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Accommodation and Compliance Series:
Ergonomics in the Workplace: A Resource Guide

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Introduction


JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA).

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://askjan.org/soar.

APPLYING ERGONOMICS IN MAKING ACCOMMODATIONS

Ergonomics is the science of fitting jobs to people. The discipline encompasses a body of knowledge about physical abilities and limitations as well as other human characteristics that are relevant to job design. Essentially, ergonomics is the relationship between the worker and the job and focuses on the design of work areas to enhance job performance. Ergonomics can help prevent injuries and limit secondary injuries as well as accommodate individuals with various disabilities, including those with musculoskeletal disorders (MSDs)

With workers’ compensation costs soaring and ergonomic legislation coming to fruition in certain industries (e.g., meatpacking, nursing homes, retail stores, poultry processing), employers are implementing broad-based ergonomic programs. For those industries not covered by existing ergonomic standards, the Occupational Safety and Health Administration (OSHA) expects employers to follow Section 5(a)1, the General Duty Clause, of the Occupational Safety and Health Act (OSH Act), which says that “a place of employment must be free from recognized hazards that are causing or are likely to cause death or serious physical harm to [ ] employees.” According to OSHA, "work-related [MSDs] currently account for one-third of all occupational injuries and illnesses reported to the Bureau of Labor Statistics (BLS) by employers every year. These disorders [ ] constitute the largest job-related injury and illness problem in the United States today.”

The benefits of implementing an ergonomics program apply to all workers, but ergonomics can be particularly important when accommodating employees with disabilities. The Americans with Disabilities Act (ADA) mandates that employers accommodate employees with disabilities, which may include individuals with MSDs. An accommodation is any change or adjustment to a job or work environment that allows a qualified employee with a disability to participate in the job application process, to perform the essential functions of a job, or to enjoy the benefits or privileges of employment. For individuals with MSDs, accommodations may be as diverse as alternative keyboards, tool balancers, or scissor lifts. Before determining what accommodations might be effective, an employer must know the essential functions of the job in question as well as the limitations of the individual performing the job. Though not required by the ADA, a job analysis can aid in determining the essential functions of a position and is an important precursor to an ergonomic analysis.

The following document provides tips for completing a job analysis and outlines how to perform an ergonomic analysis with a special emphasis on accommodations. Considerations for the worker, workstation, and work-site are highlighted. In particular, the document looks at proper ergonomic spacing, flooring, doors, and storage areas for office, industrial, service, and health care settings. Administrative controls are also addressed.

I. JOB ANALYSIS TIPS

To properly perform a job analysis, the individual performing the job should be observed and interviewed. In addition, co-workers and other individuals with similar and related jobs should be interviewed. It is imperative that job tasks be recorded with videotape, pictures, and/or sketches. Also, if the job is performed in a sequence, the work completed before and after the particular job should be documented.

A. Purpose

B. Job Setting

1. Work-site

2. Workstation

3. Work Activities

II. ERGONOMIC ANALYSIS TIPS

The following information summarizes several tips for completing an ergonomic analysis. The first step in an ergonomic analysis is to define the population that is to be served. For example, when implementing ergonomics for an individual who uses a mobility aid, the mobility aid and its user must be considered one unit. The type of mobility aid may change what is considered “ergonomic.” Implementing ergonomic principles for an individual with a disability can be very specific to that individual. Also, when dealing with accommodation issues in the workplace, special attention should be given to the location and set-up of assistive technology to ensure good ergonomics. Second, the individual’s workstation and work-site must be addressed.

A. Worker

General guidance on accessibility and proper ergonomic positioning can be obtained from the Americans with Disabilities Act Accessibility Guidelines (ADAAG) . Typically, anthropometric data are used to design workstations that adjust to fit the smallest member of the population (the 5th percentile female) and the largest member of the population (the 95th percentile male). However, a majority of those left outside of this range are people with disabilities. This means ergonomics is situational. Thus, when accommodating an individual with a disability, an effective analysis may need to go beyond general guidelines.

B. Workstation

1. Office

2. Industrial

3. Service

4. Health Care

5. General

C. Work-site

1. Spacing

2. Flooring

3. Doors

4. Storage

5. Other

D. Administrative Controls

III. GLOSSARY

The following information was edited from several sources, including many of the resources listed in the resource section of this publication. The information is not intended to be medical advice. If medical advice is needed, appropriate medical professionals should be consulted.

A. MSD-related VocabularyWork-related Musculoskeletal Disorders (MSDs): 
Disorders of the musculo-tendinous-osseous-nervous system that are caused, precipitated or aggravated by repeated exertions or movements of the body. MSDs are caused from wear and tear on tendons, muscles, and sensitive nerve tissue caused by continuous use or pressure over an extended period of time. Most common parts of the body that are affected by poor work habits and workstation design are the wrists, hands, shoulders, back, neck, and eyes.  MSDs are groups of disorders with similar characteristics and may be referred to as: cumulative trauma disorders (CTDs), repetitive trauma disorders, repetitive strain injuries (RSIs), overuse syndromes, regional musculoskeletal disorders, and work-related disorders.

