Vocational rehabilitation considerations for people with reflex sympathetic dystrophy

Reflex sympathetic dystrophy (RSD) is identified by the existence of pain, trophic changes, vasomotor instability, limited range of motion and swelling of an extremity. RSD is difficult to treat and prognosis is often poor. Although widely noted in the medical literature, the vocational rehabilitation literature has failed to address the potential role of vocational rehabilitation professionals in the social and economic employment outcome for people with RSD. Vocational rehabilitation professionals are defined as those performing vocational assessments, assessing transferable skills, determining adaptive skills, certifying residual work-related capacities, conducting vocational interest testing, coordinating efforts with pre-injury employers to assist in work reentry efforts, or performing other activities to assist in the placement or retraining of individuals with RSD. The sources used for this article include a review of the literature and observations of the authors. A vocational rehabilitation primer is provided. The following topics are addressed: the anatomical and physiological basis of RSD, treatment protocols, difficulties in accurately diagnosing RSD, influence of litigation, job placement considerations and vocational planning. As the vocational rehabilitation counsellor faces a greater number of people either diagnosed with RSD, or exhibiting RSD symptoms, he/she will be challenged to: (1) increase one's knowledge base about the etiology and treatment of RSD; (2) coordinate personal efforts with other professionals; and (3) provide personal counselling to address lifestyle and motivational factors.