Physical Rehabilitation: Evidence-Based Examination, Evaluation, and Intervention / Edition 1

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The only physical rehabilitation text modeled after the concepts of the APTA’s Guide to Physical Therapist Practice, 2nd Edition, this detailed resource provides the most complete coverage of rehabilitation across the preferred practice patterns of physical therapy all in one place! Each chapter is consistently organized to make it easy to find the information you need, with clear guidelines, examples, and summaries based on the latest clinical evidence to help you improve quality of care and ensure positive patient outcomes.

• In-depth, evidence-based coverage of more key content areas than any other rehabilitation resource of its kind, including orthopedics, neurology, and wound management, ensures a comprehensive understanding of rehabilitation supported by the latest clinical research.
• More than 65 case studies present a problem-based approach to rehabilitation and detail practical, real-world applications.
• Over 600 full-color illustrations clarify concepts and techniques.
• A FREE companion CD prepares you for practice with printable examination forms and reference lists from the text linked to Medline abstracts and reinforces understanding through interactive boards-style review questions, and vocabulary-building exercises.

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Editorial Reviews

Doody's Review Service
Reviewer: Omar Alphonso Ross, PT, ATC (North Hills Orthopedic and Sports Physical Therapy)
Description: This book provides physical therapy students and clinicians with a wealth of information about treatment and examination in a manner consistent with the Guide to Physical Therapist Practice, Rev. 2nd edition (American Physical Therapy Association, 2003), as well as current and applicable evidence.
Purpose: The purpose is to provide students and practicing clinicians with recommendations for evidence-based rehabilitation, examination, and intervention for a variety of patients. It further provides generalist and specialist practitioners with guidance in providing care across a wide variety of areas and patients. The book allows online access by instructors for lab instruction and image collection. The CD-ROM that accompanies the book enhances the text. This is a worthy effort, particularly in tying the information based on the Guide and the best available evidence together in a book for the student and practitioner alike.
Audience: Although geared towards both students and practitioners, students may benefit the most, particularly in the alignment of this book with the Guide and its introduction during didactic and clinical education.
Features: This book covers musculoskeletal, neuromuscular, cardiopulmonary, and integumentary systems. An interesting section provides information for interventions for many common conditions facing therapists.
Assessment: This is a necessary resource. Its strength is that it links evidence with the Guide without being confusing for students and too wordy for clinicians. This is a worthy addition to the library of anyone who teaches, practices, or is matriculating through a physical therapy program.
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Product Details

  • ISBN-13: 9780721603612
  • Publisher: Elsevier Health Sciences
  • Publication date: 4/5/2007
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 1120
  • Sales rank: 1,297,563
  • Product dimensions: 8.90 (w) x 11.10 (h) x 1.80 (d)

Table of Contents

Ch01: Introduction

• Introduces the student to physical rehabilitation

• Includes an introduction to disablement models (Nagi, ICIDH, ICF) and the Guide to Physical Therapist Practice, 2e

• Introduces the student to the text, including the structure, its basis in the APTA Guide to Physical Therapist Practice, 2e, and the additional resources available with the text

Ch02: Evidence-based Practice

• Presents the history and principles of evidence-based practice

• Includes a detailed discussion of techniques for evaluating the quality of research studies including criteria for what makes a study good or bad

Ch03: Skeletal Demineralization

Pathology discussion includes:

• Bone physiology (Unique)

• Risk factors (Unique)

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Testing considerations for patients with skeletal demineralization

• An overview of medical tests for bone mineral density

Intervention discussion includes:

• Aerobic exercise

• Resistance training

• Weight-bearing exercise

• Body mechanics training

• Medications, diet, and rehabilitation interventions for osteoporotic spinal fractures

Ch04: Posture

• Introduction covers ideal alignment and forces affecting posture

Pathology discussionincludes:

• Impaired posture

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• General posture

• Joint positions and motions, Positions and motions of specific joints (including the spine)

