The guidelines provided by the New York State Workers Compensation Board offer general principles for Rehabilitation. These directives aim to assist healthcare professionals in determining appropriate diagnostic approaches as part of a comprehensive assessment.
Healthcare professionals specializing in Rehabilitation can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable diagnostic methods for their patients.
It is important to stress that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding diagnostic studies should involve collaboration between the patient and their healthcare provider.
Rehabilitation
Rehabilitation (supervised formal therapy) necessary due to a work-related injury should concentrate on restoring the functional ability required for the patient’s daily and work activities, aiming to return the patient to their pre-injury status to the extent feasible. Active therapy involves internal effort from the patient to complete specific exercises or tasks, while passive therapy relies on interventions delivered by a therapist without patient exertion.
Generally, passive interventions are seen as a means to facilitate progress in an active therapy program and achieve objective functional gains. Emphasis should be placed on active interventions over passive ones. The patient is advised to continue both active and passive therapies at home as an extension of the treatment process to maintain improvement levels. Assistive devices may be included in the rehabilitation plan as an adjunctive measure to facilitate functional gains.
Physical/Occupational Therapy Recommended for improving function, including range of motion and strength. The total number of visits may range from two to three for patients with mild deficits to 12 to 15 for those with more severe deficits, with documentation of ongoing objective functional improvement.
If ongoing deficits persist, more than 12 to 15 visits may be indicated with documented improvement towards specific functional goals. A home exercise program should be developed and performed in conjunction with therapy as part of the rehabilitation plan. Discontinuation is indicated in case of pain resolution, intolerance, lack of efficacy, or noncompliance.
Activities of Daily Living (ADL) Instruction, active-assisted training, or adaptation of activities or equipment to improve a person’s capacity in normal daily activities are considered. Recommended for select patients as clinically indicated. Typically, two to three times per week with four to five treatments needed to produce effect and a maximum of three weeks as clinically indicated.
Functional Electrical Stimulation The application of electrical current to elicit involuntary or assisted contractions of atrophied and/or impaired muscles is recommended for select patients as clinically indicated. Indications include muscle atrophy, weakness, and sluggish muscle contraction due to pain, injury, neuromuscular dysfunction, or peripheral nerve lesion, or in cases where the potential for atrophy exists. It is typically administered three times per week, with two to six treatments needed to produce an effect and a maximum of eight weeks as clinically indicated.
Gait Training
Gait Training involves instruction on crutch walking, cane, or walker use.
Recommended – for select patients with lower extremity injury or surgery.
Indications: include the need to promote a normal gait pattern with assistive devices, instruct in the safety and proper use of assistive devices, guide in the progressive use of more independent devices (e.g., platform-walker, to walker, to crutches, to cane), provide instruction in walking on uneven surfaces and steps (with and without railings) to reduce the risk of fall or loss of balance, and instruct in equipment to limit weight-bearing for the protection of a healing injury or surgery.
Frequency: Typically, two to three times per week with three to four treatments needed to produce an effect and a maximum duration of two weeks as clinically indicated.
Neuromuscular Re-Education
Recommended – for select patients as clinically indicated.
Indications: May be indicated for retropatellar and patella-femoral degenerative joint conditions.
Frequency: Two to three times per week with three to four treatments needed to produce an effect.
Optimum/Maximum Duration: Two weeks.
Therapeutic Exercise
Therapeutic Exercise, with or without mechanical assistance or resistance, may include isoinertial, isotonic, isometric, and isokinetic types of exercises.
Recommended – for select patients as clinically indicated.
Indications: Include the need for cardiovascular fitness, reduced edema, improved muscle strength, improved connective tissue strength and integrity, increased bone density, promotion of circulation to enhance soft tissue healing, improvement of muscle recruitment, increased range of motion, and promotion of normal movement patterns. Can also include complementary/alternative exercise movement therapy.
Frequency: Typically, three to five times per week with two to six treatments needed to produce an effect and a maximum of eight weeks as clinically indicated.
Wheelchair Management and Propulsion
Wheelchair Management and Propulsion involve instructing and training individuals in self-propulsion and the proper use of wheelchairs, including transfer and safety instructions.
Recommended – for select patients as clinically indicated.
Indications: For patients unable to ambulate due to bilateral lower extremity injuries, inability to use ambulatory assistive devices, and in cases of multiple traumas.
Frequency: Typically, two to three times per week with two to six treatments needed to produce an effect and a maximum duration of two weeks as clinically indicated.
Continuous Passive Movement (CPM)
Continuous Passive Movement is a form of passive motion using specialized machinery that moves a joint and may also facilitate blood and edema fluid away from the joint and periarticular tissues.
