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Accommodation and Compliance Series:
Employees with Back Impairments
By John Greer, M.S.

Preface

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). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

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://www.jan.wvu.edu/soar.

Information about Back Impairments

How prevalent are back impairments?

Next to headaches medical experts note that back problems are the most common medical complaint. Back problems are also found to be second only to the common cold as the greatest cause of lost workdays. Back injuries alone cost American industry $10-14 billion in workers compensation costs and about 100-million lost workdays annually (Shelley, 2002).

What are the symptoms of back impairments?

The major symptom of most back impairments is back pain, which can be localized or widespread radiating from a central point in the back. Sciatica is pain starting in the lower back and traveling down one or both legs.

What causes back impairments?

If ligaments and muscles are weak then discs in the lower back can become weakened. With excessive lifting, or a sudden fall a disc can rupture. Years of back abuse, or with aging, the discs may simply wear out and you may live with chronic pain for several years. However, back pain caused by a muscle strain or a ligament sprain will normally heal within a short time and may never cause further problems. Poor physical condition, poor posture, lack of exercise, and excessive body weight contribute to the number and severity of sprains and strains. Degeneration of the spine, due to aging, is also a major contributor to lower back pain, but it is often misdiagnosed as a sprain or strain. Only a small percentage of all serious back injuries are true sprains, strains or fractures. Most are the result of degeneration of the spine caused by aging and abuse. Most back-injuries, however, occur in the 24 to 40 year old age group (Shelley, 2002).

How are back impairments treated?

Most back impairments are treated with non-invasive treatment techniques. Treatment options include drug therapy, chiropractic adjustments, acupuncture, physical therapy, and rest. In a few cases surgery may need to be performed; some surgery options are vertebrea fusion, discectomy, and laminectomy.

Back Impairments and the Americans with Disabilities Act

Are back impairments disabilities under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with back impairments will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

If the major life activity affected by a back impairment is lifting, what lifting restriction is substantial enough to meet the ADA definition of disability?

There is no exact lifting restriction that is considered substantially limiting. However, in an informal guidance letter, the EEOC states that an individual whose back impairment prevents him/her from lifting more than fifteen pounds is substantially limited in the major life activity of lifting because the average person in the general population can lift fifteen pounds with little or no difficulty. On the other hand, an individual whose back impairment prevents him/her from lifting more than fifty pounds is not substantially limited in the major life activity of lifting because the average person in the general population cannot lift fifty pounds with little or no difficulty. Furthermore, an individual whose back impairment does not substantially limit a major life activity may still be covered if an employer perceives him/her as being as substantially limited in a major life activity (for example, lifting or working) (EEOC, 1998).

Accommodating Employees with Back Impairments

(Note: People with back impairments may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with back impairments will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with a back impairment experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with the back impairment been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with the back impairment to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding back impairments?

Accommodation Ideas:

Large Blue Triangle Bullet Activities of Daily Living:

Small Triangle Blue Bullet Allow use of a personal attendant at work
Small Triangle Blue Bullet Allow use of a service animal at work
Small Triangle Blue Bullet Make sure the facility is accessible
Small Triangle Blue Bullet Move workstation closer to the restroom
Small Triangle Blue Bullet Allow longer breaks
Small Triangle Blue Bullet Refer to appropriate community services

Large Blue Triangle Bullet Fatigue/Weakness:

Small Triangle Blue Bullet Reduce or eliminate physical exertion and workplace stress
Small Triangle Blue Bullet Schedule periodic rest breaks away from the workstation
Small Triangle Blue Bullet Allow a flexible work schedule and flexible use of leave time
Small Triangle Blue Bullet Allow work from home
Small Triangle Blue Bullet Implement ergonomic workstation design
Small Triangle Blue Bullet Provide a scooter or other mobility aid if walking cannot be reduced

Large Blue Triangle Bullet Gross Motor Impairment:

General
Small Triangle Blue Bullet Modify the work-site to make it accessible
Small Triangle Blue Bullet Provide parking close to the work-site
Small Triangle Blue Bullet Provide an accessible entrance
Small Triangle Blue Bullet Install automatic door openers
Small Triangle Blue Bullet Provide an accessible restroom and break room
Small Triangle Blue Bullet Provide an accessible route of travel to other work areas used by the employee
Small Triangle Blue Bullet Modify the workstation to make it accessible
Small Triangle Blue Bullet Make sure materials and equipment are within reach range
Small Triangle Blue Bullet Move workstation close to other work areas and break rooms