• Joint alignment by region

• Range of motion

• Muscle performance test

Intervention discussion includes:

• Stretching and mobilization

• Stabilization

• Exercise

• Coverage of proper alignment and control by region (Unique)

Ch05: Muscle Weakness

• Chapter begins with discussion of muscle structure, including physiology of muscle contraction and factors that affect muscle performance (Unique)

Pathology discussion includes:

• Muscle strain

• Disuse atrophy

• Muscle diseases

• Neurological diseases affecting muscle performance

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Testing of muscle performance and joint integrity

• Circulation, ventilation and respiration/gas exchange

• Orthotic, protective and support devices

Intervention discussion includes:

• Overload and SAID principles

• Exercise prescription and progression (Unique)

• Neuromuscular electrical stimulation

• Resistance training

• Muscle strength (isometric, isotonic, isokinetic, or plyometric) training (Unique)

Ch06: Connective Tissue Dysfunction

• Chapter focuses on systemic inflammatory diseases that cause joint inflammation

Pathology discussion includes:

• Systemic lupus erythematosus

• Rheumatoid arthritis

• Spondyloarthropathies

• Polymyalgia rheumatica

• Polymyositis and dermatomyositis

• Sjogren's syndrome

• Crystal-induced arthropathies

• Juvenile rheumatoid arthritis

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Focuses on musculoskeletal and neuromuscular examination

• Functional examination includes discussion of self-care and home

• management as well as community and leisure integration

Intervention discussion includes:

• Concerns specific to all disease processes discussed

Ch07: Localized inflammation

• Discussion focuses on osteoarthritis, bursitis, tendonitis, and tenosynovitis

Pathology discussion includes:

• Stages of tissue healing (Unique)

• Components of the functional joint complex (Unique)

• Specific inflammatory conditions: osteoarthritis, bursitis, capsulitis, ligament sprain, muscle strain, tendinitis, tenosynovitis, plantar faciitis, tensor fascia lata fasciitis, and pre- and post-natal soft tissue inflammation (Unique)

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Focus on musculoskeletal and functional examinations (gait, locomotion, and balance; assistive and adaptive devices/orthotic, protective, and supportive devices; ergonomics and body mechanics)

Intervention discussion includes:

• Iontophoresis

• Manual therapy

• Therapeutic exercise

• Orthotics

• Joint protection and tool modification

• Conservation of energy

Ch08: Spinal Disorders

• Discussion of low back pain, spinal degeneration, radiculopathy, intervertebral disc disease, spinal stenosis, spondylolysis, spondylolisthesis, whiplash-associated disorders, and back pain during (and after) pregnancy

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Specific examination techniques (including range of motion tests, muscle performance tests, mechanical provocation tests, peripheral nerve tests, neurodynamic tests)

Intervention discussion includes:

• Techniques for specialized topics (spinal stenosis, spondylolisthesis, and whiplash) (Unique)

• Special tests includes discussion of vertebral artery test, sacroiliac joint tests, examination of neighboring joints (Unique)

• Detailed mobility examination tests

• Tests for spinal instability (Unique)

• Craniovertebral joint examination tests (Unique)

Ch09: Fractures (Unique)

• Chapter begins with an introduction to normal bone

Pathology discussion includes:

• Fracture etiology, classification, risk factors, and healing

• Healing discussion that covers primary and secondary healing, stages and prognosis of healing, and types of fixation

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Examination for peripheral nerve integrity

• Examination of function (including gait, locomotion, and balance, and an examination of pre-existing assistive, adaptive, or support devices)

Intervention discussion includes:

• Communication, Documentation

• Exercise, Conditioning

• Functional training

• Manual therapy

• Physical, mechanical, and electrotherapeutic modalities

Ch10: Joint Arthroplasty (Unique)

• Chapter covers arthroplasty of the hip, knee, shoulder, elbow, wrist, and fingers

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Range of motion and joint mobility