Recommended – in select post-operative patients.
Indications: CPM is effective in preventing joint stiffness if applied immediately following surgery. It should be continued until the swelling limiting joint motion no longer develops. Range of motion for the joint begins at the level of patient tolerance and is increased twice a day as tolerated. Home visits may be required for equipment use.
Frequency: Up to four times per day for up to three weeks post-surgery.
Contrast Baths
Not Recommended
Electrical Stimulation (Physician or Therapist Applied)
Recommended – as a component of a comprehensive treatment plan.
Frequency: Two to three times a week for a maximum of up to two months.
Not Recommended – as a stand-alone treatment.
Fluidotherapy
Fluidotherapy employs a stream of dry, heated air over the injured body part, allowing exercise during the application of dry heat.
Recommended – in select patients as clinically indicated.
Indications: Include the need to enhance collagen extensibility before stretching, reduce muscle guarding, or reduce inflammatory response.
Frequency: Typically, one to three times per week with one to four treatments needed to produce an effect and a maximum of one month as clinically indicated.
Infrared Therapy
Not Recommended
Iontophoresis
Not Recommended
Kinesiotaping, Taping, or Strapping
Recommended – in select patients.
Indications: Acute joint immobilization (e.g., acute ankle sprain).
Not Recommended – for acute or non-acute pain.
Manipulation
Manipulation is manual therapy that moves a joint beyond the physiologic range of motion but not beyond the anatomic range of motion.
Recommended – in select patients as clinically indicated.
Indications: Locked knee, contracture, or pain and loss of range of motion due to adhesions or contractures.
Frequency: Typically, one to five times per week (as indicated by severity and desired effect) with immediate effect and a maximum of ten treatments as clinically indicated.
Manual Electrical Stimulation
Manual Electrical Stimulation is employed for peripheral nerve injuries or continuous pain reduction, requiring continuous application, supervision, or extensive teaching.
Recommended – for select patients as clinically indicated.
Indications: Include muscle spasm (including TENS), atrophy, decreased circulation, osteogenic stimulation, inflammation, and the need to facilitate muscle hypertrophy, muscle strengthening, and muscle responsiveness in Spinal Cord Injury/Brain Injury (SCI/BI) and peripheral neuropathies.
Frequency: Typically, three to seven times per week with a maximum duration of two months as clinically indicated.
Massage: Manual or Mechanical
Not Recommended
Mobilization (Joint)
Mobilization is passive movement, possibly including passive range of motion, performed in a manner within the patient’s ability to prevent the movement if they choose.
Recommended – for select patients as clinically indicated.
Indications: Include the need to improve joint play, improve intracapsular arthrokinematics, or reduce pain associated with tissue impingement/maltraction.
Frequency: Typically, three times per week with six to nine treatments needed to produce an effect and a maximum of ten treatments as clinically indicated.
Mobilization (Soft Tissue)
Mobilization (Soft Tissue) is the skilled application of manual techniques designed to normalize movement patterns by reducing soft tissue pain and restrictions.
Recommended – for select patients as clinically indicated.
Indications: Include muscle spasm around a joint, trigger points, adhesions, and neural compression.
Frequency: Typically, two to three times per week with two to three weeks needed to produce an effect and a maximum of ten treatments as clinically indicated.
Paraffin Bath
Not Recommended
Superficial Heat and Cold Therapy
Superficial heat and cold therapies involve thermal agents applied to lower or raise body tissue temperature, reducing pain, inflammation, and/or effusion resulting from injury or exercise.
Recommended – for select patients as clinically indicated.
Indications: Include acute pain, edema, hemorrhage, the need to increase pain threshold, reduce muscle spasm, and promote stretching/flexibility. May be performed with other active therapy or self-administered by the patient.
Frequency: Typically, two to five times per week with immediate effect, a maximum duration of two months, and an optimum duration of three weeks as primary or up to two months if used intermittently as an adjunct to other therapeutic procedures.
Short-Wave Diathermy
Not Recommended
Traction
Not Recommended
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) treatment requires at least one instructional session for proper application and use.
Recommended – for select patients as clinically indicated.
Indications: Include muscle spasm, atrophy, and control of concomitant pain in the office setting. Minimal TENS unit parameters should include pulse rate, pulse width, and amplitude modulation. Consistent, measurable, functional improvement must be documented, and determination of the likelihood of chronicity must precede the provision of a home unit. TENS treatment should be used in conjunction with active physical therapy.
- Time to produce effect: Immediate.
- Frequency: Variable.
- Optimum duration: Three sessions.
- Maximum duration: Three sessions. Purchase or provide with a home unit if effective.
