Bledsoe Occupational Therapy, LLC

09/01/2025

Topic: Working in the COLD
Word Count: 229
Estimated Read time: 55 seconds.

In my clinic, we operate without heat or air conditioning because many of my patients work in similar conditions.

Is it harder to work in the heat or in the cold?

Working in cold conditions can be risky. The body responds in two primary ways: constricting blood vessels to retain heat in the core (resulting in cold fingers and toes) and shivering to generate more heat.
In the cold, your BP will increase due to vasoconstriction. You also have unaware dehydration with cold work. Cold air is often dry, and breathing in such conditions leads to significant water loss through respiration. Vasoconstriction triggers the kidneys to produce more urine, leading to fluid loss. Cold temperatures can reduce muscle flexibility and increase the risk of strains.
This is why even a few minutes of shoveling snow has a well-documented history of triggering heart attacks. While there are numerous strategies to mitigate the risks of working in cold environments, these are often overlooked by medical professionals when advising patients. Following a significant injury, careful consideration must be given to the environment the patient is returning to. Simply marking "return to work full duty" is insufficient. Additional time and preparation may be necessary to ensure the patient is truly ready to resume full-duty work safely.

I plan on adding a section to address these concerns on my 2025 FCEs.

Thanks for your time, hope everyone had a Happy New Year. Please continue sending me your FCE / PPI questions.
Dave

19/12/2024

15/11/2024

Topic: Length of FCEs

Word Count: 223

Estimated Read Time: 50 seconds

You’ve heard the quote: If I Had More Time, I Would Have Written a Shorter Letter. I guess since you guys are lawyers, you could say “If I Had More Time, I Would Have Written a Shorter Brief.
How many pages is enough for an FCE?
A big part of my week is reviewing FCEs from around the country. I typically review 5-10 reports per week. I have seen as brief as 2 pages and as much as 76 pages. I usually keep mine at 6-8 pages but will occasionally limit it to 3-4. Most of the lengthy FCEs are just boilerplate language and bolstered by a lot of useless “filler”. Reports that are either too brief or too wordy are easy to impugn.
If you stumble across either one of these, send them my way and I can give you my free “thin slice” opinion. It will be worth what you pay for it, but sometimes I can expose vulnerabilities you may have overlooked. (The short ones will usually be missing one or more of the 4 FCE requirements)
As far as the quote “If I Had More Time, I Would Have Written a Shorter Letter”., many different attributors are claimed. After a thorough (almost 3 minutes!) search, it is more likely than not to been first said by Blaise Pascal (1657).
Thanks for your time and your business. Please continue sending me your FCE / PPI questions.
Dave
Cell phone (205) 427-6329

28/03/2024

Topic: Treadmills on FCEs
Word Count : 211
Estimated Read Time: 45 seconds.

On many FCEs you will see walking tested on a treadmill. I am reviewing one that says, “15 minutes on treadmill @ 2.0 mph without difficulty”. To offer an opinion on walking from a treadmill test may not be the best idea.
(We are not going to discuss the fact that 2.0 mph is 33% slower than norms and that the patient probably used their hands on the treadmill supports and relied on the belts motion to maintain pace)
1. In real life, walking involves traversing varied terrain, inclines, declines, and obstacles, which require different muscle groups and coordination.
2. The treadmill belt limits the natural stride length. The automatic motion of the belt also assists walking.
3. Balance is not properly assessed on a treadmill. Treadmills provide minimal proprioceptive feedback, and the patients hands are often on support bars.
4. Studies shown that muscle activation patterns differ between treadmill walking and overground walking, (engage different muscle groups and utilize different movement strategies).
While treadmills are a useful tool for exercise, they do not fully replicate the complexities of real-life walking.
If you are examining an FCE that used treadmills instead of “overground” walking, you have a vulnerability in the report that you can exploit.