The functional limitations will be directly related to the location of the pain. Low back pain, which is very frequent with vocational rehabilitation clients, will produce the following limitations:

• Pain in muscles or joints

• Sleep problems

• Breathing difficulties

• Swallowing problems

• Fatigue

• Lifting, reaching, walking, climbing, balancing, stooping, kneeling, crouching, twisting, fingering, motor coordination, eye-hand-foot coordination

• Self-care, including: eating, hygiene, dressing, grooming

• Stamina and strength

• Transportation can be a barrier if usual mode of transportation is no longer accessible.

• Depression can interfere with working or preparing to work because of recurrence or worsening of limitations.

• Often the person has worked for years but can no longer perform necessary job duties.

• Vocational problems may relate to activities of daily living (being able to care for self at home) thus affecting ability to get to or perform work.

• Functional limitations need to be assessed carefully. Vocational goals must be determined with those limitations in mind to assure that goals are reasonable.

• The counselor needs either to be informed on adaptations that might be possible, to help the person remain in his/her present job, or to prepare for a new one. These can be anything from refitting a brace to assessment of need for a wheelchair. For those already using a wheelchair, it might be advisable to have the chair motorized. Some clients might need ventilators for night use.

• Transportation may be a barrier if the person can no longer operate a motor vehicle or find alternatives.