Models & Frames of Reference

Allen Cognitive Model

Model of assessment and treatment that is built around functional cognition, or the interaction between cognitive abilities and the activity setting that results in performance.

An occupational therapist administers the Allen Cognitive Levels screening test to determine how much assistance a new patient with mild dementia will need to follow precautions following hip replacement surgery. what model is being used?

Allen Cognitive Model

.A cooking activity is structured by the occupational therapist to accommodate the cognitive skills of a patient with schizophrenia, based on the outcome of the Routine Task Inventory (RTI). what model is being used?

Allen Cognitive Model

Behavioral Modification

Positive or negative reinforcement is used to elicit a desired response.

In a public school setting, an occupational therapist asks a student to write three sentences, after which he may choose an activity that he would like to do. what model is being used

Behavioral Modification

A head injury patient is required to clean up the occupational therapy treatment area after throwing objects while refusing treatment. what model is being used

Behavioral Modification

Biomechanical Frame of Reference

Synergies and reflexes that occur in early normal development are also a normal part of the recovery process for patients with hemiplegia following a stroke. These synergies should be facilitated and encouraged during the course of treatment.

For an outpatient who has had rotator cuff surgery, an occupational therapist leads active range of motion exercises, and then has the patient reach for plastic glasses in a cupboard. what model is being used?

Biomechanical Frame of Reference

An occupational therapist has a patient complete upper body strengthening exercises to improve the patient's ability to push up from a chair during transfers. what model is being used

Biomechanical Frame of Reference

Brunnstrom Movement Therapy Frame of Reference

Synergies and reflexes that occur in early normal development are also a normal part of the recovery process for patients with hemiplegia following a stroke. These synergies should be facilitated and encouraged during the course of treatment.

During occupational therapy treatment for a woman who has hemiplegia following a stroke, the occupational therapist has the woman perform a reaching activity with her unaffected arm while the therapist moves the affected arm in the same manner. what model is being used?

Brunnstrom Movement Therapy Frame of Reference

Canadian Model of Occupational Performance

A framework that illustrates the interaction between people, their environments, and their occupations related to self care, productivity, and leisure.

An occupational therapist develops a treatment plan for a woman with rheumatoid arthritis, based on the woman's desire to resume playing the organ at her church. what model is being used?

Canadian Model of Occupational Performance

Cognitive Behavioral Frame of Reference

People are taught to replace behaviors that result from abnormal thought processes with more normal or adaptive thought processes and behaviors.

An occupational therapist helps a young woman with Down's Syndrome learn that she does not need to be afraid to use the bathroom by herself. what model is being used?

Cognitive Behavioral Frame of Reference

Compensatory Frame of Reference

Patients who will not regain functional skills can compensate by using adaptive equipment or techniques to complete tasks in a different way.

A woman with severe osteoporosis uses long handled gardening tools to weed her flowers while standing. what model is being used?

Compensatory Frame of Reference

A man with multiple sclerosis who has short term memory problems uses a smart phone to set reminders for appointments. what model is being used?

Compensatory Frame of Reference

Dynamic Interactional Approach, previously called Cognitive Rehabilitation

Functional performance is restored for people with cognitive dysfunction by specifically focusing on the following areas: orientation, attention, visual processing, motor planning, cognition, occupational behaviors, and effort.

An occupational therapist structures a supported employment job activity for a man who has had a traumatic brain injury to accommodate his current problem solving and decision making skills. what model is being used?

Dynamic Interactional Approach, previously called Cognitive Rehabilitation

Ecology of Human Performance

A person's occupational performance is viewed in relation to the context in which activity occurs. Activity is selected and adapted based on physical, social, temporal and cultural contexts.

An elderly man with Parkinson's Disease is able to feed himself using regular utensils, but is unable to finish a meal before his food gets cold. The occupational therapist provides the man with adapted dishes and utensils, which allows the man to finish a meal while his food is still warm. what model is being used?

Ecology of Human Performance

Lifestyle Performance Model

A person's total activity repertoire is considered within the context of that person's world. The framework allow for a holistic approach to treatment.

An occupational therapist completes a full occupational profile with a man admitted to inpatient rehabilitation for a spinal cord injury. The profile includes daily routines, living situation, employment, leisure activities, relationships, spiritual views, and priorities for treatment. What model is being used?

Lifestyle Performance Model

Model of Human Occupation (MOHO)

Occupation is assessed based on the three components of volition, habituation, and performance capacity, within the environmental context.

An occupational therapy assistant helps a 5th grade student with learning disabilities to improve his handwriting. The student has an interest in science, so the OTA has the student hand write and draw his own periodic table of the elements. what model is being used?

Model of Human Occupation (MOHO)

Neurodevelopmental Treatment (NDT)

This frame of reference, used for rehabilitation for neurological conditions, focuses on specific handling techniques to facilitate normal posture and movement patterns while inhibiting abnormal patterns.

An occupational therapist physically positions a three year old child with cerebral palsy on his hands and knees while the child reaches to play with blocks. what model is being used?

Neurodevelopmental Treatment (NDT)

Occupational Adaptation

The integration of occupation and adaptation is viewed as a single, integrated process. The model focuses on improving adaptability, rather than functional skills.

An occupational therapist teaches a woman with multiple sclerosis how to drive using an adapted van. what model is being used?

Occupational Adaptation

Person-Environment-Occupation-Performance Model (PEOP)

The interaction between a person's abilities, environmental factors, and the demands of occupation influences performance outcomes.

In a home health setting, an occupational therapist works with a woman with muscular dystrophy to adapt the bathroom in her new home so that she can shower independently. what model is being used?

