solve how to manual

Getting Started with SOLVE (Company and Provider only)

ABOUT SOLVE ........................................................................................................................................................ 2

INTRODUCTION ..................................................................................................................................................... 2

THE SOLVE SYSTEM ................................................................................................................................................ 4

SOLVE ONLINE ....................................................................................................................................................... 5

SOLVE HOMEPAGE ......................................................................................................................................................... 5

ADMIN LOGIN SCREEN .................................................................................................................................................... 5

ADMINISTRATION SCREEN ................................................................................................................................................ 5

Company Tab ........................................................................................................................................................ 6

Survey Tab ............................................................................................................................................................. 6

Respondents Tab ................................................................................................................................................... 7

Report Tab............................................................................................................................................................. 8

SOLVE SURVEY ..................................................................................................................................................... 10

LOGGING ON THE SURVEY .............................................................................................................................................. 10

TAKING THE SURVEY ..................................................................................................................................................... 10

SOLVE SERVICES ................................................................................................................................................... 17

CONFIDENTIAL ALL COPYING & DISTRIBUTION PROHIBITED

ABOUT SOLVE

The purpose of SOLVE is simple SOLVE exists for the purpose of improving the performance and

SOLVE resolves emergent work problems before they become costly the kind of problems likely to erode profitability, productivity, quality, morale, job security, and peace-of-mind. Simple solutions require an understanding that surpasses complexity solutions based on science and experience, not theory and opinion, with deep understanding of human performance, biomechanics, Applied Functional Science, injury prevention, pathology, work environments, ergonomics, rehabilitation, training and conditioning. The SOLVE System represents the confluence of state-of-the-art internet technologies, two decades of global research and development in Applied Functional Science, and three decades of innovation in occupational health and ergonomics with companies ranging from local entrepreneurs to Fortune 500. SOLVE lives up to its name. For additional information visit www.SolveGlobal.com

INTRODUCTION Employers are constantly challenged by the demand to produce more goods and services, of better quality, for less cost, with greater profits in an environment of ever increasing global competition. Business has never been tougher; the stakes have never been higher; and the business environment less

disagree. We believe that, It is with that understanding that SOLVE brings value to the workplace. This is the context in which work and non-work related injuries and illnesses occur.

While the incidence of worker compensation cases have decreased over the last 3 decades the associated expenses have increased, particularly those that are medically related. The decrease in cases can be attributed primarily to the reduction of traumatic injuries due to better occupational safety requirements and programs. Today the focus and expense has shifted from traumatic injuries to cumulative trauma illnesses involving the arm, wrist, hand, back, and neck. Such conditions require new understandings, strategies, and tools that go beyond traditional occupational safety and health. Artificial divisions between work and non-work related health conditions are beginning to erode across many business sectors. This is driven by the reality that it is difficult to differentiate between conditions that are caused by work and those that are aggravated at work. When the additional liability of worker compensation indemnity (wage replacement) is considered, most employers are more than happy to have employees use group health benefits rather than worker compensation benefits. While such strategies have the potential to reduce indemnity costs, work related medical costs are still incurred and

ecognize that medical costs

Copyright 2001-2009 Performance Builders LLC All Rights Reserved. Used by SOLVE LLC with permission.

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for worker compensation cases exceed that of similar cases treated under group health benefits industry fact. Most employers have systems and resources to manage traditional safety issues those that cause traumatic injuries related to accidents. Traumatic injuries are relatively easy to manage. There is obvious cause and effect. There is a time and a place for the event that occurred. There are usually witnesses.

capacity is generally complete in about six weeks. Most traumatic injuries are resolved in a matter of weeks. Repetitive strain injuries/ cumulative trauma illnesses are different. Cause and effect are not usually obvious. There is no specific event with time and place. There are no witnesses. Injury is commonly not visible thus motivation, validity, and trust issues arise. Treatment may not begin for weeks or even months, meanwhile the condition worsens and may even spread within the body. Such conditions are persistent and often difficult to diagnose and treat. Thus, intervention is costly and too often disappointing. Employers are less well equipped to manage cumulative trauma / repetitive strain illnesses such as carpal tunnel, tendonitis, rotator cuff, back, and neck conditions that evolve gradually over time. Employers have occupational safety programs, accident reporting, and emergency response capabilities in place. Most, however, lack knowledge, resources, and systems in such matters and are financially at the mercy of healthcare providers who are prone to practice defensive medicine and who have limited expertise and experience in biomechanics, function, and ergonomics. As an example some 30% of medical imaging costs are the result of defensive medical practices. When it comes to workplace injury prevention Employers have a host of state and federal safety regulations, standards, and guidelines promulgated by state and federal Departments of Labor (DOL),

Council, and worker compensation insurers or Third Party Administrators (TPAs) to guide them. However, when it comes to cumulative trauma conditions most employers lack the systems and professionals to efficiently resolve them. Cumulative trauma conditions routinely cost tens of thousands of dollars in direct costs (medical and indemnity) per case. When indirect costs (lost time, labor replacement, training, legal, etc.) are considered the actual costs may run into the hundreds of thousands of dollars per case. The problem of work related cumulative trauma has been a growing problem for the past half century and continues to worsen as productivity demands, average worker age, and obesity increases and general health declines. Physical therapists have long provided treatment in worker compensation cases but most have been reluctant or ill prepared to tackle work related stressors in the workplace that cause them. That reluctance is usually rooted in the lack of familiarity with work related production processes, tools, environment, culture; and relevant strategy, experience, resources, business models necessary for intervention. There is a significant business opportunity for motivated Practices to differentiate their offerings to employers through the integration of biomechanics, chain reaction function, human performance, and

ergonomics what SOLVE calls Functionomics TM

. Practices have the opportunity to forge loyal relationships with employers, expand service offerings, and secure competitive advantage in a market segment that has considerable community influence and unregulated reimbursement. Relationships with employers often expand to other employers (follow-the-leader is big in business), group health


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insurance (worker and family), payers, and health providers. Business relationships with employers denote efficacy, credibility, integrity, and influence.

These training materials are intended to provide qualified professionals with the understandings and tools to prosper in a new and expanding market.

THE SOLVE SYSTEM

The SOLVE System consist of six elements:

1. Education for Providers and Employers 2. Internet tools 3. A qualified network of local SOLVE Providers 4. The SOLVE Survey 5. Interpretive Reports 6.

Comprehensive SOLVE training materials provide critical workshop information that business leaders need to understand in order to make informed decisions about their most important business challenges - keeping good people productive producing quality products and services at competitive prices. SOLVE is structured on a virtual business model. Business resources and tools are online. An independent Provider Network provides local marketing and client support. Expert SOLVE support professionals are never more than an online click away with email and video conference calling. The SOLVE Survey takes just a minute or so to complete online safe, secure, and confidential. The Survey collects insightful information from each worker about their personal performance and comfort at work. The responses are automatically aggregated, analyzed, and summarized in an interpretive report presented with priorities and recommendations.

Solve Surveys are conducted on a periodic basis - usually monthly. Survey access is also available to workers to report emergent problems on an ad hoc basis allowing for real time intervention. The SOLVE Survey is all about the early identification of emerging problems the kind that systematically erode performance and comfort over time and predictably result in costly cases involving medical intervention, worker compensation, and lost time expense. When appropriate SOLVE Network Providers deliver customized intervention services to employers and employees. Such services may include one-on-one interventions with employees and at-risk employee groups, regular onsite consultation/intervention services, and trusted offsite community based rehabilitation and conditioning services. The net result is seen in enhanced productivity, reduced risk, fewer recordable injuries/illnesses, lower premiums; less lost time, greater employee morale, and improved profitability. Every SOLVE engagement incorporates a proven system and responsive service for right-sized interventions and reliable results.

