Exam #1 2004



Medical and Psychosocial Aspects of Rehabilitation Counseling

Exam 1

DUE: TUESDAY, OCTOBER 12, 2004 1:55 PM

On my honor, I have neither given nor received unauthorized aid on this examination.

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Case Study #1

Joel is a 45-year-old construction worker. This job is heavy and typically considered unskilled work activity. Joel was a laborer and helper at various construction sites for the past 15 years. His primary job duties involved lifting and carrying of equipment and supplies, loading and unloading trucks, and assisting skilled construction workers. In helping the skilled construction workers (especially the carpenters), he acquired many of their skills. One could classify the last seven years of his work as a combination of unskilled and semiskilled work.

Joel is divorced and has 2 children, both living with their mother in the local area. He pays monthly child support. Joel completed the 10th grade; he received poor grades throughout school.

The injury occurred on the job while Joel was lifting heavy bags of cement. His diagnosis was a herniated disc in the lower lumbar region between L4 and L5 and between L5 and the sacrum. Two laminectomies were performed over a two-year period. It has been one year since the last surgical procedure.

Joel was drinking moderately at the time of the industrial injury. Since the injury, he has continued drinking and, in addition, is taking prescribed as well as non-prescription pain medication, including Valium.

Joel's treating physician restricts him to light work, including no repetitive bending, stooping, or kneeling. He should alternate sitting and standing/walking throughout the work shift. Standing is limited to 30-minute increments and sitting to a maximum of one hour at a time. He is able to alternate these activities throughout the day.

Joel's previous employer is willing to take him back to modified work, but needs help from a rehabilitation counselor. Concerns of the employer involve Joel's physical limitations, attitude, motivation, and possible substance abuse.

Joel is willing to see a rehabilitation counselor, but feels he can only do sedentary work activity. He states he no longer drinks and takes only medically prescribed drugs. It is his opinion that the employer may be suggesting a return to work to harass him.

Questions

1. Would you, as the rehabilitation counselor, attempt to return Joel to work with the previous employer? Justify your response with your knowledge of low back injuries in regards to medical aspects and vocational implications.

2. If Joel returned to his previous employer, what types of accommodations and modifications might be necessary?

3. If Joel does not return to his previous employer and secures a sedentary position as a receptionist in a local office building, what types of accommodations and modifications might be necessary?

Case Study #2

Cynthia is employed as a meter reader for the local utility company, Metropolitan Water and Power. The Dictionary of Occupational Titles (DOT) describes the position of meter reader as follows:

Reads electric, gas, water, or steam consumption meters and records volume used by residential and commercial consumers: Walks or drives truck over established route and takes readings of meter dials. Inspects meters and connections for defects, damage, and unauthorized connections. Indicates irregularities on forms for necessary action by servicing department. Verifies reading to locate abnormal consumption and records reason for fluctuations. Turns service off for nonpayment of charges in vacant premises, or on for new occupants. Collects bills in area. Returns route book to business office for billing purposes.

This job involves lifting a maximum of 15 pounds occasionally, with frequent lifting and carrying of 2-5 pounds. It typically takes 1-3 months to learn this job.

Cynthia has been employed by this company in the same capacity for 15 years. She recently has been experiencing diffuse pain that has caused her to miss days of work or be late for her route. The continued pain prompted her to see her doctor. Her primary care physician referred her to a neurologist who eventually made a diagnosis of fibromyalgia.

Questions

1. How would you explain fibromyalgia to Cynthia's employer?

2. What are Cynthia's potential vocational limitations in regards to her job as a meter reader?

3. What are some possible reasonable accommodations or assistive devices that would assist Cynthia to retain employment?

Case Study #3

Maria is a self-referral to the Department of Rehabilitation. She is a 49-year-old married Latina who works as a personal care aide for an elderly woman in the woman’s home. She holds a Bachelor of Arts degree in architecture from a university in South America and wishes to obtain more appropriate employment. Both of her children are grown and living independently.