• Muscle performance

• Gait, locomotion, and balance

Intervention discussion includes:

• Options specific to the type of arthroplasty discussed

• Specific intervention topics within individual joints focus on examination, pathology, prognosis, and interventions (including pre- and post-operative care)

• Individual interventions such as the use of modalities and reintegration of previous activities

Ch11: Soft Tissue Surgery (Unique)

Pathology discussion includes:

• Non-mineralized connective tissues of the musculoskeletal system: ligaments and tendons, articular cartilage, joint capsules, superficial fascia, and synovium

• Biomechanics

• Effects of immobilization and remobilization

• Overview of rehabilitation following soft-tissue surgery

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Functional examination covering gait, locomotion, and balance; orthotic, protective, and support devices; ergonomics and body mechanics; environmental barriers; and work, community, and leisure integration

Intervention discussion includes:

• General recommendations for the immediate and intermediate postoperative phases as well as in advanced strengthening and return to activity phases

• Specific recommendations after surgery of bursa and/or synovium, cartilage, fascia, ligament or capsules, or tendons (all tissue-specific topics cover examination, prognosis, and intervention)

Ch12: Amputations and Prostheses

Pathology discussion includes:

• Basic surgical procedures

• Reasons for amputations (including acquired versus congenital conditions)

• Types of amputations (both upper- and lower-extremity)

• Illustrations to clearly demonstrate levels of amputation

Examination discussion includes:

• All body systems, but is specific to the needs of a patient with an amputation

• Focus on the musculoskeletal examination and nerve sensation

Evaluation, Diagnosis, and Prognosis discussion includes:

• Medicare/Medicaid functional levels

• Functional impact of amputation on the patient

• Prognoses in patients with specific medical conditions

Intervention discussion includes:

• Pre- and post-operative care (mental, emotional, and physical)

• Early postoperative management

• Lower extremity prosthetic optionsh26

• Upper extremity prosthetic options (Unique)

• Prosthetics for lower extremity (partial foot, Syme's, transtibial, knee, transfemoral, hip, transpelvic, translumbar, and bilateral) and upper extremity (partial hand, transradial, transhumeral)

• Sections dedicated to functional training are also included (dressing, transfers, balance, gait, wearing schedule, use training, vocations, care of the residual limb)

Ch13: Balance and Fall Risk

• Epidemiology and definitions of balance and falls

Pathology discussion includes:

• Causes of balance dysfunction (peripheral sensory, central sensory, peripheral motor, central motor, and cognitive impairments)

• Impact of poor balance and limited postural control on gait

• Neurological disorders that affect balance (including Parkinson's disease, ataxia, and multiple sclerosis)

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Focus on the musculoskeletal, neuromuscular and functional examinations

• Six standardized tests of locomotion, balance, and fall risk

Intervention discussion includes:

• Flexibility exercises, strength training

• Vestibular training, sensory and perceptual training

• Postural awareness training

• Canalith repositioning treatments or maneuvers

• Patient education and injury prevention

Ch14: Impaired Neuromuscular Development

• Introduction to pediatric disorders (Unique)

• Introduction covers development terminology; delay, dissociation, and deviance; core developmental concepts (including forces that can impact development), principles of motor development and acquisition of motor milestones

Examination discussion includes:

• All body systems with a focus on how those systems develop

• Standardized tests of participation and activity

• Eight common measures for developmental testing

Ch15: Pediatric Nonprogressive Central Nervous System Disorders

• Discussion of pediatric disorders (Unique)

• Main chapter focus is cerebral palsy and spinal dysraphism in the pediatric population

Intervention discussion includes:

• Activity- and impairment-focused interventions

• Prevention of secondary complications

• Modification of the home environment

• Surgical interventions

• Structure of each section reflects structure of individual chapters from the text (follows the progression of pathology, examination, evaluation, diagnosis, prognosis, and intervention)

