Frames of Reference

What are the frames of references for Physical Function? (4)
Biomechanical, Neurodevelopmental Treatment, Rehabilitation, Proprioceptive Neuromuscular Facilitation.
What are the frames of references for Psychosocial Function?
Behavioral, Psychodynamic, Cognitive-Behavioral.
What are the Frames of references for Pediatric?
Motor Skills Acquisition, Sensory Integration.
What are the Frames of references for Cognitive/Perceptual?
Cognitive-rehabilitation, Neurofunctional Approach, dynamic interactional
Models used in Occupational Therapy
Client-Centered Models, Model of Human Occupation, Occupational Adaptation, Occupational Science
Which FoR was originated by Bolderin, Taylor, and Licht. Adapted from Dutton (1995)
Theoretical Basis for Biomechanical?
Anatomy, physiology, and kinesiology
Theoretical Assumption for Biomechanical?
1. Purposeful activity can be prescribed to remediate loss of ROM, strength, and endurance.
2. If ROM, strength and endurance are regained, the person will automatically use these prerequisite skills to regain functional skills.
3. The body must be rested, then stressed.
4. The person must have an intact brain that can produce isolated, coordinated movements.
Function/Dysfunction Continua for Biomechanical
Structural Stability, endurance, edema, ROM, and strength
Indicators of Function and Dysfunction
1. Structural stability
2. Passive ROM
3. Muscle strength
4. Peripheral edema
5. Endurance
Postulates reguarding change for Biomechanical FoR.
1. If the therapist uses orthoses and positioning, structural damage will be prevented.
2. If the therapist uses orthoses, positioning, and rest followed by stress, structural stability will be regained.
3. If the therapist prescribes increased duration and/or intensity of activities, then endurance will be regained.
4. f the therapist uses elevation, pressure, temperature control, and ROM, then peripheral edema will be reduced.
5. If the therapist uses PROM, active assisted ROM, AROM, scar preventin, orthoses and positioning, then passive ROM wil be maintained.
6. If the therapist uses heat, scar remodeling, passive stretch, active stretch, orthoses, poistioning, and activities, then ROM will be increased.
7. If the therapist uses AROM and activities, then strength will be maintained.
8. If the therapist uses isometric, active assistive, active, and progressive or regressive resistive exercises, then strength will be increased.
Which FoR was originated by Berta and Karl Bobath. Adapted from Dutton (1995)
Neurodevelopmental Treatment (NDT)
What is the theoretical Basis for NDT?
Neurology and developmental theories.
Theraretical assumptions for NDT?
1. It is important to remediate foundation skills that make normal skill acquisition possible.
2. Normal movement is learned by experiencing what normal movement feels like
3. Postural control is essential for limb movement.
4. Normal movement cannot be imposed on abnormal muscle ton.
Function/Dysfunction Continua for NDT?
1. Axial control
2. Automatic reactions
3. Limb control with specific focus on the scapula and pelvis mobility and stability.
Indicators of Function and Dysfunction for NDT?
1. Reflex development
2. Automatic reactions
3. Synergies
4. Muscle tone
Posutlates Regarding Change for NDT FoR?
1. If the therapist uses passive elongation, reflex inhibiting patterns, positionins, and weight shifts, then hypertonia can be inhibited.
2. If the therapist uses joint compression, joint traction, manual resistance, and weight shifts, then increased tone for hypotonia can be facilitated.
3. If the therapist uses passive elongation, active weight shifts, passive pelvic tilts, and active axial rotation, then axial control can be facilitated.
4. If the therapist uses reflex inhibiting patterns and desired combinatins of movement patterns, then automatic reactions can be facilitated.
5. If the therapist uses dissociation of synergy patterns, reflex inhibiting patterns, limb weight shifts, place and hold, and postures and movements with rotational and reciprocal limb movements, then limb control can be facilitated.
Which FoR was originated by Dunton. Adapted from Dutton (1995)
Rehabilitation FoR
What is the Theoretical Basis for Rehabilitation FoR?
Systems theories and learning theories.
Theoretical assumptions for Rehabilitation FoR?