At the age of 27, Maria developed a moderate to profound sensorineural hearing loss of unknown origin. The loss is permanent and not reversible or correctable by surgery. When she uses her hearing aids, her hearing is improved.

Maria relies on speech reading to communicate. The family speaks Spanish in the home. Her husband loses his temper with her because of her difficulty in dealing with the public. She speaks broken English with a very thick South American accent that is difficult to understand due to the nasality caused by her deafness. Maria stressed that her receptive English is much better than people realize. Her relatives seem to question her hearing loss because of inconsistencies as to what she can and cannot hear; she cannot explain why her hearing loss seems to fluctuate.

For 5 years, Maria was employed as a drafter in South America. She had a one-year job in drafting when she arrived in the US. Both jobs were performed primarily in a seated position with lifting and carrying of minimal weights up to a maximum of 10 pounds. More recent work experience has consisted of housecleaning, baby-sitting, and office cleaning. She stated she has difficulties working in a noisy environment – it gives her headaches. Maria is motivated to work in a position more commensurate with her training and background.

Questions

1. Describe Maria's possible functional limitations as related to a drafting position.

2. How would you describe Maria's disability to a potential employer?

3. What job modifications or accommodations/assistive technology would assist Maria in adjusting to a work environment?

Case Study #4

Chris is a 35-year-old female who has been recently diagnosed with osteoarthritis in her knees. She is currently an x-ray file clerk at a local hospital. Her daily duties include transporting x-rays to and from units, filing x-rays, and manning the phones at the front desk. This job is considered a light to medium-duty position.

Questions

1. How would you explain Chris's disability to her employer?

2. Do you recommend that Chris continue working as an x-ray file clerk? Please discuss why or why not.

3. If Chris remains as an x-ray file clerk, what accommodations would you recommend to her and her employer?

Case Study #5

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 #6

Joseph has hemophilia and is 18 years of age, single, and living with his parents in a small Midwest town. He recently graduated from high school, receiving average grades throughout his educational experience.

Described as a "loner," Joseph has one or two close friends and avoids large gatherings and most social events. Besides having hemophilia, Joseph is in good health and has no major complications of the disease. Occasionally, he will need to self-infuse, but has no problem doing this.

You have been assigned as his rehabilitation counselor. For the initial interview, his mother accompanied him and insisted on sitting in on the interview. Although she provided useful information, she did most of the talking and stated that she would attend all future appointments, as it is her opinion that, by attending these meetings, it will be in her son's best interest.

Joseph was hesitant about discussing his interests, although he appeared to enjoy repairing the family cars and doing minor mechanical and electrical repairs around the home. His mother was of the opinion these activities were potentially dangerous and needed to be avoided. She believed Joseph should attend the local community college and pursue a career in accounting, as her husband is an accountant. Joseph could "follow in his father's footsteps," in her opinion. Also, she believed Joseph should do sedentary work, needs to be in a protected environment, should not perform manual jobs, and may need time off work because of occasional "bleeds."

Joseph was of the opinion that this goal would be "OK," as he did not have any other ideas as to what to pursue. His mother insisted he be enrolled in the accounting program the following week as the next semester was starting in six weeks.

Questions

1. Discuss hemophilia in terms of the mother's opinion that Joseph needs to do sedentary work, stay away from manual jobs, be in a protected environment, and will need time off for occasional bleeding episodes.

2. How would you describe hemophilia and related vocational implications to an employer?

3. What recommendations would you give Joseph regarding reasonable accommodations if he decided to pursue employment in his interest area of automotive repair?

Case Study #7

Steve is a 56-year-old married male with one grown child. Although he did not complete the 11th grade, he received his GED. There is no additional school or training. He is co-owner, with one other partner, of a small, but highly successful company. By trade, Steve is an electrician and is a member of the local electrician's trade union.

The Dictionary of Occupational Titles classifies this job as telephone electrician. Steve and his partner install, test, and repair telephone and communication systems. They update and expand old equipment, install new computerized systems, and also wire burglar alarm devices and related equipment. Both partners are involved with repairing and restoring this electrical and electronic equipment. The work involves use of small handtools and testing devices, the ability to read schematics, and knowledge of electrical and electronic principles. Lifting and carrying on the job involves a maximum of 50 pounds, with repetitive lifting of up to 25 pounds.