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SOLVE ONLINE

Key URLs: www.SolveGlobal.com | www.SolveGlobal.com/AdminLogin | http://solveglobal.com/batchentry

Solve Homepage

The SOLVE Homepage at www.SolveGlobal.com provides several functions:

1. A brief Welcome and Introduction to SOLVE (main text) 2.

navigation links). 3.

SURVEY and access to interactive report samples. No passwords are required, survey answers are not saved, and reports data is illustrative (i.e. not linked to the sample survey responses).

4. login screen for SOLVE Survey respondents. In actual usage, respondents will be taken directly to the login page via links in their email invitation from their employer.

5. 6. 7. Top and Footer navigation provides both redundant and supplemental links.

Providers. Client companies work through SOLVE Providers but do not access the Solve System directly. SOLVE Providers have access only to their companies. SOLVE has access to all companies. Admin Login Screen

It requires ID and Password and restricted to registered SOLVE Providers. Each SOLVE Provider will be issued a Username and Password by SOLVE. Providers can access only their own account. It is very important to protect IDs and Passwords to prevent unauthorized access to corporate clients, surveys, and data. SOLVE Providers must carefully limit and manage their SOLVE account access. SOLVE accepts no responsibility for misuse of login credentials by Providers. Administration Screen

Provides functionality for all administrative tasks pertaining to establishing and managing

s clients. Functionality is organized around 5 Menu items on the left side of the screen that are context sensitive (i.e. only shown when relevant). Select the appropriate Tabs to perform the desired administrative tasks:

1. Company Profile Register new client 4

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companies


2. Survey Schedule create and implement surveys and survey templates 3. Respondents Register qualified survey respondents 4. Reports Filter, review and download reports 5. Batch Entry

Company Tab

Captures demographic information about each company that participates in SOLVE Surveys.

drop down menu, in the left column, is used to add and delete companies or modify previously entered company data. The Company ID and Client Password is automatically generated by the SOLVE System. The company ID will be used by Respondents when logging in to take a Survey. The Client Password is used by the Provider when the batch file input option is used.

Industrial Classification System. Many companies will know their code otherwise it can be looked up online at http://www.census. gov/eos/www/naics/ or on other websites. This information will eventually provide confidential industry specific comparative performance data. The remaining demographic information on the Company Management Tab is self-explanatory. At the

Survey Tab Used to structure specific Surveys. The relevant company for which a Survey is being created is selected from the

companies that have been registered on the Company Management Tab will be listed. If the desired company is not shown in the Company List on the Survey Tab, it will first need to be entered on the Company Tab.

Two tasks are completed on the Survey Tab a new Survey can be created and existing

Survey can be modified. To modify a Survey, choose the appropriate Survey from the Survey List on the left side of the screen. Use the Save button to complete the task.

that will be used for the Survey choosing a descriptive name will add convenience.

month. Generally a 5 - 10 day period will be suitable. If the Survey is to be conducted less frequently than monthly, simply skip Respondent Notification for the months to be skipped.


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Anonymous or Confidential and is selected with the radio buttons. An Anonymous Survey is one in which the respondent is not identified with the response. Its use is appropriate when a profile of comfort and performance is desired without identification of individuals. It is useful when employees fear retribution, when a company is simply interested in accessing the magnitude of a potential problem, or when demonstrating the SOLVE Survey to a prospective client. A Confidential Survey is one in which the respondent by linking individual employee with specific Survey responses and identifying individual employees in reports. It is useful when there will be follow-up with specific individuals for the purpose of further accessing the complaint or providing intervention services. Respondents Tab Used to manage who is allowed to participate in the Survey. Use the Company and Survey List dropdown menus (left column) to select the desired completed or active Survey for viewing Respondent participation information and for preparing to upload new or updated Respondents for Surveys.

right table header) is used to import the list of approved Respondents the CSV file is created using the Excel spreadsheet downloaded from the Download Tab. The Respondent table lists

employees validated for the selected

Company and Survey. Employees

who have not yet responded to the

Survey are shown in Bold Red while

those who have completed the

Survey are shown in Green. The

color coded count of Open and

Completed Respondents appears

just above the table.

Three types of Surveys are possible Confidential (Validated), Anonymous (Non-validated), and Hybrid

(Validated Anonymous).

1. Validated Surveys limit participation to specific individuals who are prequalified/validated to

respond once to the Survey by logging in using their employee identification number (as stated

in the Excel file) as their password. Validated participants are determined by the company and

are identified by employee number, Name, and Groupings. Each employee can be associated

with up to three affinity Groupings for drill down filtering for data analysis and reporting (e.g.

building, position, shift, department, work team, etc). Within each Grouping, an unlimited

number of subgroups can be created (e.g. buildings 1-99). Groups are user defined. A list of

6 qualified participants is created using Microsoft Excel spreadsheet, downloadable from the

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Download Tab. It is recommended that the Employer enter the employee information in the


Excel spreadsheet the employer may be able to export their employee list to Excel to avoid the need for data entry of the individual names. The spreadsheet will accept up to 2500 employee names. It is important that the employee list begin on row 11 of the spreadsheet DO NOT LEAVE EMPTY ROW ABOIVE THE FIRST ENTRY! After the Excel file has been completed and saved

ocated in the gray box in the

all apostrophes, commas, and hyphens within the spreadsheet; and will only work if Macros have been enabled in Excel refer to Microsoft Help for instruction if needed. After punctuation

uploaded tRespondents heading. Each Validated Survey Respondent will be required to Login using their Company and Employee IDs. The validation process assures that only preapproved employees can respond and allows them to only respond one time. It also enables statistical tracking as to participation/response levels.

2. Non-validated Surveys eliminate the need to pre-qualify participants. Thus there is no validation

of participants and no employee Groupings are possible. Non-validated Surveys do not require the uploading of participant lists using the downloaded Excel spreadsheet as in the Validated Survey. Using a Non-validated Survey means that an individual could potential respond more than once to the Survey, that bogus data could be submitted, and that Grouping functionality cannot be identified within the data set. The benefit of non-validated Surveys is that it eliminates administrative work/time, assures absolute anonymity for respondents, and provides a simple and efficient way to offer Survey demonstrations. Non-validated Surveys do not require an employee ID at login.

3. A Hybrid Validation Survey is also possible. In such Surveys, the above instructions for the

Confidential (Validated) Survey should be followed. But, instead of each employee receiving a unique individual ID number, multiple employees from various groupings are all assigned the same ID Login. Doing so will allow data filtering by Groupings without identifying individual employees.

Report Tab UThere are three types of reports Survey Summary, Respondent Summary and the Trend Line Report. Report functionality provides the ability to filter responses by Groupings to facilitate analysis and the scope of reports. Multiple filtering iterations enable multiple reports to be created.

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The left column provides options to query the database and structure reports. The relevant data set is selected through the Company and Survey drop down menus on the left side of the screen and the selection of checkboxes in the Groups List. Each time a Grouping box is checked or unchecked, the report automatically recalculates.

option near the top of the Report Tab. The Respondent Summary and the Trend Report can also be filtered using the checkboxes in the left column to generate respondent lists who have participated in Confidential or Hybrid Surveys a respondent list is not available for Anonymous Surveys so that anonymity is protected. This report enables specific employees to be identified for confidential follow-up by the SOLVE Provider.

Both the Summary and Respondent Reports can be further customized and prioritized using the blue font column headers. The Index column is particularly useful when prioritizing the need for interventions amongst a large employee population. Summary Report

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SOLVE SURVEY

Logging on the Survey

The Survey Login can be accessed in any of three ways.

1. Click on the My Company Survey link in the left column of the SOLVE homepage. 2. Click on an Invitation Link placed embedded in an email sent directly to them by the company.