Ch16: Adult Nonprogressive Central Nervous System Disorders

• This chapter focuses on stroke and traumatic brain injury

• Introduction covers stroke etiology and sequelae

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Focus on the neuromuscular examination including: arousal, attention, and cognition; spasticity and muscle tone; and coordination, and movement patterns

• Functional examination: balance, and gait, self-care and home management and a variety of standardized functional measures specific to this population

Intervention discussion includes:

• Neurodevelopmental treatment (NDT)

• Proprioceptive neuromuscular facilitation (PNF)

• Task-oriented approaches

• Functional training in self-care and home management

Ch17: Progressive Central Nervous System Disorders

• This chapter focuses on Alzheimer'sdisease, amyotrophic lateral sclerosis, Huntington'sdisease, Parkinson'sdisease, and multiple sclerosis

Pathology discussion includes:

• Stages of progressive central nervous system disorders

• A table outlining common impairments and disabilities at different disease stages

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Considerations specific to each condition

Intervention discussion includes:

• Strength training and aerobic exercise

• Gait and balance training

• Sensory cueing

• Relaxation

• Functional and task-specific training

• Assistive devices and equipment

• Ventilatory support and airway clearance techniques

• Considerations specific to each condition are included within individual intervention topics

Ch18: Peripheral Nerve Injuries

• Chapter includes an overview of the peripheral nervous system including anatomy, physiology, and pathology of peripheral nerves (Unique)

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Neuromuscular examination focuses on: pain, cranial and peripheral nerve integrity, reflex integrity, and sensory integrity

• Three approaches to cranial and peripheral nerve integrity testing: electrophysiological, provocative, and autonomic

• Wide range of provocative tests used to detect nerve injury: Tinel'stest, Roos test, neural tension tests, elbow flexion test, Phalen'stest, carpal compression test, and piriformis tests

• A discussion of assessment of muscle function in children with obstetrical brachial plexus palsy (Unique)

Intervention discussion includes:

• Patient education

• Therapeutic exercise (including nerve gliding exercises)

• Joint range of motion and muscle stretching

• Sensory retraining

• Manual therapy techniques

• Splints and orthoses

• Electrotherapeutic, physical, and manual modalities

• Surgical intervention

Ch19: Polyneuropathies

Pathology discussion includes incidence, etiology, pathogenesis, and clinical presentation for:

• Guillain-Barré Syndrome

• Chronic Inflammatory Demyelinating Polyradiculopathy

• Diabetic neuropathy

• Charcot-Marie-Tooth disease

• Toxic neuropathies

Examination discussion includes:

• All body systems, and focuses on nerve integrity, electrodiagnostic evaluation, quantitative sensory testing, and the Semmes-Weinstein monofilament testing

Intervention discussion includes:

• Education (patient and family)

• Exercise

• Electrical stimulation

• Orthoses

Ch20: Nonprogressive Spinal Cord Disorders

Pathology discussion includes:

• Spinal shock

• Evolution of spinal cord injury

• Autonomic dysreflexia

• Pressure ulcers

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Neuromuscular examination includes examination of cognition, pain, reflex integrity, sensory integrity, and motor control

• American Spinal Injury Association (ASIA) scale

• Concerns of circulation, ventilation, aerobic capacity, and levels of function (Unique)

Intervention discussion includes:

• Options specific to the acute and rehabilitation phases

• Ten types of mobility skills including five types of transitions

• Functional training and leisure activity reintegration

• Airway clearance techniques

Ch21: Disorders of Consciousness: Coma, Vegetative State, and Minimally Conscious State

Pathology discussion includes:

• Etiologies for changes in consciousness including structural lesions, toxic or metabolic abnormalities, or diffuse brain damage (Unique)

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary) in a manner that addresses the medical needs of patients with changes in level of consciousness

Intervention discussion includes:

• Options presented to address general care concerns for patients with varying levels of awareness as well as optional interventions for special-needs patients (e.g. sensory stimulation or casting)

