Enabling Access Blog


Today’s disability rehab and insurance world, stuffed with heavy caseloads, time pressures, and all-consuming client needs, often stretches rehab professionals and disability case managers to their breaking point. Some days, getting out of bed to drag yourself into the office or clinic can seem overwhelming. One in five Canadians will experience a mental illness at some point in their lifetime The annual cost of loss of productivity due to mental illness in the workplace in Canada was estimated to be over $6.4 billion in 2011.² Let's switch our focus from clients to self, for a moment. We all know there are several things we should be doing for our own health and wellness, such as exercising and eating well, but there are also many small steps we can take to improve our mental health and productivity so we are better able to cope with our stressors and support those clients who need us at our best.


1. Take frequent breaks. A recent study found that people who worked for 52 minutes and then took a 17-minute break were the most productive.³ Set a timer, stretch, go to the bathroom, chat with a co-worker, get a drink of water, or go retrieve something from the printer. This will also help discomfort related to static sitting or standing at your desk.


2. Start drinking peppermint tea. Caffeine consumption is often under-recognized as a contributor to the development of anxiety disorders and panic attacks. Peppermint tea can help you feel more alert and improve your memory, but will not contribute to anxiety as both coffee and black can.


3. Spend time with positive, supportive people. This seems like common sense, but we often end up having lunch with whoever happens to be in the lunchroom. Find people whose company you truly enjoy, and who lift you up. Arrange lunch and coffee dates with them. Having strong social supports is an essential part of resilience, so they will help you be able to weather your workplace and home stressors. 


4. Shut off your screens (T.V., tablet, phone, etc.) at least an hour before bedtime. Sleep deprivation has so many negative effects on our mental health. Often, we feel like we are resting when we do these activities, but our bodies are actually alert. The blue light from the screens makes us more alert and interferes with our ability to fall asleep. We become distracted by what we are doing and end up staying up way too late, which we regret the next morning.


5. Practice mindful relaxation for 2-5 minutes, twice daily. Relaxation techniques can help boost your mood and find a feeling of calmness when everything feels chaotic. You can do them anywhere and anytime, and they do not have to be difficult or time-consuming. Start by sitting comfortably and closing your eyes. Take several deep breaths and pay attention to the feel and sound of the breath coming in and out of your body. Keep doing this for a couple minutes. When thoughts come into your head (and they will!), let them pass through and re-focus on your breath.


6. Surround yourself with pictures of green spaces. We know that spending time in nature helps relieve depression and anxiety and increase productivity, but working in an office or clinic can be about as far away from nature as possible. Ideally, we would all be out walking in a park on our lunch breaks, but having a plant at our desk and/or pictures of green spaces (e.g. as your computer background picture) can help lower our stress levels. 


7. Choose cues to link your habit changes. If you are trying to change a habit, such as exercising more, link it to something you already do. For example, if you want to start meditating, decide to do it when you get your first cup of coffee in the morning (or peppermint tea!), you will be a lot more successful than if you just decide to do it every morning. You can also choose cues to replace an old bad habit with new ones. If you usually use your afternoon break (which is the cue) to go get a donut, you could change that behavior pattern to going for a short walk in a nearby green space with a friend. 


8. Take your vacation. When we get busy, it is easy to feel like we need to keep plowing through the work to get it done. However, vacation time decreases our errors and increases our productivity. Shifting focus from work to fun does the body and mind, good!


9. Choose your environment carefully.  Just as a shade plant will never thrive in the sun, no matter how often you water or fertilize it, there are some work environments you may never thrive in, no matter how much yoga or deep breathing you do. If you are in this situation, think through your options carefully. Can you do a different job with the same employer? Can you do your same job at a different employer? Is there flexibility available to do your job part-time? You are much better to think through your options now when you are not on stress leave, than to wait until you are no longer able to work. It is much harder to find a new job when you are not working.  


10. Do not be afraid to seek help. Talk to your doctor about your mental health. Many employers have an Employee Assistance Plan where you can access free counseling sessions. You do not have to wait to be in a crisis situation to use these. In fact, it is totally fine to do “preventive counseling”. 



1.Linda Harrison, Occupational Therapist with Enabling Access Inc. specializes in mental health screenings, activation therapy, cognitive behavioural therapy, is a certified BrainFX 360 cognitive evaluator and leads our Mental Health and Cognitive OT services.

2. Marnie Courage, Occupational Therapist and Director at Enabling Access Inc.


References and Related Reading:





5.http://www.scielo.br/scielo.php pid=S1414753X2014000300009&script=sci_arttext&tlng=en







March 13 to 19, 2017 is Brain Awareness Week.


The Canadian Human Rights Act requires that employers ensure that all people are treated equally. This sometimes involves accommodating an employee’s needs, changing the work environment, or duties to enable full participation in their jobs. Duty to Accommodate applies only to needs that are based on one of the grounds of discrimination.


The following are brain function related disabilities:


Neurological Disability - A neurological disability refers to a group of disorders that primarily relate to the central nervous system comprised of the brain and spinal cord. For example, cerebral palsy, epilepsy, acquired brain injury, and multiple sclerosis.


Mental Disorder - A Mental Disorder is a syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. (5th ed.; DSM-5) For example, anxiety disorders, depression, obsessive-compulsive disorder (OCD), and attention-deficit hyperactivity disorder (ADHD).


Mental Illness, like Depression, can cause memory loss and concentration difficulties and anxiety can lead to difficulty with organization of thoughts, concentration, and problem-solving. In fact, 80% of disability costs are related to mental health conditions (Conference Board of Canada 2011).


Learning Disorder -  Disorders which may affect the acquisition, retention, understanding, or use of verbal or nonverbal information (Job Accommodation Network, 2013) For example, dyslexia, dyscalculia, and dysgraphia.