This method provides the benefit of being able to provide simple instructions/support to the recipient and eliminate the need to navigate to the Login screen.

3. Computers specifically for use in responding to the Survey can be setup within the worksite and set to display the Login screen. This again eliminates the need to navigate from the SOLVE homepage and is a good option for workers without internet access. This approach can be tweaked by providing an open welcome (MS-Word, notepad, etc.) with instructions and a link to the Survey LogIn screen.

The SOLVE LogIn Screen requires two ID codes to gain access to the Survey A Company ID and an Employee ID. It is important to provide employees with the appropriate ID information to prevent LogIn problems. LogIn IDs can be distributed by email or given to employees by other means. The Company ID may be found by the Provider at the top of the Company Tab in the Admin area. The Employee ID comes from the first column of the Excel Upload worksheet or the Respondents Tab in the Admin area once the CSV file has been uploaded. To begin taking the SOLVE Survey the employee simply enters their Company and Employee IDs and selecting Login or pressing the Enter key. If an Anonymous (un-validated) Survey is used, the Company ID and a single Universal Employee ID will be required. After Login, the respondent will be taken to the first Survey question.

Taking the Survey

The Survey takes just a minute or two to complete and requires minimal computer literacy i.e. simply use mouse to point and click. There are 8 questions/screens in the Survey. The first 7 questions provide check box or radio button responses; the last question invites additional unstructured comments.

Upon completion of each question the respondent clicks on the Next Button (lower right) to move on to

in the upper right of the screen they show the Respondents progress and selecting them will take the Respondent to the respective question if needed for corrections or changes.

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Question/Comments Screen shot 1. Do you experience problems of

physical discomfort or difficulty associated with your normal job activities?

question, they are taken to a transition screen that thanks them for their participation and the Survey is complete. If

advanced sequentially through the . remaining 7 questions.

This question has implications relative to employer/employee exposure to work related risk and expense related to lost productivity.

2. How long have you experienced your

problem?

There are 5 possible responses only one

can be selected. The time frames are

intended to be approximations appreciating

that many respondents will lack precision in

recalling actual unset of the problem. Each

time frame option has specific strategic

connotations associated with it.

2 weeks At 2 weeks most minor Note that circular response options (radio buttons) allow for

musculoskeletal (MS) strains and only one response square response options (check boxes)

sprains are normally well on their way allow multiple responses.

to resolution. Problems less than 2

weeks in duration warrant passive

monitoring and perhaps simple first aid

(ice, compression, NSAIDs and

avoidance of over exertion). Problems

10 remaining at 2 weeks warrant a brief

biomechanical assessment to rule out a

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serious condition and to assess the potential benefit of therapeutic intervention.

4 weeks At 4 weeks, most minor MS conditions are resolved. Those that are not should be evaluated and therapeutic intervention implemented to facilitate healing, reduce stressors, and prevent biomechanical compensatory complications.

6 weeks At 6 weeks all acute symptoms should be resolved. Remaining problems should receive evaluation and therapeutic intervention including rehabilitation as appropriate.

12 weeks At 12 weeks, rehabilitation should typically be complete and full normal function restored. Remaining problems may warrant outside consultations to assess potential complications and other factors.

>12 weeks Problems remaining longer than 12 weeks have higher potential for chronicity and associated long term impairment/disability and should be managed aggressively.

3. What is the primary physical activity

that seems to contribute to your problem?

This question seeks to identify the single most problematic functional activity associated with the reported problem. There are 24 possible responses including

This provides initial hints as to underlying biomechanical causes and contributors, relevant transformational zones, possible interventions, and urgency.

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4. Where do you experience your problem?

This question provides 53 possible individual responses. Multiple body areas can be selected by clicking on the body diagram doing so shades the portion of the body selected. To unselect simply click an area a second time.

Responses that include large areas of the body or anatomically remote areas warrant assessment and may be indicative of non-somatic and non-biomechanical conditions.

5. What kind of problems do you experience?

This question provides 10 possible

category that is user defined. Multiple selections are permitted. Responses are suggestive of the severity of the problem. Response options increase in severity moving from left to right on the screen. Responses including weakness, numbness, or tingling warrant priority consideration. 6. How great is your problem? This question provides 8 possible individual responses. Multiple selections are permitted. It assesses the impact of

activities. Responses including concentration, safety while working and sleep warrant priority consideration. Responses including mood, quality, intensity, and quantity of work have immediate productivity implications.


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7. How frequently does your problem occur?

This question provides 4 possible individual responses. Multiple responses are not permitted. Responses suggest the severity of the problem. The more frequent the problem the higher its potential priority.

8. Please add any additional information or comments below:

This question is an unstructured textbox that allows respondents to add information regarding any of the questions, elaborate on their problem, or raise worries, concerns, and questions, etc. It provides a failsafe option to capture unclassified problems.

Upon completing the last question and

button, the respondent is taken to a transition page that thanks them for their participation. After 10 seconds the page automatically closes and again presents the SOLVE homepage.

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In some situations employees may not have access to a computer. In such situations a SOLVE Paper Survey can be used. It can be downloaded as a pdf file from the SOLVE website > Admin LogIn> Download Tab. There are two Paper Survey options Anonymous and Confidential. In such situations, the Provider should set up the Survey online as usual. Each employee would then complete a SOLVE Paper Survey and return it to the Employer who would then forward the completed Paper Surveys to the SOLVE Provider. In the case of Validated Surveys, the completed Paper Survey would be returned in a sealed envelope (to assure anonymity) and given to the Provider for data inputting using the SOLVE Survey online. In the case of Non-validated Surveys where the employee is not identified in any way, the Paper Surveys can simply be collected in a container, and forwarded to the Provider for processing. The Provide should use the Batch Entry URL (http://solveglobal.com/batchentry) for data entry. A few comments about the Survey ...

The SOLVE Survey is a simple and highly effective tool for discovering emerging musculoskeletal problems that may affect performance and comfort. From an employer perspective, risk of claims and performance is usually of greater priority than comfort. For employees the reverse is generally true. When talking with various stakeholder audiences, care should be taken to get the priority right with the various audiences. Employers care about quantity, quality, and intensity of work matters of performance. Employees care about feeling good at work, home, and in leisure matters of comfort. Employees also care about job security, pay, and advancement matters of performance that many people have a tendency to overlook.

The Survey can provide an indication as to the magnitude of Performance and Comfort issues in

the workplace and it can also be used to identify specific individuals that would benefit from follow-up (if confidential rather than anonymous).

A Demonstration/Pilot SOLVE Survey can provide an effective marketing tool to help employers

understand the SOLVE process and to determine whether they have an unrecognized problem or not. In such cases, it is generally best to do a Sample Survey with a high risk portion of employees rather than the entire employee population. Not doing the entire employee population provides incentive for employers to move from demonstration to purchased services and reduces the complexity and time required to conduct a pilot.

and would in fact rather not know about. The concern is that in asking awareness might be surfacing a hidden

problem someone with responsibility and accountability might be exposed and embarrassed. These are real possibilities and appropriate responses should be prepared to defuse the issue to the extent possible.

Like the ostrich many companies would rather bury their head in the ground than confront issues. The point they need to understand is that the Survey simply measures what is. Ignoring or denying what is will not resolve problems, protect employees, or make the company stronger. Dealing with issues will. Help them keep in mind that many problems that are identified will not require costly intervention. Those that do will have better outcomes at less expense than allowing matters to worsen over time.

Drawing parallels between the investment and value of monitoring, maintenance, and early 14

repair of machinery and people is often useful. Companies invest considerable resources Page


(money and people) into maintaining the mechanical performance of facilities and equipment but much less into maintaining the biomechanical performance of employees.

