4
Medical and Psychosocial Aspects of Rehabilitation Counseling
Exam 2
DUE: THURSDAY, NOVEMBER 6, 1:55 PM
(will receive 5 extra credit points if turned in by 1:55 on November 4, 2003)
On my honor, I have neither given nor received unauthorized aid on this examination.
(Please print name, then sign)
Case Study #1
Sylvia is a 28-year-old loan officer who worked for a bank at the time of her injury. Raised in Mexico, she immigrated to the United States with her family when she was 16 years old. While in the US, she learned English and received an Associate of Art (AA) degree at the age of 20. She began working for the bank as a teller when she was 20 and had been promoted consistently during her 8 years of employment.
Bank teller involves lifting and carrying a maximum of 15 pounds, with repetitive lifting and carrying of 5-10 pounds. Sylvia performed the job standing or sitting, as the bank provided a stool for the tellers that wanted or needed to sit. Most of the tellers alternated sitting and standing throughout the work shift. It typically takes 6-12 months to learn this job. The bank promoted Sylvia consistently during her 8 years of employment. Her most recent position at the bank was loan officer.
Sylvia was injured in a car accident when delivering some loan documents to a bank customer. Following the injury, she was unconscious for 4 days.
When referred for vocational assessment approximately 8 months after the injury, Sylvia reported that she was not able to return to work. She suffered headaches on a daily basis and spent most of the day lying down, rarely watching television or reading, because both activities increased her headaches. Sylvia could not walk for long periods because of dizziness, fatigue, and back pain. Noise and large groups of people gave her headaches, so she avoided people. Her speech was slow, but appeared fluent; physical movements were slow and she frequently touched walls or furniture for balance when walking. A housekeeper was paid by the workers' compensation carrier to clean her house, but Sylvia had resumed responsibility for shopping and cooking.
Medical reports indicated that she had a light work restriction due to a back injury that was diagnosed 6 months after the original injury. The cognitive assessment conducted 6 months after the accident showed problems with concentration, memory, attention, and word retrieval. Physical therapy, speech pathology, and other ancillary services had ended before the referral for vocational rehabilitation. Sylvia had participated in biofeedback to reduce her headaches and provide pain control; she refused to take medication for pain.
On untimed multiple-choice academic tests, Sylvia had above average skills in vocabulary, reading, spelling, grammar, arithmetic operations, and problem-solving. Especially strong in mathematics, she reported liking working with numbers. However, she took approximately three times the average amount of time to complete these tests. After an hour of concentration, she would have a headache and terminate the testing. She had typing skills but could not tolerate the noise of a typewriter.
The rehabilitation counselor conducted a thorough job analysis of her job as a loan officer shortly after the vocational referral. As a loan officer, Sylvia examined, evaluated, authorized, or recommended approval of customer applications for lines or extension of lines of credit, commercial loans, and real estate loans. This involved reviewing the loan application for completeness, analyzing the applicant's financial status, credit, and property to determine the feasibility of granting the loan request. She interviewed applicants applying for loans to elicit information, prepared the loan request papers, and obtained related documents from applicants, such as blueprints and construction reports. The loan officer corresponded with the applicant or creditors to resolve questions regarding applications and investigated the applicant's background to verify credit and bank references. The applicants were then informed whether the loan requests had been approved or rejected. If the loan was accepted, the loan office completed the loan agreement. Sylvia prepared forms for forwarding to insuring agencies. The job involved supervising a loan assistant and a secretary.
The work of a loan officer at the bank involves lifting and carrying a maximum of 20 pounds with frequent lifting of paperwork. It is primarily a seated job and takes over 2 years to learn.
Data analysis was a major part of the job, and there were continual interruptions, multiple ongoing projects, and complex interactions with applicants and loan agencies. The job involves decision-making and analysis with no clear-cut guidelines or standards. There were stringent deadlines that had to be met in funding or approving loans. Sylvia's secretary reported that the telephone rang 3-4 times per hour, and each call involved a new problem or task. Prior to her injury, Sylvia frequently worked 10 hours per day. A general survey showed that most banks were as fast-paced and stressful as where Sylvia worked.
Sylvia frequently drove to people's homes and to lenders' offices. Although she was able to drive, she reported that she was frightened when driving because it was difficult to pay attention to the cars, the road, the lights, and where she was going. The counselor observed that she drove slower than the speed limit and tended to stop too far behind stop signs and traffic lights.
Questions
1. What are Sylvia's functional limitations as they relate to working as a loan officer?
2. How would you explain Sylvia's disability to the employer?
3. What accommodations can you recommend to Sylvia and her employer if she does return as a loan officer?
Case Study #2
You are employed at a community college as a counselor specializing in providing academic and career counseling for students with disabilities. One of your clients is a 20-year-old female student who wants to take vocational interest tests to confirm her occupational objective.
Jeannie has Type 1 diabetes and takes insulin twice a day. She has no complications or other health problems.
Her college major is police science and she wants to become a police officer. The interest testing confirms her vocational goal. Other interests, according to the testing results are nursing and teaching. In discussing this with Jeannie, she stated her primary interest is police work, and she sees no reason why she cannot pursue this as a career. The job description of a police officer follows.