Person-Environment-Occupation-Performance Model (PEOP)

Proprioceptive Neuromuscular Facilitation (PNF)

A treatment model that focuses on motor development through the shift in flexor and extensor muscles, using diagonal movement patterns to facilitate mature motor movements.

An occupational therapist works with a woman who has had a stroke on reaching for cones in a diagonal pattern across her upper body, then has the woman apply the movement to combing her hair. what model is being used

Proprioceptive Neuromuscular Facilitation (PNF)

Psychoanalytic and psychodynamic theory

Personality development is driven by conscious and unconscious factors. The therapy process uses self awareness, emotional expression, social relationships, and defense mechanisms to help patients direct their actions to complete tasks.

An occupational therapist teaches a high school student with an anxiety disorder how to use relaxation techniques to help prepare for a test. what model is being used?

Psychoanalytic and psychodynamic theory

Psychoeducation

A treatment model in which patients and their families are educated about their diseases in order to change their thinking and behavior.

An occupational therapist teaches an 8th grade student with a diagnosis of autism about his condition so that he understands why he needs to use noise reducing headphones during assemblies. what model is being used?

Psychoeducation

Rood Frame of Reference

A neurological treatment approach in which motor patterns are facilitated and normalized through the application of sensory stimulation to specific sensory receptors.

While working with a man who has hemiplegia following a stroke, an occupational therapist performs a quick stretch facilitation technique to the man's affected triceps, followed by weight bearing on the affect arm. what model is being used?

Rood Frame of Reference

Sensory Integration

This frame of reference is based on the way the brain receives sensory input from the environment and organizes it so that the body can respond with action. As normal development occurs, the brain's ability to integrate sensory input matures.

An occupational therapist helps a child with attention deficit hyperactivity disorder (ADHD) to participate in vestibular swinging to organize and calm his neurological system so that he can sit still in his classroom. what model is being used?

Sensory Integration

Strengths Model

A mental health frame of reference in which the practitioner views people as individuals, not as patients or clients. A person's strength are the focus, not their weaknesses or "disability".

An occupational therapist adapts a social studies lesson for a student with autism so that he can learn by reading and looking at pictures instead of listening to the teacher's lecture, because visual memory is one of his strengths. what model is being used?

Strengths Model

Model of Human Occupation (MOHO)

• Occupation is context dependent

• Volition

• Habituation (roles + patterns of behavior)

• Performance capacity (physical + mental skills)

• Environment (physical + social)

Person - Environment - Occupation Model (PEO)

• Occupation is dynamic

• P + E + O = occupational performance

Lifestyle Performance Model

• match environment & individual needs

• 4 hypotheses

  • competence in socially significant activities inc social efficacy

  • Activities have reality and symbolic meanings that effect motivation/experience

  • mastery/competence more easily achieved in activities that match a persons neurobiological and psychological structure and are more easily seen in the end product/outcome of an activity

• Performance made of

  • self care and maintenance

  • intrinsic gratification

  • social contribution

  • reciprocal relationships

Ecology of Human Performance Model (EHP)

• Context (cultural, physical, and social env.) impact task performance

• Ecology = interaction between person + env

• person - context - task interactions

Occupational Adaptation

• Person occupation environment + interaction btwn the two

• Desire to participate in occupation in driving force behind adaptation

Role Acquisition Frame of Reference

• Use tasks and social skills to meet demands of personally desired roles

Cognitive Disability Frame of Reference

• Cognitive ability determined by biological factors

• Cognitive Performance Levels

  • Level 1: Automatic Actions

    • automatic motor responses and changes in autonomic nervous system

    • conscious response to external environment is minimal

  • Level 2: Postural Actions

    • movements associated with comfort

    • some awareness of large objects, may assist caregiver with simple tasks

  • Level 3: Manual Actions

    • beginning to use hands to manipulate objects

    • can perform limited # tasks with long term repetitive training

  • Level 4: Goal Directed Actions

    • perform simple tasks to completion

    • reliant on visual cues, cannot cope with unexpected events

  • Level 5: Exploratory Actions

    • overt trial and error problem solving

    • New learning occurs

  • Level 6: Planned Actions

    • absence of disability, can do mental trial and error problem solving when thinking of actions

Cognitive Behavioral Therapy (CBT)

• Works to alter negative thought patterns by correcting misinterpretations of life events (cognitive restructuring)

• Development of insight is necessary for growth and change (changing the way a person thinks can reduce symptoms and thinking can be self regulated)

Contemporary Task Oriented Approaches to Motor Control Training

• Occupational performance result of person + task + environment

• Rejects hierarchical model of motor control

• Functional tasks help organize motor behavior

• Stages of motor learning

  • Skill acquisition (cognitive stage)

  • skill retention (carryover/associative stage)

  • skill transfer stage (autonomous stage) → demonstrate skill in new context

Neurodevelopmental Treatment (NDT)/Bobath technique

• Need to normalize tone (postural and limb) prior to normal movement

• Inhibit primitive reflexes and abnormal limb movements

• Postural reactions are the basis for control of movement (righting, equilibrium, protective responses)

• Focus on improving movement quality

  • normalize movement patterns

  • integration of both sides of the body/reestablishment of symmetry of sides of the body

  • Est. ability weight bear/weight shift through limbs

  • Est. normal righting and equilibrium reactions

  • “Handling” primary intervention to promote normal movement.

Proprioceptive Neuromuscular Facilitation (PNF)

Stimulate proprioceptors to increase neuromuscular mechanism response

• Diagonal movement patterns (D1 and D2), mass movement patterns, sensory stim., visual cues, verbal commands

• Movement develops cervico-caudally and proximodistally

• Use of goal directed activities + facilitation