Employers should understand that anytime new questions are asked a certain backlog of problems will be present. It is common for the number of problems discovered by Survey to decrease over the first year as old issues are eliminated and only truly emergent issues are identified. Unrecognized repetitive strain conditions are a ticking time-bomb.

For optimum benefit it is recommended that employers conduct monthly Surveys. Doing so

allows problems to be identified and resolved in the most cost effective and expedient manner. For various reasons (often short term economics) some employers will be tempted to opt for a quarterly or even annual survey. In such cases the benefits of monthly Surveys should be discussed. A key consideration is that emergent problems lasting more than 4 weeks represent employees at-risk for evolving into full-blown muscular-skeletal disorders (MSDs); and problems not resolved within 12 weeks (one quarter) are at increased risk for expensive worker compensation claims and potential disability.

The Survey is a critical component of a comprehensive loss management strategy / system. The smooth and thoughtful meshing of SOLVE Surveys, injury reports, first aid, safety, engineering, maintenance, occupational health/medicine/rehabilitation, worker compensation, group health, insurance, and fitness and wellness resources are essential to providing credible and sustainable value.

Providers should be exceptionally conservative when engaging in interventions for employees particularly those of new clients. Failure to do so invites relational erosion and loss of credibility. Do not over-necessary for each individual. Triage carefully to optimized resource stewardship. Differentiate between those that need monitoring, instruction, encouragement, and intervention. Calibrate

be patient, prudent, and conservative. It is just as important to know when not to provide intervention as it is to know when to do so.

Awareness of regulatory compliance issues is important. Providers operate under certain practice act constraints just as companies operate under certain OSHA, IRS, ADA and insurance constraints. Creative solutions associated with managing worker access, employer risk, and reportable cases should never compromise compliance.

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SOLVE SERVICES

The SOLVE Survey is one portion of the SOLVE System that includes related consultation and support services for employers. Support services can be onsite, offsite, or virtual and may include:

Consulting (employees, management, operations, engineering, ergonomics, safety & health) Screening and assessment Educational and training Job assessment and modification Therapeutic intervention Fitness and conditioning Case management and referrals

Of course these services are delivered in the context of a deep professional expertise in human performance and Neuro-muscular-skeletal pathology.

It is important to package service offering to meet the unique needs and resources of each client company. One size does not fit all. Cost justification is crucial. It is important to take the time to

ght-significantly between companies.

The value of onsite services is that it provides convenience, reduces employee travel and waiting, and if structured correctly reduces cost.

The value of offsite services is that of resource availability and economy when a small subset of employees might need such services.

The value of virtual services (internet, email, phone, etc.) is convenience, the elimination of travel and the enhancement of productivity.

A well-structured service to employers will:

Reliably identify emerging problems Resolve problems fast, cheap, and effectively Make appropriate referrals to the right professionals at the right time for the right reasons Provide evidence of effectiveness, satisfaction, and value.

The primary emphasis of SOLVE related services is not physical therapy! Physical therapy is perceived as part of traditional health care services that are equated with the high cost of health care. Physical

differentiation. While physical therapy is an important offering to have available in the service mix, it is a

philosophy of First Aid, FunctionomicsTM

and Ergonomics that should be emphasized.

SOLVE ROLES

It is critical that professionals assume the role of consultant rather than that of clinician if they are to be successful onsite with employers. Consider these differences.

The Clinician Role The SOLVE Role

16

The customer is the worker The customer is the company

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Define a plan of care Define countermeasure strategies


Focused on an individual Focused on a worker population

Advocate for worker performance Enhance company performance

Clinical Services Workplace services

Focus on worker potential Focus on worker performance

Process oriented Results oriented

Work within health systems Work within corporate systems Credentialed by licensure Validated by results and value

Covered by malpractice insurance Covered by business insurance

The problem solving process however is fundamentally similar in both the clinician role and the

1. Marketing creates customers 2. A chief complaint provides the basis for the engagement 3. Symptoms are identified i.e. the evidence of the complaint 4. A history is taken to understand context, circumstances, onset, and sequential events 5. A physical examination / assessment is conducted 6. Data is analyzed and interpreted 7. Intervention options are identified and considered 8. Options are discussed with the customer 9. A plan is agreed upon activities, timelines, and deliverables 10. The plan is implemented, modified as appropriate, and completed 11. The process and outcome is documented 12. Follow-up may be arranged

There is also strong similarity in the strategies that are used think Functional Testing and Tweaking! We will come back to those considerations later.

The focus of the consultant is on a seven step process:

1. Identify root causes of the problem and likely contributing factors through analysis. 2. Quantify the causes, contributing factors and systems through measurements and testing. 3. Stratify issues and opportunities by importance and develop intervention strategies. 4. Modify the environment, equipment, processes, and individuals to resolve the problem. 5. Verify that the intended results are achieved. 6. Satisfy all stakeholders (management and labor) in the solution. 7. Indemnify the parties to mitigate unnecessary potential risk exposure.

This seven step process provides a convenient framework for considering and organizing ergonomic engagements and an efficient way to communicate process and progress to employers.

An important word of caution is appropriate. As a consultant the professional has an ethical

for conflict of interest that exits whenever the clinician and consultant are one. Any misuse or abuse of the consultant role by making unnecessary referrals for clinical service represents a self-serving ethical breach of conduct that will invariably undermine the credibility and integrity of the consultant / client relationship at some point in time. Employers often view health care providers as part of the problem and not part of the solution they may be naturally suspicious. That suspicion is well earned and cannot


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be overlooked or brushed aside as offerings are marketed, relationships formed, and services are delivered. Providers will be held accountable and reputations are at stake. It is important to approach problem solving from a strategic resource perspective at all times.

A few thoughts about resource allocation, intervention strategies and case management...

Historically, health professionals have come to employers offering either clinical services or education. Both are generally seen as either expensive or inefficient. The adjacent Corporate Resources Strategies illustration makes the point if only 2.5% of cases (25/1000) account for 90% of the cost, where is the value of training the remaining 975 employees and taking them away from production while the training is taking place! And, a large and growing percentage

reatment. Further, it is medical professionals who take employees off work for extended periods of time, thus increasing the likelihood for indemnity payments (wage replacement), legal fees, and failure to ever return to work.

It is critical that financial resource use be optimized. That means identifying emergent cases to resolve them quickly and inexpensively. It also means optimal intervention and case management for the few cases that represent the greatest critical risk. Strategic resource allocation management is a critical SOLVE strategy.

The adjacent Corporate Resource Strategies graphic suggests distinct strategies for the various groups of employees. The 1000 Employees can be routinely monitored via the SOLVE Survey to detect emerging problems before they become problematic. The 75 Simple Cases are best served with triaging advice and simple Functionomic interventions as necessary. The 25 Involved Cases are likely to respond to conservative biomechanical treatment. The remaining Problem Cases will be best served with active support and aggressive case management to assure optimal medical care and avoidance of unnecessary testing and consults.

There are 8 predictive factors related to identifying employees who are at risk during time-away-from-work (illustrated in order of importance in the adjacent graphic). These are matters that should be considered when managing high risk cases i.e. any that involves more than a few days away from work.

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In addition, there are matters of overall job satisfaction to consider. The Gallup Organization has done extensive research on factors that determine job satisfaction that are revealing factors that recognize the nonphysical side of the work environment. The

an important story. It is not unusual that physical complaints are manifestations of larger non-somatic issues. While the SOLVE System does not claim expertise in managing such issues, it is important to recognize non-somatic contributors to physical problems.

