• Upper extremities

  • Fine hand movements

  • Fingering

  • Manual dexterity

  • Grasping

  • Working over the shoulders

  • Tactile discriminations

• Lower extremities (including back)

  • Stooping

  • Bending

  • Twisting

  • Lifting

  • Crawling

  • Sitting

  • Balancing

  • Kneeling

  • Climbing

  • Turning

  • Carrying

  • Standing

• Either upper or lower extremities

  • Abrupt extremes of weather/temperature conditions

  • Strenuous activities without frequent rest periods

  • Trauma/jarring/overuse of affected joints

  • Pain

  • Mobility

These diseases display frequent undefined periods involving exacerbation or remission of symptoms. During remission, the client may have periods with few limitations. The counselor should be aware of which joints are affected, and counsel the client toward vocations that utilize less affected joints.

An arthritic patient should have certain evaluations performed to aid in diagnosis and treatment. An internist, especially a rheumatologist, is best equipped to provide this. If an individual has multiple range-of-motion difficulties, it could also be effective to consult a physiatrist to evaluate these. The counselor should always insist, however, that the physician in attendance provide information about the client's range-of-motion, muscle strength, and weakness of affected joints.

The counselor needs to tie the specific functional limitations to the individual's problems in handling past job duties or show how the limitations would impede future employment opportunities. Specifically you could look at:

• Does pain accompany task performance?

• Are there mobility restrictions in performing tasks?

• Is the client able to drive or access other modes of transportation?

• Side effects of medications may cause illness that interfere with daily work routine.

• Jobs with temperature extremes must be avoided.