Funded By:
The use of the Dictionary of Occupational Titles (DOT) requires some understanding of the total Job classification processes. These are as follows:
Summary Listings of Occupational Categories, Divisions, and Groups
Occupational Divisions:
(000 through 199) Professional, Technical or Managerial Occupations
(200 through 299) Clerical and Sales Occupations
(300 through 399) Service Occupations
(400 through 499) Agricultural, Fishery, Forestry, and Related Occupations
(500 through 599) Processing Occupations
(600 through 699) Machine Trades Occupations
(700 through 799) Benchwork Occupations
(800 through 899) Structural Work Occupations
(900 through 999) Miscellaneous OccupationsTerm Titles and Definitions:
These are listed in DOT, Fourth Edition, 1977 (pp. 5-14). These were used to select appropriate jobs for individuals with NMDs.Occupational Group Arrangement:
These are listed in DOT, Fourth Editions, 1977 (pp. 15-946). Definitions in this section were used to select appropriate jobs for individuals with NMDs.Glossary.
Listed in DOT, Fourth Edition, 1977, (pp. 947-963).Alphabetical Index of Occupational Titles:
Listed in DOT, Fourth Edition, 1977 (pp. 965-1156).Occupational Titles Arranged by Industry Designation:
Listed in DOT, Fourth Edition, 1977 (pp. 1157-1367).Physical Demands:
See Selected Characteristics of Occupations Defined in the Dictionary of Occupational Titles, 198 1, Appendix A, (pp.465-466.)
Used to classify jobs for individuals with NMDs.Environmental Conditions:
isted in Selected Characteristics of Occupations Defined in the Dictionary of Occupational Titles, 198 1, Appendix B, (pp. 467).Specific Vocational Preparations-Training Time:
Listed in DOT Supplement, Appendix D, 1981 (pp. 473).Physical Demands:
Listed in DOT Supplement to Fourth Edition, Appendix D, 1986 (pp. 101-102).Environmental Conditions:
Listed in DOT Fourth Edition Supplement, Appendix D, 1986 (pp. 103).
The job listings for NMDs (at the end of this guide) have been abstracted from the DOT and include ratings for "physical demands " and "environmental conditions.”
The ratings are.
1. S. - Sedentary Work
2. L. - Light Work
3. M. - Medium Work
4. H. - Heavy Work
5. V. - Very Heavy Work
6. For environmental conditions see Appendix B, D.O.T., 1981, p.467.
These ratings are helpful when selecting occupations for the general public. For individuals with NMDs it was necessary to break down the light and medium occupations into subcategories which are consistent with physical / mental limitations imposed by NMD.
Individuals with NMDs are placed in work ability categories, and these are matched with jobs and job areas. They are:
Social attitudes and preconceptions play an important role in how people with disabilities are perceived. In the past, misinformation and stereotypes have governed how individuals with neuromuscular disease are treated across a broad set of situations. This has begun to change but there is still a long way to go. The foregoing was intended to provide some insight into the functional capacity of those who live with neuromuscular disease and enable you to better serve this segment of the community.
The mission of the Department of Rehabilitation (DR) is to “assist Californians with disabilities in obtaining and retaining employment and maximizing their ability to live independently in their communities.” However, the ability of the DR to serve the NMD population has not been entirely successful. Among individuals with NMD who have been referred to the DR in the past, only 18% wanted to be referred again and of those who had not been referred only 30% were interested in a referral. This implies that people who have experience with the DR were not entirely satisfied, and those with no experience did not appear to believe DR services would be beneficial. So, how can rehabilitation counselors better serve this segment of the community?
Unemployed disabled individuals who want to and believe that they are able to work cite low-paying jobs and the lack of education, training and skills needed for full-time work as a major cause of their unemployment. This does not however mean that they cannot successfully complete training programs or, with some adaptations in the work environment, succeed in high level positions. Through effective functional assessment, education, and the use of assistive technology, the functional consequences of NMD on career success can be greatly reduced and in some cases even eliminated.
Improved service begins with an accurate understanding of what a person with neuromuscular disease can do and what their limitations are. Currently, societal attitudes and lack of understanding are among the most significant barriers individuals with NMD face. Perhaps the best way to convey the impact that stereotypes and misinformation have on persons with NMD is to hear it in their own words:
A participant in one RRTC study remarked, "Physical barriers did not turn out to be the problem.... Social attitudes were the most profound barriers throughout the course of my life." (interview #4, 3/17/95).
Another reported, "My biggest barriers have been my own attitudes to begin with. And then when I worked on that attitude and became very healthy with where I was as a disabled person, it became even more glaring, the attitude problems that society has with disability." (interview #36, 8/12/96).
It is important to understand that the needs of people with a slowly progressive NMD change over time, which requires a periodic reassessment by the rehabilitation team of assistive technologies that can improve mobility and speech.