FUNCTIONOMICSTM

Functionomics is a systematic approach to enabling people to better perform (efficiently and comfortably) functional activities (physical tasks) at work. Because Functionomics targets only those people who are experiencing problems it is financially very efficient. Because it identifies those people as their problem emerges it prevents worker compensation losses and facilitates employee accommodation. The result is favorable financial value for employers concerned with productivity, quality, and loyalty. Functionomics involves the subtle management (manipulation/adjustment) of work related movement, forces, and time reduces the physical demands of work while enhancing the physical capacity of the worker. Functionomics and ergonomics are complementary. Where ergonomics is oriented toward universal engineering solutions to generic work stressors; Functionomics is oriented toward biomechanical solutions to specific subtle work stressors. Simply stated, Functionomics effectively and efficiently positions employers and employees for success at work.

(* Note: Managing involves the subtle management of physical variables associated with tasks, environments, and individuals in order to enhance functional performance by building on success at the threshold of success. Tweaks

primary involve aspects of position, movement, force, and time. In Applied Functional ScienceTM

, Gray Institute, the

A distinctive competency of Functionomics is Applied Functional ScienceTM

* (AFS) which uniquely integrates the physical, biomechanical, and behavioral sciences. AFS brings a deep understanding of how the human body physically functions / performs in work, sport and leisure activities. The optimization


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and management of biomechanical chain reactions in the body is its core competency. By tweaking critical biomechanical demands of a task, Functionomics improve the biomechanical response that is elicited. The result is better performance and greater comfort.

(*Note: AFS evolved out of over two decades of research and development by Gary Gray PT; and is taught through the Gray Institute www.GrayInstitute.com)

FunctionomicsTM

Rosetta

quality control, human resources, employee training safety & health, , wellness, fitness, first-aid, urgent care, specialty care, rehabilitation, case management, and return-to-work. It is holistically concerned with stable, scalable, and sustainable performance of work by workers in the workplace.

FunctionomicsTM

is investigative, integrative, innovative, and interventive. It does not seek one-size-fits-all or silver-bullet solutions. Rather it recognizes and resolves pre-emergent, emergent, acute and chronic conditions involving repetitive stress/strain and cumulative trauma. The need for Functionomic intervention is indicated by discomfort, functional impairment, and compromised productivity. Functionomic interventions are simple and sophisticated.

(The term FunctionomicsTM originated with Performance Builders, LLC and its use is trademarked. It is used by SOLVE

with Permission. All other use not associated with the SOLVE Survey is strictly prohibited without written permission.) The term takes its meaning from the Latin functio nomos

oikonomos iokos

stewardship of performance resources in the workplace. Inherent in the term are connotations of efficiency, effectiveness, quality, sustainability, and value.

The influence of FunctionomicsTM

is subconscious and natural. It facilitates what the human body instinctively seeks but often does not achieve effectiveness, efficiency, and economy. Human function / performance are the product of Biomechanical Chain Reactions (BCRs). A BCR involves

(neuro-muscular-skeletal) to perform functional tasks for particular purposes. BCRs are made up of 3 elements rooted in the scientific method and a robust neurologic feedback system:

1. Antecedent (Stimulus) Antecedents are the stimulus/provocation that sets the stage for a

biomechanical chain reaction to occur. The provocation is neurologically processed in a complex

interaction involving prior learning, experience, conditioning, and real-time environment,

positioning, subconscious proprioceptive input, and conscious will.

2. Behavior (Action/Reaction) Behaviors are what a person physically/functionally does.

Behaviors are where value is either found or lost. Behavior is purposeful. It is influenced by the

antecedent and drives the consequence. Behaviors are evoked by their subtle interplay between

the Antecedent and the Consequence.

3. Consequence (Result) Consequences are influenced to varying degrees by the effectiveness,

efficiency, and quality of the behaviors performed. Consequences produce a functional feedback

20 loop that either increases or decreases future behaviors via positive reinforcement, negative

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reinforcement, punishment, or penalty.


All BCRs always have either positive or negative consequences impacting the quantity and quality of work performed and the comfort, health, and sustainability of the body to perform work. BCRs are learned motor skills acquired, developed, and modified by repetition over time. BCRs are accommodative and may vary significantly between individuals and within individuals in response to habits, training, changing conditions, and injury. BCRs are temporal events (TEs) having spatial and time dimensions. BCRs can be anticipated, measured, modified, and enhanced. There are three variables associated with all BRC TEs motion, force, and time:

1. All human movement simultaneously occurs in three planes of motion (sagittal, frontal, and transverse) within three dimensional space.

2. That movement is subconsciously and dynamically managed by the neuro-muscular-skeletal

3. Time introduces the dimension of intensity and dosage to functional tasks through repetition, pacing, and duration.

BCR TEs are task specific and involve complex interplay between gravity, momentum, ground reactions, center of gravity, leverage, and compression, tensile, shear, and torsional forces. Such interplay influences performance variables such as speed, accuracy, power, endurance, balance, agility, comfort, and vitality. Keep in mind that the poverty of movement can be just as demanding as its excess; the forces of nature are never at rest even in sedentary work; and time marches on. When these three variables are optimized performance soars. When they are compromised performance suffers. Performance has both a quantitative and a qualitative dimension. Physical performance is objectively measured also subjectively perceived performance over time can be highly credible and useful particularly when they include the qualitative dimension of comfort. These understanding are the foundation for the SOLVE Survey. Work and sport is comprised of repetitive BCR TEs repetitive movement patterns repetitive strain. When things are going well and repetitive strain is balanced with repetitive recovery then performance is sustainable. When recovery exceeds strain over time, performance feels good, looks good, and is good. When strain exceeds recovery over time (i.e. recovery is exhausted) performance and comfort predictably and progressively erodes. That difference is readily apparent when a similar task results in a callus vs. a blister; or when it results in muscle hypertrophy vs. tendonitis. Repetitive tasks facilitate either a conditioning or de-

competitive field of sport but we overlook the same phenomena on the competitive field of work.

dimensional movements through the production and absorption of complex forces enable functional diversity beyond comprehension. BCRs are weakest link phenomena. Intolerance associated with one task involving one joint in just one portion of one plane of motion can disrupt the efficiency of an entire BSR. That disruption could easily extend from the fingers to the toes (e.g. try balancing on one foot while reaching out to turn off a light switch watch the finger and feel the toes). In such situations, the body effectively compensates and adapts but at the cost of incurring repetitive strain. Efficiency,


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comfort, and productivity all suffer. While the weakest link may disrupt a BCR and result in a costly worker compensation case, the smallest biomechanical tweak can restore the BCR and eliminate the

cause of the strain it instantaneously. This is why FunctionomicsTM

is so potent and profitable. A key reference point in the performance of all BCRs is the Transformational Zone (TZ). TZs represent the position, time, and space in which BCRs structures transform between loading and unloading functionality. Loading and unloading patterns may be driven from the top-down or the bottom-up; and may cover or expose weak links in the BCR. TZs may facilitate or impair the recruitment and integration

g performance and comfort.

FunctionomicsTM

provide principles, strategies, techniques, process, and discipline for optimizing human performance, health, and wellbeing by managing BCRs, TEs, and TZs within the context of workplace design, production operations, performance training, and health intervention.

FunctionomicsTM

is essentially industrial strength manipulations of motion, force, and time variables that affect the performance of activities / tasks that people do every day at work.

Professionals engaged in FunctionomicsTM

are uniquely trained and experienced in the physical, health, and behavioral sciences. They have acquired sophisticated skills in the prevention, intervention, and rehabilitation of neuro- muscular-skeletal conditions and the enhancement of human performance in individuals ranging from the disabled to elite athletes. High frequency, high cost worker compensation injuries / illnesses (cumulative trauma) predominately involve the neuro-muscular-skeletal system and are usually caused by repetitive tissue strain of biomechanical origins the primary domain of physical therapists (PTs). PTs who understand biomechanical chain reaction principles and intervention strategies have much to contribute to that which presents the greatest worker compensation risk and expense to employers. Human performance and comfort is a dynamic balancing act that is ever changing. There are four elements at play the demands of the work, the capacity of the worker, the behaviors through which the worker engages the work, and administrative systems including intended policies, procedures, and processes and unintended culture, habits, and practices.