1. A person can regain independence using compensation when underlying deficits cannot be remediated.
2. Motivation for independence cannot be seperated from volitional and habitual subsystems.
3. Motivation for independence cannot be seperated from environmental contexts.
4. A minimum level of emotional and cognitive prerequisite skill must be present to make independence possible.
5. Clinical reasoning should take a top down approach. Focus should first be on environmental demands and resources. Tehn, volitional and habitual subsystems should be considered followed by functional capabilities and then prerequisite skills/deficits.
Function/Dysfunction Continua for Rehabilitation FoR?
This frame of reference addresses ADL's, work, and leisure activities.
Indicators of Function of Dysfunction for Rehabilitation FoR?
1. Ability to safely perform ADL in a timely manner.
2. Ability to safely perform home management tasks in a timely manner.
3. Work behaviors, work tolerance, general work traits, and/or specific work skills.
4. Ability to participate in meaningful leisure activities. Clinical observations and interview are used to evaluate these areas of occupational performance.
Postulates Regarding change for Rehabilitation FoR?
1. If the therapist uses adaptive devices, orthotics, environmental modifications, wheelchair modifications, ambulatory aids, adapted procedures, and/or safety education, then independence in ADL, home management, work and leisure will be maximized.
Which FoR was originated by Kabat. Adapted from Voss, Ionta, and myers (1985)?
Proprioceptive Neuromuscular Facilitation
What is the theoretical basis for Proproceptive Neuromuscular Facilitation FoR?
Neurophysiology, anatomy, and kinesiology.
What is the Theoretical Assumption for Proprioceptive Neuromuscular Facilitation?
1. Normal movement and posture are dependent upon a balanced interaction of antagonists.
2. The growth of motor behavior has cyclic trends as evidenced by shifts between flexor and extensor dominance.
3. Early motor behavior is dominated by reflex activity.
4. Normal motor development proceeds in a cephalocaudal and proximodistal direction.
5. Developing motor behavior is expressed in an orderly sequence of total patterns of movemnet and posture.
6. Normal motor behavior has an orderly quality with overlapping occuring.
7. Imporovement of motor ability is dependent on motor learning.
Function/Dysfunction Continue for PNF FoR?
Smooth, controlled functional movement patterns of the head, neck, trunk, and extremities.
Which FoR was originated by Anne C. Mosey. Adapted from Mosey (1986)?
Role Acquisition
What is the Theoretical basis for Role Acquisition FoR?
Sociology, psychology, and behavioral learning theories.
Theraretical assumptions for Role Acquisition FoR?
1. The individual has an inherent need to explore the environment.
2. What an individual must learn (roles) is specified by the society and cultural group in which he or she lives.
Function/Dysfunction Continua for Role Acquisition FoR?
The areas of concern can be viewed as hierarchical in nature, with task skills and interpersonal skills forming the base; family interactions, ADL, school/work, and play/leisure/recreation forming the middle; and temporal adaptation making up the top portion of the pyramid.
Indicators of Function and Dysfunction for Role Acquisition?
1. Adaquate participation in the physical, cognitive, and psychological aspects of tasks. Evaluation of task skills is usually accomplished through data gathered from a general interview and the Survey of task skills.
Postulates reguarding change in the Role Acquisition FoR?
1. Long term goals are set based on the client's expected environment.
2. The sequence of the change process is generally task skills, interpersonal skills, social roles beginning with ADL, and temporal adaptation.
Which FoR was adapted from Bruce and Borg (1993,2002)
The Behavioral Frame of Reference
What is the Theoretical Basis for the Behavorial FoR?
The behavioral frame of reference is based on concepts drawn from experimental psychology, classical conditioning (Pavlov), operant conditioning (Skinner), and social learning theories (such as Bandura, Mischel, and Rotter).
What are the Theoretical Assumptions for Behavioral FoR?
1. A person's behavior is predictable, measurable, and objective.
2. A person's verbalization and self-descriptions are behaviors.
3. The patient has a repertoire of behaviors (adaptive and maladaptive) that have been learned through selective reinforcement from the environment.
Function/Dysfunctin Continua for Behavioral FoR?
The focus of this frame of reference is on the behaviors that elicit or inhibit functioning in the areas of ADL, work, and play/leisure. There is an emphasis on the stimuli that act as cues to the behavior and the reinforcers for specific behaviors.
Indicators of Function and Dysfunction for Behavioral FoR?