Examples of MSDs are:

Bursitis:
Bursitis is inflammation of bursae, which are closed sacs that contain fluid and are located at points of friction in joints. Bursitis can occur in several joints, but the shoulder and knee joints are the most common, which may be acute or chronic. The inflammation is attributed in some cases to excessive use of the joint.
Carpal Tunnel Syndrome (CTS):
CTS is a disorder that causes a prickling or numbness in the hand. It often results in burning pain, decreased hand dexterity, and, in some cases, paralysis. CTS is caused by compression of the median nerve, which runs through a bracelet like bone structure in the wrist, the carpal tunnel, and branches to the thumb and first three fingers. Tendons in the carpal tunnel may swell and pinch the nerve.
Cubital Tunnel Syndrome:
Similar to the pain that comes from hitting the funny bone, cubital tunnel syndrome affects the ulnar nerve where it crosses the elbow.
DeQuervain’s Disease:
DeQuervain’s Disease pain results from the tendons (and the covering of the tendons called the tenosynovium) becoming inflamed on the side of the wrist and forearm just above the thumb.
Epicondylitis:
Lateral epicondylitis, sometimes referred to as Tennis Elbow, can result from excessive activities such as painting with a brush or roller, running a chain saw, and using many types of hand tools continuously. Medial epicondylitis, sometimes referred to as Golfer's Elbow can result from activities such as chopping wood with an ax, running a chain saw, and using many types of hand tools continuously.
Guyon’s Canal Syndrome:
Guyon's canal syndrome is a common nerve compression affecting the ulnar nerve as it passes through a tunnel in the wrist called Guyon's canal.  This problem is similar to carpal tunnel syndrome, but involves a different nerve.
Impingement Syndrome:
Impingement syndrome, also known as rotator cuff syndrome, is a result of the lack of room between the acromion and the rotator cuff.  Usually the tendons slide easily underneath the acromion as the arm is raised; however, each time the arm is raised, there is a bit of rubbing on the tendons and the bursa between the tendons and the acromion.  This rubbing, or pinching action, is called impingement. Continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the arm can result in impingement syndrome.
Intersection Syndrome:
Intersection syndrome affects the thumb side of the forearm where two muscles cross over - or intersect - two underlying wrist tendons.
Radial Tunnel Syndrome:
Radial tunnel syndrome causes aching in the forearm just below the elbow.  The symptoms of radial tunnel syndrome can be confused with tennis elbow.
Tendonitis:
Tendonitis is an inflammatory condition of a tendon and most often occurs in the knees, hips, shoulders, wrists, and elbows. 
Tenosynovitis:
Tenosynovitis is an Inflammation of the tendon sheaths that may follow trauma, overuse, or inflammatory conditions.
Trigger Finger:
Trigger finger affects the movement of the tendons as they bend the fingers or thumb toward the palm of the hand. 
Thoracic Outlet Syndrome (TOS):
TOS affects the shoulder, arm, and hand.
B. General Vocabulary
 
Adduction:
Motion toward the midline of the body that decreases the angle between a limb and the sagittal plane.
Anthropometry:
The study of the range of human physical dimensions, such as size (e.g., height), breadth (e.g., shoulder width) and distance between anatomical points (e.g., upper arm length).
Dynamometer:
A device for measuring the force of muscle contraction; for example, a handgrip dynamometer measures power grip strength.
Electromyography (EMG):
The study of muscle behavior (i.e., action potentials from contracting muscles) via electronic means.
Ergonomics:
A multidisciplinary activity dealing with the interactions between the worker and the working environment, plus such traditional and environmental aspects such as atmosphere, heat, and light, as well as of tools and equipment in the workplace.
Extension:
Movement involving the bending of a joint whereby the angle between the bones is increased (opposite of flexion).
Flexion:
Movement involving the bending of a joint whereby the angle between the bones is diminished (opposite of extension, except at the shoulder).
Force:
The effect of an exertion on internal body tissues (e.g., compression on a spinal disc from lifting, tension within a muscle/tendon unit from a pinch grasp) or the physical characteristics associated with an object(s) external to the body (e.g., weight of a box, pressure required to activate a tool, pressure necessary to snap two pieces together).
Goniometer:
A device that measures the angle and range of angular movement between two body segments connected by a joint.
Grip:
The conformity of the hand to an object accompanied by the application of exertion used to manipulate the object.
Kyphosis:
The convexity of the spine that is normally observed in the thoracic region.
Lordosis:
The concave curvature of the spine that exists in the neck and the lumbar region.
Maximum Permissible Limit (MPL):
In the NIOSH manual lifting guide, the recommended upper limit of the weight to be handled with two hands in the sagittal plane at 76 cm (30 in.) above the floor and at different locations in front of the ankles. (Less than 15 percent of the work force has the capacity to do this type of lifting without increased risk of musculoskeletal injury).
Moment (Torque):
The product of the magnitude of a force and the perpendicular distance from the line of action of the force to the axis of rotation.
Newton:
The amount of force required to give a one-kilogram mass an acceleration of one metre per second per second.
Noise:
Unwanted sound, which may be continuous or intermittent and present in various ways (clatter of a pneumatic wrench, sound of copier).
Posture:
The position of the body while performing work activities.
Pronation:
The action of rotating the flexed forearm toward the mid-sagittal plane, so that the hands become prone, with palms down, back of hands up.
Psychosocial:
The factors that produce both psychological and social effects.
Range of Motion (R.O.M.):
The range of translation and rotation of a joint for each of its degrees of freedom.
Recovery Time:
The time quantification of rest, performance of low stress activity, or performance of an activity that allows a strained body area to rest.
Repetition:
The time quantification of a similar exertion performed during a task.
Segmental Vibration:
Vibration applied to the hand can cause a vascular insufficiency of the hands/fingers (Raynaud's disease or white finger).
Static Exertion:
The performance of a task from one postural position for an extended duration.
Supination:
The action of rotating the flexed forearm outward so that the palm of the hand is facing upwards.
Whole Body Vibration:
Exposure of the whole body to vibration.

Resources

Updated 04/29/13

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