Changes in work performance and comfort result from the interplay amongst these four elements. A change in any one element affects all elements for better or worse. There are actions, reactions, and compensations that constantly interact over time. Some achieve balance (temporary or sustained) others do not. There are many potential balance point configurations. For every balanced situation there are multiple tipping points. Thus, there are multiple solutions for restoring balance when it is lost. Balance is more to achieve than imbalance. Apparent equilibrium may be only temporary. Optimization of performance and comfort requires the sustained avoidance of tipping points. In some instances sustained balance may require ongoing tweaking to accommodate evolving situations (getting better or worse). When avoidance is not possible a timely recovery, with


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perhaps a certain amount of overcorrection, is all important. Risk is associated with the absence of

The implementation of FunctionomicsTM

within the SOLVE System is uniquely differentiated in four ways:

1. Its holistic worker-centric perspectives 2. Its focus on emergent issues and intervention efficacy 3. Its functional orientation on human performance and comfort 4. Its cost effectiveness and return on investment.

FunctionomicsTM

combines a can -do attitude, innovation, efficient problem resolution, and relational integrity between management, labor, and external stakeholders.

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INTEGRATIVE FUNCTION MODEL

FunctionomicsTM

is about making work more workable by building comfort, productivity, and reward in

and companies for greater success, security, and sustainability. The physical function of work consists of 7 core elements Position, Excursion, Locomotion, Propulsion, Distribution, Manipulation, and Transformation. Within each of the functional core elements are multiple functional skills.

Those functional skills are subconsciously assembled, modified, disassembled, integrated, and accommodated on-the-fly to enable the completion of an infinite range of functional tasks at work, home and play. They are learned motor skills that build on past experience, current challenges, and real-time proprioceptive feedback.

their functional capacity to work while actually performing the work; i.e. the work trains them to perform it just like the mouse trains the cat

building an airplane while flying it with the airplane providing the instructions.

s capacity to integrate core functional

skills efficiently and economically in the performance of work. It involves the subconscious management of biomechanical resources through coordination, balance, power, and agility while responding dynamically to ever-changing internal and external forces. Transformation is influenced by motion, force and time. It incorporates three-dimensional movement in the sagittal, frontal, and transverse planes; the biomechanical forces of gravity, ground reaction, and momentum; and the temporal variables of repetition, rate, and duration. When function goes well there is gracefulness, elegance, and capacity building. When function goes poorly there is inefficiency, awkwardness, and capacity erosion as tissues breakdown due to tensile, compressive, shear, torsional, and yield forces.

exploited to tweak the work environment.

1. Engage alternative functional skills e.g. push instead of pull

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2. Enhance functional skill levels e.g. enhance pushing capacity

3. Enhance transformational skills i.e. enhance coordination, balance, power, and agility

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4. Reposition the body i.e. change Transformational Zones to re-triangulate starting and ending points

5. Redistribute movement within the three plains of motion e.g. more/less movement in select planes

6. Redistribute movement within the body i.e. recruit and integrate resources rather than remove and isolate resources

7. Modify internal force generation e.g. more or less loading or unloading 8. Modify external force absorption e.g. more or less loading or unloading 9. Modify temporal exposure e.g. increase or decrease repetition, speed, frequency, or duration

Such Tweaking of work demands/capacity will alter performance and comfort. Since the effect of tweaks are immediately visible and measurable the value of Functionomic tweaks are immediately apparent with functional testing. Tweaking is an iterative process. Use and repeat that which works and discard

ss and work at the threshold of success.

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ERGONOMICS

Functionomics and ergonomics are complimentary.

Ergonomics is an interdisciplinary body of knowledge that extends well beyond the scope of most PT practitioners. It encompasses the entire worker/work system including: industrial engineering, physiology, anthropology, psychology, computer science, mathematics, and more. The sweet spot for physical therapists lay in: biomechanics, applied functional science, anthropometrics, training, conditioning, injury prevention, rehabilitation, human performance, and disuse/overuse syndromes of the neuro-muscular-skeletal origins. Professionals engaged in ergonomics come from many disciplines and each tends to specialize within their particular knowledge domain. Ergonomics is

member contributing within their scope of knowledge and experience.

In the US, there are two primary certification bodies for the ergonomist. The first is Board for Certification in Professional Ergonomics and the second is Oxford Research Institute. Keep in mind however that even without ergonomic certification, particular areas of ergonomics are well within the professional domain of the physical therapist as illustrated in red in the adjacent graphic.

The term ergonomics originated with Wojciech Jasrzeboski (1857), who defined and used the concept. He described ergon, meaning to work, and nomos, meaning principle or law.

knowledge about human abilities, human limitations and other human characteristics that are relevant to design. Ergonomic design is the application of this body of knowledge to the design of tools, machines, systems, tasks, jobs, and environmen Ergonomics is sometimes used synonymously with human factors particularly in Europe. In the US human factors includes both physical and cognitive attributes of human performance. The Ergonomist typically has expertise in human performance, biomechanics, and anthropometrics. They typically work in the design and implementation of work spaces, processes, and tooling in manufacturing and office environments with the intent of promoting safety and productivity.

- that is, work is designed around the worker to optimize performance and comfort. Ergonomics focuses on the interface between the worker and the work (machine, tool,


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control, product, etc.). Ergonomics makes work accommodative focusing predominantly on permanent engineering solutions that change the nature of the work such that most workers could perform it safely and successfully. The reference standard not average performance and not individual performance, but rather the range of achievable performance by 95% of the population

who would potentially be engaged in the work (2.5 th

%tile 97.5 th

%tile). Thus statistically speaking,

perceptual capabilities of a population group that includes everyone within two standard deviations of the mean.

or a specific work group as the reference standard. In such situations the intent is not to design the most inclusive ergonomic solution for an entire population, but rather to make the necessary modifications to adequately accommodate a portion of the population. Such solutions are about economy, and expediency rather than optimal inclusiveness. Thus functionally speaking, ergonomic accommodation is concerned

ility, speed, and perceptual capabilities of an individual or group of individuals whose comfort or productivity may be enhanced.

The functional orientation of a clinical therapist is distinctly different from that of an ergonomic consultant. This can be illustrated by the following example. In a jumping task, if one cannot jump over the bar there are two options. The jumper can be trained or the bar can be lowered. Therapists are clinically oriented toward training the jumper / worker through exercise, training and conditioning strategies. In ergonomics, the orientation is on lowering the bar, i.e. reducing work stressors through ergonomic

jump over the bar (think Special Olympics). This is a fundamental difference between human performance in sports and in the workplace. In the practice of ergonomic accommodation, the best solution may be a combination of both strategies. This brings up three critical understandings for those trained in clinical practice who engage in ergonomic related activities.

1. Ergonomics is focused on changing the work not the workers. 2. Ergonomics may change work for a population of workers or individual workers. 3. While both the performance of the worker (comfort, health, and job security) and the

performance of the company (productivity, quality, and profitability) are equally important considerations; ergonomically speaking, company performance is what almost always justifies the ergonomic related decisions made by companies! This understanding is essential!

Ergonomics is a natural extension of the biomechanical expertise of a functionally orientated therapist.

s appreciation of and attention to such differences are significant and have implications on the acceptance and potential


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success of ergonomic service relationships with companies. The professional always needs to be cognizant of which hat is being worn patient advocate or corporate advisor!

