion caused by unrelieved pressure resulting in damage of underlying tissue." 1


Most people think that this breakdown starts at the skin surface, when in fact pressure ulcers typically develop at the subcutaneous level (muscle or bone). As pressure is translated through tissues to the bone the measure of pressure intensity may be significantly higher and the amount of external pressure required to prevent oxygenation is much less over the bone than over muscle. Common areas on the body which are prone to pressure ulcers from sitting are locations with boney prominences such as under the buttocks, the low back, shoulder blades.  From lying in bed the heels, ankles, back, shoulders, elbows and hips.


Although healthcare professions are trained to spot the initial signs of pressure ulcer development, they are not with the disabled  person day to day and the lack of education provided to caregivers and family is what sends these folks to the hospital with stage 3 or 4 ulcers because risks factors went unknown and undetected.  The following are a list of 10 common pressure ulcer risk factors:


1. Perpendicular Pressure - Direct point pressure will ultimately result in compromised circulation and cell death. This is usually the result of inadequate pressure management either in intensity or duration.


2. Parallel Pressure (Shear) - When the body slides across a surface and friction is in effect, usually the result of improper positioning, movement or non-uniform pressure distribution.


3. Moisture - At the body surface can be due to incontinence, perspiration; insufficient drying after bathing which all can create friction and magnify the risk of shear.


4. Friction - Caused by repetitive movements, sliding transfers, spasticity, agitation, over high friction surfaces can result in the damage to superficial skin causing mild burn.


5. Increased Age - With normal aging there is a general atrophy of soft tissue such as fat and muscle, which normally acts as a protective cushioning barrier to external pressure.


6.Decreased Sensory Perception - Due to nervous system impairment impedes the person from receiving cues to change position.


7. Impaired Mobility - A person who is unable to physically reposition themselves. 


8. Decreased Mental Status - A person who has an impaired responsiveness to their environment.


9. Circulation Impairment - blood vessels that are structurally compromised are more likely to become occluded due to pressure, shear and resulting tissue ischemia.


10. Poor Nutrition - Decrease nutritional status can result in weight loss and loss of protective soft tissue. Decrease protein intake as well as Vitamin C, impairs collagen formation.


Early signs of pressure ulcers include any areas of redness after exposure to pressure, hardening of the skin, bogginess and increased skin temperature at the suspected area. If caught early worsening of these pressure ulcers can be prevented. Knowing the risk factors and learning about prevention strategies could make the difference in saving someone from the deadly infections that often show up with aggressive pressure ulcers.


For more information on the prevention of pressure ulcers visit http://www.preventpressureulcers.ca



Marnie Courage, OT reg (MB)

Managing Director

Enabling Access



1.Bergstrom,N.,Bennett,M.A.,&Carlson,Ce.E. (1994). Clinical practice guideline: Pressure ulcer treatment


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There is a growing demand for Life Care Planning or "Future Cost of Care Analysis" as we refer to it in Canada.  A life care plan is defined as “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health needs" (International Academy of Life Care Planners, 2002, Standards of Practice. Journal of Life Care Planning.1 (1), 49-57) The cost of these documents varies based on geographic location and the experience of the Life Care Planner. In Canada you can anticipate costs on average to run anywhere from 20-60 hours of billable time for a catastrophic injury at anywhere from $90-150/hr. An even higher rate is typical for court appearances.      


Life Care Plans are prepared by many disciplines including Nurses, Physiotherapists, Occupational Therapists, Kinesiologists, and more. There is now a certification for Life Care Planners, and companies are popping up everywhere dedicated to providing this service exclusively. Typically, these Life Care Plans are required for judicial/forensic use when determining compensatory damages and assisting the court in assessing the disability. They are also prepared for clinical use as a cost effective case management tool to help clients prevent future injuries, and they provide details how the plan can be implemented - a road map of the future for the individual and family. Insurance companies also request these Life Care Plans for making decisions regarding optimal allocations of resources for the client.


The Life Care Plan is usually required for individuals with catastrophic Injury (Brain Injury, Spinal Cord Injury, Amputation, Low Vision, Burns, Multiple Orthopedic Injuries, etc).  When sourcing out professionals to conduct the Life Care Plan, ensure that the approach used by the Life Care Planner is neither Plaintiff Oriented or Defense Oriented, and instead is "Needs based" to ensure a fair and defendable product. All recommendations should maximize the individual's level of independence and ability to participate in society, and prevent functional deterioration and medical complications.