The above differences may be invisible to others, but certainly present real challenges for the individual experiencing the conditions, those working with, and supervising the individual. Cognitive performance areas often affected can include working memory, attention, concentration, judgment, calculation, sequencing, and more. Often, emotional regulation and sensory processing issues co-exist.


Sometimes employers are challenged with finding accommodations for employees without fully understanding (or without being provided with) the medical background related to the disability. When there are questions about an employee’s cognitive abilities, A Cognitive-Functional Capacity Evaluation can answer task-specific employee limitations and strengths. If it is determined the current job is no longer a safe match for the employee, a Psycho-Vocational Assessment can assist in determining appropriate job match criteria, further training and accommodations required. 


Here are some workplace accommodation resources for brain function related disabilities:


Mental Health Accommodations

Cognitive Accommodations

Cognitive Academic Accommodations


Enabling Access Inc. assists employers with job accommodation services,  including the assessments above, as well as, Stay-at-Work and Return-to-Work consultation.


Marnie Courage, OT Reg (MB)

Director of Enabling Access Inc.

Winnipeg, Manitoba, Canada




If you are an occupational therapist, work in human services, or have an adult family member with an intellectual or developmental disability, you know that teaching daily living skills takes patience, repetition and demonstration.  Often we use role playing, workbooks and computer programs to assist us in getting the content across, as learning this stuff can be a challenging experience for many.


Linda Harrison’s “Daily Living Skills Worksheets” is a great teaching aid for content related to Memory/ safety, Leisure/productivity, Communication, Managing Meetings, Problem Solving/reflection and Recording thoughts and feelings. Each worksheet is accompanied by guidelines that include the purpose and directions for use, including helpful tips.



I can see this being a helpful tool when an individual is moving into a new residence, is having difficulty living on their own, lacks initiative for creating structure in their routine, or lacks awareness of personal hygiene and health, which all can be barriers to living independently.  Many worksheets deal with budgeting, home and community management, as well as medication management. There are even a few sheets that deal with social skills.


The importance of first assessing barriers to independence and identifying which occupational performance components to measure, cannot go unmentioned here. The OT, teacher or caregiver should focus on the concepts that require improvement, and not overwhelm the student with working through several concepts  at once by working through these sheets quickly. In my experience, choosing one area of focus for several sessions and allowing the student to absorb the information, practice the skills and apply them to their life, is best, before moving other areas.  Using SMART goals are a great way to know when it is time to move onto the next concept.


It is refreshing to see occupational therapists sharing information and tools, while making them accessible to all, in order to improve our practices and assist new OT’s in their professional development. You can learn more about this resource at www. dailylivingskills.com.



Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access




When working with clients to make a home or work space welcoming, accessible and without barriers, one can incorporate the ancient art of Feng Shui.


Feng Shui (pronounced fung schway) is for everyone. How a house or work space is designed, decorated and put together can ultimately influence your clients to experience positive energy tied to happiness, fulfillment and harmony.


To start, there are four classifications of Feng Shui:


Practical Feng Shui, where you logically design a space for happiness and success;

Energy Feng Shui, where types of energy openly flow through a space, which ultimate affects a person's well-being;

Symbolic Feng Shui, where personal belongings reflect a person's personality, passions and mementos; and

Personal Feng Shui, where physical, emotional, mental and spiritual energies influence a person's path to fulfillment.


To fully embrace Feng Shui and all its components, it's essential that you open a particular space to the many levels where the ancient art has meaning.


Start by walking into a room/space with your client and ask them what they see.  If the response is lots of clutter - stacks of papers, bills and unopened mail; clean laundry that needs to be organized and put away; or hoards of collectibles without any true "place" - then the natural flow of energy is displaced, scattered and has created a feeling of "chaos".  If the response shows meaning - deep connections to pieces of furniture, décor, and artwork that are present in the space - then your client has already begun to create a self-made sanctuary that is fulfilling and replenishing of the mind, body and soul.

This is just one of many examples of the power behind Feng Shui.


To incorporate Feng Shui into a space, start with the following series of simple steps that will help your client see and feel the positive and lasting impacts of this ancient art:


  • Clean up the clutter. Actively work with your client to keep their home or work space clean of clutter in order to create a space that promotes happiness, efficiency and peacefulness. 


  • Make room for the things that matter most. If a space is overwhelmed with "stuff", ask your client to prioritize the items that matter most and store away the things that he/she won't miss.


  • Let there be light. Natural light instantly boosts your spirit, expands your vision and enhances feelings of life, creativity and productivity. Don't let your client close themselves in with darkness - which is associated with feelings of confinement, hibernation and sadness. Instead, open the shutters lift the blinds and let the natural light shine through!


  • Bring the outdoors in. Nature creates natural feelings of harmony and healing to its surroundings.  Incorporate some natural greenery into your client's space - the added oxygen from plants or the soothing sound of flowing water create feelings of serenity, calmness and relaxation.


  • Experiment with colour. Colour has a powerful influence on your mood. Help your client bring in colours that speak to their personality and energy levels - Red and orange colours spark feelings of passion and excitement; blue and green colours create feelings of calmness and relaxation; and yellow and gold colours add feelings of wealth, optimism and influence.


  • Have a dedicated work space. Create a room/space that's dedicated to your client's work, which gives them the freedom to leave their stresses behind and soak in the positive energies associated with the other rooms of their space.


  • Display positive pictures of you and your loved ones. Encourage your client to hang photos that capture feelings of happiness, healthiness and confidence - this will automatically make your client feel more happy, healthy and confident.


