Frames of Reference Guidesheet PDF

Common Frames of Reference Used in the Evaluation and Treatment of Adult Clients Assumptions Examples of Evaluations and Assessments Frame of reference objectives All frames of reference aim to increase (restore), adapt, maintain,...

Common Frames of Reference Used in the Evaluation and Treatment of Adult Clients Assumptions Examples of Evaluations and Assessments Frame of reference objectives All frames of reference aim to increase (restore), adapt, maintain, prevent or enhance (promote) occupational performance so that health, well-being, and participation are the outcome. Although the process objectives in the final column of this table are mainly stated at a body function or structure level, it is implicit that the practitioner’s therapy goals would be functional and focused on a client’s performance skills and engagement in his/her daily occupations. Biomechanical Frame of Reference Clients’ condition, diagnosis, or impairment is musculoskeletal disorders e.g., fracture, amputations, rheumatoid arthritis, hand injuries, or back pain. Applies knowledge from anatomy, physiology, Occupation-based Assessments To enhance occupational performance by: kinesiology, and physics to restoring function. Barthel Index Increasing strength, endurance or range of Borg Rate of Perceived Exertion (RPE Scale motion. Engagement in occupation requires movement via for endurance) Compensating for musculoskeletal pathology. body structures and functions. Disability of Arm, Shoulder and Hand (DASH) Functional Independence Measure (FIM) Reducing pain, swelling, or scarring. Client Factor Assessments Preventing deformity or contractures Hand Strength using a dynamometer and pinch Maintaining joint ROM or muscle strength meter Manual Muscle Test Pain Scale (visual analog and numerical rating scale) ROM measured using a goniometer Volumeter for edema Rehabilitative Frame of Reference Clients’ condition or disabilities are usually associated with neuro-motor, sensorimotor, or neurodevelopmental disorders such as multiple sclerosis, spinal cord injury, cerebral vascular accidents, or those that include cognitive, psychosocial or visual-perceptual disorders such as an acquired brain injury, that creates performance difficulties associated with the chronicity of a disorder. Engagement in occupation requires adaptive Occupation-based Assessments To maximize performance in occupations through techniques/ compensatory strategies to Canadian Occupational Performance Measure adaptation of the environment or activity environment, and/or occupation. (COPM) (Client factors, performance skills and patterns, Functional Independence Measure (FIM) may not be able to be restored in a timely manner) Klein-Bell Activities of Daily Living Scale Kohlman Evaluation of Living Scale (KELS) Client Factor Assessments Bells Test Mini Mental State Exam (MMSE) ROM using goniometer Semmes-Weinstein for sensation Frames of Reference for cognition, perception, and motor planning problems focus on the ability to perceive and participate in one’s environment to perform occupations. Multicontext Treatment Approach:(Toglia)25,26 This approach is used with clients who have neurological disorders that involves cognition, psychosocial and/or perceptual dysfunction. Addresses the dynamic nature of cognitive (i.e. Occupation-based/focused Assessments To restore cognitive and/or perceptual abilities to memory, sequencing, motor planning, problem- Assessment of Motor and Process Skills engage in occupational activity. solving, visual processing, attention, self- (AMPS) awareness, and how participation in occupation is Cognitive Performance Test (CPT) To adapt the activity or environment to allow the influenced by personal factors, the Executive Function Performance Test (EFPT) client to participate in meaningful occupations. activity/occupation being performed and the Arnadottir OT-ADL Neurobehavioral environment in which it takes place. Evaluation (A-ONE) To facilitate transfer of learning across a variety of Client Factor Assessments contexts Cognitive Assessment of Minnesota (CAM) Aims for clients to generalize strategies learned in Lowenstein Occupational Therapy Cognitive To develop self-awareness to utilize strategies to therapy to transfer these techniques across new Assessment (LOTCA) promote function and decrease barriers. situations. Motor Free Visual Perceptual Test (MVPT)  Test of Everyday Attention (TEA) Emphasizes the practice of skills in context. Quadraphonic Approach: (Abreu and Peloquin)27 Cognitive deficits following a brain injury Continuous analysis of occupational performance See assessments above To remediate or compensate for abilities in body is required for effective rehabilitation. function (cognitive, perceptual and motor abilities) to be able to participate in occupations. Emphasizes a “micro” focus on body function( e.g., attention, sequencing, problem-solving, motor To promote client-centered strategies based on age, planning) and postural control, and a “macro” health and personal characteristics to promote focus on occupational performance areas, such as engagement in functional activity ADL’s and Work, and understanding the client’s priorities, motivation and well-being. 