Ch22: Vital Signs

• Definitions and measurements of: temperature, pulse, blood pressure, respiratory rate, arterial oxygen saturation, and pain

• Discussions also include outside factors that can affect vital sign measurements (e.g. white coat hypertension or low perfusion rates) (Unique)

• The discussion of blood pressure includes both hypo- and hypertension (Unique)

• Specific information on autonomic dysreflexia

Ch23: Deconditioning

Pathology discussion includes:

• Introduction to the processes that result in deconditioning

• Etiologies

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Body composition and BMI

• Aerobic capacity and endurance

• Sub-maximal aerobic testing to estimation of VO2max

• Aerobic capacity

• Self-care and home management

Intervention discussion includes:

• Communication, education, and motivation

• Aerobic exercise guided by heart rate, metabolic demand, and perceived exertion

• Weight and circuit weight training

Ch24: Airway Clearance Dysfunction

Examination discussion includes:

• Chest examination; inspection; auscultation, palpation, and percussion

Intervention discussion includes:

• Breathing strategies for airway clearance

• Manual and mechanical techniques

• Mechanical devices for airway clearance

Ch25: Congestive Heart Failure

Pathology discussion includes:

• Classification of types of heart failure

• Characteristics of heart failure contributing to exercise intolerance

Examination discussion includes:

• All body systems with a focus on the cardiovascular and pulmonary components

• Circulation, and aerobic capacity and endurance

• Staging of heart failure

• Functional examination: quality-of-life measures

Interventiondiscussion includes:

• Aerobic, resistive, or interval training

• Safety concerns for patients with heart failure

• Special considerations for patients with heart transplants or mechanical assist devices

Ch26: Respiratory Failure

Pathology discussion includes:

• Anatomy of the respiratory system

• Physiology of ventilation and gas exchange

• Pathophysiology of the respiratory system

Examination discussion includes:

• Oxygen requirements and ventilation

• Arterial blood gases

• Chest and abdominal muscle function

Intervention discussion includes:

• Oxygen prescription, mechanical ventilation, breathing techniques, inspiratory muscle training, and behavioral interventions

Ch27: Lymphatic System Disorders

• Thorough introduction to the anatomy and physiology of the lymphatic system

Pathology discussion includes:

• Definitions of primary- and secondary- lymphedema

• Stages of lymphedema

Examination discussion includes:

• Measurement of edema

• Evaluation of circulation

Intervention discussion includes:

• Manual therapy (complete decongestive physical therapy and manual lymphatic drainage)

• Compression therapy (pneumatic, bandaging, garments)

• Exercise

Ch28: Tissue Healing and Pressure Ulcers

• Chapter includes epidemiology of pressure ulcers

• The chapter describes the process of wound healing and serves as an introduction to chapters 29, 30, and 31

Pathology discussion includes:

• Wound healing

• Chronic wounds

• Etiology of pressure ulcers (including an extended discussion of risk factors)

Examinationdiscussion includes:

• Wound and periwound tissue description

• Wound measurements

• Techniques for taking wound cultures

• Pressure ulcer staging

Intervention discussion includes:

• Wound prevention: support surfaces, positioning, moisture management, and nutrition

• Wound dressing

• Adjunctive therapies: pulsed lavage with suction, vacuum-assisted closure, and electrical stimulation

Ch29: Vascular Ulcers

Pathology discussion includes:

• Vascular anatomy

• Etiology of arterial ulcers, venous ulcers, and mixed arterial and venous ulcers

Examination discussion includes:

• Circulation (pulses, ankle-brachial index, transcutaneous partial pressure of oxygen measurement, capillary refill time

• Typical characteristics of venous and arterial ulcers

Intervention discussion includes:

• For arterial ulcers: dressings, pain management, exercise and activity, electrotherapy, growth factors, intermittent pneumatic (dynamic) compression, hyperbaric oxygen therapy, nutrition, surgery, education

• For venous ulcers: focus on compression therapy

Ch30: Neuropathic Ulcers

• This chapter focuses on treatment of ulcers associated with diabetes

Pathology discussion includes:

• Sensory, motor, and autonomic neuropathies

• Pathology of diabetes mellitus

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Sensation testing

• Evaluation of circulation (capillary refill test, venous filling time, rubor of dependency test, great toe pressure, transcutaneous oxygen tension, systemic blood pressure)

• Integumentary integrity

Intervention discussion includes:

• Patient education

• Blood glucose control

• Exercise

• Orthoses and footwear

• Foot care

• Treatment of the neuropathic wound focuses on off-loading with total-contact casting or cast alternatives

• Management of the post-amputation wound and post-healing foot

Ch31: Burns

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Integumentary examination focuses on burn depth, burn size, and scar

Intervention discussion includes:

• Wound care

• Edema control

• Pain control

• Strengthening, range of motion, and aerobic exercises

• Scar management

• Rehabilitation for associated injuries

Ch32: Gait Assessment and Training

• This chapter provides clear and extensive discussion of functional walking and the gait cycle (Unique)

Pathology discussion focuses on:

• Each phase of the cycle; their subdivisions and functional events; temporal and distance parameters; and limb and trunk kinematics

Examination discussion includes:

• All body systems in relation to gait

• Gait-specific tests and measures in a framework of observational gait analysis (OGA) and stride analysis

• Observational gait analysis: procedure, reliability and validity, videotaping, standardized tests and measures that rely on OGA, and standardized tests and measures that do not rely on OGA

• Stride analysis: gait velocity, and footfall measurement technologies discussion includes hand-held stopwatch, six-minute walk test, inked footprint methods, instrumented walkways, stride analyzers and in-shoe microprocessor systems

Intervention discussion includes:

• Task-specific training for gait

• Body weight support treadmill training

• Non-task-specific training for gait (strength training, neurodevelopmental treatment approaches, motor relearning program approach, balance training, and aerobic conditioning)

Ch33: Assistive Devices for Mobility: Canes, Crutches, Walkers, and Wheelchairs

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• Musculoskeletal and neuromuscular examination, including discussions of range of motion, muscle performance, pain, nerve integrity, and sensory integrity

Intervention discussion includes:

• Selection of assistive devices for ambulation (canes, crutches, and walkers)

• Fitting of assistive devices for ambulation includes canes, crutches, walkers, and complications of assistive device use

• Wheelchair selection

• Wheelchair features: mode of propulsion (dependent, independent, combination), frame, seat, backrest, armrests, front rigging, wheels, and support accessories

• Wheelchair fitting: seat, backrest, armrests, and complications of wheelchair use

Ch34: Orthotics

• Design factors (function, comfort, pressure systems) and materials

• Lower-extremity orthoses:

• Shoe and foot

• Ankle-foot

• Knee-ankle-foot

• Hip-knee-ankle-foot

• Trunk-hip-knee-ankle-foot

• Spinal orthoses:

• Trunk (corsets, and rigid lumbosacral and thoracolumbosacral)

• Cervical

• Orthoses for patients with scoliosis

• Upper-extremity orthoses:

• Wrist-hand

• Thumb and finger

• Forearm and elbow

• Shoulder

Ch35: Environmental Assessment: Home, Community, and Work

Examination discussion includes:

• All body systems (musculoskeletal, neuromuscular, cardiopulmonary, and integumentary)

• A focus on environmental barriers outside the home, inside the home, in specific rooms, and special work considerations

• A section on Americans with Disabilities legislation

Intervention discussion focuses on:

• Optimization and modification of environmental barriers

• Environmental barriers:

• Exterior (access routes, stairs, ramps, handrails, elevators, escalators)

• Interior barriers (access routes, doorways, turning, lighting, seating, countertops, reach zones, sinks)

• Specific rooms (kitchen, bathroom, toilet, bath/shower, bedroom, laundry room)

• Communication (telephone, writing, computer use)

• Unique workplace considerations

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