If you, or someone you know has filed a personal injury claim or if you are a case manager or lawyer who deals with catastrophic injury cases, knowing what you get from a Future Cost of Care Report or Life Care Plan is essential in ensuring that the best interests of the client are being addressed. If possible, hiring a Life Care Planner who resides in the same city as the client will save you money as they will have good knowledge of local resources for the client, looking down the road at rehabilitation, housing, personal care supports and more. These reports need to be defendable in court and you don't want to have the Life Care Planner questioned about availability and quality of resources in an unfamiliar community.


Choosing an occupational therapist who provides rehabilitation services to catastrophic injured clients will give you peace of mind, knowing they have the practical knowledge of physical and mental rehabilitative needs for these clients.  Remember, the final product is not just a document, but you are also paying for the author to potentially appear in court, be professional, fair and be able to articulate well the defense of that document regardless of being on the plaintiff or defendant side of the courthouse.



Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access




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I am writing this blog using Windows Voice Recognition software on my laptop, to demonstrate just one of the accommodations I have had to make following a recent injury.  I am having some frustration with traditional typing due to a Scaphoid fracture in my wrist, which I sustained a couple of weeks ago when I fell getting into a boat, at our family’s cottage near Kenora, Ontario.


A fractured wrist is a temporary impairment resulting in a mild disability.  The injury occurred as I was attempting to assist a badly burned man into our boat to get him to the ambulance that was waiting for us on the mainland.  This man had barely escaped a fire which had destroyed the cottage he was staying at, and took the life of his friend who didn’t get out.  The cause of the fire is still undetermined and the man we helped suffered severe smoke inhalation, 3rd degree burns, and major lacerations from breaking a window to escape. He is still in critical condition in an induced coma. This tragedy has taught me many things, and has offered me a gift I can’t ignore.


I’ve been struggling with reliving the sequence of events, the sights, smells and other sensations I experienced during the event, trying to process if there was more we could have done.  My husband assures me that we gave the man we helped the best chance of survival.  Luckily, one of our neighbours is a paramedic and his wife is a nurse.  Together, the four of us cared for this injured man and got him to the ambulance as fast as we could, keeping in mind it was pitch black at 4 am, with no moon and we were on an island 20 minutes from mainland.  Although I did not know the man I helped, I feel connected to him and I am fearfully anticipating the tremendous journey he has before him, should he survive his critical status in a U.S. burn center.


I have worked with people living with disabilities since I was a teenager. As an occupational therapist for the past 11 years, I feel like I’ve been an empathetic therapist, understanding the needs and pain of my clients and how their impairments affect their lives on a daily basis.  I also thought that I was doing a good job assisting clients with mental health issues like depression, post-traumatic stress disorder and grief, return to work and to their previous level of function, following accidents and injury.


By witnessing the fire, loss of life and suffering, my eyes have been opened to the horrors one must feel after living through a traumatic event. The cast on my left arm is a constant reminder that life is precious and it can be taken from us, in just minutes.  I also see it as a call to action, prompting me to share with others, that we all have a responsibility to be prepared and have a plan in place in case of emergency, as it may prove to save a life.


Although my injury is not life changing, it has made me aware of the difficulties people living with disabilities encounter on a daily basis.  Having to only use one hand for all of my activities of daily living, although frustrating, is a minor inconvenience when compared to the barriers people living with more involved disabilities face each day. Tasks that I took for granted like getting dressed, cutting my food, driving, and using my computer, have become difficult and require that I modify how I conduct them. For folks who have been impacted by injuries or diseases that render these basic tasks impossible, I am truly empathetic and will be more compassionate and patient, moving forward.


I just returned from travelling to another city and had to explain what had happened to me to many curious people I met throughout the week.  I had a short script prepared explaining, “ I slipped and fell into a boat” so I didn’t have to relive the event over and over again.  It makes me wonder how people with profound disabilities deal with curious observers, feel about the second looks, and also what scripts they have prepared for the inevitable questions.


Even as someone who works with people who live with a variety of disabilities, it took a tragic event for me to finally understand and appreciate fully what people may be going through after experiencing loss, illness or injury. Although I don’t want people to go through a similar experience, I do hope we can all dig a bit deeper in our hearts and minds to image what our clients, our neighbours, or strangers may be going through. We can each advocate, donate or make changes in our lives to prevent injuries, and to remove barriers in our homes and workplaces to make our communities more accessible for people living with mental or physical disabilities.


Please share this link. It might save someone you know.  http://www.foca.on.ca/Fire-Safety



Marnie Courage

Managing Director

Enabling Access


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Work Hardening in the rehabilitation world has widely been used to assist people with regaining physical capabilities in efforts to return them back to work, following injury or illness. We are seeing more and more people suffering from mental health issues, either as a result of having to live with their physical disability or from injuring or ending someone else’s life.