Steve was in good physical and emotional health until he was diagnosed with prostate cancer. Steve and his oncologist decided to use the "watchful waiting" treatment to analyze the course of the cancer. One year later, he underwent surgery. Three months postoperatively, physicians felt he was disease-free with an excellent prognosis. The main functional limitations that Steve experiences are frequent urine leakage and erectile dysfunction. He was hesitant to return to work after surgery.

Questions

1. Do you think that Steve can return to his previous work as a telephone electrician? Please discuss why or why not?

2. If Steve decides to return to his job as a telephone electrician, what information can you give him and his business partner about the diagnosis of cancer and the probable course?

3. What possible accommodations can you recommend to Steve to assist him in returning to work as a telephone electrician?

Case Study #8

Ken is a 22-year-old who has completed an Associate Degree in Computer Science. He has recently been hired by a company to work in their IT department as a computer support specialist. His job duties include assisting staff with computer problems, training on various software packages, and maintaining the company's webpage.

Ken was diagnosed with Irritable Bowel Disease when he was 16 years old and the disease has steadily progressed since then. One month after obtaining employment, Ken had to have ostomy surgery that resulted in a permanent colostomy bag.

Questions

1. How would you explain Ken's disability to the employer?

2. What are Ken's possible functional limitations as a computer support specialist?

3. What accommodation recommendations would you give to Ken and his employer?

Case Study #9

Ronnie is a 35-year-old single male, who lived with his parents until they recently passed away. After their deaths, he inherited their home and now lives there by himself. Because of epilepsy and current seizures, Ronnie does not drive. Ronnie's social skills are underdeveloped as a result of living in such a protected environment for so many years. His reaction to the death of his parents was aggravated by the fact that he had developed no independent living skills.

Despite adherence to a medical regimen, Ronnie has complex partial seizures several times a month. He takes several doses of his anticonvulsant medication daily. Occasionally, he requires hospital visits in order for his physician to monitor medication level and make adjustments. Seizures consist of his wandering around, looking dazed and confused. During a seizure, he does respond to gentle coaxing without exhibiting any anger or aggression. The recovery after a seizure is rapid and he is able to return to his activities quickly.

Ronnie is somewhat paranoid, expecting problems before they occur, taking offense easily, and tending to blow negative personal encounters out of proportion. These characteristics and his lack of response to social cues make him somewhat difficult to deal with on a personal level.

Ronnie recently began work in the nursery of a large retail home and garden store (this store has 5 other locations throughout the city) as a Horticultural Worker II, where he is responsible for (a) planting, spraying, weeding, and watering plants, shrubs, and trees; (b) planting shrubs and plants in containers; (c) tying, bunching, wrapping, and packing flowers, plants, shrubs, and trees to fill orders; (d) assisting customers in choosing purchases and transporting the purchases to vehicles; (e) arranging and positioning plants and plant care products in order to artistically display them; and (f) occasionally acting as a runner, going for change from the front cash registers to fill the plant department registers. He has no problem with the physical aspects of the job, which involves hauling large bags of soil and plants (weighing up to 60 pounds). Working in the nursery requires little customer contact and there is no driving on the job.

Certain simple accommodations are required. You are a rehabilitation counselor working at a Department of Rehabilitation office. The employer has contacted you requesting information on epilepsy and advice about how to proceed with Ronnie if problems occur.

Questions

1. How would you describe epilepsy to the employer?

2. Describe Ronnie's possible functional limitations as related to his job.

3. What recommendations would you give Ronnie and his employer regarding reasonable accommodations/assistive technology to help him continue employment as a Horticultural Worker II?

Note: These case studies and questions were modified from the respective chapters in:

Brodwin, M. G., Tellez, F., & Brodwin, S. K. (Eds.). (1995). Medical, psychological and vocational aspects of disability. Athens, GA: Elliot & Fitzpatrick.

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