1. Age appropriate, culturally acceptable behaviors that contribute to or interfere with adaptive function.
2. Behaviors necessary for adaquate function in teh person's natural environment.
3. The frequency of specific adaptive and maladaptive behavior.
4. The ability of the person to discriminate among stimuli and to generalize learning effectively.
Postulates reguarding change in the Behavioral FoR?
1. If the therapist uses pelasurable activities, then adaptive behaviors are reinforced.
2. If the therapist uses negative reinforcement or ignoring of maladaptive behaviors, tehn those behaviors are decreased.
3. If the therapist grades activities to provide progressively more difficult learning challenges, tehn adaptive behaviors needed to function in teh community environment are shaped.
Which FoR was previously referred to as the Object Relations FoR. Adapted from Bruce and Borg (1993, 2002)?
Psychodynamic FoR
Theoretical Basis for Psychodynamic FoR?
The basis is an eclectic integration of principles from Freud, Jung, Hartmann, White, rogers, Maslow, and Goldstein (Freudian, Jungian, neo-Freudian, existential-humanistic, and social and ego psychologies).
Theoretical assumptions for Psychodynamic FoR?
1. A person is a valuable, unique individual
2. The person is the expert on his or her life, including his or her feelings, emotions, and what he or she needs to change in order to function more successfully in teh environment.
3. Activities and objects have no meaning in and of themselves--people give them meaning
Function/Dysfunction Continue for Psychodynamic FoR?
The focus of this FoR is on the inner workings of the hums psyche. The concepts addressed include:
1. self awareness, self identity, self actualization, and adaptation to the real world.
2. Motivation for participation in meaningful occupations.
3. Use of defense mechanisms.
4. Engagement with human and nonhuman objects.
5. Self control of impulses.
6. Social and occupational skills
Indicators of Function and Dysfunction of the Psychodynamic FoR?
Function is indicated by:
1. the ability to make realistic assessments about what is going on in the environment.
2. Adaptation to environmental expectations, which include exerting self-control and deferring gratification.
3. In pursuit of spiritual health, the person participates in activities that are meaningful to him or her and feels that he or she has a quality of life.
Dysfunction is indicated by:
1. The person views him or herself or situations outside of the self in ways that are very different from how others see these.
2. The person is unaward of feelings that are shaping decisions.
3. Loss of self motivation, feelings of helplessness, hopelessness and/or anxiety.
Postulates reguarding change for Psychodynamic FoR?
According to Bruce and Borg (1993), the intervention process occurs in individual and group situations with clients who are reality oriented and capable of ligical thinking. To facilitate a dynamic understanding of behavior and problems, the occupational therapist uses creative media or semistructured experiences to help the patient project his or her thoughts, fellings, needs, fantasies, desires, and frustrations onto the end product (i.e. activity). The therapist uses activities and the discussions around him or her for one or more of the following.
Which FoR was adapted from Bruce and Bord (1993, 2002)
Cognitive Behavioral FoR
What is the Theoretical Basis for Cognitive Behavioral FoR?
Based on principles from social learning, cognitive and behavioral theories (such as Adler, Piaget, Beck, Bandura, Kazdin, and Wilsonx
Theoretical Assumptions for Cognitive Behavioral FoR?
1. A person makes decisions regarding vehavior based in part on what he or she expects will be the outcome.
2. A person's emotions and feelings are interdependent with what he or she knows and velieves.
3. The self monitoring process can be learned.
4. One's thoughts are not always in conscious awareness; making thoughts aware makes them more amenable to change.
Function/Dysfunctio continua for Cognitive Behavioral FoR?
1. Self-knowledge.
2. Cognitive functioning, including an ability to understand the environment and effective or flexible problem solving repertoire.
3. sense of safety
4. feelings of competence.
6. Self regulation.
indicators of Function and Dysfunction for Cognitive behavioral FoR?
The person may think he is incapable of taking responsibility for his or her own life, lack a realistic understanding of his or her own abilities and limitations, have self defeating beliefs or be unclear regarding his or her beliefs, or b eunable to adapt and cope with changing circumstances.
Postulates Regarding Change in Cognitive Behavioral FoR?
Intervention can take place in both individual and group settings. The intervention does not eliminate the disorder but provides cognitive, affective, and vehavioral learning experiences to teach skills, strategies, and methods of coping. Intervention is more effective when specific techniques and skills are learned then when only verbal methods are utilized. The therapeutic tasks should consider the person's cognitive knowledge, level of function, and interest. Therapy should stress the highest degree of self regulation, not the highest cognitive developmental level.