These steps are the first of many that can be done to improve accessibility and enhance a client's space as they overcome any physical, mental or spiritual barriers in their own life. Accommodating mobility, cognitive or sensory impairments will be of primary importance, but why not consider some Feng Shui concepts as a secondary goal? 

For more information and steps to incorporating Feng Shui into a home or work space, visit your local bookstore and pick up the book, Feng Shui Your Life, by Jayme Barrett. This book is a game-changer and will help your clients learn to love their home and work all over again.


Marnie Courage, OT Reg. (MB)

Director & Inclusive Design Consultant

Enabling Access Inc.



Many employees dealing with chronic pain are not ready to return to work following a long absence from injury or illness. Disability Managers and Rehabilitation Professionals have the task of determining barriers to occupational engagement and providing accommodations where needed, to assist employees back to meaningful work.  Occupational Therapists understand that one way we achieve meaning in our lives is through the intrinsic and extrinsic purpose that work can provide us.  Intrinsic purpose or motivation could be to master a task, feel good about the work we do, feel that we are contributing, with no ulterior motive. The extrinsic purpose or motivation may be to earn money, please a boss, or get a promotion.


Through Motivational Interviewing (MI), a counselling approach developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. (Miller and Rollnick, 1991), Rehab Professionals can work with an employee to address the intrinsic values that work provides, and assist them to challenge their fears, and self-imposed barriers to returning to work.  Common fears are that their symptoms will increase, co-workers’ and supervisor’s attitudes about accommodation, there will be new learning requirements, their replacement is doing a better job, etc.


Using MI to align the employee's values and goals with returning to work, Rehab professionals can help take employees who are at "Pre-contemplation" to the “Contemplation Phase” and right through to “Action Phase” of the Motivational Interviewing: Stages of Change, to reduce fears, and replace with an acceptance that returning to work will bring purpose, meaning, and promote engagement in activities that will lead to improved productivity in preparation for returning to work.


Returning to work can be a challenging endeavour for employees and their advocates for other reasons as well, such as having an employer who is not willing to make reasonable accommodations, the wait for physicians to send medical documentation, employee feeling pushed back to work before being ready, and many more. Using MI might just smooth the ride while navigating around these obstacles.


An Australian article review of MI outcomes in Return to Work suggests, “Whilst evidence for the efficacy of MI in clinical settings to motivate health behaviour change is strong, more research is needed to determine whether MI can be usefully applied to improve RTW and other work-related outcomes.”1


1. Kathryn M. Page and Irina Tchernitskaia (2014). Use of Motivational Interviewing to Improve Return-to-work and Work-related Outcomes: A Review . The Australian Journal of Rehabilitation Counselling, 20, pp 38-49. doi:10.1017/jrc.2014.5.


October is Occupational Therapy Month!


If you or a family member has ever required Occupational Therapy Services please help us in the fight to get OT services covered by insurance companies across Canada! Physiotherapy, Massage Therapy and Chiropractic Treatments are all recognized and insured, but Occupational Therapy is not?


As occupational therapy becomes well-known and valued by health care consumers, many Canadians are disappointed to find that that their extended health insurance plans provide limited coverage for occupational therapy services. In order to encourage the coverage of these services, consumers need to contact their extended health insurers. Below is a letter that you can "cut and paste" into a word document to send to your insurance company to begin these conversations.


This letter is intended as a template and may be changed to specific needs and requirement. Let us know if your insurance company covers OT services and we will add the company name here, so others can see who which companies have jumped on board! We want to hear from you.






RE: Inclusion of occupational therapy services in health benefits plan


To Whom It May Concern:


I recently required the services of an occupational therapist and, to my dismay, I learned that my extended health benefits plan through your company does not cover these services. I am requesting coverage of occupational therapy services in my plan.


Occupational therapy is a recognized, registered health profession that provides a broad spectrum of client centered services that focus on health promotion, disability prevention, and functional restoration. Occupational therapy is offered in many settings including the home, workplace, community, hospitals, educational environments, and personal care homes.  As part of insurable health service, occupational therapists seek to identify and address issues that affect disability, improve daily function and level of independence, and reduce disability claims by offering a perspective that encompasses both the physical and mental health of the individual. Occupational therapists are key members of health care teams; no comprehensive benefits package is complete without occupational therapy.


As a policyholder with your company, I would appreciate a response indicating when your company will cover occupational therapy services, which I feel is a valuable allied health provider, and whether or not a flexible plan is being considered as an option for your clients so that I may take advantage of the services that an occupational therapist would offer.




Client’s name & insurance number


Here are the top 3 reasons why the construction industry continues to have some of the highest worker’s compensation rates, musculoskeletal injuries and employee lost time:

1. High Physical Demands

2. Productivity Pressures/ Work Pace
3. Supervisors are technicians, not necessarily leaders.


The first two reasons should be familiar and there are some intuitive solutions for these; offer customized ergonomic training at the worker level and ensure messaging that supports a productivity pace that does not sacrifice safety. The third reason may not be as recognized as the first two, and the solution is not being well implemented.

Safety professionals in construction continue to struggle with changing worker behaviour, trying to impress upon the workers, the importance of following safe work procedures and using ergonomics to guide manual material handling, prevent injuries, workers compensation claims, and lost time.


Becoming a skilled bricklayer, concrete worker, drywaller, or other tradesman, requires training and many years of experience. Workers who demonstrate proficient skills, save time and get the work done quickly, are often promoted to Lead Hand, Foreman or Supervisor.


In other industries, supervisors are promoted and offered leadership training to ensure they demonstrate desired corporate behaviours that will lead their team to success. In construction, this is not a routine practice and instead supervisors are often the most skilled technicians, are able to follow productivity focused protocols, and provide direction to their crew....but do not necessary know how to lead, and therefore may not recognize the influence that their behaviour has on their crew. If the Lead Hand on the site is taking short cuts, not using the appropriate tools, not wearing PPE or following safety procedures in every instance, the message to the crew will be that these behaviours are condoned, regardless of the safety messaging they are sending their workers verbally.


