Frame of Reference

behavioral (Skinner, Pavlov)
1. description
  1. person's behavior is result of feedback from environment. Insight & personality are not considered
  2. One can unlearn maladaptive behaviors and learn adaptive ones through the use of techniques such as shaping, teaching, and reinforcement.
  3. OT works with others on the team to consistently work toward positive changes in behavior.
2. how it is reflected in documentation
  1. Evaluation reports contain detailed observations of behavior, including descriptions of the behavior; frequency of it; and where, when, and under what circumstances the behavior occurs.
  2. Progress notes document behavior modification methods used and the results of these interventions.
  3. Measurable goals specify the person, the observable behavior expected, and conditions for the behavior such as where, when, frequency, and any cuing that will occur.
3. https://ottheory.com/therapy-model/behavioral-frame-reference
biomechanical
1. description
  1. Focus on “the body as a machine.” Improving strength, endurance, and structural integrity will lead to improved function
  2. Use splinting, exercise, massage, PAMs, and other physical means of intervention.
  3. Once range of motion, strength, edema, and endurance are regained, functional use will follow.
  4. Pain, loss of sensation, and poor coordination are not of primary concern.
2. how it is reflected in documentation
  1. evaluation reports focus on perf skills/client factors
  2. Progress notes reflect improvements in ROM, strength, edema & endurance
  3. ROM, strength, edema & endurance are easily quantified for goal setting
  4. functional goals would reflect new activities that increased mvmt will allow
3. http://occupationaltherapyot.com/biomechanical-frame-reference/
4. https://prezi.com/4ftp4v2epcfy/biomechanical-model/
Canadian Model of Occupational Performance (Law et al.)
1. description
  1. person is in constant interaction with the environment
  2. client-centered practice
  3. spirituality gives meaning to occupations
  4. envionrment influences occupational performance
2. how it is reflected in documentation
  1. evaluation reports focus on ADL, play, spirituality & work
  2. Progress notes focus on client's ability & satisfaction in perf. meaningful occupations
  3. goals relate to ability & satisfaction in performance of meaningful occupations
3. https://ottheory.com/therapy-model/canadian-model-occupational-performance-and-engagement-cmop-e
Cognitive-Behavioral Therapy (Bandura; Rotter; Ellis & Beck)
1. description
  1. maladaptive behaviors are result of cognitive distortions & self-defeating thinking
  2. people have automatic thoughts that they tell themselves internally.
  3. "core schemas" are thoughts people tell themselves that color the way they perceive themselves and their environment.
  4. clients are taught to repeat positive "self-talk" to alter core schemas
2. how it is reflected in documentation
  1. evaluation reports focus on client report of occupational problems & insight into barriers to occupational performance
  2. Progress notes reflect client’s report of feelings and thoughts, skills, attitudes, and contexts which lead to changes in behavior.
  3. Goals suggest the positive statements the client will repeat to oneself, use of stress management techniques, and identify desired behavioral outcomes.
3. https://ottheory.com/therapy-model/cognitive-behavioral-frame-reference
Cognitive Disabilities (also called Cognition & Activity) (Allen)
1. Description
  1. Neurological problems lead to limitations in cognitive capacity, which lead to a performance deficit.
  2. Cognitive levels are categories of function and dysfunction
  3. Occupational therapy cannot change cognitive levels that are the result of brain pathology.
  4. Tasks and activities are analyzed for fit with a person’s cognitive level; they are adapted to remove obstacles to performance and use a person’s available cognitive capacity.
2. how it is reflected in documentation
  1. Evaluation reports identify the current cognitive level as supported by functional performance in everyday occupations.
  2. Progress notes describe the client’s response to adaptations in the task or environment and any changes noted in cognitive level (based on observations).
  3. Goals are established to identify desired performance within the context of the client’s environment, and relate to palliative, expectant, or supportive treatment.
Contemporary Task- Oriented (Haugen & Mathiowetz)
1. Description
  1. Focus on the interaction between the characteristics of a person and the contexts in which the person exists.
  2. The personal and environmental characteristics have no hierarchy in terms of their influences on performance.
  3. The client’s perspective is the focus of evaluation and intervention; it is client-centered.
  4. Intervention involves practice and experimentation.
2. how it is reflected in documentation
  1. Evaluation reports center on the client’s unique characteristics, contexts, and motivations.
  2. Recording observations is essential in progress notes.
  3. Goals relate to functional performance.
3. https://prezi.com/s7jeeljbvhg-/ot-task-oriented-approach/
Developmental (Piaget, Freud, Erickson, Kohlberg, and many others)
1. Description
  1. Humans normally develop in a SEQUENTIAL fashion.
  2. Each new gain in structure enables a gain in function; each new gain in function enables further development.
  3. Physical, sensory, perceptual, cognitive, social, and emotional development are interconnected and affect the whole person.
