Week 5: Frames of Reference

frame of reference: consistent guide for a particular area of practice that outlines
- theoretical assumption
  - draw from at least one theory
- function-dysfunction continuum: focuses on the concern or problem areas
  - functional end of the continuum represents abilities
  - dysfunctional end of the continuum represents disabilities
- postulates for change: provides practical actions that therapist can take to facilitate change in the client
- utilities / use for frames of reference
  - guide for evaluation
  - postulates regarding change
Biomechanical Frame of Reference
- population
  - impairment based
  - multiple diagnoses
  - across the lifespan
  - physical limitations in systems
- principles
  - range of motion
  - strength
  - endurance
- function-dysfunction continuum
  - structural stability
  - passive ROM
  - low level endurance
  - edema control
  - strength
  - high level endurance
- theoretical assumptions about change
  - purposeful activities can be used to treat loss of ROM, strength and endurance
  - if ROM, strength and endurance are regained, the patient will regain function
  - rest and stress
  - most appropriate for a normal functioning CNS
- practitioner role/intervention approaches
  - improve strength
  - increase ROM
  - extend endurance
  - exercise, stretching, body mechanics, splinting
  - occupation-based
- assessment tools
  - goniometer
  - volumetry
  - MMT
  - grip strength
  - METs
  - clinical observations
Rehabilitative 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
  - environment modifications
- population
  - used across lifespan
  - restorative goals
- function-dysfunction continuum
  - focus on performance areas vs performance components
  - minimize disability barriers to role performance
  - performance areas of ADLs, IADLs
- theoretical assumptions on change
  - client can regain independence through compensation
  - motivation based on a client’s values, roles, interests is a basic requirement for independence
  - importance of environmental factors
  - base level of emotional and cognitive skills required
- practitioner role / intervention approaches
  - self care/ADL eval and training
  - assistive/adaptive devices
  - IADLs
  - work simplifications
  - environment modifications
  - wheelchair management/modifications
  - orthotics/prosthetics
  - community transportation
- assessment tools
  - assess clients capabilities
    - prioritized area of occupation
    - frequently used ADL or IADL
  - levels of assistance
    - min assist vs mod assist vs max assist
  - work evaluations
    - work tolerance, work conditioning, grip strength, balance
  - leisure skills
    - interest checklists, play evaluation