Medical Perspectives in Vocational Assessment of Impaired Workers.

Medical Perspectives in Vocational Assessment of impaired Workers

Scheer S, Steven J, eds. Gaithersburg, MD 20878, Aspen Publishers Inc, 1991, hardback, 449 pp, illus, $56.

This book is one of two volumes on perspectives for medical and vocational professionals in evaluating the work capacity of the worker with a disability.

The second volume, Multidisciplinary Perspectives in vocational Assessement of impaired Workers, was not reviewed. This volume on medical perspectives focuses on specific medical conditions such as amputation, neuromuscular disease, and cardiac impairment and offers for consideration both the limitations and capabilities for individuals with these conditions to return to work. The editors have written or contributed to 3 of the 15 chapters. The rest are written by health professionals including physicians, psychologists, physical therapists, occupational therapists, and speech pathologists, who, by virtue of their practice setting or credentials, have experience with the specific impairment. The first chapter addresses the physician's role in assessing vocational capacity. The World Health Organization (WHO) system for classifying disease consequences, including impairments, disabilities, and handicaps, is discussed. It is interesting to note that, as pointed out in a subsequent chapter on the law in vocational capacity assessment, the legal definitions of the terms impairment, disability, and handicap differ slightly from those popularized by the WHO. In this litigious age, this difference in semantics may be of importance for workers seeking disability compensation. The next 12 chapters are dedicated to vocational capacity in specific conditions, including impairment with low back pain; upper extremity conditions; arthritis; amputation; cognitive, neuromuscular, or communication impairment; psychiatric disability; substance abuse; epilepsy; and cardiac or respiratory conditions. The chapters are generally well written and are organized similarly, with discussion of the common pathologies, followed by assessment and vocational management, and finally conclusions or summary statements. Although most of the contributing authors addressed vocational capacity appropriately, several discussed pathology and testing measures in-depth, with scant attention paid to vocational assessment or return to work. Further differences among chapter authors are noted in that some chose to discuss the most common ailments in their category, whereas others gave a more thorough overview of the problems of the worker affected with the particular disability or impairment. The author of the chapter on neuromuscular impairment, for example, discusses the muscular dystrophies and multiple sclerosis with only mention of other neuromuscular diseases, whereas the author of chapter 3 gives a very thorough view of upper-extremity impairment and discusses testing and evaluation tools for return to work. The final chapter considers the law and medicine as they interface in assessing vocational capacity. Compensation packages are discussed, and pertinent laws dealing with the worker with a disability are mentioned. The author also includes a discussion of the possible forums for a health care worker testifying as an expert witness in legal cases. There is a glossary of terms included at the end of the book, and several chapters also index specific evaluation tools and tests that will aid the reader in understanding and utilizing the assessment measures. Illustrations are included in the chapters on low back pain, upper-extremity impairment, arthritis, and amputation. More helpful perhaps are the numerous tables found throughout the text. I found the tables in the chapters on amputation and cardiac impairment most helpful, as they listed the degree of involvement and predicted limitations for work capacity. Although this book will not be of great value to many general practitioners in acute care settings, I believe it would serve as a good resource for those health care workers involved in assessing the vocational rehabilitation potential and return-to-work status of their patients.

Elaine Filusch Betts, PhD, PT Medical Center Hospital of Vermont Burlington, Vt