ECONOMICS As a corporate advisor, the economics of matters is what matters.

Economics is all about the creation, use, and management of assets (financial, physical, and human) for the primary purpose of earning profits of course more is better. Yes there are other priorities but they fall far behind profitability. Profit is the ultimate measure of the decisions made by management and those that advise management.

Through work, assets are put to use and value is created. There are only four ways to improve financial performance:

1. Improve revenue 2. Improve expense 3. Improve asset utilization 4. Improve risk

Functionomics and ergonomics primarily impacts expense, asset utilization, and risk. Unless services can demonstrate a measurable return on investment in less than a year, companies will likely show little interest. Economic performance demands accountability. Accountability demands active management toward definable goals. Return on investment is about enhancing value. It can be measured in multiple ways:

Output Productivity Quality Employee morale/loyalty Waste Errors Management time and worry Medical expense Lost time Labor replacement costs Labor and customer retention Revenue Expense Asset utilization Risk exposure Insurance costs/liabilities

Functionomics is only justified by its positive financial impact, thus economic impact need always be addressed impact is understood client interest can be high. More positive impact in less time is always good.


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ESTABLISHING CONTEXT How does one know that there are likely issues in the workplace that could/should be addressed? What should cause suspicion? Consider these metrics as the Dirty Dozen

1. Worker compensation incident data incident rates and risk ratings (Mod Rate) 2. Worker compensation expenses medical, wage replacement, premiums 3. Work restrictions, job rotation, and absenteeism 4. OSHA, Department of Labor, or work comp insurer involvement / citations 5. Deteriorating employee morale 6. Employees complaints about comfort and resources 7. Employee turnover 8. Deteriorating productivity 9. Increased waste or rework 10. Quality related issues 11. Employee modified tools and equipment 12. Frequent and intensive use of medical or rehabilitation services

These are topics that need to be discussed during exploratory interviews with employers the

tablish a relationship, understand issues and context, discuss and shape expectations, define the scale and scope of opportunity, and understand budgetary resources. Upon completing such a discussion there should be an understanding of the following:

W Who does it involve? What is its scope people, dollars, locations? Where is it occurring? When did it begin? How has it progressed? What work demands, policies, and procedures impact the problem? What attempts have been made to resolve the problem? What have been the results? What does the client worry about happening? What is the net financial impact of the problem? (Consider economic, operational, quality,

productivity, relational, and competitive impact.)

this save a lot of guess work as to project content and pricing. Also inquire as to how a decision will be made Who will be involved? How many steps will be required? How long will it take? How will you need to participate in the process?

If intervention is successful, how will things change and how will those things be measured? Who from the company will champion the project and expedite resources? What is the process and timeline for making a decision concerning the matter?

Foundational information that is generally helpful for such discussions includes the following:


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OSHA Form 301 Injury and Illness Incident Reports* OSHA Form 300 Log of Work Related Injuries and Illnesses* Insurer or Third Party Administrator (TPA) periodic reports** Industry specific loss data*** Health services provider data****

*Occupational Safety and Health Administration For OSHA information: www.osha.gov.com For information on OSHA Forms: www.osha.gov/recordkeeping/OSHArecordkeepingforms.pdf ** Insurer reports vary widely but generally provide a summary of cases and financial expenditures and reserves. The

average, 1.0 = average, > 1.0 = worse than average) *** Pertinent loss data can be obtained from:

OSHA (http://www.osha.gov/oshstats/work.html),

States OSHA List http://www.osha.gov/dcsp/osp/states.html

US Bureau of Labor Statistics (http://www.bls.gov),

State Bureaus of Labor Statistics List http://www.bls.gov/bls/ofolist.htm

US Department of Labor http://www.dol.gov/

State Departments of Labor List http://www.dol.gov/esa/contacts/state_of.htm,

State Worker Compensation Agencies List (http://www.ic.nc.gov/ncic/pages/all50.htm),

National Safety Council (www.nsc.org). **** Most employers have little if any data from providers. Its absence makes a strategic point.

Having reliable information as a foundation is critical to assuring that interventions and investments are strategic in nature and able to produce reliable and meaningful results. Not taking a project is better than taking one and failing for any reason! B PERSPECTIVES

Traditional ergonomics, like traditional clinical practice, has been too long focused on cook book solutions, protocols, and tools that are habitually applied to common classes of problems. They have tended to be tactical interventions rather than strategic solutions, thus resources have often been wasted and results compromised.

In FunctionomicsTM

, the focus shifts to understanding underlying biomechanical causes that impact the biomechanical chain reactions that are work. Interventions are strategic, custom, and efficient. Traditionally ergonomics has been driven by academics, researchers, engineers, and tool manufacturers, none of whom typically understand subtle functional chain reaction biomechanics. This is not to say the solutions and products they design are wrong. What it does suggest is that many ergonomic designs are poorly applied due to errors in selection or implementation. It also means that traditional ergonomics has a blind spot that leaves unexplored and underexploited opportunities. Ultimately, it means that something important is missing. Work related data proves it year after year! If off-the- shelf ergonomic solutions were the answer, the problems of muscular-skeletal disorders (MSDs) in the workplace would not persist as they do. The problem is that MSDs are of biomechanical origins. Ergonomic solutions may be necessary but are often not sufficient. Functionomics provides an added dimension to ergonomic and engineering solutions and enhances their potency. MSDs are the result of repetitive stress caused by work interrelated forces and motions over time that

tolerance/adaptability threshold.


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Repetitive stress can be relieved by altering one or more of these three contributing factors. An analogy to fire makes the point. In the case of fire, three elements are needed: fuel, temperature, and oxygen. A fire can be extinguished by eliminating any one of the three elements. So too, MSDs can be extinguished by eliminating or even modifying one or more of its three elements. Like fire, MSDs are more easily extinguished when caught early before they intensify and spread! When workers engage their work it is accomplished through physical efforts of one type or another. Thus, if work tolerance and performance is to be enhanced it too will need to be accomplished through physical means!

FunctionomicsTM

is a vital component of a comprehensive strategy for safeguarding the performance contribution of human assets in a uniquely designed, operated, and managed business environment.

The principles and strategies of Applied Functional ScienceTM

provide a systematic and replicable framework with which to reliably assess workers and work for stable, scalable, and sustainable productivity. When it comes to function, one can approach the assessment and management of work stressors the same way one approaches functional interventions in the clinic i.e. with Tweaking. The principles and

In the clinic, one works with the client from a work performance perspective to enhance functional capacity. In the workplace, one works with functional tasks from a work demands perspective to improve functional requirements. Functional tweaking from both the capacity and demands side of the equation provides an unlimited variety of potential solutions and enhancements. Tweaking is used to modify testing and exercise demands in the clinic and work demands in the workplace. Functional capacity and functional

so subtle, changes in motion (positions, joints, direction, and displacement), force (gravity, reactive

forces, mass and momentum) and time (rate, cycles, frequency, duration). This is the essence of

FunctionomicsTM

.

There are 6 functional principles that establish the framework for FunctionomicsTM

:

1. Solutions are uniquely individualized to a particular situation -size-fits-all off-

the-

2. For every problem there are multiple potential solutions and combinations of solutions the so

3. Solutions may be found:

At points of transformation i.e. where biomechanical loading and unloading and

neuromuscular proprioceptive training occur.

With multi-joint tri-plane motion i.e. where integrated isolation is avoided and

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neuromuscular recruitment occur.

In timing where speed, duration, frequency, rates, rhythms, and repetitions are managed.

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4. Identify and modify biomechanical causes, not compensations and symptoms.


5. Better questions drive better solutions answers are inherent in the problem. Questions are both verbal (ask for information and listen) and physical (ask for activities and watch).