26,28 The narrative process of story- telling and story making is integral to the rehab process. Neurofunctional Approach:(Giles)29 Used with clients who have severe cognitive deficits following a brain injury28 “Intervention emphasizes the use of task-specific See assessments above To retrain the lost skill/s through compensatory training or rote repetition of a task/routine in techniques and repetitive practice using the same natural contexts to develop habits or functional task and within the same environment behavioral routines.” (p.746) 26,29 Frames of References for sensorimotor disorders, motor learning or motor control disorders. These are clients with impairments due to injuries, trauma or disorders of the central nervous system. These frames of references are designed to assist clients to learn and acquire appropriate developmental movement patterns and utilization of sensory input to engage in functional actions in a controlled way that allows an individual to respond to their environment and occupations.30 Motor learning/Motor Control Approach: (Carr and Shepherd) 20 Musculoskeletal, neuromotor, sensorimotor, neurodevelopmental conditions, and cognitive/perceptual disorders Usually associated with assisting clients to learn and acquire appropriate developmental movement patterns utilizing sensory input to engage in functional actions in a controlled way that allows an individual to respond to their environment and occupations.30 Motor control is the result of motor learning. 30 Emphasizes the practice of learning motor Occupation-based Assessments To learn and practice strategies to enhance the movement and control of movement to enhance AMPS (Assessment of Motor and Process quality and effectiveness of movement in participation in occupational activity (e.g., Skills) functional activity (i.e., the goal is to increase intrinsic and extrinsic feedback). FIM (Functional Independence Measure) motor control). AMAT (Arm Motor Ability Test) Emphasizes a heterarchic dynamic process of COPM (Canadian Occupational Performance Utilizes both facilitation and inhibitory techniques. client factors, context, environment and Measure) occupations. (Phipps) Wolf Motor Function Test (WMFT) To gain voluntary, motor control to participate in Client Factor Assessments occupations in a variety of contexts. Fugl-Meyer Assessment (FMA) Modified Ashworth Scale Motor Assessment Scale (MAS) Reflex Testing Observe the quality of volitional movement patterns Observe reflex patterns, such as equilibrium and righting reactions. Sensorimotor Approach: ( Rood ) Neuromotor, sensori-motor, and neurodevelopmental conditions that utilizes a neurophysiological approach to treatment Emphasizes the use of facilitation and inhibitory See assessments above To normalize muscle tone through the use of sensory stimulation techniques to normalize facilitory or inhibitory techniques to initiate muscle tone in order to initiate a volitional motor controlled developmental movement. Utilized response for functional performance skills31 primarily as a preparatory precursor to engage in occupations.31 Emphasizes both a reflexive and hierarchic model of motor control.31 Movement Approach: (Brunnstrom) Approach is specific to people who have suffered from a cerebral vascular accident (CVA) and is a neurophysiological approach to treatment. This approach addresses the reflexive and See asessments above To improve movement from a reflexive pattern to abnormal patterns in the UE and encourages The Brunnstrom Approach has influenced the voluntary control31 synergic (flexor or extensor) activation of development of a standardized assessment to muscles to promote the development of evaluate a person recovering such as the Fugl- purposeful, voluntary movement. The approach Meyer Assessment of Physical Performance identifies six sequential stages of motor recovery (FMA). after a stroke-induced hemiplegia. Emphasizes both a reflexive and hierarchic model of motor control.31 Proprioceptive Neuromuscular Function- PNF: ( Kabot, Knott and Voss) Focus on Central Nervous System Disorders and is a neurophysiological approach.32 Emphasizes the use of diagonal patterns (use of To produce a controlled diagonal movement agonist and antagonist muscles) combined with See assessments above pattern of the limbs and trunk (during functional sensory stimulation to promote voluntary, activity) that incorporates sensory input and functional movement31 strengthens both the agonist and antagonist muscles. Emphasizes developmental sequencing of motor _______ movement31 Emphasizes both a reflexive and hierarchic model of motor control.31 Neurodevelopmental Treatment Approach- NDT:( Bobath and Bobath)33 Central Nervous System Disorders and is a neurophysiological approach. Utilizes the facilitation of functional volitional See assessments above Important to emphasize normal and quality movement patterns through manual facilitation movement patterns in functional activity with techniques. manual facilitation Guides “normal’ movement patterns through the To gain proximal stability to produce distal use of “handling” at key points of control (i.e., the mobility head, shoulders, and pelvis) to engage in function activity31 To restore quality movement and postural control to engage in occupations31 Reinforces developmental motor milestones and integration of reflexes to promote volitional movement patterns required for performance skills Compiled with information from Cole (2012)35, Pendleton (2013)36, Radomski &Trombly (2008)37, Crepeau (2009)14 Additional Frame of Reference and Assessment Resource Website links: OT Theory: https://ottheory.com/theories-and-models Rehab Measures: https://www.sralab.org/rehabilitation-measures OT Assessment Index: https://mh4ot.com/resources/ot-assessment-index/ MOHO Assessments: https://www.moho.uic.edu/resources/findTheAssessment/home.aspx OT Mental Health: https://occupationaltherapyot.com/occupational-therapy-mental-health/ ADL Assessments: https://www.payingforseniorcare.com/longtermcare/activities-of-daily-living.html