Which FoR was originated by Gentile. Adapted from Kaplan and Bedell (1999).
Motor skills acquisition (pediatric-focused)
What is the theoretical base for Motor Skills Acquisition?
Dynamic Systems Theory emerges from the interaction of many systems. The 3 general systems are the person, the task and the environment. Motor Control and Learning and Development Theories (developmental level of child is also acknowledged. although do not aim to increaseskills at one level before moving to next).
Theoretical Assumptions of Motor Skills Acquisition?
Functional tasks help organize behavior (focus on tasks that are meaningful).
2. Successful performance of meaningful tasks emerges from the interaction of multiple personal and environmental systems.
3. Motor problems observed are the result of all the systems interacting and compensating for some damage or problem in one or more of those systems. (Don't always focus on underlying neurological problem in treatment.)
Function/Dysfunction Continua for Motor Skills Acquisition?
This FoR focuses on the child's ability to perform a task. Thios is determined according to the needs of each individual.
Indicators of function and Dysfunction for Motor Skills Acquision FoR?
1. The indicators of function are those aspects of the task that the child is able to perform
2. The indicators of dysfunction are those aspects of the task that the child is unable to perform
3. Stage of motor learning
4. Child task environment match
Postulates regarding change in Motor Skills Acquisition FoR?
If there is a maych among the task requirements, environmental demands, and the child's abilities, then it is more likely that motor skill acquisition will be improved.
2. If the child understands what is to be achieved and is provided with clear information about the expected motor skill performance and outcome, then it is more likely that motor skill acquisition will be improved.
3. If the child is provided with a task that is channenging and motivating, it is more likely that motor skill acquisition will be improved.
Which FoR was originated by Ayess. Adapted from Kimball (1999)?
Sensory integration
The Theoretical Basis for Sensory Integration?
Neuroscience and developmental theories
Theoretical Assumptions for Sensory Integration?
1. The central nervous system (CNS) is hierarchiacally organized. Cortical processing relies on adaquate organization of inputs supplied by the lower brain centers.
2. Meaningful registration of stimuli must occur before the CNS can make a response to it and, therefore, allow for higher functioning to occur.
3.The brain is innately organized to program a person to seek out stimulation that is organizing or beneficial in itself.
4. Input from one sensory system can facilitate or inhibit the state of the entire program. Input from each system influences every other system and the whole organism.
5. There is plasticity within the CNS.
6. Normal human development occurs sequentially.
Function/Dysfunction Continua for Sensory Integration?
1. Sensory modulation
2. Functional support capabilities
3. End product abilities
Indicators of Function and Dysfunction for Sensory Integration?
Tactile system, auditory system, relationship to gravity, movement level, oral arousal, olfactory arousal, visual system, attention level, postrotary nystagmus, sensitivity to movement, proprioceptive sensitivity, and emotional arousal.
Evaluation is completed using clinical observations; parent, teacher and child interviews; and several assessment tools including the sensory integration and praxis test, touch inventory for elemantry school aged children.
Postulates regarding change for Sensory integration?
1. If the therapist provides a situation that requires an adaptive response that is developmentally appropriate, then the adaptive response is more likely to occur and more likely to promote growth.
Ther are specific postulates regarding change that address each of the 3 level of continua. They are considered to be hierachical, which means each of the levels should be addressed in order.
Which FoR was developed by occupational therapists at Loewenstein Rehabilitation Hospital. Adapted from Averbuch and Kats (1998)?
Cognitive Rehabilitation
Theoretical Basis for Cognitive Rehabilitation?
Neuropsychological and cognitive therories (developmental and information processing).
Theoretical Basis for Cognitive Rehabilitation?
1. Each brian region is involved in various functions and interacts with other regions in completing a specific task.
2. Every normal act is a result of a dynamic balance between all brain structures.
3. Higher mental processes in the human cortex constantly change during child development and are influenced by the environment (learning and training process.
4. The functional system as a whole can be disturbed by a lesion in one area.
5. It can be disturbed differently by lesions in different localizations.
6. Impaired intellectual processes can be improved through cognitive retraining.
Function/Dysfunction continua for Cognitive Rehabilitation FoR?