6. Behaviors contribute to either the problem or the solution. Behaviors are reactive. Solutions are found in subconscious behavioral recruitment.

PRINCIPLES

The biomechanical domain of FunctionomicsTM

revolves around the interaction of three variables force, motion, and time. Understanding those relationships is the foundation for all biomechanical strategies. These are the same three relationships that establish the foundation for Tweaking in the clinic. With an understanding of force, motion, and time, the worker-work interface can be tweaked both on the side of the work and the side of the worker to provide an almost unlimited range of opportunities to improve work performance and comfort.

laws with an emphasis on force considerations.

in motion with the same speed and in the same direction unless acted upon by an unbalanced

The acceleration of an object as produced by a net force is directly

proportional to the magnitude of the net force, in the same direction as the net force, and

- "For every action, there is an equal and opposite reaction."

Applications:

1. Introduce mass between work and worker to absorb impact and vibration forces

that originate from external sources and are transferred to, and dissipated through, the worker.

2. Introduce mechanized force production and control systems to assist workers to

celerate (accelerate or decelerate) loads.

3. Introduce objects with reduced mass to enable workers to celerate loads manually.

4. Introduce leverage to reduce forces transmitted to and from workers.

5. Introduce counter-forces to achieve equilibrium and reduce manual force

requirements.

6. Introduce neutral or mid-range postures, biomechanical alignment, and external

support for static postural tasks to minimize leveraged forces of gravity. Newton reminds us that the physical nature of work involves force related actions and reactions. Worker generated actions produce work reactions; and work generated actions produce worker reactions the result is a dance between work and worker constant give and take. Depending upon


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biomechanical and physiologic variables, these dances may either build-up or break-down workers. The difference could be a callus or a blister, a bulging biceps or an inflamed tendon, a strong core or a bad back. The only difference being the dosage and relative interplay between motion, force, and time. Within biomechanics there are four important types of forces to consider Tensile, Compressive, Shear, and Torsion. Tensile forces occur within a structure and are related to elongation forces (e.g. attempting to stretch or

Compressive forces occur within and between structures and are related to compacting forces (e.g. external pressure applied perpendicularly to soft tissue or internal pressure due to compartmental

Shear forces occur between structures and are related to frictional forces (e.g. finger flexor tendons sli

Torsion forces occur within structures and are related to twisting around an axis (e.g. spinal column and discs undergo torsion forces with rotational, transverse plane, body movements). Think tendency to

From a biomechanical perspective, force management brings up three considerations.

The first is the matter of resiliency a workers ability to absorb forces. While the body is reasonably capable of absorbing transient external forces, as is demonstrated in athletic events involving contact, soft tissue breakdown can result from sustained external force exposure of sufficient frequency and duration (i.e. cumulative micro-trauma). Two patterns are common - muscle / tendon breakdown (inflammation) can occur with repetitive strain and vascular compromise can result from vibration exposure in the frequency range of 5 - 36 m/s. (For more information on vibration and cumulative trauma visit www.cdc.gov/niosh/homepage) The second is the matter of neuromuscular force generation by the worker. Force generation and coordination is influenced by four variables learned motor patterns in the central nervous system, proprioceptive input from the peripheral nervous system, peripheral neural-motor performance, and muscle composition / bulk.

-powerful and effective when they are immediately preceded by sufficient eccentric loading. Efficiency can be gained through facilitating biomechanical cycles of eccentric loading-transformation-concentric unloading-transformation- e.

Applications:

1. Introduce biomechanical task designs that engage muscle groups involving multi-

joint chain reactions.

2. Introduce biomechanical task designs that prevent integrated-isolation of muscles

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i.e. tasks where force generation is demanded of isolated and relatively weaker

muscles while larger more distributed muscle groups are prevented from being

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recruited due to joint positioning.


3. Introduce biomechanical task designs that facilitate force transfer between work and worker in mid-ranges of joint motion.

4. Introduce biomechanical work patterns that naturally recruit powerful muscle

groups such as the buttocks, quads, core, and shoulder girdle.

5. Introduce and enhance multi-plane eccentric muscle loading immediately preceding demands for concentric muscle force generation.

6. Introduce body mass, momentum, gravity, leverage, as internal substitutes for

muscle generated force.

motion as it occurs in the body by considering four variables. The first three variables are quantitative while the last variable is qualitative.

Functional motions are tri-plane. That is, they involve the sagittal, frontal and transverse planes. Even though one plane may be dominant all three planes are involved to some extent.

Functional motions are multi-joint. That is, motion is distributed across multiple joints, thus multiple motion and force distribution alternatives always exist. Even though one joint may be dominant, multiple joints may participate in varying degrees at different times or under different circumstances.

Functional motions are multi-dimensional. That is, motion occurs with direction, height, displacement, and velocity.

Direction Relative to anatomical neutral or relative to external references (i.e. a 360

degree range of possible bearings in the transverse plane). Height Relative to vertical (i.e. a range from maximal reach down to maximal reach

up). Displacement Relative to a starting point or relative to external references (i.e. a linear

or angular measurement of distance). Velocity Relative to displacement over time (i.e. distance per second)

Functional motions are synergistic. That is, motions occur within a coordinated and integrated chain reaction contributing to the quality of motion whose attributes include balance, agility, efficiency, and flow / gracefulness / artistry.

Applications:

1. Introduce subconscious planes of motion modifications to tasks to facilitate,

enhance, or limit required / desired motor patterns or alter the range of potential user options.

34Page


2. Introduce task placement and/or orientation to facilitate multi-joint participation thus enhancing the recruitment of motor resources and better distributing biomechanical loads.

3. Introduce alternative dimensional variables to modify work demands -Work Tweaks.

Alter direction to modify stance, orientation, and alignment. Alter height to modify postures, joint involvement, and motor recruitment. Alter displacement to modify the physical demands of walking, reaching and

lunging. Alter velocity to modify accuracy, efficiency, productivity, and motor patterns.

4. Introduce alternative staging, positioning, sequencing, timing, flow, combination, and assignment of work tasks to choreograph and enhance the efficient and natural quality of biomechanical reactions.

time as it influences biomechanical work

tasks.

The variable of time has 3 dimensions that need to be considered in the context of work and functional ergonomics. They are Cycle, Frequency, and Duration each is typically a ratio (e.g. units per minute, cycles per hour, and hours per day). Taken together they provide a terminology for describing exposure time (or dosage) to work tasks / activities / stressors.

Cycle time is the time taken to accomplish a particular task (e.g. 90 seconds per part or 2 minutes per inspection).

Rhythm has to do with an interval during which a regular sequence of events occurs and reoccurs (i.e. the timing of the things). Work rhythms can be regular or irregular.

Frequency is the number of Cycle occurrences within a period of time (e.g. 30 cycles per hour).

participation time within a work shift. Frequency can be occasional (6 33% of work time), frequent (34%-66% of work time), or continuous (67% - 100% of work time).

Duration is the time during which Cycle time and Frequency occur (e.g. per day).

So for example, a task could have a cycle time of 90 seconds, occurring at a frequency of 10 cycles per hour for duration of 8 hours per day. Thus the task would occur for 2 hours per day

(i.e. 90 seconds per cycle x 10 cycles per hour x 8 hours = 7,200 sec or 2 hours)

Rate is a ratio. It measures the number of occurrences within a specified time span. It suggests pacing and productivity (e.g. units per minute) . In the manufacturing environment rate is about

k flow. Rate can be self-paced or system paced.


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Repetition is a matter of occurrences that are time independent. When time factors are introduced (i.e. repetitions completed within a defined span of time) repetitions could be stated either as an absolute quantity per unit of time or as a rate for a certain duration or time.

Applications:

1. Introduce a regular rhythm to tasks to

solve how to manual

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