Some construction companies have identified the leadership element and are promoting, hiring, and training supervisors with proven leadership skills and are successfully reducing their injuries. More research is needed to evaluate if leadership training for construction supervisors can be correlated to the reduction of injuries, but from what has been proven in the corporate office based workplace, it can change behaviour.   This leadership tool, coupled with customized ergonomic training at the worker level and safety messaging that supports a productivity pace that does not sacrifice safety, will surely reduce costly musculoskeletal injuries on the construction site.


With only the few months of gardening weather we have in the Canadian prairies, it's important to make the most of the time we do have outdoors, which can create the "Binge Gardener" in some of us. Quickly getting our plants, veggies and flowers in after the first sign that frost has retired till fall, is a task most gardeners anticipate all winter and for those living in Manitoba, we often have to wait till June to be certain the frost gremlin will not rear its ugly face again till October sometime.


The trouble with binge gardening is that we try to do all the tasks to ready a garden, plant and nurture our new ground residents in concentrated doses, instead of spreading the tasks out over the growing season. The repetitive physical demands such as bending, squatting, kneeling, reaching, etc., involved in gardening can create musculoskeletal injuries, which can be harder to undo than a overflowing spread of Snow in the Valley that creeps into your lawn!


For folks who have mobility challenges, who are pregnant or are seniors who have energy limitations, this once beloved leisure love can turn out to be a source of pain and aggravation just as gardening  season gets underway. Here are some ergonomic tips and adaptations that might help you are someone you know who loves to garden, but hates the pain it causes.


1. Energy conservation - Break your gardening tasks up into tasks of 30 minutes or less to ensure you have energy to finish what you need to get done without wiping yourself out for the next two days.

2. Engage in Stretch Breaks - The muscles you use in your back, legs and arms are challenged by having to maintain awkward static positions and your hands and wrists are often grasping tools and plants while conducting repetitive tasks. It's important to stretch those muscles to offer relief and prevent stiffness and muscle fatigue

3. Drink plenty of water - While gardening bring out a water bottle of cold water to keep you hydrated and to keep your joints lubricated as you work. Remember if you feel thirsty, you are already dehydrated.

4. Sit on garden stool - For those who have difficulty getting on or off your knees, the tendency is usually to stand and bend from the hips to reach the plants or ground you are working on. This position creates undue forces on your lower spine and can cause low back muscle strain and aggravate the discs between your vertebrae.  Instead purchase a small stool to sit on as you plant or tend to your flowers to prevent low back musculoskeletal injuries.

5. Raise your garden - One of the best ways to prevent the bending and reaching that often causes back pain is to raise your garden bed. This is easily achieved by building a 2-3 foot border with wood or bricks around your garden and filling with the appropriate soil for your gardening zone. Planting in raised beds allows you to sit on your stool or mobility device and reduce the physical demands on your body.

6. Use hose with holes for watering - Gardeners can spend a lot of time watering their plants, especially during a dry season. Instead of lugging watering jugs outside, (which aggravates your shoulders and upper back) use an old hose, lay it alongside your garden and puncture holes along its length to squirt out water, eliminating the need to walk around grasping the spray nozzle and having to wrestle with the knots in the hose as you pull it along.

7. Use proper body mechanics- If you are using wheeled carts for transporting tools or plants, push instead of pull where you can, as pulling a cart behind you can cause injury to your shoulders.  When using standing tools like a rake or hoe or claw, stand with feet shoulder width apart, one in front of the other  and bend your legs while using your upper leg muscles (quadriceps, hamstrings and buttocks) instead of standing with straight legs and bending or twisting at your low back.

8. Hire help for the tough stuff- Although we would like to say we can do it all, doing it all sometimes does us in. Where possible hire someone to do the most physically demanding working like mowing the lawn or turning the garden beds in the spring. Save your energy for the fun tasks like planting, watering, and pruning, which will give you the gratification only fellow gardeners can appreciate, without the aches and pains.



Marnie Courage. OT Reg. (MB)

Managing Director

Enabling Access













As new night clubs, restaurants and bars pop up around town, with funky wall murals, modern bar stools and high tables, one may be captivated with how the design brings people together and influences the way people interact in the space. The intent of tall tables and bar stools is often to encourage patrons to stand, lean in, perch on a stool, walk around, and mingle. The other reason to include bar style tables and stools is to avoid the perception that the establishment is full, when all the seats are taken, and instead invites more patrons to consume and join in, backed by the idea that "Standing room only" can translate to it being a hot and happening scene!


Unfortunately, sometimes accessibility gets sacrificed when style is the focus and people can overlook the barriers that this stand-and-perch environment creates. Building Codes vary by region, and although most require the inclusion of at least 5% of the tables to be accessible at 28-34 inches high, just imagine the segregation experience of patrons at a small venue sitting at one of the only low tables, when the majority of people are milling about, leaning or standing at their high tables. Further, take notice of height of the service counter at your favorite night spots, as I would suspect few have a wheelchair accessible counter where a patron can order a drink and pay without having to wheel around the side of the bar or have a friend order for them.


The wonderful thing about inclusive design is that barriers can be removed without sacrificing style, intent or feel of the environment. By including a good mix of high and low tables,  considerately distributed throughout, with spacious passage areas, patrons can mingle at varying levels without creating high/low, us/them segregation. This provision is, in many cases, easy and inexpensive to meet, also by removing some of the fixed seats/booths (but leaving the tables) and replacing them with seats that can be removed for a customer who uses a wheelchair. This measure also creates aisles wide enough to people using wheelchairs or other mobility devices to negotiate.