Rehabilitative treatment for clients who are physically injured may involve Work Hardening in a clinic setting to improve strength, coordination, endurance and pain tolerance, with their simulated job tasks. Often clients make good improvements in this type of intensive treatment program. Unfortunately, once they complete the program some folks still have difficulty returning to work, due to their mental health status.


Symptoms of depression, anxiety and anger are common barriers to successful Return to Work experiences. In these cases, clients are usually sent for psychological consult, to determine if regular treatment sessions are warranted. After much time, many beneficial sessions and several attempts of returning to work, we still see these clients struggling to work at the capacity they did prior to their accidents.


Cognitive Work Hardening is like the physical Work Hardening we see in the clinic, but it is conducted by an occupational therapist who works closely with the client in their place of work. The goal of Cognitive Work Hardening is to walk with the client, through their daily tasks, evaluating potential challenges, barriers and triggers that may result in exacerbating their symptoms of depression, anxiety, anger or other emotional distress.


In Cognitive Work Hardening, we can assist our clients by providing strategies for managing work flow, simplifying processes, dealing with coworkers, providing recommendations for clustering  like-energy tasks,  incorporating mental breaks, thought blocking, self-talk, and much more. The common goal is to increase productivity, motivation, confidence and reduce emotional pain and non-productive thinking that stems from emotional distress.


Just because the accident or incident that caused the client to be off work is in the past, doesn’t mean it's not presently running through that client’s mind several times a day. It takes both Body and Mind to heal from injury or loss and we should make sure we are treating both in our rehabilitative programs.



Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access



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Even after practicing occupational therapy in Canada for 11 years, I still have a hard time defining what I do in one sentence. The profession of Occupational Therapy (OT) has been around since the First World War, as we provided wives of husbands, who were off at war, the skills to make them employable in previously male dominated industries. We also assisted the injured soldiers with relearning their "activities of daily living" (a term adopted by the profession to describe all tasks related to self-care, productivity and leisure).


Since then, the profession, which has grown worldwide, includes rehabilitative therapy for people living with disability throughout the lifespan, from infancy to death. OT's can specialize in a variety of practice areas including the treatment of clients with Mental Health conditions, orthopaedic injuries, spinal cord and brain injuries, the science of Ergonomics and the effects on people, acute hand injury intervention, neonatal care and much more. Through education and skill building we teach injury prevention techniques at work and home, which many companies and groups are benefiting from.


Most Canadian OT's are now graduating from a Master’s Program in schools of Medical Rehabilitation within the faculty of Medicine, along with other allied health professionals, such as physiotherapists. Our academic credibility is supported by the vast amount of research that comes from the profession of many hats, making strong contributions to the medical research community. For more information about the profession, please visit the Canadian Association of Occupational Therapy at http://www.caot.ca


It might seem surprising that most insurance companies do not recognize OT as a basic insurable service, as they do with Massage Therapists, Physiotherapists, Chiropractors and other allied health professionals. Some insurance companies have included OT in their extended health packages, but often these limit coverage to one visit per year or the equivalent in maximum limits. The Canadian Association of Occupational Therapists have been fighting the battle for many years to get the recognition we deserve in the eyes of the insurance companies, with only minimal success.


In speaking with insurance companies locally, it is clear that their members are not asking for the services OT's provide, unless they have a family member with a disability or they themselves have been injured. Unfortunately, like any other insurance coverage, you many only see the value in it following a loss, like house insurance if your house burns down. These insurance companies only include services the majority of their members are requesting they cover.


We need to do a better job, at least in Canada, to educate people about how occupational therapy can help people following an injury, medical diagnoses, or in later life when the physical changes with aging affect mobility and independence. People need to start requesting that their insurance providers cover the services that they or their family member may urgently need one day. We also need to do a better job of marketing the profession. You have seen commercials for Physiotherapy and Chiropractors, but have you ever seen a commercial about Occupational Therapy? Instead of blaming my association for not putting enough resources into marketing and advocating our profession, I am doing my part to spread the word.  OT's are building skills for living, and its time everyone knew what we do and how we can help them.


Here is my best stab at a one sentence definition of what an occupational therapist does: "Helping people to be as healthy and independent as possible in all areas of living, at home, work and play, throughout the lifespan." I would love to hear how you define what OT is or how it has helped you, a friend or family member. I will post a collection of definitions titled "What OT Means to Me" that can be used in our national campaign to have OT recognized by the majority of insurance companies as a basic insurable service.



Marnie Courage, OT Reg (OT)

Managing Director

Enabling Access






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