rehabilitative frame of reference-1
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Rehabilitative Frame of ReferenceBiomechanical Approach
Rehabilitative Frame of ReferenceBiomechanical Approach
OT 606
Spring 2004
Rehabilitative Frame of Reference
Rehabilitative Frame of Reference
• Philosophy: To enable a person with a physical or mental disability or chronic illness to achieve maximum function in the performance of his or her daily activities (p.538)
• Based on: medical sciences, physical sciences, social sciences.
Rehabilitation Frame of Reference
Rehabilitation Frame of Reference
• Rehabilitation: The process of helping a person perform competently in his or her social roles and daily activities (p.538).
• Focus: compensatory techniques, adaptive/assistive devices, environmental modifications
Rehabilitative Frame of Reference Assumptions
Rehabilitative Frame of Reference Assumptions
• 1. Through the use of compensation strategies and techniques an individual can restore independence when the underlying impairment cannot be remediated.
• 2. A person’s level of motivation affects the extent to which an individual regains independence
• 3. Environments in which daily activities are performed influence a person’s motivation for independence.
Rehabilitative Frame of Reference Assumptions
Rehabilitative Frame of Reference Assumptions
• 4. Rehabilitation involves the teaching-learning process. Therefore, cognitive skills are needed to learn and apply compensatory strategies. Motivation enables the person to participate fully in the teaching-learning process.
• 5. Clinical reasoning, used by the practitioner, begins with the individual's functional capabilities, then moves to the environments in which the person will function, and then to the types of compensatory strategies the person needs to use his or her capacities.
Rehabilitative Frame of Reference Evaluation
Rehabilitative Frame of Reference Evaluation
• Evaluation assesses client’s functioning in self care, work, and leisure.
• Evaluation involves:• Observation• Interviews of client’s daily living priorities• Client self-report re: ability to perform tasks
Rehabilitative Frame of Reference Evaluation
Rehabilitative Frame of Reference Evaluation
• Therapist focuses on:• 1. characteristics of environments in which client
functions• 2. equipment and client’s economic resources• 3. level of assistance/supervision available for
client• 4. developmental expectations for client
performance• 5. absent or limited performance components
(skills & abilities). (p.539)
Rehabilitative Frame of Reference Mechanisms for ChangeRehabilitative Frame of Reference Mechanisms for Change
• Assumption is that client’s impairment is stable
• Can alter function through compensatory strategies and adaptive equipment
• Therapist teaches client new ways to perform ADL’s.
Rehabilitative Frame of Reference Change in Function
Rehabilitative Frame of Reference Change in Function
• Client must• Be motivated• Be able to use compensatory strategies – and • have underlying perception/cognition to do that
• Environment must:• Have necessary
• equipment• Objects
• Support and feedback systems
Rehabilitative Frame of Reference Treatment
Rehabilitative Frame of Reference Treatment
• Includes purposeful activities:• Daily living• Work• Leisure
• Compensatory strategies• Practice of these tasks and strategies• Collaboration with client important• Client must cooperate• Therapist must be creative in problem-solving
Rehabilitative Frame of Reference Strengths and Limitations
Rehabilitative Frame of Reference Strengths and Limitations
• Strengths:• Long successful history• Focus on client capabilities, and
important ADL’s• Client centered• Evaluates Client’s interests,
roles, resources, environments, support systems
• Holistic perspective
• Weaknesses:• Some ADL instruments lack
validity/reliability testing – outcomes research is limited
• Does not address unmotivated client
• Does not offer alternative approaches if compensatory strategies ineffective or client unable to learn new ways of doing
• Does not address psychosocial needs of clients
• Linked to medical model
Biomechanical Frame of Reference Domains of concern
Biomechanical Frame of Reference Domains of concern
• 1. Structural stability
• 2. low-level endurance
• 3. Edema control
• 4. Passive range of motion (PROM)
• 5. Strength
• 6. High-level endurance
Biomechanical Frame of Reference – Assumptions
Biomechanical Frame of Reference – Assumptions
• 1. purposeful activities can be used to treat loss of ROM, strength, and endurance
• 2. After ROM, strength, and endurance are regained, the client will automatically regain function.
• 3. The principle of rest and stress: first the body must rest to heal itself; then structures must be stressed to regain range, strength, endurance
• 4. The biomechanical frame of reference is best suited for clients with an intact central nervous system because clients must be able to perform smooth, isolated movements (p.541).
Biomechanical Frame of Reference - Evaluation
Biomechanical Frame of Reference - Evaluation
• Domains of concern:• 1. Structural stability• 2. low-level endurance
• 3. Edema control• 4. Passive range of
motion (PROM)• 5. Strength
• 6. High-level endurance
• Evaluations:• 1. X-ray (Physician)• 2. Cardiac step charts,
recording time pt can tolerate sedentary activity
• 3. Volumetry• 4. Goniometry• 5. Manual muscle tests,
palpation, clinical observation
• 6. Number of reps or duration pt. can perform activity.
Biomechanical Frame of Reference –Client Practitioner Interaction
Biomechanical Frame of Reference –Client Practitioner Interaction
• Therapist must explain connection between client’s deficit and biomechanical goal and functional outcome.• in writing – for reimbursement purposes
and • verbally to client – because treatment can
be painful
Biomechanical Approach -Strengths and LimitationsBiomechanical Approach -Strengths and Limitations
• Strengths:• Easy to write
measurable goals – quantifiable
• Oldest form of treatment for physical disabilities
• Weaknesses:• Purposeful activities
much more effective than rote exercise
• Does not address pain, loss of sensation, incoordination
Rehabilitative Frame of ReferenceBiomechanical Approach
Rehabilitative Frame of ReferenceBiomechanical Approach
Whose Life is it Anyway?
Questions for “Whose Life is it Anyway?”
Questions for “Whose Life is it Anyway?”
• 1. Which approach is more appropriate for the main character– rehabilitative or biomechanical?
• 2. What would you suggest an OT do to help this person transition from hospital to home environment?
• 3. Treatment activities would you suggest?• 4. What are some barriers to treatment being
successful?• 5. What are some resources the main charcater has?• 6. If the main character had more use of his upper
extremities and trunk, what else could you have him do? Which approach would you use?