A Police Officer I patrols an assigned beat on foot, using a motorcycle, or in a patrol car, to prevent crime or disturbances, and is responsible for arresting law offenders. Also, the officer is involved in controlling crowds and dispersing gatherings that become unruly or dangerous. Rendering first aid at accidents and investigating causes and results of accidents are part of the job duties. The officer will direct and reroute traffic around emergency situations. Part of the job involves issuing warnings and tickets to traffic violators and inspecting public establishments requiring licenses to insure compliance with rules and regulations. The work of a police officer involves medium level exertion and rotating shifts. Job demands vary daily and change continuously throughout any particular day. Environmental conditions include extremes of temperature, noise, and hazardous occurrences.
Questions
1. Is Jeannie's occupational goal realistic, taking her disability into consideration? Please discuss why or why not.
2. Jeannie wants to know more about diabetes and the possible future course of the disease. How would you respond to these questions?
3. What recommendations regarding possible accommodations would you give Jeannie if she decides to pursue a job as a Police Officer?
Case Study #3
Ricardo is a 22-year-old male who, while attempting to prime a carburetor with gasoline, had his shirt and coat catch fire. He suffered deep partial-thickness (2nd degree) and full-thickness (3rd degree) burns over 33% of his body. These burns involved his trunk from the waist up, both arms and hands, face, and neck. Treatment at a burn center required 3 months of hospitalization. Ricardo has contractures of his hands, elbows, and axillae. His facial features are deformed, and
there are contractures around the mouth, preventing full opening of the mouth. The physicians have kept his eyes closed to prevent the lids from scarring open. There is distortion of facial features, including the nose, which has been partially burned away. Fifty percent of his scalp has been burned causing baldness.
Ricardo was an apprentice baker prior to the injury and is married with one son, 3 years of age. He completed the 11th grade and a training program in baking. For the last month, he has been home from the hospital. There has just been a medical and vocational rehabilitation staff consultation with Ricardo, his wife, and child. Following careful interviews and assessment by all team members, the following problems are observed.
· Physical problems
· both eyes bandaged due to scar contractures of the upper and lower eyelids
· perioral scar contracture of the mouth
· deformity of the nose
· flexion contracture of the neck
· alopecia over 50% of the scalp
· scar contractures flexion of the interphalangeal joints of both hands, all digits
· first webspace contracture of both thumbs
· flexion contracture of both elbows
· contracture of both axillae, anterior and posterior
· Emotional problems
· anxiety and depression
· inability to sleep regularly
· impotence
· fears be will be unable to see when his eye bandages are removed
· concerns regarding inability to use his hands or return to work and earn a living
· inability to keep up with rent payments
· family seems more distant
· his son is frightened of him
· has had thoughts of suicide
The plastic and reconstructive surgeon has come up with a plan for surgical intervention. It is felt that after three surgical procedures, the top priority physical problems will be markedly improved.
Questions
1. What type(s) of employment would you recommend to Ricardo, assuming that he will have marked residual decreases in strength and range of motion of the hands and arms?
2. What would you tell an employer about Ricardo's disability?
3. What types of accommodations/assistive technology would you recommend to Ricardo to assist in the job(s) that you have suggested?
Case Study #4
James is a 29-year-old male oil refinery worker. Although he did not finish high school, he completed most of the 12th grade. His job title is oil-field equipment mechanic (petroleum production). The job involves installation, maintenance, and repair of oil well drilling machinery and equipment. He uses handtools and power tools, and reads diagrams and schematics. The job involves disassembly and reassembly of equipment, such as pumps, transmissions, and diesel engines, to make repairs. Occasionally, the mechanic does welding and soldering, as needed. All oil refinery mechanics run tests to insure the equipment is fully functional. This type of work takes 1-2 years to learn proficiently and involves occasional lifting of 50 pounds with repetitive lifting and carrying of 25 pounds. James has worked as an oil-field equipment mechanic for 6 years. Before this job, he worked in the construction field. The construction job is classified as a construction worker II. This work did not involve any skills and required lifting of up to 120 pounds occasionally and 75 pounds repetitively. The job responsibilities included loading and unloading of building materials, tools, and supplies. It also involved digging, spreading, and leveling dirt and gravel, using a pick and shovel. James held this job for 4 years.
In late 1988, James began to develop feelings of fatigue at work, especially when climbing the "cracking" towers at the oil refinery. Gradually, his fatigue worsened and his work performance began to decline. He never felt rested, even after a good night's sleep. His boss told him to "shape up" or he would be fired. In January of 1989, he noticed fatigue when climbing the towers at the refinery. Shortly after that, he started having night sweats. Finally, when he developed a dry cough and a fever of 102° F, he went to see a physician. The physician diagnosed pneumonia and admitted James to the hospital the same day.
James's pneumonia turned out to be caused by Pneumocystis carinii. His doctors became suspicious and ordered an HIV antibody test. He had a positive HIV antibody test and, on laboratory analysis, was severely immunodeficient. During his hospitalization, he had intermittent diarrhea; no cause was found. There was a loss of weight of about 30 pounds. Also, he developed CMV retinitis in the left eye, which left him with a 50% visual loss in that eye. He was hospitalized for a total of 6 weeks.
After 3 months of convalescence, James felt much better and wanted to return to work. He takes a short nap during the middle of the day, but feels he can work an 8-hour shift. The physician restricts him to a maximum of light duty work. He wants to return to his previous work because he thinks he is physically fit to do the work. He is very concerned and would like to return to work to support himself. He recently received a letter from the oil company terminating his employment.
Questions
1. What are the possible physical limitations associated with James's medical condition that can influence his rehabilitation potential?