The Australian system which varies from state to state includes a number of points that you raised.
Generally the there is overall management by a doctor/consultant a physiotherapist is involved An occupational therapist is involved Adjustments are made to work demands usually by an occupational therapist Workplace risk is managed by independent rehab providers
Sometimes the rehab process is managed at the discretion of a GP.
The dilemma is that pain is another specialty altogether and there are a number of different types of pain e.g. neuropathic, central sensitisation, myofascial etc. Pain is often not managed well within this system and this can be when specialist pain clinics are involved.
The main difficulties I believe involve the co-ordination and choice of the various services to allow the best treatment for the patient. This is frequently limited by the funding which is provided by the insurance agent. The disruption of funding often means poor delivery of services or inappropriate timing.
These difficulties may be reduced by surveying the workers (this is probably already done within your system). This problem may also be addressed by surveying the therapists that treat the patients as they are at the coal face of the problem as they often negotiate between insurance agents, patients etc. I feel that this would identify the problems to a far more accurate degree and provide a much better insight into the problem. It may be worht your while pursuing a copy of the questionnare used.
This information could then be used to assist in aligning the insurance agents practise with the ethical values of the various Workcover systems. This might be achieved through performance based bonuses or penalties that could be applied to achieve the desired worker satisfaction outcome.
I feel that it would be a long bow to draw that following and initial medical check that management should be placed in the hands of an ergonomists. As discussed earlier there are many forms of pain. These different forms e.g. myofascial, central sensitisation etc all require different treatment regimes. The chronic pain group also has many other demands as a result of their condition e.g. depression, social needs, medication, psychological needs. These needs require balancing to achieve the best patient outcomes.
An initial assessment may not effectively identify the patient
There is also a bicycle trainer that is connected to a computer and program, so as example you can race the computer with simulated riders and environment on the screen. Being a computer I presume you could use it for other purposes as well.
Below are possible options that could be used in combination as appropriate include Platform steps approximately 1100mm square are much cheaper than ramps and allow the client to mount one step at a time more safely, run to the uphill side Non-slip surfacing Coluor contrasting non-slip edging on the steps Organise supervision Fit a bannister rail Lightweight walker, a lightweight three wheel walker if appropriate can be folded easily and easier to carry up the steps Use one walker inside and if possible leave one outside at the bottom of the steps
I think they have done predictions, but I have not got access to the data. The figures that I remember are that more people die as a result of mismanagement than as a result of motor vehicle accidents but this may be incorrect as it was a while ago. This is pretty scarey if you consider the varying laws re seat belts etc in the USA.
It is probably worth having a look at the stats on how many people die in the US as a result of car accidents and compare it against the figures for how many people die as a result of medical mismanagement. I cannot remember the exact figures but they were pretty scarey.
A well set-up support can be a positive or negative. They can also have the impact of holding the limb in a reltively fixed posture. If you have muscle wind-up occuring prior to the use of the support especialy around the shoulder you can end up with a locked shoulder as hand problems frequently have flow-on effects. (The chicken or the egg did your hand problem start from your hand or did it originate from your shoulder use whilst using your mouse etc) So it is worth your while encouraging movement as well as using the support. Feldenkrais and Alexander technique may also be of assitstance. I tend to believe that the use of multiple modalities at a number of points in the chain will have the greatest impact, if it is muscle related. These modalities vary with the individual person’s needs
There are a number of issues here. The track ball, use and impact on the body flow from the hand back up the arm to the shoulder girdle and beyond. Depending on the reason for the trigger thumb e.g. muscle spasm, damaged tendon/pulley within the thumb, other contributing factors or focal dystonia. If it is muscle spasm is it worth your while looking at the muscle stressors back up to the shoulder girdle and beyond. From the set-up point of view this would include all you standard office type ergonomics and alternating hands, you may wish to integrate this with myofascial techniques and maybe something like a back knobber which can be used to assist in unwinding muscle groups in your back. If you only look at the end result of the problem the impact will be minimal. There is a great book called anatomy trains which is of benefit in identifying muscle pattern use. If it is a dystonia based problem there are programs by Nancy Byl I have not utilised them and do not know there efficacy. One I have been interested in using with a dystonia is a program callled limb laterality by Lorrimer Mosely which is used for chronic pain which I feel could have uses with dystonia. The first question you need to ask is what is causing the trigger thumb?