Using the principles of Universal Design, business owners are beginning to understand the benefits of designing spaces where their patrons cab access their services in the same manner and will hopefully start to include an accessible service counter not only for those who are shorter, or in wheelchairs, but for all to use, without barriers.


As you might know, there is much social buzz about the health concerns related to sedentary work, especially for those who sit for the majority of their workday. There is also a common misconception that anyone who sits to do their work, should stand up for their right to kick the chair to the curb and exclusively use a standing work station. This move, may in fact create new risk factors that will have you looking for that chair again.
The ergonomic research motivating us to stand supports the idea that when compared to sitting, the position of standing creates less compression forces on our low back, in addition to the more obvious benefits of increased circulation to your extremities and the increased caloric expenditure. What isn’t talked about as much is the idea that moving from static sitting, to static standing is not much of an upgrade. Just ask anyone who stands for the majority of their workday. These folks often experience low back pain, heel or forefoot pain, muscle fatigue and other discomforts.
We are designed to be moving creatures, doing work that uses a variety of positions and muscle groups. Therefore, it holds true that we should be designing our workstations to move with us. Instead of throwing out your existing office furniture, look around and get creative.
Here are some practical workstation options to choose from, which allow a single user to change positions while they work:


(Whichever option you choose, remember to use a desktop stopwatch or widget to limit your sitting and standing to an hour, and stretch between positions.)

1. Create a standing station that also allows you to sit. This may require you to install a counter height desk or table (slightly lower than your elbows when standing). You will need a monitor riser or arm. If you use a laptop, you will need a laptop stand and an external keyboard. Have an ergonomic task stool with foot rest ring handy for the standing station if you need to perch a cheek, or take a quick break from standing.


2. Create a height adjustable work station by purchasing a unit that attaches to a standard desk to allow you to adjust the unit up or down, from sitting in an ergonomic task chair to standing, with products such as an Ergotron, Varidesk, or other. These move the keyboard and monitor up and down with some adjustment. 


3. Purchase a height adjustable desk surface that moves up and down as you do. An adjustable keyboard tray and monitor arm will be required for ergonomic positioning as you move from sitting to standing. You will require an ergonomic task chair for the sitting position.


It is important to know the ergonomic guidelines for setting up sitting and standing workstations. See our customized Office Stretching Poster and Ergonomic Guidelines Poster at http://enablingaccess.ca/shop-enabling-access-inc-ergonomic-and-stretching-posters.html



Marnie Courage, OT Reg. (MB)
Managing Director
Enabling Access Inc.




According to Visitable Housing Canada, “VisitAble Housing or VisitAbility is the concept of designing and building homes with basic accessibility. VisitAble homes provide easy access on the main level for everyone. VisitAble housing offers a convenient home for residents and a welcoming environment for visitors in all ages and mobility.” 


Visitable homes have three basic accessibility features:


No Step Entrance - At minimum, there must be one accessible, no-step entrance at the front, back or side of the house.

Clear Passageways - All doorways and halls must be wider so there is clear passage throughout the main floor. 

Accessible Bathroom - The bathroom or powder room on the main floor must be accessible by visitors who use mobility devices.


These visitable homes not only appeal to people living with disability, but also to young families with strollers, and older people who anticipate changes in mobility as they age and want to age in place. Here in Manitoba, the neighbourhood of Bridgewater in South Winnipeg meets visitable design standards. According to Manitoba Housing, the provincial department responsible for the neighbourhood of Bridgewater, the development will include over 1,000 visitable homes and hundreds of multi-family units with visitable features. To date, more than 200 of these homes have already been built.


As societal demand for accessible and sustainable housing grow, and accessibility laws stretch beyond provincial building codes for new residences, we should see more initiatives like Bridgewater in this province, making our communities more inclusive by design. At the very least it is a step in the right direction. See my comment reply to this post for how Canada's Visitability Standards fall short of those in the US.


For more information on visitable housing visit:







Marnie Courage, OT Reg (MB)

Managing Director of Enabling Access Inc.


A concussion is a mild traumatic brain injury caused by a blow to the head, neck or upper body and may include symptoms such as a headache, dizziness, nausea or loss of consciousness. Unfortunately, some people go undiagnosed, or misdiagnosed and continue to experience memory, attention deficits, poor emotional control, and other lasting symptoms, which prevent them to returning to work months after their injury.


Returning to work after a physical injury is difficult and with a concussion, the experience is complicated further by the interfering cognitive and psycho-emotional symptoms. Often folks are returned to work too quickly without the appropriate supports in place, or healthcare providers are waiting for the employee to recover before recommending a return to work plan.


The following are some tips for case managers and employees when returning to work following a concussion:


1)    Once the initial 3-4 week acute injury phase has passed, don’t wait until the employee has “recovered” before returning to the workplace. Instead, discuss opportunity for modified duties as the employee learns to manage their symptoms while being exposed to increasing physical and cognitive demands.

2)    Understand that this RTW plan may take longer than a standard 4-6 weeks, as unlike physical injuries, the complexity of symptoms experienced by someone with a concussion may necessitate more time.

3)    Consider psychological treatment for co-existing mental health conditions like depression and anxiety that may be associated.

4)    Determine workplace accommodations required, prior to the employee returning to the workplace to reduce risk of being overwhelmed.

5)    Ensure all cognitive, perceptual, and physical limitations are being accommodated, by involving an occupational therapist.

6)    Consider a gradual return to work experience to build tolerance to the physical and cognitive demands of the job.

7)    Promote good communication between the employee, the employer and the case manager/therapist to ensure a dynamic return to work plan that is flexible to change with the employee’s needs.