  4. Stress can cause regression to earlier levels of adaptation.
  5. Focus on seven developmental areas: Perceptual–Motor, Cognitive, Drive–Object, Dyadic Interaction, Group Interaction, Self-Identity, and Sexual Identity.
2. how it is reflected in documentation
  1. Evaluation reports focus on comparing a child’s performance to that of a typically developing child of the same chronological age to identify areas in need of intervention.
  2. Progress reports show the child has made gains in functional performance of daily occupations.
  3. Goals identify desired occupations to enable the child’s maximum participation in life situations.
3. http://occupationaltherapyot.com/developmental-frame-reference/
Ecology of Human Performance (Dunn, Brown, & McGuigan)
1. Description
  1. Ecology is the interaction between a person and contexts (the environment).
  2. person, the context, and task performance interact with and affect one another.
  3. Performance is improved by establishing/restoring the person’s skills or abilities, altering/ adapting the context or the task to support performance in context, preventing occupational barriers, or creating enriching occupational performance.
2. how it is reflected in documentation
  1. Evaluation reports look not only at the person but also at contexts and tasks and the person–context match.
  2. Progress reports describe what interventions/alterations have been tried and their results.
  3. Goals reflect the person’s participation in occupations and performance in context.
3. https://ottheory.com/therapy-model/ecology-human-performance-framework-ehp
4. https://prezi.com/cupu1azy5bjw/ecology-of-human-performance-ehp-model/
Model of Human Occupation (Kielhofner)
1. Description
  1. VOLITION, habituation, and performance are interrelated subsystems within a person that regulate choice, organization, and performance.
  2. Personal and environmental factors influence choice, organization, and performance.
  3. Change is a holistic process.
  4. Occupations must be relevant and related to a person’s roles, habits, and environment.
2. how it is reflected in documentation
  1. Evaluation reports focus on the client’s performance in areas of occupation, interests, motivation, habits, and roles.
  2. Progress notes focus on the client’s choices, habits, and roles during meaningful occupations.
  3. Goals relate to performance in meaningful occupations, habits, and roles.
3. http://occupationaltherapyot.com/model-of-human-occupation-moho-frame-of-reference/
Neurodevelopmental Treatment (NDT) (Bobaths)
1. Description
  1. Spasticity and hypotonia are the major barriers to normal movement.
  2. The trunk and proximal joints need stability to enable limb movement.
  3. The brain is plastic and capable of new learning.
  4. Work toward INHIBITING abnormal reflexes and synergies to enable learning of normal movement.
  5. Bilateral focus; use positioning, handling, and sensory stimulation to facilitate normal movement patterns.
2. how it is reflected in documentation
  1. Evaluation reports focus on observations of movement patterns and barriers to normal movement.
  2. Progress notes need to reflect frequent clinical observations.
  3. Goals relate to patterns of movement that enable occupational performance.
3. https://ottheory.com/therapy-model/neuro-developmental-treatment-frame-reference
Occupational Adaptation (Schkade & Schultz)
1. Description
  1. As clients become more adaptive, their ability to function improves.
  2. ability of clients to adapt can be overwhelmed by stressful life events, including illness, injury, or disabilities.
  3. Dysfunction occurs when a client’s ability to adapt is challenged so much that performance demand cannot be satisfactorily met.
  4. Internal and external factors continually interact resulting in an occupational response; the observable outcome of the person-environment interaction.
2. how it is reflected in documentation
  1. Evaluation reports focus on the environmental demands, internal resources, occupational roles, and occupational adaptation abilities of the client.
  2. Progress notes focus on the client’s ability to adapt to changing demands.
  3. Goals may begin with the client learning adaptive skills, and then evolve into the client using adaptive skills and occupational MASTERY.
3. https://ottheory.com/therapy-model/occupational-adaptation-frame-reference
Occupational Behavior (Reilly)
1. Description
  1. Active participation in tasks can lead to development of mastery and, therefore, permit successful role performance.
  2. Focus is on work, play, and self-care.
  3. Role fulfillment provides positive feedback to the person and enables that person to go on to new skills, more complex tasks.
  4. Occupational therapy intervention moves the client through the continuum of exploration, competence, and achievement.
2. how it is reflected in documentation
  1. Evaluation reports focus on work, play, and activities of daily living that are meaningful to the client.
  2. Progress notes focus on the client’s performance during meaningful occupations.
  3. Goals relate to performance in occupations and roles that are meaningful to the client as well as prevention of barriers to occupational performance.