Industrial
Small Triangle Blue Bullet Provide overhead structure for lifting devices
Small Triangle Blue Bullet Modify the work area to make it adjustable
Small Triangle Blue Bullet Place frequently used tools and supplies at or near waist height
Small Triangle Blue Bullet Provide low task chairs for work that cannot be brought to waist height
Small Triangle Blue Bullet Provide stand/lean stools and anti-fatigue mats for standing work
Small Triangle Blue Bullet Make wheelchairs, scooters, industrial tricycles, or golf carts available if walking long distances is required
Small Triangle Blue Bullet Provide compact lifting devices to push and pull supplies and tools from storage

Office Settings
Small Triangle Blue Bullet Provide a height adjustable desk and ergonomic chair
Small Triangle Blue Bullet Move workstation close to common use office equipment
Small Triangle Blue Bullet Provide low task chair and rolling safety ladder to access high and low file drawers and supplies
Small Triangle Blue Bullet Provide a cart to move files, mail, and supplies
Small Triangle Blue Bullet Provide a lazy Susan carousel or desktop organizers to access frequently used materials

Service Settings
Small Triangle Blue Bullet Provide anti-fatigue mats and stand/lean stools for functions requiring long periods of standing
Small Triangle Blue Bullet Provide a height adjustable desk and ergonomic chair
Small Triangle Blue Bullet Move workstation close to commonly used office equipment
Small Triangle Blue Bullet Provide compact lifting devices to push and pull stock and supplies from shelves
Small Triangle Blue Bullet Provide carts to move supplies and stock

Medical Settings
Small Triangle Blue Bullet Provide a spring-bottomed linen cart
Small Triangle Blue Bullet Make patient lifting and transfer devices available
Small Triangle Blue Bullet Make wheelchairs, scooters, industrial tricycles, or golf carts available if walking long distances is required
Small Triangle Blue Bullet Train employees on proper lifting techniques and on proper use of patient lifting and transfer devices
Small Triangle Blue Bullet Provide powered beds for transporting patients
Small Triangle Blue Bullet Provide a height adjustable desk and ergonomic task chairs to fit use for different people

Situations and Solutions:

A systems administrator with a back impairment is required to move, lift, and carry computers throughout the office. The person was accommodated with a compact, adjustable height lifting device with straps to secure the load.

A maintenance worker with a bending and lifting restriction due to a back injury is required to lift manhole covers. The worker was accommodated with a truck mounted jib crane and manhole cover lifter.

A clerical worker with scoliosis has sitting and standing restrictions. Because the worker is required to work at a desk a majority of the time, the worker was accommodated with an ergonomic workstation evaluation, ergonomic chair, and a sit/stand computer workstation.

A mechanic with a bending restriction due to a low back impairment has problems accessing the engine compartment and low task areas of vehicles. The mechanic was accommodated with a tire lift, a mechanic's low task chair, and a specialty creeper designed to support the body while accessing engine compartments.

A file clerk with a back impairment has functional limitations limiting her ability to bend and access files in low file drawers. An electric automated filing system was purchased to allow accessing of file drawers at a standing height.

A chemical process plant worker is limited in his ability to turn large wheel valves due to a back injury. The worker was accommodated with a specialty tool designed to increase torque on wheel valve handles.

An appliance delivery driver with a lifting restriction due to a low back injury was accommodated with a stair climbing hand truck. This battery-powered piece of equipment also doubles as a lift gate to help lower appliances on and off the truck.

A grocery check-out person with a standing restriction due to a back injury was accommodated with a sit/lean stool and anti-fatigue mats.

A mailroom worker with a push/pull restriction was required to deliver the mail on a cart that weighed more than the individual's push/pull restriction. An accommodation of a motorized cart allowed the person to stay on the job.

A truck driver with a back impairment was limited in the time he could drive. Accommodations of a suspension seat and a vehicle cushion designed to reduce vibrations allowed the driver to comfortably sit for longer periods of time.

A health care worker with a lifting restriction was accommodated with patient transfer devices and individualized training on proper use and selection of the equipment.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Equal Employment Opportunity Commission. (1998). EEOC guidance letter. Retrieved July 1, 2005, from http://www.jan.wvu.edu/letters/Back_JUN_98.doc

Shelley, J. and Dennis, M. (2002). Muscle, bone, and back injuries. Kansas State University, Manhattan, Kansas. Retrieved July 1, 2005, from http://www.cdc.gov/nasd/docs/d001001-d001100/d001015/d001015.html

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