This frame of reference addresses cognition (the acquisition, organization, and use of knowledge), perception, visual motor organization, thinking operations (executive functions), memory, attention, and concentration.
Indicator of Function and Dysfunction for Cognitive Rehabilitation FoR?
1. Basic cognitive task performance in the various cognitive subcomponents.
2. Comparison of current cognitive performance to premorbid information.
3. Sensorimotor function.
4. Functional performance of daily activities.
Assessment of cognition may be completed using various cognitive batteries, including the Loewenstein Occupational Therapy Cognirive Assessment, The Rivermead Behavioral Memory Test, teh Behavioral Inattention test, and/or the Neurobehavioral Cognitive status examination.
Postulates regarding change in Cognitive Rehabilitation FoR?
1.In the first phase, component specific (perception, visual motor organization, thinking operation, and memory) training is completed using specific tools in a laboratory environment.
2. therapist instructs pt. to complete tasks to their capabilities.
3. Difficulty of tasks are increased when person masters the task.
4. The person is trained to develop specific strategies for each specific component.
Which FoR was originated by Toglia. Adapted from Toglie (1998)?
Dynamic Interactional
What is the theoretical basis for Dynamic Interactional?
Concepts are drawn from neuropsychology and learning theories.
What are the Theoretical assumptions for Dynamic Interactional FoR?
1. Cognition is the individual's capacity to acquire and use information in order to adapt to environmental demands. Cognitive abilities are not conceptualized as specific components, but as the underlying straategies and potential for learning.
2. Cognitive function (i.e., the ability to receive, elaborate, and monitor incoming information) is influenced by the dynamic interaction between the individual (strategies, metacognition, the learner charachteristics), the task, and the environment.
3. Cognitive abilities are modifable and vary with the characteristics of the task, the environment, and the individual.
Function/Dysfunction Continua for Dynamic Interactional FoR?
1. Processing strategies
2. Metacognition
3. Learning capabilities.
4. Transfer of learning to varied tasks an denvironments.
Indicators of function and Dysfunction for Dynamic Interactional FoR?
1. The ability to select and use efficient processing strategies to organize and structure incoming information.
2. The ability to acticipate, monitor, and verify the accuracy of performance.
3. The ability to link new information with previous experience.
4. Flexible application of knowledge and skills to a variety of situations.
Assessment methods include the use of the dynamic interactional assessment, which includes awaremess questioning, response to cueing and task grading, and strategy investigation: The Dynamic Visual Processing Assessment; and the t\Toglia Category Assessment.
Postulates Regarding Change in the Dynamic Interactional FoR?
Processing strategies
Individual treatments need to be combined with group treatments to reinforce self monitoring or task strategies.
Which FoR was developed by Giles, Clark-Wilson, and Yuen. Adapted from Giles (1998)
The Neurofunctional Approach
Theoretical Basis for The Neurofunctional Approach?
Neuroscience and learning theories
Theoretical Assumptions for The Neurofunctional Approach?
1. Deficits in memory, attention, processing, and frontal lobe functions interfere with a person's ability to perform daily functional skills
2. The person's cognitive abilities and learning charachteristics impact the manner in which daily functional skills can be retrained.
3. Damage to the cerebral cortex often results in deficits in adaptive behavior and the ability to reacquire adaptive patterns of behavior.
4. The extent and location of injury to the cerebral cortex places constraints on human learning, but the ability to acquire new behaviors is retained in all but the most profoundly impaired.
Function/Dysfunction Continua for The Neurofunctional Approach?
This frame of references focuses on performance in areas of occupation, including ADL, instrumental ADL, education, work and productive activitiesand play or leisure activities.
Indicators of Function and Dysfunction for The Neurofunctional Approach?
Function is designed as adaquate completion of performance in areas of occupation in a naturalistic environment in which cues are not provided and demands are not specifically manipulated. Assessment methods include observation, standardized assessments, questionnaires, checklists, and rating scales. If the person is not able to perform tasks in a naturalistic environment, structure and cures are provided to obtain baseline information. If despite careful observation, the origin of some functional skills deficits remains unclear, the occupational therapist may use standardized testing to attempt to elicit the true cause of the problem and develop an adaquate treatment plan.
Postulates Regarding Change
Practice of functional skills lead to modification.