Frame of Reference:

What is a Theory? An understood as true assumption about how events/behaviors are related or develop. (typically from other disciplines, form basis for frame of reference and model of practice)

What is ‘Model of Practice’? Structure for how practice elements relate to each other and how we approach practice.

domain of concern, nature/principles for sequencing aspects of practice, philosophical/theoretical assumptions

Frame of Reference: A consistent guide for a particular area of practice that outlines:

  1. theoretical assumption

  2. function-dysfunction continuum

  3. postulates for change

Function-dysfunction continuum- focuses on the concerns or problem areas. Therapist should identify specific areas of performance that are important to the client’s skills and abilities

Functional end of …= what the therapist expects the client to be able to do what by the end of the therapy

postulates- means to change

Guide for evaluation:

baseline for the intervention and performance

relates to the indicators of function-dysfunction

Postulates regarding change:

Provides structure to the frame of reference, guides the therapist about the changes seen after applying the action

Biomechanical approach: impairment-based, multiple diagnoses, across the lifespan, physical limitations in systems

Examples of biomechanical systems:

  • peripheral nervous system

  • musculoskeletal

  • skin

  • cardiopulmonary

Things to look at when using the biomechanical frame of reference:

  • structual stability

  • proom

  • low level endurance

  • edema control

  • strength

  • high level endurance

You may work with individuals with: SCI, a heart condition, etc

Biomechanical assumptions on change:

Purposeful movements can be used to treat loss of ROM

If ROM, strength, and endurance are regained, the patient will regain function

Rest and Stress

Most appropriate for normal functioning central nervous system

Biomechanical: Used in Intervention Approaches

  • Improve strength

  • Increase ROM

  • Extend endurance

  • Exercise, stretching, body mechanics, splinting

  • Can be occupation based

Biomechanical Assessment tools:

  • Goniometer

  • Volumetry (edema)

  • MMT

  • Grip strength

  • Clinical observations

  • METs (endurance)

Rehailitative Frame of Reference:

Act of restoring someone’s health through training and therapy after an illness or injury

Requires client as part of rehabilitation team

Programs preferred in client’s natural environment ( all interventions aim to work ‘in’ the patient’s natural environment, but there a therapeutic limitations that do not always allow that to happen)

Involves modifying client’s environment and introducing compensatory strategies

Rehabilitative Population:

Used across the lifespan, works with any population who has lost skills,, and has a goal to regain function

Rehabilitative: Function-Dysfunction-

  • Focus on performance areas

  • minimize disability barriers

  • focus on performance areas of ADLs, IADLs

Rehabilitative Theoretical Assumptions on Change:

Regaining independence through compensation

Motivation based on client values, roles, and interests (all these aspect are required when pursuing independence)

Environmental factors play an important role in rehab

Client needs a base level of emotional and cognitive skills to achieve independence

Rehabilitative: Practitioner Role/Intervention Approaches:

  • Self-care/ADL eval and training

  • Assistive/adaptive devices

  • IADLs

  • Work simplification

  • Environmental modifications

  • Wheelchair modifications and management

  • Orthotics and prosthetics

  • Community transportation

This FOR is used with clients who have experienced a…. stroke (CVA), SCI, amputation, etc

Rehabilitative Assessment Tools:

  • Assess client’s capabilities- prioritize areas of occupation, frequently ADL/IADL focused

  • Generally, use levels of assistance to describe performance areas- Min assist, Mod assist, Max assist

  • Work evaluations- work tolerance, work conditioning, grip strength, balance, etc

  • Leisure skills- interest checklists, play evaluations