8)    Consider allowing the employee to seek quiet/dark space periodically through their shift to reduce the sensory overload they may be experiencing. If employee is sensitive to light allow a visor or sunglasses to be worn.

9)    If computer work is involved, symptoms of headaches and nausea can be aggravated. Allow for gradual exposure and breaks for sustained monitor work. Avoid scrolling tasks and instead read full page before scrolling down to next section.

10) Daily communication is required with the employee to assess if the accommodations are helping and to come up with possible solutions to help manage any other aggravated symptoms.



Marnie Courage, OT Reg (MB)
Owner/ Managing Director
Enabling Access Inc.



The following tips can help prevent musculoskeletal disorders from developing and promote good ergonomics in the classroom:

1. Sit/Stand Teaching - alternate between standing and perching on a teller stool to prevent static positions and fatigue.

2. Introduce Standing Work Stations - bar height tables at the side or back of the room, to allow students opportunity to stand and learn.
3. Introduce 2 minute movement breaks, every 30 minutes, and have students alternate the leading of stretching routine.
4. Avoid awkward postures - reduce writing on chalk/white board above shoulder height; use podium or standing height desk for reading books/documents to class.
5. Wear low heeled footwear that support the arch and cushion the forefoot, if standing the majority of the workday.
6. Keep a water bottle on your desk to keep you hydrated and promote walking to fill it up the bottle, and to use the bathroom on breaks.
7. Have a therapy ball or mov’n sit cushion available to allow students who have difficulty sitting still to have some movement built into their day. Use a signup sheet, so everyone gets a chance to move and learn.
8. Use good computer ergonomics-Set up the keyboard and mouse at same height; raise/lower chair so wrists are flat on the keyboard (not bent); use a foot rest if feet not supported on floor; raise or lower monitor so you are looking straight at the top 1/3 of the screen; ensure space between edge of seat and behind knee; raise backrest to lumbar cushion supports the curve of your low back.
9. Pin up stretching posters and ergonomic guideline posters in the classroom a resource.

10. Identify and report any environmental ergonomic risk factors in your classroom or with the furniture in your classroom, so your supervisor can address and mitigate the risks.

Marnie Courage, OT Reg. (MB)
Owner & Managing Director
Enabling Access Inc.


Just as an antagonizing strain of virus infects a population and a new vaccine is created to fight it off, symptoms of Presenteeism sneak up on a workplace long before Absenteeism does, and the treatment is all in the prevention.


“Presenteeism is the action of employees coming to work despite having a sickness that justifies an absence and as a consequence, they are performing their work under sub-optimal conditions.”[1]


Some may ask why these employees don’t take time off, and from what surveys have uncovered, it has more to do with the pressures they feel to stay at work and the workload that will be waiting for them when then return. Many workplaces make the error of measuring absenteeism and sickness rates and figure if those numbers are low and productivity is good then their employees are generally healthily.


The unfortunate truth is that many employees, who are undergoing stressful events in their life (either at home or at work) are pushing through life with a mental health affliction that is not being treated, gets worse, and can lead to long term disability claims.


Presenteeism possible causes:

  • High production expectations
  • Role Conflict
  • Relationship issues with co-workers/supervisors
  • Reduced decision authority
  • Fear of job security


Possible costs to the Workplace:

  • Reduced production
  • Reduced Morale
  • Toxic Workplace Culture
  • Us Versus Them
  • Absenteeism
  • STD/LTD claims


The vaccine is not a single dose and instead takes multiple doses in the form of Mental Health Check-Ins. A workplace should examine the health of its employees on a continuous base, instead of asking for a doctor’s note once the employee reports an illness. Having human resource policies in place that support employees and provide regular health assessments that include mental health screenings can be the early intervention the employee needs to get back on track.


Learning about workplace conflicts before they erupt, can be very helpful in diffusing situations and keeping employees happy and healthy. Having a Conflict Resolution Specialist, Counsellor or Occupational Therapist at close hand could be a powerful vaccine. Creating a workplace culture of acceptance, trust and respect may be difficult to build, but one based on mistrust, unfair workloads and pressures to attend, can easily fall.


[1] C. Biron et al., “At work but ill: psychosocial work environment and well-being determinants of presenteeism propensity,” Journal of Public Mental Health, 5 (2006) 26  



Marnie Courage, OT Reg. (MB)

Owner /Managing Director

Enabling Access Inc.




If your workstation includes an “L-shaped” desk, you may be positioned in the corner of the two desks, where your computer is located. Often one desk is designated for paper work and the other is chaired for coworkers or client interactions. Many of you would say this is how the workstation was set up when you were assigned the office space and so that is how it has remained. There are a few ergonomic risks that exist for employees who are positioned in the corner of two desks that I wanted to share:


Risk Factors:


1. The armrests on your chair most likely hit the front edge of the desks as you approach the corner to do your computer work. I have met many people that have removed their armrests, so they don’t interfere with positioning the chair closer to the corner of the desks. Without arm rests your upper back and shoulders do more work supporting your arms and by mid-day your body is fatiguing, posture is compromised and discomfort sets in.


2. If your armrests are still in place you probably are not able to get close enough to your keyboard and mouse on the desk surface, requiring you to reach to access those tools. This forward reach causes discomfort between your shoulder blades, upper back and shoulders.


3. Further discomfort in the corner position can be caused by your chair being positioned too low in relation to the desk. The lower you are seated, the more shoulder shrugging, elbow abduction (away from the body) that is demonstrated. This awkward positioning results in upper back, shoulder and neck discomfort.


Quick Fixes and Cautions:


DO NOT REMOVE YOUR ARMRESTS. These accessories are required to support your forearms and allow your shoulders to relax while you work and should be positioned at a height so your elbows are bent at 90 degrees.