3. https://prezi.com/snd-phmqnbsi/occupational-behavior/
Person–Environment– Occupational Performance (Christiansen & Baum)
1. Description
  1. Many intrinsic (neurobehavioral, physiological, cognitive, psychological, and spiritual) and extrinsic (social support, social and economic systems, culture and values, built environment and technology, and natural environment) factors contribute to occupational performance.
  2. Adaptation is the process used by people to meet challenges in daily living through the use of personal resources.
  3. characteristics of the person, environment, and the nature/ meaning of actions, tasks, and roles are considered when trying to understand occupational performance.
  4. Focus is on the person’s wants and needs rather than on dysfunction.
2. how it is reflected in documentation
  1. Evaluation reports reflect the client’s assets and limitations in relation to his or her occupational performance as well as the supports and barriers in the environment.
  2. Progress reports demonstrate the client’s occupational performance within environmental contexts.
  3. Short-term goals may relate to intrinsic factors inhibiting occupational performance.
  4. Long-term goals may relate to functional performance of daily life tasks and roles.
3. https://ottheory.com/therapy-model/person-environment-occupation-performance-model-peop
Proprioceptive Neuromuscular Facilitation (PNF) (Knott & Voss)
1. Description
  1. Weakness and lack of voluntary control over movements are the main obstacles to normal movement patterns.
  2. Frequent repetition and stimulation of the proprioceptors support the learning of new motor abilities.
  3. Movements are more often diagonal than linear.
  4. Vision, breathing, and verbal commands all play a strong role in movement.
2. how it is reflected in documentation
  1. Evaluation reports emphasize observable movement patterns.
  2. Progress notes reflect client responses to inhibition and facilitation techniques.
  3. Goals relate to the client’s movements during activities of daily.
Psychoanalytic (Freud); Object Relations (Fidler)
1. Description
  1. Intrapsychic (unconscious) conflicts are at the heart of the problem.
  2. major areas of concern are the psychodynamics, level of psychosexual and psychosocial development, and alterations of intrapsychic content.
  3. Goal is to resolve these inner conflicts.
  4. Use of activity to resolve intrapsychic conflict and reality orientation such as psychodrama, projective art, creative writing and poetry therapy, and guided fantasy.
2. how it is reflected in documentation
  1. Evaluation reports focus on the affect of the client, symptoms of psychopathology, and how these interfere with daily life functions.
  2. Progress reports often reflect the client’s subjective report of feelings as well as observations of client behavior.
  3. Goals reflect the client’s self-expression of feelings.
3. http://occupationaltherapyot.com/psychodynamic-frame-reference/
Rehabilitative (Compensatory)
1. Description
  1. Aim is to increase independence by providing environmental adaptations and compensatory strategies
  2. Consider client’s roles and the tasks the client considers essential for satisfactory performance of those roles.
2. how it is reflected in documentation
  1. Evaluation reports emphasize both strengths and areas in need of improvement.
  2. Progress notes document what types of adaptations have been tried and the results of each trial.
  3. Goals reflect functional outcomes; what the client will do.
3. http://occupationaltherapyot.com/rehabilitative-frame-reference/
Spatiotemporal Adaptation (Gilfoyle, Grady, & Moore)
1. Description
  1. Movement and activity influence a person’s development.
  2. Movement is important for physical, psychological, and social development of a child.
  3. Development occurs in an ever widening spiral that represents increasing skills as influenced by experiences with the environment.
  4. Emphasis on integration of old behaviors with new ones.
2. how it is reflected in documentation
  1. Evaluation reports focus on the movements of the child in relation to environmental demands.
  2. Progress reports reflect the increasing complexity of the movement–environment interactions of the child.
  3. Goals can be structured to reflect prevention, remediation, and/or adjustment to dysfunction.
Sensory Integration (Ayers)
1. Description
  1. Sensory integrative dysfunction is a result of a failure of the brain to properly organize and interpret sensory input.
  2. There is interaction between brain organization and adaptive behavior.
  3. People have an inner drive to participate in sensory motor activities and seek out organizing sensations.
  4. Play is self-directed, within an environment carefully set up by the OT to meet that client’s needs.
  5. Environment provides the opportunities to experience needed sensations in a safe, nonthreatening atmosphere, and includes access to sensory input to all sensory processing systems of the body, including vestibular.
2. how it is reflected in documentation
  1. Evaluation reports focus on identifying areas of sensory processing deficits and how these impact participation in everyday life experiences.
  2. Progress notes reflect the child’s responses to different sensory experiences, qualities of movement, and changes in the client’s participation in everyday life experiences.
  3. Goals focus on increased duration or repetitions of an activity, the quality of movements during an activity, or on socially acceptable ways of obtaining achieving sensory stimulation.
3. https://ottheory.com/therapy-model/sensory-integration-frame-reference
4. https://occupationaltherapyot.com/sensory-integration/