Perceived limitations can play an important role in how a person with NMD is placed in an employment setting. By educating themselves on the basic characteristics of NMD or even just spending a little extra time with each person discussing specifically how the disease affects them, counselors can develop a better understanding of the barriers a person with NMD faces. More important is to figure out how to work around those barriers for a successful career placement outcome. Remember that the most common barriers a person with NMD faces are related to lack of mobility, not cognitive deficits.
Successful career placement requires the expertise and cooperation of everyone involved in the rehabilitation process, including the employee, their doctor, employer, and rehabilitation technology specialist, but it must begin with an accurate assessment by the rehabilitation counselor. An elementary understanding of NMD would contribute significantly to a counselor's ability to assess an individual's competitiveness in the job market. Also, focus on what people are able to do and what they could be capable of doing if the proper training and assistive technology were available to them.
Assistive technology was defined in the Technology Related Assistance for Individuals with Disabilities Act of 1988 as:
"any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."
Rehabilitation professionals must develop a general awareness of the potential for assistive technology for individuals with NMD. Comprehensive knowledge of AT is helpful but not required. However, the counselor must know enough to recognize when AT is appropriate and provide the necessary resources or referrals. Selection, implementation, and follow up all contribute significantly to the utility of adaptive technology and the difference it makes in a person's ability to succeed in a career. Assistive technology can greatly increase independence, productivity, and confidence, all of which contribute to an individual's success in the employment marketplace.
The most effective application occurs when a multidisciplinary team works together to develop solutions to resolve barriers to employment. This team should include the rehabilitation counselor, the client, an expert in assistive devices, and the employer. Having someone on the team knows the potential sources of funding for AT can contribute to a client's success in obtaining AT. However, solutions do not need to be expensive. A close partnership between the rehabilitation counselor, employer, and employee can create cost-effective solutions that benefit both the employee and employer.
The rehabilitation counselor is also in a good position to facilitate and coordinate effective communication between the members of the rehabilitation team. A counselor can address potential concerns of employers and dispel any misconceptions they may have regarding accommodation of a disabled individual. For example, some employers assume that adaptations are expensive and time consuming, when most accommodations are very simple and have a minimal cost.
Agencies must look for innovative ways to provide AT expertise. This can be accomplished several ways. Someone who has a strong technical background in assistive technology can be hired as part of the regular staff. Counselors can attend training programs or attend assistive technology conferences to improve their understanding of how to effectively integrate assistive technology into the rehabilitation process. Another option is to use a program like Project threshold.
Project Threshold at Los Amigos Research and Education Institute, Inc. at Rancho Los Amigos National Rehabilitation Center is one example of how a range of services can be provided efficiently to clients who are experiencing problems as they pursue independent living, education or vocational goals. This program provides services to clients throughout the state of California . Occupational therapy and engineering staff provide evaluations, recommendations, custom modification of equipment and follow-up. These services are available in most areas, but what makes Project Threshold unique is that they come to the individual's home and office. This in turn provides an accurate assessment, because they can identify barriers specific to an individual's home and work environment and allows hands-on testing of technology before recommendations are made.
Obtaining feedback is a critical component of successfully completing the job placement process. The current low satisfaction rate with the DR might be improved by revising the way in which clients give feedback in order to elicit more constructive suggestions about the job placement process.
Another tool that may contribute to successful job placement is the new Occupational Information Network (O*NET). This is a database that contains comprehensive information on job requirements. O*NET replaces the Dictionary of Occupational Titles and offers a more dynamic, interactive framework for exploring career options. By identifying and describing the key components of occupations, including the high-tech industry, O*NET supplies up-dated information critical to the effective training, education, counseling and employment of workers.
People with neuromuscular disease have shown a remarkable ability to adapt to their disease. Integrating new resources, like O*Net, with assistive technologies, combined with an increased level of awareness on the part of the rehabilitation counselor, could contribute significantly to long term, fulfilling careers for individuals with neuromuscular disease. However, an individual with NMD must also make a significant contribution to the career placement process.
The consumer has much to do with the success of the job placement process. The consumer must provide detailed information about what their needs are and be prepared to advocate on their own behalf. Each person going through the rehabilitation process must make a strong effort to educate him or herself, because without a basic awareness of the resources and services that are available, the ability to overcome barriers to independence, productivity, and professional success will be limited.
Consumers must also be willing to provide constructive feedback about the effectiveness of AT and other services. Without this feedback, improvements to existing services and technology will be limited. By playing an active role in the rehabilitation and job placement process, an individual with NMD will increase the chance that they will find a fulfilling and lasting career.
Currently, societal attitudes and lack of understanding are among the most significant barriers individuals with neuromuscular disease face. In the past, misinformation and stereotypes have governed how individuals with neuromuscular disease are treated, especially in the employment marketplace. We hope that, by increasing awareness about NMD, we have dispelled some of these stereotypes and are contributing to a change in attitude that will improve the quality of life and job opportunities for individuals with neuromuscular disease.
REFERENCES.
1 Employment Profiles in Neuromuscular Diseases, American Journal of Physical Medicine & Rehabilitation. Am J Phys Med Rehabil 76: 26-37, 1997.
2 O*Net, http://online.onetcenter.org/