Ask for a “Corner Creator” which is a flat piece of plastic or metal and sits on the desk surface between the two desks to create a straight edge. The keyboard and mouse are positioned close to the front edge of this Corner Creator and will allow you to move your chair closer to these devices without interference from your armrests or without having to reach to your keyboard.


If you can, reposition your computer, keyboard and mouse to the straight edge of one of the two desks, (you may need longer computer cords from IT).  Working at this straight edge will allow you to get closer to your work, prevent reaching and the resulting discomforts.



Marnie Courage, OT Reg. (MB)

Managing Director

Enabling Access 





Whether your company was introduced to the world of social media via your tech savvy IT rep or you were strong-armed into joining the conversation by the ever growing influence of young employees, the result is the same: You have opened the can of time sucking worms that social media is. If it is your role to keep up with health and safety best practices, networking with other safety professionals or staying on top of professional development opportunities, then you need to focus on how to use your social media time wisely.


Here are some social media tips for health and safety folks to keep current and still keep up with your workload:


1. Create measurable objectives for your social media program. For example:

"To keep customers and employees up to date with company health and safety initiatives, industry news, and engage potential employees and customers in discussions relevant to the health and safety of our employees by posting educational web resources and intelligent perspectives on trending topics, using built-in social media analytics to track followers, impressions, comments and clicks."


2. Establish rules for who posts to these sites and what gets posted.


3. Create a schedule for your social media tasks broken down into daily, weekly and monthly tasks including searching for relevant web resources and news, updating status, and engaging in discussions.


4. Use social media management applications like Tweetdeck or Hootsuite to see at a glance what others are posting, who is mentioning your company and to schedule posts to more than one site by saving your drafted status to post at a later time. 


5.  Concentrate your time to complete your tasks instead of "surfing" the web and social media sites throughout your day. Use the timer on your computer to limit the time you spend searching for information to post and reading posts. If you are short on time there is no harm in reposting someone else's posts as long as you work in original thoughts regularly.


6. On Twitter use keywords to search for relevant information like #ergonomics, #safety, #health, #wellness, etc.


7. Follow news and journal publications relevant to Health and Safety to keep current with industry news.


8 Use blog readers like RRS, Blogger and others to narrow down Health and Safety blogs to follow.


9. Don't hesitate to "unfollow" or "unlike" anyone who is posting information not relevant to Health and Safety so you are not bombarded by information you need to weed through.

10. Be transparent in your posts. If the post is provocative then expect negative comments and always respond to negative comments, even if you need to recant a statement or admit you did not represent your company's opinion.


Please share here any other tips Health and Safety professions would benefit from so we can be more mindful of how we spend our social media time. 



Marnie Courage, OT Reg (MB)

Owner/ Managing Director

Enabling Access



In the disability management world, returning an injured employee back to work has presented many challenges for the HR departments of industrial companies. Often the jobs are physically demanding and offering modified or light duties can create friction between employees who continue to do the hard work and the injured employees who get to do “the easy stuff”.


Pressure to accommodate injured workers from Workers Compensation Boards,  and  threats of being fined by Provincial Workplace Safety and Health, keep disability management staff motivated to create jobs that injured workers can return safely to.


Unfortunately, these modified duties may include tasks that do not contribute to maintaining or improving the productivity of the workplace.  In addtion, often these injured employees are conducting these duties for an undefined amount of time. Moreover, the cost of  the WCB claims and bringing in other employees to cover the injured worker’s job tasks may negatively affect productivity and have a financial impact on the company.


Disability Managers should be challenging physician’s to clearly define the physical restrictions of the injured workers by having them  review the job demands analysis of the target job and checking off the duties that the patient should be able to safely conduct. Most importantly, they should be encouraged to stipulate exactly how long the injured employee is restricted so they don’t end up in modified duty wasteland.


Where appropriate, the employer can order a Functional Capacity Evaluation to objectively and functional test which tasks the injured employee is safely able to perform.


If the Disability Manager is getting frustrated with return to work options, creating modified duties for injured employees or having trouble getting injured workers off modified duties, they could invite their Workers Compensation Adjuster to discuss options for accommodation within reason and have independent medical assessments conducted to challenge the employee's physican's note.


Marnie Courage, OT Reg. (MB)

Owner/Managing Director

Enabling Access


There is much written about workplace ergonomics, specifically dealing with risk factors that may result in musculoskeletal injuries, including repetitive strains, which account for almost 50% of workplace injuries in Manitoba (Safe Work MB). Less is written about the ergonomics of housework that present similar risk factors and may lead to injuries preventing you from doing the job of living.


Think about the tasks you do during your workday, the positions you assume and the strength requirements you meet in your daily work tasks. If you are engaging in activities and tasks at home that involve the same positions, and present similar strength requirements, your risk for injury is increased.

Consider a person who’s job is mainly computer based, involving static seated positioning, requiring a flexed neck to read documents on the desk, involving repetitive typing and filing. They should be aware that exposing themselves to household tasks with these physical demands, such as spending extended time on the home computer, flexing their neck when standing to do dishes at the sink and over the counter for meal preparation, scrubbing to cleaning the bathtub, etc will present similar ergonomic risk factors.


Reduce your exposure to ergonomic risks at home by:

1. Limit or break up the activities you engage in at home that require the same awkward postures, repetitive movements and forces on your body that you are exposed to in your workday.
2.  Have family members take turns doing more physically demanding tasks by creating a sign up chart so everyone knows their tasks for the week.
3. Try not to do all your chores in one afternoon and instead spread them out over the week.
4. Build in stretch breaks to tasks that require awkward postures like bending, twisting, reaching, etc.
5. If grocery shopping and lugging bags from the car puts you at greater risk of injury because you do similar physically demanding work, consider purchasing a grocery deliver service.

