People are complicated, so there’s no one-size-fits-all approach to Occupational Therapy (OT). The ten accepted Frames of Reference (FOR) in the profession speak to this hypothesis, but for many clinicians, the temptation remains to pigeonhole clients into one of the FOR while other equally relevant concerns are secondary in the therapeutic protocol. While it is true that therapists should focus on one particular issue at the time, they should also design the intervention so that the FOR are managed as a whole.
Frames of Reference – The Building Blocks of Occupational Therapy (OT)
Legos are a great analogy for frames of reference. You can take a small set of little plastic blocks and build cars, people, airplanes, and dinosaurs from the same set of blocks. The difference is in how you use the individual pieces to get the desired result.
Putting Frames of Reference into Practice
AC Mosey developed the structural scaffolding for clinicians to evaluate and assess patients, and determine the best interventional therapies. There are five components to the framework: theoretical base, function/dysfunction, evaluation, postulates for change, and postulates for intervention
Theoretical Base
This is the foundation for determining FOR, and it usually taps several of the following theories during evaluation and assessment: assumptions, concepts, definitions, and postulates, and the relationship they share.
Function- Dysfunction continua
Function/dysfunction balances on the theoretical baseline that was initially established and evaluates the areas of concern. What are the individual’s skills and what are their disabilities? At one end of the functional continuum, the therapist defines what the patient should be able to do following the interventions–their abilities. The dysfunctional end of the continuum corresponds to disabilities–the limitations that bring the patient to the therapist. Frames of reference do not exist in singular vacuums; therefore, they are manifestations of dysfunction continua–several dysfunctions in one FOR.
Evaluation
A therapist’s evaluation toolkit is heavily dependent on their specialty, but the general assessments for adults measure the following.
- Assessment of process and motor skills
- Beery-Buktenica Developmental test of visual/motor integration
- Sensory profile
- Vineland Adaptive Behavior Scales
- Motor-Free visual perception test
Special assessments for infants, children, and adolescents range from Bayley Scales of Individual Development for infants to pre-school readiness evaluations to motor skills tests for college students. Therapists will usually administer a range of tests that will measure all the areas of concern, and evaluate the client based on professional observation.
Postulates Regarding Change
Postulates are the basis for the cause-and-effect theory of OT. A therapist postulates the causes of the patient limitations and determines the interventions that will cause improvement. This is where abstract theory and evaluation turns into concrete results.
Postulates Regarding Intervention – The Link between goals and treatment
Change postulates guide the postulates for intervention–how a therapist puts their assessment-based theories into tangible actions that lead to change in the clients’ abilities or behaviors. Interventions postulates are meant to set goals for the client and implement the therapies and techniques that will help achieve these goals.
Ten Frames of Reference in Occupational Therapy
Here are the ten commonly accepted frames of reference in the OT sphere.
- Behavioral
- Biomechanical
- Cognitive
- Developmental
- Model Of Human Occupation (MOHO)
- Neurodevelopmental
- Occupational Adaptation
- Psychodynamic Frame of Reference
- Sensory Integration
- Spatiotemporal Adaptation
Frames of reference are theoretical. New therapists have a steep learning curve in mastering all the FOR and how they intersect; even experienced Occupational Therapists, with years of putting theory into practice, sometimes find it challenging to find the right FOR for some patients.
The guiding principle for therapists is that they understand exactly what they are doing, and exactly why they’re doing it. That ability allows them to explain the interventions to the patient, observers, and colleagues, in turn building greater self-confidence for the OT. Any therapist should have a mastery of a given frame of reference before applying that theorem to a given patient–a supervising practitioner should be available to work with less experienced OTs to confirm diagnoses. Any FORs that a therapist chooses for intervention should have clear and achievable goals.
Implementing Frames of Reference in Sequence
Some frames of reference are best implemented in sequence–once the patient masters one activity; they move on to another challenge.
For orthopedic rehab patients, biomechanical and occupational and compensatory adaptation come into play. The therapist would begin with biomechanical intervention–range of motion, endurance, and strength. Once the patient has regained muscle tone and strength, the therapist moves on to occupational exercises, which will ultimately result in full recovery and a resumption of normal activity, or in limited abilities that would demand some compensatory adaptations, Assuming the patient was an avid golfer who had knee replacement, this may mean that she would ride in a cart to the ball rather than walk or leave the cart on the path. Her upper body is unimpaired, but the cart compensates for bad knees,
Implementing Frames of Reference in Tandem
Tandem implementation means there are two FOR in use during the intervention, addressing several concerns at once.
A child with developmental concerns can be treated with neuro-developmental therapies simultaneously with biomechanical intervention to improve the child’s movement and range of motion patterns. Cognitive therapies can also be introduced alongside the others; developmental issues in children are frequently accompanied by some cognitive challenges, an autistic child may have difficulty manipulating crayons or blocks so the neuromuscular and biomechanical interventions can help with flexibility and range of motion, while an intervention like noise-cancelling headphones would eliminate sensory overload.
Streamline Your Processes
Evaluations and assessments for Occupational Therapy patients are complicated and time-consuming, but essential for your patients and your practice. It’s common for OT patients to work with physical and speech therapists simultaneously, and our fully unified EMR system lets the entire team work together towards that one goal.
A2C software helps you manage your evaluations, interventions, and results easily and effectively, ensuring you can devote more time to your practice than to paperwork. Schedule a demo to learn how our solutions can work for you.
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