OT Frames of Reference and Practice Models - Notes

Adaptive Skills Model (Mosey)

  • Developed by Anne Cronin Mosey

  • Stage-by-stage progression of development in these areas:

    • Sensory integration skill: ability to receive, select, combine and use information from balance (vestibular), touch (tactile) and position (proprioceptive) senses to perform functional activities

    • Cognitive skill: ability to perceive, represent and organize sensory information for thinking and problem solving

    • Dyadic interaction skill: ability to participate in a variety of relationships involving one other person

    • Group interaction skill: ability to participate successfully in a variety of groups; generally being able to be a productive member of the group

    • Self-identity skill: ability to recognize one’s own assets and limitations and to perceive the self as worthwhile, self-directed, consistent and reliable

    • Sexual identity skill: ability to accept one’s sexual nature as natural and pleasurable and to participate in a relatively long-term sexual relationship that considers the needs of both partners

  • See Table 3.1 for the stages of development

  • Guiding Concepts of the Adaptive Skills Model:

    • Therapist provides environment that facilitates growth

    • Subskills are completed in order following developmental sequence

    • Consumer must recognize their own capacity and limitations

    • Various/multiple subskills may be addressed or treated at same time as long as normally developed at same chronological age

    • Recognize self-assessment and cooperative skills

    • Consumers intrinsic motivation or desire for mastery of subskills must be engaged

Role Acquisition and Social Skills Training

  • Helps a person gain the specific skills needed to function in the occupational and social roles they have chosen

  • Principle 1: Client Participation

    • Person should participate in identifying problems and goals for treatment and in evaluating their progress

    • Is usually structured in the first meetings with them

  • Principle 2: Personalized goals

    • Choose goals and activities that reflect the client’s interests, personal and cultural values and present and future life roles

    • Values may be shaped by ethnicity, social class and culture

  • Principle 3: Ability Based Goals

    • Choose goals and activities that provide a realistic challenge but are consistent with the client’s present level of ability

    • Activities should require some effort from client, but not too difficult that they become tired or frustrated

  • Principle 4: Increasing Challenges

    • Increase challenges and demands as the person’s capacity increases

  • Principle 5: Natural Progression

    • Present skills in their natural developmental sequence

  • Principle 6: Client Knowledge

    • Clients should always know what they are supposed to be learning and why

  • Principle 7: Client Awareness

    • Clients should be aware of the effects of their actions

  • Principle 8: Practice Makes Perfect

    • Skills must be practiced repeatedly and then applied to a new situation

  • Principle 9: Parts of the Whole

    • If a task is too complex or time consuming to learn all at one time, teach one part at a time, but always do or show the whole activity

  • Principle 10: Imitation

    • People learn how to do things by imitating others

Social Skills Training Model

  • Essentially teaches interpersonal skills needed to relate effectively with other individuals

  • Motivation

    • Identifying behavior to be learned

    • Identifying importance of learned behavior

  • Demonstration

    • Shows consumer how behavior should be performed

  • Practice

    • Performing task in structured environment

    • Learning is improved upon and built on

  • Feedback

    • Summarize what person has learned

Cognitive Disabilities Model (Allen)

  • Developed by Claudia Allen

  • Mental disorganization may affect task performance

  • Level ratings (can be in whole or sublevels)

  • Leather Lacing: extLevel1:lowestleveloffunctioningwithsevereimpairmentsext{Level 1: lowest level of functioning with severe impairments}

    • extLevel6:highestleveloffunctioningwithnoimpairmentsext{Level 6: highest level of functioning with no impairments}

  • Levels 1-4 appropriate for occupational therapy intervention:

    • Level 1:

    • Lowest level

    • Consumer slow/limited in response timing

    • Short attention span

    • Minimal interaction with others

    • Level 2:

    • Aware of external/internal movements

    • Initiates gross motor movement

    • Unaware of social context and may have decreased attention span

    • Level 3:

    • Attends to external stimuli

    • Engages in simple, repetitive tasks, however, becomes surprised when produces product at end (unable to participate in projective thought process)

    • Difficulty understanding cause and effect

  • Level 4:

    • Copy demonstrated directions one step at a time

    • Can visualize and complete two-dimensional activities

    • Unable to identify and correct errors independently

  • Level 5:

    • Understands in concrete and obvious object relations

    • Complete 1 to 3 step task independently

    • May function with assistance or independently in community

  • Level 6:

    • Highest functioning level

    • Able to identify and correct errors

  • Functions independently in community

Leather Lacing

  • Notation within the Cognitive Disabilities Model highlighting levels 1–6 and corresponding task demands/integrity of function.

Model of Human Occupation (MOHO)

  • Developed by Gary Kielhofner

  • Encompassing model which covers all areas the individual

  • Views the individual as an open system that is affected by internal and external stimuli

  • 3 Subsystems:

    • Volition subsystem: Choices and consists of motivation; Thoughts, feelings, and enacting in an occupation or activity

    • Habituation subsystem: Consists of habits or internalized roles, patterns and routines for organizing behavior

    • Performance capacity subsystem: Based on physical and mental structures and functions

  • Changes in environment can lead to changes person’s actions

  • Environment can affect sensory integration/stimulation

Person-Environment-Occupation Model (PEO)

  • Developed by Mary Law

  • Occupational behavior is the outcome of an interaction among the person, the occupational task, and the environment

  • PEO is holistic in nature

  • Environment: The individual and their occupations cannot be separated from the environment

  • PEO defined by transactions-adjustments and changes

  • Person-Environment fit

  • PEO-person centered

Sensory Integration / Sensory Processing Model

  • Originated from treating children with learning disabilities

  • Sensory system working together to provide information to individual

  • Provides perception and motor action input

  • Proprioception:

    • extBodyawarenesswithouthavingtoattendtoindividualbodypartext{Body awareness without having to attend to individual body part}

    • extKnowledgeofwherebodyisinspaceext{Knowledge of where body is in space}

  • Vestibular Awareness

    • extProvidesbodywithinputconcerningbalance,velocity,andaccelerationofbodyext{Provides body with input concerning balance, velocity, and acceleration of body}

  • Relationship between sensory integration and consumers with schizophrenia:

    • Consumers may present with deficits in reception or processing of proprioceptive and vestibular information

    • Can contribute or cause psychotic symptoms

  • King identified common postural habits in individuals with schizophrenia which she related to impairment in the central nervous system; see the bullet points on page 80 regarding their posture

  • Key concepts when working with mental health population using the sensory integration model:

    • Attention should be kept on outcome of activity

    • Activity should be pleasurable so there is an increase in success

  • See pages 100-103 for treatment ideas used by therapists to address SI and SP

Proprioception and Vestibular Awareness (Sensory Integration Details)

  • Proprioception: Body awareness without having to attend to individual body part; Knowledge of where body is in space

  • Vestibular Awareness: Provides body with input concerning balance, velocity, and acceleration of body

  • Relationship with schizophrenia:

    • Deficits in reception or processing of proprioceptive and vestibular information

    • May contribute to psychotic symptoms

  • King’s work on postural habits in schizophrenia and CNS impairment (page 80 reference)

  • Practical concepts for MH populations using SI model:

    • Focus on outcome of activity

    • Ensure activities are pleasurable to boost success

  • Therapeutic ideas referenced in pages 100–103