6. When taking out the garbage try filling two smaller bags instead of one big one to carry and distribute the weight evenly between both sides of your body.

7. Purchase a long handled dust pan and use a Swiffer wet jet instead of bending down if you have symptoms in your low back.

8. You can use a swiffer wetjet in your bathroom to clean your tub and avoid awkward twisting and bending needed to scrub the tub.

9.On your days off try to set goals that will allow for rest time so you can recharge and have energy to get your list of chores completed.

10. Remember to use proper body mechanics when lifting, bending and reaching during your chores to protect your back and limit your exposure to ergonomic risks at home.

Mrnie Courage, OT Reg. (MB)

Owner/Managing Director

Enabling Access



Running my business from my home office with a seven month old has forced me to modify how I work. Instead of spending hours in front of my desktop computer up in my office, I am grabbing fifteen minutes here and there on my smart phone and tablet whenever and where ever I can .This change in working behaviour has brought with it new aches and pains that no APP (that I can find) will fix.


With devices getting smaller and more portable to keep up with the busy lifestyles we lead, the physical demands have changed but the work related aches and pains have followed. Repetitive Strain Injuries are common and our busy fingers, thumbs, and wrists are taking the heat. Here are a few tips to reduce discomfort and increase productivity in our tech savvy day:


  • Pain in the thumb-Thumb pain can be related to texting with the thumb when holding the mobile device in the same hand. Instead hold the phone in one hand use index finger of the opposite hand with full arm movements, so you are not making small repetitive  movements with the finger. Of course this might mean you will have to put down your coffee.
  • Pain in the neck -Instead of holding the phone to your ear with neck flexed to the side, use the Hands Free option, unless you are listening to a co-worker vent about your jerk of a boss, when he is sitting in your office.
  • Pain in the neck-The portability of a tablet far surpasses the ergonomics. To use a tablet, you either hold it in your hands or set it on a table/desk to use. The nature of its design requires that you flex your neck down to view. When possible,  bring your tablet up closer to your eye level to reduce upper back and neck pain, and don’t use your tablet on your tummy  while lying in bed, as your neck will surely be flexed and you might just fall asleep waiting  for a cat video to load.

Pain in the eyes- When reading web content on your device, the continous scrolling requires that you read moving  text, for some this can causes eye strain or headaches, and if you are me....motion sickness. Scroll down and read the whole screen before you scroll again. Virtual vertigo can feel very real!

  • Pain in the eyes- If you wear glasses, but don’t always have them on, you may have trouble reading the font on your phone. Go to your settings and  increase the size of the font so you can leave your glasses where you lost them.
  • Look for “short cut” key combinations to reduce the number of keystrokes or button pushing on your phone or tablet or use voice activation when you can, to dial a contact, or search the web for delivery options at 11 pm, because you just realized you haven’t taken you r eyes off your device since you got home from work.
  • Wrist pain- Using a touch on-screen keyboard on a tablet is slow and requires that your wrists be extended (bent up) to type on the screen in front of you. To reduce wrist pain, get a tablet cover with WIFI keyboard, and make writing long emails, reports or editing your kid’s resume so he will actually get a job and move out someday.

There seems to be an APP for everything, but until someone comes up with one that will help us tweak our tech behavior to prevent injuries, we might want to listen to our bodies whispers of discomfort before they become screams of agony.


Marnie Courage OT Reg. (MB)

Owner of Enabling Access



One challenge that small and large businesses have in common is being able to afford the strategies that they believe will lead them to achieving their business goals. Certainly, one of those strategies is to retain and protect valued employees by ensuring their health and safety at work. The costs associated with workplace injuries, employee lost time, WCB and disability claims far outweigh the costs of implementing some proactive ergonomics.

Here are some cost effective ergonomic considerations that will help your staff stay safe and will help you stay within your budget:

1. Provide ergonomic screening assessments and accommodation for all new employees to ensure the proper set up of furniture and accessories and to prevent future musculoskeletal injuries. This could be a simple checklist tool that outlines ergonomic risk factors for chair, desk and accessory set up and include commonly recommended items for quick implementation.



2. Provide ergonomic education to new and existing employees to promote healthy working behaviors, proper body mechanics and will teach them how to recognize symptoms of MSI's, so early intervention can be introduced before their condition becomes chronic.

3. Choose task chairs that accommodate most of your employees, offering adjustable seat depths and backrest heights. For the very short, very tall and very wide, there are some chairs that you can order different sized seat pans and back rests to mix and match as your employees require. One example is the Global Tritek Ergo Select.

4. Create an Ergonomic Solutions Catalogue for your workplace that includes products from your office supply and furniture vendors, as a go-to list of commonly prescribed ergonomic solutions. This will make it easy to quickly implement the solutions when ergonomic risk factors have been identified.

5. Provide Ergonomic Assessor Training for designated employee/s to conduct the ergonomic assessments in house, saving on professional consultation fees associated with each ergonomic assessment that will be required.

6. Get connected with social media; namely Facebook, LinkedIn and Twitter, using the hashtag #ergonomics, read blogs and evidenced based articles on ergonomics to keep current with best practices in the field.

If you are part of a large business, creating an ergonomics committee using your WPHS group is a great way to get the topic of ergonomics on an agenda. If you are part of a small business, appointing an Ergonomic Coordinator would be the first step to creating accountability and designating some of the above duties. Regardless of the size of the company, the goal is the same; spend as little as possible and protect your employees as much as you can. 


If you have some cost-effective ergonomic methods that have been successful in your workplace, please share!


Marnie Courage, OT, Reg(MB)

Owner/Managing Director

Enabling Access